Rocks for the homeless: the health conditions of Spokane homeless people

Over the past four decades, the United States has seen an increase in the numbers of homeless. Upward of half a million people in the United States experience homelessness per night. This thesis discusses causes and conditions of homelessness in Spokane, Washington. Specifically, the thesis focuses on the causes of homelessness, the homeless people’s lived experiences on the street, their encounters with the medical establishments, and the public perception about them. Data was collected beginning in the summer of 2018. A total of twenty homeless individuals were interviewed. I also attended public events and forums where the issue of homelessness in the city was discussed and debated. The findings indicated an entrenched society-wide misunderstanding about homelessness making helping the homeless daunting and costly. Society and those in power view them as individuals who inflicted poverty and wretchedness upon themselves, and even the homeless blame themselves. However, a more in-depth analysis indicates homelessness is structurally produced. Many of the interviewees were forced into homelessness because of family fractures, loss of employment, unaffordable housing, and untreated mental illness. Once they became homeless, they experienced hunger, physical and sexual violence, and many other societal brutalities. The majority felt discriminated by the medical establishment and were even denied services, although they had serious chronic medical issues. Maltreatment and neglect forced them into potentially unsafe health services. The lack of an institutionalized approach to help the homeless make their effort to find permanent shelter an uphill battle. The multiple levels of physical, psychological, and societal cruelties could be significantly reduced. However, the thesis discusses the continued neglect perpetrated by the various organizations attempting to serve the homeless. Spokane city’s policymakers and other stakeholders treat them as undeserving, thankless, and ungrateful. The thesis argues that the problem of homelessness can significantly be reduced when a poor-people-centric social policy is implemented. Through changes to unfair economic arrangements, Universal Basic Income (UBI), affordable housing, and Medicare for all, homelessness can become a distant memory

Physical Therapists’ Role in Health Promotion as Perceived by the Patient: A Descriptive Study

Background and Purpose: Physical therapists have acquired the skills and knowledge to discuss and advise patients about personal health behaviors (PHB). Research has shown that PTs believe it is their role to discuss PHBs with patients yet there are barriers which keep them from doing so consistently. There is a lack of evidence regarding what patients believe physical therapists’ role is in regards to health promotion. The purpose of this study was to determine if patients believe that PTs should advise them on PHBs. Methods: Three outpatient PT clinics received 100 surveys to distribute to patients who met the inclusion criteria. Participants responded to questions about 4 PHBs; physical activity, fruit and vegetable consumption, smoking and healthy weight; their stage of change for each behavior and their belief about the role of PTs was recorded for each health behavior. Results: One hundred surveys were analyzed using SPSS. The majority of the respondents agreed that PTs should advise them on PA levels (88.0%). Most respondents (70.7%) reported that their PT discussed physical activity (PA) with them. Few respondents (4.0%) stated their PT discussed fruit and vegetable (F&V) consumption with them. Some (28.3%) of the respondents believed PTs should advise them on F&V ii consumption; however, 54.5% were neutral on this subject. One tenth (10.4%) of the respondents were smokers and 9.1% of them reported their PT discussed smoking cessation with them. Self determined body mass index fell in the overweight category for 46.9% respondents; only 8.1% reporting their PTs discussed maintaining a healthy weight. The majority of respondents (75.8%) believed that PTs should advise patients about maintaining a healthy weight. Based on their determined stage of change, 58.1% of participants were engagers in physical activity, 58.4% for fruits and vegetables consumption, 91.8% engaged in smoking cessation and 54.1% for maintaining a healthy weight. Conclusions: A discrepancy was found between the percent of patients who reported their physical therapist addressed their PHBs and the percent of patients who believed their PT should advise them about PHBs. The study results suggest that patients may be expecting and open to their physical therapist discussing PHBs during their PT sessions

Medium-Pressure UV Disinfection: Evaluation of Unintended DNA Damage Reversal and Adenoviral Protein Damage Using Wavelength Specific Irradiation

