MEDICA@MUSC (Medical University of South Carolina)
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Sensory Processing and Intervention in the Pediatric Setting: Resources for Implementing Sensory Strategies in the Pediatric Outpatient Clinic, Community, and Among Different Diagnoses
No full textSensory Integration is such an important concept as sensory processing underlies all independent functioning (Miller et al., 2017), and it is particularly important for pediatric occupational therapists as sensory processing differences are especially common in pediatric populations (Ahn et al., 2004; Leekam et al., 2007).
The purpose of this capstone project is to facilitate occupational therapy clinician competence and confidence in implementing sensory strategies and techniques within an outpatient pediatric clinic that provides in-clinic and community-based services. Project goals include the creation of educational materials in order to improve confidence and to facilitate creativity when incorporating sensory strategies into treatment sessions.
After creation and implementation of additional sensory resources, data was collected using a mixed-methods approach via anonymous REDCap survey to evaluate satisfaction with the created educational materials and their application within practice. Participants include clinic-based and community-based OT clinicians at an outpatient pediatric clinic on a volunteer basis (n=10). Two teachers also provided additional feedback regarding private school and preschool-focused resources (n=2).
Data collection yielded 9 returned surveys (60% response rate) with respondents reporting an average of 3.4 years of clinical experience. Key findings include 100% of respondents strongly agree to the following statements: “These resources will be beneficial when providing support to junior OTs”, “These resources are effective when providing education to caregivers and teachers”, “These resources are helpful when planning treatment activities”, and “These resources are of high quality (clear, organized, and written in appropriate terminology)”. 90% of respondents strongly agree and 10% of respondents agree to the following statement: “I am more confident in my chosen treatment activities”. A few respondents provided additional qualitative feedback, which have also been analyzed and incorporated into the final results. In conclusion, data collection has determined the effectiveness of the created resources and the encouragement of sustainability within the clinic
Molecular Pathology of the Breast Microenvironment Contributing to Risk and Outcome in Breast Cancer Disparities Using Multimodal, Multiplexed Mass Spectrometry Imaging
No full textBreast cancer is the most common type of cancer diagnosed in American women as of 2020. Despite White women (WW) having the highest incidence rates compared to any other racial/ethnic group in the United States, Black women (BW) have the highest overall mortality rates. One major difference between breast cancer diagnosed in BW and WW is the aggressiveness of the malignancy, with BW having over twice the frequency of triple-negative breast cancer (TNBC). TNBC, characterized by the lack of receptors for estrogen (ER), progesterone (PR), and human epidermal growth factor 2 (HER2), is considered aggressive due to increased proliferation, metastatic potential, recurrence, and ineffective treatment options. Research demonstrates that the disparity in breast cancer mortality between racial groups is not solely attributable to healthcare inequities, but also to distinct tumor characteristics, raising the question of whether biological markers exist within normal breast tissue that may predispose Black women to more aggressive breast cancer subtypes. One important regulator of the tumor microenvironment is the collagen-rich extracellular matrix (ECM), which acts as a dynamic scaffold that influences cell fate and tissue function by mechanical and biochemical signaling. The organization of collagen fibers within the ECM, particularly fibers that project perpendicularly from the tumor, has been associated with worse outcomes in breast cancer due to enhanced tumor cell invasion and metastasis facilitated by this ECM architecture. Although the physical structure of collagen organization has been explored in breast cancer, the molecular composition of collagen proteins, including post-translational changes, has not been well defined for the breast normal or tumor microenvironments (NME/TME). Post-translational modifications (PTMs) within collagen domains, especially proline hydroxylation, have the potential to modulate cellular interactions, function and signaling pathways. Our central hypothesis is that there are specific collagen signatures that characterize increased risk in healthy breast and associate with worse clinical outcomes in TNBC. This work defines collagen signatures within the breast NME from genetic ancestry-defined healthy donors (n = 20 BW and n = 20 WW) and TME from triple-negative breast cancer tumors (n = 78 BW). The combination of ECM and microenvironment spatial evaluation is accomplished through optimized multimodal, multiplexed imaging techniques including ECM-targeted mass spectrometry imaging, antibody-based mass spectrometry imaging – immunohistochemistry, and second harmonic generation microscopy. The assessment of the normal breast, including extracellular and cellular markers, highlighted similarities in the microenvironment based on genetic ancestry alone. However, when