Researcher
Externally Funded
Internally Funded
Dawn Aycock
Nursing
Alter
Title: Alter
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
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 – 12/31/2021
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 J. Brandenberger
Respiratory Therapy
Detecting weakness in former ICU patients using a muscle fatigue test
Title: Detecting weakness in former ICU patients using a muscle fatigue test
Agency/Program: The Lewis College Tenure-Track/Tenured Faculty
Intramural Grant Award
Award Date: Fall 2019/one year
Abstract:
Our goal is to develop a test to identify unresponsive patients in the intensive care unit
(ICU) with extreme muscle weakness. As many as 80% of patients surviving critical care experience persistent muscle weakness impairing their daily lives. There are currently two methods for diagnosing ICU acquired weakness (ICUAW). Comprehensive nerve conduction studies with electromyography (EMG) are sometimes used, but testing for muscle weakness requires the patient to be responsive. The other method is manually measuring strength, which also requires the patient to be responsive. With as many 75% of critical care patients on mechanical ventilation being unresponsive the current tests limit diagnosis of this condition in the population most at risk. We propose using a muscle fatigue test to directly assess muscle function without the need for subject responsiveness. We use a device to create muscle twitches using low-current electrical pulses. The pulses are delivered at 2, 4, and 6 Hz for 3 min each, for a total of 9 min of testing. A small accelerometer is also attached to the muscle between the electrodes using double sided tape to record twitch accelerations. We then use a python program to calculate the total acceleration for each muscle twitch. We will use the pattern of these muscle twitches for each individual in a cluster analysis to identify separate patterns of fatigue. We will then use a logistic regression to develop diagnostic criteria for ICUAW. The goals of this project are to determine which patterns of fatigue are needed to diagnose ICUAW, and to develop a logistic regression for diagnosing future cases of ICUAW.
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/one year
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.
Patricia Clark
Nursing
Carepartner Collaborative Integrated Therapy in Sub-acute Stroke
Title: Carepartner Collaborative Integrated Therapy in Sub-acute Stroke
Project Period: 04/03/2019 thru 03/31/2020
Agency: Emory University and National Institutes of Health
Award Number: A149458
Abstract
Stroke affects approximately 795,000 individuals in the United States each year and is a leading cause of long-term disability. Family members are key component in stroke recovery; however, carepartners (family members) frequently experience high levels of burden, including increased anxiety, depression and social isolation. To date, research has placed little emphasis on how to integrate the family into the rehabilitation process without increasing negative carepartner outcomes. We have developed and implemented a novel, web-based carepartner focused intervention (CARE-CITE) designed to foster problem solving and skill building while facilitating carepartner engagement during upper extremity functional activities in the home setting. The proposed research will evaluate the application of the CARE-CITE intervention paired with usual and customary care during the sub-acute stroke.
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 – 03/31/2022
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.
Promoting Healthy Families of NICU Infants: An Adaptation of the SafeCare Parenting Program
Title: Promoting Healthy Families of NICU Infants: An Adaptation of the SafeCare Parenting Program
Budget Period: 07/01/2020 – 06/30/2021
Agency: University Research Services and Administration
Abstract: Promoting healthy families of NICU infants: An adaptation of the SafeCare parenting program
Infants in the Neonatal Intensive Care Unit (NICU) face multiple hardships during their NICU stay and post-discharge. Specifically, premature infants discharged from the NICU have a higher likelihood of experiencing child abuse and neglect compared to other infants. The majority of interventions aimed at promoting child health well-being among NICU infants are primarily focused on the infant rather than addressing healthy parenting behaviors. The current proposal seeks to adapt and pilot test a well-established, evidence-based home visiting parenting program (SafeCare) for caregivers in the NICU setting. To date, SafeCare has been implemented in child protection and public health settings with at-risk parents, but this will be the first test of this program within a hospital setting with caregivers of infants in the NICU. This project will consist of three phases: 1) Completing qualitative interviews to assess unique parental perceptions, stressors, and concerns of NICU caregiver to determine what would be beneficial in a targeted parenting program for the NICU setting, 2) dynamic adaptation of the SafeCare modules to meet the needs of NICU caregivers, and 3) pilot testing of the adapted SafeCare program among a small sample (n=10) of caregivers and infants currently in the NICU. The overall purpose of this project is to assess the feasibility, acceptability, and sustainability of a modified SafeCare program in the NICU setting (SC-NU). The project team interdisciplinary, with faculty experts in Respiratory Therapy, Nursing, and Public Health who have extensive experience in violence prevention and maternal-child health. This project will result in the critical pilot data needed to pursue a federal grant to conduct a randomized trial examining the efficacy of SC-NU and a strong foundation for securing an interdisciplinary team who can conduct imperative and innovative future projects in the NICU setting.
