MEDICA@MUSC (Medical University of South Carolina)
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Determining Microbial and Neuroimmunological Differences Associated with Adolescent Alcohol Use
No full textEarly alcohol use is an important risk factor for alcohol and substance use disorders, but the neurobiological changes that lead to increased vulnerability are not well understood. Alcohol-induced alterations in the microbiome at an early age may lead to neural changes that affect the escalation of alcohol use. Consequently, the microbiome is a novel area of research for adolescent alcohol use disorder (AUD). The present studies investigated differences in the oral microbiome of human adolescents (ages 17-19) who engage in heavy drinking (n=21, 52.4% female) compared to non-drinking control participants (n=18, 44.4% female). We explored associations between the oral microbiome, oral cytokine mRNA levels (interleukin 6 [IL-6], interleukin 1 beta [IL-1β], tumor necrosis factor alpha [TNF-α]), and proton magnetic resonance spectroscopy markers of neuroinflammation (myo-inositol, total choline, total creatine, N-Acetylaspartate). As hypothesized, adolescents who engaged in heavy drinking had significant differences in the diversity and composition of the oral microbiome. Compared to the control group, the alcohol-using group exhibited lower evenness and higher abundances of Rothia and Corynebacterium. We observed no significant differences in cytokine mRNA levels between the groups; however, levels of IL-1β correlated with the abundances of several genera in both groups, including abundances of Rothia. IL-1β was also associated with a higher number of alcohol use days in the past 90 days and phosphatidylethanol concentrations in the alcohol-using group. While there were no significant group differences in neuroinflammation markers, abundances of Rothia were associated with significantly higher concentrations of total creatine-containing metabolites across the whole sample. The associations between Rothia, mRNA cytokine levels, and neurometabolite levels are intriguing, as Rothia is well known for its high capacity to covert alcohol into acetaldehyde, suggesting a potential link between the oral microbiome and neurobiological processes related to alcohol use. Taken together, these studies indicate that the oral microbiome may be affected by alcohol use and is associated with cytokine mRNA levels and neurometabolite concentrations in individuals who use alcohol and controls. The microbiome may aid in prevention and intervention efforts for adolescent AUD by providing new targets for treatment and/or diagnostic and therapeutic response biomarkers
Improving Parent and Daycare Staff Confidence in Monitoring Developmental Milestones Through Education of Pediatric Development
Get PDFThe most effective approach to identifying developmental delays involves a combination of developmental monitoring by all caregivers involved in the child’s life, ongoing communication among caregivers, and the administration of formal developmental screenings. This quality improvement capstone project focused on enhancing the education and resources available to daycare teachers regarding developmental milestones, recognizing red flags in development, communicating with parents, and determining appropriate next steps if milestones are missed or therapy services are required. A resource binder was created for each daycare classroom alongside a presentation given to educate staff on developmental topics by age. Evaluation of daycare staff perception revealed high satisfaction with the provided education and resources, recognition of the material\u27s value, and an overall improvement in knowledge and confidence in identifying and addressing developmental delays
Supporting the Caregiver’s Transition Home After SCI: Resource Development for Roper Rehabilitation’s Family Training Program
No full textOccupational Therapy plays a key role in evaluating and recommending Durable Medical Equipment (DME) and Adaptive Equipment (AE). The utilization of appropriate, efficient, and safe equipment referrals is crucial for maximizing functional independence and setting patients up for success in their home environments. However, not all pieces of equipment are readily accessible through insurance coverage, out-of-pocket expenses, or knowledge of community resources creating a gap in accessible DME and AE resources for under/uninsured vulnerable populations (Martinez et al., 2021).
From January – April 2024, a quality improvement (QI) project was conducted in partnership with PHC Home Health and DME to improve an existing reused equipment storage facility (Jean’s Fund) and increase healthcare professionals\u27 awareness of existing community resources for reused equipment. PHC Home Health staff were observed during patient encounters, interviewed one-on-one, and given surveys (n=2) to test and provide feedback on multiple online inventory systems developed to enhance Jean’s Fund organization and accessibility. Following inventory development and implementation, an easy-to-replicate Reused Equipment Toolkit was created with access to a compilation of local and statewide reused equipment community resources, access to free online inventory system templates created in Google applications, and an accompanying tutorial video to walk healthcare professionals through inventory system setup.
