VTechWorks Repository :: Browsing by Author "Rockwell, Michelle S."

Browsing by Author "Rockwell, Michelle S."

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The Benefits of Vitamin D Supplementation for Athletes: Better Performance and Reduced Risk of COVID-19
Grant, William B.; Lahore, Henry; Rockwell, Michelle S. (MDPI, 2020-12-04)
The COVID-19 pandemic is having major economic and personal consequences for collegiate and professional sports. Sporting events have been canceled or postponed, and even when baseball and basketball seasons resumed in the United States recently, no fans were in attendance. As play resumed, several players developed COVID-19, disrupting some of the schedules. A hypothesis now under scientific consideration is that taking vitamin supplements to raise serum 25-hydroxyvitamin D [25(OH)D] concentrations could quickly reduce the risk and/or severity of COVID-19. Several mechanisms have been identified through which vitamin D could reduce the risks of infection and severity, death, and long-haul effects of COVID-19: (1) inducing production of cathelicidin and defensins to reduce the survival and replication of the SARS-CoV-2 virus; (2) reducing inflammation and the production of proinflammatory cytokines and risk of the “cytokine storm” that damages the epithelial layer of the lungs, heart, vascular system, and other organs; and (3) increasing production of angiotensin-converting enzyme 2, thus limiting the amount of angiotensin II available to the virus to cause damage. Clinical trials have confirmed that vitamin D supplementation reduces risk of acute respiratory tract infections, and approximately 30 observational studies have shown that incidence, severity, and death from COVID-19 are inversely correlated with serum 25(OH)D concentrations. Vitamin D supplementation is already familiar to many athletes and sports teams because it improves athletic performance and increases playing longevity. Thus, athletes should consider vitamin D supplementation to serve as an additional means by which to reduce risk of COVID-19 and its consequences.
Body Project Implementation in Virginia Tech Athletics: Effect on Body Image Satisfaction and Thin Idealization
Labiaga, Janelle S. C. (Virginia Tech, 2020-05-21)
Eating disorders and disordered eating have a prevalence of 6% to 45% in collegiate female athletes (Knapp, Aerni, & Anderson, 2014). Thin idealization and body image dissatisfaction are risk factors for the development of disordered eating and eating disorders. Dissonance-based prevention programs have been shown to be effective in reducing thin idealization and body image dissatisfaction, as well as lessening risk of developing disordered eating and eating disorders. Currently, Virginia Tech Athletics does not utilize a group-based eating disorder prevention program for its female athletes. The purpose of this pilot project was to administer the Body Project, a dissonance-based prevention program aimed at reducing thin idealization and body image dissatisfaction, to female swimmers at Virginia Tech and evaluate the program’s effect on thin idealization and body image dissatisfaction. Thin idealization and body image dissatisfaction were evaluated via the Body Parts Satisfaction Survey-Revised (BPSS-R) and the Ideal Body Stereotype Survey-Revised (IBSS-R), respectively, before and after completion of the Body Project. Ten female swimmers, without current eating disorders, volunteered to participate, and nine swimmers (19.44 ± 1.42 years old; 5 freshmen, 2 juniors, and 2 seniors) completed the full project. Sixty-seven percent of participants (6 out of 9) experienced a reduction in their subscription to thin-ideal internalization (IBSS-R 2.96 ± 0.92 pre, 1.85 ± 0.88 post, p<0.05), while 78% of participants (7 out of 9) experienced an increase in body satisfaction (BPSS-R 4.42 ± 1.35 pre, 5.08 ± 0.90 post, p<0.05, p< 0.05). The findings of this pilot project suggest that the Body Project is an effective tool to influence subscription to thin-ideal internalization and body satisfaction in female college athletes. Continued effort to refine and implement the Body Project as group-based eating disorder prevention program for female college athletes is needed.
