Browsing by Author "Lee, Jaehoon (TTU)"
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Item A televideo exercise and nutrition program for children with acute lymphoblastic leukemia in maintenance therapy: Design and methods(2015) Gibson, Cheryl A.; August, Keith J.; Greene, Jerry L.; Herrmann, Stephen D.; Lee, Jaehoon (TTU); Harvey, Susan P.; Lambourne, Kate; Sullivan, Debra K.Changes in nutrient intake and decreased exercise resulting from cancer therapies as well as their side effects may be contributing factors in the increased body weight and differences in physical fitness observed in survivors of childhood acute lymphoblastic leukemia (ALL). This article will describe the study protocol for an intervention program designed to improve the physical activity and nutrition behaviors of ALL survivors. Twenty-four children aged between 4 years and 12 years with ALL will be randomized to a 6-month technology-based exercise and nutrition program (TLC4ALLKids) or to enhanced usual care (eUC). The participants randomized to the TLC4ALLKids will participate in weekly, 1-hour coaching sessions on nutrition and physical activity and 1-hour physical activity classes delivered by group video conferencing. Participants will be provided with iPad tablets loaded with video conferencing software and the Healthy Lifestyle Tracking calendar to track daily nutrition and physical activity goals and weight. Both groups will be provided with Fitbit™ Zip to monitor physical activity. To assess feasibility, participant recruitment (achievement of proposed sample size), attendance (per weekly online sessions/assessment sessions), and adherence (number of families at 3 and 6 months) will be evaluated. Outcome measures to assess the intervention will include anthropometrics (weight, height, and waist circumference), physical activity (accelerometry), energy and macronutrient intake (food records), sleep habits (Children's Sleep Habits Questionnaire), and quality of life (Pediatric Quality of Life Inventory) will be obtained at baseline, 3 months, and 6 months. Semi-structured interviews will be used to gather information about ways to improve the program and overcome barriers to participation. If successful, the TLC4ALLKids intervention will provide a means to educate and improve the health behaviors of ALL survivors that can be delivered remotely and conveniently to participants.Item Actions of annatto-extracted tocotrienol supplementation on obese postmenopausal women: Study protocol for a double-blinded, placebo-controlled, randomised trial(2020) Aryaie, Amir (TTUHSC); Tinsley, Grant (TTU); Lee, Jaehoon (TTU); Watkins, Bruce A.; Moore, Lane (TTU); Alhaj-Saleh, Adel (TTUHSC); Shankar, Kartik; Wood, Sarah R. (TTUHSC); Wang, Rui (TTUHSC); Shen, Chwan Li (TTUHSC)Introduction Obesity is a major health concern in postmenopausal women, and chronic low-grade inflammation contributes to the development of obesity. Cellular studies and high-fat-diet-induced obese mouse model mimicking obesity show the antiobesity effect of annatto-extracted tocotrienols (TT) with antioxidant capability. We aim to assess the safety and efficacy of TT consumption for lipid-related parameters in obese postmenopausal women. Methods and analysis Eligible obese postmenopausal women will be randomly assigned to placebo group (430 mg olive oil) and TT group (DeltaGold Tocotrienol 70%) for 24 weeks. In the present study, the primary outcome is total/regional fat mass and visceral adipose tissue. The secondary outcomes include lipid profile in serum, mRNA expression of fatty acid synthase and carnitine palmitoyltransferase 1A in fat tissue, oxylipins and endocannabinoids in plasma and adipose tissue, abundance and composition of intestinal microbiome in faeces, high-sensitivity C-reactive protein (hs-CRP) in serum and leptin in serum. Every participant will be evaluated at 0 (prior to starting intervention) and 24 weeks of intervention, except for serum lipid profile and hs-CRP at 0, 12 and 24 weeks. â € Intent-to-treat' principle is employed for data analysis. Hierarchical linear modelling is used to estimate the effects of dietary TT supplementation while properly accounting for dependency of data and identified covariates. To our knowledge, this is the first randomised, placebo-controlled, double-blinded study to determine dietary TT supplementation on an obese population. If successful, this study will guide the future efficacy TT interventions and TT can be implemented as an alternative for obese