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Student Contribution  |   January 2012
2011 Student Abstracts and Poster Competitions
Article Information
Medical Education / Neuromusculoskeletal Disorders / Pediatrics / Pulmonary Disorders
Student Contribution   |   January 2012
##### 2011 Student Abstracts and Poster Competitions
The Journal of the American Osteopathic Association, January 2012, Vol. 112, 34-62. doi:10.7556/jaoa.2012.112.1.34
The Journal of the American Osteopathic Association, January 2012, Vol. 112, 34-62. doi:10.7556/jaoa.2012.112.1.34
SOMA Abstracts
Osteopathic Manipulative Medicine/Osteopathic Principles and Practice
S1
Neurophysiologic Effects of Non-impulse Manual Therapy in Patients With Chronic Low Back Pain
David A. Goss, BS, OMS III1; James S. Thomas, PhD2; Steven Walkowski, DO3; Shawn Clark, OMS II1; John C. Licciardone, DO, MS, MBA4; Guang H. Yue, PhD5; Brian C. Clark, PhD6
1Ohio University Heritage College of Osteopathic Medicine (OU-HCOM), Athens; 2School of Rehabilitation and Communication Sciences, Ohio University, Athens; 3Family Medicine, OU-HCOM, Athens; 4Medical Education, University of North Texas Health Science Center—Texas College of Osteopathic Medicine, Fort Worth; 5Biomedical Engineering and Physical Medicine, OU-HCOM, Cleveland; 6Biomedical Sciences, OU-HCOM, Athens
Context: While there is growing evidence for the efficacy of spinal manipulation (SM) to treat patients with low back pain (LBP), little is known on the mechanisms and physiologic effects of these treatments.
Objective: To determine if nonimpulse manual therapy (MT) attenuated side-to-side differences (asymmetry) of the erector spinae (ES) stretch reflex amplitude in 9 patients with chronic LBP.
Methods: We used electromechanical tapping to elicit short-latency stretch reflexes (SR) from the ES muscles before and after a single treatment session of nonimpulse MT (ie, muscle energy, myofascial release, and strain-counterstrain).
Results: A large asymmetry in the SR was observed at baseline, with the higher of the paraspinal sides exhibiting a 100.2±28.2% greater value than the lower side. Following the intervention, this SR asymmetry was reduced (100.2±28.2% to 36.6±23.1%; P=.03). This change was largely due to reduced amplitude on the side that was higher at baseline (35% reduction following treatment; P=.05), whereas no change over time was observed in the low side (P=.23). In addition, there was no difference between the respective sides following the intervention (P=.38), indicating that the asymmetry was normalized following treatment.
Conclusion: These findings provide insight into the mechanism(s) of action of nonimpulse MT, and suggest that it acts to down regulate the gain of the muscle spindles and/or the various sites of the Ia reflex pathway. Ultimately, developing a better understanding of the physiologic effects of manual therapies will assist in optimizing treatment strategies for patients with LBP.
S2
Association of Biomechanical Changes and Weight Gain Throughout Pregnancy
Natalie Wessel, DO1; Eric Shamus, DPT2; Kenneth Johnson, DO3; Yasmin Hussain-Quereshi, DPT4; Meighan O'Connor, OMS III1; Rohit Mehra, OMS IV1
1Nova Southeastern University College of Osteopathic Medicine (NSU-COM), Fort Lauderdale, Florida; 2Physical Therapy, NSU-COM; 3Obstetrics and Gynecology, NSU-COM; 4Osteopathic Principles and Practice, NSU-COM
Context: Low back and posterior pelvic pain are common musculoskeletal complaints during pregnancy. The biomechanical theory implies that the enlarging uterus causes the maternal center of gravity to move anteriorly causing stress on the low back. As the center of gravity shifts anteriorly, this can cause joint, muscle and fascial stresses on the body. The lumbosacral angle, weight distribution and low back pain were examined. These biomechanical measurements will be correlated with reported low back pain. As an osteopathic physician, it is important to understand the biomechanical changes during pregnancy and their association with low back pain. This study will provide guidance in focusing osteopathic manipulative treatments to the fascia and muscular attachments along the lumbosacral region that may have a contributing change in the biomechanics.
Hypothesis: An increase in weight gain during the second and third trimesters of pregnancy will correlate with an increase in the sway rate, lumbosacral angle, and the percentage of body weight distribution posteriorly as the center of gravity moves anteriorly. An increase in reported low back pain during the second and third trimester will correlate with an increase in these biomechanical changes.
Methods: Thirty pregnant women in at least their second trimester (13 weeks) are being recruited at the Nova Southeastern University's Osteopathic Manipulation Clinic, NSU's Obstetrics and Gynecology Clinic, and at Red Pearl's Prenatal Yoga Class in Fort Lauderdale, Florida. In this study, a quadruple postural scale is utilized to measure body weight distribution and sway rate. The quadruple postural scale measures the participants' weight gain and shift of weight anteriorly or posteriorly. A digital inclinometer is used to measure the lumbosacral angle. The Oswestry Low Back Pain Scale is utilized to measure the degree of reported low back pain. Ladies in the study will be measured throughout their second and third trimesters of pregnancy.
Results and Conclusion: Preliminary results (N=22) have shown that weight gain throughout the second and third trimesters of pregnancy increases the lumbosacral angle while the shift of body weight distribution moves posteriorly as the maternal center of gravity moves anterior. The higher degree of low back pain reported correlates with an increase in postural sway rate. Higher reports of low back pain also correlate with an increase in lumbosacral angle and shift of body weight posteriorly onto the heels. The results from 30 participants will be presented at the meeting.
S7
Effect of OMT on Heart Rate in Normotensive and Prehypertensive Individuals
Vivian N. Siu, OMS IV; Amanda Cooper, OMS III; Mostafa Rezk, DO; Michael Terzella, DO; Sheldon Yao, DO; Wolfgang Gilliar, DO
Department of Osteopathic Manipulative Medicine, New York College of Osteopathic Medicine of New York Institute of Technology, Old Westbury
Hypothesis: We hypothesize that by using osteopathic manipulative treatment (OMT), one is able to target the autonomic nervous system (ANS) and thus alter (ie, increase or decrease) heart rate in normotensive individuals. The regulation of heart rate is under the control of the ANS with automaticity of the cardiac pacemaker cells being responsible for the heart's baseline rhythmic contraction. The sympathetic (nerve fibers from T1-T5) and parasympathetic (vagus nerve) branches of the ANS increase and decrease heart rate, respectively. Using heart rate variability analysis, Henley et al quantitatively demonstrated that cervical myofascial release is able to shift the sympathovagal balance from the sympathetic to the parasympathetic nervous system.
Methods: Heart rate data were collected by measuring the participants' cardiac pulse taken during our NYIT/IRB-approved study on the effect of OMT on blood pressure. We conducted a sham vs OMT single-blinded pilot study. We recruited 21 adults aged between 18 and 65 years who had a blood pressure less than 140/90 mm Hg. All participants signed the consent forms before enrollment. We excluded adults with symptoms of severe hypertension, myocardial infarction, stroke, syncope episodes, recreational drug use, or family history of sudden cardiac death. The study was carried out during a 6-week period in which participants received 2 weeks of OMT vs a benign sham procedure. Techniques included rib raising, thoracic outlet release, suboccipital release and OA decompression. We measured heart rate and blood pressure before and after every visit.
Results: Results from t tests for immediate, short-term, and long-term effects on heart rate (n=21) showed no statistically significant difference between OMT (n1=11) and sham treatments (n2=10) in normotensive or prehypertensive participants. P values for difference of pulse immediately, short-term, and long-term were .953, .190, and .863, respectively.
Conclusion: Our data demonstrated no significant immediate, short-term, or long-term effects of OMT on heart rate. We believe the treatment aimed at normalizing autonomic control did not demonstrate a measurable effect because our participants were healthy without any documented autonomic dysfunction. For future studies, we will consider focusing on 1 branch of the ANS at a time (eg, parasympathetic vs sympathetic), recruiting participants who may have abnormal heart rates, and applying various OMT techniques to determine potential outcome differences.
S31
Use of Consensus Training and Calibrated Pelvic Models to Determine the Accuracy of Medical Students Palpating Pelvic Landmarks
Benjamin R. Cook, OMS II1; Blake Hood, OMS II1; Samuel Engemann, OMS II1; Melissa Kuehl, OMS II1; Allison Dooley2; Joshua Wilson2; Brian Degenhardt, DO3
1A.T. Still University of Health Sciences-Kirksville College of Osteopathic Medicine (ATSU-KCOM), Missouri; 2Truman State University, Kirksville, Missouri; 3A.T. Still Research Institute, ATSU-KCOM
Context: Five landmarks are commonly palpated to diagnose innominate somatic dysfunction, but objective characteristics of these tests are poorly known.
Objective: To determine at what level of asymmetry can a group of medical students achieve 0.80 accuracy for each landmark using standardized, calibrated pelvic bone models and consensus training.
Methods: Four osteopathic medical students palpated 5 pelvic landmarks: anterior superior iliac spine (ASIS), pubic tubercle (PT), iliac crest (IC), posterior superior iliac spine (PSIS), and ischial tuberosity (IT). Eight models were calibrated and set to various degrees of rotation/shear to create vertical asymmetries from +1 to +6 mm and covered with a foam pad (0.5” thick) to obscure settings and simulate soft tissue. Asymmetry settings were randomly assigned. Four models were palpated at a time in a blinded fashion. Student findings were compared to model settings to determine accuracy. Initially, tests were performed using techniques taught within the students' curriculum. Consensus training was performed to identify any differences in the performance of technique that caused variation in findings. After each consensus training session, agreement on the standardized performance of the technique was recorded and subsequent performance of technique was modified to these standards. Over three 8-hour periods, each landmark was evaluated independently by each student 40 to 60 times.
Results: For the ASIS, PSIS, and IT, accuracy was related to the amount of asymmetry (P=.003, P=.02, and P=.03 respectively). For these landmarks, accuracy improved as asymmetry increased. For the PT and IC, accuracy did not statistically correlate with asymmetry (P=.13 for both). Eye dominance was not correlated with accuracy for any of the landmarks. The thresholds for 0.8 accuracy was at 4 mm for the ASIS and PSIS, and 3 mm for the PT, IT, and IC.
Conclusion: Accuracy thresholds for innominate positional asymmetry tests were determined. Accuracy levels varied no more than 1 mm between landmarks. A study assessing accuracy of landmark asymmetry on humans is methodologically challenging, so use of pelvic models may provide a good feedback system for training purposes. A goal from this study is to determine ways to translate this work into studies in which humans are palpated.
Acknowledgments: This research was supported by a grant from the American Osteopathic Association #F11-01 and resources from the A.T. Still Research Institute.
Clinical
S5
INSPIRE Diabetes: An Intensive Insulin Regimen as a Primary Treatment of New-Onset Type 2 Diabetes
Jennifer A. Belsky, MS, OMS II; Victor Heh, PhD; Frank Schwartz, DO; Jay H. Shubrook, Jr, DO
Ohio University Heritage College of Osteopathic Medicine, Athens
Context: Diabetes mellitus is the seventh leading cause of mortality in the United States. INSPIRE Diabetes is a clinical trial that offers a novel approach to the use of insulin therapy in new-onset type 2 diabetes mellitus (T2DM) with the aim of determining its efficacy toward producing lasting glucose control.
Hypothesis: We hypothesized that treating newly diagnosed T2DM patients with a pulse of insulin therapy versus standard care would lead to long-term improvement in glycemic control. Outcomes included potential to reduce medications, to control glucose levels faster, and to preserve declining function of the pancreas through intensive insulin therapy. Interim analysis results have compared the intensive insulin to a control group in regards to time and need to rescue point, glycosylated hemoglobin (HbA1c), oral glucose tolerance test (OGTT), c-peptide, and total number of hypoglycemic events and tolerability based on side effects.
Methods: INSPIRE Diabetes clinical trial was designed as a prospective randomized nonblinded intervention trial. Participants were patients with newly diagnosed T2DM adults with laboratory confirmation. Patients were randomized to standard care, ADA 2009 protocol, or intensive insulin treatment. For full protocol, refer to the clinicaltrials.gov identifier, NCT01087567.
Results: Interim analysis of INSPIRE Diabetes showed similar HbA1c values for both experimental (-3.1) and control arms (-3.0). Improvement persisted for in the first 9 months. During the intervention phase of the intensive-insulin arm, trends began to show a decline in HbA1c value. Results of OGTT estimated firstphase insulin release remained relatively unchanged. Second-phase insulin release in the insulin arm trended toward a better insulin response. Treatment arm also showed a significant decline in fasting glucose levels along with improved second-phase insulin release. Adverse events were limited in both groups and were similar. Rescue therapy was utilized by 3 intensive-insulin and 2 routine-care patients.
Conclusion: INSPIRE Diabetes interim analysis shows improvements in glycemic control and presents a new outpatient treatment hierarchy for diabetes care. INSPIRE Diabetes final results are expected to be analyzed in early 2013. Future directions include addition of inflammatory markers, expansion to other research sites, and other intensive treatment regimen that could produce similar effect.
♦ S12
Social, Societal, and Economic Burden of Mal de Debarquement Syndrome
Allison L. Macke, OMS II1; Andrew LePorte OMS I1; Brian Clark, PhD2
1Ohio University Heritage College of Osteopathic Medicine (OU-HCOM), Athens; 2Biomedical Sciences, OU-HCOM
Context: Mal de Debarquement syndrome (MdDS) is a disease of phantom perception of self-motion of currently unknown cause. Patients experience symptoms of rocking, bobbing, fatigue, cognitive slowing, and intolerance to visual motion.
Objectives: To describe the quality of life (QOL) of patients with MdDS and to estimate the economic costs associated with this disorder.
Hypothesis: We hypothesized that patients with MdDS would report low QOL and that the economic burden on an individual basis would be high.
Methods: We used one survey to assess the impact of MdDS on QOL and a separate survey to estimate the economic costs in 101 and 94 patients diagnosed with MdDS, respectively. All surveys were administered by means of the MdDS Balance Disorder Foundation website. The QOL survey was a modified version of a QOL survey used for another neurological disease (Multiple Sclerosis; MSQOL-54), and the economic costs were estimated based on self-reporting of direct and indirect costs using Medicare reimbursement payment rates for 2011.
Results: On average, patients with MdDS reported a poor overall QOL as indicated by a mean composite QOL score of 59.26 (out of 100). The subcategories having the lowest QOL rating were role limitations due to physical problems (18.32), energy (34.24), and role limitations due to emotional problems (36.30). Subcategories having the highest reported QOL were pain (67.64) and sexual function (64.36). Overall physical health composite score including balance was 49.40, and the overall mental health composite score was 52.40. On average, the total annual cost of MdDS medical care was $1708 which included diagnostic imaging and physician visits. Average wages lost per year was$21,444, making the total annual cost of the disease $23,152 per patient. Average cost of diagnosis was$3007, with an average of 19 doctor's visits before obtaining a diagnosis.
Conclusion: Mal de Debarquement syndrome negatively and dramatically impacts QOL, and also poses a substantial economic burden for MdDS patients. These findings underscore the need for further research into MdDS, particularly as it relates to determining the pathophysiologic origins of MdDS and eventually developing effective treatment interventions that can improve QOL and reduce the economic burden.
♦ S18
Salivary C-Reactive Protein and Adiponectin in Metabolic Syndrome
Izabela Robel, OMS III1; Maria Soukup, BS2; Edward G. Bridges, PhD2; Andrea M. Nazar, DO3; Kristie G. Bridges, PhD2
1West Virginia School of Osteopathic Medicine (WVSOM), Lewisburg; 2Biomedical Sciences, WVSOM; 3Clinical Sciences, WVSOM
Background: Type 2 diabetes mellitus and cardiovascular disease are among the leading causes of death in the United States and having metabolic syndrome (MBS) increases risk for both of these. Hypertension, dyslipidemia, elevated blood glucose, and central adiposity, all of which contribute to MBS, can be prevented by early screening and lifestyle modifications. We have shown that salivary uric acid levels are elevated in patients with MBS.
Objective: To determine if salivary C-reactive protein (CRP) and adiponectin levels are also altered in MBS and can be used as a noninvasive tools for monitoring cardiovascular and diabetes risk.
Hypothesis: Salivary CRP will be higher and salivary adiponectin will be lower in individuals with MBS.
Methods: Volunteers for the study were recruited after approval by the WVSOM Institutional Review Board. A medical history was obtained and individuals with conditions that could affect saliva content were excluded. Fasting saliva and blood samples, blood pressure, height, weight, and waist circumference were obtained for the remaining participants. Blood samples were analyzed for glucose and lipid content and MBS status was assessed using International Diabetes Federation criteria. Saliva samples were analyzed for uric acid, adiponectin, and CRP.
