Researcher
Externally Funded
Internally Funded
Dawn Aycock
Nursing
Alter
Title: Alter
Website: https://alterdementia.com
Agency: Emory University and Health Resources and Services Administration
Project Period: 07/01/2019 – 08/31/2024
Project Number: A238809
Abstract
Georgia’s (GA) workforce and health system are underprepared to address the unique healthcare needs of the rapidly growing, racially and ethnically diverse population of older adults. The purpose of the GA GEAR is to improve the health and well-being of older Georgians, their families and their communities. This will be accomplished through partnerships in a program of interdisciplinary education to improve health outcomes across urban and rural areas while addressing the five objectives of the Health Resources and Services Administration (HRSA) GA GEAR Program. The School of Nursing at Georgia State will work with GA GEAR to provide training on Alzheimer’s Disease and Related Dementias (ADRD). Georgia State’s work will address the provision of training on the ADRD through an educational outreach program in the African American faith community, called Alter. Faith-based communities are important outlets for health-related information and access to services, particularly for African Americans. Historically, churches have been a safe haven for African American families, but many churches do not have programs to support families/congregants living with dementia. Alter is a nurse-led program that offers workshops and community forums and includes health profession students/trainees. The community forums (2 hrs.) and workshops (4 hrs.) include lectures, testimonies, memory screenings and simulated dementia experiences. Georgia State will further implement, expand and evaluate this program in African American congregations in the Atlanta metro area and replicate the program where Memory Assessment Centers are located (Albany, Augusta, Columbus, or Macon). Ultimately, the Alter program will provide churches with the knowledge needed to support African American families living with dementia.
Stroke Counseling for Risk Reduction in Young African American Men
Title: Stroke Counseling for Risk Reduction in Young African American Men
Agency: Betty Irene Moore Fellowship Program for Nurse Leaders and Innovators
Project Period: 07/01/2020 – 09/30/2023
Project Number:
Abstract
Compared to other similar age groups, young African American (AA) men have a higher incidence of stroke and stroke-related morbidity and mortality, and a greater prevalence of modifiable risk factors, including hypertension, diabetes, obesity. Maintaining ideal cardiovascular health can reduce the impact of these risk factors and eliminate most strokes. There are no evidence-based primary stroke prevention programs tailored specifically for this high risk, hard to reach, and understudied group. Therefore, we will adapt our Stroke Counseling for Risk Reduction (SCORRE) intervention to the specific needs and preferences of at-risk, young, AA men in Atlanta, GA. SCORRE, a brief, age-and culturally relevant individual counseling intervention, was designed to improve accuracy of perceived stroke risk and increase stroke risk reduction behaviors in young adult AA men and women using established methods. These include: 1) a motivational video of young adult AA stroke survivors, 2) the AHA’s Life’s Simple 7®, 3) a behavioral risk reduction diary, and 4) motivational text messages. Our preliminary data found that young AA men were significantly less ready for behavior change and had a measurably lower awareness of their stroke risk. Therefore, using a mixed method design, the specific aims of the proposed fellowship project are to: 1) adapt and enhance SCORRE with guidance from focus groups of young AA men (N=30) and expert consultants; and 2) determine the feasibility and acceptability of the adapted SCORRE-Men using a two-group pre-post test design with 80 at-risk, AA men aged 20-35 years over 8 weeks. Outcomes include feasibility and acceptability (i.e., recruitment, retention, adherence, satisfaction), and exploration of changes in theoretical (i.e., accuracy of perceived stroke risk, readiness for behavior change) and behavioral (i.e., diet and physical; BP, BMI, glucose; risk factor score change) variables. If successful, our findings will inform implementation of a larger trial, with the overall goal of designing a feasible and effective model of primary stroke prevention that can be used in community and clinical settings to address the alarming disparities in stroke among young AA men.
https://health.ucdavis.edu/nursing/NurseLeaderFellows/2020fellows.html
Monique Balthazar
Nursing
Program to Increase Diversity in Faculty Engaged in Behavioral and Sleep Medicine
Agency: University of Miami
Title: Program to Increase Diversity in Faculty Engaged in Behavioral and Sleep Medicine
Project Period: 01/01/2022 – 12/31/2022
Award #: OS0000854
The proposed project, in conjunction with a structured mentoring and training plan, are designed to facilitate the primary investigator’s (PI), Dr. Monique Balthazar, long-term goal of developing an independently-funded clinical and translational sleep research program focused on improving sleep health for vulnerable populations, specifically people living with human immunodeficiency virus (HIV) (PLWH), consistent with the mission of the National Heart, Lung, and Blood Institute (NHLBI) and National Institutes of Health (NIH) Office of AIDS Research (OAR) strategic plan and priorities for HIV and HIV-related research. Healthy sleep is essential for optimal health and plays a vital role in chronic disease prevention and management. Up to 75% of PLWH in the United States (US) experience sleep disturbances of some kind. Poor sleep is associated with changes in immune cell count and activity as well as alterations in arginase, IDO, glycolytic, fatty acid, and amino acid activity. HIV directly affects T-lymphocytes and macrophages; the functioning of these cells is modulated by the arginase and indoleamine 2,3 dioxygenase (IDO) metabolic pathways. Sleep, metabolism, and immune function are inextricably interlinked. However, very little is known of the molecular and cellular pathways by which sleep, metabolism, and the immune system are interrelated for PLWH. Black people account for approximately 43% of new HIV infections annually, they experience the highest rates of HIV-related deaths, and also report poorer sleep quality compared to White people. Sampling from a subset of PLWH most vulnerable to poor sleep and adverse health outcomes, the aims of this study are to: (1) characterize immune activation, inflammation, and antiviral immune function (i.e., levels and activity of cytolytic cells such as CD8+ T cells and NK cells) of PLWH with poor sleep (n=7) and healthy sleep (n=7), compared people without HIV with poor sleep (n=7) and healthy sleep (n=7). (2) Characterize specific metabolites associated with the arginase, IDO, glycolysis, lipid, and amino acid pathways of PLWH with poor sleep (n=7) and healthy sleep (n=7), compared people without HIV with poor sleep (n=7) and healthy sleep (n=7). (3) Explore contributions of select covariates (racism, stress, depression, and stigma) to the immune-metabolic interactions of those with poor sleep as compared to those with healthy sleep. The PI will use high-resolution, liquid chromatography-mass spectrometry (LC-MS) metabolomics and multi-scale data integration analysis to take the first steps towards understanding the complex relationships identified in the aims. The proposed study may lead to the identification of biomarkers that could reshape clinical practice through precision health.
Maureen Beebe
Nutrition
Berry Consumption as a Therapeutic Strategy in Chronic Lung Disease Induced by Electronic Cigarettes in Hypertensive Rats
Agency: Department of Agriculture (U.S.)
Title: Berry Consumption as a Therapeutic Strategy in Chronic Lung Disease Induced by Electronic Cigarettes in Hypertensive Rats
Project Period: 06/01/2021 – 05/31/2023
Award Number: 2021-67034-35045
ABSTRACT
Cardiopulmonary conditions serve asare the leading causes of death in the United States. Hypertension (HTN) and cigarette smoking (CS), serve as major risk factors for these conditions. With the emerging popularity of electronic nicotine delivery systems (ENDS), the its impact of ENDS, specifically in a hypertensive state, on the development of cardiopulmonary diseases requires further attention. The renin-angiotensin system (RAS), in particular derived Angiotensin angiotensin (Ang) II, plays a significant role in the pathophysiology of HTN and induces oxidative stress and an inflammatory response which mediates Ang II-induced chronic lung conditions. Despite modern pharmacological treatments, HTN and chronic lung diseases remain significant public health burdens and adjunct therapies are urgently needed. Polyphenols such, such as gallic acid and p-coumaric acid, rich in blackberries, exhibit beneficial effects on the airway and have potential to mitigate lung damage induced by HTN and ENDS exposure. Therefore, the chief goal of this proposed study is to determine the combined effects of ENDS exposure and Ang II-induced HTN on respiratory and cardiac function in an animal model of Ang II-induced HTN and to further determine if whether blackberries have the potential to mitigate these detrimental effects. Sprague Dawley will be fed a diet supplemented with blackberry for four weeks prior to Ang II infusion and daily ENDS aerosol exposure in order to determine the potential for blackberries to mitigate the effects of HTN and ENDS aerosol exposure on the function and architecture of lungs and heart. Additionally, to advance mechanistic understanding, microvascular endothelial cells will be co-treated with blackberry, Ang II and ENDS aerosol condensate to determine direct effects on the endothelium. The following aims will be addressed: Aim 1: Determine the effectiveness of blackberry in preventing morphological and functional changes to the lung in Ang-II infused rats exposed to ENDS aerosol. Aim 2: Determine the mechanisms by which blackberry mitigates changes in lung function and architecture. By addressing these aims, we will be able to determine the potential for blackberry to act as an adjective therapy in the treatment of chronic lung conditions.
