Dissertation Defense Announcements

Candidate Name: Christine Sisk
Title: Effectiveness of Cardiac ERAS Multimodal Analgesia on Perioperative Pain in Adult Cardiac Surgery Patients
 March 27, 2024  1:00 PM
Location: College of Health and Human Sciences: Room 102


CHRISTINE SISK. Effectiveness of Cardiac ERAS Multimodal Analgesia on Perioperative Pain in Adult Cardiac Surgery Patients. (Under the direction of Dr. KATHLEEN JORDAN)

Cardiac surgeries often rely on opioid analgesics, which can lead to adverse effects. The implementation of the multimodal analgesic approach, as a part of the ERAS protocol, has the potential to optimize intra- and postoperative pain management, leading to reduced opioid-related complications and improved patient outcomes. The purpose of this study was to evaluate the efficacy of multimodal analgesia within a Cardiac Enhanced Recovery After Surgery (ERAS) program in reducing postoperative pain and opioid consumption in adult cardiac surgery patients. This study compared the effects of cardiac ERAS multimodal analgesia against traditional opioid-based analgesia on postoperative pain and opioid consumption during the operation and the initial 24 hours postoperative.
The study was conducted at a level-one trauma center that had recently implemented the ERAS protocol on all cardiac surgical patients. Data was collected retrospectively from patients undergoing cardiac surgeries before and after the protocol’s implementation. The pre-ERAS group received traditional opioid-based analgesia, while the ERAS group received the ERAS multimodal analgesia protocol.
Data analysis revealed significantly lower intraoperative opioid consumption in the post-ERAS group compared to the pre-ERAS group (U = 1496.00, p = .026, z = -2.30). However, no statistically significant differences were observed in opioid consumption between the groups at 6 hours and 24 hours postoperatively. These findings suggest the ERAS protocol’s effectiveness in reducing intraoperative opioid requirements but limited impact on postoperative opioid consumption within the first 24 hours.
The study demonstrates that cardiac ERAS multimodal analgesia can effectively reduce intraoperative opioid consumption, highlighting its potential as a valuable component of perioperative pain management in cardiac surgery. While the findings did not show a significant reduction in postoperative opioid use, implementing such protocols can still offer benefits for patient care. This includes reducing opioid-related adverse effects and potentially improving patients’ overall recovery. Further research is needed to explore the longer-term impacts of multimodal analgesia on postoperative opioid consumption and patient outcomes in cardiac surgery.

Candidate Name: Jaime Moore
Title: The Impact of Evidence-Based Sepsis Education on the Recognition of Clinical Deterioration and Reducing Sepsis Mortality Among Inpatient Medical-Surgical Units
 April 04, 2024  9:00 AM
Location: CHHS 131

Sepsis is one of the leading causes of intensive care unit (ICU) transfers and mortality in the inpatient setting due to delayed recognition and untimely management of sepsis symptoms on non-ICU medical-surgical floors. Educating nurses on units with the highest rates of sepsis mortality and ICU transfers is important to increase confidence and knowledge to promote early recognition of sepsis and implementation of initial management guidelines. There is growing evidence of the effectiveness of escape rooms, however, most studies have been completed with students in academic settings. Additionally, sepsis education is traditionally targeted to the ICU and emergency department (ED) settings, not medical-surgical floors. The purpose of this project was to implement interactive escape room education with evidence-based sepsis content to prepare nurses to identify early warning signs of sepsis and clinical deterioration in medical-surgical patients. A two-group pre-/post-test quality improvement project was conducted with a sample of 17 nurses in the non-ICU medical-surgical units within the medicine service line at the project site. After the interactive escape room educational event, a statistically significant improvement in confidence and increased knowledge was demonstrated. Mean knowledge scores increased from 77.4 (SD=13.7) pre-intervention to 82.4 (SD=14.3) post-intervention. Significant improvements were seen in self-reported knowledge and confidence in identifying sepsis patients (z=2.33, p=.02), knowing how and what to monitor in sepsis patients (z=2.714, p=.007), and knowing initial management of patients with sepsis (z=2.646, p=.008). Mean ICU transfers decreased from 13 (SD=1.0) pre-intervention to 8.67 (SD=3.51) post-intervention indicating the project units performed better than the comparison units. Implementing an innovative escape room education intervention for non-ICU medical-surgical nurses is recommended to improve nurse knowledge and confidence in managing sepsis patients. By increasing nurse knowledge and confidence, earlier recognition of clinical signs of deterioration may assist with reducing ICU transfers related to clinical deterioration due to infections and sepsis.

