Publications by authors named "Amanda Blake"

10 Publications

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Sustained resiliency building and burnout reduction for healthcare professionals via organizational sponsored mindfulness programming.

Explore (NY) 2021 Apr 16. Epub 2021 Apr 16.

Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, OH, United States.

Purpose: To measure healthcare professional (HCP) result sustainability following implementation of an organizationally sponsored Mindfulness Based Intervention (MBI), Mindfulness in Motion (MIM), in areas of burnout, perceived stress, resilience, and work engagement.

Methods: A follow-up survey was sent via email to healthcare professionals (n = 220) who previously participated in the 8-week MIM intervention. Survey assessed burnout, perceived stress, resilience, work engagement, and included open-ended questions pertaining to barriers, facilitators, and sustained impact of practicing mindfulness after program end.

Results: Analysis included 66 healthcare professionals with sustainability time frames ranging from 3 to 28 months from initial program finish. Average time since intervention end was 12.2 months. Based on 12.2 months sustained results post MIM, there were significant differences from pre-MIM to sustainability follow-up in burnout (*p = 0.0047), perceived stress (*p = 0.00001), and resilience (*p = 0.0004). Work engagement benefits were non-significant from pre-test to follow-up (p = 0.4008). There were no significant differences in results when comparing the length of time since participant was enrolled in the initial study. Additionally, analysis of the qualitative data revealed multiple subthemes relating to facilitators of sustained mindfulness, barriers to practicing mindfulness, and lasting impacts of the MIM intervention.

Conclusions: For Healthcare Professionals, the organizationally sponsored mindfulness intervention outcomes were sustained beyond the 8-weeks of the initial MIM intervention for all but one outcome variable. Post 8-week intervention end, participants were given the option of receiving weekly "Mindful Moment" emails and attending monthly mindfulness booster sessions. Organizational support may be a pivotal factor in sustaining positive results achieved via mindfulness programming.
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April 2021

Embracing Change: A Mindful Medical Center Meets COVID-19.

Glob Adv Health Med 2020 11;9:2164956120975369. Epub 2020 Dec 11.

College of Medicine, The Ohio State University, Columbus, Ohio.

Background: Healthcare professional (HCP) burnout transcends clinician job title and role, thus creating a need for interprofessional strategies to address burnout. The organizational framework of offering employer-sponsored mindfulness programming to HCPs sets the stage for an orchestrated, mindful response to COVID-19.

Objective: This single arm pre-post interventional research tested changes in measures of burnout, resilience, perceived stress and work engagement for interprofessional HCP faculty and students participating in , a novel eight-week multimodal evidenced-based onsite intervention.

Methods: A Graduate Medical Education (GME) pilot of was expanded to target inter-professional resiliency within an academic health center. is the core offering of the Gabbe Health and Wellness program for students, staff, faculty, and residents and is embedded across the entire medical center.

Results: The faculty/student role demographic categories (n = 267) included resident physicians, resident chaplains, attending physicians, medical center faculty, and hospital administrative/managerial clinical staff. These cohorts demonstrated significant 27% reduction in participants meeting burnout criteria. Total burnout was determined by scores on subscales of emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA) of the Maslach Burnout Inventory (MBI). There was a highly significant pre/post decrease in the in the emotional exhaustion (p < 0.00001) and depersonalization scores (p < 0.001), with highly significant increase in the personal accomplishment (p < 0.00001) scores. Resilience, as measured by the Connor Davidson Resiliency Scale (CDRS), significantly increased (p < 0.00001), alongside a significant increase (p < 0.00001) in the total Utrecht Work Engagement Score (UWES) and a significant decrease in scores on the Perceived Stress Scale (PSS) (p < 0.00001).

Conclusion: significantly reduced burnout and perceived stress, for interprofessional (HCP) faculty and staff, while increasing resilience and work engagement in a large healthcare system. These results paved the way for an organizational response that utilized mindfulness to empower HCPs to navigate through the novel challenges presented by COVID-19.
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December 2020

Developmental stages in microbiota, bile acids, and clostridial species in healthy puppies.

J Vet Intern Med 2020 Nov 13;34(6):2345-2356. Epub 2020 Oct 13.

Gastrointestinal Laboratory - Texas A&M University, College Station, Texas, USA.

Background: The fecal microbiota, fecal bile acid concentrations, and abundance of Clostridium perfringens and Clostridium difficile are altered in acute and chronic gastrointestinal disease in adult dogs. However, less is known in young puppies.

Hypothesis/objectives: To determine composition of the fecal microbiota, assess development of fecal bile acid profiles, and determine the abundance of Clostridial species in puppies, young adult dogs, and adult dogs.