Results: A cohort of 70 volunteers completed the study. After uric acid determination, 40 saliva samples had sufficient volume remaining for adiponectin and CRP assays. Of the 40 individuals, 35% were determined to meet the criteria for MBS. Adiponectin was lower in individuals with MBS (655.6 pg/mL) than in those without MBS (2345.2 pg/mL) but the difference was not statistically significant (P=.067). There was no significant difference in salivary CRP between normal participants and those with MBS (96.4 pg/mL and 213.3 pg/mL respectively, P=.588). Adiponectin and CRP levels did not correlate to oral health status, salivary flow rate, serum triglycerides, glucose, or total cholesterol levels. There was a significant correlation between adiponectin and high-density lipoprotein cholesterol levels (r=0.336, P=.034) and obese patients (body mass index >30) had significantly lower salivary adiponectin (486.8 pg/mL) than nonobese individuals (2244.4 pg/mL, P=.008).
Conclusion: Salivary adiponectin is low in obese patients and correlates to serum high-density lipoprotein cholesterol levels. Additional studies exploring its usefulness in monitoring disease risk are needed.
⋄ ♦ S19
Intra-amniotic Gene Delivery of Irf6 to the Periderm Using an Adenoviral Vector
Youssef A. Kousa, MS, OMS IV; Brian C. Schutte, PhD
Michigan State University College of Osteopathic Medicine, East Lansing
According to the March of Dimes, cleft lip and palate (CLP) accounts for 4.7% of all congenital malformations, the fourth most common congenital anomaly. To study the pathogenesis of CLP, our lab developed a mouse model. While heterozygous Irf6 genetrap (gt) embryos did not demonstrate a cleft, Irf6 knockouts (Irf6gt/gt) showed severe craniofacial, skin, and limb anomalies, including a cleft palate with ubiquitous oral adhesions resulting in neonatal death. The presence of widespread oral adhesions and the absence of periderm in Irf6 deficient embryos suggest that at least 1 role of this superficial epithelium is to provide a “Teflon” coating for the palatal shelves as they grow and move inside the oral cavity. Thus, we hypothesize that Irf6 plays a role in palatal development by contributing to the maintenance of the periderm in the oral cavity. We propose to use an adenoviral vector to deliver Irf6 in-utero to oral periderm in knockout embryos, thereby rescuing superficial oral epithelium and reducing oral adhesions in Irf6 knockout embryos. To delineate the optimal dose and time point for intra-amniotic injection, I have conducted 7 surgeries and injected more than 60 experimental embryonic sacs with an adenovirus-LacZ vector. All pregnant mice survived the surgery and thrived in the days following until the embryos were collected, demonstrating feasibility of the procedure. Minimal fetal dysmorphology was observed only at earlier timepoint. Preliminary experiments done on E14.5 embryos were designed to replicate the work of Mitchell et al (2000) to ensure that both the surgical procedure and injections had the potential for successful transduction and minimal perturbation of embryonic development after injection. To determine the dose and timepoint most fitting my aim of oral gene delivery, 1 surgery was done on E12.5 embryos with harvest at E14.5 using 1 × 108 viral particles (8 embryos), 2 surgeries were done on E12.5 embryos with harvest at E13.5 using 3 × 109 viral particles (17 embryos) and 2 surgeries were done on E13.5 embryos with harvest at E14.5 using 3 × 109 viral particle (16 embryos total). Embryos injected at all timepoints demonstrated extensive LacZ expression. Beta-Gal staining was not observed in PBS-injected or uninjected controls. We observed Ad-LacZ transduction to superficial epithelium of the oral cavity. On the basis of these data, we concludde that surgeries done on E13.5 embryos with harvest at E14.5 using 3 × 109 viral particles provide the most robust transduction. However, oral adhesions can be observed at E13.5, indicating that an earlier surgical time-point might be necessary to rescue the adhesion phenotype. Low fetal dysmorphology and Beta-Gal staining in the periderm on E12.5-injected embryos suggest that vector delivery to superficial oral epithelium is feasible and can be optimized in future experiments.
S21
HPV Awareness, HPV Vaccine Uptake, and the Potential Impact of Physicians: A Cross-Sectional Community-Based Survey
Kyle Kjome, OMS II1; Lauren Christman, OMS II1; Melissa Deer, OMS II1; Rachel Reimer, PhD2
1Des Moines University College of Osteopathic Medicine (DMU-COM), Iowa; 2Public Health Department, DMU-COM
Background: Human papillomavirus (HPV) is the most common sexually transmitted infection (STI) in the United States. Human papillomavirus has been shown to be a prominent cause of nearly all cervical cancers and is also associated with some penile cancers (Rock et al, 2000; Schiffman et al, 1993; Palefsky, 2008). Because HPV is typically asymptomatic, it tends to be thought of as a benign infection. One study of primarily white heterosexual male college students revealed that participants ranked HPV as the least severe STI (McPartland et al, 2005).
Hypothesis: The goal of the current study is to examine the effects of ethnicity, age, and gender on HPV vaccine uptake, knowledge of HPV and the HPV vaccine, and willingness to receive the HPV vaccine based on physician recommendations.
Methods: A convenience sample of participants (n=458), aged 15 to 30 years, were recruited (June 2010 to July 2011) from local health care clinics. Each participant completed a cross-sectional survey. A series of ANCOVAs and logistic regressions were conducted to examine the effects of ethnicity, age, and sex on the key constructs described above.
Results: Thirty three percent of all participants reported never having heard of HPV prior to the study, with male participants being significantly less likely to have heard of HPV (F1,330= 14.17, P<.001). In addition, 25% didn't know if getting the HPV vaccine would be good for their health. However, younger participants were more likely agree that it would be. (There were no significant effects of ethnicity or sex.) Only 13% of participants had received the HPV vaccine. Logistic Regressions revealed a significant main effect of age (odds ratio [OR], 0.04; 95% confidence interval [CI], 0.01-0.19) and sex (OR, 0.84; 95% CI, 0.78-0.91), but no significant effect of ethnicity. Younger individuals and female participants were the most likely to have received the vaccine. Among those who were not vaccinated, most (54%) reported that they would be interested in the HPV vaccine if their doctor recommended it; there were no significant differences regarding ethnicity, age, or sex.
Conclusion: The results suggest that there is a lack of awareness of HPV and the HPV vaccine, mainly among men. The results also suggest that the physicians may play an influential role in vaccination uptake as most would agree to receive the vaccine if their doctor recommended it. The ability of medical professional to educate patients, particularly male participants, will not only affect male HPV vaccine uptake and acquisition, but also HPV transmission to others.
S23
Compliance as a Factor in a Placebo-Controlled, Double-Blind Trial of Saw Palmetto for Patients With Type 2 Diabetes
Anastasia Buerger, MS, OMS I1; James T. Martin, PhD1; Duc H. Nguyen, DO2; Joseph V. Davis, DO3; Niren A. Raval, DO4
1Western University of Health Sciences College of Osteopathic Medicine of the Pacific (WesternU/COMP), Pomona, California; 2Mommies and Me Medical Group, Pomona, California; 3Surgery, WesternU/COMP; 4Family Medicine, Arrowhead Regional Medical Center, Colton, California
Context: Type 2 diabetes mellitus (T2DM) affects multiple organ systems and is usually diagnosed by abnormally elevated blood glucose. Most efforts to find the cause of this disease focus on the metabolism and uptake of sugars. However, other biochemical realms are also abnormal. Women with T2DM have elevated serum testosterone and sex steroid binding globulin levels, whereas men have abnormally low testosterone. There is evidence that these hormone levels were abnormal prior to the onset of the disease. Excess perinatal androgen exposure in female mammals is known to increase adult body weight and dysregulate adult gonadal steroid production. Little attention has been paid to normalizing steroid action in patients with T2DM.
Objective: To test the hypothesis that reducing androgen action in females with T2DM would improve glycemic control, we conducted a clinical trial of Saw Palmetto (SP) extract, an anti-androgen therapy that has been successful in treating benign hypertrophy of the prostate and one that has a good safety profile.
Methods: The research design was a double-blind, placebo-controlled clinical trial in conjunction with the participants regular medication. A total of 118 participants of either sex were randomly assigned to receive 320 mg of SP or 500 mg of olive oil daily for 3 or 6 months. Inclusion criteria were glycosylated hemoglobin (HbA1c) values between 6.5 and 10 and no medication changes for 3 months prior to or during the study. Patients received bottles of 45 capsules at monthly visits and were asked to return the bottle with the remaining capsules at the next visit. Compliance of each participant was calculated by counting the absolute number of capsules returned over the length of their participation relative to the predicted capsule count expressed as a percent of perfect compliance. Participants were asked to keep a log of their daily fasting glucose, and HbA1c was measured at enrollment and again at 3 and 6 months.
Results: Compliance ranged from 53% to 100%. Participants whose compliance was above the median compliance score had significantly lower HbA1c levels at visit 3 than participants whose compliance below the median. At visit 3, neither sex receiving SP differed significantly from placebo in HbA1c. However, if only participants above the median compliance were compared, women showed a highly significant drop in HbA1c levels at both the third and final visit compared to participants receiving placebo. Men did not differ from placebo controls.
Conclusion: These data support the hypothesis that blocking androgens in female patients with T2DM can improve glycemic control.
S25
Juvenile Pilocytic Astrocytomas: A Preliminary Surveillance, Epidemiology, and End Results Database Study
Pooja Patel, OMS II1; Edward P. Finnerty, PhD2; David K. Strom, PhD2; Chris S. Karas, MD3
1Des Moines University College of Osteopathic Medicine (DMU-COM), Iowa; 2Physiology/Pharmacology, DMU-COM; 3Mercy Medical Center, Des Moines, Iowa
Background: Astrocytomas are the most common subgroup of central nervous system tumors in children. Of the 4 primary types of astrocytomas, juvenile pilocytic astrocytomas (JPAs) are considered low-grade and account for approximately 20% of all brain tumors in children younger than 15 years. The primary therapy for JPAs is gross total resection (GTR). Studies have shown that GTR reduces tumor burden, provides tissue diagnosis, permits management of increased intracranial pressure, prevents irreversible neurologic deficits, decompresses adjacent brain structures, and controls seizures. Because of the excellent outcomes following GTR, chemotherapy and radiation therapy are generally not indicated. Despite this indication, many researchers have focused on adjuvant chemotherapy and radiotherapy to control the progression of the tumor and assess their optimal therapeutic effect and toxicity after GTR.
Hypothesis: The goal of this preliminary study is to determine if advancements over time in treatment strategies have improved overall 5-year survival among various age groups for male and female patients.
Methods: A total of 1244 male and female patients, aged 1 to 19 years, diagnosed with JPAs from 1973-2002, were analyzed using the Surveillance, Epidemiology, and End Results database (SEER 17 Registry). Groups were divided by year of diagnosis (1973-1982, 1983-1992, 1993-2002), age (1-4, 5-9, 10-14, 15-19 years), treatment (none = surgery alone and radiation), and gender (male and female). The 5-year survival was recorded and the probability of survival and relative risks were calculated for each group.
Results: An overall upward trend was seen in the probability of survival from 1973-2002 with a significant increased survival in the 1993-2002 period (RR=1.091; 95% CI, 1.0-1.19) particularly in the surgery-alone treatment group. There were no discernible differences in the survival by age group or gender. Interestingly, radiation treatment showed a decreased survival relative to the surgery-alone treatment (RR=0.9222; 95% CI, 0.88-0.97).
Conclusions: Juvenile pilocytic astrocytoma is a relatively common childhood CNS tumor with a very high 5-year survival rate. There are no observed differences in the survival by age or gender. While the 5-year survival does show an increase over time for the surgery-alone treatment, the radiation treatment actually shows a diminished survival rate in the 1993-2002 period. Further study of this observation is warranted.
⋄ S32
Growth and Nutritional Status of Peruvian Children
Shane Sergent, OMS II1; Michael J. Burla, OMS III1; Rochelle Hughes, OMS II1; Gary Willyerd, DO2; Christina Dokter, PhD1; Joe Eisenmann, PhD1; Melissa Hart, OMS II1
1Michigan State University College of Osteopathic Medicine (MSUCOM), East Lansing; 2MSUCOM, Detroit
Context: The basis for this study is to examine anthropometric values, body mass index (BMI) and body fat percentage of children aged 2 to 18 years in the city of Huamachuco, Peru. Research findings from a Medical Service Elective in 2010 showed that there was a significant amount of children that were obese and overweight in Huamachuco when measured against the Centers for Disease Control and Prevention (CDC) standards (Sergent et al, 2010). In August 2011, Michigan State University College of Osteopathic Medicine returned to Huamachuco for another Medical Service Elective. Further data were collected to better discern the anthropometric values, BMI, and body fat percentage.
Hypothesis: Based on the factors examined, there could be indicators for BMI or body fat percentage deviating from the normal standards set by the CDC. Poor diet, poor sleeping patterns, and poor nutritional education may be affecting these values.
Methods: Data were collected in a clinical setting from children aged 2 to 18 years. The biometric factors included height, weight, BMI, body fat percentage, and waist and arm circumference.
Results: Based on CDC standards, 26% (n=178) of the children were considered obese or overweight.
Conclusion: This percentage is significantly lower than the number in 2010, which was 42.7% (n=325). The deviation in percentages could be the result of a lacking sample size in 2011. Regardless, the results still show a trend toward children's obesity and overweight in Huamachuco, Peru.
S33
TAKE ACTION 3: A Long-Term Follow-Up to Previous Healthy Lifestyle Interventions
Michelle R. Crane, OMS II1; Joseph Bianco, PhD2; Jay H. Shubrook, Jr, DO2
1Ohio University Heritage College of Osteopathic Medicine (OU-HCOM), Athens; 2Family Medicine, OU-HCOM
Context: Long-term maintenance of healthy lifestyle behaviors is difficult. TAKE ACTION (TA) 1 & 2 utilized a multidisciplinary team to help address behavior change in at-risk children and their families. Even in intervention programs, change is often limited to the duration of intervention.
Hypothesis: We hypothesized that the benefits from TA 1 & 2 would diminish over time. TA 3 aimed to understand what aspects of these healthy lifestyle programs endured in the long term, elicit the health attitudes that may impede healthy lifestyle maintenance, and identify the interventions and activities that participants found most helpful.
Methods: Participants were children (n=9) and parents (n=8) who participated in TA 1 & 2. This study measured anthropomorphic (body mass index, waist to hip ratio, percentage body fat) and physiologic (glucose, glycosylated hemoglobin, lipid panel, urine microalbumin) data. Psychosocial questionnaires were administered, including exercise and nutrition stage of change scales. Finally, participants underwent a semi-structured interview regarding their experience in the program.
Results: All of the anthropomorphic and physiologic outcomes worsened over time. Stage of change questionnaire results reveal children were most often in action for exercise, but preparation for nutrition; adults were most often in action for nutrition and preparation for exercise. Only 25% of both children and adults were in maintenance for either behavior. Interview responses highlighted the value of social support and access to exercise in the program, while identifying time constraints, lack of physical fitness, and fatigue as barriers to behavior change or maintenance.
Conclusion: There was no long-term benefit in physiological measures from participation in TA 1 & 2. Most participants were in action phase for 1 health behavior, but few were in maintenance. However, participants describe positive attitudes toward health and wellness in interviews and health-related questionnaires. This mismatch will be explored in this presentation.
Basic Science
♦ S3
Optimal Vascular Conduits for Multiple Coronary Artery Bypass Grafting
Tova Appleson, OMS IV1; Robert V. Hill, PhD2
1New York College of Osteopathic Medicine of New York Institute of Technology (NYCOM), Old Westbury; 2Department of Anatomy, NYCOM
Despite increasing usage of stents and medication to manage coronary artery disease numerous cases are still managed surgically, using coronary artery bypass grafts (CABG). This study investigated the histomorphometric qualities of the posterior interventricular artery (PIV), and compared it to 5 arteries in order to determine the best potential candidate for CABG. We dissected specimens of each vessel from human cadavers and then histologically sectioned representative samples. Using light microscopy and digital image analysis of H&E and Von Gieson's-stained slides, we examined the following aspects of the candidate vessels: luminal diameter, arterial wall thickness, and relative proportion of muscular and elastic fibers. Results from the study indicate that the inferior epigastric artery (IEA) exhibits the greatest similarities to the PIV in all qualities studied. When performing CABG that involves blockage of the PIV, surgeons should be aware of the marked similarity of the IEA and consider this vessel as a graft instead of internal mammary arteries or saphenous veins. Although patient-specific details, patient history, and surgical counterindications must also be taken into account, the IEA provides the optimal bypass graft for the PIV.
