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School of Allied Health Professions Forum on Evidence-Based Medicine April 30, 2014 2014 Forum on Evidence-Based Medicine Each spring the School of Allied Health Professions sponsors a forum. This interprofessional event is intended as an opportunity for students and faculty in all eleven SAHP programs to share scholarly activity that supports evidence-based clinical practice. The primary goal of the scholarly activity that is presented in the forum is to promote the understanding of the research process in allied health. The ultimate goal is the continuous updating of best practices in clinical settings. There are three general categories of scholarly activity that are presented in this forum: research projects in which data are collected, analyzed, and interpreted; critical reviews of the literature which address a clinical question based on published, peer-reviewed research studies; and, educational exhibits which highlight either a specific pathology or new clinical procedure. The School of Allied Health Professions would like to thank the faculty and staff who have contributed time and effort to the success of this Forum. The complete book of abstracts is online at: www.unmc.edu/alliedhealth/forum.htm Annual School of Allied Health Professions Awards Ceremony MSC 3001 at 1:05 P.M. Poster Display and Reception Truhlsen Campus Events Center from 2:00-3:30PM Excellence in Research Ka-Chun “Joseph” Siu, PhD Excellence in Teaching Kathleen Volkman, PT, MS, NCS Outstanding Service Dennis Strauss, MD Educational Exhibits Clinical Laboratory Science Krystal Davis, Amanda Stastny, Ulrike Otten. An Interprofessional Guide to Laboratory Testing for Student-Run Free Clinics: A Reference Guide to Diabetic Diagnostics and Management 1 Computed Tomography Leicy Franklin. The Correlation between CT Scans and Childhood Cancer 2 Macey Fuhr. A Look inside Coronary Artery Disease 3 Ariel Heckman. Fibrodysplasia Ossificans Progressiva 4 Rachel Kettelhake. Understanding Esophageal Cancer While Utilizing Different Imaging Modalities For Diagnosing and Staging 5 Makenzie Shank. Comparison of Computed Tomography Perfusion and Magnetic Resonance Imaging Diffusion in Diagnosing Acute Ischemic Stroke 6 Jared Thompson. Contrast-Induced Nephropathy 7 Corey Andrews, Emily Bluedorn, Courtney Einspahr. Mycotic Aortic Aneurysm: an Incidental Finding 8 Sarah Liss, Lindsey Nannen, Andrea Sedlacek. Portal Venous Aneurysm 9 Heather Bell. High Definition Fiber Tractography 10 Hannah Coffman. Imaging Alzheimer's Disease with MRI 11 Tanner Foxhoven. Magnetic Resonance Imaging of the Fetus 12 Meghan McGoldrick. MRI’s Role in the Detection and Diagnosis of White Matter Disease 13 Karlyn Miller. Epilepsy Evaluation through Functional Magnetic Resonance Imaging 14 Tannis Reif. Diagnosis of Pulmonary Embolism with CT vs. MRI 15 Chad Schock. Composition of Metals: How Elements from the Periodic Table Affect MRI 16 Allison Hukill. Radium-223 Dichloride: Advanced Stage Prostate Cancer Treatment 17 Ahmed Naciri. Lymphoscintigraphy: Lymphoseek Tc-99m Tilmanocept vs. Tc-99m Sulfur Colloid 18 Lisa Bartenhagen, Tanya Custer. HPV Related Cancers 19 Diagnostic Medical Sonography Magnetic Resonance Imaging Nuclear Medicine Radiation Science Technology Education Radiography Jessica Backhaus. Breast Tomosynthesis: The Digital Future of Mammography 20 Olga Biletska. Salter-Harris Fractures: Radiologic Factors that Predict Premature Growth Plate Closure 21 Whitney Brooke. Imaging Modalities Utilized in the Diagnosis of Inflammatory Breast Cancer 22 Megan Bygland. Out With the Old, Flip the New: Flipped Classrooms for the Modern Learning Age 23 Conner Coffin. Using Automated Breast Ultrasound Systems to Image and Detect Masses in Dense Breast Patients 24 Blair Dixon. Müllerian Duct Anomalies: Diagnosing Uterine Didelphys 25 Molly Gallagher. Working Together for a Common Goal: Developing Interprofessional Activities among Radiation Science Professionals and other Healthcare Team Members to Promote Quality Patient Care 26 Christina Gregg, Tammy Jones. Mapping What Makes Humans Unique: The Human Connectome Project 27 Blair Hild. Imaging Thoracolumbar Burst Fractures 28 Alicia Hultquist. The Use of YouTube: Enhancing Student Learning in the Imaging Sciences 29 Brianna Jacobitz. Echocardiography: Congenital Heart Defects in Children 30 Tammy Jones. Positioning Imaging Science Students for Effective Learning 31 Katie Kuehn. Multiple Sclerosis in the Medical World 32 Jennifer Laughlin. Volunteerism among Radiation Science Professionals: A Generational Assessment 33 Sarah Meissner. Computed Tomography: Prognostic or Pathogenic 34 Brigette Root. Effectiveness of Antibiotic Treatment on Lower Back Pain: A Case Study 35 Emily Schlautman. There’s an App for ThatTM #Radiology #Medical Apps 36 Justin Williams. Catheter Ablation as a Means to Treat Atrial Fibrillation 37 Radiation Therapy Daniel Gunderson, Kristy Stevens. Advancements in Multiple Myeloma Treatment 38 Ashley Micek, Erin Rosales. Rapid Arc 39 Blair Thompson, Erinn Moritz. Pediatric Total Body Irradiation 40 Critical Reviews Physical Therapy Radiation Science Technology Education Celeste Baumert, Morgan Bugosh. Virtual Reality as Intervention for Patients with Chronic Stroke 41 Kristin Clough, Rashelle Smith. The Effect of Treadmill Training in Children and Adolescents with Cerebral Palsy 42 Annie Woodruff, Xin Zhang. Effectiveness of Botulinum Toxin A Injections on Motor Function and Gait Pattern in Children with Cerebral Palsy 43 Iman Ahmad, James Temme. Nutritional and Life Style Determinants of Radiation-Induced Oxidative Stress in Occupationally Exposed Workers 44 Research Projects Clinical Perfusion Andrew Beck, David Holt. Dynamic Roller Pump Occlusion Using Pressure Monitoring 45 Kailin Bellows, David Holt. The Risks of Extracorporeal Integrated Arterial Filters 46 Dan Gillespie, David Holt. Quantifying Gaseous Microemboli in Coated Arterial Line Filters versus Non-coated 47 Matthew Hansen, David Holt. Optimizing Platelet Function in ANH-Collected Blood 48 Kathleen Kubes, David Holt. Assessing the removal of potassium and plasma free hemoglobin using hemofiltration and centrifugation cell saver techniques 49 Robert Ledbetter, David Holt. Evaluating the need for a “clear and colorless” effluent in a cell saver’s wash cycle 50 Trent Little, David Holt. Integrating Apple iOS Technology into a Graduate Level Perfusion Curriculum 51 Ryan Robertson, David Holt. Removal of Complement C3a and C5a in Residual Cardiopulmonary Bypass Circuit Blood: A Comparison between Cell Salvage and Ultrafiltration 52 Kristie Steffens, David Holt. EDAC Evaluation for Strategic Placement of Arterial Filter Purge 53 Cytotechnology Medical Nutrition Physical Therapy Ria Ward, David Holt. Risk of Vacuum-Induced Air Embolism With Auto-Venting Arterial Filters 54 Nick Baker, Maheswari Mukherjee, Amber Donnelly. Survey of a Virtual Microscopy Teaching Module Utilizing Cell Block, Diff Quick and Pap Stained Slides 55 Vincent DeAgano, Maheswari Mukherjee, Amber Donnelly. Assessing the Use of Virtual Microscopy in Cytotechnology Education 56 Sarita Gawandi, Amber Donnelly, Elizabeth R. Lyden, Maheshwari Mukherjee. Comparative study between fine needle aspiration cytology glass slides and virtual images 57 Jillian Schneider, Amber Donnelly, Elizabeth R. Lyden, Maheswari Mukherjee. Digitalizing Cytology Specimens: Reproducibility of Virtual z-stacked Images by Ventana Scanner 58 Clare Becker. Elderly Adult Malnutrition in the Adult Intensive Care Unit (AICU) 59 Jessica Hinds. Adequate Protein Intake in the Elderly 60 Jenna Paseka. Prevalence of unintentional weight loss and the nutritional response upon admission to The Nebraska Medical Center 61 Heidi Pfeifer. Identification of Enteral Nutrition Target Goal at The Nebraska Medical Center 62 Nicole Rezac. The Prevalence of Malnutrition in Pediatric Patients at The Nebraska Medical Center (TNMC) 63 Carly Sorenson. Vitamin D Status Not Associated With Inflammatory Markers in Bariatric Patients 64 Betsy Becker, Katherine Jones, Patricia Hageman, Ruth VanGerpen. Integrating Best Evidence into Practice: Outcomes of a Community-Based 12-week Exercise and Education Intervention in Women with Cancer 65 Megan Bradberry, Sarah Kennedy. Tai Chi as a Balance Intervention for Older Adults: Web-based vs. Video-based? 66 Zach Douglas, Zach Long, Katherine Jones, Anne Skinner, Nicole Vanosdel. Geographic Distribution of Specialized Stroke Rehabiliation Services in Nebraska 67 Robert Fuchs. Pre and Post-Instruction Changes in Physical Therapy Student Item Scores for a Standardized Patient Assessment Tool 68 Troy Goetsch, Travis Jurgens. The Impact of Cognitive Level and Task Difficulty on Spatiotemporal Gait Measures During Dual Task Performance in Older Adults 69 Physician Assistant Radiation Science Technology Education and Clinical Laboratory Science Lukas Hoover-Rathjen, Patricia Hageman, Carol Pullen, Paul Dizona, Linda Boeckner. Comparison of Participants’ Perspectives about a Web-based Intervention Targeting Guided Weight loss in Overweight and Obese Rural Women 70 Chun-Kai Huang, Ka-Chun (Joseph) Siu. A Conceptual Model for Gait Maintenance in Patients with Diabetes 71 Joseph Norman, Bunny Pozehl, Kathleen Duncan, Melody Hertzog, Steven Krueger. Effects of Exercise Training versus Attention on Plasma B-type Natriuretic Peptide, 6-Minute Walk Test and Quality of Life in Individuals with Heart Failure 72 Michaela Schweitzer, Amy Schnoes. The Effectiveness of Massage Therapy on Weight Gain in Preterm Infants 73 Xin Zhang, Swati Surkar, Regina Harbourne, Sandra Willett, Max Kurz, Lynne Capoun. Intervention to Advance Postural Transitions and Problem Solving Ability in Children with Cerebral Palsy 74 Michael Huckabee, Ryan Wessel. Attitudes and Preferences of Potential Physician Assistant Program Applicants About Attending the University of Nebraska-Kearney Campus 75 Tamara Ritsema, Jeffrey Bingenheimer, Patty Scholting, James Cawley. Differences in the delivery of health education to patients with chronic disease by provider type, 2005-2009 76 Tamara Ritsema, Lorraine Williams. Doctor Satisfaction with the Physician Associate Role in Great Britain 77 James Temme, Karen Honeycutt, Stephanie Vas. A Preliminary Study of Bacterial Cultures Obtained from MR Imaging Equipment 78 EDUCATIONAL EXHIBITS ABSTRACT #1 An Interprofessional Guide to Laboratory Testing for StudentRun Free Clinics: A Reference Guide to Diabetic Diagnostics and Management Krystal Davis, Amanda Stastny, Ulrike Otten. Clinical Laboratory Science Education program, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE The University of Nebraska Medical Center’s student-run free clinics operate within an interprofessional paradigm. The SHARING, GOODLIFE, and RESPECT clinics address the specific needs of acute and chronic medical care, diabetic care, and sexually transmitted infection treatment, respectively. Diagnostic laboratory testing offered includes point-of-care, waived testing and send out tests. The presence of on-site laboratory services at the SHARING, GOODLIFE and RESPECT clinics has proven to be beneficial both in issues of quality and convenience. Specimen collection and handling by clinical laboratory science (CLS) students reduces the occurrence of pre-analytical error in the testing process. After collaboration with multiple members of the SHARING student advisory committee, it was recommended that reference guides for laboratory testing might be extremely useful tools. The reference guides could potentially aid the student healthcare providers in choosing the most appropriate, informative and cost effective laboratory tests for their patients. A needs assessment was conducted with a student provider survey, which confirmed the potential utility of laboratory guides. A reference guide to diabetic diagnostics and monitoring was created and is currently being approved for use at the SHARING Clinics. The intent is for future CLS students to create additional guides on the topics of sexually transmitted infections and overall health and wellness. This poster documents the process used in determining the student provider expressed need in ordering diagnostic tests and the endeavor to provide a useful tool to meet that need at the SHARING clinics ABSTRACT #2 The Correlation between CT Scans and Childhood Cancer Leicy Franklin. Computed Tomography Program, Division of Radiation Science Technology Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE In recent years, Computed Tomography (CT) scans have become more frequently used in the United States. This is due to the fact that computed tomography provides physicians with more information than with plain radiography and CT can be utilized to view any part of the body in a timely manner. During CT imaging, an x-ray tube rotates around the patient, producing multiple images at numerous angles, thus increasing the dose received by the patient. Although CT provides physicians with useful information they need to treat their patients, it also contributes to more exposure to the patient. It is important for physicians to understand the increased risk this poses for their patients, especially in the case of pediatric patients. Pediatric patients are at a greater risk in regard to radiation exposure due to their decreased body mass and frame size. Over the years, there has been stipulation that the doses of radiation children have received from CT scans has put them at risk for developing cancer. ABSTRACT #3 A Look inside Coronary Artery Disease Macey Fuhr. Computed Tomography Program, Division of Radiation Science Technology Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE The purpose of this research is to explore the different ways of imaging heart disease, specifically coronary artery disease (CAD). The benefits of using computed tomography in the imaging of CAD are evident. The quick scan times and quality images allow diagnosis to be made from this noninvasive procedure. Magnetic resonance imaging of the heart has also been beneficial and is working towards being combined with positron emission tomography to allow morphologic information and perfusion abilities of the heart to be imaged. Echocardiography uses sound waves to create images and can also be used to see venous or arterial blood flow as blue or red vessels. The images obtained through echocardiography are not as detailed as compared with CT/MRI imaging but the diagnostic quality of blood flow and muscle contraction is easily verified. Harmonic power Doppler imaging and mammography are also explored in short detail. The radiation risks and cost effectiveness of CT angiography compared to cardiac catheterization is no question. CT results in a larger radiation dose, while the cardiac catheterization is a more costly procedure. The future of cardiac imaging will most likely be seen looking at slices of a CT scan, because of the cost-effectiveness of the exam. ABSTRACT #4 Fibrodysplasia Ossificans Progressiva Ariel Heckman. Computed Tomography Program, Division of Radiation Science Technology Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE Fibrodysplasia ossificans progressive (FOP) is a rare genetic mutation disorder that occurs in one out of two million people around the world. This crippling disease allows growth of new bone outside of the skeleton, resulting in patients becoming “frozen” in place. Bone can grow in muscles, tendons, ligaments, and in the facia of the body. If a patient has FOP, they can usually be diagnosed at birth by possessing deformed great toes. An FOP patient will over time, become wheelchair bound. Life expectancy for the disease is 40 years of age. The progression of the disease occurs differently with every FOP patient. The disease can be triggered by any small amount of trauma to the body, resulting in an area of inflammation, or a “flare-up”, causing the ossification process of the soft tissue to begin. This exhibit will discuss the origin, clinical presentations, treatment and disease management, and the important role that imaging professionals play in an FOP’s patient’s life. Without proper education and awareness about the disease, an uneducated imaging professional may cause severe harm to an FOP patient. modalities including computed tomography, ultrasound, positron emission tomography, and barium contrast esophagrams that are effective in diagnosing, staging, and following this life changing disease. The various imaging modalities are also helpful for physicians and other healthcare professionals in formulating an effective treatment plan specific for each patient. There is a continuing effort by researchers to find more effective solutions to treat esophageal cancer each day. ABSTRACT #6 Comparison of Computed Tomography Perfusion and Magnetic Resonance Imaging Diffusion in Diagnosing Acute Ischemic Stroke Makenzie Shank. Computed Tomography Program, Division of Radiation Science Technology Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE Stroke is one of the leading causes of death in the United States. Imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI) employ certain scanning protocols such as angiography, perfusion, and diffusion to look for the origin and causes of specific types of stroke. The purpose of this exhibit is to help the radiographer compare the advantages and disadvantages of CT perfusion and MRI diffusion in diagnosing and treating acute ischemic stroke. ABSTRACT #5 Understanding Esophageal Cancer While Utilizing Different Imaging Modalities for Diagnosing and Staging Rachel Kettelhake. Computed Tomography Program, Division of Radiation Science Technology Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE Cancer has become more prominent