Association Between Safety Perceptions and Medical Error Reporting Among Nurses and Respiratory Therapists in the Neonatal Intensive Care Unit
Title: Association Between Safety Perceptions and Medical Error Reporting Among Nurses and Respiratory Therapists in the Neonatal Intensive Care Unit
Agency/Program: The Lewis College Tenure-Track/Tenured Faculty
Intramural Grant Award
Award Date: Fall 2019/one year
Abstract:
Medical errors are the third leading cause of death in the United States. Neonates and sick infants are particularly susceptible to even the slightest deviation from normal practices because of their small size, vulnerability, and complexity of care. Previous research has found strong associations between cultures of patient safety and reduction in medical errors. However, few studies have examined these associations in the context of medical error reporting, specifically in the NICU. This project aims to identify the association between perceptions of safety and culture among NICU staff (nurses and respiratory therapists) with medical error reporting behaviors. This proposal seeks to sample a total of 80 NICU staff across 9 hospitals in the Piedmont Hospital network using Qualtrics survey software. This project will yield preliminary data that will be used to inform the development of a web-based module for NICU Staff to improve reporting of medical errors for application to the NIH grant (R03), “Patient Safety in the Context of Perinatal, Neonatal, and Pediatric Care” (PAR-17-791). Subsequently, the combination of pilot data and results from the R03 (if funded) will be used in the development of a larger clinical trial for testing the intervention (R01: PA-18-790).
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 05/30/2022
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.
Restoration of Reaching and Grasping Function in Individuals with Spinal Cord Injury Using MyndMove® Neuromodulation Therapy
Title: Restoration of Reaching and Grasping Function in Individuals with Spinal Cord Injury Using MyndMove® Neuromodulation Therapy
Agency: MyndTec Inc.
Project Period: 08/01/2018 – 12/31/2021
Abstract
Introduction: A two-arm, parallel group, multicentre, single-blind, randomized controlled trial comparing electrical neuromodulation delivered by MyndMove® therapy to intensive upper-limb conventional therapy in the treatment of patients with moderate to severe motor impairment to their arms and hands from an incomplete, sub-acute, traumatic spinal cord injury.
Purpose: To compare two different treatment interventions of MyndMove® therapy and Intensive Conventional therapy and compare the effectiveness of these interventions on improving the ability of individuals to move their arms and hands
Method: Individuals enrolled had traumatic incomplete C4 – C7 spinal cord injury with the injury occurring at least 4 months and less than 1 year (365 days). Individuals will be randomized into an intervention group. Treatment frequency for both groups are the same of 40 sessions of 1 hour during a period of 8-14 weeks. Over the 40 one-hour sessions, individuals will go through various movement sequences aimed at regaining natural, unassisted voluntary movement in the affected limb.
Assessments: The primary assessment is the Spinal Cord Independence Measure self-care sub score (SCIM-SC) Th Secondary assessments are Graded Refined Assessment of Strength Sensibility and Prehension (GRASSP), Toronto Rehab Institute Hand Function Test (TRI-HFT), Spinal Cord Injury-Quality of Life (SCI-QOL) and Healthcare Resource Utilization questionnaire.