S8
Plastic Additives Decrease Myotube Formation and Agrin-Induced AChR Clustering in C2C12 Skeletal Muscle Cell Culture
Kelsey S. Neufeld, OMS III1; Wade A. Grow, PhD2
1Midwestern University/Arizona College of Osteopathic Medicine (MWU/AZCOM), Glendale; 2Department of Anatomy, MWU/AZCOM
Common additives in plastics, such as bisphenol A (BPA) or phthalates like di-(2-ethylhexyl) phthalate (DEHP) are environmental estrogens that have been shown to be endocrine disruptors in some experimental animal models. Our current project examines the effect of plastic additives on skeletal muscle development. Our objective was to investigate 2 aspects of skeletal muscle development after exposure to BPA or DEHP using the C2C12 cell culture model: (1) myoblast fusion into myotubes, and (2) clustering of acetylcholine receptors (AChRs). When C2C12 myoblasts proliferate and reach 80% density, growth medium is replaced with differentiation medium. Subsequently, myoblasts fuse into myotubes within 72 hours. During myotube formation, AChRs cluster spontaneously, and can be visualized with fluorescence microscopy by using rhodamine bungarotoxin. Treatment with motor neuron derived agrin increases the frequency of AChR clusters through an agrin-signaling pathway that also clusters other postsynaptic components of the neuromuscular synapse. Many labs have examined normal myotube formation and AChR clustering in C2C12 cell culture. For the current project, we exposed C2C12 myoblasts or myotubes to various concentrations of BPA or DEHP. At concentrations as low as 10 mM BPA or 100 mM DEHP we observed a higher ratio of myoblasts to myotubes after 72 hours in differentiation medium, suggesting a reduction in the fusion of myoblasts into myotubes. In addition, we determined that 10 mM BPA or 100 mM DEHP reduced the frequency of agrin-induced AChR clustering. We conclude that plastic additives like BPA and DEHP may pose a risk for skeletal muscle development in humans.
⋄ S9
Study of Neuronal Sensitivity to Oxygen Glucose Deprivation in a Transgenic Mouse Model of Alzheimer Disease
Rung-chi Li, PhD, OMS III; Jennifer O. Mytar, OMS II; G. Joey Broussard, BS; Scott Drew, OMS I; Thuan-Thien Ho, OMS I; Gloria J. Klapstein, PhD
Touro University California, College of Osteopathic Medicine, Vallejo
Context: Accumulating evidence has demonstrated a strong link between risk factors for cardiovascular and for Alzheimer disease (AD). Recent studies suggest that vascular effects (such as vascular reactivity and inflammation) may play an important role in AD pathophysiologic progression, rather than a simply direct effect on neuronal sensitivity to ischemia. However, it is challenging to completely separate the vascular and neurologic system and independently to investigate the importance of each system in the AD pathology.
Hypothesis: We proposed here to use an acute brain slice preparation to directly examine neuronal synaptic properties under controlled conditions by removing the need for the vascular system for delivery of oxygen and glucose. This method avoids the variable and confounding effects of amyloid on vascular dysfunction. Therefore, using oxygen glucose deprivation, we can investigate whether ischemic neuronal damage in a triple transgenic mouse model of AD is due to intrinsic neuronal sensitivity to ischemia or has contributions from vascular dysfunction.
Methods: Ischemic damage was modeled using oxygen-glucose deprivation (OGD; an in vitro global cerebral ischemia model) in brain slices from mice with an APP/PS1/tau triple gene mutation, an aggressive model of AD. These mice develop amyloid plaques at about age 2 to 3 months, and behavioral memory deficits are well established by age 6 months.
Results: Our results have demonstrated a significantly higher maximum recovery rate after OGD for 7.5 minutes in 3.5-month-old AD mice compared to the wild-type cohorts. More interestingly, 8-month-old AD mice group subjected to 5 minutes OGD showed a similar trend, compared to age-matched wild-type cohorts. The hippocampal slices from transgenic mice show less sensitivity to OGD, indicating that the sensitivity seen in AD mice subject to vascular-occlusion models of ischemia may be due primarily to vascular factors rather than intrinsic neuronal sensitivity.
Conclusion: The observed changes in electrophysiologic responses to OGD may reflect compensatory mechanisms in response to disease state similar to those seen in classic models of ischemic preconditioning. Such compensations may confer direct neuronal protection against stressors such as ischemia without improving vascular deficiencies that might lead to chronic hypoperfusion of AD brains. The current findings provide a new understanding of the close relationship between neuronal and vascular contributions to AD.
S11
Filopodial and Lamellipodial Interaction in Axon Guidance and Growth Cone Directionality
Fayha Lakhani, OMS I; Tamira Elul, PhD
Touro University California, College of Osteopathic Medicine, Vallejo
Context: Axon development relies on the pathfinding abilities of the growth cone, which is a dynamic structure at the tip of the growing axon. The route that the growth cone takes involves steering maneuvers via signaling pathways at the growth cone cytoskeleton. The interactions between microtubules and actin filaments, which make up filopodia and lamellipodia, are important for axon growth and growth cone turning.
Objective: Here, we examined the relationship between filopodia and lamellipodia in growth cone pathfinding and motility.
Methods: We used an in vivo time-lapse video of retinotectal axon pathfinding in Xenopus Laevis made by Sonia Witte, Cambridge University, to quantify the interaction between filopodia and lamellipodia and growth cone directionality. We measured the length/width of the growth cone to determine the relationship between filopodia and lamellipodia. In addition, we measured the angle of the axon as it developed to determine the correlation of directionality with filopodia or lamellipodia.
Results: Our observations and measurements of length/width ratio for growth cones indicate that there is an antagonistic relationship between filopodia and lamellipodia. As a filopodia protrudes out from the growth cone, a lamellipodia retracts. Also, the growth cone spends different amounts of time in filopodial or lamellipodial morphology. Specifically, we found that the growth cone spends more time in the lamellipodial morphology than the filopodial morphology. Additional observations show that there is a bias in direction of both filopodial and lamellipodial extension that correlates with the direction of the growth cone motility.
Conclusion: The interaction of filopodia and lamellipodia allows the growth cone to progress and reach its target. Filopodia likely respond to guidance cues by stabilizing when they encounter an attractive guidance molecule or by retracting on contact with a repellent guidance molecule. The intracellular cues sensed by the filopodia facilitate the directionality of the growth cone. Lamellipodia appear to be the actual motor portion of the cell that then acts to pull the cell forward during the process of axon migration. These data provide basic kinematic measurements of optic axonal growth cone motility in vivo for future studies involving molecular and biomechanical perturbations.
S14
Osteopontin-Induced Inhibition of DC Polarization Toward pDC Is Enhanced in the Presence of RSV Infection
Brooks Beal, MS, OMS I; Kainath Durre, MS; Mahboob Qureshi, MD, PhD
Touro University Nevada College of Osteopathic Medicine, Henderson
Background: Respiratory syncytial virus (RSV) bronchiolitis and pneumonia during early infancy is associated with increased susceptibility to asthma. Our studies have shown skewed polarization of plasmacytoid DC (pDC) and decreased osteopontin (OPN) production as well as an increased NKT cell response in the RSV-infected neonatal lungs. The current study examined the effect of exogenous OPN administration on DC polarization in the RSV-infected neonatal lungs.
Hypothesis: RSV-infection-induced immunomodulation augments the inhibitory effects of OPN on the skewed polarization of lung DCs towards pDC.
Methods: Wild type (WT) and NKT cell knock out (CD1d-/-) mice were infected with RSV and were treated with or without intranasal OPN. Control groups received PBS. Mice were euthanized on designated time points and the NKT cells as well as the pDC and mDC populations were determined by flow cytometry. In addition, T cell and macrophage responses were also examined. Production of IFN-γ and IL-10 was measured in the lung lavage fluid by ELISA. In addition, effect of OPN administration on RSV-induced inflammation was examined by histologic analysis of lung tissues.
Results: Flow cytometry revealed a decreased NKT cell response to RSV infection in the neonatal lungs upon administration of OPN as compared to those without OPN. OPN treatment induced inhibition of DC polarization towards pDC even in the absence of NKT cells (CD1d-/- mice). This was associated with an enhanced activation of T lymphocytes, macrophages recruitment and production of IFN-γ in neonatal lungs. To note, the effect of OPN on inhibition of DC polarization towards pDC was most efficient in the presence of RSV infection, compared to those without infection.
Conclusion: OPN modulated the immune responses to RSV infection in neonatal lungs. In addition, a consistent observation was that of the downregulation of DC polarization towards pDC by osteopontin was most efficient in the presence of RSV infection. Understanding the underlying mechanism of this finding would be instrumental in explaining the differential responses of neonates and adults to RSV as well as development of hyper-responsive airway and susceptibility to asthma in individuals previously infected with RSV.
S15
Osteopontin Enhances MHCII Expression on RSV-Infected Lung Antigen Presenting Cells in an NKT-Dependent Mechanism
Sherman Wu, MBA, OMS II; Nicole Pietras, MS, OMS II; Brooks Beal, MS, OMS I; Kainath Durre, MS; Mahboob Qureshi, MD, PhD
Touro University Nevada College of Osteopathic Medicine, Henderson
Background: Respiratory syncytial virus (RSV) bronchiolitis and pneumonia are associated with increased susceptibility to asthma. We showed that skewed polarization of DC towards plasmacytoid DC (pDC) in the pups in response to RSV is inhibited by exogenous administration of osteopontin (OPN). This was associated with a shift towards Th1 immune response, which was enhanced in presence of natural killer T (NKT) cells. This may indicate that OPN administration induced enhanced antigen presentation ability of the lung antigen presenting cells (APC), including macrophages (MQs) and DCs, in an NKT-dependent mechanism.
Hypothesis: Osteopontin enhances MHCII expression on the antigen presenting cells (APC) in the RSV-infected lungs to enhance their antigen presenting ability in an NKT cell-dependent mechanism.
Design: Wild type (WT) and NKT knock out (NKT-/-) pups were infected with RSV and were treated with or without OPN. Expression of MHCII on the lung APCs, including MQs and DCs (pDC and myeloid DC [mDC]), was determined by flow cytometry (FACS). A comparative analysis was done to understand the effect of OPN on MHCII expression in presence or absence of NKT cells.
Methods: Five-day-old WT and NKT-/- pups were intranasally infected with RSV. RSV-infected pups were treated with intranasal OPN since the day before infection until day 7 after infection. Lungs were collected 15 days after infection, and the expression of MHCII on MQ (CD11bhi), pDC (CD11blo/-CD11Clo/-CD45Rhi) and mDC (CD11blo/-CD11ChiCD45Rlo/-) was determined by FACS.
Results: Expression of MHCII was higher on the pDCs than mDCs in the RSV-infected WT lungs. In the absence of NKT cells, MHCII expression on pDCs was increased. OPN treatment augmented expression of MHCII on MQ and DCs, which was further enhanced in the absence of NKT cells.
Conclusion: Osteopontin enhances MHCII expression on the lung APCs, thus influencing the antigen presenting ability. In addition, NKT cells play an important role in dictating the outcome of OPN treatment. Further experiments are required to explore the underlying mechanism of this phenomenon, which may help develop a therapeutic strategy to stop skewed polarization of DC in RSV infected lungs in preventing susceptibility to asthma.
S16
Patients With Mal de Debarquement Syndrome Exhibit Heightened Corticospinal Excitability
Mark T. Rose, MA, OMS II1; Andrew D. LePorte, OMS I1; Richard L. Hoffman, MS2; Adam Quick, MD3; Brian C. Clark, PhD2
1Ohio Musculoskeletal and Neurological Institute, Ohio University Heritage College of Osteopathic Medicine (OU-HCOM), Athens; 2Ohio Musculoskeletal and Neurological Institute, Department of Biomedical Sciences, OU-HCOM; 3Department of Neurology, Ohio State University College of Medicine, Columbus
Context: Mal de Debarquement syndrome (MdDS) is a disorder of perceived motion most often occurring following passive motion. Presently, there have been no systematic research studies on MdDS, and as such the etiology is poorly understood.
Purpose: We sought to understand how the corticospinal system of patients with persistent MdDS differed from age- and sex-matched controls.
Hypothesis: Based on our recent case study (Clark and Quick, J Neurology, 2011), we hypothesized that patients with MdDS would exhibit heightened corticospinal excitability.
Methods: Single pulse transcranial magnetic stimulation (TMS) was used to measure motor evoked potentials (MEP) from the flexor carpi radialis (FCR) muscle in 10 patients with persistent MdDS (9 females, 1 male; 49.2±15.6 years) and age- and sex-matched controls (9 females, 1 male; 45.0±14.2 years). MEP amplitudes were quantified in response to TMS under differing state-dependent conditions. Transcutaneous electrical stimulation was used to elicit the maximal compound muscle fiber action potential (Mmax), and the MEPs were normalized to Mmax.
Results: MEP amplitudes were significantly higher in MdDS cases compared to controls when the TMS stimulus was applied at rest with eyes open (12.6±8.5 vs 5.6±4.3 %), at rest with eyes closed (12.1±7.3 vs 5.5±3.6%), and when vibration was applied to the FCR (17.4±10.2 vs 7.5±4.2%). Differences in MEP amplitude were not observed during cognitive loading or during a sub-maximal wrist flexion contraction.
Conclusion: These findings suggest that patients with MdDS have heightened corticospinal excitability relative to controls. This work is significant, as it provides insight on the pathophysiology of MdDS and will help guide future work on this rare condition.
S17
Altered Interhemispheric Inhibition in Mal de Debarquement Syndrome
Shawn C. Clark, OMS II1; Brian C. Clark, PhD2
1Ohio Musculoskeletal and Neurological Institute, Ohio University Heritage College of Osteopathic Medicine (OU-HCOM), Athens; 2Department of Biomedical Sciences, OU-HCOM
Context: Mal de Debarquement syndrome (MdDS) is a neurologic disorder that occurs when habituation to passive background movement becomes resistant to readaptation to stable conditions. This results in a phantom perception of motion which typically disappears quickly after return to stable ground; however, in rare instances the symptoms may persist for months to years (persistent MdDS). The pathophysiology of MdDS is poorly understood, but it appears to be a disorder of neuroplasticity and sensory arrangement.
Objective: To explore whether impaired interhemispheric inhibition (IHI) is a possible pathophysiologic mechanism(s) for persistent MdDS. We hypothesized that patients with MdDS would exhibit a longer ipsilateral silent period (iSP) in comparison to healthy control participants.
Methods: We used single pulse transcranial magnetic stimulation (TMS) on the hand area of the left motor cortex (M1) to elicit an iSP during a sustained contraction of the left flexor carpi radialis (FCR) muscle. This procedure was performed on 7 patients with persistent MdDS as well as 7 age- and sex-matched controls. Surface electromyography was used to measure the response to the M1 TMS pulse in the left FCR muscle.
Results: iSP durations were approximately 45% longer in MdDS cases compared to controls (23.39±2.26 vs 16.28±1.45 ms; P=.02). Difference in iSP latency were not observed between groups (27.14±2.54 vs 27.18±2.17 ms; P=.99).
Conclusion: These findings suggest that MdDS patients have heightened levels of IHI when compared to age- and sex-matched controls. This provides insight into the possible pathophysiologic mechanism(s) of persistent MdDS which will ultimately assist in optimizing both detection protocols and treatments for this rare disorder.
S20
A Rat Model of Ankle Injury to Test Efficacy of Manual Treatment for Pain Relief
Bart D. Worthington, MS, OMS III1; Rachel L. Ruhlen, PhD2; Eric J. Snider, DO3; Jane C. Johnson, MA2; Vineet K. Singh, PhD4; Neil J. Sargentini, PhD4
1A.T. Still University of Health Sciences-Kirksville College of Osteopathic Medicine (ATSU-KCOM), Missouri; 2A.T. Still University Research Institute, ATSU-KCOM; 3Neurobehavioral Sciences, ATSU-KCOM; 4Microbiology/Immunology, ATSU-KCOM
Objective: Our goal was to develop a rat model of acute nociceptive pain in the ankle.
Hypothesis: We hypothesized that manual treatment (MT) would reduce injection-induced ankle pain resulting in improved daily voluntary running, via the central nervous system (CNS).
Design: Ankle inflammation was induced by injecting carrageenan into the joint. Treatments were performed 12 and 36 hours later. Rats were given ad lib access to activity wheels, and voluntary running behavior was measured. To examine the role of the CNS in mediating the effects of MT on pain, we collected spinal cords in a subset of rats immediately after MT, and analyzed differential gene expression with microarrays.
Methods: Rats were allowed to run for 3 days prior to ankle injection to establish baseline running (n=53). Roughly 12 hours after injection, MT or no touch control (NT) was applied to the ipsilateral knee joint. MT was applied by flexing and extending the knee joint to its end range of extension, while the tibia was simultaneously translated in an anterior-to-posterior direction using grade III and IV mobilization forces. Running was recorded for 6 days after the last MT. Differential gene expression was identified using genome-wide microarrays with RNA isolated from spinal cord (n=3).
Results: Running distance diminished dramatically after carrageenan injection (91% reduction in number of revolutions per day, P<.01). Several variations on the MT protocol were examined (eg, tibial extension, effleurage), and no difference was observed between MT and NT groups. However, over 80 genes were upregulated in the spinal cord by more than a 2-fold increase in MT rats versus NT rats. In addition, joint stiffness was reduced immediately and 24 hours after MT.
Conclusion: The advantage of voluntary running over other measurements of pain is that it is a functional endpoint. However, rats compensate for an injured limb by transferring weight to other limbs. Thus, relieving pain in the injured limb did not yield a measureable increase in running distance. The observation of differential gene regulation in MT vs NT rats suggests that MT may have observable effects on a different endpoint or in another model. Specifically, we have observed a reduction in joint stiffness after MT, and are in the process of determining how to quantify this.