nationwide. The number of individuals diagnosed with cancer each day is alarming. Even more concerning is the number of deaths from cancer every day. In the year 2012, nearly 1,500 people died of cancer each day. Esophageal cancer is one of many aggressive cancers impacting Americans. The early symptoms of esophageal cancer are difficult to distinguish from other esophageal abnormalities, therefore making it hard to correctly diagnose esophageal cancer early. Esophageal cancer, both squamous cell carcinoma and adenocarcinoma types, is unfortunately frequently diagnosed in an advanced stage. Healthcare professionals can help people reduce their possibility of getting esophageal cancer by educating individuals of the symptoms as well as the risk factors associated with esophageal cancer, in order to catch the cancer early. However, there are a number of imaging 1 ABSTRACT #7 Contrast-Induced Nephropathy Jared Thompson. Computed Tomography Program, Division of Radiation Science Technology Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE Contrast-induced nephropathy (CIN) is the 3 leading cause of hospital acquired renal failure and affects 150,000 patients annually. CIN is a preventable situation that accounts for hospital costs of over eight billion dollars annually. It is caused by a combination of the vasoconstriction effect of the contrast media and the cytotoxic effects of the parent benzene ring of iodinated contrast molecule. Once CIN occurs, there are no proven treatments and the best thing that can be done is to monitor the patient. Prevention is the best treatment for CIN. Prevention can be accomplished by being aware of risk factors, monitoring renal function, and being educated on other preventative measures. Other preventative measures include hydration, being aware of patient medications that can further reduce renal function, and tracking the amount rd and type of contrast media used. Incidence of CIN has decreased from 15% to 7% which proves that it is a very preventable condition. ABSTRACT #8 Mycotic Aortic Aneurysm: an Incidental Finding Corey Andrews, Emily Bluedorn, Courtney Einspahr. Diagnostic Medical Sonography program, Division of Radiation Science Technology Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE The focus of this poster is to share a case study of a mycotic aortic aneurysm discovered incidentally during a pelvic ultrasound exam. A mycotic aortic aneurysm is a bacterial infection of the aorta, which causes the aorta to balloon outwards. Mycotic aneurysms comprise 2.6% of all aortic aneurysms. Staphylococcus specis and salmonella are the primary infectious agents. The majority of patients are asymptomatic, but clinical manifestations may include fever, leukocytosis, back pain, GI bleed, neuropathy, and palpable mass. Sonography and computed tomography are imaging modalities used to diagnose aortic aneurysms. ABSTRACT # 9 Portal Venous Aneurysm Sarah Liss, Lindsey Nannen, Andrea Sedlacek. Diagnostic Medical Sonography program, Division of Radiation Science Technology Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE Portal vein aneurysms are a rare type of aneurysm, seen either extrahepatically or intrahepatically. Aneurysms are the result of a weakened vessel wall. The portal vein is considered aneurysmal when its diameter exceeds 1.5 cm in a healthy patient, and 1.9 cm in a patient with cirrhosis. Portal vein aneurysms are typically detected by sonography and followed up clinically. This poster will highlight a portal venous aneurysm detected by ultrasound in a young patient post-liver transplantation. ABSTRACT # 10 High Definition Fiber Tractography Heather Bell. Magnetic Resonance Imaging Program, Division of Radiation Science Technology Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE Injury induced trauma to the brain is one of the leading causes of permanent disability in the United States.1 1.7 million people sustain a traumatic brain injury each year, resulting in 30% of death related injuries.1 High definition fiber tractography (HDFT), a newly developed imaging technique, accurately displays the brain’s fiber network in colorful subvoxel resolution images using high-definition magnetic resonance imaging.3 Brain injuries may often lead to breaks in fiber tracts that cannot be visualized through traditional imaging techniques, making it difficult for clinicians to know exactly what brain functions have been affected and to predict whether there is long-term damage. High definition fiber tractography will aid in the diagnosis and treatment of injury induced brain trauma by allowing physicians to visualize and locate exact broken, compressed, or damaged neural connections within the brain’s fiber network. High definition fiber tractography is still at an early stage of development and is a continually evolving technology. HDFT carries the potential to become the future of diagnoses in patients who have sustained a traumatic brain injury and other neurological deficits. ABSTRACT #11 Imaging Alzheimer's Disease with MRI Hannah Coffman. Magnetic Resonance Imaging Program, Division of Radiation Science Technology Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE Alzheimer's disease (AD) represents the most prevalent form of dementia, accounting for 50-90 percent of all dementia within the United States. Currently, research is assessing and determining the optimal approach for Alzheimer's imaging, particularly through the use of magnetic resonance imaging (MRI). MRI excels in depicting soft tissue structures through the use of magnetic resonance and radiofrequency (RF) pulses which create images of the anatomy. The magnetic field, combined with the RF pulses, excite protons from within the subject, mainly hydrogen nuclei, to produce the images. Different MRI parameter controls can be manipulated to form images with varied contrast based on the behavior of fat and water in response to the magnetic field and applied RF pulses. The purpose of this exhibit is to discuss the advantages of utilizing MRI for diagnosis, evaluation and management of AD. ABSTRACT #12 ABSTRACT #14 Magnetic Resonance Imaging of the Fetus Tanner Foxhoven. Magnetic Resonance Imaging Program, Division of Radiation Science Technology Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE Epilepsy Evaluation through Functional Magnetic Resonance Imaging Karlyn Miller. Magnetic Resonance Imaging Program, Division of Radiation Science Technology Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE Imaging modalities used in the diagnosis of fetal abnormalities include ultrasound and magnetic resonance. These imaging modalities can greatly assist in the diagnosis of abnormalities that may be present within the developing fetus. The first fetal MRI dates back to 1983. Although, MRI has better contrast resolution than alternative imaging modalities, it is not always the first option. Ultrasound (which is relatively inexpensive) is more commonly the first imaging option when it comes to fetal imaging. Physicists and radiologists have, over time, vastly improved the fetal imaging protocols. Faster sequences allow technologists to more efficiently image the fetus. This is a major advantage because motion in fetal imaging can be very detrimental in MR imaging. With faster sequences, the fetus has less time to move around and cause blurred images. In many cases the mother is kept NPO prior to the exam to help reduce fetal motion. With ever growing technology, especially in the medical field, fetal MRI has a very bright future. No adverse effects have yet to be noted on follow-ups of children who had undergone in-utero MRI’s. Fetal MR imaging provides radiologists with diagnostic images allowing them to make more informed diagnostic assessments. ABSTRACT #13 MRI’s Role in the Detection and Diagnosis of White Matter Disease Meghan McGoldrick. Magnetic Resonance Imaging Program, Division of Radiation Science Technology Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE The majority of the brain is made up of white matter. This matter is made up of millions of microscopic nerve fibers. These nerve fibers are responsible for the signals the brain receives. As one ages, it is normal to lose a certain amount of white matter. This loss of white matter contributes to perceived “signs of aging” i.e. forgetfulness, confusion and so on. MRI is currently equipped with technology that is capable of tracking these nerve fibers and thus contributing to the collected data that is needed to understand the true cause and effect of the aging brain. Functional magnetic resonance imaging (fMRI) has been evolving since 1991, when it was first created. Brain fMRI is only one of the many ultra-fast imaging techniques that have arisen from conventional magnetic resonance imaging (MRI). fMRI is capable of capturing images of the brain during activity and rest. These sets of images can be manipulated to demonstrate the functional brain activity associated with particular tasks. If affected by certain pathologies, such as epilepsy, these images can show its affect on the motor, visual and language cortexes of the brain. Treatment planning can be based off of functional brain imaging to provide better outcomes. Research and advancements in fMRI are constantly evolving and providing new pathways for patient care. ABSTRACT #15 Diagnosis of Pulmonary Embolism with CT vs. MRI Tannis Reif. Magnetic Resonance Imaging Program, Division of Radiation Science Technology Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE A medical emergency can be described as a condition in which ten percent of patient’s not diagnosed within the first hour, will not survive. One of those conditions is a Pulmonary Embolism (PE). A pulmonary embolism is a blood clot that is found in the pulmonary arteries. The pulmonary arteries supply blood to the lungs. Patients with a history of deep vein thrombosis are at greater risk for a pulmonary embolism. This is due to the blood clot traveling from the extremity, where it originated, and into the lungs, creating a life threatening event. Due to the seriousness of this condition, it is important for a quick diagnosis. The most commonly utilized imaging modality for this condition has been a contrasted Computed Tomography (CT) scan. MRI chest scans are also currently being researched as a means to rule out a pulmonary embolism. As with any advancement, there are many improvements that need to take place before this secondary modality will be considered the “gold standard.” The purpose of this exhibit is to compare CT and MRI in the diagnosis of a pulmonary. ABSTRACT #16 Composition of Metals: How Elements from the Periodic Table Affect MRI Chad Schock. Magnetic Resonance Imaging Program, Division of Radiation Science Technology Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE The periodic table is organized into several groups: alkali metals, alkaline earth metals, transition metals, posttransition metals, metalloids, lanthanides, actinides, nonmetals, halogens, and noble gases. Each element group exhibits specific characteristics that are important to the field of magnetic resonance imaging (MRI). Each group also has different susceptibility to magnetic fields and is further categorized into diamagnetic, paramagnetic and ferromagnetic materials. The transition metal group contains ferromagnetic elements that can cause issues while scanning patients. Iron, cobalt, and nickel are ferromagnetic elements that are commonly used in metals. If a surgically placed object is made of materials that are magnetic or composed of alloys, then artifact or the distortion of an image may occur. Certain devices such as stents, pacemakers, tattoos, and aneurysm clips may be harmed during an MRI scan and could potentially harm the patient. By being aware of the different elements in the periodic table, the technologist can reduce the amount of damage done to a patient. ABSTRACT #17 Radium-223 Dichloride: Advanced Stage Prostate Cancer Treatment Allison Hukill. Nuclear Medicine Technology program, Division of Radiation Science Technology Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE Radium-223 dichloride (Ra-223) is the first in its class, alpha emitting radiopharmaceutical that targets areas of osteoblastic metastasis in advanced stage, castration resistant prostate cancer (CRPC). The research presents a review of the published literature detailing radium-223 dichloride as an advanced state prostate cancer treatment. The radiopharmacy, ALSYMPCA clinical trial, and efficacy will be discussed. Awareness and appreciation of this newly United States Food and Drug Administration approved radiopharmaceutical therapy and its efficacy will enable clinicians to thoroughly asses each advanced stage prostate cancer patient by planning and implementing the appropriate intervention. Radium-223 will assist in optimizing the length and quality of life of patients with advanced stage prostate cancer. The results demonstrate that radium-223 dichloride therapy has significantly delayed the onset of skeletal-related events (SREs), while improving pain response, as well as increased the length and quality of life in metastatic castration resistant prostate cancer (mCRPC) patients. Currently, when comparing the risks to the benefits ratio of Ra-223 therapy, it appears to be quite favorable. Considering the results from the ALSYMPCA trial, efficacy of Ra-223 therapy is reassuring. Furthermore, this therapy may improve the quality of life and survival of patients with other tumor types who suffer from bony metastases as well. Additional research and clinical trials will be necessary before Ra-223 therapy of other tumor types can be approved. ABSTRACT # 18 Lymphoscintigraphy: Lymphoseek Tc-99m Tilmanocept vs. Tc99m Sulfur Colloid Ahmed Naciri. Nuclear Medicine Technology program, Division of Radiation Science Technology Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE Lymphoscintigraphy is used to localize the first primary lymph node that drains a tumor site. This technique has been using technetium -99m sulfur colloid for the last thirty years. In this poster, we will compare Lymphoseek (technetium-99m tilmanocept), as a newly FDA approved agent that was specifically made for sentinel lymph node (SLN) mapping, to sulfur colloid. These agents will be compared to the characteristics that an ideal agent would exhibit. These are: standardized size & minimal manipulation, safe and relatively painless, high injection site clearance and uptake, good accumulation in SLN, reside in SLN and not pass to other secondary nodes. Results of this comparison showed that Lymphoseek ( technetium-99m tilmanocept) has small standardized size, high uptake in SLN and clears the injection site better than sulfur colloid, resides and accumulates in the SLN in higher amounts as compared to sulfur colloid. ABSTRACT # 19 HPV Related Cancers Lisa Bartenhagen, Tanya Custer. Division of Radiation Science Technology Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE Human Papillomavirus (HPV) is associated with more than 150 viruses. HPV is an infection of the basal epithelium and transmission can occur either by direct contact or during childbirth. More than 50% of sexually active people will be infected with some form of HPV during their lifetime. Two categories of sexually transmitted HPV include low-risk HPVs, which are not cancer causing, and high-risk, or oncogenic HPVs, which can lead to a cancer diagnosis. Malignancies found to be associated with HPV infection include cervical, vaginal and vulvar cancers, penile and anal cancers as well as cancers of the oropharynx. Treatment of HPV-related cancers often includes surgery, chemotherapy and radiation therapy. Health education and prevention is necessary to reduce cancers related to HPV infections. Education on abstinence and vaccinations are two methods proven to be effective. The role of the health care provider is to educate adolescents regarding the risk of sexually transmitted disease and ways to protect themselves from HPV-related cancers such as the cases included. ABSTRACT #20 Breast Tomosynthesis: The Digital Future of Mammography Jessica Backhaus. Radiography Program, Division of Radiation Science Technology Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE The use of mammography for early cancer detection is a widely accepted practice in many countries. Mammography can drastically reduce the mortality rates of breast cancer.1 However, standard mammography has limitations. It is limited by the superimposition of thick breast tissue. It can mislead the radiologist by making normal tissue appear abnormal, or it can conceal actual cancers.2 Digital breast tomosynthesis is a new tool in early detection methods. The breast anatomy can be complex. Breast cancer can appear all throughout the breast and in any breast tissue. Breast tomosynthesis is proving to be more useful than standard conventional mammography. It can accurately image through dense breast tissue more efficiently than conventional mammography. Moreover, research has shown that combining the use of standard conventional mammography and breast tomosynthesis has proven to be more effective than conventional mammography alone. Breast tomosynthesis can significantly reduce radiologist recall rates and detect breast cancer quicker and earlier. However, along with its advantages, breast tomosynthesis also has disadvantages such as image artifacts. Summing it all up, breast tomosynthesis is the future of mammography. It will better improve the rates of discovering abnormal breast tissue quicker. Adding breast tomosynthesis to routine breast cancer screening will ultimately improve cancer detection and should also help lower the radiologist’s recall rate.1 This exhibit highlights how digital