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Open Access Publications from the University of California

Scholarly Works (80 results)

  • Thesis
  • Peer Reviewed
UCLA Electronic Theses and Dissertations (2021)

BACKGROUND: In the non-surgical cosmetic setting, anxiety (blood-injury-injection phobia) and pain are strongly associated with a procedure that involves facial injections. Reiki therapy, a Japanese healing technique, is already used in the healthcare setting to assist with reducing anxiety and pain. OBJECTIVES: To determine whether Reiki therapy effectively reduces anxiety and pain while also improving patient satisfaction in patients receiving facial injections. STUDY DESIGN: Using a randomized experimental control group design, Reiki therapy (Reiki group) lasting 15 minutes was compared against the current standard of care (control group) in a non-surgical cosmetic office in women ages 25-65 receiving botulinum toxin facial injections. METHODS: Measurements include anxiety (State Trait Anxiety Inventory), procedural pain (Analog Pain Scale), satisfaction (likely to refer survey), and vital signs measured pre- and post-Reiki in the intervention group and pre- and post-procedure in the control group. Statistical analysis includes descriptive statistics, independent and paired sample t-test, Mann-Whitney test, and Wilcoxon matched pairs test. RESULTS: Anxiety and pain were significantly decreased, and satisfaction significantly increased in the Reiki group compared to the control group. CONCLUSIONS: This study demonstrates that Reiki therapy has a significant effect on reducing anxiety and pain while improving satisfaction in patients receiving facial injections in the non-surgical aesthetic medical care setting. Future studies should consider a larger sample size and target other treatments that involve needle injections.

    Cover page: Reiki Therapy for Anxiety in Patients Receiving Botulinum Toxin Facial Injections
    • Thesis
    • Peer Reviewed
    UCLA Electronic Theses and Dissertations (2017)

    Background: Congenital Heart Disease (CHD) is one of the leading birth defects in the United States, encompassing approximately 40,000 neonates (newborns) annually (American Heart Association, 2015; Reller, Strickland, Riehle-Colarusso, Mahle, & Correa, 2008). Advances in surgical technique and postoperative management result in approximately 1.3 million adults who are CHD survivors (American Heart Association, 2016). Despite efforts aimed at prevention and early detection of developmental delays in infants and children, many with CHD will have neurologic deficits lasting into adulthood, influencing employability, self-care, and quality of life (Pike et al., 2007; von Rhein et al., 2014). Large multicenter studies have ruled out surgical factors as independent predictors for these developmental delays leading to examination of factors more intrinsic to the neonate as the cause for poor outcomes (Gaynor et al., 2015; Newburger et al., 2012). A hypothesis not extensively examined is whether impaired Cerebrovascular Autoregulation (CA), is responsible for poorer neurodevelopmental outcomes in preoperative neonates with CHD (Paulson, Strandgaard, & Edvinsson, 1990).

    Purpose: The purpose of this study was to assess CA in neonates with and without CHD, and to evaluate the association of CA with neurodevelopmental outcomes. The specific aims of this study were to: 1) Compare CA between 28 preoperative neonates with CHD and 16 age- and gender-matched healthy neonates at less than 12 days of age; 2) Examine associations between impaired CA and abnormalities in motor, auditory, and visual functions when controlling for preoperative neonates with and without CHD; and 3) Exploratory Aim: Determine associations of clinical factors such as: a) 1 minute Apgar scores, b) cord pH, c) head circumference, and d) birth weight to impaired CA.

    Methods: This study was a prospective, cross- sectional, 2-group case control design. We enrolled 44 neonates (28 with CHD and 16 healthy controls). Inclusion/exclusion criteria were chosen to decrease variability in CA. CA was determined using regional cerebral oxygenation (rSO2) with the INVOS Somanetics Near Infrared Spectroscopy (NIRS) 5100C (Troy, MI) device and a postural change. The Einstein Neonatal Neurobehavioral Assessment Scale (ENNAS) measured neurodevelopmental outcomes.