Sutanuka Bhattacharjya
Occupational Therapy
mHandRehab: Virtual Hand Rehabilitation using Computer Vision
Title: mHandRehab: Virtual Hand Rehabilitation using Computer Vision
Agency: Intramural Grant Award
Project Period: 01/01/2021 – 12/31/2022
Adults over the age of 65 account for nearly three quarters of all incidents of stroke. Considering aging demographics, the need to better address post-stroke recovery continues to grow. Hand function is fundamental to making efficient movements in activities of daily living. However, in clinical rehabilitation, the current standard of practice is to discharge patients from therapy services with a written program to continue exercise at home. Whereas the exercises can be effective when adhered to, the lack of performance-based feedback to gauge one’s own hand function or level of improvement severely limits the effectiveness of home-based exercises. Creating an automated system that provides real-time movement feedback to the client while they engage in their rehabilitation, will allow the user to self-monitor their performance. Herein is a plan to transform home programs for hand function by using digital technology to offer remote rehabilitation and support self-management of home programs by individuals with stroke. We propose to use digital technology that will use state-of-the-art computer vision and deep learning models to recognize the time-series of hand movements. The mHandRehab application will provide real-time, quantitative, performance-based feedback during hand function activities performed by individuals with stroke in their homes. We hypothesize that receiving real-time quantitative feedback will improve functional mobility. We will examine performance changes in trained activities of daily living. In practice, receiving real-time feedback during home program s will serve to better inform the user of their progress and actively engage them in their rehabilitation, thus encouraging self-management skills.
Kyle Brandenberger
Respiratory Therapy
GSU THRIVES: Georgia State University - The Health Resilience Initiative for Veterans-Soldiers
Title: GSU THRIVES: Georgia State University – The Health Resilience Initiative for Veterans-Soldiers
Project Period: 07/01/2022 – 06/30/2023
Agency: University Research Services and Administration
GSU THRIVES: Georgia State University – The Health Resilience Initiative for Veterans-Soldiers
Current world events remind us of the toll of warfare on human suffering. Recognizing the tremendous costs of physical and mental health problems suffered during training and deploying to warzones, the United States (U.S.) Department of Defense began two separate initiatives in the late 1990s to 1) reduce mental health issues associated with combat and 2) reduce the incidence of preventable musculoskeletal injuries. Despite 20 years of focused investment on prevention and treatment strategies, 22% of veterans from the wars in Iraq and Afghanistan have diagnosable Traumatic Brain Injuries (TBI) and Post Traumatic Stress Disorder (PTSD), and more than half of soldiers experienced a physical injury with 70% of these being overuse musculoskeletal injuries. Current estimates of the cost associated with treating physical injuries and mental health problems associated with the War on Terror are a staggering $700 billion. In addition to the economic strain on the healthcare system, mental health disorders and musculoskeletal injuries exert deleterious impacts on the quality of life of the military personnel and their families. GSU-THRIVES brings together an interdisciplinary team of experts with the primary mission to prevent/mitigate musculoskeletal injuries and build physical and mental resilience in military recruits, active-duty personnel and veterans. In addition, we seek to restore fitness and resiliency more efficiently after injury in military personnel and veterans, and prevent secondary adverse health outcomes associated with PTSD through holistic health interventions.
Emily Buchman
Occupational Therapy
Student Learning Outcomes Using Simulated Learning Environments in Assistive Technology
Title: Student Learning Outcomes Using Simulated Learning Environments in Assistive Technology
Agency/Program: Lewis College NTT Faculty Intramural Grant Award
Award Date: Fall 2019 – 10/31/2022
Abstract:
For individuals with disabilities, assistive technology can help them to complete activities that they would otherwise be unable to do. Occupational therapists are trained to recommend equipment that meets the needs of each individual client to enhance quality of life. However, consumer needs as well as technologies are complex and require a great deal of analysis and understanding. Therefore, there is a current trend to develop training tools that enhance clinical understanding and reasoning for learners. Simulated environments are one such area of current interest for clinical training opportunities. So, this project proposes to critically evaluate the current literature on simulated learning environments and explore the scope of current training methods utilized to teach assistive technology in occupational therapy programs. These two foci of this project are proposed in preparation for re-submission of an external grant that was not accepted due to an inability to clearly delineate the need for development of innovative teaching tools in the area of assistive technology. The larger scope of this project, then, is to propose the development of a virtual to enhance training for providers of assistive technology.
Karis Casseus
Nursing
Systematic Review & Meta-analysis: The Role of Cytokines in Adult Women 18 Years or Older with Fibromyalgia
Title: Systematic Review & Meta-analysis: The Role of Cytokines in Adult Women 18 Years or Older with Fibromyalgia
Agency: Southern Regional Education Board
Project Period: 01/01/2021 – 05/14/2021
Casseus, K., Ijeh, N., Chernecky, C., Su, S., Xu, N., *Young, L.
*= Major Advisor
Background: Fibromyalgia (FM) is a chronic disease characterized by widespread pain of no confirmed etiology. Evidence supports an association between neuroinflammation and people with FM.
Purpose: The purpose of this study is to examine the role of inflammatory cytokines in the development of fibromyalgia in adult women 18 years or older. We hypothesize a positive association between dysregulation of inflammatory cytokines and the development of FM in adult females.
Methods: A systematic review – meta-analysis will be conducted to identify, select, appraise, and summarize studies researching inflammatory cytokines in adult women with FM. All studies evaluated will report at least one inflammatory cytokine (TNF-alpha, IL-1, IL-6, IL-8). Using an exhaustive systematic search of electronic databases (PubMed, CINAHAL, Cochrane, PsycINFO, Web of Science, and clinicaltrials.gov), eligible studies will be identified. Medical subject headings and text words related to fibromyalgia and cytokines [fibromyalgia, fibrositis, fibromyositis, central nervous system centralization, cytokines, interleukins, tumor necrosis factor] will guide the search. Non-interventional and interventional studies or secondary data analysis studies investigating cytokines and FM in adult females will be included. Two data abstractors will independently extract data and assess study quality using the Cochrane risk of bias tool. If studies are homogenous, a meta-analysis will be considered.
Discussion: Identified inflammatory cytokine patterns associated with FM may help understand the pathophysiological processes or additional risk factors associated with FM. Findings from this study may be used as a basis for future research, explicitly investigating cytokines’ use to diagnose FM in adult women.
Mei-Lan Chan
Nursing
Effects of Resistance Exercise on Cognitive Function and Mental Health among Older Chinese Americans
Agency: Come-Well Clinics Physical Medicine and Rehabilitation (Con-Rui Clinics)
Title: Effects of Resistance Exercise on Cognitive Function and Mental Health among Older Chinese Americans
Project Period: 12/07/2021 – 12/31/2023
ABSTRACT
Physical activity interventions have shown to be potentially effective for improving cognitive function and psychological well-being in older adults. However, few studies assessed the effect of resistance exercise on cognition and mental health in older Chinese Americans. The purpose of this study is to examine the effects of a 12-week resistance exercise intervention (50 minutes per session, 2 times per week) on cognitive function, stress, depression, and social engagement in community-dwelling older Chinese Americans. This study is a secondary analysis using existing data from a completed two-arm randomized controlled trial. Changes in cognitive function, perceived stress, depressive symptoms, and social engagement from baseline to 12 weeks (post-intervention) will be assessed. Descriptive statistics and t tests will be performed for data analysis. The success of this project will lead to a substantial positive impact on connecting exercise medicine with healthcare and provide exercise recommendations for future research and clinical practice.
Yi-An Chen
Occupational Therapy
Clinical Utility of Fitbit and Apple Watch to Measure Daily Arm/Hand Use in Stroke: A Comparison with Research-Grade ActiGraph Accelerometer
Title: Clinical Utility of Fitbit and Apple Watch to Measure Daily Arm/Hand Use in Stroke: A Comparison with Research-Grade ActiGraph Accelerometer
Project Period: 04/01/2022 – 03/31/2024
Agency: Intramural Grant Award
The benefit of continuous daily use of the paretic limb after stroke has been extensively addressed in neurorehabilitation. To better understand and promote the daily arm/hand use behavior, research-grade accelerometers, such as ActiGraph, have been commonly used to quantify and track stroke survivors’ paretic arm/hand use in everyday life. However, such sensors have demonstrated limited clinical use due to the need for additional programming and the high cost. In contrast, commercial fitness trackers, such as Fitbit and Apple Watch, are more user-friendly with a more acceptable price range. Previous studies have established the accuracy of Fitbit and Apple Watch in tracking gross physical activity. However, these sensors have not been used for measuring post-stroke arm/hand use. Our goal is to determine the clinical utility of commercial sensors for tracking arm/hand use behaviors in stroke survivors in the everyday environment. We propose to compare the fitness outcomes (i.e., step counts, active time) reported from Fitbit and Apple Watch with the validated “gold-standard” arm/hand use measures (i.e., time duration and magnitude intensity) calculated from ActiGraph data. In a laboratory setting, we will recruit healthy and stroke participants to perform several types of daily activities (e.g., fine vs. gross motor) with both types of sensors to establish a basic but thorough understanding of the accuracy of the commercial trackers. Stroke participants will be asked to continue a 3-day home monitoring period to allow us to understand the sensitivity of commercial trackers under natural, uncontrolled, real-world conditions. Results from this study may suggest an affordable and accessible alternative for clinical use in measuring post-stroke daily arm/hand use behavior. Building upon the findings, we will be able to explore and develop algorithms to transform the commercial tracker data to provide accurate daily arm/hand use information. We will then be able to utilize the low-cost, widely-used commercial trackers to develop real-time interventions (e.g., reminder systems) to promote stroke survivors’ paretic arm/hand use and to continue stroke recovery in everyday life.