clinical risk factors were considered, especially body mass index (BMI), ancestry-dependent differences were observed. These differences include opposing regulation of the physical attributes of collagen fibers, with fiber widths increasing as BMI increases for BW (overweight, OW vs obese, OB, p = 0.008) but decreasing as BMI increases for WW (OW vs OB, p = 0.012). Intensities of collagen peptides within the normal breast widely differed based on BMI; 214 collagen domains showed differential intensities when comparing normal breast from overweight and obese women (FDR p \u3c 0.025). Ancestry-based differences persisted within BMI categories, identifying significantly different peptide intensities when comparing overweight BW and WW (8 peptides, p \u3c 0.05) and obese BW and WW (3 peptides, p \u3c 0.05). Overall, fibrillar collagen proteins, Col11, Col12, and Col31, (37 modified peptides vs 10 unmodified peptides on average), generally expressed decreased intensities in PTM-regulated domains compared to unmodified domains. A similar trend in collagen composition was demonstrated in TNBC samples, with slightly lower intensities of fibrillar collagen domains containing hydroxylated prolines but increases in the number of hydroxylated peptides detected (64 modified domains vs 15 unmodified on average). In a cohort of BW with TNBC, collagen characteristics, including length, width, and curvature varied based on clinical characteristics. Molecular characteristics of collagen within the TNBC TME revealed trends in intensities of collagen domains containing known receptor binding motifs, showing differential expression based on survival status. Further analyses demonstrated that fourteen ECM peptides differentiated the probability of survival, with low intensities relating to better outcomes (log-rank p \u3c 0.05). Novel work considering the immune profiles and the surrounding ECM types as a holistic neighborhood showed distinct microenvironment composition that varied by survival status. This work is one of the first investigating the proteomic profile of the collagen ECM within the ancestry-defined normal breast and TNBC with high molecular detail. The proline hydroxylation PTM variation defined in the normal and TNBC tissue microenvironment provides insight into regulation of the cell-ECM communication that impacts breast tissue homeostasis and pathological development and progression of cancer. Additionally, the identification of novel ECM peptide domains that discriminant survival status in TNBC has the potential for further study as biomarkers or therapeutic targets
Occupational Therapy’s Role in Palliative Care: Helping Those with Serious Illnesses Participate in Meaningful Activities
No full textPalliative Care (PC) is a service that provides people living with life-limiting illnesses with additional layers of support throughout disease progression. Benefits of PC include improved pain and symptom management, improved Quality of Life, and dying experiences. A Program of S.U.P.P.O.R.T™ (Symptom management, Understanding the disease, Pulmonary rehabilitation, Palliative care, Oxygen therapy, Research considerations, and Transplantation intervention) is an educational program for patients who live with life-limiting pulmonary illnesses to improve understanding of disease progression. While research about occupational therapy’s role in PC is limited, the literature suggests that interventions can positively impact patients\u27 ability to participate in their Activities of Daily Living (ADLs). The occupational therapy (OT) scope of practice includes interventions such as mental health support, durable medical equipment and adaptive equipment utilization and management, home modification, and energy conservation (EC), among others that could be beneficial to individuals receiving PC services. EC consists of modifying daily activities to minimize feelings of fatigue, stress, and breathing difficulty and has benefits in reducing anxiety and stress during ADLs. Survey data collected as part of an OT Doctoral Capstone project revealed that a sample of people living with serious pulmonary diseases felt they would benefit from EC techniques as their disease progresses. Other focus group data revealed that a team of healthcare professionals reported that advocacy for OT’s scope within PC is necessary. The focus group also revealed that OT services would be beneficial to their patients living with pulmonary diseases and/or receiving PC services. These data were used to enhance the Program of S.U.P.P.O.R.T™, to include EC strategies for patients and their caregivers to use, how to ask for rehabilitation services, and the scope of rehabilitation services (OT, physical therapy, and speech-language pathology) within PC. Advocating for OT’s role in PC may empower patients to better participate in ADLs throughout their disease progression
Implementing a Palliative Care Approach in Acute Care Occupational Therapy Practice