    Results: The Χ2 test revealed no significant difference in impaired CA between CHD and control groups (p =.38). Multiple linear regressions showed CHD neonates significantly associated with poorer total neurodevelopmental scores (β =9.30, p =.02) and motor scores (β = 7.6, p = .04) when controlling for CA status. Independent t-tests demonstrated baseline and sitting rSO2 were significantly lower in the CHD neonates (p <.00).

    Discussion: The results provide evidence of poorer developmental outcomes and hypoxemia in preoperative CHD neonates warranting further investigation of causes for delays. For patients who might be at risk for impaired CA, some strategies to optimize cerebral blood flow are: 1) maintaining higher systolic blood pressures; 2) preventing episodes of hypoxemia and; 3) taking more time to change the patient’s positions. Identifying the mechanism of injury and the neonates at higher risk of developing delays will assist healthcare providers in tailoring interventions to prevent neurodevelopmental delays in this vulnerable population.

      Cover page: Cerebrovascular Autoregulation in Preoperative Neonates with Congenital Heart Disease Compared to Healthy Controls
      • Thesis
      • Peer Reviewed
      UCLA Electronic Theses and Dissertations (2014)

      Background: Endoscopic Foreheadplasty Surgery (EFS) is a surgery addressing facial aging. Frequent consumers of EFS are females (91%) between ages 35-64. Case reports reveal commonly experienced moderate to severe incapacitating postoperative headache lasting 2-7 days. Headache characteristics, medication management, and impact on emotional and functional status are not well understood. The specific aims for this study were to explore in women following EFS: 1) the intensity, location, quality, and duration of headache; 2) compare EFS headache with migraine; 3) examine medication use and efficacy following EFS; 4) evaluate headache and a) emotional and b) functional outcomes; and 5) evaluate the effect of estrogen levels on headache for patients undergoing EFS.

      Methods: Forty-two women (mean age 59.0 � 7.9 years) undergoing EFS were recruited from twelve private cosmetic practices in three California counties. Four interviews with the Acute Short-Form 12v2, and the Headache Questionnaire were conducted on postoperative days (POD) 1, 3, 7, and 30.

      Results: Most women experienced headache (93%) which was moderate to severe in intensity (64%). Headache was associated with migraine-like symptoms, including light sensitivity and nausea. Current acute therapy provided inconsistent relief. Most EFS triggered headaches (79 %) met International Classification of Headache Disorders (ICHD) criteria for migraine (with the exception of the requirement for previous episodes and limited duration), even in women with no previous history of migraine. Functional and emotional status deteriorated below baseline level postoperatively. Emotional status returned to baseline levels by POD 7 and functional status by POD 30. Those on hormone replacement therapies (HRT) had lower pain intensity, shorter headache duration, and less associated symptoms than those not on HRT.

      Conclusion: The findings confirm women experience significant headache following EFS, which improves by POD 7. EFS headache was consistent with ICHD migraine criteria, providing evidence migraine may have an extracranial trigger. With current management inconsistent in relieving EFS headache migraine therapies may be of benefit. This study also offers evidence that HRT and a history of migraine both influence headache episodes and characteristics. Future investigations applying effective migraine strategies for those with EFS migraine-like headache may lead to improved patient outcomes.

        Cover page: Characterization of Headache Following Endoscopic Foreheadplasty Surgery in Women: Evidence for a Peripheral Trigger for Migraine
        • Thesis
        • Peer Reviewed
        UCLA Electronic Theses and Dissertations (2024)

