MEDICA@MUSC (Medical University of South Carolina)
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Influences of Sex, Alcohol, and Stress on Conditioned Fear Responses
Get PDFLearned fear responses are acquired through the identification and association of threatening stimuli with aversive outcomes. Fear responding and the proper maintenance of defensive behaviors is integral to survival. However, without the homeostasis of such systems, fear responses can become maladaptive and lead to dysregulated behavioral responding. Psychological conditions such as alcohol use disorder (AUD) and post-traumatic stress disorder (PTSD) often lead to impairments in fear learning, deficits in fear memory, and heightened fear responses. While there are clear sex differences in the prevalence of both AUD and PTSD, development of either disorder increases the risk for comorbid AUD/PTSD, leading to exacerbated symptomology of both disorders. The experiments in this dissertation focused on the impact of stress, alcohol, or the combination of these two variables on fear learning and responding in male and female rats. As threat response strategies often diverge between the sexes, both passive and active fear behavior paradigms were utilized in these studies to probe for sex differences in fear-related behaviors.
In Chapter 2, male and female Wistar rats were subjected to chronic intermittent ethanol (CIE) vapor exposure, single-prolonged stress (SPS), or both before Pavlovian fear conditioning. The results from these experiments highlight baseline sex differences present in Pavlovian fear conditioning and impairments in fear renewal in males and females as a result of alcohol exposure and stress, respectively. Chapter 3 investigated the effects of chronic ethanol exposure on active avoidance behavior in the Platform Mediated Avoidance (PMA) task in male and female Wistar rats, which resulted in a mild impairment in extinction learning in male rats. Chapter 4 utilized in-situ fluorescent hybridization to characterize a novel population of corticotropin-releasing factor (CRF) neurons in the lateral septum (LS), as these neurons may be involved in fear responding. Overall, the data presented in this dissertation highlight divergent threat response strategies adopted by male and female rats in passive versus active fear paradigms, add to our understanding of the effects of alcohol and stress exposure on fear behavior, and explore novel cell populations that may be responsible for these behavioral effects
Supporting Families and Providers of Children with Low Vision/ CVI Through Comprehensive Resource and Website Development
No full textCerebral/Cortical Visual Impairment (CVI) is the most prevalent cause of visual impairment in children. Children with CVI face unique challenges that significantly affect their development and participation in daily life. This capstone project aimed to support both therapists and families of children with CVI by fostering a deeper understanding of the condition and enhancing access to evidence-based resources. Guided by the Person-Environment-Occupation-Performance (PEOP) model, the project focused on identifying existing gaps in available materials, then addressing them through the creation of tailored resources and the development of a comprehensive, user-friendly website.
Deliverables included a digital resource library/website with over 40 resources (six original), a physical binder, and a custom-designed sensory/ positioning board to promote skill development. Pre- and post-intervention surveys measured the usefulness and impact of the resources provided. The findings indicated increased provider confidence in knowledge of CVI interventions, and improved accessibility of resources for families. This project ultimately aims to empower caregivers and therapists to deliver more effective, individualized care for children with CVI
Loss of Myosin 5b Disrupts Liver Function, Altering Bile Acid Homeostasis, Zonation and Lipid Metabolism
No full textBackground: Molecular motors are essential for maintaining epithelial cell function, orchestrating intracellular transport, membrane trafficking, and cellular organization to support specialized functions. One such motor, Myosin 5b, is responsible for transporting key proteins to the apical surface of epithelial cells. Inactivating mutations in Myosin 5b lead to the development of Microvillus Inclusion Disease (MVID), a congenital diarrhea disorder. Individuals with MVID frequently present with cholestasis in addition to their intestinal defects. Myosin 5b missense mutations have been associated the development of Progressive Familial Intrahepatic Cholestasis 6 (PFIC6), indicating alterations in liver function arising from the loss of Myosin 5b. While the role of Myosin 5b is widely studied and well characterized in the intestine, there is a paucity of data on Myosin 5b’s