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Item Minced muscle autografting improves bone healing but not muscle function in a porcine composite injury model(Wiley, 2023-09) McKinley, Todd O.; Natoli, Roman N.; Janakiram, Naveena B.; Warden, Stuart J.; Fuchs, Robyn K.; Gunderson, Zachary; Diggins, Nichlaus; Sun, Seungyup; Kolettis, George; Goldman, Stephen M.; Dearth, Christopher L.; Mendenhall, Stephen; Staut, Caio; Kacena, Melissa A.; Corona, Benjamin T.; Health Sciences, School of Health and Human SciencesComposite tissue injuries (CTIs) in extremities include segmental bone defects (SBDs) and volumetric muscle loss. The objective of this study was to determine if skeletal muscle autografting with minced muscle grafts (MMGs) could improve healing in an SBD and improve muscle function in a porcine CTI model that includes an SBD and adjacent volumetric muscle loss injury. Adult Yucatan Minipigs were stratified into three groups including specimens with an isolated SBD, an SBD with volumetric muscle loss (CTI), and an SBD with volumetric muscle loss treated with MMG (CTI + MMG). Bone healing was quantified with serial x-rays and postmortem computed tomography scanning. Muscle function was quantified with a custom in vivo force transducer. Muscle tissue content was determined by biochemical analyses and histology. Anterior cortex-modified Radiographic Union Score for Tibia fractures (mRUSTs) decreased from 2.7 to 1.9 (p = 0.003) in CTI versus SBD animals. MMG improved anterior mRUST scores to 2.5 in CTI + MMG specimens (p = 0.030 compared to CTI specimens) and overall mRUST scores increased from 9.4 in CTI specimens to 11.1 in CTI + MMG specimens (p = 0.049). Residual strength deficits at euthanasia were 42% in SBD (p < 0.001), 44% in CTI (p < 0.001), and 48% in CTI + MMG (p < 0.001) compared to preoperative values. There were no differences in strength deficits between the three groups. Biochemical and histologic analyses demonstrated scattered differences between the three groups compared to contralateral muscle. MMG improved bone healing. However, the primary cause of muscle dysfunction and biochemical changes was the presence of an SBD. Clinical significance: Early mitigation of SBDs may be necessary to prevent muscle damage and weakness in patients sustaining composite extremity trauma.Item Modeling and Simulation of Robotic Palpation to Detect Subsurface Soft Tissue Anomaly for Presurgical Assessment(ASME, 2024-08) Bhattacharjee, Abhinaba; Loghmani, M. Terry; Anwar, Sohel; Health Sciences, School of Health and Human SciencesSurgical Haptics is an emergent field of research to integrate and advance the sense of robotic touch in laparoscopic tools in robot-assisted minimally invasive surgery. Haptic feedback from the tooltip and soft tissue surface interaction during robotic palpation can be leveraged to detect the texture and contour of subsurface geometry. However, precise force modulation of the robotic palpating probe is necessary to determine stiff inclusions of the anatomy and maneuver successive manipulation tasks during surgery. This paper focuses on investigating the layered deformations associated with different force profiles involved in manipulating the superficial anatomy of soft tissues during dynamic robotic palpation to determine the underlying anomaly. A realistic three-dimensional (3D) cross-sectional soft tissue phantom with anatomical layers and tumor, as an anomaly, is designed, modeled, and analyzed to examine the effects of oriented palpating forces (0–5 N) of a 7 DOF robot arm equipped with a contoured palpation probe. Finite element static structural analysis of oriented robotic palpation on the developed 3D soft tissue phantoms (with and without anomaly) reveals the soft tissue layer deformations and associated strains needed to identify presence of stiffer inclusions or anomaly during Robotic palpation. The finite element analysis study shows that the difference in deformations of soft tissue layers (e.g., underlying myofascial layers) under stiffer inclusions at different force levels can facilitate haptic feedback to acquire information about subsurface tumors. The deformation variations are further compared to assess better palpation orientations