breast tomosynthesis is improving the future of mammography and detecting abnormal tissue more accurately. ABSTRACT #21 Salter-Harris Fractures: Radiologic Factors that Predict Premature Growth Plate Closure Olga Biletska. Radiography Program, Division of Radiation Science Technology Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE This is a retrospective review of the literature studying Salter-Harris growth plate fractures that can cause premature epiphyseal closure in pediatric patients. Studies have attempted to confirm the relationship between the injury mechanisms, the radiologic pattern, the management, and the outcome of epiphyseal plates fractures in order to predict and reduce bone deformity and growth arrest in children. Based on initial radiographs, fracture displacements between the epiphysis and metaphysis were measured in millimeters. The amount of displacement was compared before and after reduction. Post reduction residual displacement was recognized as problematic when the physeal gap was >23mm. Depending on Salter-Harris fracture type, amount of displacement, age, and mechanism of injury, two types of treatment was performed: closed reduction or open reduction and internal fixation. If follow-up appointments with radiographic evaluation revealed the possibility of PPC, a computed tomography (CT) or magnetic resonance imaging (MRI) was recommended for accurate physeal gap measurement and surgical planning. ABSTRACT #22 Imaging Modalities Utilized in the Diagnosis of Inflammatory Breast Cancer Whitney Brooke. Radiography Program, Division of Radiation Science Technology Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE Breast Cancer is one of the leading causes of death in the United States. One of the most rare, aggressive forms of breast cancer is Inflammatory Breast Cancer (IBC). The importance of imaging modalities is critical in diagnosing IBC in order to detect this disease at an early stage. Mammography, ultrasonography, and magnetic resonance imaging are three of the most common imaging modalities used to detect IBC. The purpose of this exhibit is to focus on these three imaging modalities when diagnosing a patient with IBC. ABSTRACT #23 ABSTRACT #25 Out With the Old, Flip the New: Flipped Classrooms for the Modern Learning Age Megan Bygland. Radiography Program, Division of Radiation Science Technology Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE Müllerian Duct Anomalies: Diagnosing Uterine Didelphys Blair Dixon. Radiography Program, Division of Radiation Science Technology Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE With the medical world evolving with new information all the time, it is a wonder how students who pursue education in the medical profession can stay on top of all the information. It is hard for students to listen to a professor lecture for an hour and try to comprehend all of the information. A new concept of learning, called blended learning, is taking the traditional classroom and flipping it. Professors now post lectures online and use in-class time for students to get hands-on education whether it is in a simulation lab or in groups collaborating together to come up with a solution to a problem. The effectiveness of a flipped classroom has a positive effect to students who are exposed to it. ABSTRACT #24 Using Automated Breast Ultrasound Systems to Image and Detect Masses in Dense Breast Patients Conner Coffin. Radiography Program, Division of Radiation Science Technology Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE Dense breast tissue makes mammography interpretation challenging for radiologists because of its similar appearance to cancer. Because of the overlying tissue, dense breasts show up coarse and have white spots on the mammogram, similar to cancerous masses, which appear granular and white. Sonography has evolved as an adjunct to mammography in the diagnosis of breast cancer for women with dense breasts. Automated Breast Ultrasound (ABUS) is a newly developed technique of sonography used as a supplementary modality to mammography to allow for a closer look at breast tissue. This growing imaging system is cost effective, painless, and gives the radiologist a clearer look at the breast tissue. ABUS is approximately a fifteen minute automated scan of the entire breast that creates three-dimensional images. The machine takes three views each breast; these views include frontal, medial-frontal, and lateral-frontal. Currently the market has taken a “wait and see” approach for ABUS systems, but it is expected for the ABUS systems to be a part of imaging centers due to it’s low cost, rapid speed, and non-ionizing radiation. The female embryo’s reproductive system develops from the müllerian ducts.1-3 In some instances, the ducts do not form properly and anomalies of the uterus, cervix, and vagina occur. There has been a classification system developed to organize the different types of anomalies that may occur. One type of müllerian duct anomaly is uterine didelphys. Uterine didelphys is described as “two uteri and two cervixes with the duplication of the vagina.”1, 3-6 Diagnosing uterine didelphys may be a difficult task due to the unique feature of completely separate reproductive structures, more specifically, the duplication of the vagina. Ultrasonography and hysterosalpingography (HSG) exams are the most utilized imaging diagnostic exams to evaluate reproductive organ anomalies and infertility problems.1,3,5,713 Ultrasonography is usually the first imaging modality chosen to evaluate these female reproductive complications, followed by the use of HSG. Magnetic resonance imaging (MRI) is also an imaging method used to diagnose infertility and reproductive organ anomalies, although not used as frequently as ultrasonography and HSG exams.1, 6-15 The three imaging modalities each have strengths and weaknesses in accurately diagnosing and differentiating between the classes of müllerian duct anomalies. Research is continually underway, to discuss the accuracy of these imaging modalities in diagnosing and differentiating between the seven classes of female reproductive anomalies. ABSTRACT #26 Working Together for a Common Goal: Developing Interprofessional Activities among Radiation Science Professionals and other Healthcare Team Members to Promote Quality Patient Care Molly Gallagher. Radiography Program, Division of Radiation Science Technology Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE Interprofessional education is defined as, “an intervention where the members of more than one health profession learn interactively together for the explicit purpose of improving interprofessional collaboration and the health/welling being of a patient”. With the increasingly high rate of clinical procedures and advancement of technology in multiple health professions today, it is essential that healthcare professionals work together. Interprofessional education can be integrated at the pre-professional level and should be carried over to professional practice. The specific model that is discussed is the Meinersmann-Randall Transformed Model of Nursing Education or M-RTMNE. The M-RTMNE model has the components of theory acquisition, simulation, and a clinical application. Theory acquisition involves the aspect of integrated coursework at the preprofessional level. The simulation aspect gives preprofessionals a chance to develop important clinical skills. Once those skills are acquired in a simulation scenario, preprofessionals will move to the next step of clinical application. These three components are essential in developing an interprofessionally skilled health care professional. ABSTRACT #27 Mapping What Makes Humans Unique: The Human Connectome Project Christina Gregg, Tammy Jones. Radiography and CVIT Programs, Division of Radiation Science Technology Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE The National Institutes of Health’s Human Connectome Project is an ambitious research effort to uncover the brain’s neural pathways that underlie human function. The $40 million in grant funds have been awarded to a collaborating research consortia consisting of Washington University, University of Minnesota, Massachusetts General Hospital /Harvard University and the University of California Los Angeles. This highly coordinated research will use state-of-the-art imaging instruments, analysis tools and informatics technologies with the mission of freely sharing all resultant data with the research community at large. Altogether, the Human Connectome Project will lead to major advances in understanding of what makes each individual uniquely human and will set the stage for future studies of abnormal brain circuits in many neurological and psychiatric disorders. ABSTRACT #28 Imaging Thoracolumbar Burst Fractures Blair Hild. Radiography Program, Division of Radiation Science Technology Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE The thoracolumbar region is the most common site of injury to the spine, with half of those injuries being better described as burst fractures. Obtaining adequate images is vital to treatment planning. This exhibit compares imaging options for thoracolumbar burst fractures. Radiography, Computed Tomography (CT), and Magnetic Resonance Imaging (MRI) are viable imaging options. The various imaging techniques have advantages and disadvantages. ABSTRACT #29 The Use of YouTube: Enhancing Student Learning in the Imaging Sciences Alicia Hultquist. Radiography Program, Division of Radiation Science Technology Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE The Internet is continuing to grow and expand everyday with new websites, new users, and new technologies. With this growing form of media comes a change in the way people acquire their knowledge. The Internet has provided students with a way to gain information from all over the world without even having to leave their homes. There are many different varieties of learners in today’s world. YouTube is a great way for professors to combine learning styles to help get a message across to their students. In a pilot study regarding the perception and use of YouTube among college-level health education faculty, 41.7% of the respondents reported using YouTube in their courses to help engage their student’s interest. However, almost all were willing to take the time to learn about YouTube and ways to be able to incorporate as a learning resource for their students. ABSTRACT #30 Echocardiography: Congenital Heart Defects in Children Brianna Jacobitz. Radiography Program, Division of Radiation Science Technology Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE Congenital heart defects (CHD) are the most common type of birth defects, and are the cause of more deaths than any other birth defect. In the U.S., roughly 8 out of 1000 babies, approximately 1%, are born with a CHD.1 The importance of accurate diagnosis cannot be overemphasized. With advancements in technology, a CHD can be detected early with the use of an imaging modality called echocardiography. This exhibit will demonstrate that echocardiography is the best method in detecting CHD’s in children. ABSTRACT #31 Positioning Imaging Science Students for Effective Learning Tammy Jones. Radiography and CVIT Programs, Division of Radiation Science Technology Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE Effective student learning is the goal of any educational curriculum. In order to facilitate effective student learning, cognitive theories of knowledge acquisition and pedagogical frameworks and delivery will be examined. A literature review of relevant scholarly resources was conducted to provide a foundational knowledge base for the constructs of cognitive theory and pedagogical frameworks discussed. The cognitive theories employed include; working memory, attention, practice, repetition and encoding. The pedagogical framework and delivery models employed include; blended learning, teacher and student centered learning, technology in education, and assessment measures. From the foundational literature review, a discussion regarding the traditional and recommended environments for effective learning will be explored, followed by strategies for evaluation. The cognitive theories coupled with the pedagogical framework and delivery models will show that the recommended environment is most conducive for fostering effective student learning in a fundamental imaging science course. ABSTRACT #32 Multiple Sclerosis in the Medical World Katie Kuehn. Radiography Program, Division of Radiation Science Technology Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE Multiple Sclerosis (MS) is one of the most common debilitating pathologies seen in young adults. Although it manifests each patient differently, each patient has a constant struggle. To initially diagnose the disease there are three diagnostic tests that may be used; spinal tap/lumbar puncture, visual evoked potentials, and MRI. Of the three, MRI is considered to be the main diagnostic tool for imaging patients with MS. MRI scans can visualize MS lesions in the brain. These lesions are damages in the myelin sheath that surround the axon, and weaken or diminish nerve conductivity. Through these lesions you can tell the age of them, which can be interpreted as how long the MS has been affecting the patient, and how progressed the disease is. With this information the treatment plan can be set in place. Treatment can be conventional with pharmacological treatment, while the others forms of treatment can be considered as less conventional such as physical activity to maintain physical ability and reduce fatigue. Caregivers may suffer from a different form of fatigue, compassion fatigue. This fatigue is due to contact with suffering, overexposure, and increased stress. To cope with this fatigue the caregiver must acknowledge certain thoughts and feelings that may come about when helping patients. By coping with compassion fatigue, there is less tension in the relationships and a better well-being with both the patient and caregiver. ABSTRACT #33 Volunteerism among Radiation Science Professionals: A Generational Assessment Jennifer Laughlin. Radiography Program, Division of Radiation Science Technology Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE Maintaining and introducing new volunteers within an organization is advantageous to success. The American Society of Radiologic Technologists produced a survey to explore the generational differences in volunteerism among radiation science professionals. Their research determined that while a majority of professionals have at one point or currently participate in a volunteer activity, they do not contribute within their profession. The common barrier was cited as being uninformed as to the options available within ASRT. The youngest age group surveyed resulted in the lowest percent of people who have volunteered for the ASRT. Those currently volunteering represent less than eight percent of members across all of the generations surveyed. There are varying motives for volunteering ranging from personal satisfaction to aiding in career advancement to interest in learning new skills. While there are ample opportunities to volunteer in formal or informal settings obstacles continue to hold individuals back. In order for organizations to continue operating with costs as low as possible, they should attempt to boost volunteer numbers. ABSTRACT #34 Computed Tomography: Prognostic or Pathogenic Sarah Meissner. Radiography Program, Division of Radiation Science Technology Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE Since its invention in the 1970s, computed tomography (CT) has been a topic of interest and study. Advances in technology have only increased that attention. Today, CT scans have many capabilities; including 3D imaging, faster scan times, and the ability to image a larger area with organs from many systems. Advancements in CT appeals to both physicians and patients as these developments lead to an increased confidence in diagnosis and treatment. Unfortunately, these vast capabilities are acquired using doses of radiation that are higher than those of conventional radiography, a fact that is misrepresented and misunderstood in both interested populations. High doses of radiation have been linked to carcinogenesis. While the dose of one CT scan is comparable to the environmental radiation dose for one year, its levels are still below the carcinogenic correlation. However, when considering one of the main uses of computed tomography, screenings, the link can be considered. If CT scans are used cumulatively, the dose to the patient increases, potentially reaching that cancerous dose level. This is of concern when taking into account the population as a whole. Applying the principle of as low as reasonably achievable (ALARA) will guarantee that every scan has a medically indicated need, benefit and purpose that outweigh the risk, and dose that is the lowest possible without sacrificing image quality. By promoting and educating others on this principle, the radiation dose will be significantly decreased, one scan at a time. ABSTRACT #35 Effectiveness of Antibiotic Treatment on Lower Back Pain: A Case Study Brigette Root. Radiography Program, Division of Radiation Science Technology Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE Chronic lower back pain is a major disability among American adults. Different treatments work for particular cases, but the universal use of intravenous (IV) antibiotics is being questioned. Antibiotics have been proven as successful treatment for osteomyelitis, but are now being researched as a successful remedy for a broader range of chronic lower back cases, especially herniated discs. A 