Acknowledgment: Funding from American Osteopathic Association 09-04-597 and ATSU Strategic Research Fund 501-320 grants to N.J.S. (primary investigator).
S22
Relationship Between Speed and Foot Strike Pattern During Barefoot, Simulated Barefoot, and Shod Running
William H. Fredericks, OMS III1; Madeline B. Teisberg, MS, OMS II1; Robert Lee2; Lance Ridpath, MS3; Jandy Hanna, PhD2
1West Virginia School of Osteopathic Medicine (WVSOM), Lewisburg, West Virginia; 2Biomedical Sciences, WVSOM; 3Assessment and Educational Development, WVSOM
Context: As barefoot running becomes increasingly popular, physicians will advise patients about healthy shoe choices. Foot landing style appears to vary across shod conditions (eg, Lieberman et al, 2010); barefoot runners land on their forefoot, while shod runners land on their rearfoot. These barefoot runners, however, ran at faster speeds. It has been shown that as speed increases, shod runners start to land on their forefoot (Kellar et al, 1996). Thus, speed may affect footfall style across shod conditions, which may confound interpretations of published literature.
Objectives: We sought: (1) to determine the effects of speed on footfall in barefoot (and simulated-barefoot runners), (2) to compare footfalls at given speeds for various shod conditions, and (3) to evaluate habitual shoe-wear choice affect on footfall style.
Methods: Over 4 visits, participants ran at 6 different speeds using: (1) personal shoes (P), (2) standardized shoes (S), (3) bare feet (B), and (4) Vibrams (Concord, Massachusetts) (V). Using video records, 10 footfall events at each speed were categorized as rearfoot or mid/forefoot. Footfall distributions and a nominal logistic model, with speed and shod conditions as effects, were calculated.
Results: Six male and 8 female participants were analyzed (n=1620). Sex had no significant effect on footfall and were pooled for all analyses. Footfall tended to vary with speed, but not significantly (P=.1031). Shod condition predicted footfall (P<.0001). Footfall distributions did not vary between P and S, but all other shod conditions exhibited different distributions (P<.0001). Despite a higher percentage of forefoot landing in B and V running, the majority of footfalls were rearfoot for all treatments.
Conclusion: These data show a direct relationship between footfall and shod condition during running, even during first use of different shoe types. Thus, physicians should counsel patients that they may expect to change landing style if switching shoe type and that their running experience may change based on their shoe wear choice. Future studies should further examine the effects, if any, of speed, and they should provide a longer prospective study of the effects of shod conditions. Finally, kinematic and kinetic data should be compared across these groups for a fuller understanding of the effects of shoe wear choice on a patient's body.
Acknowledgments: All procedures were approved by the WVSOM IRB (protocol #JH05102011). Supported by WVSOM intramural program and Vibram.
♦ S24
Role of Cathepsin Proteases and Niemann-Pick C1 Protein in Ebola Virus Infection
Bryden Considine, OMS II1; John Misasi, MD2; Marceline Cote, PhD3; Anna Bruchez, BS3; James Cunningham, MD3
1University of New England College of Osteopathic Medicine, Biddeford, Maine; 2Children's Hospital Boston, Brigham & Women's Hospital, Boston, Massachusetts; 3Brigham & Women's Hospital
Background: Ebolavirus (EboV) particles express mushroom-shaped glycoproteins (GP) that protrude from the surface membrane and mediate attachment and infection of target cells. Previous studies indicate that infection is triggered when GP is cleaved by endosomal cysteine proteases (cathepsins) to remove the cap and expose the stalk that binds to the endosome membrane protein Niemann-Pick C1 (NPC1). Previous studies identified EboV strain-dependent differences in utilization of the endopeptidase cathepsin L (Cat L) and the exopeptidase cathepsin B (Cat B) for infection.
Hypothesis: Virus-specific requirements for Cat L and/or Cat B for infection reflect requirements for cleavage of GP to expose binding site for binding to receptor NPC1.
Methods: Virus particles and recombinant GPs from EboV Zaire, Sudan, CI, Reston and Marburg viruses were prepared and incubated with the protease thermolysin (THL), which mimics digestion with Cat B or with chymotrysin, which mimics digestion with Cat L during infection. Effect of cleavage was then determined by immunoblot, NPC1 binding and infection.
Results: The results confirm that infection by all strains of EboV are dependent on cathepsin protease activity and NPC1 expression in host cells. In addition, they confirm that virus GP is a target for cleavage by cathepsin proteases. They identify virus GP-specific differences in relative dependence on Cat L and Cat B for infection. Moreover, they suggest that virus preference for Cat L or Cat B during infection may be correlated with cleavage of GP1 subunit from native 35 kDa to 17-18 kDa intermediate that is the ligand for NPC1 receptor.
Conclusion: Our findings support a 2-step model of infection in which EboV particles are taken up into endosomes and transported to late endosome/lysosomes containing cathepsin proteases and NPC1. In these membrane compartments, EboV GP is cleaved by specific cathepsins—either Cat L and/or Cat B—to expose the domain in GP that is the ligand for NPC1 and binding to NPC1 activates the virus fusion machinery. This sequential 2-step mechanism of infection is analogous to human immunodeficiency infection, which is dependent on virus binding to CD4 and co-receptor. These findings indicate that cathepsin proteases and NPC1 are EboV host factors and potential targets for anti-viral agents.
S26
SIRT1 Activators Decrease Reperfusion Injury in Cardiomyocytes
Hans R. Watson, OMS IV1; Jennalee Gaiser, OMS I2; Bethany Hampton, BS3; Judith A. Maloney, PhD3
1West Virginia School of Osteopathic Medicine (WVSOM), Lewisburg; 2WVSOM, North Tonawanda, New York; 3Biomedical Sciences, WVSOM, Lewisburg
Background: Recovery of cardiomyocytes following periods of ischemia depends upon adequate reperfusion. However, reperfusion causes further damage known as reperfusion injury. One consequence of ischemia/reperfusion (IR) is apoptosis due to reperfusion generated free radical damage. Resveratrol, a compound found in red wine, is known to have anti-aging, antioxidant, and more importantly, cardioprotective effects. It has been shown to work via several downstream targets, a major target being silent information regulator 1 (SIRT1), a type III, NAD-dependent histone deacetylase (HDAC). However, the involvement of SIRT1 in the cardioprotective effect of resveratrol is still not clear. Therefore, we investigated the effect of selective SIRT1 activators, Cay105691and DCHC, on IR injury in HL-1 cardiomyocytes.
Hypothesis: SIRT1 activating drugs decrease IR-induced apoptosis in cardiomyocytes potentially causing a protective effect post-myocardial infarction (MI).
Methods: HL-1 cardiomyocytes received 2 hours of simulated ischemia followed by 6 hours of simulated reperfusion. During reperfusion, cells were treated with either 10 mM resveratrol, 50 mM DCHC, 20 mM CAY10591 or vehicle control. At the completion of reperfusion, apoptosis was determined by measuring caspase 3 activity.
Results: Two hours of ischemia alone did not activate caspase 3. In contrast, ischemia followed by 6 hours of reperfusion induced apoptosis as measured by an increase in caspase 3 activity (0.056±0.010 vs 0.197±0.026 pmol/min/mg protein, P<.05). While the specific SIRT1 activators, Cay10591 and DCHC reduced IR-induced caspase 3 activity (0.197±0.026 pmol/min/mg protein vs 0.138±0.021 pmol/min/mg protein (P<.05) and 0.111±0.017 pmol/min/mg protein (P<.05), respectively), 10 mM resveratrol had no effect on IR-induced apoptosis. In contrast there was no effect of resveratrol, Cay10591 or DCHC on caspase 3 activity in the absence of ischemia.
Conclusion: In HL-1 cardiomyocytes, DCHC and Cay10591 significantly decreased IR-induced apoptosis. Since reperfusion therapy is important for limiting cardiac morbidity post-MI, but can, paradoxically, cause additional damage, one approach to limit this damage is by concurrently administering a SIRT1 activating drug. This has the potential to reduce reperfusion injury and thereby decrease total cardiac injury.
Acknowledgment: This research was funded by a WVSOM intramural grant.
S28
Antioxidant Therapy in the Treatment of Ischemia-Reperfusion Injury of Cardiac Myocytes
William Jackson, OMS II1; Bethany Hampton, BS2; Judith A. Maloney, PhD2
1West Virginia School of Osteopathic Medicine (WVSOM), Lewisburg; 2Biomedical Sciences, WVSOM
Context: The ischemia that occurs during a myocardial infarction can cause cell damage and death. Therefore, restoring blood flow is critical for limiting morbidity and mortality. However, reperfusion can cause additional injury due to an oxidative burst, which activates cellular necrotic and apoptotic pathways. Antioxidants can reduce reactive oxygen species and be cardioprotective, yet a delicate balance exists between the levels of oxidants and antioxidants, with high antioxidant levels potentially increasing cell damage.
Hypothesis: Our hypothesis was that while the administration of a low dose of select antioxidants can diminish cellular damage due to the oxidative burst during reperfusion, high levels of antioxidants are not cardioprotective and can possibly be cardiotoxic.
Methods: HL-1 cardiac myocytes received 2 hours of simulated ischemia followed by 6 hours of simulated reperfusion. During both ischemia and reperfusion, cells were treated with 500 μM N-acetyl-L-cysteine (NAC), 1 μM Trolox (a vitamin E analog), 50 μM epigallocatechin gallate (EGCG, an antioxidant in green tea), 50 μM ascorbic acid, a combination of all 4 drugs, or vehicle control. At the end of reperfusion, apoptosis was determined by measuring caspase 3 activity. Similar experiments were performed with increasing doses of NAC from 500 μM to 50 mM.
Results: Two hours of ischemia did not activate caspase 3. However, ischemia followed by reperfusion induced apoptosis, as measured by an increase in caspase 3 activity (P<.05). Increasing doses of NAC augmented IR-induced caspase 3 activity (P<.05). In contrast, low doses of NAC, EGCG, Trolox and ascorbic acid showed a trend towards reducing IR-induced caspase 3 activity, which was negated with the combination of all 4 antioxidants.
Conclusion: While the potential for using antioxidants, especially natural antioxidants, to prevent cardiovascular disease has attracted enormous interest, this has not always been successful. In HL-1 cells, low doses of a single antioxidant appear to be cardioprotective, but increasing antioxidant activity, either with a high dose of NAC, or a combination of several antioxidants, might have deleterious effects. Hence, judicious use of antioxidant therapy, albeit a single agent or combinations of agents, may be beneficial in preventing IR injury in the heart.
Acknowledgment: This research was funded by a WVSOM intramural grant.
S29
Cardiovascular Assessment of Peruvian Children With PACER Fitness Test
Rochelle A. Hughes, OMS II; Gary Willyerd, DO; Joe Eisenmann, PhD; Christina Dokter, PhD; Michael Burla, OMS II; Shane R. Sergent, OMS III; Melissa Hart, OMS II
Michigan State University College of Osteopathic Medicine, East Lansing, Michigan
Background: The purpose of this study was to determine the cardiovascular health of local children and determine protocol for the Progressive Aerobic Cardiovascular Endurance Run (PACER). PACER is a standard multistage 20-m run test used to determine cardiovascular health of children. In 2010, during a medical service elective in Huamachuco, Peru, S.R.S. and other medical students found 17.5% of children to be obese and 31.7% as overweight, according to the World Health Organization classifications.
Objective: In August 2011, Michigan State University College of Osteopathic Medicine returned to Huamachuco, Peru, for a Medical Service Elective to conduct a follow-up study.
Hypothesis: We hypothesized that if the children continue to be overweight and obese, then they will be classified as unfit according to the PACER test standards.
Methods: PACER classifies participants as fit or unfit according to FITNESSGRAM standards. Seventy-four children between the ages of 10 and 15 years ran 20-m laps at increasing pace until the children could longer keep pace. PACER was performed at outdoor, cement courts of 2 secondary schools.
Results: PACER results found 90% of the male children who completed the test are classified as unfit. However, only 29.5% of the female children are unfit.
Conclusion: The PACER data support our findings that male children in Huamachuco, Peru, have poor cardiovascular health. MSUCOM hopes to address this community's health issues discovered with this research in a sustainable way.
S30
Preventing Ischemia/Reperfusion Injury in Cardiac Myocytes Using Ranolazine and DCHC
Steven F. Sorci, OMS II1; Christopher Williams, OMS II1; Bethany Hampton, BS2; Judith Maloney, PhD2
1West Virginia School of Osteopathic Medicine (WVSOM), Lewisburg; 2Biomedical Sciences, WVSOM
Background: Reperfusion is a common approach in the treatment of a myocardial infarction. While beneficial, it can paradoxically cause damage. This injury involves both apoptosis and cardiac hypertrophy in surviving myocytes. Therefore, ischemia/reperfusion (IR) injury is multifactoral. One proposed pathway leading to apoptosis is that calcium (Ca) overload during reperfusion contributes to the generation of reactive oxygen species (ROS). Ranolazine, an inhibitor of the late sodium (Na) current, may reduce this Ca overload by limiting Na entry during ischemia, thereby reducing Ca entry via the Na/Ca exchanger. DCHC, a SIRT1 activator, may also be beneficial against IR injury by both increasing the antioxidant capacity of the cell, and altering the activity of Akt, a major component of the hypertrophic signaling pathway.
Hypothesis: Ranolazine and DCHC may independently decrease IR injury by targeting not only IR-induced apoptosis, but also a cellular hypertrophic pathway.
Methods: HL-1 cardiac myocytes received 2 hours of simulated ischemia (sI) followed by 6 hours of simulated reperfusion (sR) with 1 μM or 10 μM ranolazine, or vehicle control. Caspase 3 activity was assessed as a measure of apoptosis. Subsequently, cells were treated with both 10 μM ranolazine and 50 μM DCHC, followed by measuring caspase 3 activity. Alternatively, cells were reperfused for 5 min-4 hours in the presence of DCHC and the phosphorylation, and hence activation state of Akt and GSK3β was measured using Western blotting.
Results: While 2 hours of sI did not activate caspase 3, IR increased caspase 3 activity (P<.05). Both ranolazine and DCHC tended to decrease IR-induced caspase 3 activity. However, the combination of ranolazine and DCHC had no effect on IR-induced caspase 3 activity. In contrast, preliminary data suggest that DCHC may decrease the activity of Akt and its downstream target, GSK3β after 4 hours of sR.
Conclusion: Activation of SIRT1 with DCHC may not only reduce IR-induced apoptosis, possibly by increasing the antioxidant activity within the cell, it also may prevent the development of cardiac hypertrophy by inhibiting chronic activation of Akt. Similarly, ranolazine may reduce IR-induced apoptosis by preventing the generation of ROS. However, the combination of ranolazine and DCHC may disrupt the antioxidant-oxidant balance within the cells and thus negate their therapeutic effect.
Acknowledgment: This research was funded by a WVSOM intramural grant.
♦ S34
Evaluation of CCR1 Antagonists in Multiple Myeloma and Osteolytic Bone Disease
Timothy Gauntner, OMS II1; Sarah Sansom, OMS II1; Daniel Pyen, BS2; Adam Luboff, BS2; Darya Kupershteyn2; Heena Rathod, BS2; Sanket Gokhale2; Annette Gilchrist, PhD2
1Midwestern University/Chicago College of Osteopathic Medicine, Downers Grove, Illinois; 2Chicago College of Pharmacy, Downers Grove, Illinois
Background: Multiple myeloma (MM) is a malignant neoplasm of B plasma cells. One of the hallmarks of this incurable cancer is osteolytic bone disease (OBD), a result of MM cells altering the delicate balance of osteoclast and osteoblast activity within the bone marrow microenvironment. The chemokine receptor CCR1, a key component of bone marrow cytokine networks, is expressed on both MM cells and osteoclasts (OC). Several small molecule CCR1 antagonists have been developed and are currently being evaluated as therapies for MM and other diseases in which CCR1 plays a key role.
Hypothesis: We hypothesized that CCR1 antagonists will decrease MM cell viability and reduce differentiation and activity of osteoclasts.
Methods: CCR1 antagonists (AZD-4818, BX471, CCX354, CP-481715, MLN-3897, PS899877, PS232149, and PS31291) were comparatively evaluated using radioactive binding assays and the results were analyzed using non-linear regression. Flow cytometry was used to measure the antagonists' effects on both MM cell apoptosis and CCR1 receptor internalization. The HaloTag protein labeling system was also used to analyze internalization by fluorescence microscopy. Several assays were initiated to determine the effects of CCR1 antagonists on the M-CSF/RANKL-induced differentiation of peripheral blood mononuclear cells (PBMC) into osteoclasts: AlamarBlue to measure cell viability, ELISA to measure IL-6 production, and tartrate-resistant acid phosphatase stains to identify osteoclast differentiation.
Results: Binding assays yielded an IC50 range of 0.32 to 407.6 nM across all compounds. CCR1 antagonists did not cause apoptosis of MM cells, however, they did prevent receptor internalization in preliminary studies. Initial data from ELISA experiments show a decrease in production of IL-6 by antagonist-treated PBMCs. Tartrate-resistant acid phosphatase staining demonstrated inconsistent, yet promising effects on OC differentiation.
