Health and Human Sciences Theses and Dissertations

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https://hdl.handle.net/1805/1639

This collection contains theses and dissertations for the Therapeutic Outcomes Research Program and the Department of Nutrition & Dietetics.

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ACTUAL AND PRESCRIBED ENERGY AND PROTEIN INTAKES FOR VERY LOW BIRTH WEIGHT INFANTS: AN OBSERVATIONAL STUDY
(2012-10-11) Abel, Deborah Marie; Rickard, Karyl A.; Brady, Mary Sue; Engle, William A.; Ingram, David A.; Poindexter, Brenda B.
Objectives: To determine (1) whether prescribed and delivered energy and protein intakes during the first two weeks of life met Ziegler’s estimated requirements for Very Low Birth Weight (VLBW) infants, (2) if actual energy during the first week of life correlated with time to regain birth weight and reach full enteral nutrition (EN) defined as 100 kcal/kg/day, (3) if growth velocity from time to reach full EN to 36 weeks’ postmenstrual age (PMA) met Ziegler’s estimated fetal growth velocity (16 g/kg/day), and (4) growth outcomes at 36 weeks’ PMA. Study design: Observational study of feeding, early nutrition and early growth of 40 VLBW infants ≤ 30 weeks GA at birth in three newborn intensive care units NICUs. Results: During the first week of life, the percentages of prescribed and delivered energy (69% [65 kcal/kg/day]) and protein (89% [3.1 g/kg/day]) were significantly less than theoretical estimated requirements. Delivered intakes were 15% less than prescribed because of numerous interruptions in delivery and medical complications. During the second week, the delivered intakes of energy (90% [86 kcal/kg/day]) and protein (102% [3.5 g/kg/day]) improved although the differences between prescribed and delivered were consistently 15%. Energy but not protein intake during the first week was significantly related to time to reach full EN. Neither energy nor protein intake significantly correlated with days to return to birth weight. The average growth velocity from the age that full EN was attained to 36 weeks’ PMA (15 g/kg/day) was significantly less than the theoretical estimated fetal growth velocity (16 g/kg/day) (p<0.03). A difference of 1 g/kg/day represents a total deficit of 42 - 54 grams over the course of a month. At 36 weeks’ PMA, 53% of the VLBW infants had extrauterine growth restriction, or EUGR (<10th percentile) on the Fenton growth grid and 34% had EUGR on the Lubchenco growth grid. Conclusions: The delivered nutrient intakes were consistently less than 15% of the prescribed intakes. Growth velocity between the age when full EN was achieved and 36 weeks’ PMA was 6.7% lower than Ziegler’s estimate. One-third to one-half of the infants have EUGR at 36 weeks’ PMA.
Acute Effects of Sound Assisted Soft Tissue Mobilization (SASTM) on Lower Extremity Flexibility, Isokinetic and Isometric Strength
(2019-07) Beer, Jeffrey Allen; Bahamonde, Rafael E.; Loghmani, M. Terry; Naugle, Keith E.; Streepey, Jefferson W.
SASTMTM is a myofascial technique used to mobilize soft tissue and aid in the elongation of soft tissue and create physiological change. The purpose of the study was to determine the acute effects of Sound Assisted Soft Tissue Mobilization (SASTMTM) on lower extremity hamstring strength (isokinetic & isometric) and flexibility. Thirty division III male athletes with limited ROM of ≤ 90o of knee extension with 90o of hip flexion while lying supine consented to volunteer. Each subject was treated and measured through a double-blinded experimental design where the subjects and tester were unaware of the real treatment being administered and measured. The research consisted of 4 visits (familiarization/baseline, and 3 data collection session). Testing sessions were conducted a week after the baseline session, followed by two sessions, 2 days and a week after the 1st session. Three different modalities (SASTMTM, Therapeutic Ultrasound and “The Stick”) were performed on a treatment leg, and the opposite leg served as a control. Data collection consisted of a warm-up on a cycle ergometer followed by one randomly chosen modality on the treatment leg. Data collection was conducted using a Cybex 300-isokinetic device and a digital goniometer. Isokinetic strength testing was performed at 60, 180 and 240o/s. Isometric testing was collected at 45o of knee flexion. Repeated two-way ANOVA’s (3-Treatment x 3-Time) were used for statistical analyses to determine the effects of interventions and the time on strength and flexibility. The statistical analyses resulted in no significant results (p≤.05) for acute effects for either strength or flexibility with respect to time, treatment or treatment and time interactions.
