Abstracts from Medical Technology,
Physical Therapy, and Nursing
Undergraduate Summer Research Symposium August 8, 2007

Ordered alphabetically by student's last name

Kelly Lapenta
Sausen Servas
Healy Kostielney McCartney Penneys
Ireton Koterwas Ogden Russo

Investigating Complementary and Alternative Medicine Within Nursing’s Scope of Practice.

Laura Bolton and Karen Aveno
Department of Nursing

Complementary and alternative medicine (CAM) use is on the rise in the United States. In 2002, it was estimated that 75% of the total adult population in the U.S. had used CAM at some point. Nurses use a variety of therapies, as permitted within their scope of practice, to deliver care and comfort to their patients. The purpose of this study was to investigate nursing’s scope of practice related to complementary and alternative medicine as defined by the individual Boards of Nursing within the U.S. By using the contact information as listed on the National Council of State Boards of Nursing website, each state Board of Nursing was contacted regarding there position about CAM within nursing scope of practice. A total of 51 state boards of nursing were contacted via e-mail or phone. After completing the data collection, the results were analyzed and respectively, sorted into categories. It was determined that 25% did not address CAM within nursing’s scope of practice, 6% allowed for a specific therapy to be practiced, 41% permit practice but lacked any specific language related to CAM regulation, and 27% either included CAM within the Nurse Practice Act or issued a separate document with specific regulation of CAM within nursing scope of practice. This study indicated that while some state Boards of Nursing addressed the issue of CAM within nursing’s scope of practice, a larger percent has still yet to include any statement regarding CAM and the nursing scope of practice. Without adequately clarifying CAM use within nursing practice, Graduate nurses and Registered nurses will  be unprepared to address the new trends of CAM in their nursing interventions. Future research on this topic could be conducted to investigate the reasoning behind the variations in CAM regulation, as well as the role of the advanced practice nurse within complementary and alternative medicine administration. Supported by NIH grant number P20 RR16472-04 from the INBRE program of the National Center for Research Resources.

Promoting The Family’s Role in Medication Reconciliation: A Telephone Intervention

Jennifer Healy
and Kathy Riley-Lawless
School of Nursing, University of Delaware, and Nemours/A.I. DuPont Hospital for Children

Pediatric nurses are challenged to promote patient safety through medication reconciliation, a process designed to decrease medication errors.  While it has long been known that children face an increased risk of medication errors, little is known about the family’s role in medication reconciliation as it pertains to decreasing medication errors.  This study builds upon the results of a previous study that focused on the barriers families identified as interfering with the medication reconciliation process (did not know they had to bring the medication, forgot the medication, or knew the information). The purposes of this study are to assess 1) the results of a telephone intervention method of contact (communication with a family member vs leaving a message), instructing families to bring their child’s medication to a pre-surgical appointment and 2) the ability of families to provide complete and correct medication information when they do not bring the medication. Preliminary results indicate that families are more likely to bring their child's medications to the appointment when a caller speaks directly to a family member than if the reminder is left on the answering machine.  Also, many families are unable to provide complete and accurate medication information when they do not bring the medication. In conclusion, the medication reconciliation process is improved through a reminder call when the caller speaks directly to a family member.  Results will be used to guide hospital policy.  Research supported by NIH grant number P20 RR16472-04 from the INBRE program of the National Center for Research Resources.

Laparoscopic Gastric Banding vs. Roux-en-Y Gastric Bypass Procedures for Morbid Obesity:
A Review of the Database

Jennifer L.Ireto
n, Erlinda C Wheeler, and Thomas Hardie
of Nursing, University of Delaware

