Medicine and Health Sciences Commons^™

Blockade Of Fgf2/Fgfr2 Partially Overcomes Bone Marrow Mesenchymal Stromal Cells Mediated Progression Of T-Cell Acute Lymphoblastic Leukaemia, Chen Tian, Yueyang Li, Lina Wang, Junqi Si, Yaxin Zheng, Junnan Kang, Yafei Wang, M James You, Guoguang Zheng

Faculty, Staff and Student Publications

The development of acute lymphoblastic leuakemia (ALL) is partly attributed to the effects of bone marrow (BM) microenvironment, especially mesenchymal stromal cells (MSCs), which interact bilaterally with leukaemia cells, leading to ALL progression. In order to find MSCs-based microenvironment targeted therapeutic strategies, Notch1-induced T-cell ALL (T-ALL) mice models were used and dynamic alterations of BM-MSCs with increased cell viability during T-ALL development was observed. In T-ALL mice derived stroma-based condition, leukaemia cells showed significantly elevated growth capacity indicating that MSCs participated in leukaemic niche formation. RNA sequence results revealed that T-ALL derived MSCs secreted fibroblast growth factor 2 (FGF2), which …

The Role Of Telehealth In Reducing Hospital Readmissions For Heart Failure Patients, Tommy Lee Bratcher

Graduate Theses, Dissertations, and Capstones

Heart failure affects over six million people annually, and is expected to increase to over eight million by 2030. Over 60 million people live in the rural United States. Telehealth is a tool to improve access to care, provide early intervention, and follow up with patients within 48 hours of a hospital discharge. Utilizing Telehealth to conduct a medication reconciliation within 48 hours of discharge to address any medication errors or admission, and reinforce adherence is a way to improve access to care to those living in rural areas.

Utilization Of A Multimodal De-Escalation Class To Improve Staff Confidence When Caring For Behaviorally Escalating Patients, Tara B. Neuner

Graduate Theses, Dissertations, and Capstones

Workplace violence is a common challenge seen in the healthcare settings across the world. This problem is steadily increasing in all types of hospitals, including a level one trauma center located in an urban area. There has been a steady rise in the number of assaults and workplace violence reported from bedside staff at this hospital. The leadership of the organization formed a work group to help combat the workplace violence and staff assaults that were occurring. In this process, a behavior response team was created to help nursing staff with escalating behavior in patients, and to help de-escalate the …

Impact Of A Multifaceted Intervention On Physicians' Knowledge, Attitudes And Practices In Relation To Pharmaceutical Incentivisation: Protocol For A Randomised Control Trial, Muhammad Naveed Noor, Mishal Khan, Afifah Rahman-Shepherd, Amna Rehana Siddiqui, Sabeen Sharif Khan, Iqbal Azam, Sadia Shakoor, Rumina Hasan

Department of Pathology and Laboratory Medicine

Introduction: In settings where the private sector constitutes a larger part of the health system, profit-gathering can take primacy over patients' well-being. In their interactions with pharmaceutical companies, private general practitioners (GPs) can experience the conflict of interest (COI), a situation whereby the impartiality of GPs' professional decision making may be influenced by secondary interests such as financial gains from prescribing specific pharmaceutical brands.
Methods and analysis: This study is a randomised controlled trial to assess the impact of a multifaceted intervention on GPs' medical practice. The study sample consists of 419 registered GPs who own/work in private clinics and …

Human Amniotic Membrane As A Dural Substitute In Neurosurgery: A Systematic Review, Zara Shah, Saqib Kamran Bakhshi, Mohammad Hamza Bajwa, Mujtaba Khalil, Michael C. Dewan, Muhammad Shahzad Shamim

Medical College Documents

Background: Several studies have highlighted the use of human amniotic membrane (HAM) in neurosurgical procedures as an effective dural substitute. HAM has inherent antifibrotic and anti-inflammatory properties and exhibits immunomodulatory effect that makes it an ideal dural substitute. Other advantages including easy availability, low cost of procurement, and storage also render it a promising dural substitute especially in low- and middle-income countries.
Methods: A systematic literature search was performed using PubMed, Scopus, and Google Scholar databases, using the search terms "human amniotic membrane," "dural repair," and "neurosurgery." To be eligible for inclusion in our review, papers had to report primary …

Telehealth And Hospital Readmissions For Heart Failure Patients: A Literature Review, Tommy Lee Bratcher

Graduate Theses, Dissertations, and Capstones

Currently heart failure affects over six million people and is expected to increase to over eight million people by 20230. The US Census Bureau estimates over 60 million people live in a rural setting. This literature review seeks to determine the state of the science regarding the utilization of Telehealth to reduce heart failure readmissions in rural areas.

