MEDICA@MUSC (Medical University of South Carolina)
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Educational Resources for Social-Emotional Regulation in Children
No full textEmotional dysregulation is defined as patterns of emotional experience or expression that interfere with goal-directed activity (Thompson 2019). Emotional development is built on the relationships created between a child and primary caregivers including parents, extended family, and/or teachers (Stern, 2010). This project supports the development of educational resources to implement social-emotional regulation tools with children. There were some resources at the site that already existed. These were updated and revamped, along with new resources created to address social-emotional dysregulation in children.
Two passionate pediatric occupational therapists based in the Charleston area created a self-regulation education program that is implemented by trained clinicians. Their mission is to equip caregivers, practitioners, teachers, and parents with a comprehensive curriculum, effective training, and practical tools to support children in developing self-regulation strategies (Lewis & Spann, n.d.).
This project aims to develop and improve educational resources to be used with the self-regulation education program created by my mentors. It involved facilitating the implementation of the resources created in classroom groups within the school system and the clinic setting. Support and feedback throughout the 14-weeks was provided by mentors and stakeholders. Adjustments were made to resources based on feedback received. This provided insight and helped to gage the effectiveness and sustainability of the resources created. These resources can be used within groups of various diagnosis or developmental levels. Different versions of some activities have been created for the use of older children vs. younger children. The resources cater in helping children become aware with their body senses. The body sensing resources center around: connection, movement, quality, and amount of sleep, and having healthy food and water each day.
Lewis, A., & Spann, H. (n.d.). Powerfully you. Powerfully You. Retrieved February 2025, from https://www.powerfullyyou.org
Thompson R. A. (2019). Emotion dysregulation: A theme in search of definition. Development and psychopathology, 31(3), 805–815. https://doi.org/10.1017/S095457941900028
Addressing Parent Confidence with Developmental Milestones Post-NICU Discharge: A Developmental Discharge Toolkit
Get PDFObjective: NICU parents have a higher prevalence of depression and anxiety compared to term, healthy newborn parents. The support while in the NICU is often tremendous; however, the guidance for the transition to home can be underwhelming. This quality improvement project aims to address parents’ confidence in providing developmentally progressive care through a resource toolkit post-NICU discharge. Methods: A needs assessment was completed by nurses and NICU parents to identify gaps in education and confidence in providing developmental care post-discharge. A therapeutic neonatal discharge toolkit was created to guide activities to support the achievement of developmental milestones for NICU graduates. Outcome measures targeted included the perceived benefit and feasibility of the toolkit. Education was provided to nursing staff, the tool was implemented, and feedback was obtained. Qualitative and quantitative data were analyzed and translated into visual and thematic charts. Results: OT Practitioners, nurses, and community providers found the toolkit beneficial and highly feasible to implement in various practice settings. Parents indicated the toolkit was easy to use, relevant to their needs, reduced stress, and helped prepare them for discharge from the NICU. The following five themes emerged from feedback surrounding review of the Developmental Discharge Toolkit: Accessibility & Ease of Use, Centralized & Comprehensive Information, Engaging Multimedia, Empowering Parent Confidence, and Emotional & Holistic Support. Conclusion: A resource tool for developmental milestone achievement post-NICU discharge was well-perceived by parents, nurses, and other providers. The Developmental Discharge Toolkit has the potential to serve as a bridge of therapeutic services and increase parents’ confidence in developmental care during the transition from NICU to home
Nourishing Skills: Online Education Materials for the General Pediatric Feeding Therapist
