Dissertation Defense Announcements

Candidate Name: Kevin Stovall
Title: IMPLEMENTATION OF A INTRAOPERATIVE COGNITIVE AID TO GUIDE NEUROMUSCULAR BLOCKADE MONITORING
 December 02, 2022  3:00 PM
Location: UNCC College of Health an Human Services- Room 406
Abstract:

Residual neuromuscular blockade (rNMB) following general anesthesia can impair pulmonary mechanics and place patients at an increased risk to develop postoperative pulmonary complications (PPCs) (Saagar et al., 2019). PPCs are associated with increased readmission rate, hospital length of stay and overall morbidity and mortality (Kirmeier et al., 2019). Current literature suggests that clinicians play a pivotal role in the reduction of rNMB through the accurate assessment and interpretation of neuromuscular blockade with a peripheral nerve stimulator (PNS) (Thilen & Bhananker, 2016). For this project, a survey was distributed to anesthesia providers at a level-1 trauma center. Nine questions regarding neuromuscular blockade monitoring were included; two questions assessed current practice and seven questions assessed literature-based knowledge. The survey results revealed that while some content areas reflected up-to-date practice and knowledge by the practitioners, others did not align with current literature. For example, only 12.9% of survey participants correctly identified the most important and reliable use of the train-of-four count (TOFC), the most commonly used mode of the PNS. The identified areas of educational needs were identified via the survey and included on a cognitive aid to be used as an intra-operative reference tool. This quality improvement project recommends continuing the evaluation and analysis of current practice trends as new literature and management modalities evolve.



Candidate Name: Michael Pleva
Title: IMPLEMENTATION OF AN INTRAOPERATIVE COGNITIVE AID TO GUIDE SUGAMMADEX USE FOR PHARMACOLOGIC REVERSAL OF NEUROMUSCULAR BLOCKADE
 December 02, 2022  3:00 PM
Location: UNCC College of Health & Human Services – Room 406
Abstract:

The incidence of residual neuromuscular blockade (rNMB) following general anesthesia remains as high as 60%, placing patients at an increased risk of developing postoperative pulmonary complications (PPCs) (Saager et al., 2019). PPCs are associated with increased readmission rates, hospital length of stay, and overall morbidity and mortality (Kirmeier et al., 2019). A quality improvement project was conducted to examine anesthesia providers' current practice using sugammadex compared to evidenced base practice guidelines revealed throughout a comprehensive literature review. An anonymous survey was distributed among anesthesia providers throughout a level 1 trauma center to identify their current practice and knowledge regarding the use of sugammadex. Seventy-seven anesthesia providers completed the survey. Almost all providers correctly identified that sugammadex interferes with hormonal birth control, while only 58% were found to correctly dose sugammadex according to the patient's actual body weight. Thirty-seven percent of anesthesia providers revealed they avoid administering sugammadex in patients with kidney disease. A cognitive aid was developed and placed throughout the operating rooms, targeting knowledge gaps identified in the survey. This quality improvement project recommends continuing the analysis of current practice trends, as this will help inform and promote best practices consistent with contemporary literature.



Candidate Name: Laura Cornette
Title: Implementation Of An Intraoperative Cognitive Aid To Guide Neostigmine Use For Pharmacologic Reversal Of Neuromuscular Blockade
 November 18, 2022  3:00 PM
Location: UNCC College of Health & Human Services – Room 406
Abstract:

The incidence of residual neuromuscular blockade following general anesthesia is as high as 60% (Saager, 2019). Residual neuromuscular blockade impairs pulmonary mechanics and places patients at an increased risk to develop postoperative pulmonary complications (PPCs) (Kheterpal et al., 2020; Rudolph et al., 2018; Leslie et al., 2021; Saager et al., 2019). PPCs are associated with an increased readmission rate, hospital length of stay and overall morbidity and mortality. A quality improvement project (QI) was conducted to examine anesthesia providers’ knowledge of clinical recommendations and to assess their current practice habits using neostigmine to reverse neuromuscular blockade. A survey was distributed to all anesthesia providers at a level-1 trauma center and data was collected anonymously during a one-month period. While 96.1% of respondents correctly identified the mechanism of action of neostigmine, about half failed to recognize the correct peak effect of neostigmine. The survey results also revealed an inaccurate understanding of the dosing recommendations for neostigmine according to the number of twitches elicited using a peripheral nerve stimulator in the train-of-four mode. After comparing the survey results to the evidence-based guidelines identified in the literature review and analysis, knowledge deficits from the survey were incorporated to create an intraoperative cognitive aid to guide the reversal of muscle paralysis using neostigmine. This QI project recommends ongoing evaluation and analysis of practice trends to promote best practices that are consistent with contemporary literature.



