Reliability of the Clinical Application of a Mechanical Inclinometer in Measuring Glenohumeral Motion

Objective: Establish intra- and inter-examiner reliability of glenohumeral range of motion (ROM) measures taken by a single-clinician using a mechanical inclinometer. Design: A single-session, repeated-measure, randomized, counterbalanced design. Setting: Athletic Training laboratory. Participants: Ten college-aged volunteers (9 right-hand dominant; 4 males, 6 females; age=23.2±2.4y, mass=73±16kg, height=170±8cm) without shoulder or neck injuries within one year. Interventions: Two Certified Athletic Trainers separately assessed passive glenohumeral (GH) internal (IR) and external (ER) rotation bilaterally. Each clinician secured the inclinometer to each subject’s distal forearm using elastic straps. Clinicians followed standard procedures for assessing ROM, with the participants supine on a standard treatment table with 90° of elbow flexion. A second investigator recorded the angle. Clinicians measured all shoulders once to assess inter-clinician reliability and eight shoulders twice to assess intra-clinician reliability. We used SPSS 14.0 (SPSS Inc., Chicago, IL) to calculate standard error of measure (SEM) and Intraclass Correlation Coefficients (ICC) to evaluate intra- and inter-clinician reliability. Main Outcome Measures: Dependent variables were degrees of IR, ER, glenohumeral internal rotation deficit (GIRD) and total arc of rotation. We calculated GIRD as the bilateral difference in IR (nondominant–dominant) and total arc for each shoulder (IR+ER). Results: Intra-clinician reliability for each examiner was excellent (ICC[1,1] range=0.90-0.96; SEM=2.2°-2.5°) for all measures. Examiners displayed excellent inter-clinician reliability (ICC[2,1] range=0.79-0.97; SEM=1.7°-3.0°) for all measures except nondominant IR which had good reliability(0.72). Conclusions: Results suggest that clinicians can achieve reliable measures of GH rotation and GIRD using a single-clinician technique and an inexpensive, readily available mechanical inclinometer.

Quality of life and application of the transtheoretical model to diabetes self -management behaviors in older adults with type 2 diabetes

One in five adults 65 years and older has diabetes. Coping with diabetes is a lifelong task, and much of the responsibility for managing the disease falls upon the individual. Reports of non-adherence to recommended treatments are high. Understanding the additive impact of diabetes on quality of life issues is important. The purpose of this study was to investigate the quality of life and diabetes self-management behaviors in ethnically diverse older adults with type 2 diabetes. The SF-12v2 was used to measure physical and mental health quality of life. Scores were compared to general, age sub-groups, and diabetes-specific norms. The Transtheoretical Model (TTM) was applied to assess perceived versus actual behavior for three diabetes self-management tasks: dietary management, medication management, and blood glucose self-monitoring. Dietary intake and hemoglobin A1c values were measured as outcome variables. Utilizing a cross-sectional research design, participants were recruited from Elderly Nutrition Program congregate meal sites (n = 148, mean age 75). ^ Results showed that mean scores of the SF-12v2 were significantly lower in the study sample than the general norms for physical health (p < .001), mental health (p < .01), age sub-group norms (p < .05), and diabetes-specific norms for physical health (p < .001). A multiple regression analysis found that adherence to an exercise plan was significantly associated with better physical health (p < .001). Transtheoretical Model multiple regression analyses explained 68% of the variance for % Kcal from fat, 41% for fiber, 70% for % Kcal from carbohydrate, and 7% for hemoglobin A 1c values. Significant associations were found between TTM stage of change and dietary fiber intake (p < .01). Other significant associations related to diet included gender (p < .01), ethnicity (p < .05), employment (p < .05), type of insurance (p < .05), adherence to an exercise plan (p < .05), number of doctor visits/year ( p < .01), and physical health (p < .05). Significant associations were found between hemoglobin A1c values and age ( p < .05), being non-Hispanic Black (p < .01), income (p < .01), and eye problems (p < .05). ^ The study highlights the importance of the beneficial effects of exercise on quality of life issues. Furthermore, application of the Transtheoretical Model in conjunction with an assessment of dietary intake may be valuable in helping individuals make lifestyle changes. ^