Get PDFThe purpose of this doctoral capstone project was to develop and provide an educational resource for acute care occupational therapists to improve knowledge and confidence in treating patients with serious illnesses using a palliative care approach. Through the needs assessment taken by the rehabilitation team, it was discovered that occupational therapists overall were least familiar with palliative care, but at least one occupational therapist reported feeling confident in addressing functional mobility, feeding, mental health, functional abilities, leisure activities, cognition, and communication to improve quality of life. While palliative care is a sub-specialty, the principles and many practices should be employed by all clinicians caring for patients with serious illnesses. Occupational therapists provide client-centered and holistic approaches to care for people throughout the lifespan. Occupational therapy involves reframing treatment activities to adapt to changing goals and roles while addressing physical, cognitive, social, and emotional needs. To improve occupational therapists’ comfort in implementing a palliative care approach to treatment, an educational presentation was given, and a sustainable, evidence-based toolkit was created. The occupational therapy toolkit includes examples of assessment, interventions, goals, and relevant billing codes to help patients improve symptom management related to their diagnosis. After the dissemination of the presentation and toolkit, the rehabilitation team reported that their understanding of palliative care services improved, and clinicians reported feeling more confident addressing symptom management in the acute care setting using the various assessments and treatment interventions provided in the toolkit
From Dysbiosis to Dysfunction: Investigating the Effects of Chronic Cocaine Use on Oral Microbial Shifts and Neuropathogenesis
Get PDFCocaine use disorder remains a significant public health challenge. However, the mechanisms by which chronic cocaine use contributes to neuroinflammation and cognitive decline are still not fully understood. Chronic non-intravenous cocaine use is associated with oral microbial dysbiosis. Although the gut-brain axis has been widely studied, the impact of cocaine-mediated shifts on the oral microbiome on systemic and neuroinflammation remains a significant yet largely unexplored gap. This dissertation investigates the hypothesis that cocaine-specifically enriched oral Streptococcus parasanguinis triggers neuroinflammation, neuropathology, and cognitive deficits. In a human study, the saliva microbiomes from chronic cocaine users exhibited reduced α-diversity, enriched Streptococcus genus, specifically S. parasanguinis at the species level, alongside decreased genera such as Neisseria, compared to non-drug users. In an in vitro study, cocaine explicitly promoted the growth of S. parasanguinis but not S. australis, S. thermophilus, or S. anginous. In a wild-type B6 mouse study with four groups (S. parasanguinis, S. salivarius, Neisseria flavescens, and vehicle control (carboxymethylcellulose), 3 months of oral inoculation with S. parasanguinis led to neuroinflammation (IL-1β), Aβ42 production in the brain, and impaired spatial memory using the Barnes Maze assay. The increased IL-1β levels were not determined in the oral swabs, gut, or serum samples from S. parasanguinis group compared to the three controls. Notably, increased Aβ42 production in the brain was also found in the two control microbiome groups but neuroinflammation and memory decline were not determined. RNAscope analysis of mouse brain tissue revealed increased resident microglial activation based on Iba1 and TMEM119 expression, and no bacterial DNA was detected. Metabolomic profiling of mouse oral swab samples identified the presence of a neurotoxic metabolite cysteine-S-sulfate in the S. parasanguinis-treated group only, which enhanced Aβ42 production in a HEK-293-APP cell line. Together, these findings suggest a synergistic effect of neuroinflammation and Aβ42 production on memory decline. Moreover, this work offers new insight into the intersection of substance use, host-oral microbiome interactions, and brain health, with implications for developing microbiome-informed approaches to address neuropathology in CUD
A Long Non-Coding eRNA Forms R-loops to Shape Emotional Experience-Induced Behavioral Adaptations
Get PDFEmotional experiences often evoke neural plasticity that supports adaptive changes in behavior, including maladaptive plasticity associated with mood and substance use disorders. These adaptations are supported in part by experience-dependent activation of immediate-early response genes, such as Npas4. We discovered that a conserved, long non-coding enhancer RNA (lnc-eRNA) transcribed from an activity-sensitive enhancer produces DNA-RNA hybrid R-loop structures that support 3D chromatin-looping of the enhancer and proximal promoter and stimulus-induced, rapid Npas4 gene induction. We also show that this Npas4 lnceRNA and its R-loops are required for the development of behavioral adaptations produced by chronic psychosocial stress or cocaine exposure, revealing a critical role for this new genomic regulatory mechanism in the transmission of emotional experiences, such as stress or drug use, to adaptive behavioral responses
Exploring Resilience in Nursing Education
Get PDFThis dissertation investigates the feasibility of integrating resilience education into nursing curricula. It evaluates the effects of the Registered Nurse Personal Resilience Enhancement Plan (RN-P.R.E.P.) on resilience and professional quality of life. An integrative review synthesized literature on educational interventions to enhance resilience among health science students, focusing on techniques and targeted internal protective factors. The multi-method study included a pilot implementation of the RN-P.R.E.P. intervention, collecting quantitative data from pre-/post-participant surveys and qualitative interviews with nursing faculty and administrators.
