MEDICA@MUSC (Medical University of South Carolina)
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Preparing Adults with Intellectual Disabilities for External Employment and Increased Occupational Engagement
Get PDFIntellectual disabilities refer problems within intellectual and adaptive functioning. In the United States, 6.5 million people have an intellectual disability (Schaepper). Adults with intellectual disabilities face many challenges throughout life. Employment is one of those challenges for a multitude of reasons including communication skills, discrimination, feelings of underappreciation, etc (Special Olympics). Only 21-44% of adults with intellectual disabilities are employed. There are services to help these individuals including occupational therapy, transition service counselors, and vocational rehab. Yet, the majority remains unemployed.
A doctoral capstone project was completed and presented in collaboration with a dog bakery whose mission is to provide employment opportunities to those who live with an intellectual disability hindering their independence in the workforce. Resources such as a resume template along with a sample resume, a list of job opportunities in the community, a list of resources in the community, a monthly meeting guide for the job coach, etc. were created to better prepare the employees for external employment and to provide staff with resources to best support the employees.
A qualitative analysis was conducted through thematic analysis (interviews, document analysis, and open-ended discussions) to gain feedback and measure usability and sustainability. Common themes were beneficial, helpful, and comprehensive. The owner, job coach, and pet chef reported the resources provided were presented in a usable and sustainable way.
Sources:
Schaepper, M. A., Hause, M., & Kagadkar, F. (2021). What is Intellectual Disability? American Psychiatric Association. https://www.psychiatry.org/patients-families/intellectual-disability/what-is-intellectual-disability
National Snapshot of Adults with Intellectual Disabilities in the Labor Force. Special Olympics. https://www.specialolympics.org/our-work/research/national-snapshot-of-adults-with-intellectual-disabilities-in-the-labor-force#:~:text=The%20unemployment%20rate%20for%20adults,without%20disabilities%20who%20are%20unemploye
Enhancing Physical and Mental Health for Children with Disabilities in Nicaragua
Get PDFThe purpose of this occupational therapy doctoral project is to partner with FNE International in creating a unified soccer program that incorporates mental health education. In Nicaragua and around the world, there is a stigma behind mental health and access to care for mental health especially in children. One way to improve an individual’s overall mental well-being is through exercise. A quality improvement study consisting of quantitative and qualitative data collection determined the parents understanding of unified soccer and the importance of physical and mental health. Brief REDCap surveys and informal interviews were done to gather statistics and thematic analysis. Results were analyzed using descriptive statistics and thematic analysis. The results indicated increase in knowledge of ways to make soccer adaptive and the importance of physical activity. The results from this study revealed that the presentation on unified soccer and the creation of soccer strikers accomplished its purpose of increasing knowledge of the importance of physical activity and mental health as well as ways to adapt soccer for all to play. The sustainability of the super striker’s soccer curriculum and the presentation unified soccer facilities future growth and impact of children with disabilities in low in come countries
In Vivo Electrophysiology Insights into Locus Coeruleus Activity across Diurnal Rhythms, And Hormone Deprivation in TgF344 AD Rat Model
No full textThe locus coeruleus (LC) produces noradrenaline (NA) for majority of the brain which influences functions like learning, memory, stress response, and sleep–wake cycles. The LC is the first brain region to accumulate hyperphosphorylated tau (pTau) in Alzheimer’s disease (AD) and this pTau accumulation occurs approximately the same time that women undergo the menopausal transition. Hormone deprivation contributes to the increased prevalence and severity of AD in females compared to males. This has been demonstrated in humans and animal models in many brain regions but remains unexplored in the LC.
The first hypothesis posited that LC-NA neurons are more active during the dark phase than the light phase. In vivo electrophysiology under anesthesia revealed that LC-NA neurons exhibit heightened baseline activity, stronger responses to foot shock during the dark phase, and more burst events. Heterogeneous modulation from stimulation supports the presence of diverse LC-NA neuron populations. Overall, recording during the animal\u27s active phase provides a more informative snapshot of LC physiology than during its sleep phase.
The second hypothesis was that ovarian hormone deprivation would exacerbate LC dysfunction in the TgF344 AD rat. Following three months of hormone deprivation, in vivo electrophysiology recordings under anesthesia were done on six-month-old animals, coinciding with pTau accumulation and physiological dysfunction in the LC of this model. Surgical menopause increases baseline LC activity in both wild-type (WT) and TgF344AD rats. We see that neurons from TgF344AD rats show decreased interspike interval, but overall firing rate did not differ, presumably due to increased phasic firing uncovered in burst events. In response to stimulation, we report both potentiation and depression across neurons. We observed strong inhibition from ovarian hormones that is lacking in WT OVX but not TG OVX, suggesting loss of response to a stimulus.