Primary outcome: To compare the efficacy of MyndMove® therapy vs intensive conventional therapy in improving upper extremity function as measured by Spinal Cord Independence Measure self-care sub score (SCIM-SC)
Xiangming Ji
Nutrition
Metabolic Reprogramming in Patients with COPD
Project Period: 07/01/2017 – 06/30/2021
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
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 – 09/29/2021
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.
Susan Lee
Occupational Therapy
Bedside commode as a safe self-toilet transfer device for aging adults: user testing to demonstrate usability and feasibility
Title The PPAL: The Bedside Commode as a Safe Self-Toilet Tran
Project Period: 09/11/2020 – 08/31/2021
Sponsor Award Number: AWD-001961-S1
The PPAL® SUMMARY Bedside commode chairs are prescribed for older adults with mobility disabilities who are unable to access a bathroom, or to avoid the risk of falling either on their way to a bathroom or in a bathroom. Yet, bedside commode chairs, as currently designed, present their own risk for falls. The “PPAL®” takes 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® enables adults aging with lower extremity weakness to safely self-toilet, thereby lowering their risk of falling and reducing caregiver burden. To ensure the success of all three phases of this SBIR, the project will be a collaborative effort between the applicant, QUA Inc., which holds the PPAL® patent, and Georgia Tech’s Center for Inclusive Design and Innovation, which has extensive experience in design and testing of assistive technologies to facilitate toilet transfers by older adults. 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. Phase 2 will maximize the static and dynamic load of the PPAL® up to 350 pounds, test for use in wheelchair-commode transfers, refine the motorized elevating feature, fabricate the beta prototype, conduct rapid cycle testing to demonstrate efficacy of the prototype, and identify a commercialization partner. Phase 3 will commercialize the product. Specific aims of this Phase 1 SBIR project are: 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 effectiveness testing in Phase 2.
Blake McGee
Nursing
Medicaid Coverage Expansion and 30-day Readmission after Acute Ischemic Stroke
Title: Medicaid Coverage Expansion and 30-day Readmission after Acute Ischemic Stroke
Agency: American Nurses Foundation Anne Zimmerman Research Endowment Fund
Project Period: 09/01/2019 – 08/31/2020
Abstract
Readmission to the hospital within 30 days of discharge after a stroke is a common and expensive problem. People with health insurance are more likely to survive stroke and receive rehabilitation afterward, and insurance promotes access to the follow-up care that prevents readmission. States that chose not to expand Medicaid under the Affordable Care Act still have many uninsured residents. Younger adults are the most likely to lack health insurance, and their share of new strokes is rising compared to older people. This study will evaluate whether adults under age 65 who live in states that expanded Medicaid are less likely to get readmitted to the hospital after a stroke than in states that did not expand Medicaid, using data from the federal government’s Healthcare Cost and Utilization Project. It will also compare the causes and cost of readmissions between expansion and non-expansion states
The Impact of State Decisions about the Affordable Care Act’s Medicaid Expansion on Acute Ischemic Stroke Severity, Outcomes, and Rehabilitation Use
Title: The Impact of State Decisions about the Affordable Care Act’s Medicaid Expansion on Acute Ischemic Stroke Severity, Outcomes, and Rehabilitation Use
Agency: American Heart Association / American Stroke Association
Project Period: 10/01/2019 – 09/30/2020
Abstract
The Affordable Care Act committed federal funds to support expansion of Medicaid eligibility to all non-elderly adults earning below 138% of the federal poverty level, but a 2012 U.S. Supreme Court decision effectively allowed states to opt out of expansion. As of December 2018, 19 states had not expanded Medicaid, resulting in a coverage gap. Yet, health insurance coverage is associated with improved access to preventive medications, emergency services, and inpatient rehabilitation for acute ischemic stroke, as well as decreased risk of stroke-related death. Many of the states with an ongoing coverage gap related to non-expansion of Medicaid are located in the “Stroke Belt” and have large minority populations. As the proportion of strokes before age 65 rises, especially for African Americans, it is important to understand the consequences of state policy decisions about insurance coverage on stroke outcomes and disparities in this population. The purpose of this study is to understand differences by state Medicaid expansion status in terms of medication use for risk factor control prior to stroke; use of ambulance to reach the hospital; time from symptom onset to arrival; NIH Stroke Scale score and ability to ambulate on arrival; in-hospital mortality; length of hospital stay; assessment for or receipt of stroke rehabilitation services; modified Rankin score at discharge; and use and type of institutional rehabilitation facility at discharge. It is hypothesized that expansion of Medicaid coverage to all low-income, non-elderly adults is associated with improved access to preventive medications, reduced stroke severity, and expanded use of institutional rehabilitation.