Get PDFIntroduction: There has been a rise in pediatric feeding difficulties, with up to 50% of typically developing children and 89% of children with developmental disabilities having a variation of feeding difficulties (Benjasuwantep et al., 2013). With occupational therapy (OT) being a field of practice that addresses activities of daily living and developmental milestones, it is imperative that providers are prepared to treat this population. Methods: Four REDcap surveys were completed by stakeholder groups to determine knowledge gaps and training methodology amongst pediatric therapy providers (Harris et al 2009, 2019). With 233 survey responses, results were gathered nationwide (123 clinicians, 39 referral sources, 30 managers, and 41 parents). Among therapists surveyed, 80% report no confidence in evaluating feeding needs, and 40% of clinics have no internal training protocol or mentorship. This indicates the need for an educational module for pediatric therapists who are working with children with feeding needs. To accomplish this, a comprehensive literature synthesis for current course content was completed along with a standardized course development process. Results: This process provides skills in literature review and course design. Additionally, technical training regarding course development offers a standardized method of course development along with an online course for feeding OTs. Conclusion: This project resulted in a good understanding of developing a well-rounded course and improved availability of care for children with mild to moderate feeding needs. Oral motor and sensory feeding needs addressed in this course will allow OTs to advance their feeding knowledge and improve the quality of care for this population
Empowering Future Practitioners: Using Constructivist Learning Strategies to Teach Occupational Therapy’s Role in Oncology Rehabilitation
No full textThis capstone project developed educational materials on occupational therapy’s role in oncology rehabilitation for first-year OT students at an accredited program. The deliverables included a lecture and lab session, guided by the constructivism theory and 5 Es educational model, to integrate foundational oncology content into early curricula. By addressing this gap, the project aims to better prepare future OTs to serve cancer survivors. Goals included enhancing students’ knowledge of oncology’s continuum of care and improving clinical reasoning during evaluations. Students completed a Pre-Quiz (testing general oncology/pathophysiology knowledge), Post-Quiz (lecture-specific questions), and Post-Survey (34 respondents). Results showed strong comprehension, with one Post-Quiz question answered correctly by all 53 students. Feedback highlighted strengths like the Choose Your Own Adventure case study, documentation assignment structure, and clear lecture/lab flow. Weaknesses included technical issues with PollEverywhere, insufficient time to review evaluation Q&A, and a lack of intervention-focused lab discussion. Future recommendations include expanding the lecture to a two-hour Musculoskeletal II block and involving physical therapy student to foster interdisciplinary learning in oncology rehabilitation
Innovative Curriculum: Entrepreneurship and Intrapreneurship for Entry-Level Occupational Therapy Students
No full textObjective: Occupational therapy (OT) education literature emphasizes the need for business competence to support innovative community programming. A needs assessment revealed gaps in entry-level OT graduates\u27 understanding of business concepts necessary for program development and sustainability. This capstone aimed to improve entry-level OT student business competency through the development, implementation, and evaluation of a business learning module as a Quality Improvement (QI) initiative.
Methods: A mixed-methods approach was used to develop the learning module Ideas2Impact: Business Brilliance for Community Innovation Module 1 (I2I:M1) targeting 15 business components aligned with the 2023 Accreditation Council of Occupational Therapy Education (ACOTE) standards. I2I:M1 was integrated into an existing entry-level OT course with 23 students participating in eight weeks of asynchronous and synchronous instruction, culminating in a community service project and presentation scaling to a viable business model.
Results: Students demonstrated measurable growth in knowledge acquisition, application, and learning experience. Quantitative data showed a 57% increase in perceived knowledge, statistically significant gains in 7 business components, and \u3e80% proficiency on 83% of quizzes. Final presentations and community partner ratings confirmed students\u27 ability to apply knowledge, with 80% of groups exceeding \u3e80% proficiency. Qualitative data revealed affective growth in professional identity, leadership, and appreciation for real-world impact.
