Funded Research Abstracts
College of Nursing > Funded Research
THE PRETERM INFANT MICROBIOME: BIOLOGICAL, BEHAVIORAL AND HEALTH OUTCOMES AT 2 AND 4 YEARS OF AGE
Project Start Date: 13-MAY-2015
Project End Date: 29-FEB-2020
This project will follow 78 Very Low Birth Weight (VLBW) infants previously enrolled in a R21 grant through the age of 4 years. The data gathered over 6 weeks of the NICU stay includes multiple factors that potentially could alter the gut micro biome, such as prenatal and postnatal events and illnesses, amount of human milk received, weekly means of cytokines, chemokine's, growth factors and secretory Immunoglobulin A in the milk, and weekly levels of fecal calprotectin. Stool samples have been preserved for analysis of the micro biome in the current study. Micro biome species and diversities will be measured in the laboratory of Dr. Jack Gilbert at Argonne National Lab using state of the science deep sequencing and amplification of microbial sRNA genes. The micro biome will again be measured in stool samples from these children at the ages of 2 and 4 years. Relationship between the pre and postnatal factors, human milk volume and immunobiology, fecal calprotectin levels and the very early micro biome will be analyzed. The predictive power of the VLBW infant gut micro biome for determining later childhood micro biomes will be analyzed prospectively. The relationships between micro biomes across time and later growth, development and health will be determined. VLBW infants are at risk for both early and later health effects, and the role of the micro biome in these effects will be measured for the first time in this prospective study.
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EFFICACY OF MBSR TREATMENT OF COGNITIVE IMPAIRMENT AMONG BREAST CANCER SURVIVORS
Project Start Date: 1-JUL-2015
Project End Date: 30-JUN-2020
Due to improved detection and treatment, survival rates among breast cancer survivors (BSC) have increased. However, BCS may experience cognitive impairment (CI) following treatment, which has been reported by BCS up to 10 years after chemotherapy (CT). There is limited evidence on whether stress- reducing interventions improve CI in BSC. The primary goal of this application is to establish the Mindfulness- Based Stress Reduction for Breast Cancer (MBSR(BC)) program as an effective treatment for CI in BCS. Specifically we aim to (1) evaluate the extent to which MBSR(BC) compared to the Breast Cancer-Education Support (BCES) program or Usual Care (UC) improves cognitive functioning among BCS off treatment; (2) determine if improvements in cognitive functioning achieved from MBSR(BC) are mediated through increased mindfulness and decreased rumination and stress; (3) evaluate genetic variants as moderators of MBSR(BC) on improvements in CI; and (4) determine the impact of MBSR(BC) on healthcare utilization and costs. To achieve these aims, we will conduct a randomized controlled trial (RCT) among 330 BCS with Stage I-III BC who have received adjuvant CT or CT and radiation. Within this RCT, MBSR(BC) will be delivered to a subpopulation of Spanish speaking BCS. Participants will be randomly assigned in a 1:1:1 ratio to (1) the 6- week MBSR(BC) program; (2) the 6-week BCES program; or (3) UC. The BCES program will match the MBSR(BC) program for time and attention and parallel the group support component of MBSR(BC). Assessments will take place at baseline, 6 weeks,12 weeks and 6 months and include clinical history and demographic information, objective neuropsychological assessments, subjective cognitive and symptom measurements, cost utilization surveys and a blood sample collection for genetic analyses. This study is highly innovative to be the first randomized trial to: 1) evaluate the efficacy of MBSR(BC) among BCS for objective neuropsychological and subjective improvements in cognitive functioning; 2) evaluate genetic profiles as moderators of MBSR(BC) on improving CI; 3) offer the MBSR trial in Spanish in addition to English for the purpose of improving cognition; and 4) determine the effect of MBSR(BC) on CT-induced CI among BCS related to health service utilization costs. MBSR(BC) provides training to promote stress reduction through self-regulation of attention and awareness to stressful events. Our preliminary results show that MBSR(BC) improves subjective cognitive functioning. If MBSR(BC) is found to be effective, it will provide evidence of a viable non-pharmacological method for managing CI in BCS. Additionally, the examination of the effects of the hypothesized mediators may yield new insights for tailoring MBSR(BC) and/or developing additional interventions to aid BCS. The assessment of genetic polymorphisms to explore if risk alleles are associated with improvement in cognitive functioning may demonstrate that specific genetic profiles may modify improvements in CI for those receiving MBSR(BC). Finally, if MBSR(BC) is shown to be effective, this may significantly impact healthcare utilization and cost and produce necessary evidence for clinicians, researchers and policymakers.