Rachel Culbreth
Respiratory Therapy
Manual Ventilation Techniques with the Sotair device and Resuscitator Bag compared to Mechanical Ventilation
Co-Investigator: Douglas S. Gardenhire, EdD, RRT-NPS, RRT, FAARC
Agency: SafeBVM Corp
Project Period: 06/01/2021 – 05/30/2022
Abstract
Introduction: The resuscitator bag is the primary method of ventilating patients that have difficulty breathing (i.e., cardiac arrest, respiratory arrest/failure, etc.) and during the delivery of anesthesia. Resuscitator bags are common in acute care settings; however, in many cases stomach inflation is a common occurrence in bagging techniques and a potentially dangerous complication. Poor manual ventilation technique is a well-documented problem which occurs irrespective of a provider’s qualifications or experience. A safety device has been created (Sotair™) to improve the quality of air delivery via resuscitation bags for providers by preventing harmful effects of manual ventilation. This study seeks to determine the differences in airflow measurements between the Sotair device via bag-valve mask and the mechanical ventilator using a non-inferiority trial design.
Objectives: The main objective of this study is to determine the differences between the airflow measurements (primary outcome: pressure; secondary outcomes: volume, flow, rise time, and inspiratory/expiratory ratio) between bagging techniques with the Sotair device administered by student respiratory therapists in ACLS class and the mechanical ventilator on two pre-determined lung resistance and compliance settings. Additionally, a secondary objective of the study is to examine the inter-variability among RT student providers using the Sotair device.
Rationale: The rationale of this study is to determine if the safety device is compared to the mechanical ventilator, which has a standard and consistent airflow delivery. This study will utilize a non-inferiority design, which is the gold standard when comparing clinical interventions that are already in use (i.e., the ventilator). Specifically, we seek to determine if the pressure, volume, and flow delivered via the Sotair device is not more harmful than the ventilator-delivered pressure, volume, and flow metrics.4
Methodology: This pilot study will be conducted at GSU Respiratory Therapy lab in Petite Science Center. The RT students will practice manually ventilating the simulated patient with artificial test lungs for approximately 2 minutes of practice time. Then, the RT students will manually ventilate a simulated patient via a standard bag valve mask with the Sotair device attached for at least 90 seconds (at 12 breaths per minute for a total of 18 breaths using a clock ticker from a tablet) for official data collection. This procedure will occur twice, as RT students will be requested to perform this procedure on a normal lung setting and an abnormal lung setting (preset compliance and resistance settings for each patient scenario). All measurements will be recorded to the 10 ms, and data will be compiled for analysis into measurements per breath. Additionally, each provider will complete a short survey that will assess age, sex, education, experience using the resuscitator bag, and confidence level in using the resuscitator bag.
For the control group, a mechanical ventilator will be used to simulate the patient characteristics using the same artificial test lung. The mechanical ventilator’s measurements will be assessed for a total of three repetitions across the two patient scenarios (normal and abnormal lung resistance and compliance settings).
Comparison of portable oxygen concentrators and inspired oxygen levels using a COPD patient simulation model
Agency: CAIRE Inc.
Project Period: 05/01/2021 -03/30/2023
Investigators:
Rachel Culbreth, PhD, MPH, RRT (PI)
Douglas S. Gardenhire, EdD, RRT-NPS, RRT, FAARC (CO-I)
Kyle Brandenberger, PhD (CO-I)
Portable oxygen concentrators (POCs) have shown efficacy in delivering adequate oxygen for various patient scenarios; however, there is a lack of research on POCs’ efficacy across different respiratory rates specifically among COPD patients. COPD patients comprise the majority of POC users, thus it’s important to evaluate the efficacy of POCs specifically for this patient population. This bench study will be conducted using the IngMar Medical Active Servo Lung 5000 attached to flexible tubing, which simulates an adult patient’s nares. The IngMar Lung will be programmed to simulate a COPD patient at the following respiratory rates: 15 breaths per minute (bpm), 20 bpm, 30 bpm, and 40 bpm. POC devices will then be compared to an oxygen wall outlet and a standard oxygen concentrator (non-portable CAIRE device). The POCs included the CAIRE FreeStyle Comfort (with Autosat), CAIRE FreeStyle Comfort (without Autosat), Inogen G4, Inogen G5, Phillips SimplyGo Mini, GCE Zen-O lite, Drive Medical iGo2, and Kingon POCs. Descriptive statistics and ANOVAs will be computed to determine statistically significant differences between POCS and control devices (wall oxygen and standalone oxygen concentrator). The main goal of this project is to identify differences in inspired oxygen concentration levels for a simulated COPD patient between wall oxygen and standalone oxygen concentrators with POCs.
Assessing Biochemical and Physiological Effects of Vaping CBD Oil on Young Adults
Co PIs: Kyle Brandenberger, BS, MS, PhD and Rachel Culbreth, PhD
Agency: Byrdine F. Lewis College of Nursing and Health Professions
Title: Assessing Biochemical and Physiological Effects of Vaping CBD Oil on Young Adults
Project Period: 04/01/2020 – 03/31/2022
Abstract:
Adverse health outcomes associated with vaping are a major public health concern. Nearly 1/3 of youth report vaping non-nicotine substances such as cannabidiol (CBD), and the prevalence of vaping among young adults has doubled since 2018. Additionally, the surge of CBD oil availability and the relaxed regulations for vaping CBD oil present a critical gap in knowledge regarding the adverse health effects of vaping CBD oil. The overall objective of this project is to bring forth evidence of the biochemical and physiological effects of vaping CBD oil in young adults. This project proposes surveying substance use behaviors and measuring cardiopulmonary function and blood biomarkers from a small sample of thirty young adults who vape CBD oil. We hypothesize that individuals who vape CBD oil will exhibit decreased cardiopulmonary function and increased biomarker measures compared to reference values. We plan to evaluate these hypotheses by 1) examining CBD use patterns among young adults, 2) evaluating cardiopulmonary measures among young adults who vape CBD oil (heart rate, blood pressure, VO2 max, forced vital capacity, forced expiratory volume), and 3) examining biomarkers associated with kidney and liver function, anemia, infection, inflammation, and DNA damage. Data generated from this timely and novel project will be included as preliminary data in an R01 application to be submitted to NIH to study prospective trends in CBD oil vaping among a larger sample of young adults across two years (to either NIDA or NHLBI).
Rafaela Goncalves Feresin
Nutrition
Berries Prevent Hypertension and Cardiac Damage by Modulating the Gut
Title: Berries Prevent Hypertension and Cardiac Damage by Modulating the Gut
Project Period: 03/01/2019 – 02/28/2023
Grant Number: 2019-67017-29257
Abstract
Hypertension affects millions of people in the US and is a major risk factor for cardiovascular disease. A number of anti-hypertensive drugs are available to treat hypertension; However, these drugs have various side effects, including fatigue, dizziness, headaches, constipation, nausea, cough and edema. Additionally, multiple anti-hypertensive medications are often needed to decrease BP, increasing potential side effects and decreasing adherence. Therefore, there is a need for identification of alternative and complementary therapeutic nutritional approaches for the prevention or treatment of hypertension. Population studies indicate that consumption of fruits and vegetables is associated with decreased inflammation and incidence of cardiovascular disease. Blackberries and raspberries are major fruit crops that are native to North America and are widely consumed in the US. These berries have strong anti-inflammatory and antioxidant properties. Scientific evidence indicates that consumption of berries may produce beneficial effects on blood pressure. However, their applicability is diminished by the lack of mechanistic explanations about their mode of action which increases uncertainty about their potential benefits and potential side effects. Thus, the overall goal of our project is to investigate the effectiveness of blackberry and raspberry, alone or in combination, in attenuating angiotensin II-induced endothelial dysfunction, hypertension, and cardiac damage in addition to determining whether these protective effects are mediated by favorable alterations in the gut microbiome and decreases in oxidative stress and inflammation. Therefore, we propose the following specific aims: 1) Determine the extent to which blackberry and raspberry, alone or in combination, prevent hypertension as well as whether they improve endothelial and cardiac dysfunction in angiotensin II-infused rats; 2) Determine the mechanisms by which blackberry and raspberry, alone or in combination, improve cardiovascular function in vitro and in vivo; and 3) Determine whether blackberry and raspberry, alone or in combination, improve vascular function by attenuating the negative effects of angiotensin II on the gut microbial population, localization, and function. Our findings will provide evidence supporting the role of berries in cardiovascular and gut health and will lay the foundation for a future grant application to investigate the effects of blackberry and raspberry on cardiovascular function and gut health in a carefully controlled clinical trial. The proposed study addresses the USDA-AFRI priority, Function and Efficacy of Nutrients, by investigating the role of bioactive components in food in preventing inflammation or promoting gut health.
Doug Gardenhire
Respiratory Therapy
Program Specific Agreement for a Collaborative Graduate
Project Title: Program Specific Agreement for a Collaborative Graduate
Agency: Taipei Medical University
Project Period: 05/11/2016 thru 10/11/2026
Statement of Work
To Credential Taiwanese Respiratory Therapy Students Through a Collaboration with Taipei Medical University.
Educational Services Agreement
Title: Educational Services Agreement
Agency: Dar Al Uloom University
Project Period: 05/01/2019 – 04/30/2023
Award Number: AGMT_ 04-01-2019
Abstract
Respiratory Therapy (RT) education in the United States (US) and the World continues to transition and transform. Currently, more colleges and universities are adding the RT discipline as an offering due to its growth. The job growth over the next ten years is much higher than averages in the US with an estimated growth of more than 23%. Georgia State University (GSU) RT has been a leader in RT education for 50 years. The utilization of the grant along with collaboration between GSU RT and Dar Al Uloom University (DAU) will develop a highly functional respiratory therapy program serving students in the Kingdom of Saudi Arabia.