Candidate Name: Meghan Marie Sullivan
Title: Risk factors and Nausea Prophylaxis in the Gynecological (GYN), Urological, and Ear Nose and Throat (ENT) Surgical Populations in a Suburban Hospital Surgical Population
 December 02, 2022  10:00 AM
Location: UNCC College of Health & Human Services – Room 406
Abstract:

This is a quality improvement (QI) project that examines post-op nausea and vomiting prophylaxis (PONV) and PONV in the Post Anesthesia Care Unit (PACU) in a Suburban hospital that is part of a large hospital system. Post operative nausea and vomiting (PONV) causes negative health sequelae, increases the financial burden, and decreases patient satisfaction. The clinical question for this QI project is: In the population of Gynecological (GYN), Urological, and Ear, Nose, and Throat (ENT) surgical patients 18 years and older, how do patient, anesthetic, and surgical risk factors for PONV and the delivery of antiemetics affect the incidence of PONV in a Suburban Hospital setting?
Data related to patient anesthesia, and surgical risk factors, and PONV in the PACU was collected via chart review. Data analysis was conducted to determine patient, anesthetic, and surgical risk factors, and PONV prophylaxis administration. The relationship between the Apfel score and the number of antiemetic medications administered during the intraoperative period was determined to not be predictive of antiemetic administration. Patient, anesthetic, and surgical risk factors did not predict PONV. The percentage of PONV was 14.29% at the Suburban hospital location. 60% of the patients in this sample did not receive the appropriate antiemetic prophylaxis, including under and over-administration. Education on patient, anesthetic, and surgical risk factors, and appropriate PONV prophylaxis administration per the Fourth Consensus Guidelines is recommended to improve practice.

Keywords: PONV, gynecologic, ENT, Urologic, surgery, suburban hospital, community hospital, anesthesia



Candidate Name: Abby Catherine Sanders
Title: Risk Factors and Nausea Prophylaxis in the Gynecological (GYN), Urological, and Ear, Nose and Throat (ENT) Surgical Population at an Urban Surgery Center
 December 02, 2022  10:00 AM
Location: UNCC College of Health & Human Services - Room 406
Abstract:

ABBY CATHERINE SANDERS. Risk Factors and Nausea Prophylaxis in the Gynecological (GYN), Urological, and Ear, Nose and Throat (ENT) Surgical Population at an Urban Surgery Center

(Under the Direction of DR. STEPHANIE WOODS PHD)

This is a quality improvement (QI) project that examines post-op nausea and vomiting prophylaxis (PONV) and PONV in the Post Anesthesia Care Unit (PACU) in an Urban Hospital system. The clinical question for this QI project is: In the population of Gynecological (GYN), Urological, and Ear, Nose, and Throat (ENT) surgical patients 18 years and older, how does patient, anesthetic, and surgical risk factors for PONV and the delivery of antiemetics affect the incidence of PONV in the Urban setting?
The purpose of this project was to compare anesthetic, surgical, and patient risk factors with the number of antiemetics given, in order to determine anesthesia providers compliance with the Fourth Consensus Guidelines. Data related to patient, anesthetic, and surgical risk factors, and PONV in the PACU was collected via chart review. Data analyses were conducted to determine patient, anesthetic, and surgical risk factors, and PONV prophylaxis administration.
The Apfel score was not significantly associated with actual antiemetics. There was also no significant association between patient, anesthesia, and surgical risk factors and the risk for PONV. The percent of PONV at the Urban facility was 14.29%. Overall, 42.9% of patients did not receive the correct number of antiemetics. Education to improve the knowledge gap between understanding of the Fourth Consensus Guidelines and the application of its antiemetic interventions into practice is recommended to improve adherence to guidelines.

Keywords: PONV, gynecologic, ENT, Urologic, surgery, urban, anesthesia



Candidate Name: Christin Bailey Coggins
Title: ANESTHESIA PROVIDERS’ PERCEIVED DISTRACTIONS IN THE OPERATING ROOM DURING INDUCTION AT AN AMBULATORY SURGERY CENTER
 December 02, 2022  1:00 PM
Location: CHHS 406
Abstract:

There are a variety of distractions that can occur in the operating room during the induction of anesthesia. A review of the literature revealed that common distractions include: noise, music, cell phones and pagers, production pressure, and unnecessary conversations. This project is part of a larger quality improvement project investigating anesthesia providers’ perceptions of the frequencies and types of distractions occurring during induction at three different sites: an ambulatory surgery center, a mid-sized, suburban hospital, and a level one trauma center. This project focuses on identifying distraction severity and frequency at an ambulatory surgery center. An anonymous, electronic survey was distributed to physician anesthesiologists, certified registered nurse anesthetists (CRNAs), and student registered nurse anesthetists (SRNAs), at these three different clinical locations within a large healthcare system. The survey asked providers to rate perceived frequency and severity of selected distractions on a modified Likert scale. A total of thirteen anesthesia providers working at the ambulatory surgery center responded to the survey. The results show that conversations were found to be the most severely distracting while music and equipment alarms were equally found to be the least distracting. Females found music, conversations, and personal cell phone use to be more distracting than males. Younger anesthesia providers found equipment alarms to be more distracting than older anesthesia providers. Across the three site locations, survey comparison found no difference between results. The aim of this project is to discover what is distracting to anesthesia providers during anesthetic induction so that future projects can begin to mitigate the occurrence of these distractors and promote increased patient safety during the induction of anesthesia.



Candidate Name: Mary Monroe Hausfeld
Title: The Effectiveness of Charismatic Signaling by Gender: a Prospective Meta-Analytic Review
 December 06, 2022  1:00 PM
Location: https://charlotte-edu.zoom.us/j/99785061717
Abstract:

While charismatic leadership tactics (CLTs) have been validated across a variety of settings and shown to improve leadership evaluations and predict follower behaviors, the role gender may play in charismatic leadership has been understudied. The present investigation assesses the influence of leader gender as well as a host of contextual variables on the efficacy of CLTs in influencing follower evaluations of leaders as well as follower prosocial behavior. Using signaling theory as an organizing framework, I examine critical moderators of the charismatic effect and integrate gender as a signal that may influence the efficacy of charismatic signaling. Through four independent experimental studies, which I conducted and then meta-analyzed, this paper identifies that the relationships between charismatic signaling, leader gender, and contextual moderators are nuanced and complex. I found a moderate main effect for charisma such that charismatic signaling did result in more positive follower evaluations (d = .185, k = 4, n = 1,002) and increased prosocial donation behavior (d = .1308, k = 4, n = 1,002), but the meta-analytic results revealed an interaction, such that these effects were often stronger for women than for men (e.g., attributed charisma d = .271 for women compared to d = .1342 for men). Furthermore, I found a main effect of gender for influence (d = .158, k = 4, n = 1,002) and donation behavior (d = .1142, k = 4, n = 1,002) favoring women, but this gender difference was reduced or disappeared entirely when the leader engaged in costly signaling behavior (influence d = .08, 95% CI = [-.0353 - .2147], k = 4, n = 1,002) or held only informal authority (influence d = .115, 95% CI = [-.0592 - .2886], k = 4, n = 1,002). Future directions and the need for a more nuanced theory of charismatic signaling are discussed.



Candidate Name: Antardipan Pal
Title: AN INTEGRATED CIRCUIT WITH SINGLE FUNCTIONAL UNIT LEVEL INTEGRATION OF ELECTRONIC AND PHOTONIC ELEMENTS: DESIGN OF THE FET - LET HYBRID 6T SRAM AND THE ELEMENTS
 October 20, 2022  3:00 PM
Location: EPIC 2224
Abstract:

Continuous scaling of complementary metal-oxide-semiconductor (CMOS) transistor technology over the past few decades following Moore’s law has led to significant enhancement in the speed and performance of computing architectures. In today’s world with high demand in data processing, CMOS scaling is focusing more on low power, cost-effective processes, and high performance to meet the requirements of high-end computations. To meet the high computation demands, reengineered, high performance, and low power device structures were necessary, and hence field effect transistors (FET) structures have evolved from planner to multi-gate, and gate all around (GAA) structures. Also, other than the very well matured silicon electronics, advanced technologies allowing heterogeneous integration of different materials systems (e.g., Si, Ge, III–V, and II-VI groups) have been developed. Though heterogeneous integration of silicon electronics with compound semiconductors can be beneficial, such developments in hybrid integration cannot address the fundamental limitations of the pure CMOS circuits, the resistive capacitive (RC) delay associated with metallic wires, and the dielectric gate delay associated with FETs. These delays ultimately limit the data speed and energy consumption.

In this research work we have explored novel applications in electronic-photonic integrated circuits of a special type of metal-semiconductor-metal (MSM) photoconductive structure known as the light effect transistor (LET) which can emulate the current voltage characteristics of a FET but with much better performances in terms of switching speed (considering carrier transit delay), energy consumption per switch and Ion/Ioff ratio, and also other optoelectronic functions like optical iv
logic gates, optical summation, optical amplification, and optoelectronic analog operation using LETs, which cannot be done using FETs. The LET can provide extremely fast optoelectronic switching (of the order of ~ ps), and its simplistic structure does-not add unwanted parasitic and leakages which are common in all gated FETs.