Animals: Healthy puppies from a whelping kennel (n = 53) and healthy client-owned dogs <1 year old (n = 20) were separated into 6 age groups, then compared to client-owned dogs over 1 year of age (n = 13).

Methods: Prospective observational study. Naturally voided fecal samples were analyzed by quantitative polymerase chain reaction to measure bacterial abundances. Fecal bile acids were quantified using gas chromatography-mass spectrometry.

Results: Puppies up to 5 to 6 weeks of age had increased Dysbiosis Index (median [min-max]: 5.39 [1.32-8.6], P < .001), increased abundance of C. difficile (4.1 [0.01-4.85] log DNA, P < .001), decreased secondary bile acid concentrations (0.61 [0.28-5.06] μg/mg, P = .006), and decreased abundance of C. hiranonis (0.84 [0.01-6.71], P = .005) compared to adult dogs (-4.62 [-8.36 to -0.61], 0.01 [0.01-0.01], 4.12 [0.32-8.94], and 6.02 [5.06-7.00], respectively). Secondary bile acid concentration positively correlated with C. hiranonis abundance (ρ = 0.77; P < .001).

Conclusions And Clinical Importance: The increase in secondary bile acids and simultaneous decrease of C. difficile and C. perfringens after 5 to 6 weeks of age warrants further investigation into regulatory impacts that secondary bile acids could have on clostridial species in dogs.
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November 2020

Effects of metronidazole on the fecal microbiome and metabolome in healthy dogs.

J Vet Intern Med 2020 Sep 28;34(5):1853-1866. Epub 2020 Aug 28.

Gastrointestinal Laboratory, Department of Small Animal Clinical Sciences, Texas A&M University, College Station, Texas, USA.

Background: Metronidazole has a substantial impact on the gut microbiome. However, the recovery of the microbiome after discontinuation of administration, and the metabolic consequences of such alterations have not been investigated to date.

Objectives: To describe the impact of 14-day metronidazole administration, alone or in combination with a hydrolyzed protein diet, on fecal microbiome, metabolome, bile acids (BAs), and lactate production, and on serum metabolome in healthy dogs.

Animals: Twenty-four healthy pet dogs.

Methods: Prospective, nonrandomized controlled study. Dogs fed various commercial diets were divided in 3 groups: control group (no intervention, G1); group receiving hydrolyzed protein diet, followed by metronidazole administration (G2); and group receiving metronidazole only (G3). Microbiome composition was evaluated with sequencing of 16S rRNA genes and quantitative polymerase chain reaction (qPCR)-based dysbiosis index. Untargeted metabolomics analysis of fecal and serum samples was performed, followed by targeted assays for fecal BAs and lactate.

Results: No changes were observed in G1, or G2 during diet change. Metronidazole significantly changed microbiome composition in G2 and G3, including decreases in richness (P < .001) and in key bacteria such as Fusobacteria (q < 0.001) that did not fully resolve 4 weeks after metronidazole discontinuation. Fecal dysbiosis index was significantly increased (P < .001). Those changes were accompanied by increased fecal total lactate (P < .001), and decreased secondary BAs deoxycholic acid and lithocholic acid (P < .001).

Conclusion And Clinical Importance: Our results indicate a minimum 4-week effect of metronidazole on fecal microbiome and metabolome, supporting a cautious approach to prescription of metronidazole in dogs.
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September 2020

Fecal Microbial and Metabolic Profiles in Dogs With Acute Diarrhea Receiving Either Fecal Microbiota Transplantation or Oral Metronidazole.

Front Vet Sci 2020 16;7:192. Epub 2020 Apr 16.

Gastrointestinal Laboratory, Department of Small Animal Clinical Sciences, Texas A&M University, College Station, TX, United States.

The aim was to characterize differences in fecal consistency, and fecal microbiota and metabolome profiles in dogs with acute diarrhea (AD) treated with either fecal microbiota transplantation as enema (FMT; = 11) or oral metronidazole (MET; = 7) for 7 days. On days 0, 7, and 28 fecal samples were obtained. Fecal samples from healthy dogs (HC; = 14) were used for comparison. Samples were analyzed by the previously validated qPCR based canine Dysbiosis Index (DI; increased values indicate microbiota dysbiosis) and 16S rRNA gene sequencing. The fecal metabolome was analyzed using a previously validated targeted canine assay for fecal unconjugated bile acids, and untargeted metabolomics. Fecal consistency improved significantly in dogs treated with FMT and MET by day 7 and day 28 ( < 0.01) compared to day 0. However, on day 28 fecal consistency was significantly better in FMT compared to MET ( = 0.040). At day 0, dogs with AD had an altered microbiota indicated by significantly increased DI, decreased alpha-diversity, and altered beta-diversity. In the FMT group, the DI decreased over time, while MET led to a significant increase in the dysbiosis index at day 7 and 28 compared to FMT. Sequencing data revealed that in FMT microbial diversity and beta-diversity was similar to HC at day 28, while in MET these parameters were still significantly different from HC. In dogs treated with FMT, a decrease in cholic acid and the percentage of primary bile acids was observed, whereas treatment with metronidazole led to an increase in cholic acid at day 7 and an increase in percentage of primary bile acids over time. Based on untargeted metabolomics, dogs with AD had an altered fecal metabolome compared to HC. Dogs treated with FMT clustered closer to HC at day 28, while dogs treated with MET did not. In this pilot study, dogs with AD had significant differences in fecal microbiota and metabolome profiles. Dogs treated with MET still had altered microbial and metabolic profiles at day 28 compared to dogs treated with FMT or healthy dogs.
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April 2020