Candidate Name: Lane K. Griffith
Title: Factors Related to Infusion of Trauma Education Among Counselor Educators at CACREP-Accredited Programs
 March 25, 2024  2:00 PM
Location: COED 246

Research has demonstrated the prevalence and cumulative nature of trauma and its lifelong adverse effects on physical, cognitive, emotional, and social wellness (Felitti et al., 1998; Merrick et al., 2019). Thus, counselor educators must prepare their students to work with clients with trauma effectively and ethically. A single study investigated trauma education and found that not all programs offer a trauma course (Montague et al., 2020). Thus, the CACREP (2015) trauma standards may be infused into other courses. The purpose of this study was to explore how trauma history, attitudes related to trauma-informed care, and prior trauma training were related to the infusion of trauma education into non-trauma-specific core courses by counselor educators working full-time for CACREP-accredited programs. It also investigated to what degree the trauma standards were infused. Multiple regression was used to analyze the data collected from 261 participants. Results indicated that moderate and substantial training were positive significant predictors of the degree of infusion (p <.001). The variables accounted for 14.1% of the variance. Although most counselor educators (91%) reported infusing the trauma standards into core courses, the standards were not infused equally. Results highlighted a high incidence of ACEs among counselor educators, with 62% reporting two or more and 33% four or more. Implications, limitations, and recommendations for future research are discussed.

Candidate Name: Jennifer Nicole Johnson
 April 03, 2024  1:00 PM
Location: 1. Login into Dr. Lewis' Zoom Video Conference Room 2. Use the following Meeting ID: 859-415-6604 3. Meeting Password: 54125

This qualitative study explores the lack of African American students enrolled in AP Calculus courses in North Carolina public high schools. It considered the perception of student-counselor relationships, academic advising practices, and sense of identity of high school counselor participants. In-depth interviews were conducted with three, African American, female high school counselors with five to twenty-four years of experience in high school counseling. The data yielded five domains: characteristics of a school counselor, expected duties of a school counselor, criteria to become an AP Calculus student, student-counselor relationships, and academic advising practices and the outcomes. From the domains, twenty-seven themes were generated: empathetic, open-minded, organized, flexible, creative, knowledgeable, serving the holistic needs of students, classroom guidance activities, non-counselor duties, resource, enrollments, interventions, advocacy, completion of prerequisite courses, exceptions to the rule, teacher recommendation, AP agreement, importance, trust, connections, race, alternatives, methods, encouragement, benefits, awareness, and partnership. Recommendations include universal access to Math I for African American students in 8th grade, update all stakeholders of the role and purpose of school counselors, professional development for school counselors, and an integrated curriculum for school counselors and administrators.

Candidate Name: Katherine Judge
 March 20, 2024  1:00 PM
Location: CHHS 131

To impact survival rates by 30%, emergency department (ED) workers should follow the Advanced Cardiovascular Life Support (ACLS) guideline of relying on end-tidal carbon dioxide (ETCO2) monitoring to ensure cardiopulmonary resuscitation (CPR) is high-quality. In a large tertiary care hospital-based ED, ETCO2 monitoring was not consistently utilized, despite workers having ACLS training and access to ETCO2 monitoring devices. The purpose of this project was to determine if high-fidelity ACLS simulation and ETCO2 monitoring training affected ED staff’s resuscitation self-efficacy and ETCO2 device application during clinical resuscitations. Twenty-eight interprofessional ED healthcare workers participated in high-fidelity adult cardiac arrest simulation scenarios. Paired-samples t-test results showed a significant pre-post simulation survey total average resuscitation self-efficacy improvement from 3.99 to 4.52 (t= 6.83, p < .001). Ten ED adult cardiac arrest events prior to simulation and twenty events post simulation were retrospectively analyzed for device utilization. Two-tailed paired-samples t-test results showed a non-significant improvement in device utilization (t= -1.96, p= .081), however utilization more than doubled from 20% to 45%. Overall, results indicated high-fidelity simulation can have a significant improvement in resuscitative confidence of ED workers, which in future studies may translate to higher survival rates for adults in cardiac arrest.

