School health counseling helps teens end abusive relationships

A study led by Elizabeth Miller, a pediatrics faculty member in the School of Medicine, provides evidence of the potential benefits of a brief, provider-delivered universal education and counseling intervention in school-based health centers to address and prevent the major public health problem of adolescent relationship abuse. The study appears online in Pediatrics.

In collaboration with the California Adolescent Health Collaborative of the Public Health Institute, California School-Based Health Alliance and Futures Without Violence, the study was conducted during the 2012-13 academic year at eight school-based health centers in California where students receive confidential clinical health services. Researchers surveyed 1,062 students ages 14-19 for exposure to adolescent relationship abuse (including cyber dating abuse), sexual behavior and care-seeking for sexual and reproductive health at their initial visit and again three months later.

Providers and staff in four school-based health centers received training on how to talk about healthy and unhealthy relationships; received palm-sized brochures about relationship abuse and available resources to hand out to patients, and learned how to refer youth to additional services and supports. No changes were implemented at the other four school-based health centers.

The researchers found students at the intervention sites were more likely than those at the other sites to recognize sexual coercion. Among students who reported relationship abuse at an initial visit on a confidential survey, students at intervention schools were significantly less likely to report such abuse on the follow-up survey three months later.

Said Miller, a Children’s Hospital researcher and chief of the Division of Adolescent and Young Adult Medicine: “This study shows that a universal education and brief counseling approach in health care settings may be a useful way to address relationship abuse among adolescents. Clinicians talking about healthy and unhealthy relationships with all of their patients can make a difference.”

Among almost 400 youth who reported experiencing relationship abuse at an initial visit, 65 percent of students in intervention schools said they still were experiencing such abuse about three months later, compared to 80 percent of students in the other schools. In addition, youth in the intervention clinics were much more likely to discuss being in an unhealthy relationship with their health-care provider.

Collaborators with Miller on the study from Pitt were Heather L. McCauley, Kelley Jones and Rebecca Dick, along with colleagues from the California Adolescent Health Collaborative, University of California-San Diego, California School-Based Health Alliance/California State University, University of California-San Francisco, Futures Without Violence and University of California-Davis.

The study was supported by the National Institute of Justice, Office of Justice Programs, Department of Justice.

New clue for development of lung fibrosis in older patients

When School of Medicine researchers took a closer look at certain cells from the scarred lungs of patients with idiopathic pulmonary fibrosis (IPF), they were surprised by what they saw: many misshapen, bloated mitochondria. The unexpected observation led them to conduct a study that could for the first time help explain why the risk of developing the deadly lung disease increases with age. The study results are online and will be featured on the cover of the February issue of the Journal of Clinical Investigation.

Older age is a well-known risk factor for IPF, a disease in which the lung tissue becomes progressively fibrotic, or scarred, leading to breathing difficulties and death within three-five years if a lung transplant isn’t possible, said senior investigator Ana L. Mora, faculty member in the Division of Pulmonary, Allergy and Critical Care Medicine and a member of the Heart, Lung, Blood and Vascular Medicine Institute (VMI). The cause of the disease is unknown, or “idiopathic.”

Said Mora: “Other chronic and progressive diseases we see with aging, such as Parkinson’s disease, have been recently associated with mitochondrial abnormalities, so we wondered if that was occurring in IPF. It was a simple question, but it hadn’t been asked before, so we examined lung cells from patients with advanced IPF and healthy people. We were so surprised to see dramatic differences in the number, shape and function of the mitochondria.”

After characterizing the oddities of the mitochondria, which provide energy for the cell, Mora’s team checked the levels of an enzyme called PTEN-induced putative kinase 1, or PINK1, that plays key roles in mitochondrial function and morphology, or shape. Experiments showed that impairment of mitochondria was associated with a reduction in PINK1 expression, and mice lacking PINK1 had dysfunctional, misshapen mitochondria in lung cells and were susceptible to developing lung fibrosis.

“We found also that low PINK1 is associated with increasing age and cellular stress,” Mora said. “This might help explain why older people are at greater risk for developing IPF, and it could mean developing drugs that can boost PINK1 levels or improve mitochondrial function will help treat IPF.”

The team also hopes to find biomarkers to identify the disease in earlier stages as well as explore other factors that could increase susceptibility to IPF.

Pitt collaborators included Marta Bueno, Yen-Chun Lai, Judith Brands, Claudette St. Croix, Christelle Kamga, Catherine Corey, John Sembrat, Janet S. Lee, Steve R. Duncan, Mauricio Rojas, Sruti Shiva and Charleen T. Chu, along with researchers from Yale and Ciudad Universitaria in Mexico City.

The project was funded by the National Institutes of Health (NIH), VMI, the Institute for Transfusion Medicine and the Hemophilia Center of Western Pennsylvania.

Faculty contribute to Energy Technology shale issue

Swanson School of Engineering, Graduate School of Public and International Affairs (GSPIA) and Dietrich School of Arts and Sciences researchers shared their findings from three studies related to shale gas in a recent special issue of the journal Energy Technology, edited by Götz Veser, the Nickolas A. DeCecco Professor of Chemical and Petroleum Engineering in the Swanson School of Engineering.

The faculty members look at “smart wells” that use wireless communication, wastewater management and information gaps between legislators, regulators, industry representatives, researchers and the public on the health and environmental impacts of shale gas drilling. The issue also included contributions from experts from across the United States, Europe and Asia.

The three papers included:

• On smart wells, Andrew Bunger and his co-authors proposed the development of a series of sensors sunk into wells that will allow drilling companies to pull data from the deep and use that information to optimize sections of productive wells, ramp up or shut down unproductive sections and find pockets of gas or oil that have been overlooked. Bunger, in civil and environmental engineering in the Swanson school, teamed with colleagues from electrical and computer engineering: faculty member Ervin Sejdic, PhD candidate Nicholas Franconi and emeritus professor Marlin Mickle. Bunger likens this nascent technology to cell phone communication, with the signal being passed from tower to tower on a call from, say, Pittsburgh to Los Angeles rather than beamed directly over great distance. The stepwise process is necessary, he said, because of the difficulty of sending data long distances through rock and other geological media.

• On wastewater management, Radisav Vidic, the William Kepler Whiteford Professor and Chair in the Department of Civil and Environmental Engineering in the Swanson school and a nationally recognized expert in water issues related to fracking, investigated methods to safely reuse drilling wastewater and ways of removing potentially harmful substances, including naturally occurring radioactive materials, from the wastewater. Vidic reviewed the management of wastewater produced during fracking in Pennsylvania’s Marcellus Shale reserve with department co-authors Can He, Tieyuan Zhang, Xuan Zheng and Yang Li.