Sujay Galen
Physical Therapy
The Impact of an Ultra-Light Manual Wheelchair on Wheelchair Skills and Performance of Individuals with Cerebral Vascular Accident
PI: Sujay Galen, PT, Ph.D., FHEA
Agency: Permobile, Inc.
Award Number: AGMT_06-01-22019
The purpose of this research study is to examine the impact of an ultralight wheelchair on wheelchair skills and performance in comparison to standard manual wheelchairs in individuals with stroke. Our research question is as follows: “Does an ultra-light wheelchair improve functional mobility and skills performance in individuals with a cerebrovascular accident (CVA)?” In this study we hope to gain evidence that ultralight wheelchairs improve functional mobility and skills performance in individuals with stroke.
Xiangming Ji
Nutrition
Metabolic Reprogramming in Patients with COPD
Project Period: 07/01/2017 – 06/30/2022
COPD is the third leading cause deaths in the US. Patients with advanced COPD often suffer from sputum production, shortness of breath and a productive cough. To significantly reduce the deaths from this disease, more accurate and reliable strategies are urgently needed to detect the disease early and to offer ways of preventing progression beyond smoking cessation efforts. This project, if successfully, is expected to shed light on the role of smoking in causing changes in epithelial cell metabolism that contribute to the development of COPD. It also has the potential to transform the management of patients with COPD for which there is no current effective treatment strategy. Using high throughput shotgun proteomic analysis of the airway epithelium of individuals with various stages of COPD, we recently discovered the overexpression of rate-limiting enzymes involved in the metabolic reprogramming. These enzymes are abundantly expressed in the epithelium in the early stage COPD tissues but not in normal counterparts. In this third year of funding, we will explore the underlying molecular mechanisms by which these key metabolic enzymes regulate the course of COPD development by examining their role in key molecular and cellular features of COPD. Ultimately, these studies provide the basis for the use of metabolic enzymes as potential diagnostic and therapeutic targets in the prevention and treatment of COPD. With the results of these investigations, we will seek NHLBI funding and other funding support to pursue this exciting research.
Susan J. Kelley
Nursing
Project Health Grandparents
The objectives of the intervention are to improve the physical health of grandparents and grandchildren; improve their mental/emotional health by decreasing distress, and increase access to community resources. By addressing the immediate health care and financial needs of the grandparents and the children in their homes, grandparents are better able to care for themselves and their families. This holistic approach emphasizes education and empowerment, as well as creating a healthier, more stable, and financially secure environment for families. A variety of standardized measures are used to assess
outcomes.
To date, results have been published in a variety of journals including Research in Nursing & Health, Journal of Nursing Scholarship, Journal of the American Dietetic Association, Journal of Family Nursing, and Children & Youth Services Review.
Jiwon Lee
Nursing
The use of actigraphy and videosomnography to measure sleep-wake patterns in mothers and their school-aged children with developmental disabilities: A feasibility study
Title: The use of actigraphy and videosomnography to measure sleep-wake patterns in mothers and their school-aged children with developmental disabilities: A feasibility study
Agency/Program: Lewis College NTT Faculty Intramural Grant Award
Award End Date: December 2021
Abstract:
Children born with developmental disabilities (DDs,) life-long mental and/or physical conditions that have resulted in substantial limitations in physical, cognitive, language, and self-care, have increased with nearly 10 million or 15.04% of children in the United States (US) experiencing DDs. Most of these children are cared for at home, and mothers are typically the primary caregivers. Growing evidence indicates that mothers of children with DDs are at greater risk for poor health, including depression, high blood pressure, and decreased immune function, and all are associated with impaired sleep. Although studies reported impaired sleep in mothers of children with DDs, existing research is limited in characterizing sleep using well-validated objective measures and in identifying maternal and child characteristics that are uniquely related to these maternal caregivers’ impaired sleep. The purpose of this feasibility study is to examine the feasibility of using objective measures for maternal (actigraphy) and child sleep
(videosomnography) and allow the principal investigator (PI) to gain skills in data analysis and interpretation using these measures. In mothers of school-aged children (ages 6-12) with DDs, the specific aims of this feasibility study are to (1) determine the feasibility (recruitment, adherence, acceptability, missing data) in using actigraphy to characterize mothers of children with DD’s sleep-wake parameters of total sleep time, sleep latency, awakenings, wake time after sleep onset (WASO), sleep efficiency, and napping during the day for 7-consecutive days/nights; and (2) evaluate feasibility (recruitment, adherence, acceptability, missing data) of using videosomnography to measure child’s sleep problems (frequency and duration of night awakenings) and mothers’ night-time caregiving activities for 7-consecutive nights and compare to maternal report of child sleep measure. This feasibility study will use a descriptive study design in a non-random sample of five mothers and five of their school-aged children with DDs (dyad). In addition to feasibility data we will collect self-report sleep data for comparison (Pittsburgh Sleep Quality Index for mothers and Children’s Sleep Habits Questionnaire for children) and additional data (e.g., caregiving stress and depressive symptoms). The results of this study will lay the groundwork to include the measures in the development of an NIH K 23 award to better characterize sleep and factors associated with mothers’ impaired sleep for a future intervention that promotes personalized sleep health strategies among mothers raising children with DDs.
Susan Lee
Occupational Therapy
The PPAL: The Bedside Commode as a Safe Self-Toilet Transfer Device for Aging Adults
Title:The PPAL: The Bedside Commode as a Safe Self-Toilet Transfer Device for Aging Adults
Project Period: 01/01/2022 – 02/28/2023
Agency: QUA, Inc.
The PPAL® SUMMARY
Despite being prescribed for older adults with mobility disabilities to manage toileting and to reduce falls risk, bedside commode chairs perversely present a new source of risk for falling. “PPAL®” is a novel and innovative approach that addresses that fall risk by resolving the transfer difficulties associated with using commodes. It re-conceptualizes the bedside commode as an elevating chair with an integral transfer board. With a securely affixed transfer board connected to a seat that is elevated by an internal motorized lift, the commode will provide a stable and “always downhill” transfer pathway, regardless of the height of the adjacent bed or wheelchair transfer surface. In doing so, PPAL® will enable adults aging with lower extremity weakness to safely self-toilet, thereby lowering their risk of falling.
To ensure success all three phases of this SBIR, the project will be a collaborative effort between the applicant, QUA Inc., which holds the PPAL® patent, Georgia Tech’s Center for Inclusive Design and Innovation, which has extensive experience in design of assistive technologies to facilitate toilet transfers by older adults, and Georgia State’s Department of Occupational Therapy, which has expertise in usability testing of product for use by people with disabilities. Phase 1 will refine the transfer interface based on the results of pilot testing of an earlier prototype and demonstrate feasibility of the refined design.
Specific aims of this Phase 1 SBIR project are to: 1) Design and fabricate a medium fidelity non-motorized prototype that responds to the problems identified with the transfer interface in the initial pilot testing; 2) conduct safety testing to demonstrate technical feasibility of the refined design based on load capacity of 250 pound minimum and stability in which the board remains in constant contact with both bed and chair surfaces during simulated transfers by occupational therapists; and 3) conduct user testing to demonstrate usability feasibility as measured by expert observation of transfer difficulty and safety, self-reported user acceptance and increased independence compared to a traditional transfer board.
Phase 1 will produce a prototype with a transfer interface that is feasible based on safety and usability as well as provide the necessary data to power the effectiveness testing in Phase 2.
Environmental Barriers and Facilitators to Assisted Toilet Transfers by People Aging with Disability and their Caregivers
Agency: U.S. Department of Health and Human Services
Project Period: 08/02/2020 – 09/29/2022
Title: Environmental Barriers and Facilitators to Assisted Toilet Transfers by People Aging with Disability and their Caregivers
This project identifies environmental factors that create barriers and facilitators to caregiver assisted transfers for individuals aging with disability to inform the development of design criteria for dyadic-centered AT/EM toilet transfer interventions. Specific aims are to: (1) describe the overall effectiveness of existing AT/EM toilet transfer interventions for individuals aging with disability and their caregivers by evaluating transfer performance of caregiving dyads using their own AT/EM interventions; (2) observe and delineate categorical differences in unmet needs for environmental supports for care recipient/caregiver dyads with different functional abilities; (3) identify the salient factors of the AT/EM that either act as barriers or facilitators to successful transfer performance based on the different needs and abilities of care recipients and their caregivers; (4) develop design criteria for the subsequent development of effective AT/EM solutions for assisted transfers by individuals aging with disabilities and their spousal caregivers; and (5) develop and execute a knowledge translation plan to disseminate study findings to appropriate stakeholders.
3D printing-enhanced assistive technology interventions to facilitate independence in activities of daily living among older adults with disabilities
Department: Occupational Therapy
Title: 3D printing-enhanced assistive technology interventions to facilitate independence in activities of daily living among older adults with disabilities
Agency: Intramural Non-Tenure Track
Project Period: 01/01/2022 – 12/31/2022
ABSTRACT
Assistive technologies (AT) are crucial for maintaining independent living and participation of older adults. Occupational therapists (OTs) often need to modify, refine, repurpose, or jury rig existing off-the-shelf AT to further customize it to meet the specific needs and abilities of their clients 1-4. While such AT adaptions are helpful 5.6, these practices typically involve hacking and makeshift methods using practical and often improvised materials at hand that lack durability and or esthetics for long-term utilization 6. In contrast, digital fabrication and rapid prototyping technologies, such as 3D printing, have the potential to empower and support OTs in designing more durable, esthetic, and highly customized AT solutions4,7,8.