Medium-pressure (MP) ultraviolet (UV) lamps are becoming a popular technology for UV disinfection. They have demonstrated significant advantages over conventional low-pressure (LP) UV lamps including markedly increased inactivation efficiency for adenovirus, which is considered the most UV resistant pathogen. MP UV lamps produce a polychromatic emission throughout the UV spectrum compared to the monochromatic emission at 253.7 nm produced by LP UV lamps. With increased use of MP UV lamps comes a need to better understand the technology for regulatory and optimization purposes.This research aims to increase the understanding of microbial inactivation and cellular damage resulting from polychromatic UV emission. It focuses on UV-induced damage resulting from single-wavelength exposures either alone or sequentially. DNA damage induced by UV light in the upper end of the UV-C spectrum, ~280 nm, has been shown to be directly reversible through subsequent irradiation at lower wavelengths, ~230-240 nm. Polychromatic emission allows for the possibility that DNA will be exposed to multiple wavelengths throughout the UV-C spectrum; therefore, there exists the possibility that some UV-induced damage may be inadvertently reversed during MP UV irradiation. It is important to know whether typical MP UV doses emit enough low-wavelength radiation to effectively reverse DNA damage as the technology would not be fully optimized if damage reversal is occurring. This was studied using culture techniques to examine cell viability and a quantitative polymerase chain reaction (qPCR) to assess DNA damage. Multiple-wavelength exposures resulted in higher inactivation levels than single-wavelength exposures when using culture techniques for bacterial growth. However, DNA damage investigated through qPCR assays showed a significant decrease for samples subjected to multiple-wavelengths in sequence.Single wavelength exposures were also used to investigate the causes for adenoviral resistance to LP UV irradiation and susceptibility to MP UV exposure. The mechanism responsible for increased inactivation efficiency by MP sources was studied through examining adenoviral protein damage resulting from single-wavelength exposures throughout the UV-C spectrum. This work helps to elucidate why MP UV lamps are so much more effective against adenovirus and also helps to understand the adenoviral mechanism responsible for its extreme resistance to LP UV irradiation. Protein damage was studied using sodium dodecyl sulfate - polyacrylamide gel electrophoresis (SDS-PAGE) as a means to separate and subsequently quantify protein presence. Initial results show significant protein damage at lower wavelengths, less than 230 nm, compared to the higher wavelengths in the UV-C spectrum

Evaluation of cross-beam vector Doppler ultrasound systems for accurate 3-D velocity measurements

Vector Doppler ultrasound (VDUS) systems offer the potential for improved accuracy in mapping of complex flow parameters, such as recirculation, turbulence, and shear stress which are probable risk factors leading to vascular disease and stroke. Cross-beam VDUS systems were evaluated for velocity accuracy to optimize the number of receivers for the inter-beam angle, wall filter, system orientation, and complexity of flow seen in a stenosed carotid artery. Preliminary results for velocity estimation show promise for validation of numerical results. © 2012 IEEE.published_or_final_versio

Producing and Measuring Oscillatory Shear in a Novel Microfluidic Chip

Purpose: To demonstrate the effectiveness of a novel microfluidic device mimicking oscillatory blood flow, allowing cell biologists to examine how endothelial cells respond to a range of oscillatory shear stress levels. Methods: The microfluidic chip consists of a circular-shaped reservoir, leading to a rectangular channel that is examined under a microscope. The plunger is connected to a speaker system and oscilloscope, allowing the plunger to apply a range of frequencies (5-60Hz) and voltages (5-10 V, leading to a variety in oscillation amplitudes) to the reservoir region. 1.1 um fluorescent particles diluted in distilled water were used for tracking. Processing was done through particle image velocimetry (PIV) which uses a cross-correlation algorithm. We used matlab to plot average velocity profiles for a cycle, and extracted data points along the centre of the velocity profiles corresponding to the maximum velocities. Results: The oscillatory chip demonstrated the ability to effectively and accurately deliver oscillatory flow between 10-60Hz using 5-10V, resulting in a variety of oscillation frequencies and amplitudes. Plotting velocity maximum values vs. voltage for frequencies 10-60 Hz demonstrated a linear trend. 3D oscillatory-flow paraboloids can be used in calculating maximum shear stress values for oscillatory flow. Conclusions: Our analysis demonstrates that this microfluidic chip is able to execute controlled shear stress conditions to test how endothelial cells respond to oscillatory shear