population in antiobesity management. Ethics and dissemination This study has been approved by the Bioethics Committee of the Texas Tech University Health Sciences Center, Lubbock. An informed consent form will be signed by a participant before enrolling in the study. The results from this trial will be actively disseminated through academic conference presentation and peer-reviewed journals. Trial registration number NCT03705845.Item Case example of a jail-based cancer prevention clinical trial: social determinants of health framework, novel experimental design, and retention strategies to facilitate long-term follow-up of clinical trial participants(2023) Kennedy, Pablo; Ratnaparkhi, Rubina; Lee, Jaehoon (TTU); Glenn, Jason E.; Kelly, Patricia J.; Kimminau, Kim S.; Assimonye, Stephanie; Ramaswamy, MeghaClinical trials conducted with incarcerated populations are rare. We present a case example of one such jail-based cancer prevention clinical trial to demonstrate the importance of including a theory-driven approach to intervention framing, novel experimental designs to boost access to low-risk trials, and retention strategies for long- term follow-up of hard-to-reach populations. As such we offer a social determinants of health framework to ensure cancer prevention research is conducted through the lenses of health promotion and health equity. Deviations from the gold-standard randomized control design, transparent systematic allotment, and street-based outreach retention strategies contribute to the feasibility of conducting clinical trials in carceral settings and after people leave jail. Best practices presented can be used in design and conduct of future clinical trials with criminal legal system involved populations.Item Designing for Effective and Safe Multidisciplinary Primary Care Teamwork: Using the Time of COVID-19 as a Case Study(2021) Lim, Lisa (TTU); Zimring, Craig; DuBose, Jennifer R.; Lee, Jaehoon (TTU); Stroebel, Robert J.; Matthews, Marc R.Effective medical teamwork can improve the effectiveness and experience of care for staff and patients, including safety. Healthcare organizations, and especially primary care clinics, have sought to improve medical teamwork through improved layout and design, moving staff into shared multidisciplinary team rooms. While co-locating staff has been shown to increase communication, successful designs balance four teamwork needs: face-to-face communications; situational awareness; heads-down work; perception of teamness. However, precautions for COVID-19 make it more difficult to conduct face-to-face communications. In this paper we describe a model for understanding how layout affects these four teamwork needs and describe how the perception of teamwork by staff changed after COVID-19 precautions were put in place. Observations, interviews and two standard surveys were conducted in two primary care clinics before COVID-19 and again in 2021 after a year of precautions. In general, staff felt more isolated and found it more difficult to conduct brief consults, though these perceptions varied by role. RNs, who spent more time on the phone, found it convenient to work part time-from home, while medical assistants found it more difficult to find providers in the distanced clinics. These cases suggest some important considerations for future clinic designs, including greater physical transparency that also allow for physical separation and more spaces for informal communication that are distanced from workstations.Item Distance learning strategies for weight management utilizing online social networks versus group phone conference call(2017) Willis, Erik A.; Szabo-Reed, Amanda N.; Ptomey, Lauren T.; Steger, Felicia L.; Honas, Jeffery J.; Al-Hihi, Eyad M.; Lee, Robert; Lee, Jaehoon (TTU); Oh, Youngha (TTU); Washburn, Richard A.; Donnelly, Joseph E.Objective: The increase in technology and online social networks (OSNs) may present healthcare providers with an innovative modality for delivering weight management programmes that could have an impact on health care at the population level. The objective of this study was to evaluate the feasibility and efficacy of using an OSN to deliver a weight loss programme to inform future, large-scale trials. Methods: Seventy individuals (age = 47 ± 12.4, minority = 24.3%) with obesity (BMI = 36.2 ± 4.0) completed a 6-month weight loss intervention and were randomized to either a conference call or OSN delivery group. Weight loss was achieved by reducing energy intake by 