54-year-old male with a herniated L5-S1 disc was the focus of the case study. Infected with streptococcus bacterium, it was treated with eight weeks intravenous therapy of Vancomycin and other medications. Studies have validated the effectiveness of intravenous antibiotic therapy as the first step in healing discitis and chronic lower back pain in general. ABSTRACT #36 There’s an App for ThatTM #Radiology #Medical Apps Emily Schlautman. Radiography Program, Division of Radiation Science Technology Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE Mobile medical applications are being created for radiologists with the goal that they will be able to diagnose patient images from mobile devices. Mobile devices, such as the iPad, have proven to show radiologic images successfully for radiologists to use. The alternative approach with using mobile devices for viewing and making a diagnosis could prove to be immensely helpful in emergency conditions when no workstations are available for the radiologist. There are apps specifically designed for viewing a patient’s data and images. Some of these apps include mobile MIM and OsiriX. They are available on iTunes and can be downloaded onto the iPhone or iPad. This advancement in radiology could improve the efficiency in terms of the time it takes the radiologist to read an image. Faster dictations due to the availability of seeing the images on a mobile device will result in quicker reports. The use of mobile devices would not replace the workstations for radiologists, but rather it would advance their ability for fast response to patient care. ABSTRACT #37 Catheter Ablation as a Means to Treat Atrial Fibrillation Justin Williams. Radiography Program, Division of Radiation Science Technology Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE Nearly 2.5 million Americans have atrial fibrillation (AF), which is the most common type of arrhythmia. As the population ages, AF is becoming more common. A heart has four chambers, the top two being atriums and the bottom two ventricles. In a heart with normal rhythm the atriums and ventricles beat separately from one another allowing the other to expand while it is contracting. During AF an atrium beats erratically, not giving itself enough time to contract and expand properly. Typically, patients diagnosed with AF are given antiarrhythmic medication. However, there are other remedies besides medications that can be utilized to treat atrial fibrillation, such as catheter ablation (CA). The use of fluoroscopy, in the interventional radiology suite, provides the necessary guidance of a catheter in a CA procedure which allows patients to receive treatment that is more effective than antiarrhythmic medications and less invasive than open heart surgery. The recovery time for CAs are relatively short compared to the more extensive heart procedures. However, although CA is effective there are still risks, complications, and a chance of recurrence associated with it. ABSTRACT #38 Advancements in Multiple Myeloma Treatment Daniel Gunderson, Kristy Stevens. Radiation Therapy program, Division of Radiation Sciences Technology Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE Multiple myeloma is a cancer caused when a plasma cell, which is naturally present in the bone marrow, becomes malignant. When there is only one plasma cell tumor, it is known as a solitary plasmacytoma. However, the presence of numerous plasmacytomas is diagnosed as multiple myeloma. For years, those suffering from advanced multiple myeloma have hoped to find a better treatment than the modern day multi-modality approach that is currently used. Recent statistics show unfortunate trends in survival from this standard treatment regimen. Between the years of 2002 and 2008, a five-year survival rate of 43 percent was stated. With the projected 24,050 new cases in 2014, this is an alarming value.1Advancements in research have returned new ideas for treatment, and the success of immunotherapy is being reviewed. ABSTRACT #39 Rapid Arc Ashley Micek, Erin Rosales. Radiation Therapy program, Division of Radiation Science Technology Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE Treatment of late-stage nasopharyngeal carcinoma (NPC) is challenging due to the close proximity of lesions to nearby organs at risk (OARs). Highly conformal radiation therapy techniques are extremely important, especially when these tumors are often extensive and extend into nearby tissues such as the spinal cord, brain stem, and temporal lobes. A study by Queen Elizabeth Hospital in Hong Kong, China explored the dosimetric differences amongst TomoTherapy, sliding-window intensity-modulated radiotherapy or IMRT, and RapidArc. In addition to dosimetric parameters, monitor units of individual plans and expected delivery time were recorded as well. The authors hope that their research may serve as a guideline to aid oncologists in the selection of patients for the appropriate treatment technique. ABSTRACT #40 Pediatric Total Body Irradiation Blair Thompson, Erinn Moritz. Radiation Therapy program, Division of Radiation Science Technology Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE Total Body Irradiation (TBI) is a type of low dose radiation therapy treatment that delivers a homogenous dose to the entire body. TBI in conjunction with chemotherapy has proven useful for eradicating residual malignant or genetically disordered cells, and for immunosuppression prior to hematopoietic stem cell transplant. In pediatric total body irradiation there are several techniques utilized. When comparing standard and helical TBI treatment studies have found only slight differences between the two techniques. The standard technique and a new helical tomotherapy technique for pediatric total body irradiation will be discussed. CRITICAL REVIEWS ABSTRACT #41 Virtual Reality as Intervention for Patients with Chronic Stroke Celeste Baumert, Morgan Bugosh. Division of Physical Therapy Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE A promising new technique is emerging in stroke rehabilitation. Virtual reality (VR) is a computer-simulated environment that allows experience and interaction between the users and virtual objects. In the physical therapy rehabilitation, it allows patients learn and exercise in a safe, three-dimensional environment that a physical therapist can adjust according to each patient’s needs. In order for clinicians to perform evidence-based practice, it is necessary to examine the body of research regarding the effectiveness of VR as a clinical intervention. The purpose of this paper was to review studies on the benefits of VR in combination with traditional physical therapy compared to traditional physical therapy alone. Reviewers systematically searched databases (PubMed 20042014, Google Scholar 2000-2014) for studies using VR as an intervention for people who had suffered from a stroke. This paper includes studies that only used adults as subjects, had a control group that received only traditional physical therapy, and that did not exclusively examine the hand. In addition, the outcome measures had to be valid and reliable. Ultimately, three articles were used which met the desired criteria. This systematic review summerizes that there is evidence showing that the use of VR in combination with traditional physical therapy is significantly more effective for patients with chronic stroke than traditional physical therapy alone. In addition, only mild negative side effects like motion sickness were noted. On average, the vast amount of benefits outweighed the minimal risks. However, due to the novelty of VR, standardization of the best types of VR still needs to be researched. With advancing technology, hopefully one day VR can become more affordable and thus more accessible to a wider population of stroke survivors. ABSTRACT #42 The Effect of Treadmill Training in Children and Adolescents with Cerebral Palsy Kristin Clough, Rashelle Smith. Division of Physical Therapy Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE Cerebral Palsy (CP) is an umbrella term for a group of non-progressive neuromuscular disorders resulting from brain lesions acquired before, during, or after birth. The motor impairments associated with CP can significantly affect ambulation. Physical therapists have and continue to utilize treadmill training as a method to improve gait for these patients. Many studies have been conducted to evaluate the effectiveness of treadmill training and conventional physical therapy in children/adolescents. This paper compared four randomized controlled trials to evaluate the efficacy of treadmill training (partial body weight support and no body weight support) and conventional physical therapy. The research articles were selected based on their inclusion criteria, reproducibility, and publication date (within the last 5 years). Treadmill training without body weight support (TTWBWS) appears to provide more benefit to children with CP at Gross Motor Function Classification System level I-III as compared to conventional therapy interventions, but both training methods improved ambulation overall compared to baseline. Partial body weight support treadmill training appears to be no more effective than conventional interventions. More research is needed for TTWBWS and exploration of combined treadmill and conventional physical therapy interventions. ABSTRACT #43 Effectiveness of Botulinum Toxin A Injections on Motor Function and Gait Pattern in Children with Cerebral Palsy Annie Woodruff, Xin Zhang. Division of Physical Therapy Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha NE Botulinum toxin type A (BTX-A) injections decrease the spasticity of lower limb muscles, but it is unknown whether it has benefits on functional outcomes and gait patterns in children with cerebral palsy (CP). In addition, limited research has examined the effectiveness of BTX-A injection by comparing with typical physical therapy (PT) care. The purpose of this review is to assess treatment effects of BTX-A on walking of children with spasticity CP compared with typical PT care. We systematically searched the databases CINAHL, Cochrane, PubMed and limited our selected papers to randomized control trials (RCT) published since the year 2000. Studies were considered eligible for inclusion in the review if they evaluated the efficacy of BTX-A for the treatment of leg spasticity in children with CP and compared the results with typical PT care. Only studies published in English were included. The methodologies were assessed by two reviewers. Meta-analysis was not possible because results were presented in an incompatible form. Five RCT papers were included. Two studies demonstrated a significant improvement of gait kinematics and decrease of spasticity in weeks 6 and 12 for the BTX-A group, but these significant differences were not maintained at week 24. The BTX-A group also had better Gross Motor Function Measure (GMFM) and problem scores at 12 and 24 weeks, with no difference on energy cost. Another study from El-Etribi and colleagues had similar results. One study showed BTX-A with comprehensive rehabilitation had no improvement in lower limb muscle activation patterns during gait but was effective in improving gait kinematics. The final study showed that though there were some changes in muscle tone with BTX-A injections, no group differences were found for gait analysis, GMFM-66 or the Pediatric Evaluation of Disability Inventory (PEDI). Though evidence is controversial in regards to this topic, the use of BTX-A with typical physical therapy care seems to improve some functional outcomes and gait kinematics compared with usual physical therapy care alone. Due to the limited number of RCT papers, more research should be done regarding this BTX-A intervention. ABSTRACT #44 Nutritional and Life Style Determinants of Radiation-Induced Oxidative Stress in Occupationally Exposed Workers Iman Ahmad, James Temme. Division of Radiation Science Technology Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha NE Oxidative stress results when the balance between the productions of reactive oxygen species (ROS) exceeds the antioxidant capability of the target cell. It has been shown that ionizing radiation (IR) produces ROS in living systems that leads to an oxidative damage to cellular proteins, lipids, and DNA. Cells have several cellular enzymatic and nonenzymatic antioxidants that detoxify ROS and protect the cell from oxidative damage. Medical x-ray workers are occupationally exposed to low level IR, which may lead to oxidative stress and affect their antioxidant status. In this exhibit a review of the effect of changing life style, such as cigarette smoke and dietary manipulations on radiationinduced oxidative stress on x-ray workers have been discussed. Three research articles were selected for review. A study by Klucinski et al., 2008 showed that a significant decrease of antioxidants GPx, SOD and CAT activity in x-ray groups as compared to controls was observed. A second study by Kayan, et al., 2009 showed significant increases in blood LP levels in the smoker and nonsmoker x-ray group when compared to age-matched controls, emphasizing the role of oxidative damage in the pathogenesis of ionizing radiation and smoke in blood. In the third study, Zeraatpishe et al., 2011 showed that oral administration of lemon balm infusion in x-ray groups resulted in a significant improvement in antioxidant enzymes level and marked reduction in LP. The results of the review in this exhibit can be used to address a major awareness for improving occupational radiation protection. RESEARCH PROJECTS ABSTRACT #45 Dynamic Roller Pump Occlusion Using Pressure Monitoring Andrew Beck, David Holt, MA, CCT. Clinical Perfusion Education program, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE Clinical Relevance: Various occlusion techniques are currently utilized to set occlusion in the DeBakey roller pump for cardiopulmonary bypass: the traditional static occlusion method, pressure drop method, and the so-called dynamic method. The potential for red cell hemolysis, spallation, and retrograde flow leading to under perfusion illustrates the importance for proper occlusion. This research investigates the possibility of establishing a dynamic pump occlusion technique that more accurately depicts flows seen during cardiopulmonary bypass by using pressure monitoring. Methods: This study used three miniature circuits of different sized polyvinylchloride tubing (1/16” x 3/8”, 3/32” x 3/8”, 3/32” x ½”) at different flows (1l/min, 2l/min, 3l/min, 4l/min) in a double-headed roller pump to test the ability of setting occlusion to a predetermined pressure point established by the static occlusion technique. 6 liters of anticoagulated bovine blood, anticoagulated with acid citrate dextrose (ACD) and diluted to 32% hematocrit, acted as the reservoir and circuit solution. An IWX/214 data acquisition unit and LabScribe 2 software connected to a pressure transducer on the outlet of the circuit created a pressure waveform generated by the roller heads. The systolic pressure on the waveform was monitored to establish a goal pressure point. With the pump set to an unoccluded setting and off, the pump was turned up to a predetermined flow as read by the digital display of the pump head module and occlusion was adjusted until the desired pressure waveform was visualized. Each attempt was recorded as successful if adjusted to within ≤ 3 “clicks” of baseline occlusion. Results: Out of the 45 occlusion samples that were tested, 31% were successfully adjusted in ≤ 3 “clicks” (95% CI: 0.1758, 0.4464) meaning we are 95% confident that the true proportion of successes ranges from 18% to 45%. A HemoCue Plasma/Low Hb Photometer was used on blood samples to reveal plasma free hemoglobin (PFH) levels of 20mg/dl pre data collection and 30mg/dl post data collection respectively. Conclusion: The overall success rate of this study indicates that dynamic pump occlusion with pressure monitoring at high flows as a consistent means for setting pump occlusion may be possible but needs further research. ABSTRACT #46 The Risks of Extracorporeal Integrated Arterial Filters Kailin Bellows, David Holt. Clinical Perfusion Education Program, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE Arterial filters integrated into the oxygenator are becoming more widely used during extracorporeal circulation (ECC) because of their benefits. However, minimal research has been conducted exploring the risks of using this type of arterial filter. The purpose of this research was to explore potential risks that may exist with the use of an arterial filter integrated into the oxygenator during ECC. The potential risks of focus were related to pressure drop, purge line shunting, and visibility of emboli. The performance of the integrated arterial filter throughout these risks was also compared to the performance of a conventional stand-alone arterial filter and a circuit with no arterial filter throughout the same risks. A one-way ANOVA test indicated that the stand alone filter had a significantly higher pressure drop (16.8 +/-2.2 mmHg) than the integrated filter and no filter. The statistical test also indicated that the integrated filter had a significantly higher volume (182.4 +/-8.5 mL) shunted via the purge line than the stand alone filter and no filter. Lastly, Fisher’s Exact test determined that there was a significant difference in terms of visibility between the integrated filter (38.5%) and the stand alone filter (100%) and the integrated and no filter (100%). These results suggest more risk exists with the use of an arterial filter integrated into the oxygenator during ECC related to increased shunting and decreased visibility but less risk exists with the use of an arterial filter integrated into the oxygenator during ECC related to pressure drop. ABSTRACT #47 Quantifying Gaseous Microemboli in Coated Arterial Line Filters versus Non-coated Arterial Line Filter Dan Gillespie, David Holt. Clinical Perfusion Science Education program, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE Arterial line filters incorporated into an extracorporeal circuit provide a last resort for defense against passage of emboli before entering the patient. Gaseous emboli provide a drastic hurdle for cardiopulmonary bypass during cardiac procedures for perfusionists. Cerebral microemboli are the main cause of cognitive dysfunction after coronary bypass grafting (Borger, 2001). Many of the gaseous microemboli are introduced during perfusion interventions such as when air is injected into the venous side of the extracorporeal circuit. The arterial line filter is placed on the arterial side of the oxygenator in the circuit and serves as the last line of defense for removing particulate and emboli. Many new advances in arterial line filters have provided substantial protection for patients. Coating the filter with heparin or endothelium-like coatings is one such technique that has become widely popular. The main goal of these coatings is to provide a replicative endothelium surface for blood interaction to avoid complement activation. This research investigates gaseous emboli with regards to the counts and volume of emboli when comparing coated versus non-coated filters. This study utilized a miniaturized extracorporeal circuit with a Terumo Capiox SX 25RX oxygenator, ½” venous tubing, 3/8” arterial tubing, and various arterial line filters. A double-headed Debakey roller pump was utilized with a flow of 3 liters/min for each trial. The Terumo emboli detection and classification quantifier (EDAC) was utilized to count the emboli. Bovine blood was the fluid of choice for the circuit. It was diluted to 25% HCT, anticoagulated with acid citrate dextrose, and heated to 37 degrees Celsius. A postoxygenator EDAC transducer, pre-filter transducer, and postfilter transducer was used on each trial. 