for subsurface anomaly detection.Item Multimodal Sequence Classification of force-based instrumented hand manipulation motions using LSTM-RNN deep learning models(IEEE, 2023-10) Bhattacharjee, Abhinaba; Anwar, Sohel; Whitinger, Lexi; Loghmani, M. Terry; Health Sciences, School of Health and Human SciencesThe advent of mobile ubiquitous computing enabled sensor informatics of human movements to be used in modeling and building deep learning classifiers for cognitive AI. Expanding deep learning approaches for classifying instrumented hand manipulation tasks, especially the art of manual therapy and soft tissue manipulation, can potentially augment practitioner’s performance and enhance fidelity with computer assisted guidelines. This paper introduces a dataset of 3D force profiles and manipulation motion sequences of controlled soft tissue manipulation stroke pattern applications in thoracolumbar, upper thigh and calf regions of a single human subject performed by five experienced manual therapists. The multimodal 3D force, 3D accelerometer and resultant gyro raw data were preprocessed and experimentally fed into a multilayered Long Short-Term Memory (LSTM) based Recurrent Neural Network (RNN) deep learning model to observe sequence classifications of two manipulation motion techniques (Linear "Strumming" motion and curvilinear "J-Stroke" arched motion) of manual therapy performed using a handheld, localizing Quantifiable Soft Tissue Manipulation (QSTM) medical tool. Each of these motion sequences were further labeled with corresponding best practice technique from validated video tapes and reclassified into "Correct" and "Incorrect" practice based on defined criteria. The deep learning model resulted in 90-95% classification accuracy for individual intra-therapist reduced dataset. The classification accuracy varied between 78%-93% range, when trained with multivariate characteristic feature set combinations for the complete spectrum of inter-therapist dataset.Clinical Relevance — AI informed online therapeutic guidelines can be leveraged to minimize practice inconsistencies, optimize educational training of therapy using data informed protocols, and study progression of pain and healing towards advancing manual therapy.Item Comparing Barriers and Facilitators to Physical Activity Among Underrepresented Minorities: Preliminary Outcomes from a Mixed-Methods Study(MDPI, 2025-02-06) Alamilla, Rafael A.; Kaushal, Navin; Bigatti, Silvia M.; Keith, NiCole R.; Health Sciences, School of Health and Human SciencesPhysical activity (PA)'s benefits are well established, yet many U.S. adults fail to meet PA guidelines. This is especially true for minorities facing social inequities. This study explored PA's barriers and facilitators among urban Midwestern minorities using a mixed-methods approach framed on the socio-ecological model. A cross-sectional survey was conducted between January and June 2024 among community-dwelling minorities. Participants were grouped as completing low (LLPA) or high (HLPA) weekly leisure-time PA for comparison. Quantitative analysis included MANOVA, follow-up ANOVAs, and calculation of effect sizes. Qualitative data were assessed using inductive thematic analysis. Twenty-nine adults (44.83% Black, 41.37% Latino) participated in the study. The HLPA group (n = 18) reported higher leisure-time PA (p = 0.001, d = 2.21) and total PA (p = 0.02, d = 1.00) compared to the LLPA group (n = 11). LLPA participants faced more personal barriers to PA (p = 0.02, d = -0.92). Common barriers identified in the interviews included a lack of time and financial costs. Facilitators included social support and available PA facilities. Both groups achieved the USPA guidelines through different PA domains. Increasing social support and lowering PA-related costs could enhance participation. Addressing barriers and leveraging existing facilitators are crucial to increasing PA among minorities.Item Is running good or bad for your knees? A systematic review and meta-analysis of cartilage morphology and composition changes in the tibiofemoral and patellofemoral joints(Elsevier, 2023-02) Coburn, S. L.; Crossley, K. M.; Kemp, J. L.; Warden, S. J.; West, T. J.; Bruder, A. M.; Mentiplay, B. F.; Culvenor, A. G.; Health