Abstracts from Medical Technology,
Physical Therapy, and Nursing
Undergraduate Summer Research Symposium August 9, 2006

Ordered alphabetically by student's last name

Bates DiRosato Feld LaRue Niedermeyer Scott Weiss
Criel Elderkin Forstrom Micale Robinson Wagner

Grandparents Knowledge of Grandchildren’s Physical Activity and Nutritional Behavior
Tessa Bates and Allen Prettyman
Department of Nursing

The prevalence of childhood obesity is increasing for children and adolescents in the United States.  15.3% of children (ages 6–11) are obese, and 15.5% of adolescents (ages 12–19) are obese. An additional 15% of children and adolescents are at risk for becoming obese (BMI for age between the 85th and 95th percentile).
Purpose: Was to explore what correlations might exist between grandparent’s level of involvement with grandchildren and their knowledge about health practices with their grandchildren.  Methods: A survey instrument that was developed.  It was distributed and collected by trained University of Delaware Undergraduate Nursing students in a variety of community setting in New Castle County, Delaware. A total of 100 usable surveys were obtained. Results: Indicated significant correlations between grandparents level of involvement providing care for the grandchild with various types of physical activity and eating habits. Goal: To use the results to help identify of areas for targeted clinical and educational interventions for the prevention of childhood obesity with families and grandparents.Sponsored by Delaware Biotechnology Institute

Energy Efficiency and Walking Speed Associated with Gait Patterns Post-Stroke 

Stacey E. Cifelli Christopher J. Wagner, Willaim Farquhar, Katherine S. Rudolph, Darcy S. Reisman
Departments of Physical Therapy and Health, Nutrition, and Exercise Sciences 

Healthy individuals, regardless of age, choose to walk at the speed that requires the least amount of energy.  When individuals walk slower or faster than this speed they must expend more energy.  Preliminary data from our lab suggests that an individual with post-stroke hemiparesis who has a self selected speed less than 0.8 m/s does not walk at the speed that is most energy efficient for them.  When these patients walk faster they are more energy efficient to a transition point, after which their energy expenditure begins to rise again.  The purpose of this study is to investigate the possible causes of this pattern.  Eight subjects with chronic post-stroke hemiparesis were tested to gather the preliminary data.  For the purposes of the investigation presented here, one subject was further analyzed along with his age-matched control. A 6 camera motion analysis system (Eva Real Time, Santa Rosa, CA) captured kinematic data which was used to calculate joint angles. Oxygen consumption (VO2) was analyzed by Trueone 2400 (ParvoMedics, Sandy, UT) for each speed tested in the kinematics session.  In this subject, kinematic changes with speed could be associated with improvements in energy efficiency as well as with continued elevation of energy cost, even at faster speeds.  Ultimately, future studies could lead to new rehabilitation programs for post-stroke hemiparetic individuals.  This project was financed by the Peter White Fellowship and the National Institutes of Health 5K01HD050582-02.

Young Couples Confronting Breast Cancer: Stress Related To “Being a Mom”

Michelle A. Criel and Christine A. Cannon
School of Nursing

 As a leading cause of cancer deaths in young women ages 15 to 40, breast cancer challenges the integrity of the family at unique phases of its development. Pre-menopausal women face a variety of issues related to fertility, childbearing, and child caring. The purpose of this qualitative inquiry was to describe the lived experiences of young, heterosexual couples during the first year after diagnosis of breast cancer with a focus on the reciprocal impacts of cancer and relationship/marital functioning. Hermeneutic phenomenological philosophy and methods guided the qualitative inquiry. Purposeful sampling yielded 12 couples with the following characteristics: six women were diagnosed between the ages of 30 and 40 and six between 41 and 45; seven couples reported a family history of reproductive cancers; ten couples had children together at the time of diagnosis, one woman had stepchildren and another was engaged and planned to have children; the children’s ages ranged from 2 to 22. Face-to-face couple interviews, each averaging 90 minutes, were audio-taped and the transcribed data were analyzed using methods described by Colaizzi (1978). Member checking and additional data collection were conducted in a session with all couples following preliminary data analysis.  Despite the focus of inquiry being marital-cancer interaction, “Being a Mom” emerged as a major theme supported by 37 statements from 11 couples.  Sub-themes included: “Would They Remember Me?”; “Is Mommy Going to Die?”; “Still Trying to Be a Mom”; and Motherhood After Cancer. Implications for couples coping with breast cancer, families, and healthcare providers are discussed. Research supported by:NIH grant number P20 RR16472-04 from the INBRE program of the National Center for Research Resources; CRD Grant, College of Health Sciences, University of Delaware; and Delaware Breast Cancer Coalition.