Conclusion: Preliminary data from these experiments indicate that CCR1 antagonists affect both MM and OC cells and serve as potential therapeutic tools. Additional studies are underway to comparatively study the full effects of different antagonist compounds.
S35
Interactions of Extracellular Potassium and Extracellular Calcium With the Cardiac Potassium Channel HERG Are Dependent on Channel Inactivation
Kevin Ha, OMS III1; Alan Miller, PhD1; Steve Tseng, DO1; Kristeen Pareja, BS2
1Touro University California, College of Osteopathic Medicine (TUCCOM), Vallejo; 2TUCCOM, Ithaca, New York
Context: The human ether a-go-go related gene (HERG) encodes a cardiac potassium channel that is important in the repolarization of the action potential. A reduction in the number of HERG channels has been implicated in long QT syndrome, which in some cases can degenerate into the lethal arrhythmia Torsades de Pointes. Many patients present with abnormal serum electrolyte levels due to a variety of conditions including gastrointestinal dysfunction, renal and endocrine disorders, diuretic use, alcoholism, and aging. We have previously shown that reduction of HERG by extracellular Ca2+ is dependent on extracellular potassium, suggesting an interaction between calcium and potassium at the extracellular mouth of the pore.
Hypothesis: Because HERG inactivation involves the outer mouth of the channel, we hypothesized that reduction of HERG by extracellular calcium may involve HERG inactivation.
Methods: Experiments were performed using 2-electrode voltage clamping of Xenopus oocytes expressing either wild-type HERG or the inactivation deficient mutant S631A. cRNA was injected into enzymatically defolliculated oocytes and currents recorded 1 to 5 days after injection.
Results: Increasing extracellular calcium from 0.1 mM to 10 mM resulted in a greater decrease in WT HERG current when extracellular potassium was reduced from 20 mM to 0 mM. However, increasing extracellular calcium from 0.1 mM to 10 mM resulted in approximately the same amount reduction in S631A in either 20 mM or 0 mM extracellular potassium
Conclusion: Although the mechanism by which extracellular calcium reduces current through HERG channels is not clear, 1 plausible explanation is pore block. The results presented here are in agreement with our previous results suggesting an interaction between extracellular calcium and the outer mouth of the HERG channel. In addition, the data suggest that inactivation may play a role in the reduction of HERG by extracellular calcium. We propose a model, consistent with our data, which suggest that there are 2 extracellular calcium binding sites and that 1 of these is dependent on extracellular potassium. This study has implications for an increased risk of cardiac arrhythmias in patients with hypokalemia.
S37
Distinct Role of PGE2 Receptor Subtypes in Immunoediting of Tumor-Associated Macrophages
Alice Rutatangwa, MS, OMS III; Ronald R. Bean, MS; Nicholas J. Zarkadis, OMS III; Adam Streit, OMS III; Alex Shnyra, MD, PhD
Kansas City University of Medicine and Biosciences College of Osteopathic Medicine, Kansas City, Missouri
Prostaglandin E2 (PGE2) is 1 of the major immune-suppressive factors in tumor microenvironment contributing to immune evasion. Poor prognosis in various human carcinomas correlates with the extent of PGE2 production. PGE2 inhibits macrophages (Mθ), which extensively infiltrate solid tumors. The extraordinary intricacy of PGE2 effects on Mθ is complicated by multiple subtypes (EP1, EP2, EP3, and EP4) of PGE2 receptor co-expressed in the same cell. Consequently, the pleiotropic effects of PGE2 in Mθ are controlled by activation of different signaling pathways by different EP subtypes. EP2 and EP4 are strongly implemented in regulation of Mθ activities, however, the role of each EP in immuno-editing of tumor-associated macrophages (TAMs) remains unclear. In order to determine which of the 2 EPs is most responsible for modulation of tumor-promoting properties in TAMs we generated EP2low and EP4low subclones of human THP-1 Mθ stably transfected with shRNA lentiviral vector plasmids capable of effective inhibition of EP2 and EP4, respectively. To reproduce tumor microenvironment in vitro, EP2low and EP4low Mθ were co-cultured with COX-2− HT-29 or COX-2+ PGE2-producing HCA-7 human carcinoma cells and TAMs obtained were then purified using CD14-specific immuno-magnetic beads. Transcriptional profiling of immunoinflammatory responses in EP2low and EP4low TAMs was performed by using RT2 Profiler PCR Array. The results obtained were independently validated by quantitative RT-PCR and Western blotting. We demonstrate that constitutive expression of cytokines, chemokines and other immuno-inflammatory genes was markedly upregulated in resting EP2low Mθ, which was further augmented by PGE2 challenge compared to THP-1 Mθ (control). These findings were corroborated by modulation of distinct transcriptional activation programs in TAMs obtained by coculture with COX-2+ HCA-7 and COX-2 HT-29 human carcinoma cells. Compared with HT-29 cells, coculture of THP-1 Mq with HCA-7 cells resulted in modulation of fewer genes, many of which are known to exhibit immunosuppressive properties. However, the disparity in transcriptional profiles modulated in EP2low TAMS by HCA-7 and HT-29 was less evident. Collectively, our data show that PGE2 in tumor microenvironment may suppress inflammatory phenotype of TAMS in an EP2-dependent manner suggesting the potential efficacy of selective EP2 antagonists in treatment of COX-2+ tumors.
⋄ S38
Increased Pressure Relative to Ambient Decreases MLC Phosphorylation in Caco-2 Cells as Early as 2 Hours After Exposure
Ivan Alger, OMS II1; Shouye Wang, PhD2; Marc D. Basson, MD, PhD, MPH2
1Michigan State University College of Osteopathic Medicine, East Lansing, Michigan; 2Department of Surgery, Michigan State University
Context: Nonmuscle myosin is required for epithelial cell motility, which is regulated by signal elements including Myosin Light Chain Kinase (MLCK). Myosin is essential for mucosal wound healing and for the maintenance of the gut mucosal barrier. Increased luminal pressure, which occurs in inflammatory bowel diseases, is associated with ulceration and failure of the intestinal mucosa.
Methods: In this study, we investigated the effects of pathophysiologically relevant levels of pressure on MLCK in Caco-2 cells in vitro. Caco-2 cells are human intestinal epithelial cells that are highly differentiated and frequently used to model normal intestinal epithelial biology, although they are originally derived from a colon cancer. We detected activation of phosphorylated Myosin Light Chain Kinase (pMLC) via western blot assay.
Results: It was found that 40 mm Hg increased extracellular pressure above ambient decreased pMLC phosphorylation as early as 2 hours post exposure. This resulted in a 35%±10% decrease in phosphorylated MLC vs control cells maintained at ambient pressure (n=3, P<.05). Exposure to pressure also decreased other signal elements (FAK, AKT, GSK).
Conclusion: Increased pressure decreases activation of signal elements, which are important to the motility of intestinal epithelial cells.
Health Policy
S27
Does Self-Perception of Rural Appalachians Positively Correlate to One's Health Status and Health Behaviors?
Beth Jacobson, OMS II1; Ross H. Brubaker, OMS II1; Bethany Lehman, OMS II1; C. Lamar Hardy, OMS II1; Soham U. Dave, OMS II1; Gretchen Lovett, PhD2; Jill Cochran, PhD, MSN, RN-BC2; Tim Leonard, MD, PhD3; Wayne C. Miller, PhD1; Brian N. Griffith, PhD3
1West Virginia School of Osteopathic Medicine (WVSOM), Lewisburg; 2Department of Clinical Sciences, WVSOM; 3Department of Biomedical Sciences, WVSOM
Context: Rural Appalachia is characterized by poor health behaviors and poor health status.
Objective: Because health perception precedes health behaviors, the purpose of this study is to examine the relationship between perceived health and objective health status in rural Appalachian adults.
Hypothesis: Our hypothesis is that health perceptions are still incongruent with rural Appalachians' health status and health behaviors based on a 5-year follow-up study of Appalachians' self-perception of health.
Methods: A 16-item questionnaire was given to Appalachian adults visiting the WVSOM blood pressure booth at the West Virginia State Fair in 2007. An expanded, 41-item questionnaire was given to visitors in 2011. Relationships between perceived health and objective health were made for both periods, and comparisons between times were made to see if health status or perceived health status had changed over 5 years. This study was approved by the WVSOM Institutional Review Board in 2011 as an expedited application.
Results: Perceived health status was incongruent with objective health status of Appalachian adults in 2007. Appalachian adults thought they were in good health, even when they were plagued with poor health and characterized with poor health behaviors. Data from 2011 are currently being analyzed and compared to the 2007 results.
Conclusion: To be effective, messages and programs about health and health needs must be formulated to take into account the current distortion about health in Appalachia and the cultural context in which this distortion is shaped.
Research
S4
Cystine/Glutamate Antiporter Regulates the Functional Expression of Indoleamine 2,3-Dioxygenase (IDO) in Human Monocyte-Derived Dendritic Cells
Brandon M. Morris, BS, OMS II1; Kayleigh Pung, BS, OMS I1; Zachary Grimes, BS2; Maria Soukup, BS1; Shea Hatcher, BS1; June D'Angelo, PhD3; Edda Fiebiger, PhD4; Bonny Dickinson, PhD5
1West Virginia School of Osteopathic Medicine, Lewisburg; 2Shepherd University, Shepherdstown, West Virginia; 3Mount Sinai School of Medicine, New York, New York; 4Harvard University, Boston, Massachusetts; 5Tulane University, New Orleans, Louisiana
Background: The cystine/glutamate antiporter transports cystine into the cell in exchange for glutamate. Inside the cell cystine is readily reduced to cysteine and used for biosynthesis of the major cellular antioxidant glutathione (GSH). Cysteine is also transported out of the cell where it creates a reducing extracellular microenvironment. We previously showed that blocking antiporter function in dendritic cells (DCs) reduces the level of intracellular GSH and interferes with antigen presentation to T cells via MHC class II and the cross-presentation pathway.
Objective: To determine whether blocking cystine/glutamate antiporter function interferes with T-cell activation by modulating DC expression of the immunosuppessive enzyme indoleamine 2,3-dioxygenase (IDO). Dendritic cells expressing IDO potently suppress T-cell responses by depleting extracellular tryptophan and generating metabolites of the kynurenine pathway.
Hypothesis: The cystine/glutamate antiporter controls the outcome of DC-T cell interactions by modulating the functional expression of IDO in DCs.
Methods: Dendritic cells were prepared from normal human monocytes using standard techniques. Digital RNA profiling and immunoblot was used to quantify changes in IDO mRNA and protein, respectively, and IDO enzymatic activity was measured using a colorimetric assay to quantify kynurenine in culture medium. Antiporter activity was blocked with L-homocysteic acid, a competitive inhibitor of the antiporter, or by incubating DCs in medium devoid of cystine/cysteine. The selective IDO inhibitor 1-methyltryptophan was used to block IDO enzymatic activity.
Results: Blocking antiporter uptake of cystine in DCs increased IDO mRNA transcripts, protein and enzymatic activity. Interestingly, depleting intracellular GSH by inhibiting GSH biosynthesis (buthionine S,R-sulfoximine) or inhibiting GSH reducing activity (diethyl maleate) did not induce IDO activity in DCs. Instead, we found that an antiporter-driven extracellular cystine/cysteine redox cycle controlled IDO activity in DCs. In the absence of an extracellular cystine/cysteine redox cycle, antioxidants (reduced GSH and N-acetylcysteine) added to the DC medium dose-dependently blocked IDO activity.
Conclusion: Our data show that the cystine/glutamate antiporter plays a critical role in regulating IDO expression in DCs by maintaining a cystine/cysteine redox cycle that provides a reducing extracellular micromilieu.
S36
Gait Analysis to Determine the Return of Normal Physiologic Performance Following Surgical Interventions to the Left Gastrocnemius Muscle
Erica D. Grippo, OMS IV1; Nicole Alexander, OMS IV1; Rhian Davies, OMS IV1; Charlotte Greene, PhD2
1Philadelphia College of Osteopathic Medicine (PCOM), Pennsylvania; 2Physiology, PCOM
Background: One of the most important fundamental understandings in osteopathic medicine is the relationship between structure and function. Therefore, the evaluation of rat movement patterns is pertinent when studying the particular influence an injury, or a structural change, may have on ambulation. Previous studies have found that these animals will alter their load-bearing away from the injured limb. Change also occurs in the stride width between the immobilized limb and the opposite hind limb. The Functional indices for print length (PL), distance between first and fifth digits or toe spreading (TS), distance between second and fourth digits or intermediary toes (IT), and toe to opposite foot (TOF), was determined for each of the experimental groups. The focus of the present study was to evaluate ambulatory function throughout the healing period and to compare results to preoperative ambulatory function following the experimental interventions; laser-induced gastrocnemius lacerations vs scalpel as well as the effect of exogenous nerve growth factor (NGF) injections into the muscle wound.
Hypothesis: A combination of laser-induced incisions and SIS sutures with added growth factors will have the earliest return to baseline physiologic performance. There will be a clear order in regards to the various treatments, Laser and NGF> Laser, Scalpel and GF> Scalpel, when looking at the functional return to baseline.
Methods: The research used 32 male, 300-g Sprague Dawley rats.
Experimental Groups No.
A: CO2 Laser incisions 8 (without NGF)
B: CO2 Laser incisions 8 with added NGF
C: Scalpel incision 8 (without NGF)
D: Scalpel incision 8 with added NGF
Experimental Groups No.
A: CO2 Laser incisions 8 (without NGF)
B: CO2 Laser incisions 8 with added NGF
C: Scalpel incision 8 (without NGF)
D: Scalpel incision 8 with added NGF
×
Pre- and postoperatively, gait analyses criteria were used to assess recovery of limb movement using a custom designed tunnel apparatus that contained a bromophenol blue paper walkway to capture the foot prints of each rat. An analysis of variance was applied to compare changes from baseline values among and within the experimental groups over time.
Results: Preoperatively, differences in functional indices among the experimental groups were not significant (P>.05) when using the value of P<.05 for statistically significant data except for the parameter TH. Using ANOVA, the 4 experimental groups' postbaseline values were compared. Significant improvements (return towards baseline values) were found for the following parameters/groups: Both parameters, PL and IT, showed significant difference among the groups. A Student Newman-Keuls test showed that for these parameters, Group C (scalpel without NGF), was the most different when compared and demonstrated the least amount of healing with respect to baseline. A univariate analysis of gait by parameter and time compared the average of the individual animals' change in baseline within each of the 4 experimental groups. For the parameters, TS and IT, Group B (laser incision and added NGF) was found to reach a preoperative value first. Group D (scalpel incision with added NGF) reached measurements that were no longer significantly different from preoperative baseline values in both parameters PL and TS. The 2 experimental groups given additional NGF (Groups B and D) demonstrated values that exceeded preoperative baseline in the following gait parameters; TS, IT and TH. TH and SS did not show consistent postoperative changes from baseline as noted by the other parameters.
Discussion: Additional exogenous growth factor was the most important surgical intervention when analyzing physiologic performance after injury. Group B (laser incision and added NGF) returned toward preoperative values earlier than the other experimental groups as indicated by measurements of TS and IT. When ranking the healing toward baseline by treatment, the following relationship was found; Group B> Group D> Group A>Group C. Additional analyses are underway to examine the significance of indices that showed changes that exceeded preoperative values. This observation needs to be examined more closely as it may reflect an adaptation related to healing seen histologically. The experiment showed that utilizing both the CO2 laser for incision and additional growth factor postoperatively improved the physiologic performance of a muscle over a shortened healing time. The structural changes that occurred overtime with healing in each experimental group were related to their overall physiologic function in direct correlation with osteopathic principle.
BIOMEA Abstracts
Research
756
Classification of Musculoskeletal Conditions in Medically Underserved Regions in Peru
Neha Patel, OMS III; Emily Eubanks, OMS III; John Daniel Murchison, OMS III; Chelsey Swaiko, OMS III; Elaine Wallace, DO; Robin Jacobs, PhD
Nova Southeastern University College of Osteopathic Medicine, Fort Lauderdale, Florida
Context: Understanding and elucidating acute and chronic musculoskeletal somatic dysfunction in regional areas of Peru has yet to be achieved and remains a priority for the World Health Organization. Existing literature for this area poorly characterizes musculoskeletal conditions, specific to body region and type of pain. Anecdotal data indicate that developing countries in South America are experiencing increases in work-related musculoskeletal disorders and that there is an expanding need for interventions that target improved health and management of somatic dysfunction.
Objective: To evaluate acute and chronic musculoskeletal dysfunctions in the Piura region of Peru.
Methods: Patients aged 19 to 83 years (mean, 46.5 years; standard deviation, 18.56 years) receiving medical care during an NSU-COM medical outreach trip as part of student community service, were invited to complete an anonymous 1-page questionnaire that ascertained generalized and specific musculoskeletal pain experienced in the past 7 days and in the past year. Survey items also included age, sex, height, weight, occupation, general health, number of physician visits in the past year, pain in the past year, and pain in the past 7 days. The survey was offered in Spanish and took approximately 10 minutes to complete. Data were analyzed using SPSS statistical software, version 19.