Long-term impact of tylosin on fecal microbiota and fecal bile acids of healthy dogs.

J Vet Intern Med 2019 Nov 31;33(6):2605-2617. Epub 2019 Oct 31.

Gastrointestinal Laboratory, Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas.

Background: Tylosin is commonly prescribed to dogs with diarrhea. Orally administered antibiotics may alter the intestinal microbiota, which is responsible for crucial key bile acid (BA) biotransformation reactions.

Objectives: To prospectively evaluate the impact of tylosin administration on fecal microbiota and unconjugated bile acids (UBAs) over time.

Animals: Sixteen healthy adult dogs.

Methods: Prospective, randomized controlled clinical trial. Dogs were randomized to receive 20 mg/kg of tylosin or a placebo capsule PO q12h for 7 days while undergoing daily fecal scoring. Fecal samples were collected on days 0, 7, 21, and 63. The microbiota was assessed using quantitative PCR and 16S rRNA gene sequencing. Unconjugated BAs were assessed using gas chromatography-mass spectrometry (GC-MS).

Results: Fecal scores were unchanged during placebo and tylosin administration. In the placebo group, no significant changes were observed in fecal microbiota or UBA concentrations. Day 7 samples from tylosin-exposed dogs exhibited decreased bacterial diversity (observed species, Chao1, Shannon, P < .001) characterized by decreases in anaerobes Fusobacteriaceae (linear discriminant analysis [LDA] score, 5.03) and Veillonellaceae (LDA score, 4.85). Primary UBA concentrations were increased at day 21 (median, [range]; 7.42, [0.67-18.77] μg/kg; P = .04) and day 63 (3.49 [0-28.43] μg/kg; P = .02) compared to day 0 (.14 [.03-1.19] μg/kg) in dogs receiving tylosin. At day 63, bacterial taxa were not significantly different compared to day 0, but the extent of microbial recovery was individualized.

Conclusions And Clinical Importance: Tylosin causes fecal dysbiosis in healthy dogs with corresponding shifts in fecal UBAs. Changes did not uniformly resolve after discontinuation of tylosin.
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November 2019

Altered microbiota, fecal lactate, and fecal bile acids in dogs with gastrointestinal disease.

PLoS One 2019 31;14(10):e0224454. Epub 2019 Oct 31.

Gastrointestinal Laboratory, Texas A&M University, Texas, United States of America.

The intestinal microbiota plays an important role in health and disease and produces, through fermentative reactions, several metabolic products, such as lactate, that can affect the host. The microbiota also interacts with and metabolizes compounds produced by the host, such as primary bile acids. Lactate and bile acids (BA) are of particular interest in gastrointestinal diseases because they have been associated with metabolic acidosis and bile acid diarrhea, respectively. The objectives of this study were to validate an enzymatic assay to quantify D-, L-, and total lactate in canine feces, and to characterize fecal lactate and BA concentrations as well as bacterial abundances in healthy dogs and dogs with gastrointestinal diseases. Fecal samples were collected from 34 healthy dogs, 15 dogs with chronic enteropathy (CE), and 36 dogs with exocrine pancreatic insufficiency (EPI). Lactate was quantified with an enzymatic assay, BA with gas chromatography-mass spectrometry, and 11 bacterial groups with qPCR. A fecal lactate reference interval was established from 34 healthy dogs and was 0.7-1.4 mM, 0.3-6.0 mM, and 1.0-7.0 mM for D-, L-, and total lactate, respectively. The assay to measure D-, L-, and total lactate in canine fecal samples was linear, accurate, precise, and reproducible. Significant increases in fecal lactate and decreases in secondary BA concentrations were observed in dogs with CE and dogs with EPI. Dogs with EPI had an increased abundance of Escherichia coli, Lactobacillus, and Bifidobacterium; a decreased abundance of Fusobacterium and Clostridium hiranonis; and a higher Dysbiosis Index when compared to healthy dogs. Further studies are necessary to determine the clinical utility of lactate and BA quantification in canine feces. These metabolites suggest functional alterations of intestinal dysbiosis and may become promising targets for further elucidating the role of the microbiota in health and disease.
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March 2020

Comparison of intestinal expression of the apical sodium-dependent bile acid transporter between dogs with and without chronic inflammatory enteropathy.