In summary, our findings highlight the LC\u27s heterogeneity, showing that diurnal rhythms and ovarian hormone deprivation significantly shape LC-NA baseline physiology and stimulus responsiveness. These insights not only deepen our understanding of LC function in AD but also point to potential windows for targeted therapeutic intervention in early stages of the disease
An Occupational Therapy Approach for Implementing a Parent-Led Intervention Strategy in Infant/ Toddler Feeding: Inservice Training and Guidelines
No full textAbstract
Objective: 25-45% of typically developing children have feeding or mealtime problems. 80% of children with physical or neurological impairment will be diagnosed with a feeding delay. In rural settings, waitlists for feeding therapists are long, and families travel long distances for specialized feeding therapy. A provider-coached, parent-led feeding intervention method is needed to meet the needs of families and improve the quality of home-visiting healthcare services.
Methods: Five continuing in-service education training sessions for local community health professionals were conducted. Each in-person or online session lasted between 45 and 120 minutes and aimed to promote a parent-led strategy for identifying feeding delays, utilizing responsive feeding practices, and applying coaching principles related to feeding. A pre- and post-survey was employed to collect information on confidence and knowledge gained. Statistical analysis was performed, and feedback was obtained through interviews.
Results: This capstone improved community healthcare professionals’ overall infant/ toddler feeding knowledge. Among the participants (N=63, N=57), there was a 167.63% increase in knowledge for identifying feeding delays, employing responsive feeding techniques, applying coaching principles, and understanding the rationale for using a parent-led intervention strategy.
Conclusion: A parent-led intervention strategy will empower parents, enhance timely referrals to feeding specialists, and increase the effectiveness of home-visiting services in government-funded community healthcare programs. Occupational therapists play a crucial role in the multidisciplinary feeding team to promote this awareness
Capital Spending Patterns: Urban, Rural, and Critical Access Hospitals, 2011-2022
No full textThis study examined the organizational, operational, and financial characteristics of rural critical access, rural non-critical access, and urban hospitals. The objective was to assess hospital capital spending, an important indicator of financial reinvestment within an organization.
In 2022, critical access hospitals allocated 6.2% of total expenses to capital spending, compared to 5.8% for rural non-critical access and 6.5% for urban. In 2011, these figures were 8.4%, 7.2%, and 7.2%, respectively. Regression-adjusted results revealed that from 2011 to 2022, each additional year contributed to a 2.6% decrease in capital expenses relative to total expenses across all hospitals. Critical access hospitals spent 13.7% more on capital relative to total spending than rural non-critical access and 12.3% more than urban.
Capital spending is a long-term bellwether for financial health. However, recent decreases in capital expenses relative to total expenses indicate that hospitals have been proportionally reinvesting less over time. These decreases are significant for rural non-critical and critical access hospitals to monitor since many rural operate under slim margins, face a higher risk of closure, and have not kept pace with urban hospitals\u27 capital reinvestments
Persistent Activation of Cardiac Fibroblasts Contributes to Myocardial Interstitial Fibrosis and Left Ventricular Dysfunction in Heart Failure
Get PDFHeart Failure (HF) is a complex clinical syndrome that is defined by an inability of the heart to meet the oxygen demands of the body. Myocardial interstitial fibrosis (MIF), the diffuse overaccumulation of extracellular matrix (ECM) proteins within the cardiac interstitium, contributes to ventricular dysfunction in HF. Mechanical devices designed to alleviate left ventricular deficiencies, termed left ventricular assist devices (LVADs), provide a pump that delivers oxygenated blood to the aorta thereby decreasing hemodynamic load on the ventricle. This end-stage HF therapy alleviates symptomatic burden for HF patients, however, LVAD support does not reduce MIF in the LV, and myocardial recovery is infrequent for patients on LVAD therapy. Currently, no direct antifibrotic therapies for HF are available representing a critically unmet clinical need. To elucidate molecular mechanisms that contribute to persistent MIF in HF myocardium both prior to LVAD implantation (pre-LVAD) or after unloading with an LVAD (post-LVAD, from heart transplant patients), we sought to characterize both ECM and fibroblast phenotype in pre- and post-LVAD myocardium in comparison to control myocardium. Tissue sections from control (no HF), pre-LVAD, and post-LVAD patients were assessed for myocardial fibrillar collagen and basement membrane content that revealed significant increases in both fibrillar ECM and the basement membrane in pre-LVAD versus control myocardium