Medical Specialties Commons^™

Prevalence Of Symptoms ≤12 Months After Acute Illness, By Covid-19 Testing Status Among Adults — United States, December 2020–March 2023, Juan Carlos C Montoy, James Ford, Huihui Yu, Michael Gottlieb, Dana Morse, Michelle Santangelo, Kelli N O'Laughlin, Kevin Schaeffer, Pamela Logan, Kristin Rising, Mandy J Hill, Lauren E Wisk, Wafah Salah, Ahamed H Idris, Ryan M Huebinger, Erica S Spatz, Robert M Rodriguez, Robin E Klabbers, Kristyn Gatling, Ralph C Wang, Joann G Elmore, Samuel A Mcdonald, Kari A Stephens, Robert A Weinstein, Arjun K Venkatesh, Sharon Saydah, Innovative Support For Patients With Sars-Cov-2 Infections Registry (Inspire) Group

Faculty, Staff and Student Publications

To further the understanding of post-COVID conditions, and provide a more nuanced description of symptom progression, resolution, emergence, and reemergence after SARS-CoV-2 infection or COVID-like illness, analysts examined data from the Innovative Support for Patients with SARS-CoV-2 Infections Registry (INSPIRE), a prospective multicenter cohort study. This report includes analysis of data on self-reported symptoms collected from 1,296 adults with COVID-like illness who were tested for SARS-CoV-2 using a Food and Drug Administration-approved polymerase chain reaction or antigen test at the time of enrollment and reported symptoms at 3-month intervals for 12 months. Prevalence of any symptom decreased substantially between baseline …

Identification Of Immune Biomarkers In Thyroid Cancer, Anupam Kotwal

Theses & Dissertations

Thyroid cancer is the most common endocrine malignancy, estimated to be the second most common cancer in women by 2030. The frequency of differentiated thyroid cancer (DTC), the most common subtype of thyroid cancer, is higher in patients with autoimmune thyroid disease but the influence of the immune milieu on thyroid carcinogenesis remains unclear. To address this gap in knowledge, we performed clinical and translational experiments to identify immune biomarkers for the occurrence and prognosis of DTC. Multiparameter flow cytometry of peripheral blood from 32 adults found advanced thyroid cancer either at presentation or during the disease-course to be associated …

An Implementation Of Combined Fecal/Gastric Occult Blood Testing In The Emergency Department, Desiree Long

Master's Projects and Capstones

Problem: The gastrointestinal occult blood test is a point-of-care (POC) test used to detect the presence of occult (hidden) gastrointestinal bleeding via stool or gastric contents. Existing fecal and gastric occult blood point-of-care (POC) testing requires separate and unique sampling cards and developer, respectively. Separate fecal/gastric tests are less definitive and take longer than a combined test. Fecal/gastric testing can be improved and more effective using a combined testing mechanism.

Context: This project includes the microsystem of the emergency department, which involves groups of medical professionals, such as groups of clinicians and staff working together with a shared clinical goal …

Tav-In-Tav And Beyond: How Far Can We Go?, Taramasso Maurizio, Ana Paula Tagliari, David L. Fischman

Division of Cardiology Faculty Papers

No abstract provided.

A Retrospective Comparison Of Dose Distribution Within Density Override And Avoidance Structures In Volumetric Arc Therapy Prostate Plans With Hip Prosthetics: A Dosimetric Evaluation, Jared Richard Brinkman

Masters Projects

Introduction

Prostate cancer is one of the most common cancers among men, and its incidence is a significant health concern. The optimal radiation treatment for prostate cancer patients needs to be tailored to reduce toxicities to organs at risk within the treated area. This study aims to retrospectively evaluate the dose distribution to organs at risk (OARs) in patients with hip prosthetics for volumetric modulated arc therapy (VMAT) prostate cancer plans.