Using Social Media To Examine Disabled Veterans’ Adaptive Sports Lived Experience At The National Veterans’ Wheelchair Games, Heather Harding

Graduate Theses, Dissertations, and Capstones

Considered the world’s largest annual rehabilitative wheelchair games event for Veterans in the United States, the National Veterans Wheelchair Games (NVWG or the Games), co-hosted annually by the Department of Veterans Affairs and Paralyzed Veterans of America, is a long-standing event that offers a view into how adaptive sports and recreational activities can impact Veterans with disabilities. This hermeneutic phenomenological qualitative study sought to discover if the Veteran athletes, who participated in the NVWG between 2017 and 2021, described their lived experiences through the lens of their public social media posts on Instagram, and if so, what can be gleaned …

Identifying Community-Engaged Translational Research Collaboration Experience And Health Interests Of Community-Based Organizations Outside Of Metropolitan Atlanta, Breanna B. Greteman, Latrice Rollins, Ph.D., Msw, Allisen Penn, Alison C. Berg, Eric J. Nehl, Nicole Llewellyn, Amber Weber, Melissa George, Darrell Sabbs, Mohamed Mubasher, Tabia H. Akintobi

Journal of the Georgia Public Health Association

Background: While rural health research has increased over the last two decades, there is limited understanding of the self-reported health priorities and research interests of rural and suburban community-based representatives and residents. These insights can be used to inform more successful intervention strategies that are responsive to the lived experiences of local residents and leaders who are the gatekeepers to buy-in and sustainability of community engaged research. The Georgia Clinical and Translational Science Alliance, a collaboration between four academic institutions includes a Community Engagement Program (CE) designed to facilitate community-academic research partnerships. This study aimed to assess the health priorities, …

Crafting Effective Regulatory Policies For Psychedelics: What Can Be Learned From The Case Of Cannabis?, Amanda J. Abraham, Christina M. Andrews Ph.D., Samantha J. Harris, Melissa M. Westlake, Colleen M. Grogan

Faculty Publications

Importance: Medicaid is a key policy lever to improve opioid use disorder treatment, covering approximately 40% of Americans with opioid use disorder. Although approximately 70% of Medicaid beneficiaries are enrolled in comprehensive managed care organization (MCO) plans, little is known about coverage and prior authorization (PA) policies for medications for opioid use disorder (MOUD) in these plans. Objective: To compare coverage and PA policies for buprenorphine, methadone, and injectable naltrexone across Medicaid MCO plans and fee-for-service (FFS) programs and across states. Design, Setting, and Participants: This cross-sectional study analyzed MOUD data from 266 Medicaid MCO plans and FFS programs in …

Technology-Based Obesity Prevention Interventions Among Hispanic Adolescents In The United States: Scoping Review, Erica G Soltero, Callie Lopez, Edith Hernandez, Teresia M O'Connor, Debbe Thompson

Children’s Nutrition Research Center Staff Publications

Background: Given that today's adolescents are digital front-runners, technology-based obesity prevention strategies are age-appropriate for this population. The use of remote and wireless technologies may be suitable for extending the reach and engagement of obesity prevention efforts among high-risk Hispanic youths, as this subgroup is disproportionately affected by barriers that limit participation in traditional, in-person interventions.

Objective: The purpose of this scoping review was to examine the intervention and sample characteristics of technology-based obesity prevention interventions among Hispanic adolescents. We also examined feasibility criteria to assess the acceptability and appropriateness of technology-based strategies among Hispanic youths.

Methods: A comprehensive search …

Senior Food Insecurity In The Usa: A Systematic Literature Review, Bertille Octavie Mavegam Tango Assoumou, Courtney Coughenour, Amruta Godbole, Ian Mcdonough

Environmental & Global Health Faculty Research

Objective:

Understanding the factors associated with senior food insecurity is key to understanding senior-specific needs to develop targeted interventions and ultimately lower the prevalence and the incidence of food insecurity. We aimed to systematically review published literature and summarise the associated factors of food insecurity in older adults in the USA.