Developing a Data-Driven Classification of South Florida Plant Communities

A comprehensive, broadly accepted vegetation classification is important for ecosystem management, particularly for planning and monitoring. South Florida vegetation classification systems that are currently in use were largely arrived at subjectively and intuitively with the involvement of experienced botanical observers and ecologists, but with little support in terms of quantitative field data. The need to develop a field data-driven classification of South Florida vegetation that builds on the ecological organization has been recognized by the National Park Service and vegetation practitioners in the region. The present work, funded by the National Park Service Inventory and Monitoring Program - South Florida/Caribbean Network (SFCN), covers the first stage of a larger project whose goal is to apply extant vegetation data to test, and revise as necessary, an existing, widely used classification (Rutchey et al. 2006). The objectives of the first phase of the project were (1) to identify useful existing datasets, (2) to collect these data and compile them into a geodatabase, (3) to conduct an initial classification analysis of marsh sites, and (4) to design a strategy for augmenting existing information from poorly represented landscapes in order to develop a more comprehensive south Florida classification.

Learning Data-Driven Models of Non-Verbal Behaviors for Building Rapport Using an Intelligent Virtual Agent

There is a growing societal need to address the increasing prevalence of behavioral health issues, such as obesity, alcohol or drug use, and general lack of treatment adherence for a variety of health problems. The statistics, worldwide and in the USA, are daunting. Excessive alcohol use is the third leading preventable cause of death in the United States (with 79,000 deaths annually), and is responsible for a wide range of health and social problems. On the positive side though, these behavioral health issues (and associated possible diseases) can often be prevented with relatively simple lifestyle changes, such as losing weight with a diet and/or physical exercise, or learning how to reduce alcohol consumption. Medicine has therefore started to move toward finding ways of preventively promoting wellness, rather than solely treating already established illness. Evidence-based patient-centered Brief Motivational Interviewing (BMI) interven- tions have been found particularly effective in helping people find intrinsic motivation to change problem behaviors after short counseling sessions, and to maintain healthy lifestyles over the long-term. Lack of locally available personnel well-trained in BMI, however, often limits access to successful interventions for people in need. To fill this accessibility gap, Computer-Based Interventions (CBIs) have started to emerge. Success of the CBIs, however, critically relies on insuring engagement and retention of CBI users so that they remain motivated to use these systems and come back to use them over the long term as necessary. Because of their text-only interfaces, current CBIs can therefore only express limited empathy and rapport, which are the most important factors of health interventions. Fortunately, in the last decade, computer science research has progressed in the design of simulated human characters with anthropomorphic communicative abilities. Virtual characters interact using humans’ innate communication modalities, such as facial expressions, body language, speech, and natural language understanding. By advancing research in Artificial Intelligence (AI), we can improve the ability of artificial agents to help us solve CBI problems. To facilitate successful communication and social interaction between artificial agents and human partners, it is essential that aspects of human social behavior, especially empathy and rapport, be considered when designing human-computer interfaces. Hence, the goal of the present dissertation is to provide a computational model of rapport to enhance an artificial agent’s social behavior, and to provide an experimental tool for the psychological theories shaping the model. Parts of this thesis were already published in [LYL+12, AYL12, AL13, ALYR13, LAYR13, YALR13, ALY14].

Potential Application of Phage Therapy Against Pseudomonas aeruginosa Biofilm Infection in Cystic Fibrosis Patients

Majority of the microbial activity in humans is in the form of biofilms i.e. an Exopolysaccharide-enclosed bacterial mass. Unlike planktonic cells and the cells on the surface of the biofilm, the biofilm-embedded cells are more resistant to the effects of the antibiotics and the host cellular defense mechanisms. A combination of biofilm growth and inherent resistance prevents effective antibiotics treatment of Pseudomonas aeruginosa infections including those in patients with cystic fibrosis. This has lead to an increasing interest in alternative modalities of treatment. Thus, phages that multiply in situ, only in the presence of susceptible hosts can be used as natural, self-limiting, and deeply penetrating antibacterial agents. The objective of this study is to identify effective phages against a collection of P. aeruginosa isolates (PCOR strains) including the prototype PAOl and the isogenic constitutively alginate-producing PD0300 strains.These PCOR strains were tested against six phages (P105, P134, P140, P168, P175B and P182). Analysis shows 69 % of the PCOR isolates are sensitive and the rest are resistant to all six phages. These phages were then tested for their ability to inhibit biofilm formation using a modified biofilm assay. The analysis demonstrated that the sensitive strains showed increased resistance but none of the sensitive strains from the initial screening were resistant. Using the minimum biofilm eradication concentration (MBEC) assay for biofilm formation, the biofilm eradication ability of the phages was tested. The data showed that a higher volume of phage was required to eradicate preformed biofilms than the volume required to prevent colonization of planktonic cells. This data supports the idea of phage therapy more as a prophylactic treatment.