Huanbiao Mo
Nutrition
The Mevalonate-Supressive Activity of Specialty Plant Oils
Seabuckthorn oil, peony seed oil, wolfberry oil, nitraria oil and safflower oil are among the specialty oils derived from plants indigenous to Qinghai Providence, China. These oils have been widely used in traditional Chinese medicine for their antioxidant, immune enhancing, anti-cancer, and anti-diabetic properties among other biological activities. However, the molecular and biochemical mechanisms of action for these oils are unclear. We will investigate the biological activities of these plant oils, particularly their impact on the mevalonate pathway and downstream effect in tumor cells and adipocytes. The potential growth-suppressive activity will be evaluated in human prostate and melanoma cells. The effect of these plant oils on adipocyte differentiation will also be examined. Upon positive phenotypical responses, qRT-PCR and Western-blot will determine the effect of these plant oils on the enzymes in the mevalonate pathway, particularly 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase; HMG CoA reductase provides essential prenyl intermediates for cell proliferation and cell cycle progression in tumor cells and signaling pathways supporting adipocyte differentiation.
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.
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.
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 – 07/31/2021
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.
Remote Delivery of a Standardized Stroke Rehabilitation Assessment
Title: Remote Delivery of a Standardized Stroke Rehabilitation Assessment
Project Period: 01/01/2021 – 12/31/2021
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.
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 – 08/29/2021
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.
Food Choice in Indian Households in the Context of the Nutrition Transition
Title: Food Choice in Indian Households in the Context of the Nutrition Transition
Project Period: 01/01/2019 – 12/31/2019
Agency: Emory University /University of South Carolina / Bill & Melinda Gates Foundation
Award Number: A113032
Abstract:
The goal of this project is to quantify aspects of women’s and men’s food choices relevant for addressing the dual burden of malnutrition in India through data collection and analysis based in Vijayapura, a remote district in Southern India that globalization is just reaching. The objectives are to: 1) Quantify the importance of factors including price, satiety, taste, reputation, and subsidies as proximate drivers of food choice in the context of globalizing food markets; 2) Identify the conditions under which women and men select global vs. traditional foods and how variations in these conditions can alter selections; 3) Assess the role of the public distribution system (PDS) as a driver of food choices and its implications for intake and for advancing nutrition transition. In a representative sample of 324 urban and rural households, we will conduct interviews with women, men, and youths. Data instruments will include methods to elicit drivers of food choice in different scenarios and a food frequency questionnaire to measure intake and nutrition transition. We will use quantitative and qualitative methods to explore gender differences and communication relating to food choices and food intake.