that were sustained in post-LVAD tissues. Increases in ECM contribute to significant increases in tissue stiffness in pre- and post-LVAD samples. Myocardial fibroblast populations were also found to be significantly elevated in pre- and post-LVAD hearts versus control. To determine whether fibroblast phenotype was altered in HF, primary cultures were isolated from each condition and plated on low (2kPa) and high (8kPa) stiffness substrates to mimic physiological myocardial conditions. Whereas control cells were found to respond to changes in substrate stiffness, fibroblasts from pre- and post-LVAD hearts did not suggest a persistently activated phenotype that was non-responsive to changes in environmental stiffness. Bulk RNA and single-cell RNA sequencing analysis revealed uncoupled mechano-sensory molecular pathways that might contribute to sustained ECM production in HF hearts. In conclusion, these results were consistent with the hypothesis that persistent activation of cardiac fibroblasts in pre- and post-LVAD myocardium maintain ECM content in the myocardium despite changes in hemodynamic load. Which contributes to on-going MIF-dependent myocardial stiffness, resulting from uncoupled mechano-sensory pathways, and the refractory nature of recovery for patients on LVAD therapy
Addressing Generalization Challenges in Clinical Section Identification: Contextual Learning and Large Language Model Approaches
No full textBackground: Electronic health records (EHR) systems have generated vast volumes of clinical narratives, driving clinical natural language processing (NLP) development. Clinical section identification is crucial for NLP tasks like information retrieval, but faces challenges from inconsistent documentation practices and highly skewed section distributions across health systems. Current rule-based, traditional machine learning, and large language model approaches suffer from performance degradation on out-of-distribution data and require extensive preprocessing or post-processing.
Methods: This study addresses these limitations through model development and downstream application validation. Aim 1 developed a contextual BERT-based approach using a novel input strategy that groups each target sentence with immediate preceding and succeeding sentences to capture narrative flow and semantic cues. We tested four BERT-family models (BERT, BioBERT, Bio_ClinicalBERT, ClinicalLongformer) on MedSecId dataset and evaluated generalizability on the i2b2 2014 Shred Task data. Aim 2 developed a novel sentence-level classification system using large language models that directly classifies sentences without requiring known section boundaries or complicated post-processing. We conducted prompt engineering and ablation studies on proprietary models (ChatGPT4o, ChatGPT4o-mini) and open models (Llama, BioMedicalLlama). Aim 3 validated the practical utility of these models by applying section identification to Alzheimer\u27s dementia phenotyping using EHRs from the Medical University of South Carolina (MUSC)\u27s Research Data Warehouse. We used the developed systems to create filtered clinical narratives excluding irrelevant sections to improve signal-to-noise ratios, comparing CNN models trained on filtered text against baseline models using identical architectures but unfiltered clinical notes.
Results: The contextual input strategy with ClinicalLongformer achieved the highest F1-scores of 0.92 (in-domain) and 0.64 (out-of-domain), surpassing previous BERT performance (F1=0.71 in-domain, F1=0.60 out-of-domain). LLM-based sentence-level classification achieved state-of-the-art performance with micro F1-scores of 0.85 and 0.74 using ChatGPT-4o and GPT-4o-mini respectively, without requiring extensive post-processing. CNN models on filtered text significantly outperformed baselines with medium-to-large effect sizes, achieving 0.90 accuracy using text filtered by ChatGPT-4o-mini.
Conclusions: This research establishes new benchmarks for clinical section identification and demonstrates practical value for downstream clinical NLP tasks, providing a foundation for more robust and generalizable clinical text processing systems
Incivility Experienced by Males in Nursing Education
No full textBackground: Nursing shortages are exacerbated by unhealthy learning environments. Men remain underrepresented among nursing students and faculty, yet their experiences of incivility are rarely examined.
Purpose: Guided by Clark’s Model of Civility in Nursing Education, this dissertation explored how male nursing students and educators in U.S. prelicensure programs experience incivility and how these patterns inform strategies to promote civility and retention.
Methods: This compendium includes (a) an integrative review of nursing faculty mistreatment using Whittemore and Knafl’s method; (b) a cross-sectional survey of male nursing educators and students using the Incivility in Nursing Education–Revised (INE-R) to estimate the prevalence and predictors of incivility; and (c) a qualitative descriptive analysis of open-ended survey responses. Ninety-six male-identifying participants from CCNE- and ACEN-accredited programs completed the survey, and 77 provided narrative responses.