• On information gaps, Shanti Gamper-Rabindran examined the gaps in the collection of information — and access to that information — that prevent the public, researchers, regulators and investors from fully understanding the health and environmental impacts of the shale industry. Resolving these information gaps would enable further innovations in risk-management strategies and, thus, benefit the industry and society. Said Gamper-Rabindran, a faculty member in GSPIA and in the Department of Economics in the Dietrich school: “Informed public debate in the lifecycle of unconventional shale gas development is critical because of the uncertainties in its benefits and risks, the unequal distribution of these benefits and risks in society, and the need to make evidence-based trade-offs between the benefits and costs of risk-mitigation strategies.”

New findings from mind-controlled robot arm project

In another demonstration that brain-computer interface technology has the potential to improve the function and quality of life of those unable to use their own arms, a woman with quadriplegia shaped the hand of a robot arm with just her thoughts to pick up big and small boxes, a ball, an oddly shaped rock and fat and skinny tubes.

The findings by researchers at the School of Medicine, published online in the Journal of Neural Engineering, described, for the first time, 10-degree brain control of a prosthetic device in which the trial participant used the arm and hand to reach, grasp and place a variety of objects.

Said senior investigator Jennifer Collinger, faculty member in the Department of Physical Medicine and Rehabilitation (PMR) Medicine and research scientist for the VA Pittsburgh Healthcare System: “Our project has shown that we can interpret signals from neurons with a simple computer algorithm to generate sophisticated, fluid movements that allow the user to interact with the environment.”

In February 2012, small electrode grids with 96 tiny contact points each were surgically implanted in the regions of trial participant Jan Scheuermann’s brain that would normally control her right arm and hand movement.

Each electrode point picked up signals from an individual neuron, which then were relayed to a computer to identify the firing patterns associated with particular observed or imagined movements, such as raising or lowering the arm, or turning the wrist. That “mind-reading” was used to direct the movements of a prosthetic arm developed by the Johns Hopkins Applied Physics Laboratory.

Within a week of the surgery, Scheuermann could reach in and out, left and right, and up and down with the arm to achieve 3-D control, and before three months had passed, she also could flex the wrist back and forth, move it from side to side and rotate it clockwise and counter-clockwise, as well as grip objects, adding up to 7-D control. Those findings were published in The Lancet in 2012.

Said Michael Boninger, faculty member, PMR chair and director of the UPMC Rehabilitation Institute: “In the next part of the study, described in this new paper, Jan mastered 10-D control, allowing her to move the robot hand into different positions while also controlling the arm and wrist.”

To bring the total of arm and hand movements to 10, the simple pincer grip was replaced by four hand shapes: finger abduction, in which the fingers are spread out; scoop, in which the last fingers curl in; thumb opposition, in which the thumb moves outward from the palm, and a pinch of the thumb, index and middle fingers. As before, Scheuermann watched animations of and imagined the movements while the team recorded the signals her brain was sending in a process called calibration. Then, they used what they had learned to read her thoughts so she could move the hand into the various positions.

Said co-investigator Andrew Schwartz, neurobiology faculty member in medicine: “Jan used the robot arm to grasp more easily when objects had been displayed during the preceding calibration, which was interesting. Overall, our results indicate that highly coordinated, natural movement can be restored to people whose arms and hands are paralyzed.”

After surgery in October to remove the electrode arrays, Scheuermann concluded her participation in the study.

The research team also included John E. Downey and Elizabeth Tyler-Kabara of Pitt and lead author Brian Wodlinger (now of Imagistx).

The project was funded by the Defense Advanced Research Projects Agency, the Department of Veterans Affairs and the UPMC Rehabilitation Institute.

High-dose flu vaccine found to be better for frail elderly

The high-dose flu vaccine is significantly better than the regular flu shot at boosting the immune response to the flu virus in frail, older residents of long-term care facilities, according to the results of a School of Medicine study.

It is the first evaluation of the vaccine in long-term care residents, which is the population most vulnerable to flu-related death. The study, published in the Journal of Infectious Diseases and funded by vaccine-maker Sanofi Pasteur, found that — with the exception of one strain of flu circulating in the 2012-13 season — the high-dose flu vaccine helped participants mount a better immune response to influenza than the standard flu shot.

Said lead author David A. Nace, director of long-term care and flu programs in the Division of Geriatric Medicine and chief medical officer for UPMC Senior Communities: “The elderly living in long-term care facilities have higher influenza exposure risks, lower immune defenses and a much greater likelihood of flu-related death than the general population. For these reasons, we need more effective flu vaccine options for frail, older adults.”

Each year in the U.S., there are 3,000-49,000 influenza-associated deaths, with over 90 percent reported among people aged 65 years and older, according to the Centers for Disease Control and Prevention (CDC). Mortality is 16 times higher among those 85 years old compared to those 65-69 years. Although the influenza vaccine is the best defense against the flu, it is not 100 percent effective. Among the elderly population, clinical efficacy of the standard vaccine is reduced by 17-60 percent.

In December 2009, the U.S. Food and Drug Administration licensed trivalent inactivated influenza vaccine — Sanofi Pasteur’s Fluzone High-Dose — specifically designed for people 65 years and older. The high-dose contains four times the antigen of regular shots.  Antigen is the part of a vaccine that prompts the immune system to make antibodies against flu.

During the 2011-12 and 2012-13 flu seasons, Nace and his colleagues followed 187 people with an average age of 86.7 years living in 15 community-based, long-term care sites in western Pennsylvania, including nursing facilities, assisted or personal care homes and independent living facilities. To ensure they were among the frail population most vulnerable to flu, only people who needed full or partial assistance in at least one daily self-care activity, such as dressing or grooming, were included.

Participants were selected randomly to receive either a high-dose or standard flu shot at the beginning of the flu season. They then were tested for their antibody response 30 and 180 days after receiving the flu shot. This helped doctors determine how much the vaccine prepared participants’ immune systems for the flu virus and also how much that protection waned by the end of the flu season.

Both the high-dose and standard flu vaccines contain inactivated versions of the three influenza strains that world health officials determine most likely to be circulating in a given flu season.

At 30 days and again at 180 days, the immune response was greater for high-dose compared to the standard vaccine for all the flu strains in both seasons, except strain A/H1N1 in the 2012-13 season. The researchers noted that A/H1N1 was identical in both seasons, and 26 percent of participants took part in the study both seasons, something that might have caused the lower generation of antibodies to the strain in the second season.

Said senior author Richard K. Zimmerman of the Department of Family Medicine: “Historically, the protection from regular influenza vaccine among seniors has been moderate. Now an option with better immunologic protection is available, as our study shows.”