500–700 kcal·d−1 below estimated total daily energy expenditure and progressing physical activity to 300 min/week. Behavioural weight loss strategies were delivered weekly throughout the intervention. Results: Conference call and OSN groups produced clinically meaningful weight loss of ≥5% from baseline to 6 months (phone = −6.3 ± 6.4%, OSN = −5.8 ± 6.7%). There was no significant difference in weight change between groups (p = 0.765). Conclusion: The phone and OSN groups met the American Heart Association/American College of Cardiology/The Obesity Society's Guidelines by reducing baseline weight by 5–10% within 6 months. OSNs appear to be a viable delivery platform for weight loss interventions; however, larger scale adequately powered trials are needed.Item Evolving norms: social media data analysis on parks and greenspaces perception changes before and after the COVID 19 pandemic using a machine learning approach(2022) Park, Sohyun; Kim, Seungman (TTU); Lee, Jaehoon (TTU); Heo, BiyoungThis study provides a novel approach to understand human perception changes in their experiences of and interactions with public greenspaces during the early months of COVID-19. Using social media data and machine learning techniques, the study delivers new understandings of how people began to feel differently about their experiences compared to pre-COVID times. The study illuminates a renewed appreciation of nature as well as an emerging but prominent pattern of emotional and spiritual experiences expressed through a social media platform. Given that most park and recreational studies have almost exclusively examined whether park use increased or decreased during the pandemic, this research provides meaningful implications beyond the simple extensional visit pattern and lends weight to the growing evidences on changing perceptions over and the positive psychological impacts of nature. The study highlights the preeminent roles parks and greenspaces play during the pandemic and guides a new direction in future park development to support more natural elements and nature-oriented experiences from which emotional and spiritual well-being outcomes can be drawn.Item Exercise volume and aerobic fitness in young adults: the Midwest Exercise Trial-2(2016) Schubert, Matthew M.; Washburn, Richard A.; Honas, Jeffery J.; Lee, Jaehoon (TTU); Donnelly, Joseph E.To examine the effect of exercise volume at a fixed intensity on changes in aerobic fitness. Ninety-two overweight/obese individuals (BMI 25–40 kg m2), age 18–30 years, 50 % women, completed a 10 mo, 5 d wk−1 supervised exercise intervention at 2 levels of exercise energy expenditure (400 or 600 kcal session−1) at 70–80 % heart rate (HR) max. Exercise consisted primarily of walking/jogging on motor-driven treadmills. The duration and intensity of all exercise sessions were verified by a downloadable HR monitor set to collect HR in 1-min epochs. All participants were instructed to continue their typical patterns of non-exercise physical activity and dietary intake over the duration of the 10 mo intervention. Maximal aerobic capacity (indirect calorimetry) was assessed on a motor-driven treadmill using a modified Balke protocol at baseline, mid-point (5 mo), and following completion of the 10 mo intervention. VO2 max (L min−1) increased significantly in both the 400 (11.3 %) and 600 kcal session−1 groups (14 %) compared to control (−2.0 %; p < 0.001); however, the differences between exercise groups were not significant. Similar results were noted for change in relative VO2 max (mL kg−1 min−1); however, the magnitude of change was greater than for absolute VO2 max (L min−1) (400 group = 18.3 %; 600 group = 20.2 %) due to loss of body weight over the 10-mo intervention in both exercise groups. Our results indicate that exercise volume was not associated with change in aerobic fitness in a sample of previously sedentary, overweight and obese young adults.Item Feasibility and acceptability of a televideo physical activity and nutrition program for recent kidney transplant recipients(2020) Gibson, Cheryl A.; Gupta, Aditi; Greene, J. Leon; Lee, Jaehoon (TTU); Mount, Rebecca R.; Sullivan, Debra K.Background: Post-transplant weight gain affects 50-90% of kidney transplant recipients adversely affecting survival, quality of life, and risk for diabetes and cardiovascular disease. Diet modification and physical activity may help prevent post-transplant weight gain. Methods for effective implementation of these lifestyle modifications are