        Background: Suicide is a significant public health issue in the United States, with 50,000 deaths in 2022, and the Korean American community has almost twice the national average of suicide rate. Korean American nurses are therefore key frontline healthcare providers in suicide prevention. Objectives: This project aimed to address the gap in suicide prevention education among Korean American nurses in Los Angeles by implementing a two-day Korean-Applied Suicide Intervention Skills Training (K-ASIST) program. The primary aim was to improve suicide prevention skills and attitudes among Korean American nurses, ultimately contributing to reducing suicide rates in the Korean community. Methods: A pre-posttest design was utilized. Data collection included demographic information, knowledge assessment, confidence and competency evaluations, and attitudes toward suicide, and satisfaction. Statistical analyses comprised descriptive statistics and paired t-tests. Results: Fourteen Korean American nurses, averaging an age of 27 at U.S. arrival with 20 years of residency, attended the workshop. The workshop led to a slight, non-significant increase in knowledge about suicide prevention (pre-test mean: 7.93, SD=0.997; post-test mean: 8.71, SD=1.490; p = 0.059, t = -2.065) and a significant enhancement in confidence and competency for suicide intervention (pre-test mean: 3.36, SD=1.336; post-test mean: 4.64, SD=0.633; p = 0.013, t = -2.857). Attitudes toward suicide showed a non-significant decrease in the belief that "suicide is wrong" (pre-test mean: 4.07, SD=1.072; post-test mean: 3.64, SD=1.277; p = 0.306, t = 1.066) and a notable increase in the belief that "everyone has a right to suicide" (pre-test mean: 2.29, SD=1.204; post-test mean: 3.36, SD=1.336; p = 0.008, t = -3.160). Overall, participant satisfaction with the workshop was above 90%. Conclusion: The culturally sensitive K-ASIST program enhanced suicide intervention skills and attitudes among participants. Although knowledge increases were modest, the program's ability to improve direct interactions with at-risk individuals and high participant satisfaction show potential for reducing suicide within the Korean American community. The encouraging initial results highlight the importance of further research to confirm these findings and their broader relevance. Ultimately, this study adds to the evidence supporting the value of culturally adapted training in preparing healthcare professionals to address the specific challenges of suicide prevention as well as mental health broadly within diverse populations.

          Cover page: Implementing Suicidal Prevention Education For Korean American Nurses in Los Angeles
          • Article
          • Peer Reviewed
          UCLA Previously Published Works (2018)

          Background

          Free water (FW) in neuroimaging is non-flowing extracellular water in the cranium and brain tissue, and includes both cerebral spinal fluid (CSF) and fluid in intercellular space or edema. For a region such as a voxel (spatial unit of measurement in neuroimaging), the FW fraction is defined as the volume fraction of FW within that volume. Quantifying the FW fraction allows estimating contamination by fluid of neuroimaging or magnetic resonance spectroscopy measurements within a voxel.

          New method

          An upper limit to the fraction of FW within a voxel, based on any diffusion tensor imaging (DTI) sequence including a standard single shell at one b-value, can be derived from the standard diffusion tensor by scaling the third eigenvalue of the diffusion tensor. Assuming a two-compartment model, the diffusivity of a voxel is a combination of tissue and FW diffusivity. FW fraction is FW volume divided by voxel volume. Assuming FW diffuses equally in all directions, the diffusivity component is representable by a single, non-tensor diffusivity value. Since the diffusivity of water is known for a given temperature, and brain temperature is relatively constant, the FW diffusivity value can be assumed constant. The third eigenvector of the voxel diffusion tensor is the direction of least diffusivity and since the FW component of diffusivity is equal in all directions, we show that FW diffusivity cannot be lower than the third eigenvalue. Assuming FW contributes proportionally to voxel diffusivity, we show that the third eigenvalue divided by water diffusivity (as a constant based on known water diffusivity at 36.7 °C) forms an upper limit on the FW-fraction (fUL ).

          Results

          We calculated fUL for 384 subjects from the IXI dataset. Values mostly ranged from 0.1 to 0.6, and were closely related to radial diffusivity.Comparison with Existing Methods:fUL is easily calculated from any DTI data, but is not a true estimate of FW-fraction.

          Conclusions

          The fUL measure offers a starting point in calculating the true FW-fraction of a voxel, or an easy-to-calculate voxel characteristic.
            Cover page: DTI-based&nbsp;upper limit of voxel free water fractionCreative Commons 'BY' version 4.0 license
            • Thesis
            • Peer Reviewed
            UCLA Electronic Theses and Dissertations (2024)

            The shifting landscape of healthcare and economic constraints necessitate hospitals and operating rooms (ORs) to improve the management of supply expenses while upholding patient care standards. The quality improvement (QI) project seeks to streamline operational processes and curtail unnecessary expenditures by leveraging advanced data analytics and implementing a two-bin supply delivery system. Key objectives encompass enhancing the supply chain's efficiency, mitigating stockout instances, and optimizing procurement practices. Using Lean Six Sigma (LSS) methodologies to streamline OR supply chain processes, implementing a two-bin supply delivery system, and using data analytics, the QI project demonstrates tangible improvements in OR supply replenishment efficiency. The successful implementation of these strategies also leads to substantial cost savings and fosters a marked enhancement in operational efficacy within the perioperative environment.

