PHD, Kent State University, 2025, College of Arts and Sciences / School of Biomedical Sciences

Spinal cord injury (SCI) significantly impairs ejaculatory function, a complex reflex controlled by the spinal ejaculation generator (SEG) located in the lumbar spinal cord. In male rats, mice and humans, the SEG comprises a cluster of specialized neurons known as lumbar spinothalamic (LSt) cells, which integrate sensory inputs during sexual activity into a coordinated autonomic and motor response culminating in ejaculation. Sensory inputs, originating partially from the dorsal penile nerve (DPN), require glutamate receptor activation in LSt cells. Previous studies have established that LSt neurons express GluN1 receptor, and antagonizing these receptors disrupts DPN-induced ejaculatory reflex. This dissertation hypothesized that GluA receptor activation is also essential for sensory-induced ejaculatory reflexes in adult male rats. To test this hypothesis, fluorescent in situ hybridization (FISH) was employed to examine the expression of GluA1, 2, 3 and 4 receptor mRNA in LSt cells in sham and SCI male rats. The results showed that GluA receptors subunits are expressed in LSt cells and remained unaffected by SCI. Furthermore, the role of GluA receptors in sensory-induced ejaculation was tested using an intraspinal injection of AMPA receptor antagonist NBQX in anesthetized, spinalized rats with DPN stimulation. NBQX administration blocked DPN-induced ejaculatory reflexes at the higher, but not lower, NBQX volume, supporting the hypothesis of GluA receptor involvement in ejaculation. In addition to peripheral sensory inputs, the SEG is influenced by supraspinal inputs from brainstem and hypothalamus areas, including dopaminergic and serotonergic projections. The dissertation also investigates the role of dopamine D3 receptors in ejaculation, hypothesizing their critical involvement in this reflex. FISH and immunofluorescence assays revealed that LSt cells co-expressed mRNA for dopamine D1, D2 and D3 receptors, with no significant alterations following SCI. Although t (open full item for complete abstract)

DNP, Otterbein University, 2025, Nursing

This project explores the rising prevalence of kratom use among patients in perioperative settings and the associated challenges for anesthesia management. With an estimated 10 to 16 million users in the United States, kratom acts as both an opioid receptor agonist and an alpha-2 adrenergic receptor stimulant, which complicates anesthetic care. The investigation reveals that a significant portion of kratom users do not disclose their usage to healthcare providers, and current hospital protocols are inadequate due to a scarcity of published studies and formal recommendations. Literature analysis indicates that kratom can lead to adverse postoperative outcomes, including resistance to anesthetics, insufficient pain control, refractory hypertension, and symptoms mimicking opioid withdrawal, often leading to extended hospital stays and unplanned admissions. This study emphasizes the urgent need for evidence-based practice guidelines to address the management of patients using kratom in perioperative care. Following institutional review board and hospital approval, the project aims to establish evidence-based practice guidelines to enhance anesthetic management for kratom users. Data will be collected from 100 patients managed under these new guidelines, and outcomes will be analyzed to determine the effectiveness of the interventions. Findings will inform future practices and potentially lead to broader dissemination of knowledge regarding the safe management of kratom-using patients in clinical settings.

DNP, Otterbein University, 2026, Nursing

According to the International Diabetes Federation, Diabetes Mellitus (DM) affects approximately 537 million people, representing approximately 10% of the worldwide population aged 20 to 79. Approximately 400,000 people with DM use continuous subcutaneous insulin infusion (CSII) pumps. CSII pump therapy mimics pancreatic insulin release, aiding in maintaining adequate insulin levels. Individuals with DM are more likely to require surgery than individuals without the disease. Among diabetics, people with Type 1 DM (T1D) are more likely to need medical interventions than individuals with Type 2 DM (T2DM). CSII therapy maintains blood glucose levels within a programmed range and decreases blood glucose level variability. When surgery is needed for patients with DM, a decision must be made to continue or discontinue CSII pump function during surgery. Many facilities lack guidelines related to perioperative CSII pump usage and glycemic control during the perioperative period. Nationally, there is an absence of guidelines from professional organizations guiding the anesthesia provider on perioperative CSII pump operation. The project team reviewed available literature to create a set of evidence-based practice (EBP) guidelines for perioperative CSII pump usage and glycemic control during the perioperative period. These EBP guidelines give the anesthesia provider information to guide the management of CSII pump therapy during the perioperative period. Guidance is provided to assist the anesthesia provider with pump management, restrictions, contraindications, imaging, CSII pump alarms and malfunctions, and CSII pump therapy discontinuation. This final scholarly project will not be implemented.