To support a client-centered use of 3D printing for AT customization, the purpose of this project is to establish feasibility of a 3D printing-enhanced AT intervention to facilitate ADL functioning among older adults with disabilities. To do so, we will engage in a participatory AT co-development process with older adults with hand impairments receiving services at Meals on Wheels. After a goal suited for 3D printing intervention is established, they will be provided an off the shelf AT solution which, as necessary, will be modified using 3D printing. Effect of the intervention will be measured (immediately after intervention and 3 months post intervention) by self-report of 1) functional ability, 2) level of difficulty during task performance, and 3) satisfaction experienced with task performance. Facilitators and barriers during implementation will be noted to understand factors that impact the success of the intervention. The nature of modifications made will be noted to inform the design requirements of an OT-friendly 3D modeling platform that will help OTs customize AT in practice.
The output of the study will provide the basis for a development proposal to the National Institute on Disability, Independent Living and Rehabilitation Research (NIDILRR). In addition to generating evidence for feasibility of this approach, the study will inform the development of 1) a manualized 3D printing-enhanced AT intervention and 2) design requirements for an OT-friendly 3D modeling platform which allows customization of AT via a simple interface.
Rami Najjar
Nutrition
USDA-NIFA Fellowship
Agency: National Institute of Food and Agriculture/USDA
Project Period: 06/15/2021 – 06/14/2023
Award No.: 2021-67034-35131
ABSTRACT
Congestive heart failure (CHF) is diagnosed 650,000 times annually in the US with a 5-year mortality rate of 50% despite pharmacological therapies. There is a critical need for adjunct or alternative therapeutic approaches in the treatment of this disease. CHF is characterized by a reduced left ventricular ejection fraction and hypertrophy of the left ventricular wall. The pathophysiological remodeling of the heart is mediated by increased reactive oxygen species (ROS), inflammation and decreased detoxifying enzymatic activity. These inflammatory and oxidative stress pathways are mostly regulated by Nf-κB signaling, as well as NADPH-oxidases. Additionally, nuclear factor erythroid 2-related factor 2 (Nrf2) is a major antagonist of these oxidative stress and inflammatory pathways, primarily responsible for detoxifying protein transcription. Raspberries, which are rich in polyphenols, reduce ROS and inflammatory signaling in vitro and our preliminary data indicate that raspberries reduce cardiac inflammation and fibrosis induced by angiotensin II. These effects are likely mediated by Nrf2 signaling. However, it is not currently known whether raspberries can attenuate cardiac inflammation and oxidative stress and improve cardiac function in CHF. Thus, using a dietary approach, the objective of this proposal aims to determine whether raspberry treatment can ameliorate the pathological characteristics of CHF. To achieve this objective, the following specific aims will be pursued: 1) determine whether raspberry consumption can mitigate cardiac dysfunction and hypertrophy in mice with CHF, 2) determine whether raspberry consumption attenuates cardiac inflammation and oxidative stress in mice with CHF and 3) determine whether raspberries attenuate these detrimental effects in cardiomyocytes in a Nrf2-dependent manner. Mice will consume either a control or 10% raspberry diet for four weeks, then will undergo left anterior descending coronary artery ligation to induce CHF. Cardiac function and morphology will be assessed. Animals will be sacrificed at week 8 and cardiac tissue will be harvested for staining or frozen for transcriptional and proteome. Cardiomyocytes will undergo hypoxia and treated with raspberry polyphenol extract and/or Nrf2 inhibitor.
Anita Nucci
Nutrition
Children’s Healthcare of Atlanta Intestinal Rehabilitation Registry
Agency: Children’s Healthcare of Atlanta
Project Period: 10/05/2021 – 10/04/2023
Abstract
The Intestinal Rehabilitation of Children’s (IRoC) program was established in 2010 at the Egleston campus of Children’s Healthcare of Atlanta. IRoC was designed to provide medical care for children suffering from intestinal failure. Intestinal failure is defined as the use of parenteral nutrition for more than 60 consecutive days. The most common cause of intestinal failure in children is surgical short bowel syndrome resulting from a surgical resection, mucosal disease, or motility disorder. Children with intestinal failure require interdisciplinary care and may require life-long parenteral nutrition or multiple organ transplantation. The IRoC program was instituted and overseen by the Transplant Service and specifically the holder of the Moss chair in pediatrics, liver, and liver transplantation. All IRoC patients who are referred to out of state intestinal or multi-visceral transplant programs return to the IRoC program for local based post-transplantation care. Through the standardization of home health protocols, parental education, and central line care, and admission to specific areas of the hospitals with expertise in care of children with intestinal failure, patient outcomes have improved. The number of central line infections and the number of children developing liver dysfunction, common complications of long-term parenteral nutrition, have decreased. The IRoC program provides care for ~65 patients. The IRoC team consists of nurse coordinators, a nurse practitioner, a registered dietitian, and 2.5 physicians who have developed expertise in the management of these patients. The development of a registry will not only be used to monitor outcomes and guide clinical care but it will also allow participation in larger multicenter quality improvement and research studies.
Melissa Osborne
Nursing
Nurse Practitioners' Acceptability and Use of Firearm Screening, Counseling, and Lock Provision in Pediatric Primary Care Settings
Title: Nurse Practitioners’ Acceptability and Use of Firearm Screening, Counseling, and Lock Provision in Pediatric Primary Care Settings
Intramural Grant Award
Award Date: Spring 2021/one year
Abstract:
Firearms are the second leading cause of death among children and adolescents in the U.S. Particularly in the case of unintentional shootings and suicides, children and adolescents are most often killed with a firearm obtained in their home or the home of a close friend or relative. There are firearms in millions of households with children in the U.S., and an estimated onequarter of these are not stored safely, allowing easier access for children and adolescents and increasing risk of serious injury or death. Firearm safe storage can prevent firearm-related injury and mortality in the pediatric population, and research has found that firearm safe storage counseling in primary care is effective in improving safe storage behaviors among parents, especially when a firearm locked is provided. Nurse practitioners (NPs) regularly care for children and adolescents in the primary care setting and are poised to deliver such prevention messaging given their expertise in health promotion. However, research in this area has primarily been conducted with physicians, and little is known about the perspective of NPs regarding these practices on firearm safe storage. This research seeks to understand the acceptability of and use of firearm screening, safe storage counseling, and firearm lock provision among NPs who care for pediatric primary care patients, using a sample of NPs in Georgia. The findings will be used to develop an R03 grant (PA-18-481) with the NIH Eunice Kennedy Shriver National Institute of Child Health and Development. The goal of the R03 will be to conduct the study with a national sample and develop clinical guidance and tools that NPs can use when addressing firearm safety with parents and caregivers.
Gena Priest
Physical Therapy
Effects of a Single Bout Combined Whole-Body VIBRAtioN and Treadmill (Vibrant) Training on Gait and Spasticity in Ambulatory Children with Cerebral Palsy
Agency: Georgia Foundation for Physical Therapy
Title: Effects of a Single Bout Combined Whole-Body VIBRAtioN and Treadmill (Vibrant) Training on Gait and Spasticity in Ambulatory Children with Cerebral Palsy
Project Period: 05/01/2021 – 04/30/2023
Background: Whole-body vibration (WBV) and treadmill training (TT) are commonly utilized rehabilitation interventions for children with neuromotor disorders such as cerebral palsy (CP). TT has been shown in the literature to inconsistently improve gait in this population but has no modulatory effects on muscle tone. A significant reduction in spasticity has been reported with WBV, however this reduction only lasts between 10 minutes to 2 hours. We propose to test the hypothesis that a combination of TT followed by WBV can improve gait related movement patterns and have an enhanced modulation of tone in children presenting with spasticity affecting their walking.
Purpose: The aim of this study is to investigate the effects of the combination of a single bout of WBV and a single bout of TT on the lower extremity spasticity and gait parameters of ambulatory children with CP.
Design: This study is a randomized crossover design.
Methods: We will recruit 35 children between the ages of 6 and 17 with spastic CP. Subjects will complete 3 different intervention sessions: (1) a 10-minute bout of TT at their preferred overground (OG) walking speed, (2) a 12-minute bout of WBV at 20Hz, and (3) a 12-minute bout of WBV at 20Hz and 2mm followed by a 10-minute bout of TT at their preferred OG walking speed. OG gait characteristics, including spatiotemporal parameters, joint kinematics and electromyographic (EMG) parameters, as well as a measure of lower extremity spasticity, the Modified Tardieu Test, will be collected at each visit before, immediately after, and 15 minutes after each intervention.
Data Analysis: Gait characteristics will be calculated using custom MATLAB programs. Changes in OG gait parameters and spasticity following each intervention will be assessed using 2-way (time x intervention) repeated measures ANOVAs. Differences in treadmill gait parameters between the stand-alone bout and the bout following WBV will be assessed using dependent t-tests. A significance level of α = 0.05 will be used for all statistical analysis.