Design:

We searched PubMed, Scopus, Web of science, EconLit and JSTOR databases for peer-reviewed articles published in English between January 2005 and September 2019 that assessed food security or its associated factors for US adults aged 60 years and older. After a two-step screening process, twenty articles were retained …

Diagnostic Accuracy Of Artificial Intelligence For Detecting Gastrointestinal Luminal Pathologies: A Systematic Review And Meta-Analysis, Om Parkash, Asra Tus Saleha Siddiqui, Uswa Jiwani, Fahad Rind, Zahra Ali Padhani, Arjumand Rizvi, Zahra Hoodbhoy, Jai K. Das

Section of Gastroenterology

Background: Artificial Intelligence (AI) holds considerable promise for diagnostics in the field of gastroenterology. This systematic review and meta-analysis aims to assess the diagnostic accuracy of AI models compared with the gold standard of experts and histopathology for the diagnosis of various gastrointestinal (GI) luminal pathologies including polyps, neoplasms, and inflammatory bowel disease.
Methods: We searched PubMed, CINAHL, Wiley Cochrane Library, and Web of Science electronic databases to identify studies assessing the diagnostic performance of AI models for GI luminal pathologies. We extracted binary diagnostic accuracy data and constructed contingency tables to derive the outcomes of interest: sensitivity and specificity. …

Mitochondrial Protective Effects Caused By The Administration Of Mefenamic Acid In Sepsis, Diogo Dominguini, Monique Michels, Leticia B Wessler, Emilio L Streck, Tatiana Barichello, Felipe Dal-Pizzol

Faculty, Staff and Student Publications

The pathophysiology of sepsis may involve the activation of the NOD-type receptor containing the pyrin-3 domain (NLPR-3), mitochondrial and oxidative damages. One of the primary essential oxidation products is 8-oxoguanine (8-oxoG), and its accumulation in mitochondrial DNA (mtDNA) induces cell dysfunction and death, leading to the hypothesis that mtDNA integrity is crucial for maintaining neuronal function during sepsis. In sepsis, the modulation of NLRP-3 activation is critical, and mefenamic acid (MFA) is a potent drug that can reduce inflammasome activity, attenuating the acute cerebral inflammatory process. Thus, this study aimed to evaluate the administration of MFA and its implications for …

Single-Cell Multiomics Identifies Clinically Relevant Mesenchymal Stem-Like Cells And Key Regulators For Mpnst Malignancy, Lai Man Natalie Wu, Joshua Rubin, Et Al.

2020-Current year OA Pubs

Malignant peripheral nerve sheath tumor (MPNST), a highly aggressive Schwann cell (SC)-derived soft tissue sarcoma, arises from benign neurofibroma (NF); however, the identity, heterogeneity and origins of tumor populations remain elusive. Nestin

Preventive Behaviors And Information Sources During Covid-19 Pandemic: A Cross-Sectional Study In Japan, Manae Uchibori, Cyrus Ghaznavi, Michio Murakami, Akifumi Eguchi, Hiroyuki Kunishima, Satoshi Kaneko, Keiko Maruyama-Sakurai, Hiroaki Miyata, Shuhei Nomura

2020-Current year OA Pubs

BACKGROUND: individual preventive behaviors are one of the key measures needed to prevent the spread of COVID-19. This study sought to identify the factors associated with the adoption of COVID-19 preventive measures, focusing specifically on information sources.

METHODS: we conducted a nationally representative cross-sectional survey of 30,053 Japanese adults in February 2021. The survey asked about socioeconomic, health-related, and psychological characteristics, attitudes toward immunization, and the use of information sources regarding COVID-19. We have constructed multivariable logistic regression to estimate the factors associated with the adoption of three preventive measures: 3Cs avoidance, hand hygiene and respiratory hygiene.

RESULTS: socioeconomic variables, …

Locus Of Control In Athletic Training, Brittany James, Lindsey E. Eberman, Kenneth E. Games, Matthew J. Rivera

Journal of Sports Medicine and Allied Health Sciences: Official Journal of the Ohio Athletic Trainers Association

Purpose: Locus of control (LOC) is the level of control an individual feels they have over the outcomes in their life; work locus of control (WLOC) is the control someone feels over their work. Both LOC and WLOC can be internally or externally affected and influence athletic trainers’ ability to change their clinical circumstances. The purpose of this study was to explore athletic trainers’ LOC and WLOC.