Results: The sample (N=65) consisted of 71% women and 29% men. Twenty-two percent had not seen a physician in the past year, 25% saw a physician once, 19% saw a physician twice, and 14% saw a physician 3 times. In the past year, women reported more neck pain (r=-.262, P<.05); older respondents saw physicians more often (r=.343, P<.01); and younger respondents reported more pain in the elbow (r=-.406, P<.05), wrist/hand (r=-.241, P<.05), knee (r=-.352, P<.01), and ankle/feet (r=-257, P<.05). In the past 7 days, younger respondents reported more pain in the hip/thigh (r=-.237, P<.05) and knee (r=-.408, P<.01).
Conclusion: Data from this study will assist in determining which treatment modalities, including osteopathic principles and procedures, will be most beneficial when considering the development of health care services and in generating guidance protocols for future medical providers practicing in this region.
822
Because the JAOA did not receive the appropriate copyright releases, we were unable to publish this abstract.
830
Barriers to Diagnosis of Sexually Transmitted Infections in El Salvador, Central America
Yevgeniya Dudko, OMS II; Deborah Lardner, DO; Michael Passafaro, DO; Zehra Ahmed, RPA-C, MBBS
New York College of Osteopathic Medicine of New York Institute of Technology, Old Westbury
Hypothesis: Culturally constructed gender roles do not allow for the accurate assessment of the incidence of sexually transmitted infections (STIs) in the rural region of Morazan, El Salvador.
Methods: A retrospective review of charts from the following 4 clinics was performed: Perquin, Torola, San Fernando, and Los Cimientos (Morazan department). Patients' age, sex, and diagnosis were used for the study. No other identifying information was recorded. Charts from 2001 (if available) to 2011 were used.
Results: A total of 290 patients were included in the study. The majority of patients were aged between 20 and 39 years; 288 (99.7%) were female and 2 (0.7%) were male. For the female patients, the 2 most common diagnoses were Candidiasis (33%) and Cocobacillus (31%).
Conclusion: Because of established gender roles, it is difficult to assess the true prevalence of STIs within the population of El Salvador. Although men engage in behaviors that put them at higher risk for STIs, women tend to be better educated on the subject and they present to the clinic for diagnosis and treatment more frequently (0.7% vs 99.3%). Our research demonstrates that individuals that are now being diagnosed represent only a small percentage of the population. We also identified additional barriers to diagnosis such as accessibility of clinics, availability of supplies in medical facilities, and lack of general health education in communities. A study that further examines these obstacles would be warranted.
♦ 835
Identifying Risk Factors Involved in the Spread of Dengue Virus in Guyana
Erin K. Philpott, OMS II1; Melissa Fujan, OMS II1; Kenneth Skeete, BSN2; Camille Bentley, DO1; Dana Grzybicki, MD/PhD1
1Rocky Vista University College of Osteopathic Medicine, Parker, Colorado; 2Medical Surveilliance Officer Guyanese Ministry of Health, Georgetown, Guyana
Context: Dengue is a mosquito-born flavivirus that has recently grown to epidemic proportions in South America. According to World Health Organization, 2.5% of the 500,000 people hospitalized with dengue hemorrhagic each year die, and untreated patients have a fatality rate of 20%. Guyana, a tropical country in eastern South America, has had an increase in dengue incidence over the past 5 years. Although Guyana has not yet recorded an exclusively dengue-related death, it is expected that repeat exposures by the ubiquitous virus will produce an increase in hemorrhagic cases and fatalities.
Objective: To identify 1 or more specific contributing factor(s) affecting the dengue infection rates with the ultimate goal to design a dengue prevention strategy that might be carried out during a return trip to Guyana.
Hypothesis: We hypothesized that the socioeconomic status of the compared regions would be the main risk factor contributing to an upsurge in dengue incidence due to factors including limited access to trash disposal, clean water, and crowded living spaces.
Methods: Retrospective de-identified aggregated dengue fever incidence data were obtained from the Guyanese Ministry of Health and were subcategorized by the 10 regions in Guyana for years 2007-2009. Initially, all data were subjected to an exploratory descriptive analysis including calculation of measures of central tendency and dispersion for the aggregated data as well as for the regional data and data distributed by possible risk factors. Risk factors assessed included rural vs urban populations, population density, the chief regional ecosystem, chief economies, and the Living Condition Index (LCI), which was used as a general indicator of socioeconomic status (1, most poor; 10, least poor).
Results: Preliminary descriptive analysis of the incidence data revealed 3 regions with contrasting mixes of risk factors (population density, economic providers, and ecosystem) and infection incidences (high, intermediate, and low, respectively), which we chose as our initial regions for further detailed examination. Region 4 is considered predominantly urban, with a high population density, commercialism as the main economy, a coastline ecosystem, and ranked 10 out of 10 on the LCI scale, region 6 is rural, with a low population density, predominantly agrarian, encompassing 4 ecosystems, and ranked 9 out of 10 on the LCI. Region 10, with the highest dengue incidence, is rural, with a low population density, a hilly sand environment, and economy that includes primarily artisanal gold and bauxite mining, with a ranking of 8 out of 10 on the LCI.
Conclusion: The findings indicated that population density, urban vs rural regional status, and LCI lacked significant correlation to dengue incidence. However, a preliminary negative correlation between the economies of each region and the dengue incidence was identified. A possible reason for this relationship that is being further examined is that the nomadic lifestyle of the miners in region 10 compared to the settled agrarian lifestyle of the farmers in region 6 impacts the introduction and spread of the virus.
♦ 837
Exposure to DEHP and Its Implication in the Pediatric Population of Taiwan
Karen Koto, OMS II1; Sandy Liao, OMS II1; Yen-Chih Jessica Lin, OMS II1; Mickey Lui, OMS II1; Bar-Han Chiu, OMS II1; I-Jen Wang, MD/PhD2; Athena Lin, PhD3
1Touro University California, College of Osteopathic Medicine (TUCCOM), Vallejo; 2Pediatraics, Taipei Hospital; 3Global Health Program (TUCCOM)
Context: In a world permeated with synthesized food additives, we often wonder if the foods that we are putting into our mouths right now are indeed safe. Moreover, even food repeatedly tested by the US Food and Drug Administration can still contain dangerous substances that are not detected by routine procedures. In May 2011, the Taiwanese government accidentally discovered that a large manufacturing firm that specialized in clouding agent, a usually harmless chemical emulsifier that enhances the consistency and color of juice products by making it more opaque and viscous, was using Bis (2-ethylhexyl) phthalate (DEHP) to substitute for more expensive natural clouding agents such as palm oil. DEHP is a plasticizer that is used for making plastic products more pliable and durable. The potential toxicity of DEHP includes kidney toxicity, thyroid problems, infertility, cancer, and precocious puberty in females, and retarded sexual development and feminization in males. The tainted clouding agents were widely distributed in many food and medicinal products, including juice concentrate, sports drinks, and even some medical supplements and drugs such as probiotic yogurt powder and pediatric antibiotic syrup. The relatively vast exposure to probiotic yogurt and the antibiotic syrup, combined with DEHP's potential effect on sexual development in children, caused unprecedented panic in the Taiwanese public. Overnight, pediatric clinics were flooded with concerned parents who wanted to get their children tested for possible DEHP exposure.
Objective and Hypothesis: The goal of this study is to test the hypothesis that DEHP exposure on pediatric patients may lead to reproductive changes. We also hypothesize that such a study will help ease public concern about the incident, raise awareness to future food contamination problems, and establish an early detection mechanism in preparation for future crisis.
Methods: While participating in the Touro University Global Health Program Summer Clerkship, we shadowed pediatricians at Taipei Hospital, Taiwan, Republic of China, that serviced pediatric patients concerned with plasticizer-tainted food products' ill health effects. Using reports of which products were found to be contaminated with diethylhexyl phthalate (DEHP), a survey was created to access patient exposure through various sources and duration since birth. After literary review of the effects of DEHP, the survey was made to capture information regarding diagnosis related to heighted allergic responses and gonadotropic changes that have both been linked to DEHP exposure. Blood samples were collected and analyzed for relevant abnormalities of gonadotropic hormones. In addition, urine samples were collected for future testing of indicators of DEHP exposure.
Results: Sixty-nine children between the ages of 1 and 13 years were included in our sample population. Survey results and laboratory results were analyzed. Initial review of the data showed no significant difference in complete blood cell count results, hormonal levels, or gonadotropic changes in our sample population. Further review of the data to look for possible connections between exposure and laboratory data is ongoing. Age-specific gonadotropic hormones levels should be considered.
Conclusion: Further analysis is needed to investigate the possible consequences of ingestion of DEHP. Comprehensive lab data and survey result comparison will be examined and discussed.
843
Comparison of OMM and TCM Tui-Na Diagnostic Methodology
Mickey Lui, OMS II; Yen-Chih Lin, OMS II; Bor-Han Chiu, OMS II; Karen Koto, OMS II; Yen-Yi Ho, CMD; Athena Lin, PhD; Janet Burns, DO
Touro University California, College of Osteopathic Medicine, Vallejo
Context: The Tui-Na branch of traditional Chinese medicine (TCM) is a manipulative therapy similar to osteopathic manipulative medicine (OMM) in that both aim to improve the patient's inherent healing abilities. Records of similar treatment modalities exist between OMM and Tui-Na, including soft tissue and articulatory techniques. Despite their similarities, currently there is limited research comparing and contrasting osteopathic and Tui-Na diagnostic methodologies.
Hypothesis: Given the analogous treatment modalities observed between OMM and Tui-Na, we hypothesized that the indications and diagnostic criteria for OMM and Tui-Na were also similar.
Methods: During the Global Health Program Summer Clerkship at Touro University California, we shadowed a TCM physician during 2 separate weeks at Taipei Hospital in Taiwan, Republic of China. A comparison of diagnostic findings in patients with chief complaints involving musculoskeletal problems was done before and after Tui-Na treatment. The TCM physician examined the patient using Tui-Na diagnostic methods before osteopathic students performed a screening examination developed by Edward G. Stiles, DO (Stiles sequencing). Findings were compared and discussed before Tui-Na treatment. Efficacy was assessed after treatment using both Tui-Na and Stiles Sequencing.
Results: We found that Tui-Na uses a wider variety of diagnostic and treatment methods than previously thought. The available literature regarding Tui-Na focused mainly on its use to restore Qi flow through acupuncture meridians as the main therapeutic endpoint. This study showed that within Tui-Na there are diagnostic protocols to OMM usage of TART findings to diagnose somatic dysfunction. Dr Ho demonstrated a form of Tui-Na that was strictly somatic in its diagnostic and therapeutic findings, focusing on assessing asymmetry, tissue hypertonicity, and myofascial strains around anatomic junctions using light contact. Many of the palpatory findings obtained using the Stiles sequencing closely correlated to those found using Tui-Na diagnosis methods.
Conclusion: Both osteopathic and Tui-Na forms of diagnosis, though different in their approaches, lead to similar palpatory findings. Treatments address the same somatic problems found by osteopathic physicans. Future research will be done comparing Tui-Na and OMM, which will enable both TCM practitioners and osteopathic physicians to incorporate complementary approaches to patient care.
844
This abstract was withdrawn from consideration for publication in the JAOA.
851
Assessing Pediataric Health Care Needs in Huamachuco, La Libertad, Peru
Melissa Hart, OMS II; Shane Sergent, OMS III; Rochelle Hughes, OMS II; Michael Burla, OMS II; Gary Willyerd, DO; Joey Eisenmann, MS; Christina Dokter, PhD
Michigan State University College of Osteopathic Medicine, East Lansing
Context: In 2010, Michigan State University College of Osteopathic Medicine (MSUCOM) conducted a medical service elective in Huamachuco, a city in the La Libertad region of Peru. We completed anthropometric studies on the pediatric population of Huamachuco and found a significantly high percentage of overweight and obese children. In this study, the lifestyle conditions (diet, sleeping patterns, access to health care, daily activities, and parental perceptions of weight) were assessed by means of a self-reporting survey.
Hypothesis: Given the 2010 finding of high body mass index (BMI) in an analogous pediatric population, we expect to find indicators of sedentary lifestyle, low access to health care, and food insecurity in this follow-up study to further explore pediatric health care needs.
Results: The average number of meals eaten per day was 3.74 (2.69 large meals and 1.5 smaller portioned meals). An average of 1.6 fruit portions, 1.3 vegetable portions, 1.4 starch portions, and 1.2 protein portions were eaten each day. Rice and potatoes were the most reported food components of a regular meal. The average nursing time was 1.6 years and 1.7 years for formula feeding; often, nursing and formula feeding were done in tandem. Seventy percent of participants reported owning a television and watching an average of 2 hours of television per day; 39% reported having seen a nutritionist; and 55% reported having a primary care doctor. Most parents reported taking their children to the doctor only when the child is sick, 44% of worrying about their child's weight, and 47% having anxiety about affording food.
Conclusion: Risk factors that may contribute to high BMI were found with 47% of participants reporting food insecurity and large amounts of time watching television. Low access or utilization of preventive health care such as yearly physicals should be explored further as an initiative to improve the health of this pediatric population. It is unclear whether diet and nutrition are a clinically significant cause of high BMI findings in 2010 as a variety of nutritious foods were reported in daily diet. High carbohydrate consumption was indicated, which may contribute to high BMI findings. This study emphasizes the need for sustainable initiatives to promote activity, healthy lifestyle, and improved access to preventive care. Students at MSUCOM have formed a relationship with local nutritionists and health care providers. Working in collaboration, we hope to promote these initiatives through sustainable community education programs.
Outreach
747
D.O.ing Right for Haiti
Carisa Rose Champion Lippmann, OMS II; Francesca Okolie, OMS II, MPH
European Disaster Volunteers; Nova Southeastern University College of Osteopathic Medicine, Fort Lauderdale
Introduction: European Disaster Volunteers (EDV), a British nonprofit organization providing relief and reconstruction assistance to disaster-stricken communities worldwide, began working in Port-au-Prince, Haiti, in June 2010. Since their arrival, they have been instrumental in the development of schooling, health services, and housing for orphans and families in the capital's neighborhood of Clercine. Upon accepting our request to volunteer with them, the program director, head pharmacist, and nurse decided that a group of medical students would be best put to use in the health arena. In the end of January, we began an almost daily correspondence of planning and strategizing a special service project from the ground up.
Our Service Project: Through countless hours of preparation, our team was able to create a comprehensive health education curriculum covering 3 major points:
1.
How do we keep children healthy?
2.
What are common illnesses that can be treated at home (how to spot them and how to treat them)?
3.
What are serious health issues requiring a visit to the doctor?
