MEDICA@MUSC (Medical University of South Carolina)
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Waring Library Society Newsletter, Winter 2024
Get PDFThe Winter 2024 issue of the Waring Library Society Newsletter is available now. In this issue, Waring Library Society President Dr. Jacob Steere-Williams discusses Dr. Francis Bonneau Johnson’s contributions to studying filariasis in Charleston; JoAnn Zeise highlights the tableaus used as part of MUSC\u27s centennial celebration; Tabitha Samuel announces the completion of the MUSC Bicentennial Resources guide; and Anna Marie Schuldt shares Waring\u27s recent events in celebration of Black History Month.https://medica-musc.researchcommons.org/wls-newsletters/1007/thumbnail.jp
Potential for Telehealth Support to Improve Access to Care: A Needs Assessment Using Heat Maps of Ed Use and Avoidable Hospitalizations for the I/Dd Population in South Carolina
Get PDFTwo healthcare issues plague the population of intellectually and developmentally disabled (I/DD) population in the United States. First, research has documented that people with I/DD are high utilizers of non-emergent healthcare services and are frequently hospitalized for conditions that are treatable by a primary care provider (PCP) in an office setting (Yamaki et al., 2019). Furthermore, despite a considerable percentage of the I/DD population qualifying for Medicaid, access to primary care is inadequate and inequitable (Yamaki et al., 2019)
Bridging the Gap in Fine Motor and Writing Readiness Skills in At-risk Preschoolers: A Professional Development Program
Get PDFEarly Childhood Education (ECE) programs play a crucial role in fostering academic skills among at-risk preschoolers, often leading to increased referrals for special education or occupational therapy (OT) services due to deficits in fine motor (FM) and writing readiness (WR) skills. This project aimed to enhance FM and WR skills among certified South Carolina ECE teachers through a Multi-Tiered System of Support (MTSS) Tier 1 curriculum and professional development training. Eight staff members underwent a 13-week MTSS Tier 1 training and implementation, including a three-week onsite small-group training and a 10-week implementation of MTSS Tier 1 interventions in four K4 classrooms. Qualitative data from teacher interviews guided the development of district-wide professional development sessions. Results of the ECE professional development training showed significant increases in teacher knowledge (62.5%) an 87% increase from the initial needs assessment, and interest (100%) in MTSS Tier 1 interventions. Additionally, feedback from OT professionals at the 2024 SCOTA conference indicated high feasibility (76.2%) and district interest (95%) in expanding such programs. This project underscores the efficacy of early interventions in improving FM and WR skills, reducing future referrals for special education and OT services, and highlighting the value of collaborative interventions in ECE settings
Addressing Home Health Caregiver Burden: Screening Tool Development for Enhancing Caregiver Health & Well-Being
Get PDFSupporting Rehabilitation in Madagascar: Training Current and Future Occupational Therapists on Constraint Induced Movement Therapy
No full textConstraint induced movement therapy (CIMT) is an effective, evidence-based treatment for adults and children with hemiparesis. CIMT is widely used in high resource countries, however, in countries like Madagascar, the 5th poorest in the world there are no intensive therapy programs for clients with neurologic conditions. Aims: The aims were to 1) train Malagasy therapists in current models of pediatric CIMT, 2) develop a contextually relevant model of pediatric CIMT for Madagascar in collaboration with Malagasy therapists, 3) pilot the new Madagascar CIMT model with children with unilateral motor weakness. Methods: Four-weeks of synchronous and asynchronous education sessions were provided to 8 Malagasy therapists and culminated in the development of a pediatric Madagascar CIMT model (3 weeks, 5 days/week, 3 hours/day, 45 hours total). This model was trialed with 5 children (mean age = 4.6 years) during a three-week period at the Growing the Nations Therapy Programmes outpatient clinic in the capital city of Madagascar. Surveys and in-person interviews were used to collect quantitative and qualitative data on therapists’ perception of the intervention. Children were assessed pre-and post-intervention using the Box and Blocks, the ABILHAND Kids, and the Pediatric Motor Activity Log. Results: Children showed improvement in all measures with all long-term goals achieved. The therapists recorded positive reviews of the trainings and pilot program, restating the need for CIMT to be readily implemented in Madagascar. However, they noted a need for modifications to the model, to allow for implementation of CIMT in rural parts of the country. Similarly, the caregiver reported positive reviews of the pilot program. Many noted changes in the children’s habits and behaviors at home. Discussion: This project is the first-of-its-kind pediatric CIMT therapy model designed to meet the needs of children with unilateral motor weakness in Madagascar. Future collaborations may include additional training, CIMT program alterations, classes, or implementation of a reformed model
We’re All in This Together: Collaboration to Strengthen Discovery and User Experience