Conclusion: Entry-level OT student business competence was improved through an experiential, collaborative, and ACOTE-aligned learning model. Findings support the value of business education intentionally embedded into OT curricula and refinement opportunities to equip future occupational therapy practitioners as sustaining community leaders
Mitigating Self-Inflicted Mortality Among Senior Veterans Aged 55 and Older with Chronic Conditions: An Exploration of an Innovative Positive-Sum Model Framework Leveraging Chronic Condition Special Needs Plans for Evidence-Based, Multidisciplinary Coordinated Care
No full textVeterans aged 55+ face higher self-inflicted mortality (SIM) risks, worsened by chronic conditions, adverse social determinants of health (SDoH), and fragmented care. This doctoral project proposes a Positive Sum Model of Care integrating Chronic Care Special Needs Plans (C-SNPs) with value-based interventions to enhance chronic disease management and reduce SIM. A mixed-methods study, including a scoping review and expert focus groups, examines model effectiveness, barriers, and stakeholder collaboration. Findings highlight multidisciplinary teams, telehealth, and SDOH-focused benefits, increasing engagement (40% rural access) and reducing costs (20% hospitalizations). CMS policy expansion for veteran-specific C-SNPs is recommended
Post-Translational Modifications of Extracellular Matrix Domains as Prognosticators of Hepatocellular Carcinoma via Integrative Serum and Spatial Proteomics
No full textHepatocellular carcinoma (HCC) remains a major global health challenge, with rising incidence, high mortality, and a five-year survival rate below 20%. Approximately 90% of HCC cases arise in cirrhosis, a stromal disease characterized by excessive deposition and remodeling of collagenous extracellular matrix (ECM). As HCC progresses, alterations in ECM composition and spatial distribution influence disease progression, emphasizing the potential of the ECM as a biomarker for HCC prognosis and treatment response. However, ECM proteomic analysis is challenging due to complex post-translational modifications, crosslinking, and insolubility. This dissertation molecularly and spatially characterizes the stromal landscape in and around HCC tumors in the context of patient outcome and improves current proteomic techniques for ECM biomarker discovery. The central hypothesis is that the composition, post translational modifications, and spatial distribution of ECM can predict clinical HCC outcomes and that ECM fragments released into the circulation can serve as noninvasive biomarkers for patient stratification.
Aim 1 uses mass spectrometry imaging (MSI) to identify ECM signatures in formalin-fixed paraffin-embedded (FFPE) resected HCC tumors that differ by patient outcome. Stromal infiltration and proline-hydroxylated fibrillar collagen peptides differentiated between tumor subtypes (S1: poor prognosis, S3: better prognosis) with high sensitivity and specificity (AUROC \u3e 0.8). Machine learning algorithms were able to identify multiple peptide signatures (n = 4-6) that could distinguish classes (AUROC \u3e 0.97). Aim 2 developed collagenase-based serum proteomics to identify circulating ECM markers for patients with liver cirrhosis and HCC. This approach enriched proteomic readouts for ECM proteins, curating a panel of ECM proteins unique to patients with liver cirrhosis and HCC. Aim 3 optimized collagenase-based proteomics workflows to enhance peptide identification for mass spectrometry imaging. Collagenase preferentially cleaved collagen at the N-terminus of glycine resides in G-P-X-G-P-X repeats, enriched for ECM proteins in FFPE tissues and generated more singly-charged peptides. Expansion of TIMS windows to include these singly-charged peptides improved MALDI-MSI peptide identifications by 30%. The combined optimization of sample preparation and mass spectrometry increased MALDI-MSI peptide identifications by 7-fold.
Overall, this research advances ECM-based biomarker discovery and noninvasive screening for HCC, with implications for personalized patient management and improved clinical outcomes
Exploring the Effect of Social Determinants of Health (SDOH) Factors on the Time to Kidney Transplant Evaluation Completion for African American End Stage Renal Disease (ESRD) Patients
No full textPurpose – The purpose of this dissertation is to investigate the relationship between demographics and Social Determinants of Health (SDOH) variables on diagnostic testing time completion in patients being evaluated for kidney transplant waitlisting.
Aims - Compared to White Americans, African Americans who are eligible to receive a kidney transplant are less likely to complete the required testing in order to be placed on the kidney transplant waiting list which puts African Americans at risk for morbidity and mortality due to prolonged exposure to dialysis. The COVID-19 pandemic was directly associated with a decrease in the number of patients placed on the kidney transplant waiting list, however, it is not clear if the pandemic specifically had an impact on evaluation completion time in preparation for kidney transplant waitlisting. The aims of this dissertation are to first determine the average time to evaluation completion in patients evaluated for kidney transplant waitlisting. Secondly, to investigate whether there is a relationship between demographics and SDOH variables on kidney transplant evaluation completion. Lastly, to investigate the effects of the COVID-19 pandemic on diagnostic evaluation completion during the following periods: January 2018 – February 2020 (pre-pandemic), March 2020 – March 2022 (lockdown and pandemic), April 2022 – March 2024 (“post”-pandemic).