The trial did not evaluate whether fewer of the high-dose recipients actually contracted the flu than those receiving the standard vaccine.

“The high-dose vaccine is not a guarantee against contracting the flu, even though it significantly decreases the likelihood,” said Nace. “That is why it is so important to take a ‘bundled approach’ to preventing flu in long-term care facilities, including vaccination of health care workers, asking people with flu-like illness not to visit residents, practicing proper cough etiquette and hand hygiene and frequent sanitation of commonly used areas and equipment.”

Co-authors on this study were Chyongchiou Jeng Lin, Stacey Saracco and Roberta M. Churilla of Pitt, and a researcher from the Vaccine & Gene Therapy Institute of Florida.

Additional grants were provided by Pitt’s Claude D. Pepper Older Americans Independence Center through NIH.

Growth of fish, local support, prove urban stream restoration success

Nine Mile Run in Frick Park once was known as “Stink Creek.” From 2003 to 2006, the City of Pittsburgh and the U.S. Army Corps of Engineers poured $7.7 million into restoring 2.2 miles of the stream and tributaries into approximating what they were prior to urban development.

The project remains one of the largest urban-stream restorations undertaken in the United States.

What can this restoration teach us as we continue to deal with streams affected by urbanization?

Dan Bain, hydrology and metal biogeochemistry faculty member in the Dietrich school’s Department of Geology and Planetary Science, believes the project has made a difference and sets an example for other cities to follow. Bain’s paper, “Characterizing a Major Urban Stream Restoration Project: Nine Mile Run,” was published in the Journal of the American Water Resources Association.

Nine Mile Run is part of a watershed that drains 6.5 square miles of Wilkinsburg, Edgewood, Swissvale, Forest Hills, Squirrel Hill and Point Breeze and had been abused by urbanization and industrialization. Toxins leached into the creek from a slag heap left over from the steelmaking process, sewer lines discharged into the water, and so much of the waterway had been buried in culverts or diverted from its natural path that Nine Mile Run had become toxic.

The three-year restoration project involved rerouting the creek to a natural pathway, re-establishing flora, creating areas to catch floodwater and building natural “slash piles” and “snags” from cut-down trees to create bird and animal habitats. It also involved infrastructure interventions: adding rain barrels to individual’s homes, preventing some storm water from overwhelming the stream and fixing parts of the underlying sewers.

Some of the impediments remain, but neighbors and Frick Park users have been motivated to continue the work. They have enlisted as volunteer urban ecostewards with the Nine Mile Run Watershed Association, a nonprofit that advocates for and monitors the area. Ecostewards visit an assigned plot on a regular basis to remove invasive species, plant native flora and clean up trash. They also install rain barrels on their property to reduce runoff and slow erosion.

Bain’s paper reported that fish populations are improving as are populations of macroinvertebrates, such as insects and crustaceans, that fish feed on, though their recovery is coming along more slowly. The human response to this restoration has been vigorous — the rise in the number of volunteer hours as well as the number of rain barrels installed at private residences appears to be associated with the restoration of the stream. If replicated elsewhere, community involvement should be considered an important part of sustaining improvements in stream health.

Said Bain: “What we found is that, properly done, urban-stream restoration can create a citizen involvement in the process of appropriately managing urban streams and give us a greater opportunity to understand how restorations work in an urban system, particularly when compared with our ability to understand restoration success in less populated areas.”

Studies to examine “school-to-prison pipeline” & help blacks in STEM

James P. Huguley, research associate in the School of Social Work and the Center on Race and Social Problems, has received $48,309 from the Heinz Endowments to study problems and identify remedies relating to racial disparities in school discipline in the Pittsburgh region.

In its initial stages, the project will examine the current research relating to the “school-to-prison pipeline” in the United States, how existing policies may affect student justice-system involvement and how the entire process connects to racial disparities in school discipline.

The project also will assess to what degree local school discipline policies and practices are equipped to remedy racial inequalities in these areas and make specific recommendations to Pittsburgh area schools.

Research has shown that zero tolerance discipline policies have serious long-term consequences and that youth who are steered toward the justice system suffer diminished academic, civil and economic prospects.

According to Huguley, the principal investigator, “The racial disparities in these juvenile justice experiences make this study extremely critical right now.” He notes that while general best practices in school discipline have been prescribed at the national level, these practices are not yet well designed to address racial differences in discipline experiences. Nor have the national policies been closely examined for their potential adaptability and impact at the local level.

“Locally we need to understand both,” Huguley said. “We need to understand what the best approaches to racial justice in school discipline are, and we need to understand how to best apply these and other best practices in school discipline to the unique social context of greater Pittsburgh.”

Huguley will be joined on this project by two University collaborators: Ming-Te Wang from the School of Education, and Katherine Monahan from the Department of Psychology. They expect to produce a set of recommendations for best practices, advocacy and policies that are specific to the greater Pittsburgh social, cultural and political context.

“It is our hope that these recommendations will assist in the design and support of local efforts to dismantle the prison-to-school pipeline and racial disproportionality in ways that might make greater Pittsburgh a model for urban regions nationally,” said Huguley.

Huguley and Wang also received $44,000 from the Heinz Endowments to collaborate with college-based science, technology, engineering and mathematics (STEM) programs to implement effective strategies for increasing African-American participation.

Historically, efforts to increase participation in STEM careers in the United States have been hampered by racial inequalities at the high-school level, where African Americans tend to have lower scores, particularly in mathematics. While remedies have been elusive in K-12 education, research has shown that effective initiatives for developing black high achievers in high school STEM programs do exist.

Huguley, principal investigator, noted that “racial disparities in college-level STEM major enrollment and persistence are in large part attributable to differences in secondary school preparation in these areas.” In addition, racial achievement disparities in mathematics grow to be larger than those in reading as students progress through school years.

This planning initiative is designed to help disseminate and develop these types of successful programs. Collaborative activities include site visits to successful programs, sharing of best practices and consulting on program development. Huguley expects the project to result in the implementation of a pilot program in a Pittsburgh area school district for the fall of 2016.

Study: Candidate gender gap persists

An interest in the gender gap between the representations of female candidates in U.S. elections compared to their male counterparts led two political science faculty members to take the issue into the laboratory for three years of research.

Kristin Kanthak and Jonathan Woon have published an article about the first phase of their research findings, “Women Don’t Run? Election Aversion and Candidate Entry,” in the American Journal of Political Science.

Said Woon: “Past research has shown that women seem to be under-confident in their ability to hold office. We tried to examine scientifically what the factors were in the decision-making process.”

Kanthak and Woon enlisted 350 undergraduate Pitt students to participate in the laboratory experiments, which Kanthak said appeared to show women are more “election averse” than men.