Clinical Management of Low Vitamin D: A Scoping Review of Physician's Practices
Rockwell, Michelle S.; Kraak, Vivica; Hulver, Matthew W.; Epling, John W. (MDPI, 2018-04-16)
The role of vitamin D in the prevention and treatment of non-skeletal health issues has received significant media and research attention in recent years. Costs associated with clinical management of low vitamin D (LVD) have increased exponentially. However, no clear evidence supports vitamin D screening to improve health outcomes. Authoritative bodies and professional societies do not recommend population-wide vitamin D screening in community-dwelling adults who are asymptomatic or at low risk of LVD. To assess patterns of physicians’ management of LVD in this conflicting environment, we conducted a scoping review of three electronic databases and the gray literature. Thirty-eight records met inclusion criteria and were summarized in an evidence table. Thirteen studies published between 2006 and 2015 across seven countries showed a consistent increase in vitamin D lab tests and related costs. Many vitamin D testing patterns reflected screening rather than targeted testing for individuals at high risk of vitamin D deficiency or insufficiency. Interventions aimed at managing inappropriate clinical practices related to LVD were effective in the short term. Variability and controversy were pervasive in many aspects of vitamin D management, shining a light on physicians’ practices in the face of uncertainty. Future research is needed to inform better clinical guidelines and to assess implementation practices that encourage evidence-based management of LVD in adult populations.
Dietary & Biological Assessment of Omega-3 Status of Collegiate Athletes: A Cross-Sectional Analysis
Ritz, Peter (Virginia Tech, 2019-11-17)
The National Collegiate Athletic Association (NCAA) recently made changes to its supplement policies, allowing Division I schools to provide fish oil/ omega-3 supplements to athletes. Given the relatively small body of research available on the topic, the purpose of this project was to assess the current intake of omega-3 fats in NCAA Division I athletes in their diets and their corresponding Omega-3 Index (O3i) blood levels, a blood measure suggested to be associated with the lowest risk of cardiovascular disease. In a total sample of 1528 participants (51% male, 19.9 ± 1.4 years of age) from 29 sports, only 6% (n=93) of participants achieved the Academy of Nutrition & Dietetics’ recommendation to consume 500 mg DHA+EPA/ day. Use of fish oil/ omega-3 supplements was reported by 15% (n=229) of participants. In a subset of 298 participants, zero participants met the suggested Omega-3 Index of >8%.This project produced similar findings to smaller previous studies, suggesting that collegiate athletes are not meeting the general recommendations for omega-3 fats.
Dietary and Biological Assessment of the Omega-3 Status of Collegiate Athletes: A Cross-Sectional Analysis
Ritz, Peter P.; Rogers, Mark B.; Zabinsky, Jennifer S.; Hedric, Valisa E.; Rockwell, John A.; Rimef, Ernest G.; Kostelnik, Samantha B.; Hulver, Matthew W.; Rockwell, Michelle S. (PLOS, 2020-04-29)
Omega-3 fatty acids (ω-3 FA) are associated with cardiovascular health, brain function, reduction of inflammation, and several other physiological roles of importance to competitive athletes. The ω-3 FA status of National Collegiate Athletic Association (NCAA) Division I athletes has not been well-described. The purpose of this study was to evaluate the ω-3 FA status of NCAA Division I athletes using dietary and biological assessment methodology. Athletes from nine NCAA Division I institutions from throughout the U.S. (n = 1,528, 51% male, 34 sports represented, 19.9 ± 1.4 years of age) completed a food frequency questionnaire (FFQ) to assess ω-3 FA from diet and supplements. Omega-3 Index (O3i) was evaluated in a sub-set of these participants (n = 298, 55% male, 21 sports represented, 20.0 ± 1.3 years of age) using dried blood spot sampling. Only 6% (n = 93) of athletes achieved the Academy of Nutrition & Dietetics’ recommendation to consume 500 mg DHA+EPA per day. Use of ω-3 FA supplements was reported by 15% (n = 229) of participants. O3i was 4.33 ± 0.81%, with no participants meeting the O3i benchmark of 8% associated with the lowest risk of cardiovascular disease. Every additional weekly serving of fish or seafood was associated with an absolute O3i increase of 0.27%. Overall, sub-optimal ω-3 FA status was observed among a large, geographically diverse group of male and female NCAA Division I athletes. These findings may inform interventions aimed at improving ω-3 FA status of collegiate athletes. Further research on athlete-specific ω-3 FA requirements is needed. Introduction
Does de-implementation of low-value care impact the patient-clinician relationship? A mixed methods study
