This case study describes an adult patient whose brachial plexus injury was treated with various modalities and exercise. The participant of this study was a 76 year old female who sustained a brachial plexus injury during an elective reverse total shoulder arthroplasty. The initial evaluation reported only passive range of motion with 90 degrees shoulder flexion, 85 degrees abduction, and 30 degrees external rotation. Muscle testing yielded significantly limited wrist and digit extension strength. Testing of sensation found diminished protective sensation along the median nerve distribution, including the thumb, index finger, and middle finger. Occupational therapy was initiated for postoperative treatment of the shoulder as well as treatment of the brachial plexus palsy. Therapy consisted of static splinting for healing structures and sensory reeducation through massage, finding objects with the eyes occluded, and fluidotherapy. Additionally, various exercises and modalities for improving motion and strength were initiated, including proprioceptive neuromuscular reeducation, passive/active assist/active exercises, dynamic splinting, muscle stimulation, kinesio tape, functional activities, and tendon glides. After five months, active range of motion in the shoulder, elbow, and wrist was finally achieved and median nerve sensation had improved. After nine months, elbow motion was within normal limits and wrist motion had significantly improved. Upon muscle testing, the elbow, forearm, wrist, and hand had made significant gains in strength. However, shoulder strength and motion was still limited. Overall, treatment made a significant improvement in the patient’s functionality.

Within the pediatric hospitalization experience, fear and anxiety are two emotions commonly felt by children of all ages. Hospitalized children can greatly benefit from interventions designed to help them cope with these emotions throughout their medical experiences. This study draws on each of our clinical experiences as volunteers at Phoenix Children’s Hospital, and uses a qualitative analysis of three semi-structured interviews with currently employed Child Life Specialists to understand and analyze the use of medical play, a form of play intervention with a medical theme or medical equipment. We explore the goals and benefits of medical play for hospitalized pediatric patients, the process of using medical play as an intervention, including the activity design process, the assessments and adjustments made throughout the child’s hospitalization, and the considerations and limitations to implementing medical play activities. Ultimately, we found that the element of fun that defines play can be channeled into medical play activities implemented by skilled Child Life Specialists, who are experts in their field, in clinical settings to promote several different and beneficial goals, including pediatric patient coping.

Motor learning is the process of improving task execution according to some measure of performance. This can be divided into skill learning, a model-free process, and adaptation, a model-based process. Prior studies have indicated that adaptation results from two complementary learning systems with parallel organization. This report attempted to answer the question of whether a similar interaction leads to savings, a model-free process that is described as faster relearning when experiencing something familiar. This was tested in a two-week reaching task conducted on a robotic arm capable of perturbing movements. The task was designed so that the two sessions differed in their history of errors. By measuring the change in the learning rate, the savings was determined at various points. The results showed that the history of errors successfully modulated savings. Thus, this supports the notion that the two complementary systems interact to develop savings. Additionally, this report was part of a larger study that will explore the organizational structure of the complementary systems as well as the neural basis of this motor learning.

Background: The purpose of this study was to assess the efficacy of a lifestyle intervention on cardiorespiratory fitness in Latino youth with obesity and prediabetes. <br/>Methods: Participants (n=50) in this study were taken from a larger randomized controlled trial (n=180, BMI ≥ 95th percentile). Youth participated in a 6-month lifestyle intervention that included physical activity (60 minutes, 3x/week) and nutrition and wellness classes (60 minutes, 1x/week) delivered to families at the Lincoln Family YMCA in Downtown Phoenix. The primary outcome was cardiorespiratory fitness measured at baseline and post-intervention.<br/>Results: The mean BMI for the sample was 33.17 ± 4.54 kg/m2, which put the participants in the 98.4th percentile. At baseline, the mean VO2max was 2737.02 ± 488.89 mL/min. The mean relative VO2max was 30.65 ± 3.87 mL/kg/min. VO2max values significantly increased from baseline to post-intervention (2737.022 ± 483.977 mL/min vs 2932.654 ± 96.062 mL/min, p<0.001). <br/>Conclusion: Culturally-grounded, family-focused lifestyle interventions are a promising approach for improving cardiorespiratory fitness in high-risk youth at risk for diabetes.