Methods

The study included ten prostate cancer patients with at least one prosthetic hip who received VMAT plans at a Midwest Radiation Oncology Center. Various data points, including target …

In Situ Characterization Of 17-4ph Stainless Steel By Small-Angle Neutron Scattering, Shibo Yan, Zijun Wang, Tianfu Li, Zhong Chen, Xiaoming Du, Yuntao Liu, Dongfeng Chen, Kai Sun, Rongdeng Liu, Bing Bai, Xinfu He, Kaitai Liu, Shuanzhu Wang

Faculty, Staff and Student Publications

17-4PH martensitic steel is usually used as valve stems in nuclear power plants and it suffers from thermal aging embrittlement due to long-time service in a high-temperature and high-pressure environment. Here, we characterized the evolution of microstructures at the nano-scale in 17-4PH steel by in situ small-angle neutron scattering (SANS) with a thermo-mechanically coupled loading device. The device could set different temperatures and tensile so that an in situ SANS experiment could dynamically characterize the process of nanoscale structural changes. The results showed that with increasing thermal aging time, the ε-Cu phase precipitates and grows as the temperature is 475 …

Swarmdeepsurv: Swarm Intelligence Advances Deep Survival Network For Prognostic Radiomics Signatures In Four Solid Cancers, Qasem Al-Tashi, Maliazurina B Saad, Ajay Sheshadri, Carol C Wu, Joe Y Chang, Bissan Al-Lazikani, Christopher Gibbons, Natalie I Vokes, Jianjun Zhang, J Jack Lee, John V Heymach, David Jaffray, Seyedali Mirjalili, Jia Wu

Faculty, Staff and Student Publications

Survival models exist to study relationships between biomarkers and treatment effects. Deep learning-powered survival models supersede the classical Cox proportional hazards (CoxPH) model, but substantial performance drops were observed on high-dimensional features because of irrelevant/redundant information. To fill this gap, we proposed SwarmDeepSurv by integrating swarm intelligence algorithms with the deep survival model. Furthermore, four objective functions were designed to optimize prognostic prediction while regularizing selected feature numbers. When testing on multicenter sets (n = 1,058) of four different cancer types, SwarmDeepSurv was less prone to overfitting and achieved optimal patient risk stratification compared with popular survival modeling algorithms. Strikingly, …

Overcoming Resistance Mechanisms To Cdk4/6 Inhibitor Treatment Using Cdk6-Selective Protac, Sarah Truong

Theses & Dissertations

Hormone receptor-positive (HR+) breast cancer (BC) constitutes approximately 75% of all breast cancer patients. These tumors rely on hormones, estrogen and progesterone, for their proliferation. The interaction between the hormones and their respective receptors enhances cyclin D expression, which results in the persistent activation of CDK4 and CDK6. The CDK4/6-cyclin D complex engages in a phosphorylation cascade that ultimately allows the cells to proceed past the G1/S checkpoint of the cell cycle. Inhibition of CDK4/6 has been shown to trigger cell cycle arrest, inhibit tumor growth, and induce apoptosis. Currently, there are three FDA-approved CDK4/6 inhibitors (CDK4/6i). A limitation of …

Characterization Of Vascular Morphology Of Neovascular Age-Related Macular Degeneration By Indocyanine Green Angiography, Anish Attarde, Thomas S Riad, Zhao Zhang, Manisha Ahir, Yingbin Fu

Faculty, Staff and Students Publications

Age-related macular degeneration (AMD) is a leading cause of blindness among older individuals, and its prevalence is rapidly increasing due to the aging population. Choroidal neovascularization (CNV) or wet AMD, which accounts for 10%-20% of all AMD cases, is responsible for an alarming 80%-90% of AMD-related blindness. Current anti-VEGF therapies show suboptimal responses in approximately 50% of patients. Resistance to anti-VEGF treatment in CNV patients is often associated with arteriolar CNV, while responders tend to have capillary CNV. While fluorescein angiography (FA) is commonly used to assess leakage patterns in wet AMD patients and animal models, it does not provide …

Structural Underpinnings Of Mutation Rate Variations In The Human Genome, Zian Liu, Md Abul Hassan Samee

Faculty, Staff and Students Publications

Single nucleotide mutation rates have critical implications for human evolution and genetic diseases. Importantly, the rates vary substantially across the genome and the principles underlying such variations remain poorly understood. A recent model explained much of this variation by considering higher-order nucleotide interactions in the 7-mer sequence context around mutated nucleotides. This model's success implicates a connection between DNA shape and mutation rates. DNA shape, i.e. structural properties like helical twist and tilt, is known to capture interactions between nucleotides within a local context. Thus, we hypothesized that changes in DNA shape features at and around mutated positions can explain …