Within those key topics, we designed lessons that addressed themes ranging from nutrition to parasitic worms and skin infections. We used colored posters, coloring sheets, demonstrations, and skits—several of which were translated into Haitian Creole. In addition, we prepared ourselves to run a children's health clinic during our stay in the countryside. Based on specific supply requests from EDV, we held a 3-week-long vitamin drive at school and collected more than 6000 children's vitamins. We also raised nearly $2,500 through numerous fundraising initiatives. Local community clinics donated medications and supplies, which we sifted through and carefully organized for transport. The Student National Medical Association funded the printing of valuable resources for EDV and the communities they serve. We brought 6 copies of “Where There is No Doctor” translated into Creole as well as several hundred health passports and healthy child forms for parents who attended the education program. Where We Worked: Fond des Negres is a small mountainous rural village about a 2½- hour drive from Port au Prince. Bumping along the dirt roads in an overcrowded “tap tap” (a pick-up truck with seats made out of wood boards), our team saw the striking poverty of the mountainous regions of Haiti. Comparatively a very poor province, Fond des Negres has been heavily burdened since the earthquake by evacuees from the capital and the resulting strain on already limited resources. Orphans in the community are considered orphans not because they are parentless but because their parents are unable to take care of them or provide enough food to keep them alive. Housing is also scarce, and most families live in 1-room shacks made out of tree limbs or materials found in the streets. These “houses” are a protected area for sleeping and storage of clothing. Cooking, bathing, etc, are all done outside. After our team arrived in Fond Des Negres, we staggered onto the property of our main contact in the community, a “wealthy” man, as he owned a house under construction. We pitched tents in his yard and our physician and EDV staff slept indoors. Our water was drawn from the property well and bleached for washing dishes and showering in our make shift outdoor stall. We shared 1 toilet in the house and took turns doing daily chores. We had hired the local pastor's wife to cook for our team at night and indulged in fresh fruit salads afterwards with fruits we purchased at the weekly market. After dinner we crawled into our tents and awoke at 6:30 am to the sounds of roosters, grunting pigs, and turkeys. What We Did: Our 3 days of work took place in a 2-story church still under construction. On the first floor we held our education classes and did preliminary examinations of the children. Our classes ran about 1½ hours long and were equipped with a translator and student teams of 7 to 8 people who divided the lessons and skits amongst themselves. No child could enter the clinic unless their parent or caregiver sat through the entire class and had their health passport stamped indicating such. Before reaching the area where medical students waited to take vital signs, every child was given a dose of Mebendazole for deworming and was able to report a chief complaint to those processing patients at check-in. After a check-up by the nurses, patients with more serious conditions like impetigo, heart murmurs, or flu-like illness were sent upstairs to see the physician and physician's assistant. In our first day alone we examined more than 300 infants and children; by Wednesday afternoon we had seen about 650 patients. A Lesson in Cultural Competency: One of the biggest challenges we faced in preparing our curriculum was being able to convey our messages in a format that was clear, concise, and respective of the culture of those with whom we were to work. Many students found it difficult to simplify illnesses we understood at a complex level to a few sentences concerning “microbes” pronounced “mee-kwrobs,” high fever, coughing, and a headache. It often took several drafts and comments from EDV to create the posters that most effectively spoke to our audience. With this trip, cultural competency was more than acknowledging the differences between our cultures and verbalizing a commitment to respect them. It was meeting the people where they were, a concept that centers on being at the level of and not above the community. More specifically, our messages reflected an awareness of resources available to residents of Fond des Negres and the cultural norms that dictated their lives. We weren't there to treat them like children or admonish any behaviors as inferior or in poor taste. We simply wanted people to know what they could do and how to do it. Some things we had to be sensitive to in light of their extreme poverty were our lesson plans with nutrition. We had to rewrite our lesson plans several times because they don't have many options when it comes to food choices. It is either eat or don't eat. The only options we could present were a boiled egg verses a fried egg or juice vs cola from the market. We also emphasized the importance of clean water and cooking away from people since the smoke of the charcoal caused a lot of pulmonary diseases in children of that town. One of the most surprising things to those who attended the classes was it's better to breast feed then give the baby formula as a lot of the time formula is mixed with dirty water, which results in infant diseases and fatalities. Mission Reflected: For many participants, this mission trip was a life-changing experience that opened their eyes to another side of Haiti. More than “the Western Hemisphere's poorest nation,” we saw Haiti as a country of strong-willed people who were fighting to survive and who were tremendously grateful for the charitable efforts of organizations like EDV and medical students like us. Not only did visiting the beautiful island dispel many of the false rumors and tales perpetuated by the media, but the students developed a real passion for international medical work. As the majority of the team was composed of M1s, we were not under the impression that our skill set would leave any meaningful impact on the community's health. However, we were really able to do so through the invaluable education we provided. While parents' minds were set at ease by the medical care some of their children were receiving for the first time in years, the greatest thing we believe we did was empower them to understand how they can keep their children healthy. With the nearest hospital more than an hour's drive away and public transportation unreliable at best, we focused our lessons on what people could do despite the limited resources they have available. Before our departure, Fond des Negres community leaders expressed their deepest thanks for our trip. It was the most touching of gestures and left us feeling sad to leave but looking forward to returning the following year. 788 Volunteer Medical Outreach in Baja California and Mexico Paige E Altom OMS III; Drew J Triplett, OMS III Lincoln Memorial University-DeBusk College of Osteopathic Medicine, Harrogate, Tennessee Statistics for Medical Outreach: A total of approximately 500 patients were seen. Staff comprised 4 physicians, 1 optometrist, 3 nurses, 2 nursing students, and 2 osteopathic medical students. The most common ailments were gastroesophageal reflux disease, allergies, musculoskeletal pain, ear infections, hypertension, and diabetes. How We Helped the People of Ensenada: The medical team, which included physicians, nurses, students, and interpreters from Texas, Tennessee, Chicago, and Georgia, set up a medical clinic at Colonia 89 Church of Christ in Ensenada, Mexico. The medical team divided up the large room into semi-private rooms to see patients. Early in the morning patients lined up outside the church where they were first triaged by nurses and then moved to another waiting area to be seen by physicians. At the clinic we had 2 family physicians, a pediatrician, the local physician from Ensenada, and an optometrist. Medical students began the trip seeing patients with the family physicians. All the patients were given vitamins and many patients were given medications to treat everything from ear infections to diabetes to high blood pressure. The clinic had a small pharmacy with a limited number of medications. Many of the patients seen had previously been treated for hypertension or diabetes, but either did not have the appropriate medication or did not understand how to manage their condition. Patients were prescribed medicine and counseled on how to keep their blood pressure and type 2 diabetes mellitus under control. The team encouraged all of the patients to receive follow-up care with the local physician. What We Learned From Our Patients: After being awarded the Rossnick Humanitarian Grant by the American Osteopathic Foundation and while preparing for the Level 1 of the Comprehensive Osteopathic Medical Licensing Examination-USA, we began planning our medical outreach to Ensenada, Mexico. Once we finished Level 1 of the examination, we left for Ensenada, Mexico, by way of San Diego. After studying for hours a day for several months, we were finally given the opportunity to use what we had been working so hard to learn during the past 2 years. We had everything we studied fresh on our minds and really felt like we could use our knowledge to help the patients we saw. The first day we saw patients with the family physicians and provided them with medication and vitamins. As rising third-year students, we were getting great preparation for starting our rotations a month later. We also were able to use our knowledge of osteopathic medicine to help our patients with many musculoskeletal problems. Although we were limited in equipment and medication, we focused more on history and physical examination. By the end of the week, we both were seeing patients with less assistance from the physicians at the clinic. Now that we are both in rotations, we appreciate our experience in Mexico even more, and we hope to go on more medical mission trips in the future. 801 Volunteering in Costa Rica and Nicaragua Angelina Hall, OMS I Lincoln Memorial University-DeBusk College of Osteopathic Medicine, Harrogate, Tennessee International Service Learning is a medical mission program that allows for students to experience hands-on medical learning while exploring another culture. However, the lessons learned from a medical mission trip extend much farther than simple medical knowledge. Lessons of compassion, empathy, and acceptance and a new outlook on life overwhelm each student. No student can possibly come back from a mission trip unchanged. The life lessons learned on a mission trip are vital to the medical field. As physicians, we take on a role to accept everyone who enters our office and treat them with as much care as we would our own family. With medical missions, we are awakened to the world of poverty, but we are also taught to appreciate the simplicities of life and happiness of those around us. My medical mission trip was a life-changing event. I had never seen people with so little who were so content. I was astonished by the ways of life, but jealous of their lack of needs for materialistic items. The children were more excited about bubbles than our children are about Disneyworld. This experience made me understand the important aspects of life. On my trip, I was reminded why osteopathic medicine is my passion. Each day of clinic, we had patients waiting in the miserable heat to be seen. The patients would be waiting before the sun would rise. Many times we did not possess the equipment, time, or medications to treat a patient who had waited all this time. One thing we always had was our hands. Luckily, we had 3 osteopathic medical students on our trip. Oftentimes, the students could perform manipulation on the patients that would change their lives. When a person can no longer work because of back pain, his or her entire family goes hungry. I was blessed to have seen 1 manipulation session bring a smile to a man's face like I had never seen before. He came back the next day of clinic with a mango for the student. This was all he had to give in appreciation of the gift that he had received. The student had not just eased the back pain, but also helped ease the hunger of the patient's family. Instead of sending the patient away with a medication that would eventually run out and leave the patient exactly where he started, this student was able to perform manipulation that would change his life. Only osteopathic medicine could provide the relief needed of many of the patients on our trip. Knowing this, I am excited to be able to take my skills that I have mastered after my first year of medical school on my next mission trip. This trip opened my eyes to life's simplicities, taught me lifelong lessons of compassion, and confirmed my passion for osteopathic medicine. I could not have asked for more from a medical mission trip, and I thank International Service Learning for allowing me a life-changing experience. 818 Acupuncture and Traditional Chinese Medicine Rotation at the China Beijing International Acupuncture Training Center Na Jen, OMS II Lake Erie College of Osteopathic Medicine-Seton Hill, Greensburg, Pennsylvania In the summer of 2011, after finishing 1 year of medical school, I decided to embark on a journey to China to learn about the concepts and techniques behind what makes traditional Chinese medicine (TCM) so fascinating and mystifying. The people of China have relied on these methods for hundreds if not thousands of years, and they are still in use today. Coming from an osteopathic standpoint, having had exposure to the holistic philosophy and embracing the concepts of self-healing and the healing touch of manipulation, I have always believed that medicine is multifaceted, an ongoing exploration of scientific and nonscientific quality. There has to be many more ways to manage an illness. As an immigrant from China, I was exposed to TCM concepts only by vague explanations my parents used to tell me. “Don't eat too much hot foods or else you will have insomnia and break out in acne.” “Drink more water to calm your fire.” I never understood what that meant because they were not “scientific” enough for me to grasp. Therefore, I hoped that this journey would be one in which I could once and for all understand what my parents were talking about, but much more importantly, immerse myself into a different way of thinking in hopes that it would broaden my view on medicine and help me become conscientious of the advancements that are happening in the arena of international medicine. The program started on June 27, 2011, in Shanghai. I met medical students from all over the states: Lincoln Memorial University, Tulane University, University of Pennsylvania, Boston University, Rochester University, and Columbia University to name a few. There were 4 DO students, 9 MD students, and 1 from New Zealand. We spent our first week touring from Shanghai to Xian and finally making our way to Beijing. This was the best time to get to know each other, and to explore the famous regions in China. The history of China, in an abridged version, was explained to us as we went from site to site, such as the Shanghai Bund, the Terra-Cotta warriors, the Great Wall, and the Forbidden City. Much of what we saw and heard helped us understand the Chinese culture. Our camaraderie developed and our understanding of the Chinese people slowly accumulated. From the second week through the fourth week, we began our TCM rotation at the China Academy of Chinese Medical Sciences Institute of Acupuncture and Moxibustion, specifically within the International Acupuncture Training Center in Beijing. We had classes in the mornings and in the afternoons, with guest physician speakers from their respective specialties teaching us the basic concepts of TCM. We learned about the Yin and Yan, 5-elements concepts, the different Zang and Fu organs of the body and their functions, acupuncture techniques, the Meridians and points on the body, etiology of diseases, tongue and pulse diagnoses, as well as other health-related topics such as Qi gong, diet therapy, pain syndrome, allergies, and acupuncture cosmetics. All lectures were given by power-point presentations as well as written annotations on white boards. Knowledge of Mandarin Chinese was not necessary because translators were with us at all times. From the third week and on, we had clinical rotations in the morning and lectures in the afternoon. We were divided into groups of 3 to 4 people and were placed under specific departments: neurology, ophthalmology, gynecology, general medicine, and dermatology. Every 2 days we would rotate between these departments to see the differences in their treatment. At first I thought we were just observing because needling and cupping isn't our forte. To my surprise, we were given a great deal of autonomy to help patients through cupping, as well as removing needles. After a few rounds, we became keen on avoiding needle sticking, removing hazardous wastes, and understanding what patients wanted despite a language barrier. Timing is important in controlling therapeutic effects. On busy days we would track 10 patients at a time. It was extremely fast paced in departments such as neurology and general medicine. Overall, I was glad and extremely happy to have participated in this rotation. I was very impressed by how patients reacted to the therapies and how competent physicians were in their specialties. We were not the only group rotating there—in fact, other groups ranging from first-year students all the way up to residents were rotating there as well. I even met students from Brazil, Ukraine, and other parts of the world. Without this opportunity I would not have the exposure to 1 of the most critical components to the health care system in China: TCM. I have come to realize why it is still around today. The results cannot be denied when voiced by so many patients that return time and time again for treatment. The enthusiasms from the practitioners combined with a rich history of documentation and literature gave me a newfound respect for TCM. I now understand what my parents meant when they told me I have “too much fire.” As a future medical practitioner, I plan to embrace international therapies such as acupuncture and to further my education so that I can offer an array of healing techniques to my patients starting from my roots as an osteopathic medical student: osteopathic manipulation. I hope other students will have the funding and opportunity to go on this amazing, eye-opening experience. 819 International Outreach: Experiences and Rewards in South America Lindsey Merritt, OMS III A.T. Still University of Health Sciences-School of Osteopathic Medicine in Arizona, Mesa As a child, I never could have imagined that spending my summers visiting family members in Ecuador would contribute so much to my future career. However, my early international experience ignited my passion for practicing international medicine. In Ecuador, I was exposed to the unique culture while volunteering in the public hospital. I developed a sense of comfort and enjoyment in this new cultural setting. During my undergraduate education I made it a priority to learn the Spanish language with the intention of returning to South America to participate in medical outreach programs. As a product of my interests and desire to work abroad in medicine, I developed the DOCARE International chapter at my medical school, A.T. Still University of Health Sciences-School of Osteopathic Medicine in Arizona. Working with fellow students who share my passion for international work, we have created a large student group that continues to expand. During my second year of medical school, I spent my winter vacation on a DOCARE medical mission trip in Nicaragua. On this trip I had the opportunity to work with hundreds of underserved Nicaraguan citizens and use my early medical training to help people in need. There were 27 participants on the trip, 5 of whom were physicians and the rest of whom were osteopathic medical students. We saw many patients with common medical problems that would have been simple to manage in the United States, but because there were such limited resources in Nicaragua, these people had endured prolonged suffering from these illnesses. The most common medical complaints were stomach aches, chronic cough, allergies, and skin rashes. It is so rewarding to know that we treated more than 800 patients who otherwise would not have had access to a doctor. I got to make house calls to patients who had limited mobility and couldn't travel to be seen in our makeshift clinics. We went into patients' homes to help manage their debilitating diseases such as gangrene and kidney disease, and to deliver much needed items, like walkers and wound care dressings. I experienced being appreciated by my patients and to provide them with counseling and education. In Nicaragua, I developed self-confidence in my patient interaction skills and a strong desire to work with underserved populations internationally. I was also fortunate enough to develop meaningful professional relationships and lifelong friendships. My trip to Nicaragua reignited my passion for medicine. It helped me to remember why I've been so dedicated to learning medicine and allowed me to experience the satisfaction and joy that comes from working with patients as their care provider. International outreach is something I feel strongly that all undergraduate medical students should be lucky enough to experience. I am immensely grateful to have had the opportunities to work internationally, and I am looking forward to my next outreach opportunity. This year, I plan to complete an international rotation in Costa Rica, where I will be able to further my commitment to international outreach. 823 Local Behaviors and Perceptions Toward Human Papillomavirus in Guatemalan Men: A Case Presentation of Oral Papillomas in a Teenage Boy in Solola Vanessa Campbell, OMS II; Brittany Van Beek, OMS II Rocky Vista University College of Osteopathic Medicine, Parker, Colorado In Guatemala, the incidence of cervical cancer in women is estimated to be 38% higher than that in the rest of the world. Correlation between cervical cancer and human papillomavirus (HPV) has directed HPV prevention, vaccination, and encouragement to seek medical treatment toward women in the Guatemalan community in heterosexual relationships. Although homosexuality was decriminalized in Guatemala in the late 19th century, there is still negative stigma against the gay community. Cultural homophobia discourages gay men from seeking medical treatment for any disease that could identify them as homosexual, including HPV. This poster focuses on a case presentation in March 2011, of a teenage boy in Sololá with HPV tonsillar papillomas. Due to HPV oral papilloma association with oral sex, the patient's young age, and the semi-private conditions of our encounter, great care had to be taken to deliver information about HPV to the patient. Methods and goals of patient HPV education will be discussed, as well as local prevention and treatment behaviors for gay Guatemalan men. 824 Learning the Hard Way: A Medical Student's Experience After the 2010 Haiti Earthquake Joanna Gibbons, OMS IV University of North Texas Health Science Center Texas College of Osteopathic Medicine, Fort Worth I was 1 of the hundreds of well-meaning but unequipped and undertrained medical volunteers that arrived in Port au Prince during the days immediately following the Haiti earthquake on January 12, 2010. Inspired by media accounts of the devastation following a disaster, the international community responded with millions of dollars in aid and donated goods that overwhelmed local agencies, and volunteers exacerbated the existing chaos. When we fail to question the effect of our altruism, our volunteer efforts can become harmful during disaster relief. 826 Osteopathic Primary Care in Cambodia: Experiences in Global Outreach Sarah Lynn Codrea, OMS II; Rachel E. Henrickson, OMS II; Patrick D. Mangialardi, OMS II Philadelphia College of Osteopathic Medicine, Pennsylvania For student physicians, medical service trips provide an opportunity to apply knowledge learned in the classroom and enhance technical skills, but more importantly, these trips present a chance to improve the health of a community through direct care and outreach programs. In the summer of 2011, a group of 7 osteopathic medical students from the Philadelphia College of Osteopathic Medicine did just that. As volunteers in Siem Reap, Cambodia, we saw firsthand the difficulties faced by the Khmer people resulting from a lack of basic knowledge regarding health care and inadequate resources. Further, many Khmer people spend their lives engaging in strenuous activities that involve heavy lifting, kneeling, and bending over most hours of the day. It was clear to us that applying OMT skills would prove a useful tool in alleviating some of the pain associated with these lifestyles and would decrease the need for Paracetamol (acetaminophen), an analgesic used almost exclusively and prescribed far too often. In addition to chronic pain, diabetes and hypertension are significant medical issues in Cambodia, so we performed blood sugar and blood pressure screenings on every patient and educated them about the levels we recorded. In addition to treating or referring patients, we emphasized the importance of hygiene in preventing a range of adverse conditions. Toothless smiles, black gingiva, and dental abscesses reinforced that an outreach program focusing on dental hygiene would greatly benefit the villagers and provide a long-term solution. Many Khmer people cannot afford toothbrushes and other such necessities and instead engage in betel chewing, a practice ubiquitous in Asia, which serves for many as a substitution for basic dental care. With the help of a translator, we created a “dental hygiene jingle” and performed a skit showing the villagers how to brush their teeth. In-kind donations from Philadelphia-area dentists allowed us to distribute hundreds of adult and pediatric toothbrushes and toothpaste tubes. A second demonstration emphasized the importance of hand washing and the pervasiveness of germs. We developed an exercise to efficiently explain how germs are spread and the effectiveness of washing with soap, which was then provided for them. Though the trip only lasted a short time, the effects on the Khmer people will hopefully last much longer. We believe that the first step for real change in a developing country such as Cambodia is identifying the needs of the people combined with developing programs that are easily administered and inexpensive. We are optimistic that this was accomplished. ♦ 829 Because the JAOA did not receive the appropriate copyright releases, we were unable to publish this abstract. 834 Use of Osteopathic Manipulative Treatment to Alleviate Symptoms of Bell Palsy in Guatemala Thomas Scott Rogers, OMS II; Kevin Stephen Dougherty, OMS II; Camille Bentley, DO Rocky Vista University College of Osteopathic Medicine, Parker, Colorado Bell palsy is an idiopathic unilateral facial paralysis due to a dysfunction of the facial nerve (cranial nerve VII). It involves a lower motor neuron lesion resulting in the inability to control facial muscles to varying degrees on the affected side. Frequent physical findings include somatic dysfunction at C3 accompanied with occipitomastoid compression with an internally rotated temporal bone on the ipsilateral side. The standard osteopathic manipulative treatment entails myofascial soft tissue treatment with counterstrain and muscle energy techniques to relieve any associated facial pain. The occipitomastoid compression should be relieved, the temporal bone assisted into normal internal/external rotation, and any C3 dysfunction corrected. In our case, we used a biodynamic approach to cranial osteopathic manipulative medicine as an adjunct to the standard osteopathic manipulative treatment to further alleviate the patient's symptoms. 836 Moringa in Swaziland: A Model for Scaleable Self-Sustaining Demand-Based Nutrition/Health Intervention Edward Lin, OMS II; Kelly McGuire, OMS II Rocky Vista University College of Osteopathic Medicine, Parker, Colorado Between 2008 and now, my group at Impala Development Services (IDS) has been running a nutrition/agro-forestry intervention in southern Africa, focused on the country of Swaziland. The program is centered around the remarkable moringa tree, which is nutrient packed, drought resistant, easy to grow, and reaches high yield within 6 months to 1 year of planting from seed. The moringa tree has been used in nutrition programs all around the world and has been a proven success. However, moringa has never been promoted in Swaziland. Our team is the first to introduce moringa to the rural farmers of this country. Just as important as the moringa tree, if not more so, is the intervention strategy used. Research into the failures and successes of past global health and international development programs has identified many key hurdles: sustainability, ownership of the projects, communications, funding limitations, and so forth. We have generally overcome these hurdles simply through smart project design. We have reached all 4 regions of Swaziland, created a self-sustained seeds provision and training enterprises, integrated moringa into standard gardening/agricultural outreach programs, generated high-value product and income for farmers, and set moringa firmly into the health and nutrition discussions at a national level. The program has had a total budget of roughly$10,000 USD spread over 3 years and has become self-sustained (independent of any external funding).
