MEDICA@MUSC (Medical University of South Carolina)
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Sympathetic Neuroeffector Junction: Formation, Maintenance, and Impact on Target Organ Function
No full textThe sympathetic nervous system (SNS) regulates heart rate and contractility in response to a variety of physical and emotional stresses. Proper formation and maintenance of sympathetic synapses are critical for SNS function, yet the underlying molecular mechanisms remain poorly understood. This dissertation investigates the role of Endothelin Receptor B (Ednrb) in the establishment and preservation of sympathetic synapses, as well as the structural and functional consequences of reduced sympathetic input. We investigate the role of Ednrb using two sympathetic neuron-specific Ednrb knockout mouse models: Th-cre/Ednrb, in which Ednrb is deleted embryonically, and THCreER/Ednrb where deletion is induced postnatally, at 3 weeks of age. We used fluorescence-based markers to visualize functional synapses of the heart and kidneys. Cardiac function was evaluated through electrocardiography, IonOptix imaging of isolated primary cardiomyocytes, and western blot analysis of proteins involved in contractility and calcium handling. Our results indicate that Ednrb deletion in sympathetic neurons significantly reduces functional sympathetic nerves in the heart, regardless of whether Ednrb loss occurs embryonically or postnatally. However, we find divergent outcomes in intrinsic cardiomyocyte function depending on when synaptic transmission at neuroeffector junction is impaired. Loss of communication between sympathetic synapses and developing cardiomyocytes resulted in a failure of cardiomyocyte to acquire normal contractile function, and ultimately led to ventricular arrhythmias. In contrast, elimination of sympathetic synaptic transmission to mature cardiomyocytes led to elevation of beta-adrenergic receptor expression and thereby beta-adrenergic hypersensitivity. These cardiomyocyte-specific responses to loss of local sympathetic neurotransmission are not compensated by systemic catecholamines and are relevant to clinical interventions for heart diseases, such as beta blocker therapy and surgical sympathectomy. Furthermore, our findings reveal that the synaptic phenotype associated with the loss of Ednrb from cardiac sympathetic nerves is not mirrored in the mature renal sympathetic nerves. These results suggest that the mechanisms of synaptic maintenance may vary between organ systems. While further research is essential to elucidate the precise mechanisms underlying Ednrb function in this context, the work presented in this dissertation overall enhances our understanding of the SNS’s role in cardiac physiology and the factors that influence sympathetic synapse formation and maintenance
Optimizing Sensory Processing: General Education Classroom Strategies
Get PDFIntroduction
In the general education setting, teachers often feel unequipped to address sensory processing deficits. There is little research in the general education setting within this area, but implementing sensory strategies can be beneficial for all students. The purpose of this capstone project is to support sensory processing behaviors within the elementary education setting.
Methods
General education classroom teachers/staff within Pembroke Elementary School (Public Schools of Robeson County, North Carolina) participated in an educational in-service that took place in February 2025. During this time, an 11-field RedCap survey was developed and a pre-survey/post-survey was provided to the participants to gauge their knowledge/awareness of general sensory processing information before and after the educational presentation was delivered. Afterwards, sensory processing consultation was provided to teachers/assistants within their general education classrooms as needed.
Results
A total of 23 (pre-inservice) and 24 (post-inservice) records were received from the teachers/assistants in attendance. Of the 10 multiple choice questions provided, 6 of them showed an increase in accuracy levels from the pre-inservice to the post and 3 questions demonstrated consistency. The results were expected to show greater post-inservice accuracy levels when compared to the pre-inservice levels.
Conclusion
The conclusion of this capstone process demonstrates increased teacher/staff awareness and knowledge surrounding sensory processing behaviors/tools/strategies. Over time and with succession of training and consultation, it is expected that student academic achievement, participation and behaviors will improve
From Data to Impact: Integrating Research, Data Analysis, and Data Visualizations to Shape the Future of Stroke Rehabilitation
No full textThis capstone project highlights the essential role of research in advancing occupational therapy (OT) practice and underscores the importance of data analysis and visualization in enhancing the communication and dissemination of research findings. Grounded in the Myers and Lotz Framework for Evidence-Based Practice and the CO-OP approach to problem-solving, the experience was structured around three core pillars: (1) gaining hands-on experience as a research therapist, (2) conducting in-depth data analysis, and (3) creating effective data visualizations to support scientific communication.