Obesity is a national health problem that has been significantly increasing over the past decades. The National Bureau of Health Statistics shows an increasing proportion of the population to be obese. Data from 1998-1994 shows 23% of adults 20 years or older were obese, compared to 31% for 1999-2002. For the morbidly obese patients, surgery is the only treatment that has been proven to have a long-term effect. The most common type of surgery is the Roux-en-Y-Gastric Bypass. Another more recent option since 2001 is the Laparoscopic Adjustable Banding procedure. The main goal for any bariatric surgical procedure is to decrease weight therefore decreasing or eliminating comorbidities. The purpose of this study is to compare the two types of surgeries using a secondary analysis of a convenient sample of 1,070 patients from the Christiana Institute of Advance Surgery database. Patient demographics, difference in weight loss, and readmission rates between the two surgeries were analyzed. Results showed that there are no significant pre-operative differences between the two bariatric surgeries except for the variables of sleep apnea and age. Younger patients and patients with sleep apnea had undergone more gastric bypass surgery compared to the lap-band surgery. There was no significant difference between the weight loss over time or the readmission rates. This study demonstrated that statistically there is no indicator for why a certain surgical technique is used over the other. More research is needed in this area to effectively compare the two surgeries in their long term outcomes and patient adaptations. Supported by NIH Grant 2P20RR016472-07 under the INBRE Program of the National Center for Research Resources (NCRR).

Dorsiflexior and plantarflexor stimulation to aid in post-stroke hemiparetic gait

Jessica H. Kelly, Katherine S. Rudolph, Trisha Kesar, Darcy Reisman, Stuart Binder-Macleod, Ramu Perumal1
Department of Physical Therapy, 1Department of Mechanical Engineering

The purpose of this study was to study how stimulation of the dorsiflexor (DF) and plantarflexor (PF) while walking on a treadmill can improve gait performance of individuals with post-stroke hemiparesis. We hypothesized that stimulation of the DF of the paretic leg would help to lift the foot during the swing phase of walking resulting in increased DF and reduced circumduction during swing, as well as increased DF at initial contact producing a better heel contact.  We hypothesized that stimulation of the PF would help increase push-off during late stance, and increase knee flexion during the swing phase of gait.  Stimulation was delivered with a variable-frequency train (VFT) functional electric stimulation (FES) that contained an initial high frequency burst (3 pulses with a frequency of 200-Hz) followed by a 30-Hz constant frequency train.  One subject with hemiparesis underwent DF and PF stimulation while walking on a split belt instrumented treadmill with separate force plates under each foot.  The subject was asked to walk at her self-selected speed of 1.7 under 3 conditions: no FES, FES to DF during the swing phase, and FES to DF during the swing phase and PF during the stance phase.  Each trial was captured using an 8-camera VICON Workstation system.  Sagittal plane angles for the ankle, knee and hip joints were analyzed and assessed with and without DF and PF stimulation using the Visual3D program.  Stimulation of the DF and PF during stance and swing produced the greatest push off force during late stance, the greatest amount of knee flexion during both mid-stance and swing, as well as the greatest amount of PF at toe off.  DF at heel strike was greatest when only the DF were stimulated.  Circumduction was relatively constant under each condition, and showed minimal change.  DF and PF stimulation helped to improve overall gait performance by increasing the push off force in late stance, increasing knee flexion throughout stride, improving the PF at toe off, and increasing DF at heel strike and preventing a foot flat initial contact.  Funding for this research has been provided by the National Institute of Health (grant number R01 HD38582)and the University of Delaware Science and Engineering Scholarship Award.

The Disintegrin Eristostatin and Its Effects on Matrix Metalloproteinases -2 and -9
Mollie Kostielney, Carrie Paquette-Straub, and Mary Ann McLane
Department of Medical Technology 