Turbulence modeling in three-dimensional stenosed arterial bifurcations

Under normal healthy conditions, blood flow in the carotid artery bifurcation is laminar. However, in the presence of a stenosis, the flow can become turbulent at the higher Reynolds numbers during systole. There is growing consensus that the transitional k ? model is the best suited Reynolds averaged turbulence model for such flows. Further confirmation of this opinion is presented here by a comparison with the RNG k? model for the flow through a straight, nonbifurcating tube. Unlike similar validation studies elsewhere, no assumptions are made about the inlet profile since the full length of the experimental tube is simulated. Additionally, variations in the inflow turbulence quantities are shown to have no noticeable affect on downstream turbulence intensity, turbulent viscosity, or velocity in the k? model, whereas the velocity profiles in the transitional k? model show some differences due to large variations in the downstream turbulence quantities. Following this validation study, the transitional k? model is applied in a three-dimensional parametrically defined computer model of the carotid artery bifurcation in which the sinus bulb is manipulated to produce mild, moderate, and severe stenosis. The parametric geometry definition facilitates a powerful means for investigating the effect of local shape variation while keeping the global shape fixed. While turbulence levels are generally low in all cases considered, the mild stenosis model produces higher levels of turbulent viscosity and this is linked to relatively high values of turbulent kinetic energy and low values of the specific dissipation rate. The severe stenosis model displays stronger recirculation in the flow field with higher values of vorticity, helicity, and negative wall shear stress. The mild and moderate stenosis configurations produce similar lower levels of vorticity and helicity. DOI: 10.1115/1.240118

Prohormones in the early diagnosis of cardiac syncope

Background--The early detection of cardiac syncope is challenging. We aimed to evaluate the diagnostic value of 4 novel prohormones, quantifying different neurohumoral pathways, possibly involved in the pathophysiological features of cardiac syncope: midregional-pro-A-type natriuretic peptide (MRproANP), C-terminal proendothelin 1, copeptin, and midregionalproadrenomedullin. Methods and Results--We prospectively enrolled unselected patients presenting with syncope to the emergency department (ED) in a diagnostic multicenter study. ED probability of cardiac syncope was quantified by the treating ED physician using a visual analogue scale. Prohormones were measured in a blinded manner. Two independent cardiologists adjudicated the final diagnosis on the basis of all clinical information, including 1-year follow-up. Among 689 patients, cardiac syncope was the adjudicated final diagnosis in 125 (18%). Plasma concentrations of MRproANP, C-terminal proendothelin 1, copeptin, and midregional-proadrenomedullin were all significantly higher in patients with cardiac syncope compared with patients with other causes (P < 0.001). The diagnostic accuracies for cardiac syncope, as quantified by the area under the curve, were 0.80 (95% confidence interval [CI], 0.76-0.84), 0.69 (95% CI, 0.64-0.74), 0.58 (95% CI, 0.52-0.63), and 0.68 (95% CI, 0.63-0.73), respectively. In conjunction with the ED probability (0.86; 95% CI, 0.82-0.90), MRproANP, but not the other prohormone, improved the area under the curve to 0.90 (95% CI, 0.87-0.93), which was significantly higher than for the ED probability alone (P=0.003). An algorithm to rule out cardiac syncope combining an MRproANP level of < 77 pmol/L and an ED probability of < 20% had a sensitivity and a negative predictive value of 99%. Conclusions--The use of MRproANP significantly improves the early detection of cardiac syncope among unselected patients presenting to the ED with syncope

Construction of 3-Dimensional Printed Ultrasound Phantoms With Wall-less Vessels

Ultrasound phantoms are invaluable as training tools for vascular access procedures. We developed ultrasound phantoms with wall-less vessels using 3D printed chambers. Agar was used as a soft-tissue mimicking material, and the wall-less vessels were created with rods that were retracted after the agar was set. The chambers had integrated luer connectors to allow for fluid injections with clinical syringes. Several variations on this design are presented, which include branched and stenotic vessels. The results show that 3D printing can be well suited to the construction of wall-less ultrasound phantoms, with designs that can be readily customised and shared electronically