Sciences, School of Health and Human SciencesBackground The general health benefits of running are well-established, yet concern exists regarding the development and progression of osteoarthritis. Aim To systematically review the immediate (within 20 min) and delayed (20 min–48 h) effect of running on hip and knee cartilage, as assessed using magnetic resonance imaging (MRI). Method Studies using MRI to measure change in hip or knee cartilage within 48 h pre- and post-running were identified. Risk of bias was assessed using a modified Newcastle–Ottawa Scale. Percentage change in cartilage outcomes were estimated using random-effects meta-analysis. Certainty of evidence was evaluated with the Grading of Recommendations Assessment, Development and Evaluation tool. Results Twenty-four studies were included, evaluating 446 knees only. One third of studies were low risk of bias. Knee cartilage thickness and volume decreased immediately after running, with declines ranging from 3.3% (95% confidence interval [CI]: 2.6%, 4.1%) for weight-bearing femoral cartilage volume to 4.9% (95% CI: 4.43.6%, 6.2%) for patellar cartilage volume. T1ρ and T2 relaxation times were also reduced immediately after running, with the largest decline being 13.1% (95% CI: −14.4%, −11.7%) in femoral trochlear cartilage. Tibiofemoral cartilage T2 relaxation times recovered to baseline levels within 91 min. Existing cartilage defects were unchanged within 48 h post-run. Conclusions There is very low certainty evidence that running immediately decreases the thickness, volume, and relaxation times of patellofemoral and tibiofemoral cartilage. Hip cartilage changes are unknown, but knee changes are small and appear transient suggesting that a single bout of running is not detrimental to knee cartilage.Item Incorporating Exercise to Buffer Aversive Health Effects of Loneliness Among Older Adults in the Life Trial(Oxford University Press, 2024-12-31) Kaushal, Navin; Pemmasani, Deepishka; de la Colina, Adrian Noriega; Nemati, Donya; Health Sciences, School of Health and Human SciencesIntroduction: In 2023 the US Surgeon General announced an epidemic of loneliness and isolation. Prolonged loneliness among older adults has been shown to predict dementia and cardiovascular disease (CVD). However, exercise has been demonstrated to have preventive effects on CVD and cognitive health, but its effects on buffering these outcomes manifested from loneliness, or gender effects have not been investigated. This study aimed to test two moderated-mediation models to investigate if exercise moderates the relationship between loneliness and health outcomes. Methods: The Lifestyle Interventions and Independence for Elders (LIFE) Study is a randomized controlled trial (n=1,600) that assigned older adults (aged 65+) to either an intervention or control group. The present observational study analyzed participants in the control group. Measures included: exercise (accelerometry), loneliness (Center for Epidemiologic Studies Depression Scale [CES-D]), CVD risk (handgrip test), and cognitive health (global cognitive function). Model #14 from Hayes PROCESS Macro 4.0 in SPSS was used to analyze the data. Results: In both models, females experienced greater loneliness compared to males(β=.25, p<.001). The CVD risk model found Moderate-to-Vigorous Physical Activity (MVPA) to independently predicted handgrip strength(β=.11, p<.001), and interacted with loneliness to predict handgrip strength(β=.05, p=.03). The cognition model also found MVPA to independently predict cognition(β=.14, p<.001), and interacts with loneliness to predict cognition(β=.07, p=.03), and also demonstrate total moderated-mediation effects(β=.02, 95%CI.003 to.367). Conclusion: Exercise can buffer aversive cardiovascular risk and cognition from loneliness. Lonely older adults are a high-risk demographic that should be sought for enrolling in exercise programs.Item The Impact of the Life Trial on Cardiovascular Health: Racial Disparities in Lifestyle Factor Improvement(Oxford University Press, 2024-12-31) Nemati, Donya; Pemmasani, Deepishka; Lavangu, Vaishali; Kaushal, Navin; Health Sciences, School of Health and Human SciencesIntroduction. Cardiovascular disease