needed. The objective of this study is to assess the feasibility and acceptability of a remotely delivered nutrition and physical activity intervention among kidney transplant recipients. Secondary aims were to estimate the effectiveness of the intervention in producing changes in physical activity, qualify of life, fruit and vegetable intake, and consumption of whole grains and water from baseline to 6 months. Methods: A randomized controlled study for stable kidney transplant recipients between 6 and 12 months post-transplantation was conducted. Participants were randomly assigned 1:1 to a technology-based, lifestyle modification program (intervention) or to enhanced usual care (control). Results: The first 10 kidney transplant recipients screened were eligible and randomized into the intervention and control groups with no significant between-group differences at baseline. Health coaching attendance (78%) and adherence to reporting healthy behaviors (86%) were high. All participants returned for final assessments. The weight in controls remained stable, while the intervention arm showed weight gain at 3 and 6 months. Improvements were found for physical activity, quality of life, and fruit and vegetable intake in both groups. All participants would recommend the program to other transplant recipients. Conclusions: Our data suggest that a remotely delivered televideo nutrition and physical activity intervention is feasible and valued by patients. These findings will aid in the development of a larger, more prescriptive, randomized trial to address weight gain prevention. Trial registration: Clinicaltrials.gov Identifier NCT03697317. Retrospectively registered on October 5, 2018.Item Impact of a brief intervention on cervical health literacy: A waitlist control study with jailed women(2017) Ramaswamy, Megha; Lee, Jaehoon (TTU); Wickliffe, Joi; Allison, Molly; Emerson, Amanda; Kelly, Patricia J.Jailed women are four-five times more likely to have had cervical cancer compared to women without criminal justice histories. Previous research has shown that an important contributor to cervical cancer risk, and perhaps lack of follow-up, is incarcerated women's low health literacy about broader reproductive health issues. Little work has been done to address this disparity. Thus, the objective of this study was to test the effectiveness of an intervention to improve incarcerated women's cervical health literacy and ultimately address cervical cancer disparities. Using a waitlist control design, we compared changes in cervical health literacy (knowledge, beliefs, self-efficacy, and confidence for screening and follow-up) among 188 incarcerated women who completed a 10-hour intervention between 2014 and 2016 in three Kansas City jails. We used bivariate tests and multivariate analyses that controlled for baseline cervical health literacy level and key covariates. Women in the intervention group showed significant gains in seven out of eight cervical health literacy domains (all p < 0.01), whereas the control group only improved in one domain (p < 0.01). When controlling for covariates, the intervention group had less barriers, perceptions of seriousness, susceptibility to disease, and increased self-efficacy for cervical health screening and follow-up, compared to the control group (all p < 0.05). A brief intervention is an effective way to improve jailed women's cervical health literacy, but should be provided alongside systemic efforts that expand access to correctional preventive health services, including the human papillomavirus vaccine, community-based cancer screenings, and health insurance after women leave jails and transition back to communities.Item Improving appropriate imaging for non-specific low back pain(2022) Al-Hihi, Eyad; Gibson, Cheryl; Lee, Jaehoon (TTU); Mount, Rebecca R.; Irani, Neville; McGowan, CaylinNon-specific low back pain (LBP) is a common condition in the USA, with approximately 80% of adults who will have LBP at some point during their life and roughly 30% of the adult population suffering from LBP at any given time. Although LBP is the most common cause of disability in the USA, it often has no identifiable anatomic or physiologic cause. Many patients seeking care for non-specific LBP receive X-rays and other imaging studies. However, for most acute LBP patients, symptoms resolve within 4 weeks and the use of routine imaging may result in unnecessary radiation exposure and add unnecessary costs and wasted time for patients without