Determination of Arsenic Species in Water and Grape-Based Beverages

Arsenic is a human carcinogen that has been found in various waters and wines throughout the world. Therefore, close examination of these liquids is necessary to prevent the intoxication of animals and humans. Wines and waters often contain significant amounts of toxic arsenic species. The source of arsenic in wines and waters is generally believed to be the result of arsenic-based pesticides and herbicides. Recent studies have also shown that toxic arsenic may be used in the cultivation and acceleration of the ripening process of fruit, ultimately contaminating fruit-based beverages. The determination of total arsenic can be found by using several methods, including AFS or ICP/MS. No pretreatment of water is necessary, except for filtering by means of a Fisherbrand PTFE 0.45 connected to a Becton-Dickinson 10 mL syringe to filter particles from water. The pretreatment of the wine includes ethanol evaporation and an addition of 0.1% nitric acid. A number of commercial drinking waters and regional lake water were analyzed. Since we have confirmed the presence of arsenic in a variety of waters and wines from different countries, we decided to test a number of commercially available beverages for the presence of arsenic. The focus ofthis project is to establish the presence of arsenic in various commercially available beverages. ICP-MS was used to determine total arsenic using certified standards. Internal standards Indium and Yttrium were also used to verify the concentration readings, which varied from 0- 20 ppb.

Monitoring of Tree Island Conditions in the Southern Everglades: The Effects of Hurricanes and Hydrology on the Status and Population Dynamics of Sixteen Tropical Hardwood Hammock Tree Islands

In 2005 we began a multi-year intensive monitoring and assessment study of tropical hardwood hammocks within two distinct hydrologic regions in Everglades National Park, under funding from the CERP Monitoring and Assessment Program. In serving as an Annual Report for 2010, this document, reports in detail on the population dynamics and status of tropical hardwood hammocks in Shark Slough and adjacent marl prairies during a 4-year period between 2005 and 2009. 2005-09 was a period that saw a marked drawdown in marsh water levels (July 2006 - July 2008), and an active hurricane season in 2005 with two hurricanes, Hurricane Katrina and Wilma, making landfall over south Florida. Thus much of our focus here is on the responses of these forests to annual variation in marsh water level, and on recovery from disturbance. Most of the data are from 16 rectangular permanent plots of 225-625 m2 , with all trees mapped and tagged, and bi-annual sampling of the tree, sapling, shrub, and herb layer in a nested design. At each visit, canopy photos were taken and later analyzed for determination of interannual variation in leaf area index and canopy openness. Three of the plots were sampled at 2-month intervals, in order to gain a better idea of seasonal dynamics in litterfall and litter turnover. Changes in canopy structure were monitored through a vertical line intercept method.

Monitoring of Tree Island Condition in the Southern Everglades: Hydrologic Driven Decadal Changes in Tree Island Woody Vegetation Structure and Composition: 2012 Annual Report

This report examines the interaction between hydrology and vegetation over a 10-year period, between 2001/02 and 2012 within six permanent tree island plots located on three tree islands, two plots each per tree island, established in 2001/02, along a hydrologic and productivity gradient. We hypothesize that: (H1) hydrologic differences within plots between census dates will result in marked differences in a) tree and sapling densities, b) tree basal area, and c) forest structure, i.e., canopy volume and height, and (H2) tree island growth, development, and succession is dependent on hydrologic fluxes, particularly during periods of prolonged droughts or below average hydroperiods.

Application of biomarkers and compound specific stable isotopes for the assessment of hydrology as a driver of organic matter dynamics in the Everglades ecosystem