A Multicenter, Controlled Human Infection Study Of Influenza A(H1n1)Pdm09 In Healthy Adults, Justin R Ortiz, David I Bernstein, Daniel F Hoft, Christopher W Woods, Micah T Mcclain, Sharon E Frey, Rebecca C Brady, Christopher Bryant, Ashley Wegel, Robert W Frenck, Emmanuel B Walter, Getahun Abate, Sarah R Williams, Robert L Atmar, Wendy A Keitel, Nadine Rouphael, Mathew J Memoli, Mamodikoe K Makhene, Paul C Roberts, Kathleen M Neuzil

Faculty, Staff and Students Publications

BACKGROUND: We evaluated the associations between baseline influenza virus-specific hemagglutination inhibition (HAI) and microneutralization (MN) titers and subsequent symptomatic influenza virus infection in a controlled human infection study.

METHODS: We inoculated unvaccinated healthy adults aged 18-49 years with an influenza A/California/04/2009/H1N1pdm-like virus (NCT04044352). We collected serial safety labs, serum for HAI and MN, and nasopharyngeal swabs for reverse-transcription polymerase chain reaction (RT-PCR) testing. Analyses used the putative seroprotective titer of ≥40 for HAI and MN. The primary clinical outcome was mild-to-moderate influenza disease (MMID), defined as ≥1 postchallenge positive qualitative RT-PCR test with a qualifying symptom/clinical finding.

RESULTS: Of 76 …

Our Search Of Immune Invaders In The Aged Lacrimal Gland, Claudia M Trujillo-Vargas, Cintia S De Paiva

Faculty, Staff and Students Publications

No abstract provided.

Clinical Outcome Of Tavi Vs Savr In Patients With Severe Aortic Stenosis, Chayakrit Krittanawong, Hafeez Ul Hassan Virk, Joshua Hahn, Zhen Wang, Fu'ad Al-Azzam, Mahboob Alam, Samin Sharma, Hani Jneid

Faculty, Staff and Students Publications

The utilization of transcatheter aortic valve implantation (TAVI) has become the treatment of choice in patients with severe aortic stenosis (AS) with intermediate-to-high surgical risk for surgical aortic valve replacement (SAVR) [...].

Unknown Rectal Lesions: A Case Of Severe Proctitis Secondary To Mpox In The Setting Of Concomitant Hiv, Syphilis, Hsv, And Chlamydia, Nicole Robertson Mph, James Crosby Do, Cynthia R. Young Md, Msc, Anne E. Sayers Md, Nicholas J. Van Sickles Md

ePublications of Emerging Medical Research Scholars

Introduction:

Mpox emerged as a public health crisis with limited research describing co-occurring HIV and sexually transmitted infections (STIs). We present a case of severe proctitis secondary to Mpox with concomitant HIV (Human Immunodeficiency Virus), syphilis, HSV (Herpes Simplex Virus), and chlamydia and review presentation, diagnosis, treatment, and prevention of Mpox with concurrent STIs.

Case Presentation:

34-year-old male living with HIV (LWH) presenting with worsening rectal pain, multiple anal papules, and fever. His laboratory workup revealed simultaneous positive results for orthopoxvirus, chlamydia, and HSV-1 PCR. We initiated tecovirimat due to rectal involvement and uncontrolled pain. He subsequently developed lesions on …

Referral Patterns For Pediatric Sports-Related Concussion In One New England Health Care System, Joseph Benert, Amy Haskins Phd, Christina T. Holt, Krystian Bigosinski

Journal of Maine Medical Center

Introduction: Patients with concussion may benefit from care provided by professionals from multiple disciplines based on the constellation of symptoms being reported. This study analyzed referral patterns from primary care and sports medicine clinicians for pediatric patients with sports-related concussion in one health care system.

Methods: A retrospective chart review identified referrals placed to physical therapy, occupational therapy, speech pathology, optometry, psychology, neuropsychology, audiology, neurology, ophthalmology, otolaryngology, psychiatry, and sports medicine for pediatric patients with sports-related concussion. These patients were evaluated at MaineHealth family medicine, internal medicine/pediatrics, pediatrics, and sports medicine clinics in southern Maine between February 2019 and June …

Atrial Fibrillation Management In Hispanic Adults, Tania Borja

Dissertations

Background: Research has found atrial fibrillation (AF) to be the primary or a contributing cause of death on 183,321 death certificates, and an underlying cause of death for 26,535 Americans in 2019. Findings indicate an increased AF diagnosis in White people compared to racial and ethnic minorities, contrasting widespread findings of increased prevalence of cardiovascular disease and ischemic strokes in minorities. Significant disparities—by race and socioeconomic status in disease distribution and access to testing and lifesaving treatments—have been documented, specifically associated with social determinants of health (SDOH); i.e., the conditions in which people are born, grow, live, work, and age. …