Effect of the Disintegrin Eristostatin on Intracellular Protein Phosphorylation in Melanoma Cells

Stephanie DiRosato, Carrie Paquette-Straub, and Mary Ann McLane
Department of Medical Technology 

Viper venom disintegrins interact with cells through integrins.  Eristostatin, a disintegrin isolated from Eristicophis macmahoni, inhibits lung colonization of melanoma cells in a murine model.  Although the mode of inhibition of eristostatin is unknown, phosphorylation studies within cells can help to identify possible pathways of inhibition.  This study focused on the effect of eristostatin treatment on intracellular tyrosine phosphorylation within six human melanoma cell lines.  A time course assay was done at five different time points.  Eristostatin treatment significantly changed the intracellular tyrosine phosphorylation in various proteins in all the melanoma cells.  Changes were not consistent in all the cell lines, however.  Proteins at approximately 240, 45, and 34 kDa showed a decrease in phosphorylation in the 1205LU cell line when treated with eristostatin.  These proteins may possibly correspond to proteins IGFR, Pten, and Crk.  An increase in intracellular phosphorylation with eristostatin treatment was seen in proteins at about 120 in C8161, MV3, and M24met, 100 in MV3, M24met, WM164, and SbCl2, 77 in MV3, M24met, WM164, and SbCl2, 70 in SbCl2, 47 in M24met and WM164, and 34kDa in MV3, C8161, WM164, and SbCl2. These may correspond to proteins FAK, FGFR, Gab, Numb, Pten, and Crk, respectively.  Unlike the wide variety of proteins that exhibited a tyrosine phosphorylation change, significantly fewer proteins showed changes in serine and threonine phosphorylation after treatment with eristostatin. By using antibodies to specific proteins, confirmation of proteins in the signaling pathway can begin.  This will lead to recognition of eristostatin’s mechanism of melanoma cell activity.  Funding provided by University of Delaware Science and Engineering Scholarship (SD) and the National Cancer Institute (CA098056, MAM).

Correlation of Preoperative FEV1 Values and Postoperative Hospital Stay Following Lung Resection

Samantha E. Feld1, Thomas L. Bauer2,3, N. Steward2, and D. Bruce Panasuk,2,3
1Wesley College, Dover DE 2Section of Thoracic Surgery, Helen F. Graham Cancer Center, Christiana Care Health Services, Newark, Delaware, 3Jefferson Medical College, Philadelphia, PA

Background: Pulmonary Function Testing (PFT) is an important preoperative assessment for lung resection candidates. An increased risk of developing a postoperative pulmonary complication (PPC) has been demonstrated in patients with a low preoperative FEV1 (Forced Expiratory Volume in 1 second), leading to a prolonged hospital stay. This study will determine the correlation between the patient’s preoperative FEV1 and postoperative hospital stay. Methods: Using the thoracic database at the Helen F. Graham Cancer Center, relevant information on 141 consecutive patients in the database who had lung surgery and preoperative PFT between April 2004 and June 2006 was extracted. The data was then compared to draw conclusions about the relationship of FEV1 and postoperative hospital stay. All eligible patients in the database at this time were included. Results: When all FEV1 values, not taking into account the surgical approach, the P-value is statistically significant (P<0.01), but the FEV1 % predicted was not (P = 0.85). Individual surgical approaches showed no real statistical significance except the FEV1 value and thoracotomy (P = 0.02) where the difference in the average length of stay is 1.8 days. Conclusion: The average length of stay was statistically lower with an absolute FEV1 is greater than or equal to 1.5 L as apposed to less than 1.5 L when comparing all surgeries (P < 0.01). FEV1 % predicted did not reach statistical significance. The difference in length of stay appears to be limited to those patients who underwent thoracotomies. This project was supported by the NIH NCRR INBRE grant to Delaware; grant number 2 P20 RR016472-06.