15 mL of air was introduced pre-filter for each trial. Three trials were done for each filter. Five filters were used for a total of 15 trials. Three coated filters were used. Two non-coated filters were used. The data was collected and exported to an EXCEL document for statistical analysis. Data were evaluated with a repeated measures ANOVA model to account for the correlated nature of the paired data produced from the before and after measurements. It has been show in this research that a significant difference in coating does not exist for the Before load measurements (p=.32) whereas, there is a significant difference for the comparison of coating for the after load measurement (p=.007) when compared to the non-coated filters. A significant difference in coating does not exist for the before measurements (p=.35) whereas, there is a significant difference for the comparison of coating for the after measurement counts (p=.004) when compared to the noncoated counts. ABSTRACT #48 Optimizing Platelet Function in ANH-Collected Blood Matthew Hansen, David Holt. Clinical Perfusion Education program, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE Introduction: Acute normovolemic hemodilution, or ANH, is a technique employed preoperatively that reduces the patient’s RBC mass by removing whole blood, and replacing the volume removed with a colloid/crystalloid just prior to surgery. The intention is to reduce the amount of RBC loss during the intraoperative, and immediate postoperative period by preserving a portion of RBC mass in the ANH container. This blood is then returned at the end of the case, or when the patient meets the criteria for transfusion. While this technique yields many benefits, a reduction in postoperative bleeding, and possible elimination of the patient’s need for allogeneic blood products, has not been reported consistently in current literature. This study aimed to determine a treatment for this blood that may better preserve platelet function in order to reduce bleeding, and the subsequent need for allogeneic transfusions. Methods: Fresh human blood samples were obtained from 18 subjects. One was used as a baseline, while the other four were utilized as a control and three experimental groups. After three hours of exposure to a combination of rocked vs. unrocked, and room temperature vs. physiological temperature, the samples were compared to baseline. All samples were run on a Sonoclot Analyzer for determination of ACT, clot rate, and platelet function. Results: The results from this study show that of the four treatment groups, only samples stored that were rocked, and at room temperature, significantly preserved platelet function. For both ACT and clot rate, only the control treatment (unrocked, room temp) sample was found to not statistically differ from the baseline values. Conclusions: In conclusion, this investigation has shown that the current protocol, or lack thereof, dictated by the AABB for ANH-collected blood, does not best preserve platelet function during the operative time period until reinfusion. This research has shown that simple rocking of the blood may, in fact, aid in platelet preservation, and reduce postoperative bleeding. This reduction in bleeding also may reduce the number of required allogeneic transfusions seen in cardiac surgery. ABSTRACT #49 ABSTRACT #50 Assessing the removal of potassium and plasma free hemoglobin using hemofiltration and centrifugation cell saver techniques Kathleen Kubes, David Holt. Clinical Perfusion Education program, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE Evaluating the need for a “clear and colorless” effluent in a cell saver’s wash cycle Robert Ledbetter, David Holt. Clinical Perfusion Education program, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE Objective: The use of autologous blood continues to be a primary treatment option for patients with the most commonly used techniques including cell salvage with centrifugation and hemofiltration. Both techniques have advantages and disadvantages with hemofiltration being ideal as it conserves the platelets, albumin, and coagulation factors while removing excess fluid. However it has been unsuccessful in removing plasma free hemoglobin and potassium to levels lower than what is found in cell salvage processing. This study aimed to explore a new technique of hemofiltration using a wash medium to aid in the removal of excess potassium and removal of plasma free hemoglobin than cell salvage with centrifugation. Methods: Bovine blood was placed in a 7-gallon bucket with anticoagulant. The blood was diluted using sodium chloride to simulate the hemodilution of blood commonly seen in surgical patients. The potassium levels were increased to approximately 10 mEq/L. Two groups were used to process the blood, Group A using hemofiltration with 0.9% NaCl wash medium and Group B using cell salvage with centrifugation. The hematocrit, potassium levels, and plasma free hemoglobin levels were analyzed pre and postprocessing. Results: In all five trials, the remaining potassium and plasma free hemoglobin was higher in the hemofiltration group versus the cell saver with centrifugation group. The amount of remaining potassium and plasma free hemoglobin in the hemofiltration blood was significantly higher than in the cell salvage with centrifugation blood when analyzed with a t-test (p = 0.001 for both tests). Conclusions: When comparing the plasma free hemoglobin levels and potassium levels in post-processed hemofiltrated blood and cell salvage with centrifugation blood, cell saver with centrifugation continues to be the superior method in eliminating both potassium and plasma free hemoglobin. Background: The use of cell salvage provides benefits such as removal of plasma free hemoglobin, leukocytes, potassium, as well as hemoglobin concentration. To ensure that a quality wash of the salvaged blood has occurred, a “clear and colorless” effluent was established as the gold standard. In effort to determine if the effluent’s color necessitates an efficient wash, this study examines the characteristics and effectiveness of two cell savers, one that observes the standard and one that does not. Methods: Bovine blood was placed in a 5-gallon bucket with anticoagulant. The blood was exposed to atmospheric air via a roller pump. This was done to simulate the blood to air interface that occurs with suction tubing. In effort to replicate bypass, the blood was continuously pumped through a heat exchanger via a roller head pump. Four protocols were established, three with the CS5 and one with the Autolog. Twelve trials were performed for each protocol; platelet count, hemoglobin/hematocrit, white cell count, potassium level, and plasma free hemoglobin were measured both prior to cell salvage and post cell salvage. Results: For the primary outcome of percent PFH removal, there was no significant difference between the mean differences of the control and experimental protocols For Potassium removal, there was not a significant difference between Protocol B, but there is a difference between the control and Protocols C and D. For the endpoint of leukocyte removal there is not a difference between the control and mean difference for Protocol D, but there is a difference between the control and Protocols B and C. In regards to platelet removal there is not a difference between the control and the mean difference for Protocols B, C, and D. For the outcome of hemoglobin concentration there is a difference between the control and the mean difference for Protocol B, but there is not a difference between the control and the mean difference of Protocols C and Protocol D. Conclusion: For the primary marker of plasma free hemoglobin removal, the presence of a “clear and colorless” effluent line does not necessitate a higher quality of product when compared to an effluent line that has particulate remaining in it. ABSTRACT #51 Integrating Apple iOS Technology into a Graduate Level Perfusion Curriculum Trent Little, David Holt. Clinical Perfusion Education program, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE Technology is everywhere; it is an evolving and striking entity born from the industrial revolution that creates jobs and fosters change. Thus, some of the fastest areas of expected growth are centered on technological advancement. As such, both up and coming professionals and those well versed in their field are learning to utilize its capabilities. One may be tempted to inquire however, “is technology being fully utilized in the educational arena and can it be soundly integrated into a curriculum?” Currently, those that believe that a sophisticated mobile technology can benefit a student of higher learning are addressing this concept. Though as of now, it is scarce to find a study that gains insight into how tablet administration affects study behavior when the curricula, teaching practices and tablet content are tailored to that individual program. Methods: Nine clinical perfusion students served as the control group and utilized a “bring your own form of technology” design, while the remaining 8 clinical perfusion students utilized a university funded Apple iPad to use concurrently in their educational pathway. Data was gathered from feedback responses related to progressive semester attitudes and perceptions, the iPad’s functionality as a testing platform, and the overall view on the implementation. Conclusions: A controlled study was conducted to collect quantitative and qualitative data of the impact of the tablet administration. Overall, we found that the students with provided iPads’ from the university found their application to be mild to moderate, at best. Additionally, the students’ attitude and perception of the tool decreased over the period of the semester yet, some benefits of the implementation shined through. For example, providing true portability of school material, reducing printing within the program and reducing computer lab usage were noted by direct student feedback. ABSTRACT #52 Removal of Complement C3a and C5a in Residual Cardiopulmonary Bypass Circuit Blood: A Comparison between Cell Salvage and Ultrafiltration Ryan Robertson, David Holt. Clinical Perfusion Education program, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE Reperfusion injury is a deleterious physiological phenomenon that occurs is post-ischemic myocardial and pulmonary tissue after cross clamp removal during cardiac surgery. Inflammation, edema, and cellular damage via oxygen free radicals are all characteristic of reperfusion injury. A potent mediator of inflammation, complement, is activated via foreign surface contact via the cardiopulmonary bypass circuit. The aim of this study is to reduce reperfusion injury by determining which blood processing method will reduce activated complement components C3a and C5a is residual cardiopulmonary bypass circuit blood. For this study, a microcircuit of non-bio coated tubing was used in conjunction with a hemoconcentrator and a cell saver. Bovine blood was used to simulate residual pump blood. This blood was circulated for 60 minutes to ensure alternative complement pathway activation. After activation, blood was shunted to the cell saver to undergo cell salvage. Following cell salvage, the remaining circuit blood was circulated through the hemoconcentrator. Blood samples were collected at baseline, after activation, and after both cell saver and hemoconcentrator treatments. Samples were centrifuged and supernatant plasma was collected and frozen. Plasma samples underwent sandwich ELISA for complement components C3a and C5a. Regression analysis and students t-test determined significance with a confidence interval of 95%. There were no significant reductions in complement C3a or C5a from the activated control group to either of the experimental groups. Additionally, there was no significant difference between experimental groups. Surprisingly, there was a significant reduction in complement from baseline to activation and a significant increase in complement C3a from activation to cell salvage. The results of this study indicate that neither cell salvage nor ultrafiltration significantly reduces activated complement C3a and C5a. Methods of reducing complement and other pro-inflammatory mediators are still debated as results are often confounding and conflicting between studies. Further research into the reduction of proinflammatory mediators is warranted to ameliorate post-cross clamp reperfusion injury. ABSTRACT #53 ABSTRACT #54 EDAC Evaluation for Strategic Placement of Arterial Filter Purge Kristie Steffens, David Holt. Clinical Perfusion Education program, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE Risk of Vacuum-Induced Air Embolism with Auto-Venting Arterial Filters Ria Ward, David Holt. Clinical Perfusion Education program, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE Objective: To determine if the location of the arterial filter purge line influences the size and count of gaseous microemboli (GME) post arterial line filter. Clinical Relevance: Cardiopulmonary bypass circuit management is essential to help eliminate emboli, especially GME, post arterial line filter. GME removal is especially concerning to perfusionists, as consequences for patients on bypass include a decrease in functional endothelial cells, hypoxia downstream from the blockage, blood brain barrier disruption and compliment activation, among others. The arterial filter purge line diverts a portion of GME away from the patient and back into the reservoir, and can be managed in a way that can reduce emboli. It was hypothesized that a purge line location that would filter the redirected blood would reduce both the size and count of GME post arterial filter. Methods: Three different purge line locations were tested: one that was directed through the cardiotomy filter, one directly on the venous line, and one directly on the venous reservoir through no filters. The Emboli Detection and Classification (EDAC) system was placed post filter to measure the count and load of GME for each test trial. A mini bypass circuit was assembled with the use of bovine blood and siphon drainage, and Bard Prime-Vu filters to test the hypothesis. 15ml of air was introduced pre-arterial filter for each run so visible air was seen in the circuit. 