Their research was conducted in three phases in the Pittsburgh Experimental Economics Lab in Posvar Hall, an interdisciplinary research center funded by the National Science Foundation and the Dietrich school. In the first phase, men and women were divided into random groups and given a task of adding up numbers. Participants solved as many addition problems as they wanted in a limited time and were paid for correct answers.

In the second phase, participants were asked if they were willing to represent the group. One volunteer was randomly selected, and everyone repeated the addition task. That time, participants earned two-thirds of their money through the addition problems answered correctly by their group leader and one third through their own correctly answered questions. In that scenario, Kanthak and Woon said, men and women each volunteered to lead the group equally about 80 percent of the time.

In the final phase of the experiment, the participants were asked to declare whether they wanted to be elected as the leader. In that case, they were told to run a short campaign and give a message to the group. Kanthak and Woon found that when a competitive election process was introduced, 78 percent of men chose to run, but only 60 percent of women did.

Kanthak noted that women will volunteer to lead a group but are less likely than men to go through an actual competition or election to do so: “We wanted to control the incentives potential candidates face and place men and women with similar qualifications, ambitions and political environments alongside one another and see if they still made the same decisions to put themselves out there as a candidate. We wanted to level the playing field, and we were able to do that by taking our questions into a lab environment.

“We also found that election aversion persists with variations in the electoral environment, disappearing only when campaigns are both costless and completely truthful.”

Center funds new biomedical devices

The Center for Medical Innovation (CMI) awarded grants totaling $53,000 to three research groups through its 2014 round-2 pilot funding program for early stage medical technology research and development. The latest funding proposals include developing super-sensitive chemical assays for detecting blood proteins, a novel retractor for abdominal and thoracic surgical procedures and a self-monitoring device for rehabilitation of stroke patients.

CMI, in the Swanson school, supports applied technology projects in the early stages of development with “kickstart” funding toward the goal of transitioning the research to clinical adoption. Proposals are evaluated on the basis of scientific merit, technical and clinical relevance, potential health care impact and significance, experience of the investigators and potential in obtaining further financial investment to translate the particular solution to health care.

Said Alan D. Hirschman, CMI executive director: “This early-stage interdisciplinary research helps to develop highly specific biomedical technologies through a proven strategy of linking UPMC’s clinicians and surgeons with the Swanson school’s engineering faculty.”

The awards were to:

• I-HITS: individualized hand improvement and tracking system for stroke — to design, build and test a rehabilitation system for stroke patients to self-monitor, track and improve hand weakness, under Amit Sethi, occupational therapy faculty member in the School of Health and Rehabilitation Sciences; Ervin Sejdic, in Swanson’s Department of Electrical and Computer Engineering, and a non-Pitt researcher.

• Diagnosis of aggressive prostate cancer via detection of MMP9 in biological fluids — to develop a prototype chemical assay device for detection of femtomolar levels of MMP9 in biological fluids, under Abhinav Acharya and Steven R. Little of the Department of Chemical and Petroleum Engineering, and

• A motorized flexible arm retractor for open abdominal surgery — to develop a prototype flexible retractor system that significantly improves effectiveness, safety and efficiency of surgical procedures, under Garth A. Elias and Pete Allen of medicine and Jeffrey S. Vipperman of the Department of Mechanical Engineering and Materials Science.

Understanding emotional reactions after terrorist acts

The 2013 Boston Marathon bombing prompted mass expressions of fear, solidarity and sympathy toward Bostonians on social media networks around the world. In a recently released study, researchers at Pitt and Cornell analyzed emotional reactions on Twitter in the hours and weeks following the attack.

The study is the first large-scale analysis of fear and social-support reactions from geographically distant communities following a terrorist attack. The findings show the extent to which communities outside of Boston expressed their emotions by using hashtags such as #PrayForBoston and how those reactions correlated with geographic proximity, social-network connections and direct ties to Boston.

The study, which has been published online in EPJ Data Science, may provide insight to governmental agencies exploring how to best handle public fear following a disruptive event.

Said Yu-Ru Lin, the study’s principal researcher and a School of Information Sciences faculty member: “When a community in one geographic location is attacked, it is important for government officials to be able to predict where public fears will be heightened most as a result of that attack. The findings of our study will potentially assist officials in predicting the exact manner and extent in which citizens in their own regions will react to tragic occurrences in another region of the country. By swiftly recognizing the heightened presence of fear as a result of occurrences elsewhere, officials within a city can respond appropriately with various measures to calm the public and reassure them that all measures are being taken to ensure public safety and well-being.”

Researchers analyzed more than 180 million geocoded tweets from individuals in 95 cities around the world; they focused their analysis on the 60 most-populated metropolitan areas in the United States as well as the 35 highest-populated cities outside of the United States.

To study expressions of fear, Lin’s team utilized content-analysis programs to search for a predetermined set of keywords — including “fearful,” “fatal” and “terror” — within tweets directly related to the bombing. The study also utilized Twitter hashtags to identify tweets reflecting expressions of solidarity and sympathy. Researchers found that citizens in some cities were more likely to express specific emotions based on geography and shared experiences.

The hashtag #PrayForBoston — a variant of the #PrayFor hashtags that have been used in recent years following various tragic events — was used to identify expressions of sympathy. Citizens in the city of London were modest in their expressions of fear and solidarity but were more forthcoming in their use of the #PrayForBoston hashtag. Lin and her team theorized that the greater show of sympathy from Londoners was due to the citizens of London having endured their own terrorist attacks in the recent past and therefore relating to the sense of tragedy that Boston’s citizens were enduring.

The hashtag #BostonStrong — a variant of the #strong hashtags made popular by Lance Armstrong’s Livestrong motto and the U.S. Army’s “Army Strong” media campaign — was used to measure expressions of solidarity. Expressions of solidarity were used most by citizens in U.S. cities that possess close geographic proximity and have similar cultural identities as Boston. For instance, citizens in Chicago and Washington, D.C., were more likely to express emotions of solidarity due to their relative closeness in distance and personal ties with Boston.

According to the study’s overall findings, the extent to which communities outside of the Boston metropolitan area expressed emotional reactions to the attack directly correlated with individuals’ geographic proximities, social network connections to Boston residents and relationships to the city of Boston. Furthermore, reactions of fear were the most likely of sentiments to be expressed by individuals with direct ties to Boston or to Bostonians. The extent to which individuals had ties to the Boston area was the best predictor of fear and solidarity expression as well as a strong predictor of an expression of sympathy.