Rockwell, Michelle S.; Michaels, Kenan C.; Epling, John W. (2022-01-06)
Background The importance of reducing low-value care (LVC) is increasingly recognized, but the impact of de-implementation on the patient-clinician relationship is not well understood. This mixed-methods study explored the impact of LVC de-implementation on the patient-clinician relationship. Methods Adult primary care patients from a large Virginia health system volunteered to participate in a survey (n = 232) or interview (n = 24). Participants completed the Patient-Doctor Relationship Questionnaire (PDRQ-9) after reading a vignette about a clinician declining to provide a low-value service: antibiotics for acute sinusitis (LVC-antibiotics); screening EKG (LVC-EKG); screening vitamin D test (LVC-vitamin D); or an alternate vignette about a high-value service, and imagining that their own primary care clinician had acted in the same manner. A different sample of participants was asked to imagine that their own primary care clinician did not order LVC-antibiotics or LVC-EKG and then respond to semi-structured interview questions. Outcomes data included participant demographics, PDRQ-9 scores (higher score = greater relationship integrity), and content analysis of transcribed interviews. Differences in PDRQ-9 scores were analyzed using one-way ANOVA. Data were integrated for analysis and interpretation. Results Although participants generally agreed with the vignette narrative (not providing LVC), many demonstrated difficulty comprehending the broad concept of LVC and potential harms. The topic triggered memories of negative experiences with healthcare (typically poor-quality care, not necessarily LVC). The most common recommendation for reducing LVC was for patients to take greater responsibility for their own health. Most participants believed that their relationship with their clinician would not be negatively impacted by denial of LVC because they trusted their clinician’s guidance. Participants emphasized that trusted clinicians are those who listen to them, spend time with them, and offer understandable advice. Some felt that not providing LVC would actually increase their trust in their clinician. Similar PDRQ-9 scores were observed for LVC-antibiotics (38.9), LVC-EKG (37.5), and the alternate vignette (36.4), but LVC-vitamin D was associated with a significantly lower score (31.2) (p < 0.05). Conclusions In this vignette-based study, we observed minimal impact of LVC de-implementation on the patient-clinician relationship, although service-specific differences surfaced. Further situation-based research is needed to confirm study findings.
The Effect of Curcumin on Oxidative Stress and Inflammatory Markers in Recreationally Active Women and Men
Ramadoss, Rohit Kumar (Virginia Tech, 2024-06-06)
Oxidative stress is a state characterized by an imbalance between the production and elimination of reactive oxygen species (ROS) within cells. ROS, also known as free radicals, are crucial for cellular signaling and are generated through natural processes. The antioxidant defense system typically regulates their concentrations to prevent oxidative stress-related damage. However, when ROS concentrations surpass a certain threshold and overwhelm the antioxidant defense system, it can lead to physiological issues and impairments in athletic performance. Additionally, oxidative stress and inflammation are closely related phenomena that can exacerbate each other, creating a vicious cycle. Both oxidative stress and inflammation play key roles in the pathophysiology of various chronic conditions such as cardiovascular diseases, neurodegenerative diseases, cancer, diabetes mellitus, autoimmune diseases, and accelerated aging. Furthermore, acute oxidative stress and inflammation have been shown to negatively affect performance by reducing skeletal muscle force output and increasing fatigue. Therefore, it is crucial to explore strategies to mitigate uncontrolled elevations of oxidative stress and inflammation. Curcumin, a bioactive compound found in turmeric, has been linked to antioxidant and anti-inflammatory properties. While cell line and animal studies have demonstrated the antioxidant and anti-inflammatory potential of curcumin, its effects in humans remain inconclusive. This dissertation project aimed to evaluate the effect of a four-week turmeric supplementation intervention on biomarkers associated with exercise-induced oxidative stress and inflammation in recreationally active individuals, 18 to 45 years of age. The study investigated curcumin's potential as an antioxidant and anti-inflammatory agent, while contributing to the existing literature on strategies for managing oxidative stress and inflammation. The findings from this research may offer valuable insights for promoting health, well-being, and athletic performance.