3 trials were done for each purge line location for a total of sample size of 12. EDAC data on GME size and count was exported in an Excel document for analysis. Results: Using One Way ANOVA, the F-test p-value was 0.62 and 0.33 for GME count and GME load between all three locations respectively. Conclusions: With p-values greater than an alpha value of 0.05, there is no significant difference between gaseous microemboli count and volume if the arterial filter purge line is placed on the cardiotomy filter, venous line or venous reservoir of the bypass circuit. Arterial filters have become a standard of care at most facilities. An auto-venting arterial filter is a filter that must be placed below the reservoir, but will vent any accumulated or trapped air to the atmosphere. It avoids dependency on a vent line and removes the need for recirculating blood through that line. Since there is a port open to air on an auto-venting filter, it is hypothesized that applying excessive vacuum for venous return will have the potential to pull air in across the venting membrane and introduce air into the arterial line. To test the hypothesis, two identical circuits were assembled; one using gravity siphon and one using vacuum assist drainage. The Emboli Detection and Classification (EDAC) system was used to count and quantify the bubbles in the circuit pre and post the auto-venting arterial filter. Bovine blood was used as a substrate to mimic human blood. A pressure drop was induced by ceasing flow for three seconds then ramping back up to full flow. Three different flows were tested with both gravity siphon drainage and vacuum assisted drainage to see what if any effects the starting flow had on pressure drop and bubble formation in the arterial line. There were a total of 9 trials run at flow rates of 1 L/min, 3 L/min, and 5 L/min for both gravity siphon drainage and vacuum assisted drainage, totaling 18 trials. Results showed that there was a large variance between trials. A normal distribution model was used and ANCOVA was used to determine significance of covariance. There were no significant differences observed in the type of drainage, gravity siphon or vacuum assisted, or the main effects of flow and sensors reading bubbles counts. At this time, it can be concluded that gravity siphon and vacuum assisted drainage are both equally safe if the auto-venting arterial filter is placed as directed, below the reservoir. Future experiments may want to test the circuit using excessive vacuum, over -40 mmHg, and the height of placement of the auto-venting arterial filter. ABSTRACT #55 Survey of a Virtual Microscopy Teaching Module Utilizing Cell Block, Diff Quick and Pap Stained Slides Nick Baker, Maheswari Mukherjee, Amber Donnelly. Cytotechnology Education Program, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE Cytotechnology education programs and residency programs in the U.S. have traditionally used glass slides and light microscopy for teaching cellular morphology. It can be difficult to compare different stains/prep types to each other using light microscopy because you cannot view more than one glass slide at a time. Additionally, cytotechnology students are more comfortable interpreting Pap stained slides than DQ and cell block prepared specimens due to the fact that they have more experience interpreting cases using the Pap stain. The objective of this research was to survey cytotechnology students as well as pathology residents regarding a virtual microscopy (VM) teaching module utilizing cell block (CB), diff quik (DQ), and Pap stained slides from body cavity fluids. Six cases were selected for this project using the laboratory computer system, CoPath. All slides were scanned to create virtual images using the BioImagene Coreo Au scanner. All images were annotated and comparison annotations were created for each case to compare Pap, DQ, and CB to one another. The participants completed surveys before and after viewing the VM module. The pre-survey results showed that 90% of participants felt that the VM module would increase their confidence in interpreting the various stains/prep types. The post survey results showed that over 80% of the participants felt that the VM module increased their understanding and confidence amongst DQ, and CB slide interpretation. ABSTRACT #56 Assessing the Use of Virtual Microscopy in Cytotechnology Education Vincent DeAgano, Maheswari Mukherjee, Amber Donnelly. Cytotechnology Education Program, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE Virtual microscopy (VM) has become a common method of teaching in histology programs across the country. The purpose of this study was to determine the extensive use and efficacy of VM in Cytotechnology (CT) education programs across the United States. To obtain data for this study, a survey was conducted in which 10 questions related to VM were formulated and sent to all CT programs in the United States. The questions included the following topics: general use of VM within the program; scanner and software brands; focal plane levels; amount of time VM has been used in program; number of slides scanned with VM; utilization of VM; opinion of VM’s effectiveness; and reasons for not using VM in CT programs. Of all the CT programs (29), 24 responded to the survey. Only 3 of the 24 respondents utilize VM in their CT programs. 2 of the 3 programs use a single focal plane level for scanning while the other uses a multifocal plane level. 1 of the 3 programs has scanned 500 – 1000 slides with VM and only 1 program has utilized VM for 2 – 4 years. 3 of the respondents use VM solely for teaching and 1 respondent uses unannotated images for daily slide screening. A popular opinion of VM’s effectiveness is that it helped to preserve slides by digitizing them as all respondents “strongly agreed” with this assertion. However, another firm opinion was that teaching with glass slides is important, an assertion that 7 of 8 respondents “strongly agreed” with and the other respondent “agreed” with. For the programs that do not use VM, 68.43% of the respondents suggest the idea is too expensive and 50% also indicate the development of the teaching module as time consuming. Aperio was the most common instrument used for scanning and digitizing images. Based on the results from this survey, VM is not a common method of teaching in CT programs across the United States but may have greater implications in future education. ABSTRACT #57 Comparative study between fine needle aspiration cytology glass slides and virtual images Sarita Gawandi, Amber Donnelly, Elizabeth R. Lyden, Maheshwari Mukherjee. Cytotechnology Education Program, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE Virtual microscopy (VM), where glass slides are scanned into digital images, has been widely used in educational, training, and research purposes in pathology. Although the diagnostic sensitivity of VM has been tested several times in histopathology, there are not many studies comparing whole slide scanned images (WSI) with glass slides in non-gynecological cytology. Gerhard et al (2013), studied thyroid cases and noted a moderate agreement rate for virtual images and conventional glass slides between two observers. The purpose of this study was to compare the diagnostic agreement between VM and LM among three cytologists for specimens obtained from fine needle aspirations of different body sites Twelve cases including breast, lymph node, liver, pancreas, and thyroid each with Pap and Diff-Quik stained slides were scanned. Three experienced reviewers were asked to interpret the WSI images followed by conventional glass slides with a gap of a few days in between. For both glass slides and virtual images the reviewers were given a list of diagnoses to select from. There was a concordance of 88.9% among all three participants when they all agreed on correct diagnosis of positive and negative for a particular case using both VM and light microscopy (LM). The concordance between original diagnosis and VM diagnosis was 91.7%, which was the same as concordance between original diagnosis and LM diagnosis (91.7%). The overall intraobserver diagnostic agreement in all three participants between VM and LM was 94%. The interobserver reliability among all three participants using VM was 72% indicating substantial agreement, and by using LM was 75%, also indicating substantial agreement. The results suggest that there was a comparable diagnostic performance between VM and LM assessment. Thus VM is a good option to LM in assessment of breast, pancreas, liver, lymph node, and thyroid FNA; however, more such studies comprising larger numbers of cases are needed to confirm the results considering the advantages of VM over LM. ABSTRACT #58 Digitalizing Cytology Specimens: Reproducibility of Virtual zstacked Images by Ventana Scanner Jillian Schneider, Amber Donnelly, Elizabeth R. Lyden, Maheswari Mukherjee. Cytotechnology Education program, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE Whole slide imaging (WSI) in cytopathology is an emerging practice that is useful in education, archiving patient records and proficiency examinations; however, the thickness and 3-D nature of cytology slides require scanning multiple z-stacked focal planes at high magnification. The large digital files and increased virtual screening time spent focusing over the z-axis have inhibited WSI from becoming a feasible option during the diagnosis process. To ensure correct diagnoses in practical applications, the scanner should consistently produce the same focused image when given set parameters. To investigate the precision of The Nebraska Medical Center’s (TNMC) scanner, Ventana iScan Coreo Au, five pre-diagnosed glass slides containing five annotated cell groups were selected from TNMC’s Cytology Laboratory archives. Each slide was scanned three times at three focal plane levels using 1-micron (µ) intervals on 40x magnification producing a total of 225 annotated cell groups. One pathologist and three cytotechnologists reviewed the digital images and determined if the same cells within an annotated group were similarly in focus on each of the three scans. Out of the 75 comparisons of the three focal plane levels, 7 comparisons (9.3%) contained three cell groups that were considered to be similarly in focus, or “the same;” 46 (61.3%) revealed that all three cell groups were not similarly in focus, or “different;” and 22 (29.3%) showed at least one group was considered to be dissimilar, or “mixed.” There was no association between focal plane level and comparison outcome (p=0.75). During the panel, each cell group was also recorded as in focus or out of focus (OOF) regardless of similarity to the other comparable groups. 56 of the 225 groups (24.9%) were determined to be OOF. Of the 56 OOF groups, 4 groups (7%), 13 groups (23%), and 39 groups (70%) occurred on the -1 µ level, 0 µ level (optimal focal plane level calculated by the scanner), and 1 µ level, respectively. A Chi-Squared test showed a significant difference (p< 0.0001) in overall distribution of OOF groups between the three focal plane levels. The results indicate TNMC’s scanner does not repeatedly produce the same digitalized image of a glass slide when given the same scanning parameters and the 1 µ level appears to have produced a disproportionately high number of OOF groups. ABSTRACT #59 Elderly Adult Malnutrition in the Adult Intensive Care Unit (AICU) Clare Becker, Dietetic Intern. Medical Nutrition Therapy Education program, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE Objective: Determine the prevalence of malnutrition among elderly adults upon admission to the AICU, and, in those patients who were malnourished, to determine whether or not parenteral nutrition (PN) was initiated appropriately. Clinical Relevance: In the critical care setting, malnutrition is estimated to be around 50%. The acute-phase inflammatory response alters energy and protein requirements by elevating energy expenditure and nitrogen excretion, respectively. In the elderly, catabolism of lean body mass (LBM) is most detrimental to their recovery. Therefore, it is vital to assess the prevalence of malnutrition, and determine if patients who are malnourished are receiving appropriate nutrition support. Methods: A medical record review was conducted on 10 patients for exploratory analysis. The criteria for malnutrition used in this study were: energy intake, unintentional weight loss upon admission, physical exam (body fat, muscle mass/wasting, edema), and overall clinical/disease status. The guidelines for initiation of PN were directly from the A.S.P.E.N. guidelines for subjects determined to be malnourished. Results: All 10 of the patients were included in the results of the study. Of the 10 subjects, 70% (7/10) were determined to be malnourished upon admission to the AICU. Of the seven subjects who were malnourished, appropriate PN was initiated for 71% (5/7). Edema, overall clinical/disease status, and energy intake were the most common criteria met by the subjects. Conclusions: A standardized assessment may be beneficial in the AICU to help clinicians screen for malnutrition in order to avoid LBM catabolism and initiate appropriate nutrition support therapy. Additional research is needed to determine the most applicable criteria to use when diagnosing malnutrition in the AICU setting. ABSTRACT #60 Adequate Protein Intake in the Elderly Jessica Hinds, Dietetic Internship. Medical Nutrition Therapy Education program, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE Objective: To compare the protein intake of men and women > 65 to their ideal protein intake. Clinical Relevance: Research has shown that inadequate protein intake results in further loss of muscle mass that delays recovery in the elderly. Depleted muscle mass reduces the function capacity of older adults. Evidence suggests that making sure that adequate protein is consumed will promote a healthier nutritional status in hospitalized elderly patients. Methods: A medical record review was conducted on 31 subjects who had a documented calorie count. Results: A total of 16 males and 15 females were included in the results of the study. Of these 31 subjects, a nutrition score of 2 (probably inadequate) was reported. The average prealbumin and albumin were 13.4 and 2.8 respectively. The mean caloric intake was 1040 as well as 45g of protein. Twenty-three of the thirty-one patients were provided with a scheduled supplement. A t-test was conducted comparing the mean of protein intake between the group that received a protein supplement and those who did not. No significant difference was found between the two groups (p =0.06). Overall, the patients met 61% of their protein needs. Conclusion: Additional research is needed to determine the best ways for elderly to achieve their ideal protein intake while hospitalized. It is in the best interest of the patient to find ways for all of them to meet their minimum protein needs. ABSTRACT #61 Prevalence of unintentional weight loss and the nutritional response upon admission to The Nebraska Medical Center Jenna Paseka, Dietetic Intern. Medical Nutrition Therapy Education program, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE Objective: The purposes were to identify the prevalence of unintentional weight loss upon admission to The Nebraska Medical Center in adults and identify the nutritional response. Clinical Relevance: Unintentional weight loss is associated with an increased mortality risk of 9-38%. In- hospital complications, decline in activities of daily living, delayed wound healing, and increased morbidity are all linked to unintentional weight loss. The goal is to have nutrition consults for those admitted with unintentional weight loss to determine nutritional interventions. Methods: In a retrospective cross-sectional study of 100 electronic medical records of patients aged 19 or older at The Nebraska Medical Center, unintentional weight loss was identified upon admission using a screening tool administered by nurses. If the subject reported unintentional weight loss, data was collected from the medical record to assess if a nutrition consult was ordered within 24 hours and whether a nutritional intervention was implemented. Results: The prevalence of unintentional weight loss was 12% among the reviewed subjects. Of those 12 subjects, 42% had a nutrition consult for a dietitian ordered within 24 hours of admission with 80% of the consults leading to a nutritional intervention. Conclusions: Unintentional weight loss upon admission is present in patients admitted to The Nebraska Medical Center. Less than half of the subjects had nutrition consults ordered within 24 hours; however, when consults were ordered, early interventions were implemented. There is a need for further evaluation of the nutritional screening process upon admission in order to improve outcomes through nutritional interventions. ABSTRACT #62 Identification of Enteral Nutrition Target Goal at The Nebraska Medical Center Heidi Pfeifer, Dietetic Intern. Medical Nutrition Therapy Education program, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE Objective: To identify if the target goal of enteral nutrition (EN) was determined and clearly identified at the time of initiation of the nutrition support therapy in the Intensive Care Unit (ICU) at the Nebraska Medical Center (TNMC). Clinical Relevance: The ASPEN Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient states that the goal rate should be clearly stated and identified at initiation of EN. Nutrition is an important factor for the recovery of patients, especially those in the ICU. Early initiation of EN, within the first 24-48 hours, is associated with better outcomes in the ICU including decreased length of ventilation, lower infection rates, and decreased length of stay (3,4). Likewise, overfeeding patients is associated with other risks including glucose overload, fatty liver, higher rates of infectious complications and increased mortality. Methods: Information was gathered through a retrospective cross-sectional chart review of subjects admitted to the adult ICU at TNMC who received EN from September 2013-December 10, 2013. Results: The average number of times the goal rate of EN was stated before the initiation of the nutrition therapy was 95.6% (65 out of 68). Conclusions: The results of this study show that a majority of the time at TNMC the goal rate of EN is stated at the time of initiation of the therapy. There is, however, still room to improve. ABSTRACT #63 The Prevalence of Malnutrition in Pediatric Patients at The Nebraska Medical Center (TNMC) Nicole Rezac, Dietetic Intern. Medical Nutrition Therapy Education program, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE Objective: To identify the prevalence of malnutrition in pediatric patients between the ages of 3 and 18 on admission at TNMC. Clinical Relevance: Malnutrition in pediatric hospitalized patients has been associated with negative hospital outcomes. While ASPEN has published diagnostic criteria for malnutrition in adults, there have been no criteria established for the diagnosis of malnutrition in pediatric patients. Due to the lack of standardized diagnostic criteria, malnutrition in pediatric patients may be largely unrecognized. Methods: The prevalence of malnutrition on admission was determined using a cross sectional retrospective chart review of inpatients between the ages of 3 and 18 at TNMC. The subjects had been admitted to TNMC between August 2013 and October 2013. All subjects that were reviewed were included. The subjects that were classified as malnourished exhibited two of the following seven diagnosis criteria. 