Perioperative Pembrolizumab For Early-Stage Non-Small-Cell Lung Cancer, Heather Wakelee, Moishe Liberman, Terufumi Kato, Masahiro Tsuboi, Se-Hoon Lee, Shugeng Gao, Ke-Neng Chen, Christophe Dooms, Margarita Majem, Ekkehard Eigendorff, Gastón L Martinengo, Olivier Bylicki, Delvys Rodríguez-Abreu, Jamie E Chaft, Silvia Novello, Jing Yang, Steven M Keller, Ayman Samkari, Jonathan D Spicer, Keynote-671 Investigators

Faculty, Staff and Student Publications

BACKGROUND: Among patients with resectable early-stage non-small-cell lung cancer (NSCLC), a perioperative approach that includes both neoadjuvant and adjuvant immune checkpoint inhibition may provide benefit beyond either approach alone.

METHODS: We conducted a randomized, double-blind, phase 3 trial to evaluate perioperative pembrolizumab in patients with early-stage NSCLC. Participants with resectable stage II, IIIA, or IIIB (N2 stage) NSCLC were assigned in a 1:1 ratio to receive neoadjuvant pembrolizumab (200 mg) or placebo once every 3 weeks, each of which was given with cisplatin-based chemotherapy for 4 cycles, followed by surgery and adjuvant pembrolizumab (200 mg) or placebo once every 3 …

A Cryptic Microdeletion Del(12)(P11.21p11.23) Within An Unbalanced Translocation T(7;12)(Q21.13;Q23.1) Implicates New Candidate Loci For Intellectual Disability And Kallmann Syndrome, Afif Ben-Mahmoud, Shotaro Kishikawa, Vijay Gupta, Natalia T. Leach, Yiping Shen, Oana Moldovan, Himanshu Goel, Bruce Hopper, Kara Ranguin, Nicolas Gruchy, Saskia M. Maas, Yves Lacassie, Soo Hyun Kim, Woo Yang Kim, Bradley J. Quade, Cynthia C. Morton, Cheol Hee Kim, Lawrence C. Layman, Hyung Goo Kim

School of Medicine Faculty Publications

In a patient diagnosed with both Kallmann syndrome (KS) and intellectual disability (ID), who carried an apparently balanced translocation t(7;12)(q22;q24)dn, array comparative genomic hybridization (aCGH) disclosed a cryptic heterozygous 4.7 Mb deletion del(12)(p11.21p11.23), unrelated to the translocation breakpoint. This novel discovery prompted us to consider the possibility that the combination of KS and neurological disorder in this patient could be attributed to gene(s) within this specific deletion at 12p11.21-12p11.23, rather than disrupted or dysregulated genes at the translocation breakpoints. To further support this hypothesis, we expanded our study by screening five candidate genes at both breakpoints of the chromosomal translocation …

Using The Multi-Theory Model (Mtm) Of Health Behavior Change To Explain The Seeking Of Stool-Based Tests For Colorectal Cancer Screening, Manoj Sharma, Christopher Johansen, Kavita Batra, Chia-Liang Dai, Ravi Batra, Traci Hayes, Aditi Singh

Social and Behavioral Health Faculty Research

Colorectal cancer is the third most common cancer worldwide and is the second leading cause of cancer-associated deaths. While colorectal cancer is on the decline in the United States (US), disparities still exist, despite the non-invasive screening modalities, such as stool-based tests have shown themselves to be effective in the detection of colorectal cancer. Many of the existing stool-based test interventions lack the use of a contemporary theory-based approach. Given the paucity of theory-based interventions intended to promote stool-based tests, this cross-sectional study utilizes the multi-theory model (MTM) of health behavior change to explain the seeking of stool-based tests for …

Deep Brain Stimulation For Substance Use Disorder: A Systematic Review And Meta-Analysis, Nour Shaheen, Ahmed Shaheen, Can Sarica, Arun Singh, Mario Zanaty, Karim Johari, Andrew Yang, Theresa Zesiewicz, Brian Dalm, Yarema Bezchlibnyk, Andres M Lozano, Oliver Flouty

Department of Neurosurgery Faculty Papers

OBJECTIVE: Substance use disorder (SUD) is a significant public health issue with a high mortality rate. Deep brain stimulation (DBS) has shown promising results in treating SUD in certain cases. In this study, we conducted a meta-analysis to evaluate the efficacy of DBS in the treatment of SUD and reduction of relapse rates.