Eristostatin is a disintegrin found in the venom of the viper snake Eristicophis macmahoni.  Eristostatin has the ability to block RGD group ligand-integrin interactions with various extracellular matrix components.  The purpose of this project is to determine whether Eristostatin is able to inhibit the effects of matrix metalloproteinases -2 and -9 secreted from six melanoma cell lines.  Four of the six cell lines have the ability to metastasize from the primary tumor site.  Each cell line was thawed and split into four plates with DMEM/10% FBS.  After a 24 hour incubation period, the cells were serum- starved and dosed with 0 nM, 500 nM, 1000 nM, or 3000 nM eristostatin.  A 7.5% acrylamide/1 ×gelatin zymography gel separated the proteins found in the conditioned media and was stained with 0.1% Coomassie Brilliant Blue R250.  Proteolytic enzyme activity is indicated by clear bands across the dark background at 92 kDa for proMMP9, 84 kDa for MMP9, 72 kDa for proMMP2, and 67 for MMP2.  According to previous studies done for this project, all untreated cell lines should express active proMMP2 and MMP2.  While MMP9 can be visualized, there has been some difficulty in expressing clear bands for proMMP2 and MMP2 in the untreated zymography runs.  Steps for troubleshooting have included concentrating the conditioned media, changing cell dilutions and serum-starving incubation times.  Funding for this project has been provided by the University of Delaware Science and Engineering Scholarship Award.

An Exploration of Hispanic Mothers and Fathers Timidity and Respect as Perceived by Grandparents
Matthew J. Koterwas
and Veronica F. Rempusheski
School of Nursing, The University of Delaware

It is well documented that the Hispanic culture promotes an outward expression of an assertive, masculine attitude (Machismo) with an underlying belief of respect for elders.  Two research questions guided this inquiry: What is the relationship between timidity and respect in Hispanic mothers and fathers as perceived by grandparents (GPs)? How is this relationship associated with their ethnicity and acculturation to American society?  This non-experimental study identified trends in Hispanic GPs’ perceptions of respect and timidity in their grandchild’s parents.  Data were extracted from the 215 subjects in the Evaluation of the Spanish Version of the Grandparent Perceptions of Family Scale study (Rempusheski, 2007).  Several demographic variables were explored in order to identify those with the highest frequency of occurrence and were correlated with the GPs’ perceptions to determine the strength and significance of their relationship.  There was a significant (< .05), but weak correlation between the GPs’ perceived disrespect and timidity in the grandchild’s mother (r = .189) and father (r = .247).  These correlations varied by GPs’ birthplace (defined as ethnicity); however, the sample size of Cuba and Peru (n = 11, 11) is not comparable to that of Mexico (n = 77).  The individuals who were more accustomed to American culture had consistently higher correlations of a single variable between parents.  Those who had less exposure to American culture presented higher correlations between timidity and disrespect toward a particular parent.  This project was supported by NIH grant 2 P20 RR016472-07 under the INBRE Program of the National Center for Research Resources (NCRR).

Science, Ethics, and Public Policy (SEPP) Program Website
Dante LaPenta, Kathryn O’Neal, and  Thomas Powers
Delaware Biotechnology Institute

As ethical and public policy issues related to science and technology became increasingly important in the academic enterprise, in 2001 the University of Delaware initiated a program for this area. Out of this initiative arose the Delaware Interdisciplinary Ethics program. Operating out of the Delaware Biotechnology Institute, the program sought to integrate the consideration of ethics and public policy into technological innovation. Under the direction of Thomas Powers and David Weir, it has developed into the Science, Ethics, and Public Policy (SEPP) program. In order give SEPP a visible, public location, the program’s website (sepp.dbi.udel.edu) needed to be constructed.  It will serve as the face of the program and also function as a research and educational tool.  Although a main focus of the site is to increase public knowledge of the emerging program, an equally vital goal is to assist faculty who wish to inject ethical discussion into their courses. The site is intended to increase the understanding of the users in the consideration of complex moral issues brought on by contemporary science and technology

.The SEPP program will explore important ethical and policy concerns in all fields of science and technology.  The content within the site is not limited to any specific subject area; a broad spectrum of issues shall be presented.  The scrolling questions in the upper right hand corner of the main page are intended to give the user an idea of the program domain and will lead to case studies on each topic.  The template on the left side of the page lists all of the research content and has been separated into 7 categories:

Research Integrity
Environmental Ethics
Biomedical Ethics
Sports and Enhancement
Nanotechnology and Ethics
Information Technology Ethics
Science and Technology Policy

Three further categories lead to links of educational and professional interest:

Teaching Resources
Journals and Organizations
Centers and Institutes

Each of these categories has been carefully constructed to give the user the best available content and has been sub-divided into more specific groupings to allow for faster, more efficient use. Funding for this project was provided by NSF-ESPCoR.