The Effect of Episodic Future Thinking on a Novel Measure of Behavioral Economic Demand for Exercise
Brown, Jeremiah M. (Virginia Tech, 2024-05-06)
Physical inactivity is a major contributor to increased disease prevalence and reduced quality of life. Measuring behavioral economic demand for exercise may enable more effective physical activity intervention development. In study one, we developed the leisure-time-as-price exercise purchase task (LT-EPT), wherein participants (n = 175) indicate hypothetical likelihood to trade leisure time for access to exercise time. We observed weak to moderate correlations between demand indices (Q1%, α, BP1, and Pmax) generated from the LT-EPT and self-reported leisure and exercise time, demonstrating initial validation of the LT-EPT. In study two, we examine the effect of episodic future thinking (EFT; vivid, personalized prospection of future events) in adults not meeting physical activity guidelines (n = 127) on demand for exercise and delay discounting (sensitivity to delayed rewards). We observed reduced delay discounting in participants randomized to engage in EFT, but no difference between EFT and health information thinking (HIT) controls. In study three, we further examined the effect of EFT on demand for exercise in adults with type 2 diabetes and obesity participating in a 24-week randomized controlled trial (n = 71). All participants engaged in a multicomponent behavioral intervention focused on weight loss and glycemic control; additionally, participants were randomized to engage in EFT or HIT thrice daily beginning in week 3. We measured demand for exercise and delay discounting (among other outcomes) at weeks 0, 8, and 24, observing no differences between EFT or HIT groups in demand indices (Q1%, α) or delay discounting at any time point. In conclusion, early evidence suggests that the LT-EPT may be a valid method to measure behavioral economic demand for exercise; however, EFT may not be an effective intervention to increase demand for exercise.
The Effect of Genetic Variations in the FADS1 Gene on Fatty Acid Metabolism
Steinbach, Rachel; Good, Deborah J.; Anderson, Angela S.; Rockwell, Michelle S. (Virginia Tech, 2022-12)
FADS1 is a key regulator of fatty acid metabolism with important implications for athlete health and performance. Mutations in the FADS1 gene have been linked to a variety of adverse health conditions, in addition to alterations in biochemical levels of fatty acids. Polyunsaturated fatty acids, including omega-3 and omega-6 fatty acids, are associated with rates of inflammation, immune function, and brain health in athletes. The purpose of this study was to explore the relationship between genetic variability, specifically in the FADS1 gene, and fatty acid metabolism in an athletic population. Methods: 20 collegiate football players were recruited for this study. Saliva samples were collected for the purpose of obtaining genetic information. Serum samples for ALA, AA, EPA, and DHA were collected to measure omega-3 and omega-6 fatty acid levels. Genotypes and serum measurements were compared using 3x3 Fisher Exact tests, and the online software PROVEAN was used to identify potential novel variants in the FADS1 gene. Results of this exploratory study suggest the minor allele for 9 variants in the FADS1 gene decrease baseline serum levels of EPA. These results suggest that genetic data may be useful in assessing individual athlete risk for n-3 PUFA deficiency and associated health consequences. Subsequently, this may allow athletes and sports practitioners to make better informed decisions about individual intake and supplementation of n-3 PUFAs, specifically, EPA and DHA.