METHODS: We performed a thorough and methodical search of the existing scientific literature, adhering to the PRISMA guidelines, to identify 16 original studies that fulfilled our inclusion criteria. We used the evidence levels recommended by the Oxford Centre for Evidence-Based Medicine to assess bias. The R version …

Multifocal And Multicentric Glioblastoma: Imaging Signature, Molecular Characterization, Patterns Of Spread, And Treatment, Maguy Farhat, Gregory N Fuller, Max Wintermark, Caroline Chung, Vinodh A Kumar, Melissa Chen

Faculty, Staff and Student Publications

Multifocal and multicentric glioblastoma (GBM) or collectively, m-GBM, is an imaging diagnosis present in up to 34% of patients with GBM. Compared to unifocal disease, patients with m-GBM have worse outcomes owing to the enhanced aggressive nature of the disease and its resistance to currently available treatments. To improve the understanding of its complex behavior, many associations have been established between the radiologic findings of m-GBM and its gross histology, genetic composition, and patterns of spread. Additionally, the holistic knowledge of the exact mechanisms of m-GBM genesis and progression is crucial for identifying potential targets permitting enhanced diagnosis and treatment. …

First-Line, Fixed-Duration Nivolumab Plus Ipilimumab Followed By Nivolumab In Clinically Diverse Patient Populations With Unresectable Stage Iii Or Iv Melanoma: Checkmate 401, Reinhard Dummer, Pippa Corrie, Ralf Gutzmer, Tarek M. Meniawy, Michele Del Vecchio, Céleste Lebbé, Michele Guida, Caroline Dutriaux, Brigitte Dreno, Nicolas Meyer, Pier F. Ferrucci, Stéphane Dalle, Muhammad A. Khattak, Jean-Jacques Grob, Karen Briscoe, James Larkin, Sandrine Mansard, Thierry Lesimple, Massimo Guidoboni, Silvia Sabatini, Erika Richtig, Rudolf Herbst, Maurice Lobo, Margarita Askelson, Paolo A. Ascierto, Michele Maio

Research outputs 2022 to 2026

PURPOSE: To address the paucity of data in patients with historically poor outcomes, we conducted the single-arm phase IIIb CheckMate 401 study to evaluate the safety and efficacy of nivolumab plus ipilimumab followed by nivolumab monotherapy in clinically diverse patient populations with advanced melanoma. METHODS: Treatment-naive patients with unresectable stage III-IV melanoma received nivolumab 1 mg/kg plus ipilimumab 3 mg/kg once every 3 weeks (four doses) followed by nivolumab 3 mg/kg (240 mg following a protocol amendment) once every 2 weeks for ≤ 24 months. The primary end point was the incidence of grade 3-5 select treatment-related adverse events (TRAEs). …

Strategies For The Genomic Analysis Of Admixed Populations, Taotao Tan, Elizabeth G Atkinson

Faculty, Staff and Students Publications

Admixed populations constitute a large portion of global human genetic diversity, yet they are often left out of genomics analyses. This exclusion is problematic, as it leads to disparities in the understanding of the genetic structure and history of diverse cohorts and the performance of genomic medicine across populations. Admixed populations have particular statistical challenges, as they inherit genomic segments from multiple source populations-the primary reason they have historically been excluded from genetic studies. In recent years, however, an increasing number of statistical methods and software tools have been developed to account for and leverage admixture in the context of …

Generation Of A Novel Stra8-Driven Cre Recombinase Strain For Use In Pre-Meiotic Germ Cells In Mice†, Avery A Ahmed, Ernesto Salas, Denise G Lanza, Jason D Heaney, Stephanie A Pangas

Faculty, Staff and Students Publications

The development of oocytes occurs over a broad time frame, starting at the earliest stages of embryogenesis and continuing into adulthood. Conditional knockout technologies such as the Cre/loxP recombination system are useful for analyzing oocyte development at specific stages, but not every time frame has appropriate Cre drivers, for instance, during oocyte meiotic initiation through early prophase I in the embryo. Here, we generated a novel knockin mouse line that produces a bicistronic transcript from the endogenous Stra8 locus that includes a "self-cleaving" 2A peptide upstream of cre. This allows for high efficiency cleavage and production of both proteins individually …

Author Correction: Membrane Translocation Process Revealed By In Situ Structures Of Type Ii Secretion System Secretins, Zhili Yu, Yaoming Wu, Muyuan Chen, Tong Huo, Wei Zheng, Steven J Ludtke, Xiaodong Shi, Zhao Wang

Faculty, Staff and Students Publications

No abstract provided.