The Reused Equipment Toolkit was disseminated in an In-service format to PHC Home Health Staff (n=11), The Villages Skilled Nursing Facility Staff (n=14), MUSC Acute Care OT Staff (n=6), and Roper Rehabilitation Acute Rehab. Staff (n=9). The outcomes for the In-Services were (95%) Strongly Agree, (~3%) Agree and (~2%) Strongly Disagree to the statements “This presentation provided me with information that I found helpful”. In Conclusion, the Reused Equipment Toolkit was well received by most health care professionals involved in this QI project. While the data collected was limited in scope, the implications of these findings are promising first steps for increasing the utilization of existing reused equipment resources and the possible development of additional reused equipment inventories throughout the community.
Source: Martinez, C. I., Sanchez, A. N., Stampas, A., Woo, J., & Verduzco-Gutierrez, M. (2021). Demographics and durable medical equipment needs of persons with disabilities in a charitable rehabilitation clinic. American Journal of Physical Medicine & Rehabilitation, 100(3), 288-291. https://doi.org/10.1097/PHM.000000000000155
Interprofessional Collaboration to Evaluate Health Disparities in the Utilization of Therapy Services for Children with Down Syndrome
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What Is the Effect of Telehealth and the Internet of Medical Things (IOMT) on Outcomes When Used in At-Risk Pregnancies: A Scoping Review of the Components of Remote Maternal Monitoring for Hypertensive Disorders that Can Successfully be Done Via Digital Technology?
Get PDFIoMT (Internet of Medical Things) is an emerging technology that facilitates individualized remote e-health services to improve patient\u27s quality of life and satisfaction while decreasing healthcare expenditures. The objective of this scoping review is to explore the usage of IoMT and remote patient monitoring (RPM) in at-risk pregnancies for hypertensive disorders to mitigate pregnancy-related complications. IoMT and other devices in an intelligent health system can meaningfully ameliorate maternal care management in the United States (U.S.). Wearables and nearables, subcategories of IoMT, can be utilized to facilitate patient-centered care and promote excellence in health maintenance/management through a holistic continuum of care approach while decreasing maternal mortality and morbidity in the U.S., which currently has the highest maternal mortality ratio/rate (MMR) among all western nations. IoMT and RPM can leverage the Quadruple Aim framework, the current gold standard in U.S. healthcare service delivery, and exist at the convergence of the different dimensions of care. The four tenets of the Quadruple Aim in delivering high-quality healthcare are to (1) Improve population health, (2) Lower healthcare costs, (3) Enhance patient experience, and (4) Improve care team well-being
Estradiol Signaling Improves Extinction Memory Recall to Combat Cue-Induced Heroin Relapse in Rats
No full textWe are in the midst of an opioid use disorder (OUD) epidemic. While several treatments mitigate a range of factors contributing to return to use, or relapse, the power of drug-conditioned environmental cues to precipitate relapse have not been adequately addressed. One treatment modality targeting cue reactivity, cue exposure therapy (CET), exacerbated relapse in individuals with OUD, perhaps due to a deficit in extinction memory recall (EMR). Here, EMR is the ability to override the drug-cue association and prevent relapse. Interest remains in combatting cue-induced relapse, potentially by introducing a pharmacologic adjunct with CET to enhance EMR. In the following chapters, this dissertation will test the prospect for estrogen signaling to enhance heroin-cue EMR in a preclinical model of OUD.
After an introduction to OUD and estrogen signaling (Chapter 1), Chapter 2 tests the effects of sex and gonadal hormones on several aspects of heroin self-administration. This revealed that females took more heroin and responded more for heroin cues than males. Based on prior literature indicating that estrogen receptor β (ERβ) may impact fear EMR, Chapters 3 and 4 tested the effects of systemic ERβ agonism on heroin- and sucrose-cue EMR after varying periods of abstinence. Notably, ERβ agonism reliably enhanced heroin-cue EMR in both sexes without affecting sucrose-cue EMR.
To uncover the neurobiological underpinnings of ERβ’s effect, the remaining experiments examined how estrogen signaling in the basolateral amygdala (BLA) impacts heroin-cue EMR. Chapter 5 introduces the amygdala and evaluates literature implicating the BLA in mediating ERβ’s effects on heroin-cue EMR. This is tested in Chapter 6, wherein ERβ agonism in the BLA enhanced heroin-cue EMR in females only. Reinforcingly, ERβ antagonism in the BLA impaired EMR in females while, unexpectedly, ERα antagonism disrupted EMR in males. In fact, inhibition of estrogen synthesis in the BLA had similar disrupting effects on heroin-cue EMR (Chapter 8). This sex-specific contribution of ERβ in the BLA may be driven by differences in ERβ expression in a subregion of the BLA (Chapter 9). Collectively, these results indicate that ERβ agonists can enhance heroin-cue EMR and are, therefore, potential adjuncts to CET to treat OUD