The Effects of Subconcussive Head Impacts on Neurocognitive Performance in Collegiate Football Athletes
Torino, Leigha (Virginia Tech, 2022-08-26)
Chronic traumatic encephalopathy (CTE) is progressive degeneration of the brain that has been found in multiple case reports of American football athletes. A major predictor of CTE are subconcussive head impacts. Repetitive head impacts that do not result in signs or symptoms of a concussion have been termed ‘subconcussive head impacts.’ Researchers have begun to identify characteristics of subconcussive head impacts experienced during football (e.g., amount, force, speed, and direction of impacts), but to date, changes in these characteristics have not been described over the course of a full collegiate football season. In addition, research on the effects of subconcussive head impacts on neurocognitive performance is inconsistent. Neurocognitive performance is defined as the capability to think and reason through concentration, recall, learning, and processing information. Therefore, in this study we aimed to describe subconcussive head impacts experienced by American football athletes throughout a full collegiate season, and to evaluate the effect of a full season of subconcussive head impacts on neurocognitive performance through the assessment of complex brain activities, or cognition. National Collegiate Athletic Association (NCAA) Division I Football athletes from two programs served as participants (n=39, age 20.4+1.6 years). The data to describe subconcussive head impacts were collected through an accelerometer that attached to the participants’ helmets during all practices and games. The assessment of cognition was conducted through a testing battery, the Cambridge Neuropsychological Test Automated Battery (CANTAB). We found that over the course of one full season, participants experienced a mean of 824.5 head impacts at varying forces. Performance on assessments of memory, reaction time, and flexible thinking decreased from the start of the season to the end of the season. In addition, participants who experienced a higher amount of head impacts and who experienced a higher rotational speed of the head upon impact, performed worse on the assessments of neurocognitive performance. These results suggest an important target for decreasing the consequences of repetitive head impacts, such as a reduction in the amount of contact practices in exchange for film study or other non-contact options.
Exploring the Role of Biofeedback in Physiological Monitoring of Alcohol and Caffeine Consumption in Collegiate Softball Athletes
Fagan, Samantha (Virginia Tech, 2021-05-21)
Alcohol and caffeine, when consumed in excessive amounts, may negatively impact performance, health, and well-being. Nevertheless, college athletes have been shown to commonly consume these substances at a high level despite numerous interventions in place to moderate intake. The goal of this pilot project was to explore the role of biofeedback in monitoring and influencing alcohol and caffeine consumption among collegiate athletes. Twelve female NCAA Division I collegiate softball athletes (age: 19.1 ± 1.3; race: Caucasian/Non-Hispanic n=11,) wore a WHOOP® strap non-stop for 60 days to measure resting heart rate (RHR), heart rate variability (HRV), recovery (calculated from HRV, RHR, and hours of sleep), sleep, and energy (kcals) expended. Subjects also completed a brief daily survey regarding alcohol and caffeine intake during the previous 24 hours. At the end of the 60-day period, subjects participated in a semi-structured interview regarding their perception of the impact of wearing the WHOOP® strap on health-related behaviors. Overall, subjects consumed alcohol on 19.2±6.0% of days, at a rate of 1.0±0.7 servings of alcohol per day (range: 0 to 14 servings). Caffeine intake was 100.3±75.9 mg of caffeine per day. Alcohol intake was negatively associated with next-day and weekly recovery % (r=-0.304, p<0.001 and r=-0.576, p=0.02 respectively), sleep % (r=-0.286, p<0.001 and r= -0.434, p= 0.04) respectively), HRV (r=-0.251, p=<0.001 and r= -0.530, p= 0.029 respectively), and kcals expended (r=-0.213, p<0.001 and r= -0.528, p= 0.029 respectively), and was positively associated with next-day RHR (r=0.333, p<0.001). Caffeine intake was positively associated with weekly RHR (r= 0.653, p= 0.010) and negatively associated with next-day and weekly HRV (r=-0.079, p=0.034 and r= -0.500, p= 0.034 respectively), but not with any other measure. Eight of the twelve subjects perceived that the WHOOP® strap influenced their behavior in some way (sleep: n=6, caffeine: n=3, alcohol: n=2). In conclusion, alcohol and caffeine intake influenced multiple WHOOP® strap-derived physiological measures in a small cohort of collegiate softball players. This method of biofeedback shows promise for monitoring alcohol and caffeine consumption and potentially modifying related behaviors in athletes.