As a research therapist, I contributed to two ongoing studies: the Cognitive Priming (Cog-P) study and the Patient Quality Rating Scale for Telerehabilitation (PQRS-T) study. The PQRS-T study aimed to evaluate the measurement properties of a modified scoring system for telerehabilitation. Ten stroke survivors completed three standardized functional tasks—donning a jacket, folding clothes, and washing dishes—which were scored independently by an in-person and a remote rater to assess inter-rater reliability. My role encompassed contributions to study design, development of the manual of procedures, study implementation, data analysis, and the dissemination of findings through a manuscript and scientific poster.
Data visualizations emerged as a critical component of this project, serving as an effective medium for translating complex data into meaningful insights. Using existing telerehabilitation data from the Medical University of South Carolina (MUSC), I created geographic visualizations to illustrate the reach and unmet needs of stroke rehabilitation services across South Carolina. These visualizations informed external reporting and supported grant submissions, emphasizing the role of visual tools in advocating for expanded access to care.
Overall, this experience reinforced the value of integrating research into clinical practice and demonstrated how combining rigorous methodology with compelling visual communication can advance evidence-based, accessible stroke rehabilitation
Enhancing Wellbeing Through Caregiver Support: Improving Quality of life for Individuals with Special Needs and Complex Medical Diagnoses in Nicaragua
No full textIndividuals with disabilities living all over the world are constantly faced with additional barriers. In low-income countries, such as Nicaragua, there is often a gap in access to resources and education, for both individuals living with disabilities and their caregivers. Access is essential to provide high quality care to meet unique needs. This occupational therapy doctoral capstone project was created to support individuals providing care to children with special needs and complex medical diagnoses in Nicaragua by providing community-based education and sustainable resources to caregivers to enhance wellbeing in daily life. The deliverable was presented in country in Nicaragua to community members and is being distributed as video modules highlighting several areas impacting wellbeing including management of challenging behaviors and mental health. These videos will be posted on the organization’s website and are available in Spanish to ensure accessibility to this specific population. Data was collected through qualitative and quantitative approaches using pre/post surveys to evaluate the level of knowledge on given topics as well as verbal feedback provided by caregivers and program directors. Results from the surveys demonstrated improved knowledge in areas of mental health, addressing challenging behaviors, and general wellbeing. Responses indicated that the presentations and resources were helpful for caregivers. This project explored opportunities for educating caregivers of children with complex medical diagnoses to improve quality of life in a developing country. Future studies should further explore the effectiveness and utilization of video modules and other educational strategies to promote caregiver education in developing countries to promote physical, mental, and social well-being as emphasized by the World Health Organization (WHO)
Supreme Court Case Study: The Variation in Rates of Miscarriage Management Care and Post-Abortion Care Across the Us Before and After the Supreme Court Decision
Get PDFThe paper examines abortion care and the management of miscarriages following the Roe v. Wade decision in restrictive states that do not allow medical intervention due to the vague legal terms. This research evaluates the need to establish protocols for providers when faced with nonviable pregnancies requiring medical intervention. Additionally, the paper highlights the impact across the US on women’s health outcomes by emphasizing the care for miscarriage management. This multi-method paper reviews the current literature on miscarriage management and spontaneous abortion MarketScan® data from commercially insured individuals with an age range of 18-50 years old by regions across the United States for the years of 2018, 2019 and 2022 that was analyzed to study miscarriage data and the variation in rates of abortion care and miscarriage management care. Overall, 31% of commercially insured individuals across the US had the procedure. Women aged 35-44 are statistically more likely to undergo a procedure compared to their younger or older counterparts, and rural women were more likely to have a surgical procedure for miscarriage management. Patients who live in states with restrictive abortion bans, including miscarriage management care, have worsening reproductive health outcomes
What Are the Minimum Dimensions in a Marketing Plan Required for Starting or Improving Marketing in a Small, New Home Health Agency?
Get PDFObjective: To fulfill an unmet need for practical, parsimonious assistance for examples of a practical marketing plan for new, small home health care agencies. The home health (HH) care industry needs customized marketing plans tailored to the unique requirements of small, emerging HH agencies. These plans are essential for navigating the competitive market driven by an aging population and technological advancements. However, the industry\u27s emphasis on this specific aspect is significantly lacking.