Patient’s own stem cells could clear cloudy cornea

Treating the potentially blinding haze of a scar on the cornea might be as straightforward as growing stem cells from a tiny biopsy of the patient’s undamaged eye and then placing them on the injury site, according to mouse model experiments conducted by School of Medicine researchers. The findings, published in Science Translational Medicine, could one day rescue vision for millions of people worldwide and decrease the need for corneal transplants.

According to the National Eye Institute, part of NIH, corneal infectious diseases affect the vision of a quarter of a billion people, and cause blindness in more than six million. As noted by senior investigator James L. Funderburgh, ophthalmology faculty member and associate director of the Louis J. Fox Center for Vision Restoration (a joint program of UPMC Eye Center and the McGowan Institute for Regenerative Medicine), trauma, such as burns, also are a leading cause of corneal scarring.

Said Funderburgh: “The body usually responds to corneal injuries by making scar tissue. We found that delivery of stem cells initiates regeneration of healthy corneal tissue rather than a scar leaving a clear, smooth surface.”

Study lead author Sayan Basu, a former corneal surgeon at the L.V. Prasad Eye Institute in Hyderabad, India, joined Funderburgh’s lab. Basu previously had developed a technique to obtain ocular stem cells from tiny biopsies at the surface of the eye and a region between the cornea and sclera known as the limbus. Removal of tissue from this region heals rapidly with little discomfort and no disruption of vision. After collecting biopsies from banked human donor eyes, the team expanded the numbers of cells in a culture plate using human serum to nourish them. They conducted several tests to verify that these cells were, in fact, corneal stem cells.

Said Basu: “Using the patient’s own cells from the uninjured eye for this process could let us bypass rejection concerns. That could be very helpful, particularly in places that don’t have corneal tissue banks for transplant.”

The team then tested the human stem cells in a mouse model of corneal injury. They used a gel of fibrin, a protein found in blood clots that is commonly used as a surgical adhesive, to glue the cells to the injury site. They found the scarred corneas of mice healed and became clear again within four weeks of treatment, while those of untreated mice remained clouded.

“Even at the microscopic level, we couldn’t tell the difference between the tissues that were treated with stem cells and undamaged cornea,” said Funderburgh. “The stem cells appeared to induce healing beyond the immediate vicinity of where they were placed. That suggests the cells are producing factors that promote regeneration, not just replacing lost tissue.”

His team’s work is the inspiration behind a small pilot study underway in Hyderabad in which a handful of patients will receive their own corneal stem cells as a treatment.

The Pitt team included co-lead author Andrew J. Hertsenberg, Martha L. Funderburgh, Michael K. Burrow, Mary M. Mann, Yiqin Du, Kira L. Lathrop and Fatima N. Syed-Picard. Researchers from the University of South Florida also contributed.

The project was funded by NIH, the Louis J. Fox Center for Vision Restoration, the Hyderabad Eye Research Foundation and Research to Prevent Blindness.

Racial, ethnic health care gaps narrow

Racial and ethnic disparities in the quality of U.S. hospital care for patients with heart attack, heart failure and pneumonia shrank considerably between 2005 and 2010, as more patients of all races received recommended treatments, according to a national analysis by several institutions, including the School of Medicine.

The study, published in the New England Journal of Medicine, found that care for blacks and Hispanics became better and more equitable when comparing hospitals principally serving whites to hospitals principally serving minorities and when comparing changes in care over time within the same hospitals. The work was supported by the Centers for Medicare and Medicaid Services (CMS).

Said senior author Michael Fine, faculty member in medicine and staff physician at the Veterans Affairs Pittsburgh Healthcare System: “It is [still] critically important to demonstrate that these improvements in care are accompanied by better patient outcomes. Further studies are needed to investigate if racial and ethnic disparities in mortality have also decreased over time.”

Fine also directs the Center for Health Equity Research and Promotion at the VA Pittsburgh Healthcare System, which is focused on detecting, understanding and reducing disparities in health and health care in vulnerable populations.

Fine and his co-investigators looked at more than 12 million acute care hospitalizations over the five-year span and found that, as quality of care improved and hospitals did a better job providing and performing recommended treatments and procedures, so did racial and ethnic equity. Nine major disparities evident in 2005 had mostly or totally disappeared by the end of 2010.

Widespread evidence remains for racial, ethnic and socioeconomic disparities in medicine, and the results of the team’s analysis, while very positive, address only a narrow spectrum of care delivery. But they suggest that when hospitals strive to improve quality, they can improve equity.

Using data publicly reported to CMS through the inpatient quality reporting program, the team looked at the performance rates by race and ethnicity for 17 procedures that are recommended to improve patient outcomes, such as giving an aspirin to heart attack patients, a flu vaccination to pneumonia patients or clearing a blood clot in an artery of heart attack patients within 90 minutes.

The overall range of improvements was between 3.4 and 58.3 percentage points. At the beginning of 2005, there were nine metrics — three among blacks and six among Hispanics — for which there were white vs. minority gaps greater than 5 percentage points. By 2010 all the gaps had narrowed significantly. Gaps between blacks and whites tightened by 8.5 to 11.8 percentage points. Disparities between whites and Hispanics narrowed by 6.2 to 15.1 percentage points.

The paper’s other authors were Leslie R. M. Hausmann, Maria K. Mor and Jonathan S. Lee of Pitt, with colleagues from Brown University, the Oklahoma Foundation for Medical Quality, the University of Oklahoma Health Sciences Center and CMS also contributing.

How long can Ebola live outside humans?

The Ebola virus travels from person to person through direct contact with infected body fluids. But how long can the virus survive on glass surfaces or countertops? How long can it live in wastewater when liquid wastes from a patient end up in the sewage system? In an article published in Environmental Science & Technology Letters, Kyle Bibby, civil and environmental engineering faculty member in the Swanson school, reviewed the latest research to find answers to these questions.

He and his co-investigators didn’t find many answers.

Said Bibby: “The World Health Organization (WHO) has been saying you can put (human waste) in pit latrines or ordinary sanitary sewers and that the virus then dies. But the literature lacks evidence that it does. They may be right, but the evidence isn’t there.”

Bibby and colleagues from Pitt and Drexel University explained that knowing how long the deadly pathogen survives on surfaces, in water or in liquid droplets is critical to developing effective disinfection practices to prevent the spread of the disease. Currently, WHO guidelines recommend to hospitals and health clinics that liquid wastes from patients be flushed down the toilet or disposed of in a latrine. However, Ebola research labs that use patients’ liquid waste are supposed to disinfect the waste before it enters the sewage system.

Bibby’s team found a dearth of published studies on the matter. That means no one knows for sure whether the virus can survive on a surface and cause infection or how long it remains active in water, wastewater or sludge. The team concluded that Ebola’s persistence outside the body needs more careful investigation.