Adapted dance- connecting mind, body and soul
(2014-01-29) Swinford, Rachel R.; Ellett, Marsha L.; Sloan, Rebecca S.; Crabtree, Jeffrey L.; Horton-Deutsch, Sara L.; Stanton-Nichols, Kathleen A.
Using Heideggerian interpretive phenomenology, this study illuminates the lived experience of an adapted dance program for individuals with Down syndrome and their family members. The overall pattern from both dancers and family members was adapted dance: connecting mind, body and soul. The primary theme from dancer interpretations was expressing a mosaic of positive experiences, and the primary theme from family member interpretations was experiencing pride in their loved ones. The dance program provided dancers an opportunity to express their authentic self while experiencing moments of full embodiment in the connection of their mind, body and soul. While dancers experienced the connection of mind-body-soul, family members recognized the importance of this connection in their loved one. This research is instrumental in advocating for opportunities for individuals with Down syndrome to experience dance as a social, physical and intellectual activity that results in learning and increasing social interactions. The research findings from this study can support future initiatives for dance programs that may influence a population that has limited access to physical activity and dance. The study’s teaching strategies, dance activities, class procedures and sequences, and feedback techniques can be used by other professionals who teach individuals with intellectual disabilities.
Adherence With Home Exercise Programs 1-6 Months After Discharge From Physical Therapy By Individuals Post-Stroke
(2008-10-10T17:10:22Z) Miller, Kristine Kay; Mac Kinnon, Joyce L.; Porter, Rebecca Elaine; Riolo, Lisa
Application of Transcranial Direct Current Stimulation During Motor Skill Acquisition
(2024-03) Meek, Anthony Wilhite; Riley, Zachary; Munk, Niki; Naugle, Kelly; Streepey, Jake
Transcranial direct current stimulation has been used to influence the acquisition of motor skills; however, most studies investigate relatively simple laboratory based motor skills tasks. Since the regions where structural and functional changes support motor learning are dependent on the qualities of the task, translation of the findings to real-world skills has been limited. In general, anodal current stimulation is associated with functional facilitation and cathodal current is associated with functional inhibition. The purpose of this dissertation is to explore the effect of transcranial direct current stimulation of the primary motor cortex and the cerebellum upon the acquisition of novel motor skills that possess varied demands comparable to everyday tasks. In order to study motor skill learning, we investigated 4 unilateral tasks made novel by using the non-dominant hand, ensuring a discernible fast phase of learning in which to observe skill acquisition. In study one, anodal stimulation applied over the primary motor cortex during a 20 minute practice session skill acquisition in a complex dart throwing task compared to cathodal motor cortex stimulation or SHAM. In study two, 20 minutes of anodal motor cortical stimulation while practicing a dexterous tweezer task significantly reduced postpractice pin-placing time compared to SHAM. In study three, anodal motor cortical stimulation during 20 minutes practicing a dexterous rhythmic-timing video game led to significantly higher performance scores compared to SHAM. In study four, in the same videogame task, concurrently stimulating the primary motor cortex with 2 milliamp anodal current while stimulating the cerebellum with 2 milliamp cathodal current during 20 minutes of practice led to significantly higher performance scores compared to SHAM, whereas 2 milliamp anodal primary motor cortex, anodal cerebellar, and cathodal cerebellar stimulation alone was not different than SHAM. These data altogether show that motor cortical transcranial direct current stimulation can facilitate skill acquisition in everyday tasks with a range of gross, fine, and visuomotor demands. They also provide the first evidence of a synergistic effect on motor learning from concurrent primary motor cortex and cerebellar stimulation, which may contribute to the development of novel stimulation protocols.