              Cover page: Improving Operating Room Supply Chain Efficiency and Cost-Reduction Using Data Analytics
              • Article
              • Peer Reviewed
              UCLA Previously Published Works (2015)
              Central nervous system processing of autonomic function involves a network of regions throughout the brain which can be visualized and measured with neuroimaging techniques, notably functional magnetic resonance imaging (fMRI). The development of fMRI procedures has both confirmed and extended earlier findings from animal models, and human stroke and lesion studies. Assessments with fMRI can elucidate interactions between different central sites in regulating normal autonomic patterning, and demonstrate how disturbed systems can interact to produce aberrant regulation during autonomic challenges. Understanding autonomic dysfunction in various illnesses reveals mechanisms that potentially lead to interventions in the impairments. The objectives here are to: (1) describe the fMRI neuroimaging methodology for assessment of autonomic neural control, (2) outline the widespread, lateralized distribution of function in autonomic sites in the normal brain which includes structures from the neocortex through the medulla and cerebellum, (3) illustrate the importance of the time course of neural changes when coordinating responses, and how those patterns are impacted in conditions of sleep-disordered breathing, and (4) highlight opportunities for future research studies with emerging methodologies. Methodological considerations specific to autonomic testing include timing of challenges relative to the underlying fMRI signal, spatial resolution sufficient to identify autonomic brainstem nuclei, blood pressure, and blood oxygenation influences on the fMRI signal, and the sustained timing, often measured in minutes of challenge periods and recovery. Key findings include the lateralized nature of autonomic organization, which is reminiscent of asymmetric motor, sensory, and language pathways. Testing brain function during autonomic challenges demonstrate closely-integrated timing of responses in connected brain areas during autonomic challenges, and the involvement with brain regions mediating postural and motoric actions, including respiration, and cardiac output. The study of pathological processes associated with autonomic disruption shows susceptibilities of different brain structures to altered timing of neural function, notably in sleep disordered breathing, such as obstructive sleep apnea and congenital central hypoventilation syndrome. The cerebellum, in particular, serves coordination roles for vestibular stimuli and blood pressure changes, and shows both injury and substantially altered timing of responses to pressor challenges in sleep-disordered breathing conditions. The insights into central autonomic processing provided by neuroimaging have assisted understanding of such regulation, and may lead to new treatment options for conditions with disrupted autonomic function.
                Cover page: Functional Imaging of Autonomic Regulation: Methods and Key Findings.
                • Article
                • Peer Reviewed
                UCLA Previously Published Works (2007)

                Background

                Hyperoxic ventilation (>21% O2) is widely used in medical practice for resuscitation, stroke intervention, and chronic supplementation. However, despite the objective of improving tissue oxygen delivery, hyperoxic ventilation can accentuate ischemia and impair that outcome. Hyperoxia results in, paradoxically, increased ventilation, which leads to hypocapnia, diminishing cerebral blood flow and hindering oxygen delivery. Hyperoxic delivery induces other systemic changes, including increased plasma insulin and glucagon levels and reduced myocardial contractility and relaxation, which may derive partially from neurally mediated hormonal and sympathetic outflow. Several cortical, limbic, and cerebellar brain areas regulate these autonomic processes. The aim of this study was to assess recruitment of these regions in response to hyperoxia and to determine whether any response would be countered by addition of CO2 to the hyperoxic gas mixture.