Methodology: We reviewed the published literature, numerous books and websites and selected sources that provided practical, small-scale approaches to marketing for health care organizations. We identified specific marketing constructs that were relevant to HH and feasible to use for small organizations with limited resources and experience. Specific features included examining demographic, geographic, psychographic, and behavioral factors influencing service demand. The aim was to gather comprehensive data from Google Scholar and the Medical University of South Carolina Library to research marketing healthcare organizations, specifically HH services. We then extracted the key features, selecting those that fit: 1) small HH agencies, 2) were relevant to start-ups with limited resources, and 3) captured tailored approaches needed for rural areas.
Findings: After reviewing the literature, several key articles and books were identified offering practical strategies for HH agencies\u27 marketing plans. These resources included “Progressive Marketing and Growth Plan for Medical Home Health Care Services” by Nat Chiaffarano, which discusses innovative ways to enhance marketing reach; “Marketing the Home Health Agency” by Schmidt et al., which explores the sector\u27s challenges and opportunities; and “Marketing Home Health Care to the Rural Elderly” by Wade Lancaster, focusing on marketing plan strategies for serving older adults in rural areas. These resources offer valuable insights for effective marketing planning in the HH care industry.
Conclusion: The marketing plan for an HH provider should emphasize community positioning. Key strategies include collaborating with primary care physicians for patient referrals, engaging with hospital case workers, and maintaining close cooperation with social workers in nursing homes. The HH provider\u27s reputation is crucial for effective marketing, quality assurance, and the referral process in HH care
Occupational Therapy Assessment & Intervention in the Neonatal Intensive Care Unit at Shawn Jenkins Children’s Hospital
No full textBACKGROUND: There is a current lack of literature and evidence to supply neonatal intensive care unit (NICU) occupational therapists with appropriate standardized assessments and interventions. This project aims to explore at which age occupational therapy services will be most beneficial and widely accepted by NICU team members. Goals of this project include understanding current best occupational therapy practices, providing the NICU with the most up to date research and outcomes of interventions and assessments on the high risk neonatal and pediatric populations, improving communication and collaboration skills to engage with all NICU team members, and leading educational sessions about evidence based developmental care for preterm, high-risk, and medically fragile infants for NICU team members.
METHODS: After extensive research and analyzing current needs at the children’s hospital, the Alberta Infant Motor Scale (AIMS) assessment was designated as the chosen assessment to implement to address the gap of appropriate standardized assessment that can apply to a wide age group of NICU patients. The AIMS assessment observes infants’ movements in four planes: supine, prone, sitting, and standing and compares infants to same corrected aged peers. Along with the implementation of the assessment, further interventions have been integrated to improve best occupational therapy practices.
RESULTS: Data has been collected and analyzed via documentation and scores from the assessment, showing a linear decline in scores with increased chronological age and corrected age.
CONCLUSION: AIMS scores on infants tested at 0-4 weeks corrected age and scored an average of 71% higher than infants tested at 9-12 weeks corrected age, thus inferring that infants with longer hospitalizations are scoring poorer than those with shorter hospitalizations. When analyzed by birth gestational age, infants born more preterm had larger differences in corrected and chorological age percentiles than those born closer to term
Exploring the Relationship between Burnout, Professional Fulfillment, and Individual and Organizational Factors in Nurse Managers Across Ambulatory and Inpatient Settings
Get PDFNurse managers play a vital role in the functioning and stability of healthcare systems, yet their well-being remains an underexplored area of research. The COVID-19 pandemic brought renewed attention to occupational burnout, including in nursing leadership, where nurse managers reported high levels of stress, emotional exhaustion, and organizational strain. While the literature on burnout has grown rapidly in recent years, there is limited research that addresses what comes next, what sustains nurse managers in their roles and how organizations might foster their long-term well-being and engagement. This dissertation compendium explores professional fulfillment (PF) as a proactive and constructive lens for understanding and supporting nurse manager well-being.