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CHRONIC TOXOPLASMA GONDII, PREGNANCY REACTIVATION, AND PERINATAL DEPRESSION
Project Start Date: 12-AUG-2017
Project End Date: 31-MAY-2022
Project Summary/Abstract Toxoplasma gondii is a ubiquitous parasite that infects one third of the world's population. It remains in a latent state, encapsulated in cysts in the brain and muscle tissue of infected hosts. Reactivation rarely occurs, and usually only when the host has become significantly immunosuppressed. However, emerging literature suggests that chronic, latent infection is not innocuous. There have been reports associating depression, schizophrenia, suicidality, unusual behaviors, and migraine headaches with T. gondii IgG titers in chronically infected individuals. In addition, a few reports suggest that T. gondii can reactivate in healthy, immunocompetent pregnant women. These relationships have not yet been studied systematically in perinatal women. This proposal will study the relationships between latent T.gondii infection and depression through pregnancy and the early postpartum in T. gondii positive Hispanic women. Hispanic women are at highest risk for the type 1 serotype and a new highly virulent strain. Studies of behavioral and mood effects of T. gondii infection in both rodent models and humans have been done, but not in perinatal women. The research team has reported a relationship between T. gondii IgG titers and depression in second trimester pregnant women. In the proposed study, the role of socioeconomics and country of origin, cytokines, and immunosuppression will be determined across pregnancy. The relationship between IgG titer and depression in the postpartum will also be studied. A T. gondii negative control group will provide comparison. The second goal is to determine the true incidence of T. gondii reactivation in pregnant women with latent T. gondii infection. Women with positive IgG titers will be followed through pregnancy for changes in titer, symptoms, and for those with retinal scars, evidence of reactivation of chorioretinitis. The third goal is to explore the possibility of live tachyzoites transiting across the placenta into the fetal blood stream in T. gondii positive women.
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ORAL CARE INTERVENTION IN MECHANICALLY VENTILATED ADULTS
National Institutes of Health
Start date: 1-APR-2001
End Date: 31-JUL-2018
Despite its prominent position in bedside care, there is little evidence to judge the benefits or associated risks of nurse-administered tooth brushing for mechanically ventilated adults, and the optimal frequency of tooth brushing in the critically il has never been experimentally determined. This project will complete the examination of oral care interventions in mechanically ventilated adults with a randomized clinical trial of tooth brushing frequency (once, twice, or three times daily) focused on conclusively defining the benefit and risk of varied frequencies, and identification of moderating patient-level factors for risk and benefit. The project's overall goal is to determine optimal tooth brushing frequency for mechanically ventilated adults. Optimal tooth brushing frequency is important for control of dental plaque and reduction of oral inflammation; it is likely to improve patient comfort, improve efficiency of nursing care, and may reduce systemic sequellae related to oral inflammation.
The primary aims of the proposed project are: 1) Evaluate the clinical equivalence (non- inferiority) o three tooth brushing frequencies on oral health (dental plaque and mucosal inflammation) in critically ill adults receiving mechanical ventilation; and 2) Quantify and compare the safety of three tooth brushing frequencies on serious adverse outcomes, including ventilator associated complications and clinically relevant HAIs. A secondary aim is to investigate patient factors that influence tooth brushing frequency benefit and risk in critically ill adults. These objectives willbe accomplished using a prospective, randomized, experimental design. Subjects (n=345) will be randomly assigned within 24 hours of intubation to one of three intervention groups which differ in frequency of tooth brushing delivered by study personnel (once, twice, or three times daily). Dental plaque (UM-OHI score, with observations documented and augmented by use of a digital intraoral camera), mucosal inflammation (gingival crevicular fluid IL-1�), and HAIs will be assessed daily during the intervention period. The data analysis will focus on providing definitive clinical practice guidance through joint evaluation of non-inferiority (comparison of dental plaque between groups by analysis of covariance) and quantification of number needed to harm. Repeated measures linear mixed models (treating dental plaque and mucosal inflammation as separate outcome variables) will provide insight as to specific patient-level factors that may modify the clinical effectiveness and safety profile associated with frequency of tooth brushing. Information about efficacy and safety of each frequency of tooth brushing will provide a clear recommendation for optimal tooth brushing frequency with direct translation to clinical practice.