Does Heading Frequency Affect Neuropsychological Test Performance In Interscholastic Female Soccer Players?

Taima A. McCartney and Thomas W. Kaminski
Athletic Training Research Laboratory

Recent media attention has been given to the sport of soccer and most notably purposeful heading and whether or not it is dangerous to the brain. Objective: The purpose of this study was to compare baseline and post-season neuropsychological (NP) scores in interscholastic female soccer players to determine if there was a decline in performance in those who head the ball more often. Methods: A total of 316 female soccer players participated and were divided into four groups based on their number of total headers during a playing season: 0 headers (N = 19); 1 – 15 headers (N = 150); 16 – 42 headers (N = 74); and 43+ headers (N = 73). Subjects were administered the computerized Automated Neuropsychological Assessment Metrics (ANAM) test battery prior to and at the conclusion of their playing season.  The number of headers were recorded during the season and totaled after the last game. Throughput scores (measures of performance speed and accuracy) were taken from the ANAM test battery for the Simple Reaction Time (SRT), Math Processing Test (MTH), Continuous Performance Test (CPT), Matching to Sample (MSP), Sternberg Memory Test (ST6), Repeat Simple Reaction Time (RSRT), and Repeat Continuous Performance Test (RCPT). Scores were analyzed using a mixed model ANOVA with repeated measures.  Results: There were no significant interactions between group status and time.  There were significant time main effects (P < .05) for the MTH, CPT, ST6, and RCPT measures. The pooled (across all groups) throughput scores for these variables improved from baseline to post-season. Conclusions:  It doesn’t appear that the total number of headers accumulated over the course of a playing season affects NP test performance in this group of soccer players.  Interestingly there was improved performance (higher throughput scores) on four of the seven variables measured, with a trend toward improvement on one other.  These changes in throughput scores are most likely associated with learning effects.  This project was funded by the University of Delaware Undergraduate Research Program.

Coordination of upper and lower extremity forces in bi-directional static force production tasks.
Laura Jane Penneys, Jim Richards, Slobodan Jaric, Venilla Krishnan
Department of Health, Nutrition and Exercise Sciences

Interpretation of the coordination between the grip (normal force that prevents slippage) and the load force (tangential gravitational force) within the human hands has been shown to reveal neurological impairments.  While these factors can be determined from grasping techniques, the lower body has yet to be examined for these neurological signs.   In this study, we tested to see if there is a central control mechanism governing load/grip and shear/normal coordination, or whether the upper extremities are controlled separately from the lower extremities.  We tested the hypothesis that both upper and lower extremities would be controlled by a similar source, showing comparable load/grip and shear/normal forces.  Subjects performed bi-directional static force production tasks at 60 hz with their hands, palms, and feet.  We then performed statistical analysis for task performance between the hand and foot, grip/load ratio, cross correlation, regression, and Eigenvectors for each subject, and a MANOVA for all subjects.  In the pilot study we found a correlation of 0.846 between the palm trials and the foot trials, 0.568 between the foot trials and grip trials, and 0.813 between the grip trials and the palm trials, indicating promising results for the remainder of the study.  Funding provided by the Undergraduate Research Program.