function in the liver. Methods & Results: Mice harboring a germline mutation in Myosin 5b (MYO5B KO) were used to identify hepatic changes resulting from loss of Myosin 5b in vivo. LC-MS/MS metabolomics revealed significant changes between Myosin 5b knockout and control littermates in key bile acids within the liver. RNAseq demonstrated significant changes in genes regulating bile acid synthesis, lipid metabolism, and proliferation in Myosin 5b KO mice compared to control littermates. Analysis of protein levels in Myosin 5b KO and control littermates via immunostaining revealed altered zonation within the liver lobule. Additionally, we observed that in the absence of Myosin 5b, lipids accumulated within liver hepatocytes, showing signs of micro- and macrovesicular steatosis. Oil Red O staining demonstrated that Myosin 5b KO mice had significantly larger lipid droplets than their control littermates. Immunostaining of Myosin 5b KO mice also showed decreased proliferation in the liver based on several markers. This was also reflected by a significant decrease in the size of Myosin 5b KO derived liver organoids when compared to organoids derived from control littermates. Conclusions: Collectively, these data indicate that mice lacking functional Myosin 5b exhibit alterations that impact liver function in vivo, specifically bile acid synthesis and zonation
Occupational Therapy in Oncology: Enhancing Quality of Life for Head and Neck Cancer Survivors
Get PDFThis occupational therapy capstone project was completed through collaboration with a site that aims to eradicate cancer through multidisciplinary patient care, innovative research, and education and training. The purpose of the project is to improve the quality of life (QoL) in Head and Neck Cancer survivors through resources created to enhance self-efficacy, symptom management, and overall well-being throughout the cancer trajectory. The project included the goal of furthering the health care team’s understanding of occupational therapy’s role within the cancer population, specifically HNC, by providing these supportive resources. Educational patient handouts were distributed to HNC care providers to then distribute to their patients. Provider feedback was used to monitor the resources. Additionally, patient feedback from 7 current individuals receiving OT services were obtained through a RedCap survey and functional outcome measure (FACT-G) to provide supportive data and feedback regarding occupational therapy within the oncology field. Results indicated that these patients found OT beneficial and that they have experienced improvements from receiving OT. Positive feedback from HNC care providers and qualitative & quantitative data from current OT patients suggest this project increased the understanding of OT’s role within the oncology population and supports increasing future referrals to OT services for QoL supporting interventions
Empowering Parents: Enhancing Burn Education to Reduce Anxiety in Pediatric Hospital Admissions
No full textShawn Jenkins Children’s Hospital (SJCH) is South Carolina’s only pediatric burn referral center, offering comprehensive, multidisciplinary care for children with burn injuries. While most pediatric burns are minor, non-accidental injuries account for up to 20% of cases (Strobel & Fey, 2018). Parents of hospitalized children with burns often experience heightened anxiety, which can negatively influence their child’s emotional well-being and cooperation during treatment (Zdun-Ryżewska et al., 2021).
This capstone project aimed to reduce caregiver anxiety by developing accessible, inclusive, and health-literate educational materials. These resources were designed to provide parents with realistic expectations, enhance understanding of burn care procedures, and support both the child and family throughout hospitalization. Research suggests that informed and emotionally supported parents are better equipped to engage positively in their child’s care (Rosenberg et al., 2015; Patel et al., 2022).
Feedback from interdisciplinary stakeholders—including surgeons, nurses, and child life specialists—highlighted the utility of the materials in improving caregiver comprehension and promoting a sense of empowerment. Quotes from providers emphasized the importance of clear, visual, and individualized educational resources as tools for coping and communication. Deliverables included print handouts and recommendations for digital access via QR codes, ongoing family feedback mechanisms, and staff training for consistent implementation.
The project underscores the role of occupational therapy in addressing family-centered care and emotional regulation. Through direct observation and hands-on experience within the burn unit, this capstone deepened understanding of the psychosocial impacts of pediatric burns and the therapeutic value of caregiver education.