Significance: Studies investigating the acute effects of WBV have suggested that the period of transient effects immediately following vibration could be taken advantage of via participation in other therapeutic activities. To our knowledge, no studies exist that combine WBV with other common rehabilitation techniques, making this protocol the first to investigate the effect of a combined intervention. Further, this intervention paradigm can be easily incorporated into a traditional 60-minute therapy session. Our findings will allow for the making of more informed decisions regarding clinical rehabilitative protocols involving WBV and TT both in isolation and in tandem.
Veronica Rowe
Occupational Therapy
Addressing socioeconomic disparities in post-stroke disability through the development of an accessible, new tool
Claire Honeycutt PHD, Arizona State University, PD/PI
Pamela Bosch, Northern Arizona University, Co-Investigator
Veronica Rowe, Georgia State University, Co-Investigator
Agency: Arizona State University / National Institutes of Health
NICHD Exploratory/Developmental Research Grant (R21) – 1 R21 HD105180-01
Title: Addressing socioeconomic disparities in post-stroke disability through the development of an accessible, new tool
Project Period: 04/26/2021 – 03/31/2023
Abstract:
Individuals with low socioeconomic status (SES) are more likely to have a stroke, more disabled at 3 months, and less likely to be independently ambulatory. Individuals with low SES struggle to adhere to physician guidelines because of 1) increased disability leaves patients ineligible or unable to tolerate therapy, and 2) poor access to quality care i.e., lack of transportation to therapy. To reduce post-stroke disparity in low SES groups, we need to invest in development of novel tools that make therapy more accessible. For the past 5 years, the PI has been developing Startle Adjuvant Rehabilitation Therapy (START), a tele-enabled, low-cost treatment to improve upper-extremity therapy outcomes in individuals with stroke – in particular individuals with severe-to-moderate stroke. START is the application of a startling, acoustic stimulus (via headphones) which increases the intensity of practice, particularly in severe patient populations. START is adjuvant, meaning it does not replace clinical practice but instead enhances current evidence-based treatments.
Objective: we seek to determine if START can be used to enhance functionally relevant movement of the upper extremity.
Preliminary data: Individuals with severe-to-moderate disability from a stroke completed a remotely delivered, 3-day training of object manipulation with START. Box and Blocks, which was targeted during training, demonstrated a large increase under START (+47.1%) compared to Control (+3.3%). Modified functional reach was also increased under START (+8.9%) compared to Control (+1.1%). Impairment also decreased under START (Upper-Extremity-Fugl-Meyer: +8.6%) resulting in subject-reported increase in arm function both in quantity (Motor Activity Log: +26.2%) and quality (+20.2%). These results indicate that START can be deployed remotely and may prove a valuable, adjuvant tool to enhance functional upper extremity movement. We propose to perform a Phase 1 clinical trial on a larger cohort of 58 subjects, with a longer, 5-day training with the goal of establishing that START can 1) enhance functional movement of the upper extremity and 2) generate sustainable changes that impact quality of life.
Impact: This proposal is significant because it tests a tool that has the potential to directly target the causes leading to disparity of care for individuals with low SES. A third (34%) of 6.5 million people in the U.S. with stroke are on Medicaid or uninsured. Our best evidence based therapies (e.g., high-intensity, CIMT) and our emerging rehabilitation technologies (e.g., TMS, robotics) are inaccessible to our minority and low SES populations. START addresses disparity because it 1) targets individuals with severe disability, which disproportionally affects low SES and minority groups, and 2) is tele-enabled eliminating transportation which 60% of individuals with low SES report as a barrier to care. If successful, this study will set the stage for larger trials to establish 1) the effectiveness of START to be incorporated into traditional therapy and as well as patient compliance, adherence, and tolerance – particularly in low SES groups.
Dr. Veronica Rowe, co-investigator, will contribute to the study by facilitating telehealth delivery, establishing interrater reliability of outcome measures through training, monitoring performance, and adjudicating conflicts in outcome measures results. Dr. Rowe will assist with data collection, compiling, cleaning, and assuring quality of outcome measures as well as other RCT duties as needed.
TRANScranial direct current stimulation for Post-stroke motor Recover - a phase II sTudy (TRANSPORT 2)
Title: TRANScranial direct current stimulation for Post-stroke motor Recover – a phase II sTudy (TRANSPORT 2)
Project Period: 08/01/2020 – 07/31/2022
Agency/Program: Duke University
Award #: A033729
Transcranial Direct Current Stimulation Current For Post-stroke Motor Recovery – A Phase Ii
Study (TRANSPORT2)
Authors: Wuwei Feng, Duke Univ, Durham, NC; Gottfried Schlaug, Baystate Health, Boston, MA;
Caitlyn Meinzer, Medical Univ of South Carolina, Charleston, SC; Pratik Y Chhatbar, Duke Univ,
Durham, NC; Christy Cassarly, Catherine Dillon, Wenle Zhao, Medical Univ of South Carolina,
Charleston, SC; Kristina Balderson, Duke Univ, Durham, NC; Jamey S Frasure, Univ of Cincinnati,
Cincinnati, OH; Veronica T Rowe, Georgia State University, Atlanta, GA; Stacy L Fritz, Univ of South
Carolina, Columbia, SC; Steven L Wolf, Emory Univ, Atlanta, GA; Joseph P Broderick, Univ of Cincinnati, OH
Abstract:
Background: Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation tool that holds promise for stroke recovery and has been demonstrated to be safe and tolerable up to 4 mA in a recent Phase I trial in stroke population. Hypothesis: There is an initial overall treatment effect of tDCS in post-stroke motor recovery as measured by the Fugl-Meyer Upper Extremity (FM-UE) motor impairment scale. Design: Multi-center, double-blinded, randomized sham-controlled Phase 2 trial involving 129 subjects (43 per arm) to either modified Constraint Induced Movement Therapy (mCIMT) only (sham), mCIMT+2 mA tDCS, or mCIMT+4 mA tDCS. Eligibility: Participants aged 18-80 years with first ever unihemispheric ischemic stroke occurring within 30-180 days; pre-stroke modified Rankin Scale ≤2; stable motor impairment defined as: >10° of active wrist extension, >10° of thumb abduction/extension, and > 10° of extension in at least 2 additional digits; Unilateral limb weakness with a FM-UE motor score of ≤ 54 (out of 66); and an absolute difference of FM-UE motor scores between the two baseline assessments of ≤ 2 points. Intervention: Participants receive 10 sessions (5 days/week) of active mCIMT for 120 minutes where the first 30 minutes are combined with tDCS intervention (or sham where only 30 seconds of tDCS ramp was applied). Outcomes: Primary: FM-UE; Secondary: Wolf Motor Function Test (WMFT) time and Stroke Impact Scale (SIS) hand domain; Assessments occur at day 0, 15, 45 and 105. Analysis: Analysis of Variance and generalized linear models will be used to compare treatment groups at day 15 (primary) and over time (secondary). A Go, No-Go approach will be used to determine proceeding to Phase III trial, taking into account safety, tolerability, feasibility and efficacy. Clinical Trial NCT03826030.
Knowledge Translation of Remotely Delivered Task Oriented Training for Stroke Rehabilitation (reTOTE - Remote Task Oriented Training and Evaluation)
(reTOTE – Remote Task Oriented Training and Evaluation)
PI: Veronica Rowe
Project Period: 01/01/2022 – 12/31/2022
Agency: Augusta University
Knowledge translation is an essential step for successful clinical implementation of contemporary evidence-based approaches in any clinical practice and stroke rehabilitation is not an exception. This study of translational research addresses the problem of evidence not reaching consumers which is highly significant given the large number of strokes that happen not only in Georgia, but in the US. In addition, the current gap in knowledge translation of evidence into practice results in slowed and arduous recovery due to ineffective treatment protocol. Not only are enormous amount of dollars being spent in the research and recovery process, but also the magnitude of burden of care is extremely significant, especially during this time of social distancing due to COVID-19. Therefore, it is imperative that as science develops innovative interventions for stroke rehabilitation, such as Task-Oriented Training (TOT), research must also be done to identify the processes to translate the science into actual therapeutic practice, such as the use of telerehabilitation. Educating occupational and physical therapists about research evidence underlying TOT and facilitating the knowledge-to-action process through telerehabilitation can address barriers and hasten the implementation of research into clinical practice.
This pilot study will utilize a case series design to determine effectiveness and feasibility of an educational program delivered to occupational and physical therapists in Georgia who work in the clinical areas of stroke rehabilitation, and provide preliminary results on the effectiveness of reTOTE delivered to stroke survivor participants.Twelve therapists will participate in a Knowledge Translation (KT) program for evidence-based TOT. To translate knowledge and bridge the “know-do” gap, the co-PIs will provide in person instruction at Georgia State University and at Augusta University to occupational and physical therapists from various settings of stroke rehabilitation (acute care, inpatient rehabilitation, outpatient rehabilitation, and home health) on the evidence based components of TOT to be delivered via telerehabilitation to clients who have hemiparesis after stroke. The TOT educational program will include evidence based research from aspects of experience-dependent plasticity, Constraint Induced Movement Therapy (CIMT) from the ExCITE trial, the Acquired Skill Acquisition Protocol (ASAP) from the ICARE trial, the Occupational Performance in Occupational Therapy (CO-OP) model, and studies on Task Oriented Training and Evaluation at Home (TOTE Home). The knowledge-to-action process will be utilized to identify facilitators and overcome barriers to implementing TOT via tele-rehabilitation. Guidance from the “myself as the instructor” model will assist therapists with the implementation of knowledge gained. Emphasis will be placed on the safe delivery of TOT remotely via HIPPA compliant video conferencing over the internet.
