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Precise exercise prescription to improve walking capacity in people with chronic stroke
No full textMcCartney, Kiersten MetaThe residual effects of a stroke impact 795,000 people in the United States each year, and it is estimated stroke prevalence will increase by nearly 50% by 2035. Following stroke, a vast majority of individuals have significant difficulty walking which impairs their ability to independently complete household and community activities. The inability to independently walk leads many with chronic stroke to fall into a cycle of physical inactivity, which exacerbates the already elevated risk of secondary complications such as secondary stroke, cardiovascular disease, and/or mortality. Stroke-related disability leads to exorbitant economic health care costs, estimated to be $103.5 billion annually. ☐ Moderate-to-high intensity walking exercise interventions have shown promise in being an effective tool to improve walking speed and walking endurance in people with chronic stroke. However, current exercise guidelines for people with chronic stroke have imprecise recommendations for multiple parameters of exercise dose (volume, intensity, duration, etc.). This imprecise exercise dosing in combination with assuming all individuals with chronic stroke present to rehabilitation with the same characteristics, leaves it up to chance which individuals with chronic stroke will achieve improvements in their walking capacity and which will not. As the United States is faced with significant increases in stroke-related disability costs in the next decade, it is imperative there is precise exercise prescription to improve walking function in people with chronic stroke. ☐ Using advanced analytical techniques and a methodical and rigorous study design, this dissertation aimed to improve the precision of exercise dosing to optimize walking capacity outcomes in people with chronic stroke. To do this, this dissertation considered the heterogeneity of the chronic stroke population and the complexity of the exercise dose-response relationship. All clinical and training data used for this dissertation is from the Promoting Recovery Optimization of Walking Activity in Stroke randomized control trial (NCT 02835313). ☐ In Aim 1, we found there are homogeneous groups of people with chronic stroke who have vastly different clinical profiles. Despite significantly differing on measures of walking endurance, walking speed, balance self-efficacy, comorbidity burden, depressive symptoms, body mass index, and daily step activity, there were no differences between groups on the exercise dose attained across a fast-walking treadmill intervention. The overall exercise dose was quantified several different ways, yet the results remained the same: there were individuals in each group who attained higher doses of exercise and individuals who attained lower doses of exercise. This result was interesting as it has generally been thought that individuals with lower measures of walking capacity or physical health at baseline are likely to be unable to engage in similar amounts of moderate-to-high intensity exercise interventions. ☐ In Aim 2, it was found that exercise dose did not mediate the relationship between a group’s clinical profile and their change in walking speed or walking endurance. As there was no relationship between the clinical profile (the predictor) and exercise dose (the mediator), no mediation can be present. This result, in combination with individuals across the entire sample attaining various exercise doses agnostic to clinical profile, led to a modified analysis. Following a pooling of the entire sample, we tested the strength of 2 different metrics of exercise intensity to predict a change in walking speed or walking endurance after accounting for several important covariates. Surprisingly, heart rate was not a significant predictor of walking capacity outcomes, but training speed was. This is important as heart rate has nearly always been used to quantify exercise intensity in walking interventions in people with chronic stroke. These results support previous work suggesting that training speed may be a more precise metric of exercise intensity to use in walking exercise interventions in people with chronic stroke. ☐ In Aim 3, we found that exercise intensity, quantified as training speed, was not a significant predictor of who would attain a small or moderate meaningful change in walking speed or walking endurance. This result is important as researchers and clinicians often use minimal clinically important differences (MCID) to interpret if the outcome of their intervention(s) were meaningful to their patient. It may be that one parameter of exercise dose may not be sufficient to predict a dichotomized result of a small or moderate change in a walking capacity outcome. However, there is no consensus on the best approach to determining an MCID for rehabilitation measures, and uncertainty about whether these thresholds accurately assess a meaningful change in walking endurance in people with chronic stroke. This is an important consideration as it raises methodological concerns in using MCIDs for interpretation of responses to interventions. Further work is needed to determine if there is a metric with improved prediction accuracy to determine which individuals with chronic stroke will meet an MCID in walking speed or walking endurance. ☐ The overarching goal of this dissertation was to improve the precision of exercise prescription to optimize walking capacity outcomes in people with chronic stroke. Exercise prescription is a complex and nuanced process influenced by individual variability, the numerous ways to manipulate exercise dose, and the countless factors which may impact one’s ability to engage in exercise on a specific day or across time. The results of this dissertation demonstrate that when a specific outcome or goal of an exercise intervention is determined for a specific population, we can further refine exercise prescription while accounting for individual factors.University of Delaware, Department of Physical TherapyPh.D.University of Delaware, Biomechanics and Movement Science Progra
Effect of sulfation on a tough hybrid hydrogel network
No full textThis article was originally published in RSC Applied Polymers. The version of record is available at: https://doi.org/10.1039/D5LP00013K.