References
Patel, K. F., Rodríguez-Mercedes, S. L., Grant, G. G., Rencken, C. A., Kinney, E. M., Austen, A.,
Hou, C., Brady, K. J. S., Schneider, J. C., Kazis, L. E., & Ryan, C. M. (2022). Physical, Psychological, and Social Outcomes in Pediatric Burn Survivors Ages 5 to 18 Years: A Systematic Review. Journal of burn care & research : official publication of the American Burn Association, 43(2), 343–352. https://doi.org/10.1093/jbcr/irab225
Rosenberg, M., Mehta, N., Rosenberg, L., Ramirez, M., Meyer, W. J., 3rd, Herndon, D. N.,
Andersen, C. R., & Thomas, C. (2015). Immediate and long-term psychological problems for survivors of severe pediatric electrical injury. Burns : journal of the International Society for Burn Injuries, 41(8), 1823–1830. https://doi.org/10.1016/j.burns.2015.06.006
Strobel, A. M., & Fey, R. (2018). Emergency Care of Pediatric Burns. Emergency medicine
clinics of North America, 36(2), 441–458. https://doi.org/10.1016/j.emc.2017.12.011
Zdun-Ryżewska, A., Nadrowska, N., Błażek, M., Białek, K., Zach, E., & Krywda-Rybska, D.
(2021). Parent\u27s Stress Predictors during a Child\u27s Hospitalization. International journal of environmental research and public health, 18(22), 12019. https://doi.org/10.3390/ijerph18221201
The Role of Neonatal Reactive Oxygen Species in Cardiac Regeneration
No full textCardiovascular disease is the number one worldwide cause of death. Cardiomyocytes have a very low proliferative rate in the adult heart, which results in an inability to regenerate after injury. After an injury such as a myocardial infarction, lost cardiomyocytes are replaced by a fibrotic scar. The loss of contractility leads to cardiac dysfunction and remodeling long-term. The murine heart exhibits a transient regenerative window that is lost within the first week of life and serves as a model to identify key regulators of cardiac regeneration.
Oxidative stress, driven by high reactive oxygen species (ROS), has many pathological implications. However, ROS serve as signaling molecules that are critical for a multitude of cellular pathways. ROS levels increase in the early postnatal period due to environmental oxygen and a metabolic shift to aerobic respiration, which is thought to drive cardiomyocyte cell cycle arrest. This halt in cardiomyocytes’ progression through the cell cycle impedes these cells regenerative ability. At the same time, neonatal ROS stimulate mechanisms that drive adaptations crucial for cardiomyocyte maturation, including mitochondrial energetics, sarcomere organization, and metabolic transitions.
The following study aimed to determine the impact of neonatal ROS on subsequent cardiac injury response. Utilizing a variety of animal models, the data presented here elucidates a feedback loop between Rbx1, a component of the Nrf2 degradation complex, and Pitx2, a transcriptional target of Nrf2. The Nrf2, or nuclear factor erythroid 2–related factor 2, signaling pathway mediates cellular defense against oxidative stress by responding to fluctuations in cellular ROS levels. Moreover, this work highlights the beneficial role of ROS in oxidative priming of cardiomyocytes during the neonatal period. Once establishing that diminished ROS impairs injury response within the myocardium, we sought to determine a mechanism for this response. Bioinformatics analysis followed by immunostaining revealed that decreased neonatal ROS leads to reduced macrophage infiltration into the infarcted area following myocardial infarction (MI).