                Methods and findings

                We studied 14 children (mean age 11 y, range 8-15 y). We found, using functional magnetic resonance imaging, that 2 min of hyperoxic ventilation (100% O2) following a room air baseline elicited pronounced responses in autonomic and hormonal control areas, including the hypothalamus, insula, and hippocampus, throughout the challenge. The addition of 5% CO2 to 95% O2 abolished responses in the hypothalamus and lingual gyrus, substantially reduced insular, hippocampal, thalamic, and cerebellar patterns in the first 48 s, and abolished signals in those sites thereafter. Only the dorsal midbrain responded to hypercapnia, but not hyperoxia.

                Conclusions

                In this group of children, hyperoxic ventilation led to responses in brain areas that modify hypothalamus-mediated sympathetic and hormonal outflow; these responses were diminished by addition of CO2 to the gas mixture. This study in healthy children suggests that supplementing hyperoxic administration with CO2 may mitigate central and peripheral consequences of hyperoxia.
                  Cover page: Hyperoxic Brain Effects Are Normalized by Addition of CO2
                  • Article
                  • Peer Reviewed
                  UCLA Previously Published Works (2012)
                  Physical activity (PA) is beneficial to overall health, in part due to physiological changes that lower risk factors for cardiovascular disease, including reduced inflammation. However, the mechanism by which PA reduces inflammation is unclear. One possible pathway is that PA improves body composition which in turn reduces inflammation. To test this hypothesis, we used structural equation modeling (SEM) to assess PA-body composition -inflammation pathways, as well as influences of age. In a sample of 72 healthy males with a range of PA profiles (age 18-65, mean ± sd = ), we measured PA as metabolic equivalent tasks (as per the International PA Questionnaire), body composition as percent body fat, lean mass, and fat mass, and inflammation as plasma interleukin-6 (IL-6). We treated body composition in the SEM analysis as a latent variable indicated by the three measures. We performed statistical corrections for missing values and one outlier. The model demonstrated significant effects of PA on IL-6 both directly and through body composition. Percent body fat, fat mass, and lean mass were significant indicators of the body composition latent variable. Additionally, age showed an indirect effect on IL-6 through body composition, but no direct effect. The findings suggest that PA does improve inflammatory profile through improving body composition, but that other pathways also exist.
                    Cover page: Pathways to Interleukin-6 in Healthy Males and Serious Leisure Male Athletes: Physical Activity, Body Composition and Age
                    • Article
                    • Peer Reviewed
                    UCLA Previously Published Works (2017)

                    Background

                    Cardiovascular disease varies between sexes, suggesting male-female autonomic control differences. Insular gyri help coordinate autonomic regulation and show a sex-dependent response to a sympathetic challenge.

                    Methods

                    We examined sex-related insular gyral responses to a short static handgrip exercise challenge eliciting parasympathetic withdrawal with functional magnetic resonance imaging (fMRI) during four 16-s challenges (80% maximum strength) in 23 healthy females (age; mean ± std 50 ± 8 years) and 40 males (46 ± 9 years). Heart rate (HR) and fMRI signals were compared with repeated measures ANOVA (P < 0.05). Additional analyses were performed with age and age interactions, as well as right-handed only subjects.

                    Results

                    Females showed higher resting HR than males, but smaller percent HR change increases to the challenges. All gyri showed fMRI patterns concurrent with an HR peak and decline to baseline. fMRI signals followed an anterior-posterior organization in both sexes, but lateralization varied by gyri and sex. All subjects showed greater signals in the anterior vs. posterior gyri (females 0.3%, males 0.15%). The middle gyri showed no lateralization in females but left-sided dominance in males (0.1%). The posterior gyri showed greater left than right activation in both sexes. The anterior-most gyri exhibited a prominent sex difference, with females showing a greater right-sided activation (0.2%) vs. males displaying a greater left-sided activation (0.15%). Age and handedness affected a minority of findings but did not alter the overall pattern of results.

                    Conclusions

                    The anterior insula plays a greater role in cardiovascular regulation than posterior areas during a predominantly parasympathetic withdrawal challenge, with opposite lateralization between sexes. In females, the left anterior-most gyrus responded distinctly from other regions than males. Those sex-specific structural and functional brain patterns may contribute over time to variations in cardiovascular disease between the sexes.
                      Cover page: Sex differences in insular cortex gyri responses to a brief static handgrip challenge
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