Augmenting the Health Belief Model to Promote Knee Massage as Self-Management Among Individuals with Knee Osteoarthritis: A Roadmap for Future Research and Intervention Development
(2023-08) Nemati, Raheleh; Munk, Niki; Kaushal, Navin; Keith, NiCole; Naugle, Kelly
Self-administered massage is a form of self-management that has been shown to alleviate symptoms among individuals with knee osteoarthritis. However, existing interventions have yielded inconsistent results in terms of promoting the practice of self-administered massage, highlighting a critical gap in the application of a theoretical or conceptual model. The current study utilized an expanded health belief model that integrates constructs from the theory of planned behavior aimed to identify the behavioral determinants associated with the practice of self-administered knee massage. An observational study was designed to address the objectives using an online survey. A total of 268 participants with knee osteoarthritis completed the survey. Data regarding the clinical characteristics of participants, including the year of diagnosis, chronicity of pain, affected knee(s), and the intensity of pain in terms of current, average, and worst levels, were collected. Structural equation modeling was used to test the predictive validity of the proposed model. The model revealed self-administered massage behavior to be predicted by intention (β = .21, p < .014). Intention was predicted by cues (β = .29, p <.001), task self-efficacy (β = .29, p <.001), affective attitudes (β = .14, p =.011), perceived severity (β = .27, p <.001), and perceived facilitators (β = .22, p <.001), but not response self-efficacy, instrumental attitudes, or barriers. Intention mediated the effects between cues (β = .06, 95% CI .025, .129) and perceived severity (β = .06, 95% CI .014, .127) and behavior. Model determinants were found to mediate between age and behavior (β = -.16, 95% CI -.224, -.093). Interventions aimed at promoting self-administered massage should focus on enhancing individuals' perception of the severity of their knee OA progression and their confidence in performing the massage by teaching them the common massage techniques.
Beet-ing Muscle Dysfunction and Exercise Intolerance in Pulmonary Hypertension
(2019-10) Long, Gary Marshall; Coggan, Andrew R.; Brown, Mary Beth; Lahm, Tim; Avin, Keith; Arnold, Brent
Background: Pulmonary Hypertension (PH) is a devastating disease characterized by pulmonary arterial remodeling, right ventricular dysfunction and ultimately right heart failure. Increased emphasis has been given to skeletal muscle dysfunction in PH, and to its implication in the severe exercise intolerance that is a hallmark of the condition. In this dissertation, skeletal muscle blood flow was measured via the microsphere technique at rest and during exercise (Aim 1), with an acute dose of dietary nitrate via beetroot juice (BRJ) gavage used to determine if supplementation could improve muscle blood flow and alter energetics (Aim 2). VO2max, voluntary running and grip strength tests were used to determine the effect of disease on performance, and to test for an ergogenic effect of BRJ vs. placebo (PL) in healthy and PH rats (Aim 3). Methods: A prospective, randomized, counterbalanced, placebo-controlled trial was used to examine the aforementioned aims across four groups; PH rats (induced with monocrotaline, MCT, 60mg/kg, s.q., 4 weeks) supplemented with BRJ (MCT BRJ, n=9); PH rats supplemented with placebo (MCT PL, n=9); healthy control rats (vehicle, s.q.) supplemented with BRJ (CON BRJ, n=8); healthy control rats supplemented with placebo (CON PL, n=9). Results: Monocrotaline induced a severe PH phenotype evidenced by increased RV wall thickness, RV hypertrophy, RVSP and reduced cardiac output and stroke volume compared to controls (p=<0.001). MCT rats demonstrated lower muscle blood flow at rest, and more prominently during exercise compared to controls (p=0.007-0.047), regardless of supplementation. MCT rats displayed a greater reliance on anaerobic metabolism, demonstrated by increased blood lactate accumulation (p=<0.001), and this was significantly related to reduced blood flow during exercise (r=-0.5879, p=0.001). BRJ supplementation resulted in increased plasma nitrate and nitrite compared to PL (p=<0.001), but at the skeletal muscle level, only nitrate was increased after BRJ. BRJ did not have a significant effect on blood flow, with no improvement during exercise shown vs. PL. Similarly, BRJ did not significantly improve exercise function in MCT or CON rats. Conclusion: MCT rats demonstrated a reduction in muscle blood flow, with BRJ supplementation not resulting in improved flow or exercise performance.
Beverage consumption and the incidence of overweight and obesity in an Indianapolis WIC population
(2016-08-19) Foster, Joshua J.; O'Palka, Jacquelynn; Blackburn, Sara; Li, Wei
The incidence of overweight and obesity in children and adolescence is a global health concern. The long term health implications of overweight or obesity include respiratory issues, mobility joint issues, cardiovascular disease, type II diabetes, and certain types of cancer. The incidence of overweight and obesity is more common in low socioeconomic populations. Though there are many factors influencing children who become overweight or obese, beverage consumption is of particular interest since it is hypothesized that the energy supplied by beverages is not compensated by energy intake from the rest of the diet.