In this poster, we would like to share (1) our experiences with moringa and its benefits to farmers and families and (2) key strategies in delivering sustainable and effective interventions in rural developing country contexts, specifically rural sub-Saharan Africa.
845
The Past, Present and Future Sustainability of the Shirati Leprosy Camp Using Best Farming Practices
Thomas Liggett, PhD, OMS II; Doris Sloan, OMS; Richard Kahn, MD; Eiman Mahmoud, MD, MPH
Tanzania Global Health Group; Touro University California, College of Osteopathic Medicine, Vallejo
Context: Leprosy is a disfiguring bacterial infection that can present with irreversible neuropathy, cutaneous ulcerations, and hypopigmented macules. Ultimately, the disease progresses to facial disfigurement and loss of digits and limbs if left untreated. Although leprosy is curable today, stigma continues to exist for those with the disease, especially in underdeveloped countries, and is not very different from what was observed in biblical times. People are often ostracized or “put out of the camp everyone who is leprous,” with no family contact, no social support, and limited access to health care. Fortunately for people in the Shirati district in Tanzania, there exists a leprosy camp in association with the Shirati hospital where individuals can live in peace. However, because the nation has limited funding, the burden of all health care costs, food, and other living expenses are placed on the individuals. The Leprosy Project was initiated by students at Touro University California to empower ostracized individuals in the camp to generate food and income through better farming practices. In addition to income generation, the farm allows individuals to feel as a useful part of society by reintegration of their skills.
Methods: Through an initial assessment 3 years ago, a pump was purchased to water crops that have suffered as a result of diminished rainfall in the region during the past decade and the nature of the equatorial climate. A reassessment the following year allowed for an increase in funding to build a chicken coop to allow the residents to raise and sell chickens. As the Leprosy camp feeds almost 40 people within the camp and the leprosy wing of the hospital, we reassessed the camp's needs for the present year and future growth.
Results: Water piping for irrigation during drought times rather than hand-watering of crops was determined to be an essential need for the camp. Because many of the individuals have missing limbs and because the path to the farm is unpaved and inaccessible by vehicle, the daily journey to the farm is difficult and time-consuming. Therefore, a bicycle adapted for transporting the pump and food between the camp and the farm was purchased. We also assessed the future needs of the camp as they will be moving in 2012 to a new building that was built in conjunction with the German Leprosy Relief Association and Shirati Hospital. Our needs assessment determined that guttering on the building and a 1000-L cistern will be needed to collect rainfall for daily cooking and bathing needs. In addition, a chicken coop in the new location will need to be built. Finally, a 250-L cistern with irrigation would be beneficial for them as a method to produce seedlings to be planted in the farm.
Conclusion: During the past 3 years, we have assessed the viability of continuing aid to allow a specific subpopulation of Shirati to become self-sustainable by growing their own food and generating income. The Leprosy Project has proven to be beneficial to the individuals in both the leprosy camp and hospital leprosy ward.
♦ 847
Effect of the Continuity of Schistosomiasis Screenings on Disease Prevalence in Rural Tanzanian Villages
Kesha Zaveri, OMS II; Marlon Tingzon, OMS II; Eiman Mahmoud, MD; Richard Kahn, MD
Touro University Tanzania Global Health Research Group; Global Physicians Corp, Vallejo, California; Touro University California College of Osteopathic Medicine, Vallejo
Context: Schistosomiasis is a tropical disease caused by a blood fluke of the genus Schistosoma. Affecting more than 200 million people globally with chronic symptoms of abdominal pain, enlarged liver, blood in stool or urine, and increased risk of bladder cancer (CDC, Schistosomiasis, November 2010), native Africans make up about half the infected population. High concentrations of the worm can be found in Lake Victoria, which is a source of water and fish for surrounding villages. The disease is largely preventable, but health maintenance resources are inadequate in Northwest Tanzania, and the infected go untreated.
Hypothesis: We hypothesized that individuals who have previously attended a schistosomiasis screening would be less likely to be reinfected compared with those who have been screened in the past.
Methods: Touro University California has been providing onsite screening, education, and treatment for patients with schistosomiasis since 2007 in Minigo and 2010 in Masonga. Screening was accomplished through fecal and urine sample testing and education through large group discussions between villagers and the medical staff. Treatment was given in the form of praziquantel for those who tested positive, and as prophylaxis for fishermen.
Results: The prevalence of schistosomiasis in Minigo in 2007 was 30%. Prevalence decreased to 14% in 2009 and 10.6% (N=113) in 2011. The prevalence of schistosomiasis in Masonga was 20% in 2010 and was 47.6% (N=149) in 2011. Of those tested in Minigo in 2011, 35% were screened in preceding years, whereas only 9% of those tested in Masonga in 2011 had been screened in 2010.
Conclusion: This study demonstrates the efficacy of the schistosomiasis screening, not only as a diagnostic and treatment modality, but as a means of communication and education with various village populations of rural Tanzania. Further studies will continue to emphasize the educational portion of this project, which has proven to be just as useful as pharmaceutical distribution and physical examinations. The decreasing prevalence of schistosomiasis in Minigo during the past 4 years may be attributable to on-site screening, education, and treatment by Touro University California students. The annual implementation of this screening process can reduce the incidence of schistosomiasis. Continuity of screening is necessary to reduce the prevalence and the severity of this parasitic disease that has detrimentally impacted many fishing village residents. Increased provision of health promotion and disease prevention efforts is vital to maintaining a self-sustaining, healthy community in villages like Minigo and Masonga.
849
Because the JAOA did not receive the appropriate copyright releases, we were unable to publish this abstract.
852
Because the JAOA did not receive the appropriate copyright releases, we were unable to publish this abstract.
853
Dominican Republic Mission Trip
Samantha Donald, OMS II
Lake Erie College of Osteopathic Medicine-Bradenton, Florida
This summer, the International Medical Society (IMS) of Lake Erie College of Osteopathic Medicine-Bradenton in Florida (LECOM-Bradenton) took students on an exciting and eye-opening medical mission trip to the Dominican Republic. The goals of this medical mission were to deliver medical care to underserved populations. Additional goals were to learn about endemic disorders, witness pathologies that are rare in the United States, and educate the lay public about human immunodeficiency virus/AIDS, sexually transmitted diseases, immunizations, nutrition, and women's health.
As the member and the current president of the LECOM-Bradenton IMS, I believe this medical mission was a wonderful opportunity for an international medical experience that has changed our perception of international health issues, and ultimately, helped prepare us for the complex challenges of our profession in the global village.
The student-run IMS club arranged to send myself and 9 other medical students on this trip with humanitarian organization Corazon Del Siervo in the Dominican Republic. The ultimate goal of our mission was to empower and promote medicine and international understanding through direct human contact and interaction, and we came back to the United States with a better understanding and appreciation for global health.
854
Unfurling the Flag Abroad: A Demonstration of Osteopathic Principles and Practices for Obstetrics in Ethiopia
Christopher Kargel, OMS IV
Touro University California, College of Osteopathic Medicine, Vallejo
Hypothesis: Taking advantage of burgeoning programs in Touro University's Global Health Program and at Debre Markos Hospital in Ethiopia, a small group attempted to demonstrate the advantages of managing obstetric patients using osteopathic manipulative medicine (OMM) to the staff of the hospital. The project proposed to study the possibility of such an endeavor by gauging the interest and aptitude of a small selection of staff at Debre Markos Hospital while demonstrating the possibilities of future training to the Debre Markos Hospital and University representatives.
Methods: In July 2011, a student from Touro University California and an adjunct faculty member initiated a project at Debre Markos Hospital. The demonstration occurred over the course of a week, contained in the late afternoon hours in an attempt to minimize a disruption of patient care. The curriculum consisted of about 1 hour of didactic information and approximately 1 hour of hands-on demonstration. The 4 days included introductions to the principles and practices of osteopathy, palpatory exercises, and demonstrations of basic techniques such the suboccipital release, round ligament counterstrain, muscle energy to the pelvis, and Still technique for the sacroiliac joint.
Results: The immediate feedback provided by the participants included considerable excitement regarding the approaches that were demonstrated. Unfortunately, most of this feedback was received in a casual, conversational regard. Few of the participants completed and returned either the didactic examination or the evaluation forms. Efforts are currently underway to recollect them from participants and hard copy versions should be returning with a student who is currently completing a rotation at the site so that the results can be tabulated. Without the formal evaluations, all that can be stated is that the participants greatly appreciated the opportunity and expressed profound interest to learn and practice the skills more and especially under a more formal framework.
Conclusion: The participants clearly demonstrated ample interest and ability in the topic, especially once the implications for possible effective management of obstetric problems was elucidated. Given the difficulty of the material and the challenges of linguistic and cultural communication, the amount of time dedicated to each topic each day clearly limited how much information could be relayed. Further investigations could conduct at least 3 weeks of training for the hospital staff or for medical students at the local university. By offering formal training, the students and staff would be more dedicated to a longer schedule and the pace could be slowed to allow for adequate absorption of the information. The opportunity would be ripe to conduct a prospective study that analyzes the outcomes of OMM treatment in the hospital.
855
Because the JAOA did not receive the appropriate copyright releases, we were unable to publish this abstract.
856
From Rags to Riches: An International Journey
Jaime C. Morris, OMS II
Lincoln Memorial University-DeBusk College of Osteopathic Medicine, Harrogate, Tennessee
Haiti is the poorest country in North and South America. Eighty percent of the population lives below poverty. Haitian dependence on agriculture combined with frequent, devastating natural disasters have exacerbated an already challenged economy. The Chadasha Foundation, founded by a group of Christian doctors and business people deeply impacted by the dire situation, have a base of operation located on the Dominican and Haitian border consisting of a hospital, orphanage, and worship area. During spring break, I went to Haiti with fellow students. During our time, we traveled to local bateys to provide medical supplies and primary care evaluations to the locals. Our medical team included medical students, primary care physicians, and an ophthalmologist. We were able to assess and treat patients with a variety of medical complaints, including infections, high blood pressure, and headaches. While based out of the medical mission field, we travelled into the bateys each day. We provided our own supplies, medications, and equipment, and we often set up “clinic” at churches and schools.
This summer, I was able to travel to an international medical program in translational neurosciences, hosted by the University Medical Center Groningen (UMCG) in the Netherlands. The Netherlands boast the 16th largest economy (primarily industry-based) in the world. The UMCG was founded in 1796 and now consists of more than 1000 beds, treating more than 31,458 people as inpatients and nearly 620,300 people as outpatients annually. The UMCG offers a range of specialist patient care, such as open-heart surgery, neurosurgery, transplantations, and specialized intensive care units. The hospital not only has the “standard diagnostic facilities” of major hospitals, but it also offers specialized diagnostic techniques such as computed tomography, magnetic resonance imaging, and positron emission tomography. The UMCG is a leader in the field of health care for the entire northern part of the Netherlands.
I was fortunate to span the extremes of health care. In Haiti, the people had no preventive health care and were excited with the gift of toothpaste. In Groningen, the hospital provided elite equipment and diagnostics and produced cutting-edge research. As a medical student, I cannot put into words how exciting it is to experience the extremes. Haiti reminded me that the humanistic factor is priceless, the physical examination should never be lost, and our resources are underappreciated and often taken for granted. In the Netherlands, I had the opportunity to visit research laboratories, visit hi-tech units, and learn about electroencephalography and electromyography. Medicine is a field of extremes, and as a medical student, it is important to master the basics and understand the limitless options of medical research, all while never forgetting that medicine should be about the person, the patient.
857
Because the JAOA did not receive the appropriate copyright releases, we were unable to publish this abstract.

♦ Indicates abstract that won in the 2011 SOMA or BIOMEA Student Poster Competition.

⋄ Indicates recipient of the SOMA Student Research Fellowship.

As stated in the editorial by Joseph K. Prinsen, OMS VII, on pages 31 to 33, this issue of JAOA—The Journal of the American Osteopathic Association contains abstracts submitted through the Student Osteopathic Medical Association and entered into the 2011 Student Poster Competition, an annual judged event held during the Poster Session at the AOA Research Conference.

This issue of the JAOA also contains abstracts that were submitted to the student competition held by the Bureau on International Osteopathic Medical Education and Affairs (BIOMEA).

For more information about these competitions and to see a list of the first- and second-place winners, see Student Doctor Prinsen's editorial on the previous pages.

To enhance the readability of this special feature to the JAOA, all abstracts have been edited for grammar and basic JAOA style. The content of these abstracts has not been modified. Neither the AOA Council on Research nor the JAOA assume responsibility for the abstracts' content.

Editor' Note: A correction to abstract 837 was published in the April 2013 issue of The Journal of the American Osteopathic Association (JAOA) (2013;113[4]:271). In addition, a correction to abstract 843 was published in the March 2012 issue of the JAOA (2012;112[3]:108). The corrections have been incorporated in this online version of the article, which was posted April 2013. An explanation of these changes are available at http://www.jaoa.org/content/113/4/271.2.full and http://www.jaoa.org/content/112/3/108.full, respectively.

Experimental Groups No.
A: CO2 Laser incisions 8 (without NGF)
B: CO2 Laser incisions 8 with added NGF
C: Scalpel incision 8 (without NGF)
D: Scalpel incision 8 with added NGF
Experimental Groups No.
A: CO2 Laser incisions 8 (without NGF)
B: CO2 Laser incisions 8 with added NGF
C: Scalpel incision 8 (without NGF)
D: Scalpel incision 8 with added NGF
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