Implementation of a Multimodal Heart Failure Management Protocol in a Skilled Nursing Facility
Rockwell, Michelle S.; Cox, Emily; Locklear, Tonja; Hodges, Brandy; Mulkey, Stacey; Evans, Brandon; Epling, John W.; Stavola, Anthony R. (SAGE, 2023-02)
Hospitals and skilled nursing facilities (SNFs) are incentivized to reduce hospital readmissions among patients with heart failure (HF). We used the RE-AIM framework and mixed quantitative and qualitative data to evaluate the implementation of a multimodal HF management protocol (HFMP) administered in a SNF in 2021. Over 90% of eligible patients were enrolled in the HFMP (REACH). Of the 42 enrolled patients (61.9% female, aged 81.9 ± 8.9 years, 9.5% Medicaid), 2 (4.8%) were readmitted within 30 days of hospital discharge and 4 (9.5%) were readmitted within 30 days of SNF discharge compared with historical (2020) rates of 16.7% and 22.2%, respectively (a potential savings of $132,418–$176,573 in hospital costs) (EFFECTIVENESS). Although stakeholder feedback about ADOPTION and IMPLEMENTATION was largely positive, challenges associated with clinical data collection, documentation, and staff turnover were described. Findings will inform refinement of the HFMP to facilitate further testing and sustainability (MAINTENANCE).
Implementation of Blood Flow Restriction for Injury Rehabilitation in the Athletic Training Setting
Ziyout, Hisham A.J.; Hulver, Matthew W.; Rockwell, Michelle S.; Goforth, Michael W. (Virginia Tech, 2019-05-06)
Rehabilitation after an injury in athletics is a major concern for athletes and athletic trainers. The athletic trainer is responsible for returning the injured athlete back to participation as fast and safely as possible. Since it is typically unsafe to apply heavy loads, such as weights, to an extremity after an injury, atrophy tends to occur to the injured area. Blood flow restriction is a modality that is fairly new in the United States. Research has shown that blood flow restriction used during low-intensity (20-30% 1RM) loads significantly increases muscular strength and hypertrophy compared to high-intensity loads (>70% 1RM) without blood flow restriction (Pope et al, 2013). The purpose of this project was to document preliminary experiences with blood flow restriction in a collegiate athletics setting and disseminate practical information about blood flow restriction to practicing athletic trainers across the United States. Blood flow restriction has been shown to be a safe and effective resource for clinicians when helping a patient rehabilitate from surgery and return to participation faster, although minimal clinical trial evidence is available. When blood flow restriction was incorporated as a treatment modality within the Department of Intercollegiate Athletics at Virginia Tech, positive effects on injury rehabilitation and patient compliance were observed. Further research on blood flow restriction during injury rehabilitation is needed in order to help practicing athletic trainers make the best evidence-based decisions when utilizing this modality with their patient.
Lessons Learned during the Transition to Online Learning
Anderson, Angela S.; Cox, Heather; Eaton, Renee; Rockwell, Michelle S.; Girmes-Grieco, Nicolin; Jaskowak, Daniel; Good, Deborah J. (2021-02-05)
Lessons Learned during the Transition to Online Learning in a University Nutrition and Exercise Department
Anderson, Angela S.; Cox, Heather; Eaton, Renee; Girmes-Grieco, Nicolin; Rockwell, Michelle S.; Good, Deborah J. (InTech Open, 2023)
In the spring semester of 2020, the COVID-19 pandemic led to an unprecedented shift from face-to-face learning to an instantaneous online learning environment. At the time, the department of Human Nutrition, Foods, and Exercise (HNFE) at Virginia Tech had few online class offerings. Twenty-nine Spring 2020 HNFE classes were transitioned from traditional face-to-face offerings to online delivery models. Many members of the HNFE faculty have strong pedagogical training, but the immediate pedagogical shift in the middle of the semester gave little time for adequate course design geared toward online learning. As such, the purpose of this study was to evaluate student perceptions of the transition to online learning. A departmental survey employing quantitative and qualitative questions was used to assess students’ learning experiences in the spring of 2020 and then re-employed at the conclusion of the Fall 2020 semester to re-assess students’ online course experience and identify if the department was improving in online course delivery. An additional component of the survey specifically evaluated students’ self-perceived motivation for learning. Examples of educational and logistical strategies in online learning environments implemented by instructors and findings of students’ experiences from both surveys will be shared.