contributing to patient outcomes. The specific aim of the quality improvement (QI) project was to determine the effect of a multicomponent intervention to enhance the appropriate imaging utilisation for acute LBP to ≥90%. During the first 6 months of the QI project, 191 patients with LBP were seen. Of those patients, 156 (81.7%) received appropriate imaging over the 6-month intervention period, missing our targeted goal. Furthermore, this rate declined to baseline values after termination of the intervention, suggesting the need for additional prompts to sustain the initial intervention effect. Following a health system-wide deployment of practice-based alerts and quality score cards, the appropriate utilisation rate increased again and quickly to the target rate of 90%. To reduce variability in our clinical practice and to sustain an appropriate utilisation rate will require continued work. Health systems must find efficient methods to reduce LBP imaging and increase appropriate management of non-specific LBP in primary care. Increasing concordance with imaging guidelines can lessen harm associated with unnecessary radiation exposure and result in significant cost savings.Item Measuring Teacher Buy-in for the Texas Pay-for-Performance Program(2021) Lee, Jaehoon (TTU); Strong, Michael (TTU); Hamman, Doug (TTU); Zeng, Yifang (TTU)Teacher buy-in is a critical component for the success of any educational reform, especially one involving evaluation and compensation. We report on an instrument developed to measure teacher buy-in for district-developed designation plans associated with a state pay-for-performance (PFP) program, and teacher responses. We used modern test theory to investigate the instrument’s psychometric properties, a procedure often missing from research reports of self-designed surveys. A sample of 3,001 elementary, middle school, and high school teachers in Texas school districts participated in the survey. Our results suggest satisfactory reliability of the instrument and adequate discriminant validity in measuring distinct but related aspects of teacher buy-in. In addition, we found that teacher support for PFP as instantiated in their particular districts was generally high, but still buy-in levels varied significantly among different teacher groupings, pointing the way for future developers of pay-for-performance schemes to improve or maximize their acceptance.Item Spectral features of non-nutritive suck dynamics in extremely preterm infants(2023) Barlow, Steven M.; Liao, Chunxiao; Lee, Jaehoon (TTU); Kim, Seungman (TTU); Maron, Jill L.; Song, Dongli; Jegatheesan, Priya; Govindaswami, Balaji; Wilson, Bernard J.; Bhakta, Kushal; Cleary, John P.Background: Non-nutritive suck (NNS) is used to promote ororhythmic patterning and assess oral feeding readiness in preterm infants in the neonatal intensive care unit (NICU). While time domain measures of NNS are available in real time at cribside, our understanding of suck pattern generation in the frequency domain is limited. The aim of this study is to model the development of NNS in the frequency domain using Fourier and machine learning (ML) techniques in extremely preterm infants (EPIs). Methods: A total of 117 EPIs were randomized to a pulsed or sham orocutaneous intervention during tube feedings 3 times/day for 4 weeks, beginning at 30 weeks post-menstrual age (PMA). Infants were assessed 3 times/week for NNS dynamics until they attained 100% oral feeding or NICU discharge. Digitized NNS signals were processed in the frequency domain using two transforms, including the Welch power spectral density (PSD) method, and the Yule-Walker PSD method. Data analysis proceeded in two stages. Stage 1: ML longitudinal cluster analysis was conducted to identify groups (classes) of infants, each showing a unique pattern of change in Welch and Yule-Walker calculations during the interventions. Stage 2: linear mixed modeling (LMM) was performed for the Welch and Yule-Walker dependent variables to examine the effects of gestationally-aged (GA), PMA, sex (male, female), patient type [respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD)], treatment (NTrainer, Sham), intervention phase [1, 2, 3], cluster class, and phase-by-class interaction. Results: ML of Welch PSD method and Yule-Walker PSD method measures revealed three membership classes of NNS growth patterns. The dependent measures peak_Hz, PSD amplitude, and area under the curve (AUC) are highly dependent on PMA, but show little relation to