No full textInterdepartmental collaboration between reference or instruction librarians and technical services librarians can foster an environment that helps create the best user experience and accessibility of the catalog and library resources. It can help build the bridge between the technical work behind the scenes and how users interact with and utilize the catalog. At our institution, this collaboration takes many forms and is built on a foundation of communication. Our entire library collection is digital, and ease of accessibility and discovery of our catalog and library resources is one of the top priorities. The Information Resources and Collections Services (IRCS) team and the Research and Education Services (RES) team have a standing monthly meeting to explore possible education sessions and updates on how the catalog works, copyright, and Interlibrary Loan information. In turn, the RES librarians can use this knowledge to strengthen their instruction sessions and ! provide feedback on how users find information easily and intuitively. This informs the technical services librarian on areas of opportunity such as changing titles in a series, new editions not linking properly, including alternative titles for journals, and providing new ways to discover content based on user needs. Additionally, IRCS coordinates with vendors to provide demonstrations of newly available resources or features for the RES team. These demos allow the RES librarians to become more fluent in the inner workings of each resource to support our users better. Finally, this collaboration supported the creation of a direct line of communication to troubleshoot when problems arise and the creation of spreadsheets to streamline existing processes. Overall, enhancing the catalog to work for the user’s needs is the best practice to create a catalog that reflects the wants and needs of the user.https://medica-musc.researchcommons.org/posters/1033/thumbnail.jp
The Role of Uncertainty in Illness: Insights into Psychological Adjustment in Systemic Lupus Erythematosus
Get PDFThere are currently few studies that directly explore the relationship between uncertainty in illness and psychological adjustment to Systemic Lupus Erythematosus (SLE), highlighting a critical gap in understanding how patients cope with and adjust to the emotional and mental challenges posed by this chronic condition. This dissertation comprises three manuscripts focused on filling this knowledge gap. The first is an integrative review guided by Mishel’s Uncertainty in Illness Theory, which examines how uncertainty affects patients\u27 psychological and emotional well-being during illness and explores strategies to manage or reduce this uncertainty. The integrative review included 27 publications that examined uncertainty in illness and psychological adjustment to diseases and chronic conditions such as cancer, diabetes, autoimmune and respiratory disorders. The findings from this integrative review supported Mishel’s theory, showing that uncertainty in illness influences psychological adjustment to illness often resulting in psychological distress rather than adjustment. Psychological distress refers to negative emotional responses, such as anxiety, depression, or frustration, that arise from the uncertainty of illness. Psychological adjustment refers to an individual\u27s ability to cope with and adapt to the challenges of illness. Thus, when uncertainty is high, it often leads to distress instead of successful adjustment, making it harder for patients to manage their illness effectively. Additionally, the integrative review identified a significant knowledge gap regarding the relationship between uncertainty in illness and psychological adjustment, in particular, to SLE. The second and third manuscripts detail the results of a multi-method cross-sectional study that explored the relationship between uncertainty in illness and psychological adjustment to SLE. The findings from the multi-method cross-sectional study showed a positive relationship between uncertainty in illness and psychological distress: as uncertainty increased, symptoms of anxiety and depression increased. Additionally, data from the qualitative analysis revealed the importance of healthcare provider rapport and peer support on decreasing uncertainty and psychological distress to facilitate the development of cognitive capacity, meaning patients are better equipped to understand their illness, manage their emotions, and make informed decisions about their health. Overall, these findings suggest that the relationship between uncertainty in illness and psychological adjustment to SLE is similar to other chronic illnesses. Further, there is preliminary evidence to suggest that the relationship between uncertainty and psychological adjustment can be modified with the help of supportive structure providers, who are individuals or systems that offer guidance, information, and emotional support to patients, including healthcare providers, peer support groups, or counseling services, to help reduce uncertainty and improve psychological adaptation
Bayesian Beta-Binomial Mixed Models for Longitudinal, Clustered, and Spatiotemporal Data
No full textOverdispersed binomial data arise in many clinical and public health research studies. Examples include timeline followback data (TLFB), which are used in addiction research to monitor recent substance use. This dissertation proposes novel beta-binomial (BB) mixed models to address the challenges associated with overdispersed binomial data, including zero-inflation, heterogenous effects, and spatiotemporal correlation. Motivated by a 12-week randomized controlled trial evaluating the efficacy of varenicline tartrate for smoking cessation among adolescents, Aim 1 develops a Bayesian zero-inflated beta-binomial (ZIBB) model to analyze longitudinal and bounded TLFB data — namely, the number of abstinent days in the past week. Because treatment effects appear to level off during the study, we introduce random changepoints for each study group to reflect group-specific changes in treatment efficacy over time. Using the model, we accurately estimate the mean trend for each group and identify critical windows of treatment efficacy, revealing a short-term positive effect of varenicline that tapers off after week 9. Aim 2 investigates treatment heterogeneity among latent classes of participants in the same trial. We propose a BB growth mixture model designed to cluster study participants based on their longitudinal trajectories to investigate treatment effect heterogeneity across latent classes. Within each latent class, we fit a piecewise linear BB mixed model with random changepoints for each study group to detect critical windows of treatment efficacy. The