Moving Online Together: Enhancing Mental Health and Social Connection Through a Virtual Dance Class During COVID-19
Humphries, Ashlee; Basso, Julia C.; Rockwell, Michelle S.; Zabinsky, Jennifer S. (Virginia Tech, 2021-05-19)
Physical activity has profound acute effects on the body and brain, causing a cascade of beneficial physiological and psychological processes to occur. Dance, a multidimensional form of physical activity, has shown similar positive effects in long-term studies, but no studies to date have looked at the relationship between mental health and social outcomes of dance. In March of 2020, the quarantine that took place due to COVID-19 caused a sense of social isolation, lack of physical connection, and increased mental health issues. In this study, we explore the hypothesis that online dance can acutely improve mental health and connection during a time of isolation. N=47 healthy adults completed a series of self-reported Qualtrics questionnaires before and after a single 60- minute online dance session. Data were analyzed using paired-samples t-tests, Pearson's correlations, and linear regressions. Online dance acutely improved mental health by increasing positive affect and self-esteem while decreasing negative affect and depression. Social and community connectedness were also enhanced, with those who experienced the largest decreases in negative affect demonstrating the largest gains in social connectivity. Further, an individual’s trait learning style influenced class efficacy, with tactile learners benefitting the most in mood state and visual learners benefitting the most socially. Finally, we found that greater levels of experienced enjoyment improved mood state, whereas greater levels of perceived difficulty resulted in increased anxiety. We suggest best practices for online dance, provide future areas of research, and highlight the importance of using online learning to increase dance accessibility to diverse populations.
Probiotic and Fermented Food Intake and Its Association with Gastrointestinal Symptoms in Collegiate Athletes
Bowman, Mackenzie (Virginia Tech, 2021-05-04)
Background: Probiotic supplements have shown the potential to reduce gastrointestinal (GI) distress symptoms; however, there is currently little research on dietary probiotic intake or the impact of probiotic food consumption on GI symptoms, particularly among athletes. Purpose: The purpose of this project was to: 1) develop and evaluate a tool for assessing intake of probiotic foods among collegiate athletes, 2) assess intake of probiotic and fermented foods among collegiate athletes at Virginia Tech, and 3) explore associations between intake of these items and GI symptoms in this study population. Methods: A literature review, review of 360 dietary recalls previously collected from collegiate athletes (n=120), and evaluation by five experts in sports nutrition and/or probiotic foods informed the development of a brief probiotic food frequency questionnaire (PRO-Q). The PRO-Q was then administered to participants (n=42), all of whom were members of Division I sports teams at Virginia Tech. Validity was assessed by comparing PRO-Q responses with probiotic intake determined using three 24-hour diet recalls (reference method). Participants also completed a questionnaire to evaluate type and severity of GI symptoms. Results: Overall intake of probiotic/fermented foods in this population was low (0.77 servings/day), with only 17% of participants reporting daily consumption. Based on Spearman’s Rho (r=0.766, p<0.001), Wilcoxon Signed-Rank test (p=0.168, indicating no difference between methods), and Bland-Altman analyses (95% agreement), PRO-Q responses were consistent with dietary recalls for average daily intake of probiotic/fermented foods. A total of 52% of participants reported experiencing regular GI distress symptoms. There was no association between PRO-Q responses and overall GI symptom score (r = 0.297, p = 0.056). Conclusion: These findings suggest that among collegiate athletes, probiotic/fermented food intake was generally low and GI distress symptoms were prevalent. The PRO-Q shows promise as a brief, self-administered method to assess probiotic/fermented food intake among collegiate athletes, although additional research is needed to confirm reproducibility and generalizability in larger samples.