Candidate Name: V. Paige Stinson
Title: Micro-Opto-Mechanical Structures for the Infrared Spectral Range Fabricated by Two-Photon Polymerization
 March 27, 2024  9:30 AM
Location: Grigg Hall, Room 131, 9320 Robert D. Snyder Rd., Charlotte, NC 28262, USA

Since initial applications in the latter twentieth century, the field of micro-optics has greatly expanded. Micro-optics now encompasses research in areas such as integrated optics, micro-electromechanical systems (MEMS), quantum technology, sensing, energy harvesting, and metamaterials. In its current stage, dynamically tunable micro-optics are crucial to providing additional processing power without increasing volume. Micro-structured optics comprise a subsection of micro-optics where the optical response is manipulated by some sub-wavelength or wavelength scale structure. One challenge in developing micro-structured optics are restrictions in terms of geometric freedom and extensive development times. As a solution to some of these challenges, rapid prototyping techniques such as two-photon polymerization (TPP) have been employed in the development of complex two- and three-dimensional optics. TPP provides nano-scale feature sizes, resolutions which surpass the diffraction limit of the light source. In search of ways to add additional degrees of tuning in micro-optics, the unique properties of TPP compatible resins can be exploited. In this study, dynamically tunable micro-structured optics are developed by TPP. Being a polymer, the fabricated structures have unique mechanical properties when compared with conventional glass and metal optics. The structures are designed such that their optical response is sensitive to induced mechanical stress or strain. Both sub-wavelength and wavelength-scale micro-structured arrays were investigated for this mechanical tuning. In each case, changes in the structure's geometry due to mechanical stimuli resulted in a change in the optical response. In combination with a MEMS device, the investigated structures could have applications in integrated optics, mechanical sensing and beamsplitting, and tunable bandgap filtering.

Candidate Name: Hesam Fallahian
Title: Synthesizing Contextually Relevant Tabular Data Using Context-Aware Conditional Tabular GAN (CA-CTGAN) and Transfer Learning
 April 10, 2024  2:00 PM
Location: https://charlotte-edu.zoom.us/j/96836215539

The Context-Aware Conditional Tabular Generative Adversarial Network (CA-CTGAN) introduces an innovative architecture for the generation of synthetic tabular data, distinguished by effectively incorporating context-specific elements into its generative process. This enables the production of synthetic datasets that not only accurately reflect real-world distributions but are also tailored to specific contexts across a variety of experimental domains, including laboratory, field, natural, and clinical experiments, as well as survey research. In many cases, CA-CTGAN can generate data suitable for research purposes, potentially reducing or eliminating the need for certain real-world experiments. By utilizing Transfer Learning the model effectively identifies and exploits complex semantic relationships within the data to ensure the implementation of rigorous contextual requirements and maintains high semantic integrity. Furthermore, a novel auxiliary classifier is implemented, which includes entity embedding and multi-class multi-label capabilities, enabling the creation of enhanced datasets that strictly adhere to the specified contextual requirements. These contributions position CA-CTGAN as a remarkably versatile and efficient tool across multiple scientific disciplines. Its ability to generate high-quality, contextually relevant synthetic data not only streamlines research processes and reduces associated costs but also addresses ethical concerns in sensitive studies. Consequently, CA-CTGAN emerges as an essential resource for researchers, facilitating more ethical, cost-effective, and data-informed experimental design and decision-making.