is the leading cause of death among older adults. The American Heart Association promotes the lifestyle 8 (LE8) for cardiovascular disease prevention which includes healthy levels of exercise, sleep, smoking, BMI, blood pressure, nutrition (sodium), triglycerides and glucose levels. Exercise alone can improve most of these factors. The purpose of this study was to test if an exercise program can improve LE8 and identify racial (Black vs. White) differences. Methods. The LIFE Study is a randomized controlled trial that randomized 1,600 older adults (age 65+) to an intervention or control group (health-education program). The intervention included one-hour on-site exercise program twice per week with additional prescription of home-based exercise. LE8 measures included: exercise (accelerometers), sleep (Pittsburg-Sleep-Quality-Index), smoking (self-report). Blood samples measured glucose, triglycerides, and sodium, and on-site assessments measured blood pressure and BMI. Data was collected every six months for two years. STATA 18.0 was used to conduct multilevel modeling for each LE8 outcome. Results. A series of multilevel models revealed significant TimeXGroupXRace interaction effects for greater exercise(β=.12, p=.006), better sleep(β=.20, p=.04), lower BMI(β=.58, p<.001) and triglycerides(β=.38, p<.001) only among White participants in the intervention arm at the fifth timepoint. Sodium(β=.13, p=.04), glucose(β=.09, p=.04), and blood pressure(β=.20, p=.04) were higher in Black participants with no time or group interaction. Smoking was nonsignificant Conclusion. The LIFE trial demonstrated improvement in some LE8 factors, and several racial health disparities. There is a need to understand biopsychosocial determinants that contribute to racial disparities to ensure that all participants benefit equally.Item Physical Exercise Training Effect and Mediation Through Cardiorespiratory Fitness on Dual-Task Performances Differ in Younger–Old and Older–Old Adults(Oxford University Press, 2021) Bherer, Louis; Langeard, Antoine; Kaushal, Navin; Vrinceanu, Tudor; Desjardins-Crépeau, Laurence; Langlois, Francis; Kramer, Arthur F.; Health Sciences, School of Health and Human SciencesObjective: It has often been reported that dual-task (DT) performance declines with age. Physical exercise can help improve cognition, but these improvements could depend on cognitive functions and age groups. Moreover, the mechanisms supporting this enhancement are not fully elucidated. This study investigated the impacts of physical exercise on single- and dual-task performance in younger-old (<70) and older-old (70+) adults. The study also assessed whether the training effect on cognition was mediated by improvement in cardiorespiratory fitness. Methods: One hundred forty-three participants (65-89 years) took part in a physical exercise intervention for 3 months or were assigned to a control group. All participants completed a DT paradigm and an estimated measure of cardiorespiratory fitness. Regression models were used to test the training effect on these outcomes, and mediation analyses were used to determine whether the training-related cognitive changes were mediated by changes in cardiorespiratory fitness. Results: In 70+, training predicted improved processing speed (βc = -.33) and cardiorespiratory fitness (βa = .26) and the effect of training on processing speed was fully mediated by change in cardiorespiratory fitness (βab = -.12). In <70, training predicted improvement in task-set cost (βc = -.26) and change in cardiorespiratory fitness (βa = .30) but improvement in task-set cost was not entirely mediated by change in cardiorespiratory fitness. Discussion: Results are discussed in terms of the mechanisms supporting DT performance improvement following physical exercise training in older adults.Item Home Health Aides in the Era of COVID-19 and Beyond(Springer, 2022) D’Cruz, Lynn; Denson, Kathryn M.; Carnahan, Jennifer L.; Health Sciences, School of Health and Human SciencesItem Considerations for Psychologically Informed Therapeutic Massage for Headache(Liebert, 2024-04) Nabity, Paul S.; Farrokhi, Shawn; Finnell, John S.; McGeary, Donald D.; Munk, Niki; Health Sciences, School of Health and Human Sciences