The following paper explores the various effects of stress on the endocrine system. Many understand that being stressed can jeopardize maintaining adequate health, but what specifically happens when humans are stressed? Why does stress affect human health? This paper delves into background information, previous research, and the depths to which stress negatively affects the body. The effects stress has on the endocrine system, specifically on the hypothalamic-pituitary-thyroid axis (HPT) and hypothalamic-pituitary-adrenal axis (HPA), is discussed, and additionally, at home de-stressing methods are researched. The study included a set of participants at Arizona State University. The method took place over the course of 2 weeks: one normal week, and the other with the implementation of a de-stressing method. The normal week involved the participants living their daily lives with the addition of a stress-measuring survey, while the second week involved implementing a de-stressing method and stress-measuring survey. The purpose of this study was to discover if there was a correlation between performing these relaxation activities and decreasing stress levels in ASU students. The results found that students reported they felt more relaxed and calm after the activities. Overall, this thesis provides information and first hand research on the effects of stress and stress-reducing activities and discusses the importance of maintaining lower stress levels throughout everyday life.

The purpose of this Barrett Thesis Project is to review the existing literature on ACL injuries specifically regarding their risk factors, prevention, and recovery options. The content of the review has been placed into four sections: physiological factors, biomechanical factors, surgery and recovery factors, as well as training factors. Physiological factors look at static structures and their impact on ACL injuries, more specifically, the role that variations on physical structure values can have on injury incidence. Biomechanical factors focus on the ways that movement can contribute to injury and the ways that incorrect movement or unanticipated movement can have on the structures of the knee. Surgery and recovery factors look at surgical techniques that have been used to correct ACL injuries and the details of their function as well as certain surgical techniques that have differing rates of success and how they can impact re-injury and rehabilitation rates. Finally, training factors analyze techniques that can be used in both pre-injury or post-injury situations therefore, this section looks at the ways that training can minimize re-injury as well as work towards preventing the initial injury. Overall, this research review looks at how these factors come together to contribute to an ACL injury and the ways that injury incidence can be minimized. Risk factors come together in order to create an undesirable situation in which the ACL ligament ruptures. These risk factors are either physiological or biomechanical in nature. As a result of injury, certain surgical techniques can be used that impact the success of a patient. Evidence for the benefit of training factors can then be applied in order to reduce injury risk or prevent future injuries.