Reallocating Cervical Cancer Preventive Service Spending from Low- to High-Value Clinical Scenarios
Rockwell, Michelle S.; Armbruster, Shannon D.; Capucao, Jillian C.; Russell, Kyle B.; Rockwell, John A.; Perkins, Karen E.; Huffstetler, Alison N.; Mafi, John N.; Fendrick, A. Mark (American Association for Cancer Research, 2023-07-05)
Timely follow-up care after an abnormal cervical cancer screening test result is critical to the prevention and early diagnosis of cervical cancer. The current inadequate and inequitable delivery of these potentially life-saving services is attributed to several factors, including patient out-of-pocket costs. Waiving of consumer cost-sharing for follow-up testing (e.g., colposcopy and related cervical services) is likely to improve access and uptake, especially among underserved populations. One approach to defray the incremental costs of providing more generous coverage for follow-up testing is reducing expenditures on "low-value" cervical cancer screening services. To explore the potential fiscal implications of a policy that redirects cervical cancer screening resources from potentially low- to high-value clinical scenarios, we analyzed 2019 claims from the Virginia All-Payer Claims Database to quantify (i) total spending on low-value cervical cancer screening and (ii) out-of-pocket costs associated with colposcopy and related cervical services among commercially insured Virginians. In a cohort of 1,806,921 female patients (ages 48.1 ± 24.8 years), 295,193 claims for cervical cancer screening were reported, 100,567 (34.0%) of which were determined to be low-value ($4,394,361 total; $4,172,777 for payers and $221,584 out-of-pocket [$2/patient]). Claims for 52,369 colposcopy and related cervical services were reported ($40,994,016 total; $33,457,518 for payers and $7,536,498 out-of-pocket [$144/patient]). These findings suggest that reallocating savings incurred from unnecessary spending to fund more generous coverage of necessary follow-up care is a feasible approach to enhancing cervical cancer prevention equity and outcomes. PREVENTION RELEVANCE: Out-of-pocket fees are a barrier to follow-up care after an abnormal cervical cancer screening test. Among commercially insured Virginians, out-of-pocket costs for follow-up services averaged $144/patient; 34% of cervical cancer screenings were classified as low value. Reallocating low-value cervical cancer screening expenditures to enhance coverage for follow-up care can improve screening outcomes. See related Spotlight, p. 363.
Screening, Assessment, and Treatment for Inadequate Vitamin D Status in Athletes: Development of a Policy for Virginia Tech Athletics
Bechard, Alexandra L. (Virginia Tech, 2020-04-29)
In the general population, up to 77% of individuals have inadequate vitamin D concentrations. Athletes are not immune to this pandemic, as many have been identified as having insufficient or deficient 25(OH)D concentrations as well. Insufficient and deficient concentrations of 25(OH)D in athletes have been linked to development of stress fracture, soft tissue injury and upper respiratory tract infection (URTI). With the appropriate tools, sports medicine and sports nutrition practitioners can provide care for at-risk athletes and attenuate the financial, health and sport participation costs of vitamin D related illness and injury. Inconsistencies in the literature and a lack of universal recommendations make it challenging to develop department policies and protocols for athletic education tools. The purpose of this project was twofold: firstly, to create a vitamin D policy based on the literature that may be used by the Virginia Tech Athletic Department. Secondly, to evaluate current Virginia Tech Sports Medicine and Sports Nutrition vitamin D practices and tools to understand the costs and systems that may influence the adoption of the policy while also ensuring current practices and tools are up to date.
Socializing the evidence for diabetes control to develop “mindlines”: a qualitative pilot study
Epling, John W.; Rockwell, Michelle S.; Miller, Allison D.; Carver, M. Colette (2021-09-07)
Background Evidence on specific interventions to improve diabetes control in primary care is available, but this evidence is not always well-implemented. The concept of “mindlines” has been proposed to explain how clinicians integrate evidence using specifics of their practices and patients to produce knowledge-in-practice-in-context. The goal of this pilot study was to operationalize this concept by creating a venue for clinician-staff interaction concerning evidence. The research team attempted to hold “mindlines”-producing conversations in primary care practices about evidence to improve diabetes control. Methods Each of four primary care practices in a single health system held practice-wide conversations about a simple diabetes intervention model over a provided lunch. The conversations were relatively informal and encouraged participation from all. The research team recorded the conversations and took field notes. The team analyzed the data using a framework adapted from the “mindlines” research and noted additional emergent themes. Results While most of the conversation concerned barriers to implementation of the simple diabetes intervention model, there were examples of practices adopting and adapting the evidence to suit their own needs and context. Performance metrics regarding diabetes control for the four practices improved after the intervention. Conclusion It appears that the type of conversations that “mindlines” research describes can be generated with facilitation around evidence, but further research is required to better understand the limitations and impact of this intervention.

Browsing by Author "Rockwell, Michelle S."

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