Regena Spratling
Nursing
Web-based Modules to Support Young Children Who Require Medical Technology and Their Caregivers
Title: Web-based Modules to Support Young Children Who Require Medical Technology and Their Caregivers
Project Period: 07/17/2018 – 06/30/2021
Agency: National Institute of Nursing Research
Abstract:
Children who require medical technology have multiple chronic conditions, and are part of the estimated total of 11 million children (15%) with special health care needs in the United States. This medical technology (e.g. tracheostomy and feeding tubes) enables children to live at home; however, the selfmanagement of child’s care by informal caregivers (e.g. parents, foster/adoptive parents, grandparents) is intensive and specialized. Our preliminary research found that 37% of ED visits and hospitalizations for children requiring technology at home to be preventable, and are costly and disruptive to the children and families. Our work and others also found, caregivers (parents) of children with multiple chronic conditions doubt their beliefs in their ability to manage their child’s care, and experience anxiety and depressive symptoms. These caregivers often are low socioeconomic status, and thus health literacy is a concern to be addressed with interventions designed to help them manage their child’s care.
The purposes of this study are to develop theory-based, health-literate, web-based modules for ‘Creating Opportunities for Personal Empowerment: Symptom and Technology Management Resources’ (COPESTAR) intervention and conduct feasibility testing of COPE-STAR with informal caregivers of children ages 1 to 5 years who require medical technology at home. Aim 1 will be content development of the web-based COPE-STAR intervention modules at appropriate health literacy levels and obtaining fidelity and usability through review by expert review and caregivers using a systematic, structured process and form. Six caregiver reviewers will review modules in the proposed study. Aim 2 will be feasibility testing of a quasi-experimental one group design with measurements at baseline and at 4 weeks postintervention in a sample of 30 caregivers (parent) of children ages 1 to 5 years who require medical technology. Caregiver acceptance and caregiver outcomes will also be examined for the web-based COPE-STAR intervention developed in Specific Aim 1. Data on recruitment results, attrition rates, usability, and caregiver satisfaction with the COPE-STAR intervention will be examined; initial data of the effectiveness of COPE-STAR in helping caregivers improve management of their child’s chronic condition, will include standard measures of family management of a child’s chronic conditions, caregivers’ beliefs about caring for their child who requires medical technology, and caregiver anxiety and depressive symptoms. Findings will provide a foundation for future development of a randomized controlled trial to test the efficacy of COPE-STAR to improve caregivers’ management of symptoms and technology at home for children who require medical technology and determine if COPE-STAR reduces avoidable ED visits and hospitalizations.
Liang-Ching Tsai
Physical Therapy
Quadriceps Muscle Function and Knee Loading Following Quadriceps Tendon Autograft Anterior Cruciate Ligament Reconstruction: Comparison to the Gold Standard Patella
Title: Quadriceps Muscle Function and Knee Loading Following Quadriceps Tendon Autograft Anterior Cruciate Ligament Reconstruction: Comparison to the Gold Standard Patella
Project Period: 05/01/2018 – 04/30/2021
Agency: Physical Therapy Associates of GA
Abstract:
The graft choice for anterior cruciate ligament reconstruction (ACLR) surgery remains controversial. The gold standard bone-patella-tendon-bone (BPTB) autografts results in anterior knee pain, prominent quadriceps functional deficits, and elevated rate of knee osteoarthritis (OA). We propose to examine the outcome of a new surgical technique that uses the quadriceps tendon as an autologous graft option. While the quadriceps tendon has superior anatomical and material properties when compared to the patella tendon and thus may reduce quadriceps impairment and abnormal knee loading associated with early knee OA, limited evidence is currently available to justify selecting the quadriceps tendon as the optimal graft choice. Using advanced biomechanical analyses and magnetic resonance imaging (MRI), we aim to conduct a longitudinal assessment comparing quadriceps muscle performance and knee loading between patients with quadriceps tendon autografts and patients with BPTB autografts. We hypothesize that patients with quadriceps tendon autografts will demonstrate greater quadriceps strength, larger muscle sizes, and more symmetrical knee loading than patients with the BPTB autografts. We will thoroughly test these hypotheses by examining 10 ACLR patients with BPTB autografts and 10 patients with the quadriceps tendon autografts at 6 and 12 months post-ACLR. Clinicians and researchers in Georgia are positioned to be at the forefront of this exciting line of research as many surgeons in Georgia have been performing ACLR with the quadriceps tendon grafts. Findings from this innovative work will determine if the quadriceps tendon autografts have advantages over other grafts on restoring quadriceps deficits and altered knee loading (i.e., the two most significant unresolved issues post-ACLR) to justify advocating for the quadriceps tendon as the new gold standard graft choice. Our longitudinal assessment of objective patient outcomes will also provide directions and insight for much-needed evidence-based rehabilitative interventions aimed to enhance the care for this new and rapidly growing patient population.