Bibby recently won a $110,000 National Science Foundation (NSF) grant to explore the issue. His team will identify surrogate viruses that are physiologically similar to Ebola and study their survival rates in water and wastewater. The findings of this study will inform water treatment and waste-handling procedures in a timely manner while research on the Ebola virus is still being conducted.

Drug proves effective against antibiotic-resistant ‘superbugs’

A treatment pioneered at the Center for Vaccine Research (CVR) is far more effective than traditional antibiotics at inhibiting the growth of drug-resistant bacteria, including so-called “superbugs” resistant to almost all existing antibiotics, which plague hospitals and nursing homes.

The findings, announced online in Antimicrobial Agents and Chemotherapy and funded by NIH, provide a needed boost to the field of antibiotic development, which has been limited in the last four decades and outpaced by the rise of drug-resistant bacterial strains.

Said senior author Ronald C. Montelaro, faculty member in microbiology and molecular genetics and co-director of CVR: “Very few, if any, medical discoveries have had a larger impact on modern medicine than the discovery and development of antibiotics. However, the success of these medical achievements is being threatened due to increasing frequency of antibiotic resistance. It is critical that we move forward with development of new defenses against the drug-resistant bacteria that threaten the lives of our most vulnerable patients.”

Each year in the U.S., at least 2 million people are infected with drug-resistant bacteria, and at least 23,000 die as a direct result of these infections, according to the CDC.

On the tail end of HIV surface protein, there is a sequence of amino acids that the virus uses to “punch into” and infect cells. Montelaro and his colleagues developed a synthetic and more efficient version of this sequence — called engineered cationic antimicrobial peptides, or “eCAPs” — that can be chemically synthesized in a laboratory setting.

The team tested the two leading eCAPs against a natural antimicrobial peptide (LL37) and a standard antibiotic (colistin), the latter being used as a last-resort antibiotic against multidrug resistant bacterial infections. The scientists performed the tests in a laboratory setting using 100 different bacterial strains isolated from the lungs of pediatric cystic fibrosis patients of Seattle Children’s Hospital and 42 bacterial strains isolated from hospitalized adult patients at UPMC.

The natural human antimicrobial peptide LL37 and the colistin drug each inhibited growth of about 50 percent of the clinical isolates, indicating a high level of bacterial resistance to these drugs. In marked contrast, the two eCAPS inhibited growth in about 90 percent of the test bacterial strains.

“We were very impressed with the performance of the eCAPs,” said Montelaro. “However, we still needed to know how long the eCAPs would be effective before the bacteria develop resistance.”

The team challenged a highly infectious and pathogenic bacterium called Pseudomonas aeruginosa — which flourishes in medical equipment and causes inflammation, sepsis and organ failure — with both the traditional drugs and eCAPs in the lab.

The bacterium developed resistance to the traditional drugs in as little as three days. In contrast, it took 25-30 days for the same bacterium to develop resistance to the eCAPs. In addition, the eCAPs worked just as effectively at killing Pseudomonas aeruginosa after it became resistant to the traditional drugs.

“We plan to continue developing the eCAPs in the lab and in animal models, with the intention of creating the least-toxic and most effective version possible so we can move them to clinical trials and help patients who have exhausted existing antibiotic options,” said Montelaro.

Additional researchers on this study were Berthony Deslouches, Jonathan D. Steckbeck, Jodi K. Craigo and Yohei Doi of Pitt, and a colleague from Seattle Children’s Research Institute.

The research also was supported by the CVR and Cystic Fibrosis Research Center.

Gold may be effective, affordable catalyst for energy, environment

Precious elements such as platinum work well as catalysts in chemical reactions, but require large amounts of metal and can be expensive. However, computational modeling below the nanoscale level may allow researchers to design more efficient and affordable catalysts from gold. These novel computer simulations to better explore how catalysts function at the nanoscale, led by researchers at the Swanson school, were the focus of the cover article in the January issue of Catalysis Science & Technology.

The study was led by principal investigator Giannis Mpourmpakis of the Swanson school’s Department of Chemical and Petroleum Engineering, with colleagues from University College London and the University of Delaware.

Said Mpourmpakis: “Gold has been widely used as jewelry since ancient times because it does not corrode and keeps its bright yellow color. However, subnanoscale catalysts consisting of only a few gold atoms show very rich and difficult-to-understand chemistry and finding the right composition requires trial and error experimentation in the lab. For example, a catalyst that consists of eight gold atoms can be extremely active for oxidation reactions, whereas the catalyst of six gold atoms is not active at all. This behavior has puzzled many researchers over the last decade.”

According to Mpourmpakis, these new computational modeling methods reduce the time and expense of lab experimentation and allow for more precise predictions of how to design a better catalyst using a minute amount of metal to reduce its cost. For example, a typical reaction on platinum catalysts would require thousands of atoms of rare metal, while the same reaction utilizing gold might require fewer than 10. The greatest potential impact for this process would be in energy-and environment-related fields, such as the catalytic reactions that convert carbon monoxide to carbon dioxide in automobile exhaust and the production of hydrogen using water and carbon monoxide.

This research endeavors to build a more efficient modeling process to accelerate catalyst design while improving efficiency and reducing costs.

“In lab experiments you can’t see in detail the physical and chemical properties that affect the catalytic activity, but with computations you can virtually ‘see’ them and reduce experimental trial and error,” Mpourmpakis explained. “By designing an effective catalyst with only a few atoms of metal, we can create a more sustainable method to improve chemical reactions across many industries, especially throughout the energy sector.”

PET scans help ID effective TB drugs

Sophisticated lung imaging can show whether a treatment drug is able to clear tuberculosis (TB) lung infection in human and macaque studies, according to researchers at the School of Medicine and their international collaborators. The findings, published online in Science Translational Medicine, indicate the animal model can predict correctly which experimental agents have the best chance for success in human trials.

According to senior investigator JoAnne L. Flynn, faculty member in microbiology and molecular genetics, an estimated 8.6 million people in the world contracted TB in 2012, for which the first-line treatment demands taking four different drugs for six-eight months to get a durable cure. Patients who aren’t cured of the infection — about 500,000 annually — can develop multi-drug resistant TB and have to take as many as six drugs for two years.

“Some of those people don’t get cured, either, and develop what we call extensively drug-resistant, or XDR, TB, which has a very poor prognosis,” she said. “Our challenge is to find more effective treatments that work in a shorter time period, but the standard preclinical models for testing new drugs have occasionally led to contradictory results when they are evaluated in human trials.”