Method: Cross-sectional web-based survey. Two validated surveys were used to measure locus of control and work locus of control in athletic trainers along with the collection of 8 demographic variables. Results: Of …

Medical School Watercooler Newsletter - November 3, 2022, Lindsey Lyle

Watercooler Newsletter

This is the November 3, 2022 edition of the Frederick P. Whiddon College of Medicine's newsletter - Watercooler.

Contents include:

• Alumna welcomes patients to new pediatrics clinic on Eastern Shore
• Help us celebrate 50 years of medical education
• Meet a Med Student: Natalie Simpkins
• Borchert named 2022 Scholar of the Year by Phi Kappa Phi chapter
• Clinical education coordinator recalls long recovery after accident

Creatively Capturing Structure And Energy: Zero Balancing's Essential Elements (Article & Video), Lisa Bardarson

Journal of Transformative Touch

Through the creative use of coloring, I am devising a way to document Zero Balancing’s two foundational elements, structure and energy and the changes that occur following a ZB session. I believe this experiential activity will be a creative fulcrum, helping the client connect more effectively with the deepest part of themselves thereby experiencing greater ease and freedom from their issues. As the activity of coloring is a “right brain”/ creative endeavor, I believe it can serve to enhance a client’s expanded state of consciousness, one of the hallmarks of a Zero Balancing session, as well as improve their overall …

2022-11-03_Michiganoverview_Misc, Michigan Department Of Health & Human Services

Michigan COVID-19 MIS-C Data

The MIS-C Data page was obtained from Michigan's COVID-19 data page: https://www.michigan.gov/coronavirus/stats/mis-c-reporting.

This report is created by the Michigan Department of Health & Human Services from data self-reported by health care providers and local health departments. Data is updated on the first and third Thursdays of the month.

Multisystem Inflammatory Syndrome in Children (MIS-C) is a condition in children and adolescents under 21 years of age where multiple organ systems become inflamed or dysfunctional which occurs in association with illness. Children with MIS-C may have a fever and various symptoms, including abdominal (gut) pain, vomiting, diarrhea, neck pain, rash, …

Deep Learning Algorithm Reveals Probabilities Of Stage-Specific Time To Conversion In Individuals With Neurodegenerative Disease Late, Xinxing Wu, Chong Peng, Peter T. Nelson, Qiang Cheng

Sanders-Brown Center on Aging Faculty Publications

Introduction: Limbic-predominant age-related TAR DNA-binding protein 43 (TDP-43) encephalopathy (LATE) is a recently defined neurodegenerative disease. Currently, there is no effective way to make a prognosis of time to stage-specific future conversions at an individual level.

Methods: After using the Kaplan–Meier estimation and log-rank test to confirm the heterogeneity of LATE progression, we developed a deep learning–based approach to assess the stage-specific probabilities of time to LATE conversions for different subjects.

Results: Our approach could accurately estimate the disease incidence and transition to next stages: the concordance index was at least 82% and the integrated Brier score …

Online-Delivered Over Staff-Delivered Parenting Intervention For Young Children With Disruptive Behavior Problems: Cost-Minimization Analysis, Justin B. Ingels, Phaedra S. Corso, Ron Prinz, Carol W. Metzler, Matthew R. Sanders

Faculty Publications

Background: High-prevalence childhood mental health problems like early-onset disruptive behavior problems (DBPs) pose a significant public health challenge and necessitate interventions with adequate population reach. The treatment approach of choice for childhood DBPs, namely evidence-based parenting intervention, has not been sufficiently disseminated when relying solely on staff-delivered services. Online-delivered parenting intervention is a promising strategy, but the cost minimization of this delivery model for reducing child DBPs is unknown compared with the more traditional staff-delivered modality.

