University Times

Wheelchair users may be at increased risk in motor vehicle crashes

Continued advances in wheelchair mobility, driving adaptations and vehicle modifications, along with the passage of the 1990 Americans with Disabilities Act, have given persons who use wheelchairs better access to transportation, via both public transportation and personal vehicles.

However, along with increased travel miles and enhanced access may come an increased risk of injury.

According to researchers at Pitt's School of Health and Rehabilitation Sciences (SHRS), when used as motor vehicle seats, commercially available wheelchairs not specifically designed for transportation may not provide adequate occupant protection in a crash.

Many wheelchair users are unable to transfer to a vehicle seat and remain seated in their wheelchairs while traveling.

Moreover, vehicle-mounted occupant restraint systems, which fail to provide proper belt fit, may further increase injury risk by failing to protect the wheelchair user in a crash.

These findings were published in a recent issue of the Journal of Rehabilitation Research and Development.

Gina Bertocci and a team of SHRS researchers evaluated, in four studies, the crashworthiness of wheelchair seating and wheelchair occupant restraint systems. In almost all of the studies, researchers found that standard wheelchair seating components failed to withstand simulated crashes, placing wheelchair users at a greater risk of injury.

In two of the studies — one that evaluated the crashworthiness of commercially available wheelchair back supports and one that assessed the effectiveness of wheelchair occupant restraint systems in a frontal crash — the components failed to withstand a simulated crash or failed to adequately protect the wheelchair user.

In another study, Bertocci and her colleagues utilized computer simulations to provide design criteria to aid manufacturers in the development of transport-safe wheelchairs.

"In most cases, typical seat and wheel assemblies will not sustain a crash well enough to maintain a person in the position necessary for effective restraint," said Douglas Hobson, associate professor, SHRS, who wrote a guest editorial in the journal.

"Substantial research is being conducted to improve the safety of vehicle seats and to improve protection for the occupant," said Bertocci. "Manufacturers of automotive seats are now required to perform extensive testing to ensure that vehicles comply with government crashworthiness standards. Our studies further prove that the stringent standards that apply to automotive seat manufacturers need to be transferred to the wheelchair transportation industry."

Other researchers involved in the project included Stephanie Szobota, DongRan Ha, Linda van Roosmalen, Patricia Karg and Ernest Deemer.

———————————-

Study of tPA use to brain site begins

Physicians at UPMC Health System Stroke Institute are beginning a study to determine whether administering tissue plasminogen activator (tPA) directly through an artery to the site of blockage in the brain, in addition to giving it systemically through a vein, can help improve patient outcome during a stroke.

The clot busting drug tPA is already an approved and effective treatment when given through a vein to patients who have strokes due to an artery blockage in the brain, if given within three hours from the onset of symptoms. Used intravenously in certain patients having a stroke, tPA dissolves the clot and restores blood flow to the brain. Using a catheter to deliver the drug directly to the clot in the brain may improve the effectiveness of the drug in dissolving clots.

"During a stroke, cells in the area of the brain that are not receiving blood begin to die immediately. The quicker we can dissolve a clot and restore blood flow, the more brain cells we can save," said Lawrence Wechsler, director the Stroke Institute and principal investigator in the study. "Intravenous administration of tPA is the only approved treatment for acute ischemic stroke. A limitation of this approach is that large clots are less likely to dissolve in a sufficiently short time frame to improve a patient's outcome. Our study will go one step further and attempt to determine if delivering tPA directly to the site of the blood clot in addition to intravenous tPA is safe and more effective in reducing the damage from stroke."

Stroke is the third most common cause of death and the leading cause of adult disability in the United States. Some 700,000 Americans suffer a stroke each year; 70 percent of these are ischemic strokes in which a clot blocks oxygen delivery to a portion of the brain. On average, someone in the United States suffers a stroke every 53 seconds and 160,000 Americans die annually from stroke.

Stroke symptoms include: weakness or paralysis on one side of the body, numbness or loss of sensation on one side of the body, difficulty with speech or inability to speak, sudden onset of loss of balance or dizziness and sudden loss of vision in one eye.

———————————-

Study using imaging to find cause of bipolar disorder

Pitt researchers are using new imaging techniques to examine biological factors that may cause bipolar disorder, commonly known as manic-depression, with the hope of finding better treatments.

The study, conducted at Western Psychiatric Institute and Clinic (WPIC), makes use of a new type of imaging technology called magnetic resonance spectroscopy. MRS allows scientists to study living human brain neurochemistry by examining naturally occurring isotopes. The technology also may prove to be a powerful tool for drug developers.

Bipolar disorder affects about 1.5 percent of the population, accounting for nearly 4.5 million people in the United States alone. The most common treatment for the disorder is lithium, which works for 50-60 percent of patients. For patients who do not respond to lithium, or who cannot tolerate it, there are few available alternatives.

"Our study will use advanced imaging technology to look into the brains of people with bipolar disorder so we can find underlying problems with brain chemistry," said Jair C. Soares, assistant professor of psychiatry, and director, Neurochemical Brain Imaging Laboratory, WPIC. "Initial studies using MRS to gauge concentrations and pharmacokinetics of lithium and other medications used to treat mental illness show the technology to be very effective in tracing the path of these medications within the brain. That ability will allow us to work with drug manufacturers to develop effective treatments."