Treadmill Ambulation:  Potential for Improved Gait Symmetry

Stephanie Russo and Todd Royer
Department of Health, Nutrition and Exercise Sciences

Asymmetric gait is common among individuals who have had a stroke, lower-extremity amputation, or another debilitating condition.  Nonsymmetrical walking contributes to secondary disabilities, such as increased risk of osteoarthritis and greater metabolic effort.  The purpose of this research project is to examine joint symmetry of the lower extremities when walking overground and on a treadmill.  It is hypothesized that the constant motion of the treadmill belt will promote more symmetric gait.  Eighteen subjects (mean age = 21.9 yrs) wore an ankle brace unilaterally that mimicked the reduced ankle motion associated with an amputee patient’s prosthetic limb.  Following a five-minute accommodation, subjects walked (1.3m/s) both overground and on the treadmill in a randomized order.  Three-dimensional coordinate data of markers affixed to the lower extremities were recorded for gait analysis.  The joint angle waveforms were calculated for left and right ankle, knee, and hip motions using Orthotrack software.  Joint angle symmetry was calculated for both treadmill and overground walking.  Dependent t-tests (p< 0.05) identified significant differences in symmetry between walking modes.  Mean symmetry values for the ankle (overground = 0.89, treadmill = 0.90) were much smaller than 1.0 (perfect symmetry) indicating the ankle brace created a gait asymmetry.  Knee joint symmetry significantly improved during treadmill walking; however, the effect size was reasonably small (0.32).  Hip joint symmetry did not improve as hypothesized.  Compared to overground, treadmill walking resulted in altered knee motion and symmetry, similar to Riley et al.’s study that observed a change in knee flexion and extension with treadmill walking.  Funding was provided by the Undergraduate Research Program.

Exercise Pressor Reflex in Hypertensive Humans

Mark T Sausen, Lindsay H Ogden, EP Delaney, WB Farquhar
Department of Physical Therapy

  During handgrip exercise, there is a sympathetically-regulated increase in blood pressure (BP) mediated by what has been termed “central command” (a neural drive originating in the brain) and the “exercise pressor reflex” (a neural drive originating in skeletal muscle).  Post-exercise ischemia isolates the exercise pressor reflex, causing BP to remain elevated.  Spontaneously hypertensive (HTN) rats demonstrate an overactive exercise pressor reflex (muscle contraction elicited by electrical stimulation).  We examined this issue in HTN humans during voluntary exercise and post-exercise ischemia.

Hypothesis: The exercise- and ischemia-induced increase in BP will be greater in HTN compared to normotensive adults. 

Methods: Eleven HTN adults (64±1 yrs) and 13 normotensive adults(65±1 yrs) were studied.  Beat-to-beat BP was assessed non-invasively with a Finometer. Three minutes of dynamic handgrip exercise at 60% of maximal voluntary contraction was performed followed by 2 minutes of post-exercise ischemia (occlusion cuff inflated to 200 mmHg to trap metabolites).  A repeated-measures ANOVA was used to examine differences between conditions and groups. 

Results (mean±SEM): Diastolic BP increased more during handgrip exercise in the HTN compared to the normotensive group (delta pressure: 11±2 vs. 6±2 mmHg, p<0.05); there was a trend towards a difference during the post-exercise ischemia condition (7±2 vs. 3±1 mmHg, p=0.06).  No group differences were observed for systolic (p=0.15) or mean BP (p=0.07). 

Conclusion: Handgrip exercise results in a greater increase in diastolic BP in HTN adults compared to age-matched normotensive adults.  These preliminary findings suggest that HTN humans have an overactive exercise pressor reflex. Funding provided by INBRE and the Science and Engineering Scholars Program.

Yersinia pestis
KIM D27 and KIM D28 Dendritic Cell Infection: Understanding the Early Immune Response

Amy T. Servas
Carrie Paquette-Straub, and Michelle A. Parent
Department of Medical Technology