In previous research, Flynn’s colleagues at NIH found that the drug linezolid effectively treated XDR-TB patients who had not improved with conventional treatment, even though mouse studies suggested it would have no impact on the disease. To further examine the effects of linezolid and another drug of the same class, Flynn’s team performed PET/CT scans in TB-infected humans and macaques, which also get lesions known as granulomas in the lungs. In a PET scan, a tiny amount of a radioactive probe is injected into the blood that gets picked up by metabolically active cells, leaving a “hot spot” on the image.

The researchers found that humans and macaques had very similar disease profiles, and that both groups had hot spots of TB in the lungs that in most cases improved after drug treatment. CT scans, which show anatomical detail of the lungs, also indicated post-treatment improvement. One patient had a hot spot that got worse, and further testing revealed his TB strain was resistant to linezolid.

The findings show that a macaque model and PET scanning can better predict which drugs are likely to be effective in clinical trials, Flynn said. The scans also could be useful as a way of confirming drug resistance, but aren’t likely to be implemented routinely.

“We plan to use this PET scanning strategy to determine why some lesions don’t respond to certain drugs, and to test candidate anti-TB agents,” she said.

The research team included lead author M. Teresa Coleman and others from Pitt, as well as those the National Institute of Allergy and Infectious Diseases (NIAID); the International Tuberculosis Research Center and Yonsei University College of Medicine, Republic of Korea; Rutgers; Frederick National Laboratory for Cancer Research, and the University of Cape Town, South Africa.

Funding was provided by NIAID, the National Cancer Institute, the Ministry of Health and Welfare, the Republic of Korea, and the Bill and Melinda Gates Foundation.

Gene mutation may explain how breast cancer spreads

A newly identified genetic mutation could increase our understanding of how breast cancer spreads and potentially guide treatment options for women with the disease, according to a study from the University of Pittsburgh Cancer Institute (UPCI) and Magee-Womens Research Institute (MWRI) presented at the 2014 San Antonio Breast Cancer Symposium.

This research represents the most comprehensive analysis to date of genomic changes that occur in breast cancer progression and indicate the extensive changes that happen during the spread of the disease.

Researchers from MWRI and UPCI sequenced frozen breast tumor samples from six patients, beginning with the primary tumor when the cancer was first diagnosed through the progression of metastatic disease. Using multiple sequencing techniques, the team identified a new gene created by two separate genes that fused together as a result of unstable DNA. This fusion gene was identified in a metastatic tumor sample and is believed to play a part in the spread of the original breast cancer.

Said Ryan Hartmaier, a research instructor in medicine’s Department of Pharmacology and Chemical Biology and lead author of the study: “We applied all of our sequencing technologies to the tumors in order to understand the changes that occur between the first breast cancer occurrence and late-stage disease.”

Since several types of breast cancer are fueled by the hormone estrogen, estrogen-blocking treatment is often recommended to prevent the disease from spreading. However, the fusion gene identified did not respond to estrogen-blocking treatment, contributing to the breast cancer’s spread.

Said Adrian Lee, the study’s senior author, director of the Women’s Cancer Research Center and faculty member in pharmacology, chemical biology and human genetics: “This research helps us further understand the genomic landscape of metastatic breast cancer. The new class of genetic changes identified take us another step further in personalized medicine and could change the way we treat certain patients if we are able to identify who will develop this genetic mutation.”

Safe, effective option for elderly acute myeloid leukemia patients

Seventy percent of elderly patients with acute myeloid leukemia (AML) who were treated with a combination of drugs aimed to make chemotherapy treatments effective and less toxic achieved remission or a slowing of disease progression, according to research at the UPCI, partner with UPMC CancerCenter. The findings were presented at the American Society of Hematology annual meeting.

The research is important because most elderly patients diagnosed with AML can’t tolerate the aggressive chemotherapy needed and tend to have more aggressive disease than younger patients, making prognosis poor. So researchers, led by UPCI’s Annie Im, medicine faculty in the Division of Hematology/Oncology, examined whether an epigenetic strategy using the drug decitabine followed by cytarabine would help make other treatments more tolerable by reactivating genes that previously had been silenced by the malignancy.

Said Im: “Outcomes are really poor in elderly patients who have AML because the only therapies we have are often too toxic to offer as treatment options, and the unmet need for novel therapies is dire. But we have shown that using this therapy in this patient population is safe and effective.”

In the study, 23 patients were evaluated after receiving what’s called an induction therapy of decitabine intravenously for five days followed by a standard dose of cytarabine intravenously for five days. Fourteen patients had complete remission and five patients had a complete remission with delayed bone marrow recovery. All patients except for two received two cycles of induction.

Researchers believe the drugs work because they help reactivate genes that had been silenced by the malignancy. In addition, evidence suggests that epigenetic priming by decitabine enhances the efficacy of cytarabine.

Researchers link brain abnormalities, concussion-related depression, anxiety

White matter brain abnormalities in some patients with depression disorders closely resemble abnormalities found in patients who have experienced a mild traumatic brain injury (mTBI), more commonly known as concussion, according to new research presented by School of Medicine researchers at the annual meeting of the Radiological Society of North America.

The researchers, who also studied anxiety in concussion patients who underwent imaging, believe determining these white-matter injuries also could help guide treatment in people who suffer such symptoms, whether they are due to trauma or not.

White matter in the brain is made up of long, finger-like fibers projecting from nerve cells and is covered by a whitish fatty material. While gray matter, the part of our brain without the fatty covering, holds our knowledge, white matter is what connects different regions of gray matter, allowing different parts of the brain to communicate with one another.

Over the past several years, cognitive consequences of concussion have dominated the news. Any association between concussion/mTBI and the development of psychiatric disorders hasn’t garnered the same level of attention. Saeed Fakhran, radiology faculty member, and his team wanted to determine if a trauma to the brain could be found in imaging as an underlying cause of depression or anxiety in certain patients.

Said Fakhran: “We know that neuropsychiatric disorders like depression and anxiety can be as disabling as Alzheimer’s dementia and chronic traumatic encephalopathy, affecting a person’s quality of life, and are often accompanied by higher rates of obesity, substance abuse and even suicide. We wanted to see if there were commonalities shared by patients with depression and anxiety disorders caused by brain trauma and those with non-traumatic depression.”

Fakhran and his team examined MRI scans performed in 74 concussion patients from 2006-14 using an advanced technique called diffusion tensor imaging.

Diffusion tensor imaging allows doctors to visualize the white matter and look for places where the white matter may be injured, resulting in decreased connections in the brain and post-concussion symptoms.

In patients with depression, researchers found injured regions in the reward circuit of the brain, which has also been found to be abnormal in patients with non-traumatic major depressive disorder.

Greater injury to the reward center of the brain correlated with a longer recovery time, similar to patients with non-traumatic major depressive disorder, the researchers said.