model simultaneously clusters participants who share similar characteristics, estimates the class-specific mean abstinence trends for each study group, and quantifies the treatment effect over time within each class. This analysis identifies two classes: high-abstinent individuals (young adults and light smokers) benefiting from varenicline, and low abstinent individuals for whom varenicline shows no effect. Aim 3 is motivated by a study examining spatiotemporal trends in five cardiovascular risk factors (CRFs) among pregnant women in South Carolina during the COVID-19 pandemic. These CRFs include pre-pregnancy obesity (BMI 30 kg/m2), diabetes (including pre-pregnancy and gestational diabetes), hypertensive disorders of pregnancy, pre-pregnancy hypertension, and kidney failure. Thus, the total number of CRFs ranges from 0 to 5 and exhibits overdispersion due to the correlation among these factors. We extend the ZIBB model to a spatiotemporal setting by developing a spatially varying coefficients model to investigate the complex relationship between CRFs and geographic and temporal disparities among non-Hispanic White (NHW) and non-Hispanic Black (NHB) women. In simulation studies, the model accurately captures trends between the two racial groups and predicts mean CRF scores in each region over time. Our analysis of CRFs in South Carolina reveals that specific counties, such as Chesterfield and Marlboro, exhibit a disproportionately wide gap in racial health disparities and may be ideal candidates for community-level interventions designed to mitigate health disparities. Collectively, this dissertation aims to advance the analytical toolkit for clinical and public health research, offering robust methods to analyze overdispersed binomial outcomes in various settings
Characterizing Lower Extremity Neurophysiological Responses to Sensory Augmentation in Chronic Stroke
No full textPaired associative stimulation (PAS) is an assay of sensorimotor plasticity that can account for individual differences in post-stroke sensorimotor communication. The objective of this study was to determine the effectiveness of individualized lower extremity (LE) PAS in healthy and post-stroke (\u3e6 months), and the relationship to sensorimotor function. PAS was individualized by measuring cortical-level afferent pathways via a somatosensory evoked potential (SEP). The SEP latency (at 34ms) was then systematically paired with single transcranial magnetic stimulation (TMS) pulses to determine the individual-level timing. Relative changes in PAS-induced motor-evoked potential amplitude (MEPAmp) targeting the non-dominant (healthy) and paretic tibialis anterior muscle (stroke), for were used to quantify sensorimotor plasticity. In healthy controls (n=10; 7F/3M; age=59 [43-71] years) changes in MEPAmpwere not associated between visits (r=0.14; p=0.9792), despite significant increases in MEPAmp in Visits 2 (42.78 [7.30-350.72]%, p=0.0020) and 3 (40.36 [15.30-204.20]%, p=0.0039). In stroke (n=7; 2F/5M; age=69 [51-77] years) there was no significant relationship between visits (r=0.21; p=0.7184). We observed significant increases in MEPAmp in Visit 2 only (97.26% [3.75-129.16], p=0.0156). There were no significant relationships between relative changes in MEPAmp and sensorimotor function. PAS has potential as an assay of sensorimotor plasticity targeting the LE, however, further investigation is required to support its reliability. Understanding post-stroke LE sensorimotor pathways is necessary for furthering targeted interventions to combat walking deficits
The Role of Midline Thalamic Nuclei in Mediating Alcohol Consumption and Cognitive Performance in Alcohol Dependent Mice
No full textMidline thalamic nuclei are a cluster of brain regions known for their involvement in higher-order cognitive functions. In particular, the medio-dorsal thalamus (MDT) is known for utilizing short term memory in order to perform tasks and the paraventricular thalamus (PVT) is known for using feedback for behavior regulation. Both regions are highly interconnected with the infralimbic cortex (IL) and involved in behavioral flexibility and decision making. Alcohol Use Disorder (AUD) has previously been shown to alter decision making, but the underlying mechanism has yet to be determined. While there is some evidence that alcohol influences MDT and PVT function, these effects are not well characterized. Current literature shows that while the pathway between these midline thalamic structures and IL is reciprocal, directionality determines the function. Projections from the MDT to the IL were involved in supporting working memory maintenance while projections from the IL to MDT supported subsequent choice for a task. Likewise, the projections from the PVT to IL consolidate emotionally important memories and the projections from the IL to PVT are involved with behavioral responses. Given the role of these midline thalamic nuclei in mediating aspects of cognitive functions impacted by chronic alcohol exposure, I hypothesized that these brain areas would be activated by alcohol consumption after dependence and inhibition of these regions would reduce alcohol drinking and improve cognitive performance. The Chronic Intermittent Ethanol Exposure (CIE) model of alcohol consumption was used to model alcohol dependence in FosTRAP::Ai14 and DREADD-expressing (designer receptors exclusively activated by designer drugs) C57BL/6J mice to assess the effects of dependence on neural activation and inhibition, respectively. While we see a trend towards increased c-Fos activation in the anterior PVT during alcohol drinking after dependence, the MDT shows significantly more activation compared to water drinking. Despite a slight increase in activation of the PVT, we did not see a significant effect of chemogenetic inhibition of the PVT on alcohol consumption after CIE. Taken together, these results indicate that while the PVT might be engaged by alcohol consumption following induction of dependence, functional inhibition of this region during dependence-induced drinking does not alter consumption