The integrative review followed Whitemore and Knafl\u27s five-step methodology, guided by the PRISMA reporting guidelines. Interventions were analyzed using the Nursing Student Resilience Model. The multi-method study employed the RE-AIM framework to explore the feasibility of implementing resilience education into undergraduate nursing curricula at a large public university in the southeast. Students participated in a 12-week intervention, followed by optional interviews, while faculty and administration only participated in interviews.
The compendium consists of three manuscripts. The integrative review highlighted the diversity of resilience interventions and their varying effectiveness, emphasizing the need for tailored interventions for nursing students. The second manuscript reported quantitative findings from the RN-P.R.E.P. pilot program, noting successful curriculum adoption despite minimal changes in student resilience and professional quality of life. The third manuscript presented qualitative findings from faculty interviews, noting faculty support for resilience education but identifying challenges such as knowledge gaps and time constraints. This dissertation provides critical insight for integrating resilience into healthcare education curricula
The Impact of Diabetes on Neurovascular Integrity: A Special Focus on Pericytes and Endothelin-1
Get PDFDiabetes increases the risk of stroke and Vascular Contributions to Cognitive Impairment and Dementia (VCID). Diabetes also dysregulates the endothelin (ET) system. ET-1-mediated constriction of brain microvascular pericytes (BMVPCs) has been shown to contribute to brain hypoperfusion. However, there is a loss of BMVPCs in VCID, but underlying mechanisms of pericyte degeneration are poorly studied. ETA receptor activation can instigate phenotypical changes and cellular senescence in endothelial cells. . There is also emerging evidence that ETB receptor agonism improves outcomes in patients with cerebral ischemic stroke, but long-term effects, especially in diabetes, are unknown. Therefore, this study aimed to determine if pericyte degeneration and phenotypical changes contribute to progressive VCID in an ET-1-dependent manner under diabetic conditions. For in vitro studies, human male BMVPCs were grown in diabetes-like and oxidative stress conditions. BMVPCs were treated with ET-1 to determine its effects on senescence and phenotype. For in vivo studies, we used a post-stroke cognitive impairment (PSCI) model of VCID to test the effects of inhibition of ETA with BQ-123 or stimulation of ETB with Sovateltide via intranasal administration on cognitive outcomes. In vitro studies confirmed that ET-1 increased β-galactosidase activity which was prevented by BQ-123. ET-1 also increased traditional and pericyte-specific senescence markers. Furthermore, ET-1 stimulated a shift toward an ensheathing or microglia-like pericyte phenotype. Our in vivo studies demonstrated that Sovateltide and BQ-123 improved multiple cognitive domains. Both Sovateltide and BQ-123 improved VCID plasma markers after stroke. Pericytes also displayed phenotypic changes in diabetes after stroke, but these pathological shifts were reduced with BQ-123 and Sovateltide. In conclusion, our findings support the idea that diabetes triggers ET-1-induced senescence and causes phenotypical changes in BMVPCs. Additionally, our results suggest that intranasal stimulation of brain ETB receptors or ETA receptor inhibition can prevent cognitive decline after stroke. While further studies are required to better understand how the brain ET system impacts stroke recovery in diabetes, our findings provide novel insights into potential neurovascular protective therapies for VCID
Mindfulness in Motion: Development of a Post-Operative Protocol for Rotator Cuff Repair using Reformer Pilates