The first manuscript is an integrative review that examines the existing literature on burnout in nurse managers and identifies individual and organizational factors that either contribute to or protect against it. This review highlights the current gaps in knowledge and underscores the need to move beyond problem-focused frameworks. The second manuscript introduces PF as a novel and underexplored construct in the nurse manager population. Using qualitative responses from a national cross-sectional study, this manuscript focuses on how nurse managers define professional fulfillment in their own words. By establishing a foundational understanding of what fulfillment means to nurse managers, this work lays the groundwork for future research and intervention design aimed at improving well-being and sustainability in nursing leadership.
The third manuscript presents quantitative findings from a cross-sectional study exploring levels of professional fulfillment and burnout in nurse managers and examines whether demographic characteristics, individual traits (e.g., resilience, self-efficacy), and organizational factors (e.g., perceived support) are associated with these outcomes. Together, these three manuscripts move the conversation from documenting burnout toward identifying what it might take to support fulfillment and long-term engagement in the nurse manager role
Development of a Mental Health Screening Protocol and Educational Materials for CARES Therapy Clinic
Get PDFIn the United States, 26% of individuals report living with mental illness each year. Those with a disability are 5 times more likely to report symptoms of mental distress. Additionally, underinsured individuals are at increased risk of going undiagnosed and untreated.
A student-run free clinic that provides occupational therapy (OT), physical therapy, and speech therapy services to underinsured individuals implemented a new initiative to screen patients using the Patient-Health-Questionnaire (PHQ) assessment due to the higher risk of undiagnosed mental illness. However, with no dedicated mental health providers on staff, there was a need to develop a standard protocol for students and supervising clinicians to follow when interpreting a patient’s score on the PHQ. This would be particularly important if a patient’s PHQ score indicated suicidal ideation.
The purpose of this quality improvement capstone project was to improve how mental health was addressed at the clinic. A mental health screening protocol was developed and included step-by-step instructions for interpretation of a patient’s score on the PHQ assessment and referral information for local clinics that provide affordable and accessible mental health care. The protocol also included guidance for initiating a psychiatric evaluation via a community mental health center in the case of a mental health emergency. Additionally, an evidenced-based educational handout was created to provide OT students with strategies for addressing mental health conditions in their treatment planning. The handout included examples of mental-health based treatment ideas, sample phrases to start a conversation on mental health, strategies for therapeutic use of self, symptoms indicative of mental illness, and tips for documenting mental-health based interventions.
Of the patients who completed the PHQ assessment, none yielded a positive score, indicating that they are currently at low risk for depression. Additionally, a satisfaction survey revealed OT students found the sample phrases and treatment ideas to be the most helpful due to feeling intimidated when addressing mental health in the clinic.
In the United States, 26% of individuals report living with mental illness each year. Those with a disability are 5 times more likely to report symptoms of mental distress. Additionally, underinsured individuals are at increased risk of going undiagnosed and untreated
Educational Resource Development for College Students with Intellectual & Developmental Disability:A Focus on ADLs and Mental Health
No full textThis Occupational Therapy (OT) Doctoral Capstone project was completed in a university-based Inclusive Post-Secondary Education (IPSE) program serving enrolled students with intellectual and developmental disabilities (IDD). These programs offer college students with IDD opportunities in academic learning, independent living, personal development, career training, and social participation. In response to a site needs analysis, this quality improvement project sought to develop educational resources to improve student confidence and preparedness for independent living and mental health education.
The project had two primary goals: (1) to create accessible, evidence-based educational materials to support students’ understanding of mental health and activities of daily living (ADLs), and (2) to promote awareness of how mental health impacts daily functioning.
To achieve these goals, three 15-minute voiceover modules were developed with complementary interactive worksheets designed to reinforce learning. Two modules focused on ADLs, covering all eight areas defined by the OT Practice Framework: bathing/showering, toileting and hygiene, dressing, eating and swallowing, feeding, functional mobility, personal hygiene and grooming, and sexual activity. The third module addressed mental health, exploring key topics such as the definition of mental health, characteristics of mental wellness, identifying signs of mental health challenges, and self-care strategies.
Project outcomes included increased student awareness and understanding of mental health and daily living skills, as well as the creation of sustainable educational tools for ongoing use by the site’s IPSE programs. These resources support greater independence, self-advocacy, and overall well-being among students with IDD