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PREDICTORS OF WEIGHT LOSS FAILURE AND REGAIN IN BARIATRIC PATIENTS
Subcontract with Kaiser Permanente Center for Health Research
Start Date: 9/25/2015
End Date: 7/31/2020
Although overall obesity rates are declining in the US, severe obesity (BMI > 35 kg/m2) is still increasing; rates are as high as 36% in some US ethnic minority populations. Bariatric surgery is the most promising treatment for weight loss in the severely obese, resulting in much higher excess weight loss (75% vs. 11%) than traditional behavioral methods. The most frequently used bariatric procedures (bypass and gastric sleeve) have clear evidence for durable weight loss, however, even within the same procedure type, weight loss varies substantially. For example, 25% - 50% of RYGB patients regain some of their initial weight lost within 3 years. We propose a unique, mixed methods, prospective cohort study to understand why some patients experience better weight outcomes than others. The healthcare setting for this work, Kaiser Permanente Southern California (KPSC), performs ~3,500 bariatric surgeries annually; a larger target population for prospective research than any other single institution. Using socio-ecological, self-regulatory, and social cognitive theories fo the basis of our study design, we propose to collect electronic medical record data and self-report surveys in 1,800 patients before surgery and at 12, 24, and 36 months post-operatively to examine demographic, behavioral, psychosocial, and perceived environmental predictors of weight loss/regain. We will also purposively select cross-sectional samples from 12-, 24- and 36-month survey respondents who do or do not achieve successful weight loss to participate in interviews and focus groups. We will test the following two main study aims and one exploratory aim: Aim 1. Over a 3-year follow-up period, determine how demographic, behavioral, psychosocial, and perceived environmental pre-surgical factors, and post-surgical behavioral and psychosocial factors predict a) the weight loss trajectory and b) weight loss success (defined as achieving and maintaining > 50% excess weight loss); Aim 2. Understand the variability in weight loss using qualitative methods in cross-sectional samples of post-operative survey respondents and use these findings to inform mediational models addressing Aim 1; Exploratory Aim 3. Over a 3-year follow-up period, study the development of adverse psychosocial consequences and determine how they relate to a) overall weight loss and b) weight loss success. Our study is designed to provide results that will move the science forward in two key areas: 1) optimizing patient selection in real-world settings for bariatric procedures using a better understanding of pre-operative predictors; and 2) program development for maximizing the benefits from surgery for the greatest number of people, using the knowledge we gain from studying mediators of post-operative weight loss.
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Dr. Maureen Groer & Velda Gonzalez-Marrero
FATIGUE AND THE GUT MICROBIOME OF PATIENTS RECEIVING CHEMORADIOTHERAPY FOR RECTAL CANCER
Start Date 5/1/2017
End Date 4/30/20
Fatigue is one of the most distressing and commonly reported side effects of chemo-radiation (CRT), with up to 78% of rectal cancer patients complaining of severe fatigue during CRT. While the etiology and associated mechanism of the cancer-related fatigue during CRT treatment remain elusive, it has been suggested that dysbiosis (an imbalance in the intestinal microbiota in the gut) may contribute to worsening of fatigue during a patients’ pelvic CRT. This study will contribute to address the knowledge gap in symptom research and the health literature by providing initial evidence of the biologic/gut microbial processes related to the relationship among CRT, dysbiosis, and fatigue in the rectal cancer population, so that more innovative and individualized interventions can be developed. The proposed research is guided by a model of chemotherapy-related side effects. The training plan was designed to allow the applicant to expand her theoretical knowledge and skills in symptom phenotyping and conducting bio-behavioral and microbiome research in order to meet the NRSA traineeship goals and launch a career as an independent nurse scientists. An experienced team of scientists will lead the research training plan as related to the following objectives: (1) to enhance her understanding of the science related to the proposed mechanism linking CRT-induced gut microbiome dysbiosis and fatigue; (2) to increase her understanding of the characterization of CRT-related fatigue phenotypes with patient biological and clinical data, and microbiome data collection techniques and analysis through a bedside-to-bench approach; (3) to obtain comprehensive training and knowledge in microbiome research including stool collection and processing, bacterial 16S rRNA amplicon sequencing, shotgun metagenomics analysis and interpretation of microbiome-derived metagenomics data; and (4) to improve scientific writing skills and building collaborations with experts in the field of bio-behavioral/symptom management/microbiome research to successfully publish in high-impact, peer-reviewed journals, and submit competitive grant applications. The training plan is for twenty four months and includes six core areas: didactic; interdisciplinary seminars; mentorship; laboratory training; research; and dissemination. The specific aims of the proposed study are to: Aim 1: Examine the temporal changes in diversity of the gut microbiome over the course of CRT of adults with localized rectal cancers. Aim 1a: To investigate whether the intensity of fatigue during CRT is associated with the gut microbial diversity changes during the course of treatment. Aim 2: Examine the temporal changes on the abundances of specific gut microbes of adults with localized rectal cancers over the course of CRT. Aim 2a: To investigate the associations between changes in the gut microbial abundance with changes in fatigue scores during the course of CRT. By focusing on the innovative investigation of the relationship between gut microbial changes and fatigue symptoms during CRT, this study aligns with the mission of NINR calling for studies on patient-centered bio-behavioral research that promote health and enhanced quality of life.
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