MEDICA@MUSC (Medical University of South Carolina)
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Web-Based Wellness
No full textAdults of all ages experience life stressors and transitions that impact their physical, emotional, and psychosocial wellness. Despite a recognized need for self-improvement, many adults face time constraints that limit their ability to engage in traditional wellness activities. Research suggests that micro-learning strategies—brief, targeted educational interventions—can effectively enhance knowledge and influence life practices.
This quality improvement capstone project explored the use of microlearning to support adult well-being by developing a web-based, modular learning system. The project implemented a series of short educational videos addressing various wellness topics, supplemented by corresponding worksheets and resource materials. Designed for asynchronous completion, these wellness materials allow participants to engage with the content at their convenience using personal electronic devices.
Findings from this capstone program indicated that participants found the modules to be engaging, user-friendly, and effective in enhancing their understanding of wellness activities. Furthermore, participants expressed appreciation for the flexibility afforded by the online format and the provision of additional worksheets. Overall, the development and pilot implementation of the web-based wellness modules demonstrated the feasibility and effectiveness of employing micro-learning techniques to support adult wellness
Socio-Demographic Factors and Contraceptive Access: A Study of Women in the DC, Maryland, Virginia Area
No full textEquitable access to birth control remains a significant public health concern, particularly among marginalized communities facing systemic barriers. This study explores the impact of socio-demographic factors and racial disparities on contraceptive access among women in Baltimore City, Maryland. Using a mixed-methods approach, data were collected from 91 participants, comparing contraceptive knowledge, satisfaction, accessibility, cost impact, and quality of care between college-educated and non-college-educated women. Findings indicate that lower educational attainment and financial constraints significantly hinder birth control access, with cost serving as a major barrier. Additionally, Black women reported lower satisfaction with reproductive healthcare services, highlighting disparities in provider interactions and systemic bias. Geographic disparities, particularly in contraception deserts, further limit access to essential reproductive healthcare. Policy recommendations include expanding Title X funding, increasing telemedicine services for birth control consultations, and enhancing cultural competency training for healthcare providers. Future research should explore broader geographic and racial populations while addressing systemic inequities in reproductive healthcare. This study contributes to the growing discourse on health equity, underscoring the need for targeted interventions to ensure that all individuals, regardless of socio-economic status or race, have access to comprehensive and affordable contraception
Medically Documented Rapes and Description of Victim Reproductive Choices for Privately Insured and Medicaid U.S. Women in 2022
No full textObjective: To assess how often women aged 18–45 in the U.S. who experienced medically documented vaginal rape received prescriptions for abortion pills within 16 weeks of the incident in 2022, using MarketScan® and Medicaid claims data.
Methods: This retrospective cohort study used ICD-10 codes to identify rape survivors in insurance claims data. Researchers tracked prescriptions for abortion pills (mifepristone and misoprostol) within 16 weeks of the incident. Descriptive statistics compared use before and after the overturning of Roe v. Wade.
Results: Among 3,314 identified survivors (508 commercially insured; 2,806 Medicaid), abortion pill use was extremely rare—only 16 women had a prescription paid by their insurer. Emergency contraception was also infrequent, with only 60 women receiving “Plan B” drugs.
Conclusion: Insurance billing data show that most rape survivors do not use insurance to obtain abortion pills or emergency contraception. This suggests a reliance on out-of-pocket care and highlights a significant limitation of using medical claims data to study the intersection of sexual violence and reproductive health choices
The Incidence of Hospital-Acquired Pressure Injuries in the Setting of the Changing Nursing Workforce Throughout the COVID-19 Pandemic
Get PDFBackground: This study examines how the experience level of Registered Nurses (RNs) has declined while the incidence of hospital-acquired pressure injuries (HAPIs) has increased from 2018 to 2022. Purpose: To evaluate the association between nurses’ experience level and patient outcomes, specifically HAPIs, on a state-by-state basis. Methods: Retrospective, observational study of Medicare patients hospitalized in 41 states using the Medicare 5% Limited Dataset. Nurse experience was measured by the date of first licensure using the Nursing Sample Survey of Registered Nurses (NSSRN). Outcomes include a comparison of the percent increase in HAPIs and change in RN experience level by state. Discussion: The Spearman correlation coefficient indicated a weak but positive relationship between RN experience loss and percent HAPI increase (r = .172)
Waring Library Society Newsletter, Summer 2025
Get PDFIn this issue, Waring Library Society President Robert Ball, M.D. highlights the accomplishments of Dr. Randolph D. Smoak, Jr., emphasizing his leadership in medical organizations, advocacy for health reform and anti-smoking efforts, and recognition as a distinguished alumnus of MUSC. Jerry Reves, M.D., shares a brief new history of the Medical College. The Waring’s staff also provide updates: JoAnn Zeise, provides updates on the Waring’s restoration project, including the asbestos; Tabitha Samuel shares the new Spring 2025 titles added to MEDICA@MUSC, Jude Arendall makes a return to the Waring.https://medica-musc.researchcommons.org/wls-newsletters/1010/thumbnail.jp
Primary Care Physicians\u27 Perspectives on Clinical Integration and Performance Metrics in a Medically Underserved Area.