© 2025 The Author(s). Published by the Royal Society of Chemistry
This article is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported Licence (http://creativecommons.org/licenses/by-nc/3.0/).Hybrid hydrogels can mimic the exceptional stiffness of tough native tissues (e.g., articular cartilage). However, many of these tough hybrid hydrogels currently lack bioactive moieties. Therefore, our work focuses on introducing sulfated alginate into a tough poly(acrylamide-co-acrylic acid)/alginate hybrid hydrogel network. This modification introduces the potential for effective tissue interactions and allows further diversification through chemical transformations. These hydrogels are synthesized via the radical-mediated polymerization and covalent crosslinking of acrylamide and acrylic acid. The covalent network is fortified with a second ionically crosslinked sulfated alginate network. FTIR, 13C-NMR, and elemental analysis confirmed a degree of sulfation of 42.5%. Mechanical testing showed that hydrogels with a sulfated alginate content of 2 wt% exhibit comparable compressive stiffness (up to 230 kPa) to native articular cartilage. Cyclical mechanical testing revealed the network's resilience and remarkable toughness. These results suggest the hydrogels’ potential as cartilage mimics and support their additional investigation in vitro.The authors gratefully acknowledge funding from the Research Foundation Flanders (FWO) under contracts 1S19023N and G080020N, as well as the Special Research Fund (BOF) under contract BOF21OWB16. The authors are grateful to Huguette Penxten, Elsy Thijssen, Wouter Marchal, Arthur Helsen, Koen Van Vinckenroye, and Gunter Reekmans for their technical support
Physical activity characteristics, sleep health, and chronic pain in older adults with arthritis
No full textJi, XiaopengArthritis affects nearly 50% of older adults and leads to chronic pain, stiffness, and impaired mobility. Biobehavioral factors, such as sleep and physical activity (PA), play a key role in pain modulation. PA is recommended for arthritis management. However, the associations between daily PA and chronic pain remain unclear, particularly in individuals with poor sleep. Additionally, social determinants of health (SDOH), such as race and poverty, influence both sleep and pain. However, there is limited evidence on complex relationships among SDOH, sleep disturbance and pain. It was thus the aim of present study to 1) systematically review the literature on the associations of daily PA characteristics and sleep patterns with pain outcomes (i.e. intensity, interference, sensitivity) as well as the effect of PA and sleep interventions on pain in older adults with OA, 2) empirically investigate the association between PA characteristics and pain severity in older adults over time and the moderating role of sleep disturbance on this association, and 3) test how SDOH modifies the association between sleep disturbance and pain severity/interference in older adults with arthritis over time and explore whether sleep mediated the SDOH and pain relationship. ☐ Study one (Chapter 2) systematically reviewed the existing studies (n=25) on the relationship between PA, sleep health, and pain outcomes in older adults with arthritis, thereby providing the background and generating hypotheses for the empirical sub-studies. Using data sets from 3 waves of the Health and Retirement Study, mixed-effect multinominal logistic regression models were performed to test the association between PA and pain severity with sleep disturbance as a moderator (n=5,304) (chapter 3). Additionally, moderation and mediation analyses were conducted (n=5,024) to examine the associations among sleep, SDOH and pain over time (Chapter 4). The study findings of these studies suggested that sleep disturbances significantly amplified the association between reduced frequency in moderate PA and higher moderate pain (Chapter 3). In addition, the results showed that sleep disturbance was linked to greater pain severity and interference, while fewer social disadvantages reduced pain severity. Educational attainment, poverty, and food insecurity moderated the sleep-pain severity and interference associations. Sleep disturbances also partially mediated the relationships between SDOH and pain outcomes (Chapter 4). ☐ Findings from this dissertation provide preliminary evidence for understanding the multifaceted and interrelated association between PA, sleep health, and pain among older adults with arthritis, which may be useful for developing interventions to optimize pain management in this population. Future research is needed to develop integrated biobehavioral interventions to improve pain outcomes.University of Delaware, School of NursingPh.D
Legal Systems and Domestic Violence: Changes in Response to the COVID-19 Pandemic
No full textThis article was originally published in Journal of Family Violence. The version of record is available at: https://doi.org/10.1007/s10896-025-00850-z.
© The Author(s) 2025.