Get PDFINTRODUCTION: Reformer Pilates, based on values of breath, whole-body health, whole-body commitment, and whole-body encompassing mind, body, and spirit, is a form of low-impact exercises using a specialized machine with springs and straps to gauge resistance, primarily targeting core and postural strength. Evidence demonstrates the use of Reformer Pilates in rehabilitation, signifying improvement in chronic pain, physical health, and mental health compared to traditional therapies. Local adult outpatient clinic prioritizes movement in rehabilitation by using Reformer Pilates, incorporating this into treatment during occupational therapy (OT) and physical therapy (PT) sessions. The clinic has a significant number of patients with post-op precautions, following various protocols per the surgeon\u27s request. As the clinic has an increase in patients with rotator cuff repairs (RCR), there is a need for a post-operative protocol for RCR to be translated using the Reformer machine. The purpose of the translated protocol is to be used as a systematic guideline for therapists to refer back to ensure safe and consistent outcomes, as well as for the patient to have an outline for the trajectory of care. METHODS: A post-survey was conducted using various qualitative and quantitative questions taken by 8 therapists (OT and PT). Additional qualitative measures were taken as informal interviews with 2 patients indicating their experience with Reformer Pilates rehabilitation. RESULTS: Outcomes of this deliverable include an evidence-based referral tool for therapists, therapists stating they will incorporate this protocol 78% of sessions. 100% of therapists indicated that the protocol was evidence-based. Patients both indicated the positive benefits of Reformer Pilates on mental and physical health. CONCLUSION: Reformer Pilates as a mind-body rehabilitation tool continues to show positive outcomes in patient physical and mental health. Continuing research should be conducted comparing range of motion (ROM) improvements using Reformer Pilates for RCR post-operative rehabilitation
Heart2Sleep: A Pilot Study on Safe Sleep Practices to Prevent SUIDs on the Cardiac Unit at SJCH
No full textThis doctoral capstone project was completed in collaboration with Shawn Jenkins Children’s Hospital, located in Charleston, South Carolina. The project focused on promoting adherence to the American Academy of Pediatrics (AAP) safe sleep guidelines through the implementation of a pilot study on the hospital’s cardiac unit. Due to the complex medical needs of infants on this unit, safe sleep practices were often inconsistently followed or adapted. By implementing a pilot study utilizing the PA Safe Sleep Program, this project aimed to enhance knowledge, confidence, and consistency in safe sleep practices among healthcare providers and caregivers. This interdisciplinary initiative involved collaboration between a doctoral capstone student, the hospital’s injury prevention coordinator, nursing leadership, occupational therapists, physical therapists, physicians, and other key safe sleep stakeholders. This collaboration allowed for the integration of diverse clinical perspectives which strengthened the initiative’s impact on education, environmental adaptation, and hospital policy.
The primary goals of the project were to: (1) improve understanding of AAP safe sleep guidelines through the use of targeted educational resources and training modules, (2) increase healthcare providers’ confidence in reinforcing safe sleep practices, and (3) develop sustainable, user-friendly tools to support safe sleep adherence. Key deliverables included updated crib cards, badge buddies, accountability checklists, a cardiac-unit-specific safe sleep algorithm, and a revised training video addressing frequently observed unsafe sleep practices. A mixed methods quality improvement design was used. Data were collected through pre- and post-implementation crib audits, healthcare provider and caregiver surveys via REDCap, and video analytics. Results demonstrated a 98.6% decrease in unsafe items found in cribs, increased use of hands-on demonstrations and visual aids in caregiver education, and positive feedback on the relevance and accessibility of the training materials. Staff reported regularly using the resources to educate families, guide clinical decision-making, and reinforce hospital policies.
Occupational therapy’s unique perspective on caregiver education, environmental adaptation, and infant positioning offers valuable contributions to initiatives aimed at reducing sleep-related infant deaths. The partnership between OT and other disciples brought added value by aligning safety-focused practice with holistic, client-centered care. By supporting interdisciplinary collaboration and addressing environmental and behavioral barriers, the project offers a replicable model for promoting safe sleep practices and reducing the risk of sleep-related infant deaths in pediatric hospital settings