“Finding such similar injuries in mTBI patients with depression and major depressive disorder may suggest a common pathophysiology in both traumatic and non-traumatic depression that may help guide treatment,” said Fakhran.

“If we can prove a link, or even a common pathway, between post-traumatic depression and depression in the general population it could potentially lead to effective treatment strategies for both diseases.”

Because so few concussion patients undergo imaging, the researchers added that future, prospective research could benefit from following a larger group of patients.

Moreover, their findings didn’t include irritability, the third neuropsychiatric symptom they set out to study — causing them to determine that not all such post-concussion/mTBI symptoms appear to result in discrete white matter injuries. It also was difficult to determine, they said, if pre-existing brain abnormalities rendered certain patients more susceptible to depression or anxiety.

Group of wheelchair professionals will be started here

The Human Engineering Research Laboratories (HERL) has been awarded a grant from the U.S. Agency for International Development (USAID) to create the International Society of Wheelchair Professionals (ISWP) devoted to the professionalization of wheelchair services around the world.

The aim is to gather partners both regionally and throughout the globe to make certain that wheelchair -related issues receive attention in ways that are both timely and culturally relevant.

To be led by a Pitt wheelchair expert at its start, the ISWP aims to grow its affiliate network and become a World Health Organization collaborating center on wheelchairs to focus on wheelchair technology improvement.

HERL researchers publish results

• HERL researchers and colleagues from the Center for Assistive Technology have published a paper titled “Stability Analysis of an Electrical Powered Wheelchair Mounted Robotic Assisted Transfer Device” in the Journal of Rehabilitation Research and Development.

The ability of people with disabilities to live in their homes and communities with maximal independence often hinges, at least in part, on their ability to transfer or be transferred by an assistant.

Because of limited resources and the expense of personal care, robotic transfer assistance devices likely will be in great demand. An easy-to-use system for assisting with transfers, attachable to electrical powered wheelchairs (EPWs) and readily transportable, could have a significant positive effect on the quality of life for people with disabilities.

The team investigated the stability of its newly developed Strong Arm, which is attached and integrated with an electrical powered wheelchair to assist with transfers. They analyzed the system’s stability and verified it with experiments applying different loads and using different system configurations.

The model predicted the distributions of the system’s center of mass very well compared with the experimental results. When real transfers were conducted with 50 and 75 kg loads and an 83.25 kg dummy, the current Strong Arm could transfer all weights safely without tip-over. The modeling accurately predicts the stability of the system and is suitable for developing better control algorithms to enhance the safety of the device.

Lead author Hongwu Wang was joined by Chung-Ying Tsai, Hervens Jeannis, Cheng-Shiu Chung, Annmarie Kelleher, Garrett G. Grindle and Rory A. Cooper.

• With first author Harshal P. Mahajan, HERL colleagues Donald M. Spaeth, Brad E. Dicianno, Karl Brown and Rory A. Cooper have published “Preliminary Evaluation of a Variable Compliance Joystick for People With Multiple Sclerosis” in the Journal of Rehabilitation Research and Development.

Upper-limb fatigue is a common problem that may restrict people with multiple sclerosis (MS) from using their electric powered wheelchair effectively and for a long period of time. This research evaluated whether participants with MS can drive better with a variable compliance joystick (VCJ) and customizable algorithms than with a conventional wheelchair joystick.

Eleven participants were randomly assigned to one of two groups. The groups used the VCJ in either compliant or noncompliant isometric mode and a standard algorithm, personally fitted algorithm or personally fitted algorithm with fatigue adaptation running in the background in order to complete virtual wheelchair driving tasks.

Participants with MS showed better driving performance metrics while using the customized algorithms than while using the standard algorithm with the VCJ. Fatigue adaptation algorithms are especially beneficial in improving overall task performance while using the VCJ in isometric mode.

The VCJ, along with the personally fitted algorithms and fatigue adaptation algorithms, has the potential to be an effective input interface for wheelchairs.

• HERL faculty also examined whether powered seating functions (PSFs) provide powered wheelchair users an independent means to adjust posture dynamically.

To facilitate the best use of PSFs in daily living, HERL researchers conducted a structured interview study to develop a preliminary user guide to provide better information to powered wheelchair users.

An internally developed questionnaire to assess clinical recommendations of PSF usage was administered in an interview format to clinical seating and mobility specialists. A qualitative analysis then was applied to codify the recommendations, and the findings were transformed into a PSF user guide.

As a result, specific varied seating positions and time of use indicators were recommended for performing pressure relief positioning. The study concluded that methods and positions of using PSFs should be determined with consideration for individual preferences, physical condition, environmental setting and desired tasks after thorough clinical seating assessments.

Precautions about positioning and driving safety, and the importance of discussing seating with clinicians, also was emphasized in the user guide.

This PSF user guide will be updated after more scientific evidence accumulates and be structurally evaluated for its face and content validity in the future. In rehabilitation, PSFs can be used to assist with many daily activities and health management.

Authors of the study, which appeared in Disability and Rehabilitation: Assistive Technology, were Hsin-Yi Liu, Rosemarie Cooper, Annmarie Kelleher and Rory A. Cooper.

• The HERL authors of a Journal of Rehabilitation Research and Development article titled, “Reliability of Freehand Three-dimensional Ultrasound to Measure Scapular Rotations” were Lynn A. Worobey, Ima A. Udofa, Yen-Sheng Lin, Alicia M. Koontz, Shawn S. Farrokhi and Michael L. Boninger.

This study evaluated the reliability of using freehand 3-D ultrasound to measure scapular rotations (internal/external, upward/downward and anterior/posterior).

The scapular position in 22 healthy, nondisabled individuals was imaged three times in four testing positions (arm at rest and humeral elevation in the sagittal, frontal and scapular planes). The research team found substantial reliability across scanning positions and scapular rotations, with intraclass correlation coefficients ranging from 0.62 to 0.95. The highest reliability was found in the rest testing position.

The results agree with the pattern of movement found in other studies, with the scapula moving toward a more externally rotated, upwardly rotated and posteriorly tilted position with humeral elevation.

Further study is needed to compare these methods to a gold standard, apply them to evaluation of dynamic movement and determine whether they can be used to detect shoulder pathology.

• HERL researchers Michael L. Boninger, Lawrence R. Wechsler and Joel Stein described “Robotics, Stem Cells and Brain-Computer Interfaces in Rehabilitation and Recovery From Stroke: Updates and Advances” in the American Journal of Physical Medicine and Rehabilitation.

The study reviewed the current state and latest advances in robotics, stem cells and brain-computer interfaces in rehabilitation and recovery for stroke. They found that these areas all have tremendous potential to reduce disability and lead to better outcomes for stroke patients.

—Compiled by Marty Levine

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