———————————-

Bradford profs' research on Internet's role in presidential election is published on-line

Two professors at the Bradford campus, who studied the role of the Internet in this year's presidential election and the future of digital politics, have had their research published on-line.

"The Digital Tea Leaves of Election 2000: The Internet and the Future of Presidential Politics" by Don Lewicki and Tim Ziaukas was featured recently on First Monday, Peer-Reviewed Journal on the Internet.

Lewicki is an assistant professor of business management and manager of Pitt-Bradford's computing, telecommunications and media services. Ziaukas is an associate professor of public relations and directs the public relations program.

Their paper can be located at: http://firstmonday.org/issues/issue5_12/lewicki/index.html.

While some pundits predicted the Internet would make a breakthrough in election 2000, that wasn't the case, the two professors wrote.

"By the end of the 2000 races, there appeared to be no breakaway winners, no singular Internet candidates …. Each candidate employed or realized one or two aspects well; no one had the whole package."

Failed Republican presidential candidate John McCain recognized the importance of the Internet and employed people who made web browsing on McCain's site appear to be an initiation to activism, which helped the candidate raise more than $10 million on-line.

Green Party candidate Ralph Nader's web site had a clean and efficient design, they wrote, and helped mobilize volunteers, especially students on college campuses.

Vice President Al Gore's site offered tools to potential supporters or "warriors" to become one-person campaign stops and hook up with other warriors to form a "tribe."

Republican candidate George W. Bush offered tightly written, regularly delivered e-mails when the campaign got tough and an efficient system for rebutting — "e-buttling" — Gore's debate claims.

Bush's digital efforts surpassed Gore's during the "second campaign," after the near-national voter tie and the political and legal wrangling in Florida, according to the professors.

The Bush web site posted a call to contribute to his post-election campaign in Florida and reinforced his message with an effective e-mail effort, Lewicki and Ziaukas wrote. Gore, however, posted information about the status of the recount in Florida that was already out of date.

The successful presidential Internet candidate in 2004 or 2008, they wrote, will raise money like McCain, develop warrior tools like Gore, have a clean and efficient design like Nader and have regularly, tightly written e-mails and efficient e-buttling like Bush, the professors wrote.

Nursing study looks at how endocrine changes contribute to antisocial behavior

Antisocial behavior in youth is a growing problem. Childhood antisocial behaviors (e.g., conduct problems) can become chronic as reflected in delinquency, adult interpersonal and domestic violence, and other criminal behavior.

The majority of studies of antisocial behavior have focused on individual psychological factors, or peer and neighborhood influence. Few studies have considered physiological aspects of antisocial behavior in children, in spite of the growing evidence linking physiological processes and crime in adults.

Pitt's School of Nursing recently received a three-year grant from the National Institute of Nursing Research to study how endocrine changes contribute to conduct problems in adolescents.

"We will examine the relationship between gonadal and adrenal hormone concentrations and conduct problems in children," said Lorah Dorn, principal investigator and assistant professor at the nursing school's Department of Health Promotion and Development. "We also want to determine whether gonadal and adrenal hormones moderate the effect of treatment on conduct problems and whether treatment of conduct problems alters gonadal and adrenal hormones of children with conduct problems."

Dorn's study will merge with David Kolko's existing randomized trial designed to compare the efficacy of a multimodal package of specialized services directed toward children, parents, and families in modifying severe conduct problems. Kolko is an associate professor of child psychiatry and psychology at Pitt's School of Medicine and a co-investigator on Dorn's study.

———————————-

Problem drinking affects adherence to HIV medication

Problem drinking affects medication adherence among individuals with HIV, according to a study by the University of Pittsburgh Center for Research on Health Care. Failure to adhere to a strict schedule of medication severely limits an HIV patient's survival.

"The results of this study emphasize the importance of screening for alcohol problems among persons with HIV," said principal investigator Robert L. Cook, a Pitt assistant professor of medicine. By identifying problem drinking, he said, doctors can better treat their patients, providing them with the supervision and support they need to adhere to their medication regimens.

Alcohol consumption, including excessive drinking, is common in the HIV population, according to the study published in the February issue of the Journal of General Internal Medicine.

The Pitt study is one of the first to look at the relationship between excessive drinking and medication adherence in those with HIV. HIV patients must follow a strict medication schedule. Even a few missed doses or taking HIV medications off schedule can result in viral resistance.

Cook and his Pitt colleagues surveyed over 200 individuals with HIV about missed or off-schedule medication doses and about their drinking habits. The researchers categorized problem drinkers in three ways: women who had five alcoholic drinks and men who had six alcoholic drinks at one sitting at least once a month, women who had more than 12 drinks and men who had more than 16 drinks weekly; and women and men with high scores on the Alcohol Use Disorders Identification Test.

Problem drinkers were more likely to take their HIV medications off schedule, the researchers found. Nearly half of the problem drinkers reported taking their medication off schedule during the previous week, compared to 26 percent of those without problem drinking behaviors.

Researchers cautioned that clinicians should not assume that problem drinkers will be unable to follow complex medical regimens. They recommended that clinicians should work with patients individually to develop strategies to help them adhere to their HIV medications.