Yersinia pestis is a facultative intracellular gram-negative bacillus.  It is the causative agent of plague and was responsible for the “Black Death,” which killed between one third and two thirds of Europe’s population in the Middle Ages.  In this age of terrorism, possible Yersinia pestis aerosol exposure and resulting pneumonic infection is a grave concern.  Toward that end, no vaccine is available to protect the public against a pneumonic infection.  History has shown that an attenuated strain of Y. pestis KIM D27 was used as a vaccine strain and evidence suggests that it protects against pneumonic infection; however, post vaccination sequelae makes it too reactogenic for the general public. We have previously shown that KIM D27 vaccination protects mice against pneumonic infection.  Our goal is to understand the underlying mechanisms of this protective immune response by studying the first interaction of bacteria with dendritic cells (DC), the host antigen presenting cell (APC).  Y. pestis KIM D27 possesses many virulence factors such as; Yersinia outer proteins (Yops on virulence plasmid pCD1), caf1 (F1 inhibits phagocytosis) and pla (role in invasion).  In order to understand the interaction of bacteria with dendritic cells, we compared Y. pestis KIM D27 (pCD1 present) dendritic cell infection to that of Y. pestis KIM D28 (pCD1 absent). Using colony forming units (CFU), the cytokine Interferon-gamma (IFNg), and Dendritic cell, Antigen Presenting cell Microarrays we are beginning to determine the immune response resulting from a Y. pestis KIM D27 infection.  This information will ultimately contribute to vaccine development.

Dynamic Stability in Medial Knee Osteoarthritis

Jason Schoenfeld, Deepak Kumar, Katherine S. Rudolph
Department of Physical Therapy

Patients with Medial Knee Osteoarthritis (MKOA) complain of knee instability and research has shown that people with MKOA have lesser knee motion and greater knee muscle co-contraction during walking than healthy subjects.  This strategy is even more pronounced when an external perturbation challenges walking stability.  In this study we investigated neuromuscular adaptations in people with MKOA when exposed to repeated perturbations.  Pilot data from one healthy control subject is presented here.  Kinetic, kinematic, and EMG data were collected as the subject walked at a self-selected speed for 10 regular trials followed by 50 consecutive perturbation trials.  During perturbation trials a movable platform translated laterally at heel strike.  The EMG data were averaged over three intervals: 100 msec before heel strike; heel strike to peak knee flexion(PKF) (loading response) and PKF to peak knee extension (mid-stance).  During the perturbation trials the subject showed unchanging muscle activity that was comparable to regular walking.  During the first few perturbation trials, the knee flexion at heel strike was greater than normal.  Over the 50 trials, the knee angle gradually decreased to a value similar to regular walking and then remained constant.  The knee angle at loading response and mid-stance was not different from normal walking trials.  The data indicate very little adaptation when dynamic stability was challenged.  These data will be compared to data from MKOA subjects to ascertain the differences in neuromuscular response strategies.  Funding:  National Institute of Health (P20 RR16458); University of Delaware Science and Engineering Scholarship Award.

Smart Knee Brace: Effects of Weight on Movement Patterns

Julie Wagner, M. Roos, D. Kumar, Katherine S. Rudolph
Department of Physical Therapy

Hemiparesis from stroke limits ambulation.  We have developed a smart knee brace (SKB) that restricts knee motion for gait training however the brace weighs 2.3 kg and it is unclear what effect the weight will have on joint movement and muscle activity.  In this study we investigate the effects of wearing the SKB during walking.  Pilot data from a 21 year old healthy female is presented.  The subject walked on an instrumented treadmill using 2 conditions (1) no brace and (2) wearing the brace on the right leg with knee free to move.   Motion analysis and EMG systems were used to collect muscle activity (EMG) and joint angles.  While wearing the brace the subject used greater hip flexion and less knee extension during late swing on the right.  The right vastus lateralis, lateral hamstring, and lateral gastrocnemius showed no differences between conditions.  However, the left gluteus medius EMG, that controls the pelvis during right swing phase, was higher in the brace condition.  We would have expected the added weight of the brace to require greater muscle activation during walking, however, only the left hip abductors showed increased activity.  The lack of EMG differences coupled with changes in hip and knee flexion, suggests that the brace, which was not custom made for this subject, was not aligned to the knee joint perfectly.  Improper fit of the SKB could interfere with knee movement that could influence the movement of other joints.  Funding:  UD Undergraduate Research Peter White Fellowship,  NIH R21HD047468

Links: Summer 2007 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  23 July 2007. Last up dated 15 August 2007 by [Hal White at udel.edu]
Copyright 2007, University of Delaware