respiratory status (RDS, BPD) or somatosensory intervention. Thus, neural regulation of NNS in the frequency domain is significantly different for each identified cluster (classes A, B, C) during this developmental period. Conclusions: Efforts to increase our knowledge of the evolution of the suck central pattern generator (sCPG) in preterm infants, including NNS rhythmogenesis will help us better understand the observed phenotypes of NNS production in both the frequency and time domains. Knowledge of those features of the NNS which are relatively invariant vs. other features which are modifiable by experience will likewise inform more effective treatment strategies in this fragile population.Item The impact of disasters on a heritage tourist destination: A case study of Nepal earthquakes(2020) Min, Jihye; Birendra, K. C.; Kim, Seungman (TTU); Lee, Jaehoon (TTU)This study examines the degree of macroeconomic recovery of the Nepal tourism industry after a natural disaster using the autoregressive integrated moving average model (ARIMA). The study investigated the case of Nepal's earthquakes in 2015 and examined the impact of the earthquakes on tourism inflows and GDP using time series data from 1990 to 2018. The results show that the increasing trend in the number of tourists changes in the post-earthquake period. In particular, the excess in tourist demand by age and purpose of visits after the earthquake indicates natural disaster as a potential reason for a tourism demand boost, often described as dark tourism in literature. This research shows the process of a heritage tourist destination assessing macroeconomic recovery from a natural disaster and fills the gap in the literature regarding purpose-based tourism demand and a link between dark tourism and disaster recovery on a heritage tourism destination.Item Wireless sensing of lower lip and thumb-index finger ‘ramp-and-hold’ isometric force dynamics in a small cohort of unilateral MCA stroke: Discussion of preliminary findings(2020) Barlow, Steven; Custead, Rebecca; Lee, Jaehoon (TTU); Hozan, Mohsen; Greenwood, JacobAutomated wireless sensing of force dynamics during a visuomotor control task was used to rapidly assess residual motor function during finger pinch (right and left hand) and lower lip compression in a cohort of seven adult males with chronic, unilateral middle cerebral artery (MCA) stroke with infarct confirmed by anatomic magnetic resonance imaging (MRI). A matched cohort of 25 neurotypical adult males served as controls. Dependent variables were extracted from digitized records of ‘ramp-and-hold’ isometric contractions to target levels (0.25, 0.5, 1, and 2 Newtons) presented in a randomized block design; and included force reaction time, peak force, and dF/dtmax associated with force recruitment, and end-point accuracy and variability metrics during the contraction hold-phase (mean, SD, criterion percentage ‘on-target’). Maximum voluntary contraction force (MVCF) was also assessed to establish the force operating range. Results based on linear mixed modeling (LMM, adjusted for age and handedness) revealed significant patterns of dissolution in fine force regulation among MCA stroke participants, especially for the contralesional thumb-index finger followed by the ipsilesional digits, and the lower lip. For example, the contralesional thumb-index finger manifest increased reaction time, and greater overshoot in peak force during recruitment compared to controls. Impaired force regulation among MCA stroke participants during the contraction hold-phase was associated with significant increases in force SD, and dramatic reduction in the ability to regulate force output within prescribed target force window (±5% of target). Impaired force regulation during contraction hold-phase was greatest in the contralesional hand muscle group, followed by significant dissolution in ipsilateral digits, with smaller effects found for lower lip. These changes in fine force dynamics were accompanied by large reductions in the MVCF with the LMM marginal means for contralesional and ipsilesional pinch forces at just 34.77% (15.93 N vs. 45.82 N) and 66.45% (27.23 N vs. 40.98 N) of control performance, respectively. Biomechanical measures of fine force and MVCF performance in adult stroke survivors provide valuable information on the profile of residual motor function which can help inform clinical treatment strategies and quantitatively monitor the efficacy of rehabilitation or neuroprotection strategies.