Get PDFWith the national movement toward improving population health and helping combat the rising costs in healthcare, there are still assumed challenges and barriers concerning performance among healthcare organizations that impact costs and health outcomes. The Physician Hospital Organization (PHO) site within this study has been plagued with poor performance with assumed challenges and barriers for years. In this mixed-methods study leveraging the qualitative approach to support existing data, all primary care physicians within the PHO under study were interviewed, and by following the inductive approach and thematic analysis, valuable themes arose. It was found that due to patient education lacking along with the underprivileged state of the population, physician performance lagged within the quality program, along with financial incentives not being optimal or well understood. Additionally, the physicians relayed that staffing needs/duties contribute toward performance and that the current quality program does not reflect the actual quality of care provided, with patients being non-adherent due to socioeconomic constraints and access to care being issues hindering performance. Physicians requested more organizational support with administrative services and improved patient access.
After understanding the reasoning behind this study and the themes that arose, healthcare organizations can leverage existing performance data with qualitative findings to better strategize how to improve quality programs and create new support methods for physicians and patients. This will reduce healthcare costs and improve health outcomes among those in need
Home Exercise Program Adherence in Stroke Rehabilitation: Analyzing Barriers and Evaluating the Efficacy of Problem-Solving Consultations
Get PDFIn post-stroke rehabilitation, the high number of task practice repetitions needed for neural plastic recovery cannot be achieved within standard therapy sessions alone. Home exercise programs (HEP) are prescribed to augment the needed repetitions. However, adherence is often poor, leading to suboptimal functional recovery. Our long-term goal is to develop tools to assist with HEP adherence. Toward this goal, the objective of our study is to investigate: (1) common barriers to HEP adherence, (2) problem-solving solutions, and (3) the impact of these solutions on adherence levels. Participants received standardized upper extremity rehabilitation therapy along with HEP for 6 weeks. Barriers to HEP adherence reported by patients, problem-solving solutions provided by therapists, and HEP adherence logs were obtained at each therapy visit. Common barriers were identified as: exercise too hard, fatigue, pain, impatient/frustrated, forgot, time, not in daily routine, and assistance needed. Common solutions were identified as: adapt HEP exercises, education on proper technique, reminders, encourage HEP, and caregiver education. HEP adherence levels tended to improve in response to the provided solutions. The impact of this study is that identification of common barriers and efficacy of solutions to HEP adherence will provide the groundwork to improve HEP adherence and maximize functional recovery post-stroke
Nurturing Potential: Building Teacher Capacity to Support Infant Developmentin Low Income Daycares
No full textNurturing Potential: Building Teacher Capacity to Support Infant Development in Low Income Daycares
Jeanae Williams, OTDS
Faculty Mentor: Kelly McGloon, PhD, OTR/L
ABRSTRACT:
Early childcare centers play a critical role in fostering young children’s learning and development. Each year, approximately 600,000 infants are born at risk for developmental delays, yet less than 50% are identified early. Early detection and support are crucial in reducing long-term developmental challenges and improving outcomes for reaching milestones. This capstone project aims to enhance the capacity of infant classroom teachers in low-income daycare settings by providing education on typical development and increasing awareness of resources for early identification of developmental delays.
Teachers were introduced to accessible developmental screening tools, online resources, and age-appropriate activities to enhance their education of the importance of early intervention. By gaining hands-on experience with these resources, this project was found to empower teachers with the knowledge and confidence to support early detection and intervention. The results proved that as teacher capacity increased, the gap in early identification and inexperience of resources for at-risk infants in low-income communities decreased. Some limitations of the capstone project include ABC Quality guidelines, teacher burnout/staff turnover, and time constraints/busy schedules. In conclusion this capstone was successful in its objectives to strengthen the role of early childhood educators in developmental monitoring, intervention, and addressing developmental concerns to promote a strong foundation for lifelong learning
Enhancing Quality of Life Through Participant-led Programming for Adults with Intellectual Disabilities
No full textThere are currently over 6.5 million Americans living with an intellectual disability (Centers for Disease Control and Prevention [CDC], 2019). Research shows that individuals with intellectual disabilities are more likely to experience a lower quality of life (QOL) compared to those without disabilities (Hughes-McCormack et al., 2017). Eight core domains have been identified as essential to quality of life: emotional well-being, interpersonal relationships, material well-being, personal development, physical well-being, self-determination, social inclusion, and rights (Lachapelle et al., 2005). In response to these needs, this capstone project aimed to implement customized, supported, participant-led programming at a day program for adults with intellectual disabilities in Charleston, SC with a goal to enhance multiple quality-of-life indicators.