To understand the superiority of LETs over FETs, particularly the potential vast performance improvement in a hybrid integrated circuit of the two types of devices, we have explored the possibilities of LETs to replace some FETs in various pure electronic circuits. Using analytical relations and simulations, we have extensively studied the effect of replacing the access FETs in a 6T SRAM (six transistor static random-access memory) structure with LETs and have made some drastic changes in the hybrid 6T FET - LET structure by replacing the whole electrical word line with an optical waveguide (OWG). We have also proposed a prototype novel hybrid 3D integration scheme for the 6T SRAM architecture where all the typical electronic and optoelectronic components (4T FET latch, access LETs, bit lines, peripherals, etc.) will be placed on a single electronic layer while photonic components (OWGs, on-chip lasers to drive the OWGs, etc.) will be placed separately on the photonic layer with regularly spaced openings that provide the optical signal for switching four LETs grouped together from two adjacent hybrid 6T cells in the electronic layer. Also a fully functional FET - LET hybrid SRAM bit cell with superior performance has been designed and implemented using the mixed-mode design environment of Synopsys Sentaurus TCAD.



Candidate Name: Yu Lan
Title: A Web-based Geographic Framework to Detect and Visualize Space-time Clusters of Infectious Diseases
 November 18, 2022  11:30 AM
Location: Zoom and McEniry 307
Abstract:

Infectious diseases pose a significant threat to public health worldwide as evidenced by the recent coronavirus 2019 (COVID-19) pandemic. Despite significant human losses, the advent of web-accessed, map-based “data dashboards” that can monitor disease outbreaks, proved essential in managing public health responses. In many cases, the backend of these dashboards employs basic mapping functionality, displaying counts or rates. As the pandemic advanced, the identification of elevated rates was increasingly important in the geographical allocation of public health resources. However, such maps miss the opportunity to provide accurate information to policy decision makers such as the rate of disease spread, cyclicity, direction, intensity, and the risk of diffusion to new regions. Space-time geoanalytics, when coupled with rich visualizations, can address these shortcomings. Moreover, when implemented over the web, such functionality can be accessed from virtually anywhere.
This dissertation presents a web-based geographic framework for detecting and visualizing explicit space-time clusters of infectious diseases. First, I conduct a systematic review of the literature around the theme of space-time cluster detection for infectious diseases to identify state-of-the-art techniques that should be included in the proposed web-based framework. Second, I develop a tightly coupled, web-based analytical framework for the detection of clusters of infectious diseases using interactive and animated 3D visualizations to aid epidemiologists in readily and adequately uncovering the characteristics of space-time clusters. As a proof of concept, I populate the framework with COVID-19 county-level data for the 48 contiguous states in the US, and demonstrate data retrieval and storage, space-time cluster detection analysis, and 3D visualization within an open source WebGIS environment. Third, I evaluate the prototype in two steps: 1) present this and two existed COVID-19 systems to a group of infectious diseases experts and solicit feedback, 2) and evaluate functionalities on the prototype by conducting a user study with graduate students in a setting of online surveys.
This tightly coupled approach facilitates the detection of space-time clusters of diseases in a computationally acceptable timeframe. The characteristics of this framework (generic, open source, highly accurate, modifiable) will enable low-cost monitoring of the spatial and temporal trends of diseases causing high risks of infection.



Candidate Name: Erin L. Harden
Title: Perceptions of College Readiness for High Achieving Black Students
 November 11, 2022  11:00 AM
Location: Zoom
Abstract:

This dissertation explores Black/African American students’ perceptions of college readiness through student demographic questionnaires, semi-structured interviews, and focus group data. One objective of this study was to explore how advanced coursework contributed to the college readiness of Black students. Another objective was to examine academic writing readiness for Black students, which is an under-researched aspect of college readiness. The findings indicated that having a fostered college mindset, collegiate academic exposure, and being provided foundational skills and knowledge were aspects of advanced course participation that contributed to postsecondary success for the participants. In terms of writing readiness, writing opportunities and writing skill enhancement contributed to the participants’ college writing readiness and success. However, misalignment between high school and college expectations, mismatch of collegiate level writing expectations, and lack of citation knowledge were other areas related to college readiness that also emerged from the data. This study provides implications for policy, teachers, school personnel, and teacher educators.




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