Purpose: This qualitative research aimed to create a developmentally and gender-appropriate game-based intervention to promote Human Papillomavirus (HPV) vaccination in adolescents. <br/>Background: Ranking as the most common sexually transmitted infection, about 80 million Americans are currently infected by HPV, and it continues to increase with an estimated 14 million new cases yearly. Certain types of HPV have been significantly associated with cervical, vaginal, and vulvar cancers in women; penile cancers in men; and oropharyngeal and anal cancers in both men and women. Despite HPV vaccination being one of the most effective methods in preventing HPV-associated cancers, vaccination rates remain suboptimal in adolescents. Game-based intervention, a novel medium that is popular with adolescents, has been shown to be effective in promoting health behaviors. <br/>Methods: Sample/Sampling. We used purposeful sampling to recruit eight adolescent-parent dyads (N = 16) which represented both sexes (4 boys, 4 girls) and different racial/ethnic groups (White, Black, Latino, Asian American) in the United States. The inclusion criteria for the dyads were: (1) a child aged 11-14 years and his/her parent, and (2) ability to speak, read, write, and understand English. Procedure. After eligible families consented to their participation, semi-structured interviews (each 60-90 minutes long) were conducted with each adolescent-parent dyad in a quiet and private room. Each dyad received $50 to acknowledge their time and effort. Measure. The interview questions consisted of two parts: (a) those related to game design, functioning, and feasibility of implementation; (b) those related to theoretical constructs of the Health Belief Model (HBM) and the Theory of Planned Behavior (TPB). Data analysis. The interviews were audio-recorded with permission and manually transcribed into textual data. Two researchers confirmed the verbatim transcription. We use pre-developed codes to identify each participant’s responses and organize data and develop themes based on the HBM and TPB constructs. After the analysis was completed, three researchers in the team reviewed the results and discussed the discrepancies until a consensus is reached.<br/>Results: The findings suggested that the most common motivating factors for adolescents’ HPV vaccination were its effectiveness, benefits, convenience, affordable cost, reminders via text, and recommendation by a health care provider. Regarding the content included in the HPV game, participants suggested including information about who and when should receive the vaccine, what is HPV and the vaccination, what are the consequences if infected, the side effects of the vaccine, and where to receive the vaccine. The preferred game design elements were: 15 minutes long, stories about fighting or action, option to choose characters/avatars, motivating factors (i.e., rewards such as allowing users to advance levels and receive coins when correctly answering questions), use of a portable electronic device (e.g., tablet) to deliver the education. Participants were open to multiplayer function which assists in a facilitated conversation about HPV and the HPV vaccine. Overall, the participants concluded enthusiasm for an interactive yet engaging game-based intervention to learn about the HPV vaccine with the goal to increase HPV vaccination in adolescents. <br/>Implications: Tailored educational games have the potential to decrease the stigma of HPV and HPV vaccination, increasing communication between the adolescent, parent, and healthcare provider, as well as increase the overall HPV vaccination rate.

Background: The US population faces a continual increase in obesity prevalence, raising health concerns due to associated comorbidities ranked as leading causes of preventable, premature death world-wide. Scientists have found a link between obesity-associated conditions and oxidative stress (OS). To date, renewed interest in the effectiveness of dietary regimens in decreasing body weight is a popular research topic. Intermittent fasting (IF) is a popular and promising weight management strategy. To date, there have been no systematic reviews examining whether IF can reduce oxidative stress in overweight/obese adults. <br/><br/>Objective: Conduct a systematic review to evaluate the effects of intermittent fasting (IF) regimens on circulating markers of oxidative stress in overweight/obese adults compared to continuous calorie restriction (CR). <br/><br/>Methods: Databases PubMed, SCOPUS, ProQuest, and Cochrane were searched on February 21, 2021 for eligible articles limiting selection to those in the English language. Predefined search terms and restrictions were applied by two of the authors conducting the search. References from articles generated were also considered. Selected articles were limited to randomized controlled trials (RCTs) and human trials evaluating the effects of intermittent fasting (IF) dietary regimens in comparison to continuous calorie restriction (CR). Study populations considered were limited to those within the range of 18-65 years having a body mass index (BMI) of ≥25 kg/m2 and in otherwise generally good health with the absence of pre-existing acute or chronic conditions. The Academy of Nutrition and Dietetics Evidence Analysis Library Quality Rating Worksheet was used to assess the methodological quality of each of the studies and the Academy of Nutrition and Dietetics Grade Definitions and Conclusion Grading Table were used to appraise the quality of evidence.<br/><br/>Results: Six articles met eligibility criteria and were included in this review. Cumulatively 355 overweight/obese participants were assessed. Quality ratings performed by two of the authors revealed a high-quality rating for all six of the articles. One of the articles reported a significant IF associated difference in circulating 8-isoprostane concentrations and another article reported a significant decrease in circulating oxidative lipoproteins concentrations. The remaining articles showed no significant difference on OS markers following IF. <br/><br/>Conclusions: Based on the six articles included in this systematic review, IF was concluded to have limited impact on reducing circulating markers of OS in overweight/obese adults. Overall, the evidence was heterogeneous in relation to IF interventions and outcomes precluding a meta-analysis. Consequently, evidence to make dietary recommendations for reducing oxidative stress with IF interventions is insufficient at this point.