Candidate Name: Zez C. Zawolo
 March 18, 2024  4:00 PM
Location: zoom https://charlotte-edu.zoom.us/j/95581010984?pwd=VG1OSnh5OFdqMlhzdTVrK2ZmSFp0Zz09

Many research studies have explored the impact of international experience on an organization's strategic decisions and overall performance. However, these studies tend only to examine the connection between a CEO's international experience, such as traveling abroad for work or study during their adult life, and their organization's Environmental, Social, and Governance Performance (ESGP). To expand on this, I examined other methods of gaining international experience, such as personal exposure from living overseas and indirect exposure from foreign-born parents and grandparents. Through the imprinting and upper-echelon theories, I identified CEOs born and raised overseas as "first-generation immigrant CEOs" and CEOs born and raised in the United States by at least one immigrant parent or grandparent as "second and third-generation immigrant CEOs." I then studied the relationship between first-generation immigrant CEOs, second and third-generation immigrant CEOs, and firm Environmental, Social, and Governance performance (ESGP) while also considering the moderating effect of firm size. To conduct this research, I obtained a list of companies from the Standard & Poor’s (S&P) 500 index for FY 2022 (N=444) and data from CSRHub and COMPUSTAT. Although the findings did not support the direct and moderating relationships studied, they provide recommendations for improvement and future research directions.

Candidate Name: Christina Page
Title: The Effect of an Educational Intervention on Clinicians' Knowledge, Skills, and Attitudes Regarding Occupational Therapy for Cancer-Related Cognitive Impairment
 March 25, 2024  1:00 PM
Location: CHHS 131

Millions of survivors are living following treatment of breast cancer. Survivors commonly experience cancer-related cognitive impairment (CRCI), which is associated with decreased quality of life. Occupational therapists (OT) assess and treat CRCI, yet are under-utilized. A barrier to utilization may be related to clinicians’ lack of education related to OT for CRCI. This project compared clinicians’ knowledge, skills, and attitudes regarding the use of OT for CRCI and the number of referrals to OT before and after an educational intervention.

A pre-test and post-test comparative exploratory design using a 17-item survey was used. Session content included interventions for CRCI focused on OT, and logistical information needed to support OT referrals. OT referral rates were extracted from the electronic medical record. The sample was a convenience sample of 9 clinicians from a suburban oncology clinic.

Significant differences were noted between pre- and post-survey scores in 7 of 8 slider scale items. Clinicians reported greater frequency in assessing for CRCI, comfort in assessing and suggesting interventions for CRCI and knowledge about OT following the educational intervention. More providers identified OT as an intervention for CRCI and fewer clinicians were unaware of available interventions for CRCI. The number of OT referrals for CRCI significantly increased in the post-intervention period.
This pilot study demonstrates the feasibility of an educational intervention to improve knowledge, skills, and attitudes of clinicians who care for breast cancer survivors with CRCI. Increase in OT referrals suggests that education led to increased awareness and management of CRCI, which may improve quality of life among breast cancer survivors. This intervention has potential to be broadly replicated, positively impacting oncology clinicians and their patients experiencing CRCI.

Candidate Name: Anupam Raina
Title: The Motherhood Penalty in the 21st Century - Replication and Extension
 March 28, 2024  1:00 PM
Location: Join Zoom Meeting https://charlotte-edu.zoom.us/j/98104889919?pwd=K2FZeGllblM0TFhZSmUybk9sUDRQdz09

Evaluating the impact of motherhood on a woman’s career is complex. There are interrelated mechanisms resulting in conflicting results. The wage disparity for mothers is noted within the literature to range from 0 – 20 percent, with a similar spectrum of negative impact on career progression, when compared with fathers and childless men and women. In this research I summarize the predominant theory-based explanations for the motherhood penalty and review a sample of the research published from 1979 to August 2023. This study shows evidence that a wage penalty for motherhood continues to persist ranging from 14 percent to 32 percent. From the NLSY97 sample of working women (2004-2021), there is evidence of a wage boost for married mothers, women who choose to delay fertility into their late 20s may experience a wage boost, race and a woman’s level of grittiness have no significant impact on women’s wages, and human capital considerations continue to matter and may work to attenuate any wage penalty for motherhood.