A Virtual-Reality Approach for the Treatment of Benign Paroxysmal Positional Vertigo

Robert Forstrom
­­­1,2, Karl V. Steiner1,2, Michael Teixido3,4
1Delaware Biotechnology Institute, 2Department of Electrical and Computer Engineering, University of Delaware
3Christiana Care Health System, Newark, DE, 4Jefferson Medical College, Department of Otolaryngology, Philadelphia, PA

Benign Paroxysmal Positional Vertigo (BPPV) is a type of dizziness which is the result of calcium carbonate particles, called otoconia, moving freely about a canal-like structure of the inner ear, called the labyrinth.  BPPV accounts for about 20% of all dizziness and accounts for about 50% of all dizziness in older people.  Carefully coordinated movements of the patient’s head can help move these otoconia back to their proper locations in the inner ear, where they dissolve.  These head movements can be choreographed and practiced using a newly developed virtual-reality-based program.  Physicians or patients will be able to place a pre-determined number of otoconia into a three-dimensional computer graphics simulation of the labyrinth canal and use the simulation to observe the motions of the octonia with the labyrinth.  This viewer will be made available through a web-based interface to otolaryngologists and present a generic case of the disorder in order to determine proper treatments for the patients. Supported by NIH grant 2 P20 RR016472-06 from the NCRR.

Stress Through Adolescent Eyes
Denise LaRue and Judith W. Herrman
Department of Nursing

Stress is a normal part of everyone’s lives—especially adolescents.  The purpose of this study is to gain a better insight into what adolescents feel are the main stressors in their lives today, as well as the reasons behind those stressors.  An ice-breaker question was asked of teens as part of a larger teen pregnancy prevention study that was being conducted in Delaware.  It was noted that the adolescents studied tended to demonstrate a pattern in answering similar stressors, yet identified some unique ones as well.  A total of 120 teens, ages 12 to 19, participated in focus group interviews that often lead to conversations playing off of each other’s answers.  The sample is a heterogeneous, purposive sampling of teens throughout Delaware.  Results show that above all, the top four stressors in the adolescents’ lives are school, money, guys or boyfriends, and parents.  This study reveals a deeper insight into adolescents’ lives, emphasizes the importance of a support system, and warns adults against putting too much pressure on teenagers.  Future implications for research include exploring exactly how teens cope with the various stressors they are facing both at school and at home.  Funding for this project was supported by the NIH grant number P20 RR16472-04 from the INBRE program of the National Center for Research Resources.

A Clinical Comparison of Forearm and Upper Arm Oscillometric Non-Invasive Blood Pressures in Critically Ill Adults

Lauren Micale, Kathleen Schell, Kate Morse, and Julie K. Waterhouse
of Nursing

Blood pressure (BP) is a vital sign routinely taken by healthcare providers to assess a patient’s health. BP can affect overall morbidity and mortality.  Accuracy of its measurement is imperative because BP reflects cardiovascular status, fluid status, and response to treatments.  The upper arm site is the “gold standard”, but inaccessibility of the upper arm or incorrect cuff size may prompt use of the forearm as an alternative BP measurement site.  Previous research has shown that forearm BP is not an accurate alternative to upper arm BP, but these studies have not included critically ill adults in the intensive care unit (ICU).  The purpose of this study is to compare upper arm and forearm oscillometric BPs in ICU patients who are positioned supine and with the head of bed raised 30˚.  We hypothesize that forearm-upper arm BP differences will exist and will be greater in this patient population because of treatments particular to the setting such as mechanical ventilation and vasopressor drug infusions. This is a preliminary analysis of the first 22 subjects in a study which will enroll 200 patients admitted to the Chester County Hospital ICU, West Chester, PA. Using a Dinamap-100 automatic BP monitor, three upper arm and three forearm BPs were taken in each position.  Paired t-tests showed statistically significant differences.  Differences were not related to body mass index, age, or use of tobacco; however, gender did influence differences.  Preliminary results show that forearm and upper arm oscillometric BPs are not interchangeable in critically ill adults.  This project was supported by the NIH grant 2 P20 RR016472-06 and 2006 American Association of Critical-Care Nurses Evidenced-Based Clinical Practice Grant.

  Comparison of Two Methods of Estimating Central Blood Pressure 
Justin Moses and David G. Edwards
Department of Health, Nutrition, and Exercise Science