Results: The integrative review identified heterogeneous definitions, measures, and perpetrators of mistreatment and revealed a lack of studies focused on male faculty. Quantitative findings showed that high-level behaviors such as threats, object throwing, and demeaning remarks were widely rated as highly uncivil, yet few demographic or program characteristics consistently predicted exposure. Qualitative analysis yielded four themes: communication breakdown, injustice, harmful behaviors, and unprofessionalism. Participants linked uncivil climates to diminished psychological safety, strained relationships, and intentions to leave programs or roles.
Conclusions: Incivility toward men in nursing education is prevalent and consequential. Findings underscore the need for systematic assessment and multilevel interventions, including clear behavioral expectations, consistent policy enforcement, and mentorship initiatives that foster civility, inclusion, and workforce stability
Adherens Junctions Recruit piRISC to Suppress Transposons and Maintain the Normal Epithelial Phenotype
No full textTransposons, or transposable elements (TEs), are mobile genomic elements that make up almost 45% of the human genome. Although TEs are mostly dormant, they can become re-activated and cause DNA damage, genomic instability, and gene mutations. To protect the genome from TE activity, cells target TEs for degradation through a mechanism that involves the PIWI ribonucleases and small RNAs called piRNAs (PIWI-interacting RNAs), which altogether form the piRNA induced silencing complex (piRISC). Although the function of the piRISC has been extensively studied in the germline, there is little understanding about its role in somatic tissues. Interestingly, recent evidence indicates that TE re-activation occurs in 50% of somatic tumors. However, the reasons for TE re-activation in somatic tissues are still poorly understood. Here, we demonstrate recruitment and regulation of piRISC by adherens junctions in differentiated epithelial cells. Specifically, we have found association of members of piRISC, including PIWIL2, the key catalytic component of piRISC, as well as of PIWIL4 and TDRD1, with the epithelial adherens junction components E-cadherin and PLEKHA7. Adherens junction disruption results in mis-localization of piRISC whereas PLEKHA7 or PIWIL2 depletion in colon epithelial cells result in downregulation of a set of noncanonical, piRNA-like, short RNAs targeting multiple classes of TEs, and in upregulation of TEs, especially of LINE-1, the only autonomous TE family in human tissues. As a result, PLEKHA7 and PIWIL2 depletion promote increased genomic insertional activity of TEs, as well as increased DNA damage. Examination of colon cancer cell lines, as well as of colon cancer patient tissue samples and bioinformatic analyses, indicate extensive disruption of the adherens junction - PIWI complex in colon cancer, as well as an overall association of piRISC defects with disease aggressiveness. Indeed, PIWIL2 knockout promotes pro-tumorigenic phenotypes of well-differentiated colon epithelial cells. Altogether, the data reveal that epithelial adherens junctions recruit piRISC to suppress transposon activity and maintain epithelial homeostasis. Since disruption of junctional integrity and increased transposon activity are both common events in cancer, this study unravels a novel mechanism that may shed light on the still obscure roles of piRISC and of TEs in somatic tissues
Connectomic Dysfunctions Underlying Cognitive Impairment in Alcohol Use Disorder and the Link to Alzheimer\u27s Disease
Get PDFAlzheimer’s Disease (AD) and Alcohol Use Disorder (AUD) are two disorders associated with a degraded life quality, high mortality, and poor prognosis. Recent evidence suggests that AUD is a risk factor for AD though the exact relationship between the two disorders is unknown. This study aimed to elucidate the relationship between these disorders by determining which patterns of functional connectivity are associated with cognitive decline in AUD and mild cognitive impairment (MCI), a cognitive pathology which frequently precedes dementia. Both resting-state and task-based fMRI data collected from AUD, MCI, and healthy control (HC) participants were used in this study. The two task paradigms consist of an episodic memory encoding task and a spatial working-memory task. The resting-state data was used to extract the default mode network (DMN), the episodic memory encoding task data was used to extract the episodic memory network (EMN), and the spatial working-memory task data was used to extract the spatial working-memory network (SWMN). Graph theory metrics were used to characterize connectome profiles associated with cognitive impairment, as measured by the Montreal Cognitive Assessment (MoCA), Craft Story Delayed Recall, and Digit Span Backwards assessments. I hypothesized that the associations between MoCA, Craft Story 21 Delayed Recall, and/or Digit Span Backwards and graph theory features of the EMN and/or the DMN healthy controls. I also hypothesized that graph theory scores of the SWMN would be associated with one or more of the three aforementioned neuropsychological scores in AUD subjects. The association between eigenvector centrality of the EMN and Digit Span Backwards score was negative in both AUD and MCI subjects while this association was positive in HC subjects. This suggests that while a greater influence of the episodic memory encoding network over the activity of the entire brain is associated with higher working-memory performance in healthy individuals, greater influence of the EMN in AUD and MCI subjects is associated with poorer working-memory performance