The goals of this project were to develop and implement participant-led programming for individuals at a day program, to create instructional materials that would guide staff in facilitating these experiences, and to evaluate the effectiveness of both the programming and materials in terms of quality-of-life indicators and sustainability. Two individuals with intellectual disability at the day program were supported in planning and leading a class for community members.
Outcomes revealed increased confidence, self-efficacy, and communication skills in both participants. These improvements were evident not only through participant self-reports but also through feedback from staff and family members, who observed stronger interpersonal engagement, initiative, and pride. Staff members also reported increased confidence in facilitating participant-led programming and expressed readiness to continue implementing these practices using the resources developed through this project.
This initiative demonstrates the positive impact of participant-led experiences on individuals’ quality of life and underscores the value of this approach in adult day programming for individuals with disabilities.
Resources
Centers for Disease Control and Prevention. (2019, Nov 19). Health care for individuals with intellectual disabilities. https://www.cdc.gov/grand-rounds/pp/2019/20191015-intellectual-disabilities.html
Hughes-McCormack, L. A., Rydzewska, E., Henderson, A., MacIntyre, C., Rintoul, J., & Cooper, S. (2017). Prevalence of mental health conditions and relationship with general health in a whole-country population of people with intellectual disabilities compared with the general population. BJPsych Open, 3(5), 243-248. https://doi.org/10.1192/bjpo.bp.117.005462
Lachapelle, Y., Wehmeyer, M. L., Haelewyck, M. -., Courbois, Y., Keith, K. D., Schalock, R., Verdugo, M. A., & Walsh, P. N. (2005). The relationship between quality of life and self-determination: An international study. Journal of Intellectual Disability Research, 49(10), 740-744. https://doi.org/10.1111/j.1365-2788.2005.00743.
Ceramide Synthase 4 in Cancer Metastasis and Immune Checkpoint Resistance
No full textMetastasis is the leading cause of cancer-related mortality. Immunotherapy, like immune checkpoint blockade (ICB), has revolutionized how we treat metastatic cancer, but ICB resistance substantially limits efficacy, especially in solid cancers like triple-negative breast cancer (TNBC). Understanding the molecular drivers underlying metastasis and immunotherapy resistance is crucial to improve clinical outcomes. This dissertation investigates ceramide metabolism, specifically Ceramide Synthase 4 (CerS4), in regulating metastasis and immunotherapy resistance through intracellular programmed death ligand 1 (PD-L1) signaling.
Using molecular in vitro and transcriptomic approaches, we established that CerS4 downregulation promotes PD-L1 internalization from the cell surface into an intracellular complex with the RNA-binding protein Caprin-1. This PD-L1/Caprin-1 complex stabilizes oncogenic mRNAs critical for promoting tumor migration/metastasis via activating Sonic hedgehog (Shh) and TGF-β signaling pathways. Genetic ablation of CerS4 in transgenic and orthotopic TNBC models significantly increased metastasis and generated an immunosuppressive tumor microenvironment (TME) characterized by elevated regulatory T cells and CD8+ T cell dysfunction. Importantly, pharmacologic targeting of the PD-L1/Caprin-1 complex with Shh pathway inhibitors combined with ICB synergistically enhanced antitumor immunity and significantly reduced metastasis.
Next, we developed a transplantable, orthotopic TNBC model of ICB resistance (E0771-2RA) via serial anti-PD-L1 therapy and interrogated this model with comprehensive lipidomics, transcriptomic analyses, and immune profiling to understand the role of CerS4 in immunotherapy resistance. The E0771-2RA model exhibited strong CerS4/ceramide suppression, enhanced intracellular PD-L1 accumulation, increased Caprin-1 interaction, and heightened prostaglandin E2 (PGE2) synthesis via prostaglandin-endoperoxide synthase 2 (Ptgs2) mRNA stabilization by the PD-L1/Caprin-1 complex. We identified that ceramide, regardless of chain length, directly binds PD-L1 and prevents Caprin-1 binding. Resistant tumors displayed significant immune remodeling within the TME with prominent CD8+ T cell dysfunction. After ICB, dynamic expression of PGE2receptors, EP2 and EP4, was observed among CD8+ T cells and impaired response in PGE2-rich tumors. CerS4/ceramide restoration or targeting the PD-L1/Caprin-1 complex via TGF-β inhibition reversed ICB resistance and reactivated CD8+ T cell response.
Collectively, these results identify the CerS4/PD-L1/Caprin-1 axis as a critical determinant of metastasis and immunotherapy resistance in cancer, providing new therapeutic strategies for targeting metastasis and improving ICB response rates