Therapists will remotely deliver a TOT program via telerehabilitation (reTOTE) to improve upper extremity function, confidence in balance and to increase quality of life in participants following stroke. As an essential part of the Knowledge Translation process, each therapist will practice the delivery of TOT with one client remotely via HIPPA compliant video conferencing over the internet with remote consultation from Co-PIs. The reTOTE delivery will occur with therapist and stroke survivor communication for 1 hour, 2-3 times per week for 10 weeks and the stroke survivor practicing TOT activities independently, which is similar to methods in other studies on TOT. Preliminary data collection and analysis will be conducted to determine feasibility and effectiveness with pre-test, post-test, and follow-up assessments of both therapists who participated in the Knowledge Translation program and the stroke survivors who received the reTOTE program.
Understanding the mechanisms of action observation as a rehabilitation intervention for stroke
Title: Understanding the mechanisms of action observation as a rehabilitation intervention for stroke
Agency: University Research Services and Administration / Research Initiation Grant
Project Period: 07/01/2021 –12/31/2022
ABSTRACT
Someone in the United States has a stroke every 40 seconds. Almost 70% of people who have a stroke experience the loss of arm and hand movement which ultimately decreases daily function and contributes to poor quality of life. Thus, there is a great need for rehabilitation in the stroke population. One way to help a stroke survivor learn how to use their arm and hand again is to have them watch and replicate “normal” arm and hand movements. This type of intervention is called action observation (AO) and has emerged as a potentially powerful therapeutic tool to improve stroke rehabilitation for the weakened arm and hand. AO involves the patient’s visual observation of video recorded intact body movements with the intent to perform the same task with their weakened arm and hand. There is behavioral evidence in stroke survivors that movement skills usually gained through physical practice can also be acquired through observation of the skill alone. In preliminary research performed in Dr. Lewis Wheaton’s lab at Georgia Tech (collaborator and mentor), AO has been successfully implemented for persons with arm and hand amputations learning how to use their prostheses. AO training in patients with amputations revealed that their movement is improved when they focus their eye gaze on specific aspects of the movement in the video that may maximally benefit the patient. It is unknown if these eye gaze patterns may serve as the mechanism behind AO and differ among those with mild or moderate movement impairments due to stroke. In this study, we seek to identify if experience with AO in stroke survivors with varying levels of impairment has a similar emergence of eye gaze patterns found in people with amputations. We hypothesize that AO augments visuomotor strategies to help support improved movement and enhance rehabilitation strategies in stroke survivors with mild and moderate impairments. The goal of this work is to utilize eye gaze tracking approaches to understand this phenomenon. In addition, we will identify the feasibility of implementing and assessing AO on eye gaze in stroke survivors. The stroke research experience of Dr. Veronica Rowe will merge well with Dr. Wheaton’s lab to help directly inform larger future studies on the mechanisms and outcomes of AO therapy for the surviving stroke population.
Remote Delivery of a Standardized Stroke Rehabilitation Assessment
Title: Remote Delivery of a Standardized Stroke Rehabilitation Assessment
Project Period: 01/01/2021 – 10/31/2022
Agency/Program: The Lewis College Tenure-Track/Tenured Faculty Intramural Grant Award
Remote Delivery of a Standardized Stroke Rehabilitation Assessment
The demand for telerehabilitation has increased dramatically requiring a shift towards online therapy assessments and treatment. For stroke rehabilitation, the Fugl-Meyer Assessment (FMA) is one of the most well-known and frequently used standardized measures of arm and hand movement. Its use is highly recommended by multiple professional disciplines to monitor stroke recovery throughout the continuum of care. There are currently no published protocols available for the remote delivery of the FMA. The objective of the proposed research is to establish the feasibility, reliability, and validity for the remote delivery of the FMA (reFMA) to assess stroke survivor upper extremity function. An instructional protocol to deliver the reFMA has been created by the investigators and contains specific instructions including information needed for scheduling and setup of the remote assessment, instructions for the therapist with specific items modified for remote delivery, and instructions for the stroke survivor and their carepartner. Feasibility testing of the reFMA protocol will include 9 participants (3 triads of therapists, stroke survivors, and carepartners) who will administer and receive the FMA remotely using the instructional protocol and provide feedback and suggestions for refinement. The process will develop with an iterative design so that changes to improve the protocol will be made after each utilization of the reFMA. Pilot testing for reliability and validity of the delivery of reFMA will then occur with the FMA being administered to 12 stroke survivor participants remotely and in person. Validity will be measured to see how the remote delivery of the FMA compares to the in person delivery of the Fugl-Meyer. Reliability will be measured between the 2 therapists’ ratings of the remote delivery of the FMA. The ability to deliver the FMA remotely would be of current benefit during these times of social distancing, and in the future for those unable to access rehabilitation facilities. Pending feasibility outcomes will contribute to future, larger grants involving the establishment of similar protocols for other outcome measures.
Jon Sanford
Occupational Therapy
Technologies to Support Aging-in-Place for People with Long-term Disabilities
Agency: GA Tech/DHHS
Project Period: 01/01/2022 – 09/30/2023
Award Number: AWD-102707-G2
The Rehabilitation Engineering Research Center on Technologies to Support Aging-in-Place for People with Long-Term Disabilities(RERC TechSAge) is a $4.6 million, 5-year grant supported by the National Institute on Disability, Independent living, and Rehabilitation Research (NIDILRR), which is housed within the Administration for Community Living, Department of Health and Human Services. TechSAge, which is a partnership among GA Tech, University of Illinois Urbana Champaign and GA State, is one of 20 RERC’s funded by NIDILRR, all of which conduct a variety of research, development, and training projects focused on different rehabilitation issues. Now in the 4th year of it’s second 5-year cycle, the TechSAge is to support and empower people with chronic conditions and long-term vision, hearing, and mobility impairments to age-in-place through increasing knowledge about, availability of, and access to effective design and technologies that enable them to sustain independence; maintain health; engage safely in basic activities at home and in the community, and fully participate in society. Specific areas of focus include: identifying users’ needs for, and use of, assistive and smart technologies to overcome limitations in daily activities; understanding the effectiveness of technology-based interventions (e.g., voice-activated software applications and an evidence-based, home exercise program) to support independence, health and safety; development and deployment of new technologies to enhance the safety and support in performing daily activities in the home and community; and training of students in a range of professions to conduct advanced rehabilitation engineering research and develop new technologies to improve the health and participation individuals with long-term disabilities. You can learn more about TechSAge at www.TechSAge.gatech.edu.
Nida Izhar Shaikh
Nutrition
Evaluation of a Semi-Quantitative Food Frequency Questionnaire to Assess Nutrition Transition in Asian Indian Adults
Title: Evaluation of a Semi-Quantitative Food Frequency Questionnaire to Assess Nutrition Transition in Asian Indian Adults
Project Period: 03/01/2019 – 01/31/2022
Agency: Academy of Nutrition and Dietetics
Abstract:
Background: Nutrition transition, shifts in dietary patterns accompanying globalization and urbanization, are believed to be contributing to the emergence of chronic diseases such as obesity and diabetes among adults in low- and middle-income countries including India. Unfolding of the nutrition transition among adults can be measured from dietary changes, but there are no validated dietary assessment instruments. We have developed a semi-quantitative 71-item food frequency questionnaire, called the Nutrition Transition-Food Frequency Questionnaire (NT-FFQ) for adults as part of a larger ongoing ‘Drivers of Food Choice’ (DFC) study, which seeks to understand the drivers of food choices and food intake among Asian Indian adults in the context of nutrition transition. The NT-FFQ assesses usual monthly food intake.
Objective: To evaluate the reproducibility and validity of a semi-quantitative 71-item NT-FFQ to assess dietary changes accompanying nutrition transition in healthy Asian Indian adults, ages 20 and older.
Methods:
Evaluation of the NT-FFQ: The NT-FFQ will be evaluated for its a) reproducibility and b) validity using a team of trained interviewers. Reproducibility of the NT-FFQ will be tested by administering the NTFFQ twice within a three-month period (NT-FFQ1 at baseline and NT-FFQ2 at month 3) among 200 Asian Indian adults, ages ≥ 20 years in Vijayapura City, India. Participants will be recruited from a representative sample of 648 adults enrolled in the larger DFC study. To assess the validity of the NT-FFQ, a sub-sample of 120 adults with also complete three interviewer-administered 24-hour dietary recalls (24-DR) within the same three-month period. Validity of the NT-FFQ will be assessed by comparing the food intakes from the second administration of the NT-FFQ (NTFFQ2) with the average intakes from three 24-DR of 2 weekdays and 1 weekend day. All interviews will be conducted at the participant’s home.
Analysis of the NT-FFQ: Responses to the NT-FFQ and 24-hr DR will be analyzed using Statistical Analysis Software (SAS version 9.4), Nutritionist Pro, and a nutrient database developed from Asian Indian food composition tables in our previous work. Reproducibility and validity of the NTFFQ will be assessed using a food-based approach. Reproducibility of the NT-FFQ will be assessed by comparing the participants’ responses at baseline and 3 months later using correlation analyses and Intra-class Correlation Coefficients (ICC). Agreement between the two administrations of the NTFFQ will be further examined by the Bland-Altman analysis. Paired t-tests, ICC and correlation analyses will be used to assess the NT-FFQ validity for agreement between the NT-FFQ and mean of the three 24-DR for calculated food and nutrient intakes.