Design and Theoretical Basis – Guided by the Social Ecological Model (SEM), we conducted a retrospective cohort study analyzing existing data from a large academic medical center in the southeastern United States (U.S.) to determine the average time to diagnostic test completion in patients who were evaluated for kidney transplantation and investigated whether there is a relationship between demographics and SDOH variables with diagnostic testing time completion.
Findings – African Americans took longer to complete the evaluation for kidney transplant waitlisting compared to White Americans. We used the Social Deprivation Index (SDI) as a proxy measure for SDOH variables and noted that evaluation completion was not dependent on race and SDI combined which raises the question of whether SDI was the best proxy measure for SDOH. When the COVID-19 time periods were investigated, the evaluation completion time across each COVID-19 time period (pre, pandemic, and post pandemic) was consistently longer for African Americans compared to White Americans. The disparity in time to evaluation completion between African American and White patients widened in the “post” COVID-19 period with African American patients experiencing significantly longer delays.
Conclusion – Recommendations are provided which may have an impact on time to evaluation completion in preparation for placement on the kidney transplant waiting list
Developing a Training Course for School Health Nurses to Decrease Stigma Towards People with Disabilities in Accra, Ghana
Get PDFThe Role of Spinster Homolog 2 (SPNS2) in Cancer Progression and Metastasis
No full textCancer metastasis remains the leading cause of cancer-related mortality, yet the molecular mechanisms driving this process are incompletely understood. Spinster Homolog 2 (SPNS2) is an important transporter exporting sphingosine-1-phosphate (S1P), a bioactive lipid that regulates cell migration, survival, and immune cell trafficking. Despite emerging evidence linking SPNS2 to tumor progression, conflicting reports suggest it may either promote or suppress metastasis depending on cellular context. This dissertation systematically investigates the role of SPNS2 in cancer metastasis and progression, addressing these discrepancies through an integrated approach combining clinical data analyses, molecular biology techniques, and preclinical models.
Kaplan–Meier analyses revealed that high SPNS2 expression is positively correlated with poor overall survival in breast, lung, ovarian, and pancreatic cancers, as well as enhanced lymphatic dissemination in breast cancer. SPNS2 overexpression in cancer cell lines promoted S1P export, activated the S1P receptor 1-AKT pathway, and induced EMT and cancer stemness, thereby increasing cell migration and lung metastasis. In contrast, SPNS2 knockout diminished S1P secretion, EMT, and cancer stemness, leading to impaired cell migration and lung metastasis. Additionally, immunophenotyping and transcriptomic analyses demonstrated that SPNS2 inhibition reprograms the tumor microenvironment by activating systemic anti-tumor immune responses mediated by T cells and myeloid cells, leading to reduced primary tumor growth and spontaneous lung metastases. Mechanistically, SPNS2 inhibition triggers immunogenic cell death (ICD), releasing damage-associated molecular patterns (DAMPs) that prime myeloid cells for antigen presentation and activate T cells to mount an effective anti-tumor response.
Notably, pharmacological inhibition using a novel small-molecule SPNS2 inhibitor (SLF82801178) recapitulated the effects observed with genetic ablation by suppressing primary tumor growth and lung metastasis while enhancing T cell-mediated anti-tumor responses. Therapeutic administration of the SPNS2 inhibitor following surgical resection of primary tumors significantly reduced distant metastatic burden, suggesting potential clinical utility in adjuvant settings.
Collectively, these findings establish SPNS2 as a pivotal regulator of cancer metastasis that functions through dual mechanisms, driving tumor cell-intrinsic pro-metastatic signaling and orchestrating an immunosuppressive tumor microenvironment. Targeting SPNS2 disrupts these processes and reconditions the immune landscape, offering a potential therapeutic strategy to curb metastatic progression and improve patient outcomes