Introduction: In-store promotion of food products leads to more frequent purchases. Product promotion can vary by store characteristics. We compared marketing strategies used by grocery stores to promote fruit and vegetables (FV) in neighborhoods with varying socio-economic and racial/ethnic characteristics.<br/><br/>Methods: Data was collected from a random sample of 12 large grocery stores from the same national chain located within a 15-mile radius of Downtown Phoenix. Store zip-code level median household income was used to classify stores as located in lower (<$50,000) or higher (>$50,000) income areas. Stores located in neighborhoods with more than 50% Hispanic population were classified as majority Hispanic serving. The ProPromo tool was adapted to document the presence and promotion of FV at 8 distinct locations throughout each store. Types of promotion strategies documented included displays, price promotions, size, or themes.<br/><br/>Results: FV were present at the entrance, islands, checkouts, and produce section; while fruits were promoted in all of these locations, vegetables were promotion in fewer locations. All stores used size and price promotion to promote FV; display was used to promote vegetables in 2 stores and fruits in all stores. On average stores promoted 32 fruits and 38 vegetables. Stores serving higher and lower income areas promoted similar numbers of FV. However, stores in Hispanic majority neighborhoods promoted fewer FV (66) in comparison to those in Hispanic minority areas (73).<br/><br/>Conclusion: Fruit and vegetable promotion disparity associated with neighborhood demographics may contribute to disparities in fruit and vegetable consumption.

In a healthcare system already struggling with burnout among its professionals, the COVID-19 pandemic presented a barrage of personal and occupational strife to US healthcare workers. Structural and everyday discrimination contributed to the health inequities of people of color in the US, exacerbated by COVID-19-related racism and xenophobia. There is little research regarding the effects of COVID-19 and related and/or concurring discrimination upon minority nursing staff, despite their importance in supporting the diverse American patient population with culturally competent, tireless care amid the pandemic. This cross-sectional survey study aimed to examine 1) the relationships between discrimination, social support, resilience, and quality of life among minority nursing staff in the US during COVID-19, and 2) the differences of discrimination, social support resilience, and quality of life among minority nursing staff between different racial/ethnic groups during COVID-19. The sample (n = 514) included Black/African American (n = 161, 31.4%), Latinx/Hispanic (n = 131, 25.5%), Asian (n = 87, 17%), Native American/Alaskan Native (n = 69, 13.5%), and Pacific Islander (n = 65, 12.7%) nursing staff from 47 US states. The multiple regression results showed that witnessing discrimination was associated with a lower quality of life score, while higher social support and resilience scores were associated with higher quality of life scores across all racial groups. Furthermore, while participants from all racial groups witnessed and experienced discrimination, Hispanic/Latinx nursing staff experienced discrimination most commonly, alongside having lowest quality of life and highest resilience scores. Native American/Alaskan Native nursing staff had similarly high discrimination and low quality of life, although low resilience scores. Our findings suggest that minority nursing staff who have higher COVID-19 morbidity and mortality rates (Hispanic/Latinx, Native American/Alaskan Native) were left more vulnerable to negative effects from discrimination. Hispanic/Latinx nursing staff reported a relatively higher resilience score than all other groups, potentially attributed to the positive effects of biculturality in the workplace, however, the low average quality of life score suggests a simultaneous erosion of well-being. Compared to all other groups, Native American and Alaskan Native nursing staff’s low resilience and quality of life scores suggest a potential compounding effect of historical trauma affecting their well-being, especially in contrast to Hispanic/Latinx nursing staff. This study has broader implications for research on the lasting effects of COVID-19 on minority healthcare workers’ and communities’ well-being, especially regarding Hispanic/Latinx and Native American/Alaskan Native nursing staff.