The purpose of this study was to compare the two most commonly used non-invasive estimates of central blood pressure using two different types of calibration.  Estimates of central pressure using a carotid artery pressure wave acquired using applanation tonometry and an aortic pressure wave synthesized from a radial pressure wave and a generalized transfer function were compared.  Carotid and aortic waves were calibrated using two different methods.  First, a brachial cuff blood pressure reading was used to calibrate the radial (systolic and diastolic pressures) and carotid (calculated mean and diastolic pressure) waves.  Next, a brachial wave was recorded and calibrated with brachial cuff pressure.  Mean pressure and diastolic pressure from the brachial wave was then used to calibrate the radial and carotid waves.  All pressure wave data were collected using the SphygmoCor system (AtCor Medical, Sydney, Australia).  Five apparently healthy men and women (mean age: 22) participated in this study.  The systolic pressure of the carotid artery (CSP) and the synthesized aortic artery (ASP) were compared.  The cuff-calibrated CSP (C-CSP) was 104 mmHg, and the cuff-calibrated ASP (C-ASP) was 95.4 mmHg.  The brachial wave calibrated CSP (B-CSP) was 108 mmHg, and the brachial wave calibrated ASP (B-ASP) was 102.2 mmHg.  The difference between C-CSP and C-ASP was 8.6 mmHg where as the difference between the B-CSP and B-ASP was 5.8 mmHg.  From the small number of subjects tested thus far, it appears that the calibration using a brachial wave may result in less variation between the two methods of non-invasively estimating central blood pressure however more subjects are required to confirm this.  Future work will be conducted on more subjects and under sympathetic activation (cold pressure test).  Funding provided by the Science and Engineers Scholars Program.

Lung Cancer Screening Using Low-Dose CT - The Christiana Care Experience
Monica Niedermeyer, Barbara Marconi*, Angela Steele-Tilton*, James Lally*, and Thomas L. Bauer*
*Helen F. Graham Cancer Center, Christiana Care Health Services, Newark, Delaware, Wesley College, Dover Delaware 

Purpose: To report the results of the first 1,000 patients that have undergone low-dose CT (LDCT) scans in accordance with the International Early Lung Cancer Action Project  Methods: As part of the International Early Lung Cancer Action Project (I-ELCAP), we enrolled 1,000 high risk participants between April 2003 and April 2006. A spiral CT was performed with 0.75mm overlapping slices, in low-dose technique. Nodules found on baseline screening were followed according to ELCAP protocol.  Results: The first 1,000 patients had an average age of 58 years old and an average smoking history of 48.5 pack-years; 464 (46%) were former smokers, 536 (54%) current smokers. 429 (43%) participants were male, 571 (57%) were female. Of the 1,000 patients screened 15 (1.5%) lung cancers were detected, 13 (87%) were detected in Stage I. 12 of 15 of the lung cancer patients underwent a PET scan and 6 (50%) of the scans were positive. Other problems were detected by the LDCT and additional procedures were performed in the screened participants. Overall, 8 VATS, 6 thoracotomies, and one mediastinoscopy followed as a result of the CT scans. 6 non-lung malignancies were also detected. Conclusion: Our results confirm that LDCT identifies small, non-symptomatic lung cancers in a high risk population, which mostly are in an early stage and can be resected with less invasive surgical procedures. INBRE- Supported by NIH grant 2 P20 RR016472-06 from the NCRR

Sun Protection Practices on the Beaches of Australia

Brittany Robinson, Catherine Elderkin
and, Amy Nagorski Johnson
Department of Nursing

Sun exposure in Australia has been associated with much higher incidence of skin cancer due, in part, to ozone depletions and proximity to the equator.  This trend has prompted a national educational program of sun safety that includes safe practices on Australian beaches across age groups.  The purpose of this study is to examine sun protection knowledge, attitudes, and practices of young adults while on the beach on a sunny day.  Interviews were conducted on Bondi Beach in New South Wales, Australia.  Young adults aged 18 to 35 years (N=139) were approached by the investigators, screened for age and nationality, and asked to participate in this study.  All participants who met the criteria of the study agreed to participate in the survey.  Sun safety program information was recalled by every study participant.  Most of the participants (94.1%) had knowledge of reducing sun exposure to reduce risk of skin cancer.  However, only 78.4% reported regularly using sun protection, and the majority of participants (73.4%) did not have regular screening for skin cancer.  While sunscreen was the most frequently used measure (85.6%), most reported the primary reason as prevention of sunburn.  No difference was found across genders, nor was there a difference across age cohorts.  Inadequacies in protective practices were common, including the lack of protective clothing and devices.  There were no significant differences noted between those born before the sun protection programs were implemented and those born in subsequent years.  Although the Australian national sun safety program has increased knowledge of sun safety, the actual practices of young adults do not reflect application of that knowledge. Funded by University of Delaware Research Foundation.