Together, the results suggest that neonatal ROS are crucial for cardiomyocyte maturation and subsequent injury response. Moreover, the data suggest that uninhibited antioxidant signaling impairs cardiac regeneration and this may be due to impaired immune cell recruitment. These novel findings go against long-held concepts concerning cardiomyocyte oxidative stress. As such, this work may inform how to properly treat patients with a predisposition for infarction
Assessing the Burden of Uncompensated Care In South Carolina Hospitals: The Role of Medicaid Expansion, Telemedicine and Primary Care
Get PDFThe financial burden of uncompensated care strains healthcare systems nationwide. In this study, we measured the uncompensated care for hospitals in SC based on outpatient surgeries (OP), inpatient visits (IP), and emergency department (ED) visits. We used the South Carolina (SC) Revenue and Fiscal Affairs Office (SCRFA) database from 2018-2023 to derive the mean charges for self-pay and indigent/charity care for each county for OP, IP, and ED visits. Without recent and publicly available cost-to-charge ratios for SC, we used the 2022 Centers for Medicare & Medicaid Services (CMS) Medicare 5% Limited Data Set (LDS) data to generate the unique payment-to-charge ratios for each of the three product lines. To better gauge potential Medicaid reimbursements, we then applied the published 2022 estimate for Medicaid to the Medicare fee index for SC. Multiplying these all together gave us an estimate for the average uncompensated care over the 5 years 2018-2023 for each of the 46 counties in SC. Our findings indicate that counties with higher telemedicine utilization generally experience lower levels of uncompensated care per capita, while counties with lower telemedicine utilization tend to bear a higher level. This trend reinforces the growing body of evidence suggesting that improved access telemedicine may reduce the need for more costly IP, OP, and ED visits, which are often the higher contributors of uncompensated care
A Retrospective Review of Emergency Department Leave Against Medical Advice Cases: Tracking Pregnant Women Presenting with Opioid Use Disorder
No full textPregnant and post-partum women are not excluded from the growing number of individuals impacted by the opioid epidemic. The opioid epidemic is well understood as a widespread public health crisis. The impact has far-reaching effects beyond the individual user, data shows that there are serious implications for families, the healthcare system, taxpayers, and communities.
Pregnancy is a particularly vulnerable period in a woman’s healthcare journey, and for women struggling with opioid use disorder (OUD), it is an extremely high-risk time. Opioid misuse during pregnancy carries serious risks for both the mother and the infant. It is extremely important to identify and remove barriers for pregnant women to get the treatment they need to abstain from opioid misuse.
Emergency Department Data indicates that there are missed opportunities for pregnant women with OUD presenting to emergency departments. Women who leave against medical advice do not receive the recommended standard of care. The data shows the sociodemographic characteristics of this population and examines the possibilities of coordinating care
Bereavement Needs of Parent-Child Dyads Following Sibling Death
Get PDFIn the United States, nearly 62,000 children and adolescents experience the death of a sibling each year and sibling bereavement is one of the most distressing life events during childhood; however, it has received less attention in research compared to other forms of childhood loss. Bereaved siblings and parents are at increased risk for negative physical and psychological outcomes, yet little is known about their support and resource needs during the early years following the death. A limitation in understanding sibling bereavement is the methodological and ethical challenges of researching this vulnerable population. Consequently, the bereavement needs of surviving siblings and the parent-child dyad remain under-explored, hindering the development of family-level interventions designed to support both members of the dyad.
This dissertation addresses these gaps in the literature by first examining potential risk and protective factors that influence coping following sibling bereavement. Using The Multidimensional Grief Theory, an integrative review of the literature examined how these factors affect adjustment in bereaved siblings. The dissertation then details the formation of a Bereaved Family Advisory Board, which established a partnership with bereaved parents and siblings, to ensure the development of meaningful and sensitive study procedures for this hard-to-reach population. Insights from the advisory board informed the design of a feasibility study, guided by the Formal Feasibility Framework. The multi methods study explores the feasibility of assessing the bereavement needs of parent-child dyads following sibling death in order to preliminarily understand how unmet needs of bereaved dyads influence parental distress, surviving siblings’ quality of life (QOL), and grief. The findings presented in this dissertation lay the groundwork to inform a larger needs assessment that will direct the development of family-level interventions. Identifying the specific needs of the parent-child dyad following sibling death will help bridge the gap between research and practice, improve the provision of bereavement support, and promote healthier outcomes for both surviving siblings and their parents
Perceptions of Artificial Intelligence in Healthcare: A Qualitative Study Among Physicians and Nurses in Florida
Get PDFThis investigation will leverage participant focus group interviews with 32 clinicians (16 nurses / 16 physicians) to study what, if anything, is inhibiting AI adoption across the hospital. Specific physicians will be sourced across the key service lines of primary care, oncology, cardiology, behavioral health, and emergency department medicine, as these tend to be patient volume driven and thus have the maximum amount of potential for positive impact leveraging AI. Nurses in these same departments will be assessed to analyze if there is a similarity or difference between the nursing and physician AI adoption barriers