1) < 5th percentile in CDC growth charts; 2) shift downward on CDC growth chart for weight of 2 or more percentiles; 3) < 75% of estimated energy needs consumed in first three days after admission; 4) disease or condition present for increased risk; 5) indicators of inflammation present; 6) physical findings including: loss of subcutaneous fat, muscle loss, localized/generalized fluid accumulation; 7) developmental/functional decline. Findings were compared with the professional opinion of the clinician conducting the retrospective chart review. Results: Of the 10 subjects reviewed, 60% (6/10) were determined to be malnourished upon admission. The clinician identified 30% of the subjects (3/10) as malnourished. The agreement of the diagnosis of malnutrition using the diagnostic criteria compared with the professional opinion of the clinician was measured using Cohan’s Kappa Coefficient (K= .62963). Conclusions: Malnutrition of pediatric patients on admission to TNMC is a prevalent problem. Future research should be done to standardize diagnostic criteria to improve the identification and treatment of this condition. ABSTRACT #64 Vitamin D Status Not Associated With Inflammatory Markers in Bariatric Patients. Carly Sorenson, Dietetic Intern. Medical Nutrition Therapy Education progam, School of Allied Health Professionals, University of Nebraska Medical Center, Omaha, NE Objective: The aim of this study was to investigate the association between vitamin D status and markers of inflammation commonly available in patients undergoing medically supervised weight loss prior to bariatric surgery at The Nebraska Medical Center. Clinical Relevance: Research has shown that lowgrade inflammation characterizes obesity and may contribute to many metabolic complications. Vitamin D deficiency has also been associated with obesity. This is significant because vitamin D has been reported to play a role in mediating inflammatory pathways. Because both inflammation and poor vitamin D status are associated with obesity, investigating the relationship between serum 25(OH)D levels and inflammation in obesity may be beneficial. Methods: A retrospective medical record review of eligible adults participating in supervised weight loss at The Nebraska Medical Center (n = 11) between April and December 2013 was conducted. Serum 25(OH)D, albumin, transferrin, and white blood cell count were recorded. Vitamin D deficiency was set at serum 25(OH)D <30 ng/mL. Results: Seven of 11 patients (64%) were found to have vitamin D deficiency (mean = 18 ng/mL). Correlative data analysis revealed no significant association between serum 25(OH)D and WBC, albumin, or transferrin. No significant difference was found between the mean inflammatory biomarker levels in the vitamin D deficient and sufficient groups. Conclusions: The relationship between the triad of obesity, vitamin D status and inflammation is complex. As the prevalence of obesity continues to grow, it is of critical importance to investigate ways to decrease the risks of comorbid conditions associated with obesity. Although previous studies have shown an inverse correlation between vitamin D status and inflammatory markers, the current study does not suggest an association between vitamin D status and the indicators of inflammation studied. ABSTRACT #65 ABSTRACT #66 Integrating Best Evidence into Practice: Outcomes of a Community-Based 12-week Exercise and Education Intervention in Women with Cancer Betsy Becker , Katherine Jones , Patricia Hageman , Ruth VanGerpen . Division of Physical Therapy Education , School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, Bryan Medical Center , Lincoln Nebraska Tai Chi as a Balance Intervention for Older Adults: Web-based vs. Video-based? Megan Bradberry, Sarah Kennedy. Division of Physical Therapy Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha NE 1 1 1 2 1 2 Objective: The objective of this project was to evaluate the effectiveness of a 12-week evidence-based cancer exercise and education intervention on outcomes of fatigue, pain, depression, sleep disturbance and quality of life for women with cancer. Methods: The intervention was delivered by an interprofessional team, led by a physical therapist, in a medically-based wellness center. Women with any type of cancer were eligible to enroll regardless of whether or not they were on active cancer treatment but excluded if they had any contraindication to exercise. Small groups completed hour-long supervised group exercise sessions twice weekly. These sessions included resistance training, aerobic, flexibility, balance, aquatic or yoga. Weekly education sessions included topics such as nutrition, sleep disturbance, depression, coping, lymphedema, exercise habits, healing arts, women’s health, spirituality, and stress management. Participants reported their pre- and post-intervention perceptions of fatigue, pain, depression, sleep disturbance and quality of life on a 0 -10 point Likert scale (0 = none, 10 = worst). We used the related-sample Wilcoxon Signed Rank test to compare pre- and post- intervention scores and sample Mann-Whitney U test to compare change scores between those on and off treatment. Results: Approximately 80% (n=139) of the women having a mean age of 53.6 years (SD=11.8; range 23-87) completed the intervention. We found significant decreases in the perceptions of self-reported fatigue (-5.5, p<.001), pain (0.5, p=.017), depression (-1.0, p<.001), sleep disturbance (0.5, p<.001), and quality of life (-1.4, p<.001); however, a subgroup analysis revealed that the impact of the intervention varied according to treatment status. Specifically, perceptions of fatigue decreased significantly for the 49 women who were on treatment (-1.4 vs. -0.03 p=.007) as compared to the 90 women who had completed treatment. Women on active treatment reported significantly higher levels of fatigue at the start of the intervention than did the women who had completed treatment (6.4 vs. 5.0, p<.0001). Conclusions: Our findings indicate that implementation of an evidence-based exercise and education intervention is effective in improving self-reported outcomes for women with cancer. The most significant impact of the intervention appeared to be in decreasing fatigue for women on active cancer treatment. Objectives of the research: (1) To assess the feasibility of implementing a web-based Tai Chi program. (2) To compare the effectiveness of a web-based Tai Chi exercise program with a DVD-based Tai Chi exercise program on improving balance among older adults. Clinical Relevance: A Tai Chi exercise program has been shown to improve balance in older adults. Previous studies have focused on instructor-led Tai Chi classes. Little attention has been paid to a program that could be done in the home, eliminating barriers to access of an instructor-led class. Methods: Eleven adults (10 females, 1 male), average age 67 ± 11.5 years, were recruited from various senior centers and companies in the local community. Subjects were randomly divided into two groups (Web and DVD) and asked to practice the Tai Chi program at home using their assigned delivery method twice a week for 12 weeks. Functional Balance measures (Berg Balance Test, Dynamic Gait Index, and Timed Up and Go Test) and questionnaires (Centers for Epidemiologic Studies Depression Screening, Health Survey Questionnaire, Tinetti Falls Efficacy Scale, and Norbeck Social Support Questionnaire) were administered to all participants at baseline and following completion of the program. Results and Discussion: Both groups showed improvements in outcome measures between baseline and post-test. Compliance was an issue with this study. The dropout rate for the study was 83%. All participants who dropped out were in the web-based group. This lack of compliance within the web-based group suggests the specific website used in this study was not feasible for older adults. Conclusions: The results of this pilot study suggest that a home-based Tai Chi program may be beneficial for older adults, but the specific website used is not feasible for this population at this time. ABSTRACT #67 Geographic Distribution of Specialized Stroke Rehabilitation Services in Nebraska Zach Douglas, Zach Long, Katherine Jones, Anne Skinner, Nicole Vanosdel. Division of Physical Therapy Education, School of Allied Health Professions; College of Public Health, University of Nebraska Medical Center, Omaha, NE The World Health Organization’s International Classification of Functioning, Disability, and Health model describes environmental factors as one of the three determinants that affect impairments, activity limitations, and participation restrictions. Access to specialized stroke rehabilitation services is an important environmental factor that helps increase quality of life for stroke survivors after inpatient rehabilitation. These services are rarely, if ever, found within a single facility, and a 2010 assessment indicated uncertainty in terms of where these services were located. This study’s purpose was to determine the geographic distribution – including the location and contact information – of 12 specialized stroke rehabilitation services in Nebraska, and to examine disparity of access to services based on that distribution. We used internet search engines and email surveys to create a database of locations and contact information for these services across Nebraska. We then used Community Analyst to geocode and generate maps for each service. Community Analyst is a web-based geographic information system that integrates population data and generates drive-time buffers around geographic coordinates. The results show that approximately 90 percent or more of adult Nebraskans 18 years of age or older have access to eight specialized stroke rehabilitation services when used infrequently. Results also indicate approximately 70 percent or more of adult Nebraskans 18 years of age or older have access to four specialized stroke rehabilitation services when used frequently. These results show that the primary barrier to accessing specialized stroke rehabilitation services in Nebraska may be a lack of information regarding their existence and location rather than the absence of services available. and which items were most likely to exhibit scoring differences. Clinical Relevance: Instructions for scoring items may appear to be ambiguous or require the clinical judgment of an experienced rater. For this reason, item scoring can have inter- and intra-rater reliability problems, especially among novice raters. Methods: All subjects were physical therapy students in the summer session of the first year of the three-year Doctor of Physical Therapy curriculum at the University of Nebraska Medical Center over two years. All subjects were shown a video of a physical therapist simulating an individual with Parkinson’s Disease performing all 14 items on the Berg Balance Scale. Each student was assigned a uniquely numbered audience response unit. Items were shown in class and the students entered the score choice for each. At the next class session, a lecture/discussion was presented as an introduction to the use of standardized assessment tools and students asked questions regarding the interpretation of item instructions and descriptions of rating choices without divulging individual scores. The subjects again scored the items on the same video they saw previously. Results: Pre- and post-discussion percent agreements were calculated for each item. Of the 8 items ranked lowest, there were 5 items in common between the two classes of students for which data were collected (range 36.2 to 70.0% for Class 1 and 40.8 to 67.3% for Class 2). An examination of the item instructions and scoring descriptors of the lowest ranked items reveals that a common thread was language that appears to require clinical judgment. Conclusions: For novice raters of performance on an assessment tool like the Berg Balance Scale, an instructional session incorporating information about the purpose and design characteristics of standardized patient assessment tools, along with discussion to help raters better understand assistance terminology and safety, may contribute to changes in rating results, illustrated by lower rates of agreement preand post-instruction, especially for test items requiring clinical judgment. ABSTRACT #69 ABSTRACT #68 Pre and Post-Instruction Changes in Physical Therapy Student Item Scores for a Standardized Patient Assessment Tool Robert Fuchs. Division of Physical Therapy Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha NE Objective: The objective was to find out if an instructional session would alter the way standardized assessment items were scored by physical therapy students The Impact of Cognitive Level and Task Difficulty on Spatiotemporal Gait Measures during Dual Task Performance in Older Adults Troy Goetsch, Travis Jurgens. Division of Physical Therapy Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha NE Objective: The purpose of this study was to determine how cognition and task difficulty impact dual-task cost (DTC). Clinical Relevance: This information is necessary to better design dual-task training programs for older adults of varying cognition. Methods: Twenty-three subjects (12 women, average age 80.7) were divided into two groups based on Montreal Cognitive Assessment (MoCA) scores (≥ 26 or not). Subjects completed a single task (ST): normal walking, and three randomized dual tasks (DT): 1) walking + counting forward by 1’s (FWD1), an easy task, 2) walking + counting backward by 3’s (BWD3), a difficult task, and 3) walking + forward digit span (FDS), a task with intermediate difficulty. Gait velocity, step length, coefficient of variability in step time, percentage of gait cycle in double-support, and center of pressure path efficiency were calculated from data collected using the Zeno Walkway (Protokinetics, Havertown, PA). DTC was calculated for each variable using [(Difference between DT and ST performance) / ST performance] x 100. Two-way ANOVA was performed to assess the effects of group and task (α≤ 0.05). Results: MoCA scores ranged from 18-28 (average 24.3). There was a significant task effect for each gait variable; BWD3 had greater DTC than both FWD1 and FDS. FWD1 and FDS did not differ. There was no group effect for any variable except double-support percentage; the low cognition group had greater DTC than the high cognition group. For step length, there was a difference among tasks within the low cognition group, but not within the high cognition group, leading to a significant interaction for this variable. No interactions were found for other variables. Conclusions: Task difficulty influenced DTC; BWD3 proved more costly for each variable than either FWD1 or FDS. The lack of difference between FWD1 and FDS was unexpected because the difficulty of FDS was individualized to each subject, while FWD1 seems automatic in nature. Due to few group differences, these gait measures may be appropriate to assess DTC for older adults of varying cognitive abilities. However, because the range of MOCA scores for this study was on the higher end, further research may assess the effects of cognition and task on individuals with even lower cognition. ABSTRACT #70 Comparison of Participants’ Perspectives about a Web-based Intervention Targeting Guided Weight loss in Overweight and Obese Rural Women Lukas Hoover-Rathjen, Patricia Hageman, Carol Pullen, Paul Dizona, Linda Boeckner . Division of Physical Therapy Education, School of Allied Health Professions, and College of Nursing, University of Nebraska Medical Center; Nutrition and Health Sciences, University of Nebraska-Lincoln 1 2 1 2 3 1 2 3 Background: Obesity is a growing health concern in the United States, particularly among rural midlife and older women. Little is known about the use of and perceptions about web-based guided weight loss in a population of rural, vulnerable, overweight and obese women. Purpose: The purpose of this study is to compare the perspectives of overweight and obese rural women, after six months of participation, who reported and did not report weight loss. Methods: 301 rural women, ages 40-69, enrolled in the Women Weigh-in for Wellness community-based randomized control trial [ClinicalTrials.gov, NCT01307644]. The web-based intervention delivered weekly messaging with a focus on perceived benefits and barriers to action, selfefficacy, interpersonal influences, and goal setting. Women were provided with a pedometer to record the number of steps taken daily and were able to record their weight loss, steps, calorie counting, and goals on the website. Of 301 enrolled, 266 remained in the study at the 6-month evaluation period, and these 266 women were asked to complete a survey about their attitudes and perspectives about the intervention. Results: Of 266 women who received the survey, 184 (69%) responded with 146 (79.3%) participants reported losing weight and 38 (20.7%) participants reported losing no weight. Chi squared