Significance: The NT-FFQ for adults would be the first tailored dietary assessment instrument to measure nutrition transition among Asian Indian adults that can be used in research and practice by researchers and dietitians.
Development of culturally-tailored mHealth messages for Diabetes Prevention Program in new immigrants in the U.S.: a pilot study
Title: Development of culturally-tailored mHealth messages for Diabetes Prevention Program in new immigrants in the U.S.: a pilot study
Agency: Lewis College Intramural Award
Project Period: Fall 2021
Type 2 Diabetes (diabetes) is of the leading risk factor for disability and death worldwide, and disproportionately affects the United States (U.S.) population. Prediabetes, known as the precursor to diabetes, continues to grow to epidemic levels. In the U.S. alone, 84.1 million have prediabetes and 30.3 million have diabetes. Recent immigrants who have arrived in the U.S. in the last ten years comprise a growing sector of the American population. Compared to US-born Americans, recently arrived immigrants in the U.S., with prediabetes are less likely to adhere to the Diabetes Prevention Program (DPP) recommendations because of their lack of knowledge about diabetes risk factors, low health literacy, ineffective communication with health providers due to language barriers, and non-compliance to lifestyle modifications pertaining to improving diet and physical activity and body weight control; all of which are compounded by the lack of culturally-sensitive diabetes prevention programs and access to care. Without targeted diabetes prevention interventions, diabetes singularly or in conjunction with other cardiovascular risk factors is likely to widen health disparities between immigrants and US-born peers. Hence, there is a need to develop culturally centered and tailored diabetes prevention messages explicitly aimed at diabetes prevention among at-risk recent immigrants with prediabetes in the US. Mobile health (mhealth) technologies offer a targeted mechanism for delivering disease prevention messages in real-time to prevent diabetes; SMS messages delivered using a mobile device could be an effective, innovative, and cost-effective medium for delivering a behavioral intervention to improve cardiometabolic health in immigrant populations with prediabetes. mHealth DPP exist, but have not been developed for new immigrants. We propose a pilot study to understand new immigrants’ lived experiences with prediabetes and perceptions towards diabetes. We then aim to create an archive of culturally-tailored diabetes prevention messages to prevent diabetes in recent immigrants, ages 20 and older, with prediabetes in the US. A convenience sample of 25 recent immigrants from Nigeria, Ghana, and India with prediabetes will be recruited from health clinics across Atlanta, Georgia, and will complete an in-depth qualitative interview in English. Data will be analyzed using thematic analysis. The results from this pilot study will be used to create an archive of culturally-tailored diabetes prevention messages; those messages will be used along with the PEN-3 cultural framework to write a R34 grant to the NIDDK to adopt, promote and deliver a mHealth DPP for recent immigrants in the US.
Liang-Ching Tsai
Physical Therapy
Regenerative Rehabilitative Principles in Modulating Weight Bearing and Joint Kinematics to Delay Post-Traumatic Knee Osteoarthritis
Title: Regenerative Rehabilitative Principles in Modulating Weight Bearing and Joint Kinematics to Delay Post-Traumatic Knee Osteoarthritis
Project Period: 04/01/2022 – End Date 01/31/2027
Award Number: 1R01AR080154-01
Agency: NATIONAL INSTITUTE OF ARTHRITIS AND MUSCULOSKELETAL AND SKIN DISEASES
Knee injuries, e.g., meniscus tears, increase the risk of developing post-traumatic osteoarthritis (PTOA) by at least 10 fold. PTOA leads to disability with a substantial healthcare cost of $3 billion per year in the US. Although rehabilitation is required after injury, current protocols only address the return to pre-injury activities. Critical knowledge gaps exist regarding how to optimize early rehabilitation efforts to preserve long-term knee cartilage health. Using a well-established rat PTOA model, we propose to characterize responses of knee cartilage to the manipulation of three elements commonly implemented during post-injury rehabilitation: 1) durations of initial non-weight bearing, 2) modifications of physical activity level, and 3) deviations in lower-limb joint kinematics. The use of a pre-clinical rat model provides the experimental control over disease timeline to facilitate a mechanistic study to understand PTOA. Our overall hypothesis is that post-injury interventions that emphasize maintaining pre-injury knee loading profile (e.g. minimizing weight-bearing restriction, regaining physical activity level, or reducing deviations in joint kinematics) will delay PTOA. We will systematically test this hypothesis using innovative experimental approaches and technologies to address the knowledge gaps in the PTOA rehabilitation literature as described in the following Aims. (Aim 1) Non-weight bearing durations in rats after the medial meniscal transection (MMT) surgery performed on the left hind limb will be varied using hind-limb suspension. The comparisons of cartilage health among varying exposures of suspension determines the causal effect of initial non-weight bearing on PTOA progression. The use of hind-limb suspension instead of limb immobilization reduces harmful consequences of joint contracture and is more in line with current practice of prescribing initial non-weight bearing after knee injuries. (Aim 2) Post-injury physical activity levels will be modified by varying the amount of daily treadmill running. Rats’ pre-injury activity levels will first be established to allow standardized quantification of post-injury activity modification (% of pre-MMT). The causal effect of post-injury activity level on PTOA progression can then be determined. (Aim 3) 3D hind-limb joint kinematics will be assessed using biplanar X-ray motion analysis at multiple time points before and after MMT to determine whether early post-injury joint kinematic deviations are predictive of the ultimate severity of PTOA. Using X-ray videos to directly quantify 3D bone movements can overcome the significant errors associated with the use of skin markers. For all three Aims, we will incorporate our contrast enhanced microCT analysis with conventional histopathology to provide complementary evaluations of the 3D microstructure/compositions of knee cartilage. Findings from this innovative work will provide insight into the potential causal effects of post-injury rehabilitative modifications in limb weight bearing and joint kinematics on PTOA progression. Such new knowledge is fundamental to advancing our understanding of the pathogenesis of PTOA and developing translational research to reduce PTOA by optimizing post-injury rehabilitation.
Gordon Warren
Physical Therapy
DoD Restoring Warfighters with Neuromusculoskeletal Injuries Research Award (RESTORE)
Title: DoD Restoring Warfighters with Neuromusculoskeletal Injuries Research Award (RESTORE)
Agency: Regents of the University of Minnesota
Award number: A008371002
Project Period: 09/15/2021 – 09/14/2024
Interaction of Estrogen, Age and Activity on Musculoskeletal Strength in Females
Interaction of Estrogen, Age and Activity on Musculoskeletal Strength in Females
Project Period: 05/01/2019 – 01/31/2024
Award # RA462-G1
The loss of skeletal muscle function occurs with age but the reason why there are differences in the rate and magnitude of loss between females and males is not clear. Losses in women are likely related to changes in ovarian hormones in addition to aging but mechanistic effects of these hormones on skeletal muscle have not been elucidated. The overall goal of the studies outlined in this proposal is to determine hormone-mediated.
Mechanisms that contribute to muscle strength loss in aged females. Estradiol is the crucial ovarian hormone that affects the function of the key contractile protein, myosin, which in turn affects muscle strength in young adult female mice but estradiol’s effects on muscle in aged female mice are unknown. Thus, the first aim of this proposal is to determine the extent to which estradiol treatment improves myosin function and muscle strength in ovarian-failed, aged mice. Estradiol treatment will be evaluated in various models of estradiol deficiency so that any age-related differential effects of estradiol on myosin and muscle functions will be revealed. Extensive functional analyses will include voluntary muscle performance, maximal in vivo lower-leg muscle strength, contractile capacity of isolated muscles, and molecular structure-function analyses of myosin. The second aim of this proposal is to determine if estradiol is beneficial to myosin and muscle strength independent of the physical activity level. The direct effects of estradiol on skeletal muscle are imperative to determine because the loss of and treatment with estradiol occurs systemically and as such, non-muscle tissue is affected and could influence muscle through indirect mechanisms. For example, physical activity of rodents is influenced by estradiol status and could indirectly impact muscle strength. The third aim of this proposal is to test the hypothesis that the beneficial effects of estradiol on myosin and muscle function are mediated by nuclear estrogen receptors, which regulate oxidative stress-related genes.
To accomplish this, estrogen receptors will be blocked and it is predicted that this pharmacological intervention will negate all of estradiol’s beneficial effects on myosin and muscle. Next, a panel of genes that are related to oxidative stress and antioxidant defense systems in estradiol-deficient and estradiol-replete mice will be probed. The rationale behind this is that myosin is susceptible to oxidation and that several oxidative stress-related genes are modulated by estradiol in non-muscle tissues. At the conclusion of these studies we will know the extent to which age-related estradiol deficiency causes a decline in muscle strength due to decrements in myosin function and whether estradiol treatment reverses these declines through genomic mechanisms. The long-term objective of our research is to elucidate the overall mechanisms underlying age- and hormone-related skeletal muscle functional losses and to utilize this knowledge to devise optimal strategies for preventing, reversing, or at least slowing the progression of weakness that occurs with age. Skeletal muscle weakness is a significant health concern because it directly contributes to a decreased quality of life, particularly for older women.
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cnhp@gsu.edu
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Byrdine F. Lewis College of Nursing and Health Professions
P.O. Box 3995
Atlanta, GA 30302-3995