Objective:This study aimed to examine the cost-minimization of an online parenting intervention for childhood disruptive behavior problems compared with the staff-delivered version of the …

Metformin Increases Natural Killer Cell Functions In Head And Neck Squamous Cell Carcinoma Through Cxcl1 Inhibition, Mckenzie Crist, Benyamin Yaniv, Sarah Palackdharry, Maria A. Lehn, Mario Medvedovic, Timothy Stone, Shuchi Gulati, Vidhya Karivedu, Michael Borchers, Bethany Fuhrman, Audrey Crago, Joseph Curry, Ubaldo Martinez-Outschoorn, Vinita Takiar, Trisha M. Wise-Draper

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

BACKGROUND: Metformin slows tumor growth and progression in vitro, and in combination with chemoradiotherapy, resulted in high overall survival in patients with head and neck cancer squamous cell carcinoma (HNSCC) in our phase 1 clinical trial (NCT02325401). Metformin is also postulated to activate an antitumor immune response. Here, we investigate immunologic effects of metformin on natural killer (NK) and natural killer T cells, including results from two phase I open-label studies in patients with HNSCC treated with metformin (NCT02325401, NCT02083692).

METHODS: Peripheral blood was collected before and after metformin treatment or from newly diagnosed patients with HNSCC. Peripheral immune cell …

Older Adults Access To Mental Health And Social Care Services During Covid-19 Restrictions In Western Australia, Claire Adams, Eyal Gringart, Daniel Mcaullay, Moira Sim, Brigitta Scarfe, Amy Budrikis, Natalie Strobel

Research outputs 2022 to 2026

Objective: This study aimed to understand the impact of COVID-19 on access to mental health and social services among older adults in Western Australia. Method: A cross-sectional study was conducted with 194 adults aged ≥ 70 years or ≥ 60 years with chronic conditions. A questionnaire co-developed by a consumer reference group was used to collect data on social networks and service access. Frequency analyses were used to assess quantitative data. Qualitative data were assessed using thematic analyses. Results: 62.7 % of participants reported being not at all/slightly affected by COVID-19; 40.7 % reported having three/four people to chat with. …

Phenome-Wide Analysis Of Taiwan Biobank Reveals Novel Glycemia-Related Loci And Genetic Risks For Diabetes, Chia-Jung Lee, Ting-Huei Chen, Aylwin Ming Wee Lim, Chien-Ching Chang, Jia-Jyun Sie, Pei-Lung Chen, Su-Wei Chang, Shang-Jung Wu, Chia-Lin Hsu, Ai-Ru Hsieh, Wei-Shiung Yang, Cathy S J Fann

2020-Current year OA Pubs

To explore the complex genetic architecture of common diseases and traits, we conducted comprehensive PheWAS of ten diseases and 34 quantitative traits in the community-based Taiwan Biobank (TWB). We identified 995 significantly associated loci with 135 novel loci specific to Taiwanese population. Further analyses highlighted the genetic pleiotropy of loci related to complex disease and associated quantitative traits. Extensive analysis on glycaemic phenotypes (T2D, fasting glucose and HbA

Impact Of Moral Injury On Work Performance In Nurses Following The Covid-19 Surges, Annette Callis, Trisha Saul, Ross Bindler

Articles, Abstracts, and Reports

Background

Moral Injury (MI) was defined by Jonathan Shay in 1994 as committing acts that betray one’s moral compass in high-stakes situations, while under the authority of another, that severely affect one’s well-being. MI was measured solely in the military prior to the COVID pandemic.

Aims

1.Explore the relationship between moral injury (MI) and perceived work performance in hospital nurses following the pandemic surges. 2. Determine relationships between MI and select participant demographics and between work performance and select demographics.

Sample

A convenience sample of 191 nurses from seven Southern California Hospitals participated in the study from March to June …

Characterization Of Bcma Expression In Circulating Rare Single Cells Of Patients With Plasma Cell Neoplasms, Libere J Ndacayisaba, Kate E Rappard, Stephanie N Shishido, Sonia M Setayesh, Guilin Tang, Pei Lin, Nicholas Matsumoto, Ching-Ju Hsu, Rafael Nevarez, Carmen Ruiz Velasco, Amin Naghdloo, Eric Yang, Kevin Kelly, James Hicks, Jeremy Mason, Robert Z Orlowski, Elisabet E Manasanch, Peter Kuhn