analysis showed that posting weekly results was associated with self-reported weight loss. ANOVA analyses showed that women who reported losing weight had higher ratings of perceived helpfulness for website messaging influencing lifestyle change and website tracking. Conclusion: Online weight loss interventions are feasible for overweight and obese rural women. Self-reported weight loss among overweight and obese rural women, ages 40-69, were associated with posting weekly results, higher mean ratings of perceived helpfulness in website tracking, and a higher influence of online messages on lifestyle changes. Physical therapists may be able to use similar methods to promote weight loss in their patients. ABSTRACT #71 A Conceptual Model for Gait Maintenance in Patients with Diabetes Chun-Kai Huang, Ka-Chun (Joseph) Siu. Division of Physical Therapy Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE Sensory systems including visual perception, somatosensory and vestibular sensation are well integrated in healthy people during walking; however, people who suffer from diabetic peripheral neuropathy (DPN) have the abnormal or loss of sensation on their feet, which increases instability and the incidence of fall injuries. Objective: We proposed a conceptual model that depicts how DPN patients would utilize their sensory systems to maintain a stable gait. This model included: 1) Patients with DPN would adjust their foot placement by the central nervous system where the sensory feedback is mainly received from visual and vestibular perception; 2) Patients with DPN would primarily rely on the visual system to maintain their balance during walking. Therefore, a preliminary study was conducted to demonstrate how the visual perception impacts on gait maintenance among healthy adults, patients with diabetes mellitus (DM) and with DPN. Clinical Relevance: The preliminary data show the supportive evidence to establish our conceptual model, which suggests patients with diabetes could rely on perceived visual information to maintain their gait. The manipulation of visual information plays a crucial role in foot adjustment in the foreaft direction (e.g. stride length is important for adjusting gait speed). Physical Therapists can acquire the information from our conceptual model that visual information can be utilized as a manipulated factor to develop a balance training program for patients with diabetes, especially those with DPN and intact vision. Methods: Two healthy adults, three patients with DM, and one patient with DPN were recruited. All participants were instructed to walk on a treadmill with a moving virtual corridor presented ahead. The spatiotemporal gait characteristics and the measurement of gait variability [e.g. coefficient of variation (CV) that can reveal the average value of deviation from the mean] were analyzed and compared between the conditions with or without the virtual environment. Conclusions: The perceived visual information (the presence of a moving virtual corridor) significantly impacted gait by increasing the CV of stride length (p= 0.02) in DM patients, and this phenomenon was also shown substantially in the DPN patient. More participants with DM and DPN were warranted to confirm the results and to distinguish the group differences. ABSTRACT #72 Effects of Exercise Training versus Attention on Plasma B-type Natriuretic Peptide, 6-Minute Walk Test and Quality of Life in Individuals with Heart Failure Joseph Norman , Bunny Pozehl , Kathleen Duncan , Melody Hertzog , and Steven Krueger . Division of Physical Therapy Education , School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, College of Nursing , University of Nebraska Medical Center, Lincoln, NE, BryanLGH Heart Institute , Lincoln, NE. 1 2 2 2 3 1 2 3 Introduction: Comparisons of Exercise Groups (EX) to Attention Control Groups (AT-C) have been conducted in various patient populations but to our knowledge have not been reported in individuals with heart failure (HF). Purpose: The purpose of this study was to compare EX with AT-C to more specifically assess the impact of exercise training on individuals with HF. Design: An experimental design was utilized for comparisons. Methods: Forty-two individuals with HF were randomized to AT-C or EX that met with the same frequency and format of investigator interaction. Baseline, 12 and 24week measurements of B-type naturetic peptide (BNP), 6minute walk test (6-MWT), and the Kansas City Cardiomyopathy Questionnaire (KCCQ) were obtained. Comparisons of group baseline measures were performed by chi-square and t-test analyses. Change over time was assessed by repeated-measures ANOVA. Results: Forty subjects completed the 24 weeks of the study and were used in the analyses. Two subjects were lost to follow up. BNP tended to increase in the AT-C while remaining stable in the EX over time. A clinically significant increase in 6-MWT was demonstrated by the EX (55 m) but not the AT-C (32 m). The EX achieved a clinically significant change on the KCCQ at 12 weeks (+8), with further improvement by 24 weeks (+11), compared to baseline, while the AT-C demonstrated a clinically significant change only at 24 weeks (+5). Conclusions: Attention alone was inadequate to positively impact BNP levels or 6-MWT distances, but did have a positive impact on quality of life after 24 weeks. Although exercise offers enhanced benefits, individuals with HF unable to participate in an exercise program may still gain quality of life benefits from participation in a peer-support group that discusses topics pertinent to HF. ABSTRACT #73 The Effectiveness of Massage Therapy on Weight Gain in Preterm Infants Michaela Schweitzer, Amy Schnoes. Division of Physical Therapy Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE Low birth weight in preterm infants increases the risk for developmental delays as their life progresses. In order to decrease this risk, massage therapy (MT) is used with preterm infants in the NICU; however, it is unknown how effective the MT is at improving weight gain. It is also unknown how effective the combination of tactile and kinesthetic stimulation with MT impacts weight gain and what other factors are improved with MT. Therefore, this paper examines the effectiveness of MT on weight gain and the protocol that is most consistent with increased weight gain. Four research articles were reviewed from the most current available studies. These studies were critiqued based on applicability to the research question, adequate sample size, and journal impact factors. Three studies showed that MT with tactile and kinesthetic components is effective at producing significant weight gain in medically stable preterm infants without other major medical complications. The fourth study did not include a kinesthetic component to the MT and found no significant difference between MT and the control group for weight gain. Standardized MT protocol with tactile and kinesthetic components should be developed and used in all MT treatments as it may help prevent developmental delays, has minimal cost and low risk for the infants. Although the fourth study showed no significant results, it showed higher cognitive scores in infants, 12 months after receiving MT. This study also included more medically complex infants. Therefore, more developmental long term outcome measures of MT should be investigated further to see if MT is effective at inducing weight gain for preterm infants with congenital disorders and other major medical conditions. ABSTRACT #74 Intervention to Advance Postural Transitions and Problem Solving Ability in Children with Cerebral Palsy* Xin Zhang, Swati Surkar, Regina Harbourne, Sandra Willett, Max Kurz, Lynne Capoun. Division of Physical Therapy Education, School of Allied Health Professions; the MunroeMeyer Institute, University of Nebraska Medical Center, Omaha NE The relationship of postural control and early selfmobility to cognitive development, although implied in many descriptions of the developmental process, is not well understood. The ability to learn about objects partly relies on motor abilities, and should be reflected in problem solving ability. The purpose of this pilot study was to investigate and compare the effects of a perceptual motor approach (PMA) and a body weight support (BWS) intervention in advancing postural transitions and problem solving skills in children with CP. Twelve infants with mild to moderate CP between the ages of nine months and three years were randomized into two intervention groups, the BWS intervention and the PMA. Infants in both groups received 60 minutes of physical therapy intervention twice weekly for 12 weeks. Gross motor function was measured using the Gross Motor Function Measure-88 (GMFM). Play and problem solving skills were measured with the Early Problem Solving Indicator (EPSI). The GMFM and the EPSI were measured pre and post intervention. The GMFM score in all dimensions significantly increased overall between pre and post intervention (Look: P=0.006, Explore: P=0.008, Function: P=0.004, and Solution: P=0.031). BWS intervention may be more helpful in advancing dynamic motor abilities, such as crawling and walking by showing larger mean change of GMFM scores. In contrast, the perceptual motor approach may be more beneficial in improving static posture control, such as sitting and standing. The scores of EPSI Explore and Function decreased in BWS group while they were increased (3.00±10.56 and 7.17±11.44 respectively) in PMA group. This finding suggests that problem solving skills can be addressed and improved with specific types of motor intervention. *This research was funded by a grant from the Section on Pediatrics, American Physical Therapy Association, to R. Harbourne. ABSTRACT #75 Attitudes and Preferences of Potential Physician Assistant Program Applicants about Attending the University of Nebraska-Kearney Campus Michael Huckabee, Ryan Wessel. Division of Physician Assistant Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE Objective: The purpose of this study was to determine attitudes and preferences of potential applicants to the UNMC PA Program to be established at the University of Nebraska-Kearney (UNK). Identifying demographic characteristics, attitudes, and preferences of those likely interested in attending the satellite campus would contribute to an informed plan for developing the instructional strategies in UNK, as well as give direction to promoting the opportunity to the correct target audience. Methods: A web-based quantitative survey of attitudes and preferences about the UNMC PA Program at UNK was administered to applicants who accepted an invitation for an admissions interview for the 2013 and 2014 years. The survey was administered after the application process was concluded for that respective year. Responses from interviewed candidates were separated into three groups: those who were accepted into the PA Program in Omaha, those who were put on the alternate list, and those who were not accepted. Measures of central tendency were analyzed including means, standard deviations, and data ranges. Results: Survey response rate was 40% (94/233) with representation across various population sizes, primarily from the Midwest region of the country. Of those responding, 28% reported prior experience with instructional television learning. When asked about choice of locations, 45% preferred the Omaha campus but would attend Kearney as a second choice, 5% preferred the Kearney campus. Of perceived concerns rated by respondents, 27% were concerned about sufficient access to faculty in the basic sciences, with others marking concerns of a new campus (20%), ITV courses (19%) and access to the medical library (18%). Conclusions: Of applicants to the UNMC campus in Omaha in 2013 and 2014, half would attend the program at Kearney. Only 28% of applicants have had experience with ITV learning. Perceived concerns about student access to faculty, technology, and library access deserve to be clearly addressed. ABSTRACT #76 Differences in the delivery of health education to patients with chronic disease by provider type, 2005-2009 Tamara Ritsema, Jeffrey Bingenheimer, Patty Scholting, James Cawley. Division of Physician Assistant Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE Introduction: Health education provided to patients can reduce mortality and morbidity of chronic disease. Although some studies describe the provision of health education by physicians, few studies have examined how physicians, physician assistants, and nurse practitioners differ in the provision of health education. The objective of our study was to evaluate the rate of health education provision by physicians, physician assistants, and nurse practitioners/certified midwives. Methods: We analyzed 5 years of data (2005-2009) from the outpatient department subset of the National Hospital Ambulatory Medical Care Survey. We abstracted data on 136,432 adult patient visits for the following chronic conditions: asthma, chronic obstructive pulmonary disease (COPD), depression, diabetes, hyperlipidemia, hypertension, ischemic heart disease, and obesity. Results: Health education was not routinely provided to patients who had a chronic condition. The percentage of patients who received education on their chronic condition ranged from 13.0% (patients with COPD or asthma who were provided education on smoking cessation by nurse practitioners) to 42.2% (patients with diabetes or obesity who were provided education on exercise by physician assistants). For all conditions assessed, rates of health education were higher among physician assistants and nurse practitioners than among physicians. Conclusion: Physician assistants and nurse practitioners provided health education to patients with chronic illness more regularly than did physicians, although none of the 3 types of clinicians routinely provided health education. Possible explanations include training differences, differing roles within a clinic by provider type, or increased clinical demands on physicians. More research is needed to understand the causes of these differences and potential opportunities to increase the delivery of condition-specific education to patients. ABSTRACT #77 Doctor Satisfaction with the Physician Associate Role in Great Britain Tamara Ritsema, Lorraine Williams. Division of Physician Assistant Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE Introduction: Physician Associates (PAs) are a new profession to the United Kingdom. There has been no prior national assessment of the perspective of doctors who work with PAs with regard to their role. Methods: Doctors in all specialties who supervise PAs were surveyed in late 2012. Results: Doctors were found to be generally satisfied with the role of PAs and believed that the addition of PAs to the team benefited doctors and patients. Doctors reported that they have received positive feedback from patients about the role of PAs as well. Respondents believe that the current unregulated status of the profession impairs their ability to use their PA staff to their fullest potential. Conclusion: Doctors who work with PAs are satisfied with their role on the team and in the National Health Service (NHS). They believe PAs are well accepted by patients, but are eager for the legal status of PAs to be resolved and support statutory regulation for the PA profession. ABSTRACT #78 A Preliminary Study of Bacterial Cultures Obtained from MR Imaging Equipment James Temme, Karen Honeycutt, Stephanie Vas. Radiation Science Technology Education and Clinical Laboratory Science, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE Purpose: All health care team members are responsible for delivering quality patient care and decreasing incidence of health care-associated infections (HAIs). The potential of magnetic resonance (MR) imaging equipment to harbor microorganisms is not documented in the literature. This study sought to determine whether MR imaging equipment harbored pathogens that could lead to HAIs. Methods: Surface surveillance bacterial cultures were obtained from 8 MR units in Nebraska hospitals. Cultures were collected after completion of patient care each day from the unit bore, coil, table surface, and control panel; collection and plating were completed using a commercial system. Cultures incubated at body temperature were evaluated for bacterial growth after 24 and 48 hours. Room temperature sheep blood agar plates were evaluated for fungal growth at 2 and 7 days. Results: None of the MR cultures recovered clinically significant isolates that are established pathogens leading to HAIs. All culture sites grew the environmental contaminant Bacillus species and Staphylococcus coagulase negative, a common and normal skin flora, as well as Micrococcus species, a normal skin flora and environmental contaminant. The table and control panel cultures grew the widest variety of isolates, including 2 environmental molds. Most sites had light culture growth quantity, but 1 MR imaging table grew >100 colonies of a mixture of 3 gram-negative rods and 1 MR imaging table grew > 100 colonies of a single isolate, Pseudomonas stutzeri, an environmental contaminant that can cause disease in a compromised host. Conclusion: This preliminary study indicates that cultured MR units did not harbor microorganisms reported to be etiologic agents of HAIs. Most sites reported light culture growth of normal skin flora or environmental contaminants that patients encounter routinely. Standard disinfection protocols preliminarily appear to inhibit the colonization of microorganisms that lead to HAIs. . School of Allied Health Professions 984000 Nebraska Medical Center Omaha, NE 68198-4000 (402) 559-6673 www.unmc.edu/alliedhealth