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.Purpose
The COVID-19 pandemic and associated public health control measures resulted in both higher rates of intimate partner abuse and violence (IPA/V) and more severe victimization. Domestic violence advocacy programs struggled to maintain organizational capacity to provide survivor-centered services in the face of both increased demand and rapid changes necessary to mitigate disease spread. The current study explores ways that legal advocates and the legal systems responded to the needs of IPA/V survivors.
Methods
Leaders of 25 state and territory Coalitions across the U.S. participated in the study. Semi-structured interview questions were based on rapidly emerging areas of concern and drew on possible strengths and weaknesses in direct service provision during the height of the COVID-19 pandemic, including questions about public health control measures, service provision, gaps in services, and lessons learned.
Results
Interviews with Coalition leaders revealed gaps in legal system responses during the pandemic, but also suggested new directions for service delivery. Four main themes emerged: lack of access to the legal system, limitations of in-person legal system responses, limitations of virtual legal system responses, and changes needed moving forward.
Conclusion
Backlogs in case processing communicate to survivors and the larger community that responding to IPA/V is not urgent. Advocates faced difficulty supporting survivors in person while virtual hearings sometimes presented other challenges for advocacy. However, some changes, including innovative online services and broad resolve to center BIPOC survivor voices, have the potential to enhance safety for survivors and push the movement forward.Funding was provided by the National Science Foundation (NSF), Award 2115943. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the National Science Foundation
EFFECTS OF A PARENTING INTERVENTION ON OXTR METHYLATION
No full textenterPrenatal opioid exposure (POE) is associated with adverse developmental outcomes,
including disruptions in caregiving quality and heightened risk for insecure attachment. Standard
medication-assisted treatment (MAT) for opioid use disorder during pregnancy does not address
deficits in maternal sensitivity, prompting interest in interventions targeting parenting behaviors.
This study examined the effects of a modified Attachment and Biobehavioral Catch-up (mABC)
intervention on DNA methylation of the oxytocin receptor gene (OXTR) in infants born to
mothers receiving MAT. Mother-infant dyads (N = 36) were randomized to receive either mABC
or a control intervention, and infant saliva samples were collected at 6 and 12 months postpartum
to assess methylation at two OXTR regions: exon 3 (OXTR3) and intron 1 (OXTRi). Mixed effects models revealed no significant main effects of intervention condition on OXTR3 or
OXTRi average methylation. These findings, however, may not capture and reflect more subtle
gene x environment interactions at the individual CpG site level, a necessary future step.
Integrating epigenetic measures into intervention research can reveal biologically sensitive
pathways that promote resilience in high-risk populations.ente
Bridging the Past and the Future: Addressing the Neglect of Boston’s Heart of African American Culture
No full textMy mission is to enhance the daily experience of residents in Nubian Square by recognizing and addressing their needs for safety, economic opportunity, and social connection. Through thoughtful design and community engagement, I aim to create a cultural corridor or greenway that fosters a sense of belonging, improves walkability, and strengthens local businesses. By prioritizing the voices of residents, my project seeks to balance revitalization with cultural preservation, ensuring that Nubian Square remains a thriving and inclusive space for all who call it home.Wik, AnnaZimmerman, Jame
Washington, Jefferson, and Franklins English ancestors: Northamptonshire and its influence on the founding fathers
No full textMontaño, JohnThe Thesis examines three founding fathers’ ancestry and why their heritage was the backbone of who they were. George Washington, Thomas Jefferson and Benjamin Franklin’s family hailed from the county of Northamptonshire, in central England, seventy miles north of London. Northamptonshire was known for its religious dissent during the sixteenth and seventeenth centuries. The county also had an abundance of wealth bought through land ownership and favors to the crown. Land enclosure also enhanced the gentry’s wealth. Religious conflict had a profound effect on the families of these three men, leading members of their English Families to move to America. Opportunities to increase wealth through trade overseas and colonization also helped Northamptonshire gentry. The thesis shows how their family history gave them financial and educational advantages not readily available to all settlers that took the journey across the Atlantic to seek a better life. Through the lens of their ancestors, the thesis shows how British History affected Thomas Jefferson’s, George Washington’s and Benjamin franklin’s lives. These men’s family’s journeys gave them the tools and confidence to pursue leadership in North America. Although each founding father’s family had a different story and outcome, they all had similar commonalities. They were all affected by the English Civil War and changes in Leadership. Their family’s status and values of education followed their families to America. Only one of the men acknowledges his English past but there is no doubt their English Heritage helped their families become some of the most important families in colonial history.M.A.University of Delaware, Liberal Studies Progra