Faculty, Staff and Student Publications

B-cell maturation antigen (BCMA), a key regulator of B-cell proliferation and survival, is highly expressed in almost all cases of plasma cell neoplasms and B-lymphoproliferative malignancies. BCMA is a robust biomarker of plasma cells and a therapeutic target with substantial clinical significance. However, the expression of BCMA in circulating tumor cells of patients with hematological malignancies has not been validated for the detection of circulating plasma and B cells. The application of BCMA as a biomarker in single-cell detection and profiling of circulating tumor cells in patients' blood could enable early disease profiling and therapy response monitoring. Here, we report …

Antibiotic Exposure Does Not Impact Immune Checkpoint Blockade Response In Msi-H/Dmmr Metastatic Colorectal Cancer: A Single-Center Experience, Victoria Serpas Higbie, Jane Rogers, Hyunsoo Hwang, Wei Qiao, Lianchun Xiao, Arvind Dasari, Kerri Mola-Rudd, Van K Morris, Robert A Wolff, Kanwal Raghav, Ryan Huey, Christine Parseghian, Jason Willis, Scott Kopetz, Michael J Overman, Benny Johnson

Faculty, Staff and Student Publications

BACKGROUND: Immune checkpoint blockade (ICB) has improved outcomes for patients with microsatellite instability high (MSI-H)/deficient mismatch repair (dMMR) tumors. However, not all MSI-H/dMMR patients will exhibit the same ICB efficacy. Previous studies suggest that concomitant antibiotic use while receiving ICB may result in poorer outcomes. We aimed to evaluate this association in patients with MSI-H/dMMR metastatic colorectal cancer (mCRC).

MATERIALS AND METHODS: A single-site, retrospective review of 57 patients with MSI-H/dMMR mCRC that received ICB was completed. Data collected included patient demographics, ICB information, and antibiotic use. Antibiotic exposure was considered from 90 days prior to ICB through 6 weeks …

Injury To The Posterior Horn Of The Lateral Meniscus From A Misplaced Tibial Tunnel For Anterior Cruciate Ligament Reconstruction: A Case Report, Amar S Vadhera, Jonathan S Lee, Harsh Singh, Safa Gursoy, Kyle N Kunze, Nikhil N Verma, Jorge Chahla

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND Posterior meniscal root avulsions can cause meniscal extrusion, joint space narrowing, and progressive knee arthritis. Iatrogenic posterior meniscal root avulsions after malpositioning of the transtibial tunnels during anterior cruciate ligament (ACL) reconstruction can account for poor long-term outcomes seen in some patients following ACL reconstruction. Therefore, correct transtibial tunnel placement during ACL reconstruction is essential to avoid iatrogenic meniscal damage. CASE REPORT A 32-year-old man presented with 1 year of right knee pain and instability following a non-contact twisting injury sustained while playing soccer. An ACL tear with no meniscal involvement was diagnosed at an outside institution. A double-bundle …

Management Of Trigeminal Neuralgia With Botulinum Toxin Type A: Report Of Two Cases, Craig Pearl, Brendan Moxley, Andrew Perry, Nagi Demian, Cyndie Dallaire-Giroux

Faculty, Staff and Student Publications

Trigeminal neuralgia is a chronic pain condition associated with sharp, shock-like pain in one or more divisions of the trigeminal nerve. For patients who do not respond well to pharmacotherapy, there is growing evidence that Botulinum toxin type A injections into the trigeminal ganglion provide pain relief for several weeks up to several months at a time. One option is to administer injections into the trigeminal ganglion in Meckel's cave by inserting a needle through the Pterygopalatine Fossa using fluoroscopy to guide and confirm the proper needle placement. However, there is evidence that Botulinum toxin travels across nerve synapses; thus, …

Sexual Dysfunction And Sexual Distress In Lymphoma Patients: A Mixed Methods Pilot Study, Dorothie S. Durosier Mertilus

USF Tampa Graduate Theses and Dissertations

Lymphoma, especially non-Hodgkin lymphoma (NHL), is among the most common categories of cancer in the United States (National Cancer Institute [NCI], 2019). The survival rate for lymphoma has significantly improved over the last few decades due to advances in therapy. However, despite these advances, lymphoma patients experience many negative consequences of cancer treatment, including sexual dysfunction (NCI, 2021b). The purpose of this mixed methods pilot study was to explore the presence and experiences of sexual dysfunction and related sexual distress in both male and female lymphoma patients during cancer treatment. A concurrent triangulated design was used to: 1) evaluate the …