Influence of limb weight bearing and joint kinematics on progression of tissue degeneration in post-traumatic knee osteoarthritis
Title: Influence of limb weight bearing and joint kinematics on progression of tissue degeneration in post-traumatic knee osteoarthritis
Agency/Program: Lewis College 2019 Resubmission Award
Award Date: Fall 2019/one year
Abstract:
Post-traumatic osteoarthritis (PTOA) progression following knee injuries remains problematic in spite of extensive and prolonged post-injury rehabilitative remediation. This proposal aims to determine the responses of knee cartilage to three most commonly modifiable rehabilitative elements that alter the knee loading
environment following knee injuries using a well-established preclinical rat PTOA model: 1) duration of initial non-weight bearing; 2) level of physical activity; and 3) lower-limb joint kinematics. This innovative work will provide foundational groundwork to better understand the pathogenesis of PTOA and to determine the optimal rehabilitative principles aimed to mitigate PTOA after traumatic joint injuries.
Desiree Wanders
Nutrition
Metabolic Benefits of Dietary Methionine Restriction
Title: Metabolic Benefits of Dietary Methionine Restriction
Agency/Program: University Research Services and Administration/Research Initiation (Mentored) Grant Award
Project Period: 07/01/2019 – 06/30/2020
Abstract:
Given the rising global obesity epidemic, the development of novel nutritional and pharmacological approaches to reduce adiposity and the deleterious consequences of obesity has become a major focus of research initiatives. Dietary restriction of the essential amino acid, methionine, to 20% of normal intake has been shown in animal models to extend lifespan, reduce body weight and adiposity, improve the lipid profile, and increase insulin sensitivity, making methionine restriction (MR) an exciting possibility for the treatment or prevention of obesity and diabetes.
The beneficial effects of MR occur despite an increase in energy intake, due to a compensatory increase in energy expenditure. We have demonstrated that MR induces a browning of the inguinal white adipose tissue (IWAT), tripling the percentage of brown-like cells within the IWAT depot. This is significant because unlike conventional white adipocytes which store energy in the form of triglycerides, brown-like adipocytes dissipate energy in the form of heat. MR also induces an 8-fold increase in in vivo glucose uptake in this tissue. The browning of WAT, coupled with increased energy expenditure and nighttime core body temperature, indicate an MR-induced increase in sympathetic nervous system (SNS) activity. Additionally, we and others have shown that MR rapidly and persistently increases circulating and tissue concentrations of fibroblast growth factor 21 (FGF21). FGF21 has only recently emerged as an intriguing therapeutic target in the treatment of obesity and diabetes. Recent studies have demonstrated that FGF21 increases energy expenditure, reduces body weight, induces browning of WAT, increases glucose uptake into adipocytes, and improves insulin sensitivity. Thus, the overarching goals of the proposed research are to determine whether MR activates SNS output to adipose tissue and to determine the mechanism by which MR increases circulating and tissue concentrations of FGF21.
Together, these studies will provide insight into the mechanisms producing the benefits of the MR diet, thus advancing the translational potential of this dietary regimen. This is an area of great need, as more than one-third of U.S. adults are obese, and obesity-related conditions including type 2 diabetes are among the leading causes of preventable death.
Gordon Warren
Physical Therapy
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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