J Vet Intern Med 2018 Nov 12;32(6):1918-1926. Epub 2018 Oct 12.

Gastrointestinal Laboratory, Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas.

Background: Intestinal absorption of bile acids is mediated by the apical sodium-dependent bile acid transporter (ASBT). Fecal bile acid dysmetabolism has been reported in dogs with chronic inflammatory enteropathy (CIE).

Objective: Characterization of ASBT distribution along the intestinal tract of control dogs and comparison to dogs with CIE.

Animals: Twenty-four dogs with CIE and 11 control dogs.

Methods: The ASBT mRNA and protein expression were assessed using RNA in situ hybridization and immunohistochemistry, respectively. The concentrations of fecal bile acids were measured by gas chromatography-mass spectrometry. The fecal microbiota dysbiosis index was assessed with a quantitative polymerase chain reaction panel.

Results: In control dogs, ASBT mRNA expression was observed in enterocytes in all analyzed intestinal segments, with highest expression in the ileum. The ASBT protein expression was restricted to enterocytes in the ileum, cecum, and colon. Dogs with CIE had significantly decreased expression of ASBT protein in the ileum (P = .001), which was negatively correlated with histopathological score (ρ = -0.40; P = .049). Additionally, dogs with CIE had a significantly increased percentage of primary bile acids in feces compared to controls (P = .04). The fecal dysbiosis index was significantly higher in dogs with CIE than in control dogs (P = .01).

Conclusions And Clinical Importance: These findings indicate that ileal protein expression of ASBT is downregulated in dogs with CIE. This change may be linked to the inflammatory process, intestinal dysbiosis, and fecal bile acid dysmetabolism observed in these patients.
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November 2018

Dermatopontin in Bone Marrow Extracellular Matrix Regulates Adherence but Is Dispensable for Murine Hematopoietic Cell Maintenance.

Stem Cell Reports 2017 09 24;9(3):770-778. Epub 2017 Aug 24.

Department of Pediatrics, Blood and Marrow Transplant Program, University of Minnesota Medical School, MMC 366, 420 Delaware Street SE, Minneapolis, MN 55455, USA. Electronic address:

The hematopoietic marrow microenvironment is composed of multiple cell types embedded in an extracellular matrix (ECM). We have explored marrow ECM using mass spectrometry and found dermatopontin (DPT), a small non-collagenous ECM protein, to be present. We found that DPT cooperates with other ECM proteins to promote hematopoietic cell adherence in vitro on plastic as well as OP9 stromal cells. We generated constitutional DPT mice that were viable and had no peripheral lympho-hematopoietic abnormalities. The composition of the marrow of wild-type and DPT mice was equivalent in terms of cellularity, CFU-C, LSK (Lineage, SCA-1, KIT), and LSK-SLAM (LSK, CD48, CD150) frequencies. These data suggest that DPT fosters adherence but is not required for steady-state hematopoiesis in vivo. There are likely overlapping cellular adhesion mechanisms that can compensate to maintain the hematopoietic niche in the absence of DPT.
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September 2017

A Functional Bioluminescent Zebrafish Screen for Enhancing Hematopoietic Cell Homing.

Stem Cell Reports 2017 01 29;8(1):177-190. Epub 2016 Dec 29.

Department of Pediatrics, Blood and Marrow Transplant Program, University of Minnesota Medical School, MMC 366, 420 Delaware Street Southeast, Minneapolis, MN 55455, USA. Electronic address:

To discover small molecules that modulate hematopoietic cell homing after adoptive transfer, we created a transgenic zebrafish expressing firefly luciferase downstream of the ubiquitin promoter (ubi:luc) to serve as a hematopoietic donor. Bioluminescence imaging (BLI) was used to detect and follow ubi:luc hematopoietic cells that homed to the marrow as early as 1 day post-transplant. BLI was able to detect the biological effect of prostaglandin E on early homing/engraftment of donor hematopoietic cells. This system was utilized in a functional screen of small molecules to enhance homing/engraftment. We discovered a phytosterol, ergosterol, that could increase hematopoietic cell homing in zebrafish and mice. In addition, ergosterol increased CXCR4 expression and promoted expansion of LinSCA-1KIT cells in vitro. We have demonstrated the utility of in vivo BLI to non-invasively monitor donor hematopoietic cell activity in adult zebrafish as a functional screen for mediators of cellular homing.
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January 2017