Community-Based Exercise Program Attendance and Exercise Self-Efficacy in African American Women
(2014-01-29) Virgil, Kisha Marie; Mikesky, Alan E.; Keith, NiCole R.; De Groot, Mary K.; Hess, Lisa M.; Mushi-Brunt, Christina R.
Rates of chronic disease and physical inactivity are disproportionately high among African American women. Despite the known benefits of physical activity and an increasing number of programs designed to increase activity, attendance rates to many exercise programs remain low. There is much to learn about program types, such as healthy lifestyle programs (HLP); individual factors, such as self-efficacy; and mediating variables that may influence exercise program attendance. An observational study design was used to compare exercise self-efficacy and attendance in a community-based exercise program in African American women who were enrolled in a HLP (N = 53) to women who were not (N = 27). Exercise program attendance was gathered across six months; demographics, self-efficacy and physical activity behaviors were assessed through surveys; and physiological variables (resting heart rate and blood pressure, height, and weight) and physical fitness (muscular strength and endurance and cardiovascular endurance) were measured at baseline. Descriptive statistics were used to describe participants and groups were compared using T-tests, chi-square and non-parametric statistics. Finally, mediation analyses were conducted using multiple regression models to assess self-efficacy as a potential mediator to exercise program attendance. Women who enrolled in this study were of low income (61% having an annual income less than $20,000), obese with a mean (standard deviation) body mass index (BMI) of 37.7 (7.6), pre-hypertensive with a mean (standard deviation) systolic blood pressure of 125.9 (14.4), and scored poorly and marginally on two fitness tests. On average, women reported being Moderately Confident in their ability to exercise regularly, yet had low attendance in the exercise program with a median number .5 days over six months and there were no significant differences in exercise self-efficacy (p = .23) or attendance in the exercise program between groups (p = .79). Additionally, exercise self-efficacy was not a mediating variable to program attendance. Women in this study had little discretionary income and several chronic disease risk factors, yet exercise program attendance was low even in those enrolled in a HLP. Identifying factors that increase exercise self-efficacy and factors that influence attendance beyond self-efficacy may help future program design and attendance.
Comparison of Intravenous Lipid Emulsions in Parenteral Nutrition: A Pilot Study
(2021-02) McGuigan, Alexis K.; O'Palka, Jacquelynn; Blackburn, Sara; Laughlin, Michelle; Carter, Amy
Background: SMOF lipid™ infusion containing soybean oil, medium-chain triglycerides, olive oil, and fish oil has been approved and recommended for use in adults receiving parenteral nutrition (PN). Research shows that SMOF lipid infusion is safe for use in post-operative and critically ill patients. Improved patient outcomes are linked to SMOF lipid use over traditional soybean oil lipid emulsions. Objective: The purpose of this study was to determine the effect of SMOF lipid infusion on incidence of infection, ICU length of stay, hospital length of stay, and mortality in adult trauma patients as compared to parenteral nutrition utilizing 100% soybean oil emulsion or a lipid-free, dextrose and amino acid administration. Methods and Analysis: A retrospective chart review was conducted for adult trauma patients admitted to Eskenazi Health’s surgical intensive care unit (SICU) that received PN from May 2017 to May 2020. Data were collected from the electronic health record and trauma registry. Results: Twenty-nine patients were included who met study criteria: 17 patients in the traditional lipid cohort and 12 in the SMOF lipid cohort. The length of PN therapy was comparable between the traditional and SMOF ILE groups, 13.9 days (± 11.5) and 13.3 days (± 14.3) respectively. All 12 patients in the SMOF lipid cohort received intravenous lipid emulsion (ILE) compared to 42% (n=7) of traditional lipid group patients (p=0.001). SMOF treatment group were provided 100% of estimated energy needs via PN compared to an average of 94% (± 9.7) of estimated energy needs in the traditional lipid treatment group (p=0.036). Incidence of infection during initial hospitalization was significantly lower in the SMOF treatment group (n=3, 25%) compared to the traditional lipid treatment group (n=13, 76%). Mortality was decreased in the SMOF treatment group (0%) when contrasted to the Intralipid treatment group (23.5%), p=0.04. Conclusion: Patients receiving SMOF lipid emulsion within PN therapy had better clinical outcomes compared to those receiving Intralipid soybean-lipid emulsion or a dextrose and amino acid administration.

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