The Everglades is a sub-tropical coastal wetland characterized among others by its hydrological features and deposits of peat. Formation and preservation of organic matter in soils and sediments in this wetland ecosystem is critical for its sustainability and hydrological processes are important divers in the origin, transport and fate of organic matter. With this in mind, organic matter dynamics in the greater Florida Everglades was studied though various organic geochemistry techniques, especially biomarkers, bulk and compound specific δ13C and δD isotope analysis. The main objectives were focused on how different hydrological regimes in this ecosystem control organic matter dynamics, such as the mobilization of particulate organic matter (POM) in freshwater marshes and estuaries, and how organic geochemistry techniques can be applied to reconstruct Everglades paleo-hydrology. For this purpose organic matter in typical vegetation, floc, surface soils, soil cores, and estuarine suspended particulates were characterized in samples selected along hydrological gradients in the Water Conservation Area 3, Shark River Slough and Taylor Slough. ^ This research focused on three general themes: (1) Assessment of the environmental dynamics and source-specific particulate organic carbon export in a mangrove-dominated estuary. (2) Assessment of the origin, transport and fate of organic matter in freshwater marsh. (3) Assessment of historical changes in hydrological conditions in the Everglades (paleo-hydrology) though biomarkes and compound specific isotope analyses. This study reports the first estimate of particulate organic carbon loss from mangrove ecosystems in the Everglades, provides evidence for particulate organic matter transport with regards to the formation of ridge and slough landscapes in the Everglades, and demonstrates the applicability of the combined biomarker and compound-specific stable isotope approach as a means to generate paleohydrological data in wetlands. The data suggests that: (1) Carbon loss from mangrove estuaries is roughly split 50/50 between dissolved and particulate carbon; (2) hydrological remobilization of particulate organic matter from slough to ridge environments may play an important role in the maintenance of the Everglades freshwater landscape; and (3) Historical changes in hydrology have resulted in significant vegetation shifts from historical slough type vegetation to present ridge type vegetation. ^

Economic assessment of best management practices in the Mara River Basin : toward implementing payment for watershed services

The Mara River in East Africa is currently experiencing poor water quality and increased fluctuations in seasonal flow. This study investigated technically effective and economically viable Best Management Practices for adoption in the Mara River Basin of Kenya that can stop further water resources degradation. A survey of 155 farmers was conducted in the upper catchment of the Kenyan side of the river basin. Farmers provided their assessment of BMPs that would best suit their farm in terms of water quality improvement, economic feasibility, and technicalsuitability. Cost data on different practices from farmers and published literature was collected. The results indicated that erosion control structures and runoff management practices were most suitable for adoption. The study estimated the total area that would be improved to restore water quality and reduce further water resources degradation. Farmers were found to incur losses from adopting new practices and would therefore require monetary support.

Trends in Water Quality within the Broward County Portion of the Biscayne Aquifer

Continuous and reliable monitoring of contaminants in drinking water, which adversely affect human health, is the main goal of the Broward County Well Field Protection Program. In this study the individual monitoring station locations were used in a yearly and quarterly spatiotemporal Ordinary Kriging interpolation to create a raster network of contaminant detections. In the final analysis, the raster spatiotemporal nitrate concentration trends were overlaid with a pollution vulnerability index to determine if the concentrations are influenced by a set of independent variables. The pollution vulnerability factors are depth to water, recharge, aquifer media, soil, impact to vadose zone, and conductivity. The creation of the nitrate raster dataset had an average RMS Standardized error close to 1 at 0.98. The greatest frequency of detections and the highest concentrations are found in the months of April, May, June, July, August, and September. An average of 76.4% of the nitrate intersected with cells of the pollution vulnerability index over 100.

Network Construction and Graph Theoretical Analysis of Functional Language Networks in Pediatric Epilepsy

This dissertation introduces a new approach for assessing the effects of pediatric epilepsy on the language connectome. Two novel data-driven network construction approaches are presented. These methods rely on connecting different brain regions using either extent or intensity of language related activations as identified by independent component analysis of fMRI data. An auditory description decision task (ADDT) paradigm was used to activate the language network for 29 patients and 30 controls recruited from three major pediatric hospitals. Empirical evaluations illustrated that pediatric epilepsy can cause, or is associated with, a network efficiency reduction. Patients showed a propensity to inefficiently employ the whole brain network to perform the ADDT language task; on the contrary, controls seemed to efficiently use smaller segregated network components to achieve the same task. To explain the causes of the decreased efficiency, graph theoretical analysis was carried out. The analysis revealed no substantial global network feature differences between the patient and control groups. It also showed that for both subject groups the language network exhibited small-world characteristics; however, the patient’s extent of activation network showed a tendency towards more random networks. It was also shown that the intensity of activation network displayed ipsilateral hub reorganization on the local level. The left hemispheric hubs displayed greater centrality values for patients, whereas the right hemispheric hubs displayed greater centrality values for controls. This hub hemispheric disparity was not correlated with a right atypical language laterality found in six patients. Finally it was shown that a multi-level unsupervised clustering scheme based on self-organizing maps, a type of artificial neural network, and k-means was able to fairly and blindly separate the subjects into their respective patient or control groups. The clustering was initiated using the local nodal centrality measurements only. Compared to the extent of activation network, the intensity of activation network clustering demonstrated better precision. This outcome supports the assertion that the local centrality differences presented by the intensity of activation network can be associated with focal epilepsy.