Under One Roof – An Integrated Clinic For Substance Use Disorder And Viral Hepatitis/Hiv Treatment, Sarah Hipkens, Emily Caron, Wendy Craig, Kinna Thakarar

Journal of Maine Medical Center

Introduction: Integration of viral hepatitis/HIV care and substance use disorder (SUD) treatment has been shown to improve patient outcomes, but data are lacking in rural states like Maine. Our study objective was to assess the baseline characteristics and outcomes of patients with SUD who receive combined substance use and viral hepatitis/HIV treatment at a recently established “Bridge Program” in our rural state.

Methods: We conducted a retrospective chart review of patients enrolled in the Bridge Program between January 2020 and November 2021. We then performed a descriptive analysis of demographics, health characteristics, preventive services, and treatment outcomes.

Results: A total …

A Website To Prepare Older Adults For Driving Cessation, Shelbi Picard, Steven M. Gerardi, Elizabeth Deluca

Summer 2023 Virtual OTD Capstone Symposium

Driving cessation, or the complete discontinuation of operating a vehicle, can result in a loss of independence and a decrease in life satisfaction (Chihuri, et al., 2016). This loss of independence is linked to a lack of knowledge on alternative options on community mobility (Liddle, et al., 2014). This leads to drivers to not want to stop driving when they are no longer safe to drive. Although there are some resources on driving cessation available online for guiding older adults in transition from driving to non-driving, they are not consolidated in one place for ease of understanding.

Analyzing Experiences With Context-Based Physical Activity Coaching (Cb-Pac) In Caregivers Of Children With Visual Impairments: A Pilot Study, Mary Godman, Angela Blackwell, Eric Hicks

Summer 2023 Virtual OTD Capstone Symposium

Caregivers have faced many barriers in providing equitable physical activity (PA) opportunities for their children with visual impairments (VI) (Armstrong et al., 2018; Columna et al., 2017; Sterbova & Kudlacek, 2014). This pilot study focused on two female caregivers of children with VI to understand their experiences and perceptions related to providing PA for their children along with a context-based coaching program to improve their child’s participation in PA. The study utilized a mixed methods design and concluded that support, motivation, strategies for participation, and equipment were important areas to address for caregivers to engage their children in PA.

Occupational Barriers In Attendance Of Diabetes Prevention Programs In Adults Of Low Socioeconomic Status, Kendra Green, Amy Lyons-Brown

Summer 2023 Virtual OTD Capstone Symposium

The purpose of this project was to meet the needs of adults of low socioeconomic status that are at risk for developing diabetes due to multiple occupational barriers through evidence-based interventions developed by Occupational Therapists. Reflecting on current literature on the social determinants of health can help clients achieve a better quality of life. It addressed the specific barriers in an individual’s lifestyle and community resources faced daily in occupations such as managing finances, shopping, sleeping, cooking, and eating healthier, along with utilizing physical activity to prevent diabetes. OT is underutilized in this area even though the expertise is needed …

Creciendo Y Floreciendo Dentro De Nuestro Ambiente: A Contextual Intervention With Latino Parents Who Have Children Diagnosed With Autism Spectrum Disorder (Asd), Jocelyn Urbina, Erik Pérez, Angela Labrie Blackwell

Summer 2023 Virtual OTD Capstone Symposium

According to the Center for Disease Control and Prevention (CDC) (2021), 1 in 44 children has been identified with autism-spectrum disorder (ASD). Children with ASD experience challenges in participation that is characterized by difficulties in areas of social communication, social interaction, repetitive behavior, and a range of impairing sensory interests or aversions (Pasco, 2018). These challenges can limit their participation in occupations if not addressed within time as well as put stress on the child’s parents or caregivers. Parents who have children with ASD experience higher elevated levels of parental stress and psychological distress when compared to parents who have …