Evaluation of Virtual Reality Bronchoscopy Simulation

Evan Scott
, Thomas L. Bauer, Nancy Steward, and D. Bruce Panasuk
Section of Thoracic Surgery, Helen F. Graham Cancer Center, Christiana Care Health Services, Newark, Delaware

Virtual reality (VR) is a simulated environment which uses computer-based graphics and specialized devices to provide visual, auditory, and tactile feedback to the user in order to simulate a real-life environment.  VR-simulators have long been used in the fields of aviation and trucking as a successful method for training new employees.  The simulators are also used to maintain professional pilot/trucker skills, and to simulate emergency situations which they may not face on a regular basis.  More recently, VR-simulators are becoming available in the medical field as a means of training medical residents in some of the more complicated invasive procedures.  This study uses a virtual bronchoscope as an alternative to live patients in training thoracic residents to perform a proficient basic bronchoscopy.  25 thoracic residents were each asked to perform 6 virtual procedural bronchoscopies over the course of 2 sessions.  Data was gathered during each procedure to track the resident’s progress.  Results from the first and last procedures were used to evaluate overall improvement in resident proficiency.  This study was funded by the Delaware NIH NCRR INBRE grant number 2P20RR016472.  

Analysis of Kinematics Associated with Manipulations in Walking Speed

Christopher J. Wagner, Cifelli SE, Darcy R. Reisman, Katherine S. Rudolph
Department of Physical Therapy

Slow walking, asymmetrical walking patterns, and poor endurance are very common among stroke patients with hemiparesis.  Previous studies have shown that certain hemiparetic individuals are more energy efficient when they walk faster than their free speed and that walking faster can bring forth more typical walking patterns.  The purpose of this study is to analyze kinematics of hemiparetic individuals to see if their walking patterns change at faster speeds.  We believe that walking faster will improve hemiparetic kinematics and increase energy efficiency.  This information will be useful in developing gait re-training programs for people with hemiparesis after stroke. Data are presented on 1 subject with hemiparesis after stroke whose self-selected walking speed was 0.313 m/sec.  This subject walked wearing an ankle foot orthosis at 7 different speeds from 0.268 – 0.805 m/sec on an instrumented treadmill (Bertec Corporation, Columbus, OH) while a 6 camera motion capture system (Motion Analysis Systems, Santa Rosa, CA) recorded  joint motion data.  Data were processed using custom labview programs (National Instruments, Austin, TX).  Improved kinematics were observed in stance and swing phases at faster speeds.  Knee kinematics improved in almost all phases of the gait cycle, most notably in the swing phase.  Ankle kinematics showed improvement in loading response.  Hip kinematics displayed improvement from mid-stance through swing.  Overall, this subject’s kinematics improved at faster walking speeds.  Future work will involve further analysis of hemiparetic kinematics and its relationship to energy costs.  Funded through Peter White Fellowship and NIH R21 HD047468-01.

Smart Knee Brace for Stroke Gait Rehabilitation

Lisa M. Weiss
, Hauck K, Roos M, Katherine S. Rudolph
Department of Physical Therapy

Stroke leads to loss of motor control of the knee that interferes with walking.  Current devices that provide knee stability also encourage abnormal walking patterns that can be difficult to overcome. A computer controlled Smart Knee Brace will promote early ambulation by providing dynamic control in stance and free motion in the swing phases of gait.  Currently, a linear damper with magnetorheologic fluid (MR) is used to control flexion during the stance phase. The purpose of this study is to demonstrate that the damper can control knee motion in the absence of muscle activation. Data were collected from a 21 year old female wearing the SKB. The subject sat on the edge of a table with the thigh supported and the lower leg free to move.  The subject held the knee in full extension and then allowed the foot to drop.  Voltage was applied to the MR damper to change fluid viscosity thereby resisting motion.  To demonstrate that the subject’s muscles were not influencing the motion, muscle activity was recorded from the vastus lateralis with an EMG system that was interfaced with a motion capture system (Vicon 5.1, Lake Forest, CA).  Knee angle, angular velocity and EMG activity were recorded simultaneously.  The results showed that the damper resisted knee motion when no muscle activity was present.  Although the linear damper was capable of resisting knee motion the resistance supplied by the damper was insufficient for use during walking.  Further prototype developments will investigate damper designs that can produce more resistance. Funding provided by Charles Peter White Fellowship program and NIH R21-HD047468

Links: Summer 2006 Undergraduate Research Symposium, Symposium Abstracts from other Colleges and Departments,
Undergraduate Research Summer Enrichment ProgramUnversity of Delaware Undergraduate Research Program, Howard Hughes Undergraduate Program.
Created  1 August 2006. Last up dated 16 August 2006 by Hal White
Copyright 2006, University of Delaware