DNP, Otterbein University, 2026, Nursing

This Doctor of Nursing Practice (DNP) project investigates the integration of the Transversus Abdominis Plane (TAP) block into Enhanced Recovery After Surgery (ERAS) guidelines for bariatric surgery patients, aiming to improve postoperative outcomes by reducing opioid consumption, time to ambulation, and hospital length of stay (LOS). Bariatric patients who undergo sleeve gastrectomy or Roux-en-Y gastric bypass (RYGB) frequently encounter challenges with postoperative pain, increasing opioid use, delaying postoperative time to ambulation, and increasing postoperative hospital LOS. Prolonged postoperative hospitalization increases the financial impact on the healthcare system, and bariatric patients who have a longer postoperative LOS have a higher rate of readmission. While the TAP block has shown promise in enhancing postoperative analgesia and reducing reliance on opioids, it remains underutilized in clinical settings. This DNP project utilizes the Iowa Model of Evidence-Based Practice to guide the development, pilot implementation, and hospital-wide adoption of the TAP block within an ERAS guideline for bariatric patients. A multidisciplinary team has designed and implemented an intervention that could be evaluated by incorporating a small-scale pilot study to evaluate its impact on patient outcomes. The anticipated outcomes include a 20% reduction in opioid use, earlier ambulation, and shorter LOS, contributing to improved patient satisfaction and decreased healthcare costs. This proposed project can potentially standardize the TAP block as an integral part of an ERAS guideline, enhancing recovery for bariatric surgery patients in rural community hospitals.

DNP, Otterbein University, 2026, Nursing

The rise in abdominal laparoscopic surgeries has underscored the need for improved ventilation strategies to reduce postoperative pulmonary complications, such as atelectasis, ventilator-induced lung injury, and pneumonia. These complications can increase hospital stays, healthcare costs, and mortality. This final scholarly project investigates the impact of lung protective ventilation in adult patients undergoing abdominal laparoscopic procedures and proposes guidelines for implementation. Lung protective ventilation strategies, including low tidal volume ventilation, individualized positive end-expiratory pressure, and recruitment maneuvers. Current research shows potential in mitigating postoperative pulmonary complications by improving intraoperative oxygenation and lung compliance. Using the Johns Hopkins Evidence-Based Practice model, this project critically reviews current literature, identifies gaps in practice, and formulates an evidence-based framework tailored for the perioperative setting. The primary aim was to develop and standardize lung protective ventilation guidelines to enhance patient outcomes and minimize postoperative pulmonary complications' clinical and economic impacts. The secondary aim was to increase adherence to lung protective ventilation practices among Certified Registered Nurse Anesthetists and anesthesia teams through education and structured implementation protocols. Findings from this project are intended to support the broader adoption of lung protective ventilation in clinical practice, setting a new standard for safer, more effective ventilation management during laparoscopic surgery.

Doctor of Nursing Practice, Mount St. Joseph University , 2025, Department of Nursing

Unplanned perioperative hypothermia occurs when a patient's body temperature drops below 36°C / 96.8°F during the perioperative period. Patients who experience unplanned perioperative hypothermia are at increased risk of multiple complications. While investigating a rise in surgical site infections at a hospital in southwest Ohio, it was discovered that perioperative patients were sustaining unplanned perioperative hypothermia throughout their entire procedure. After consultation with key team members, the absence of a warming protocol was identified as the barrier to maintaining normothermia. A literature review was conducted, and evidence was gathered, appraised, and synthesized. Based on the findings and team member suggestions, a warming protocol was developed and implemented. The protocol focused on initiating forced-air warming preoperatively and maintaining warming methods intraoperatively on surgical patients undergoing general or spinal anesthesia. During the three-month implementation period, the project impacted a total of 1,383 patients and resulted in a 32% reduction in patients sustaining unplanned perioperative hypothermia intraoperatively. Additionally, the project also noted a 31% reduction in reported surgical site infections during the implementation period. This evidence-based quality improvement project highlights the importance of implementing evidence-based practice for positive patient and organizational outcomes.

Doctor of Philosophy, The Ohio State University, 2025, Molecular, Cellular and Developmental Biology

The work described herein aims to fill a gap in knowledge regarding specific mechanisms that underlie post-operative cognitive dysfunction (POCD) following surgery and morphine administration, specifically in a mouse model of Alzheimer's Disease (AD). POCD and the exacerbation of AD symptoms are critical concerns in aging populations, particularly following surgery and opioid administration. In this study, we replicated our previous findings that surgery, morphine, and aging interact in a synergistic manner to induce POCD and worsen cognitive deficits. However, rather than aging, we examined the impact of the AD-genetic risk factor using the 3xTg-AD mouse model. Our results revealed that this surgery combined with morphine led to significant prefrontal cortex and hippocampal-dependent memory impairments. These cognitive deficits were accompanied by mitochondrial dysfunction, mild increases in neuroinflammation, alterations to synaptic markers, and an acceleration in a neurodegenerative biomarker in morphine- treated mice. Crucially, we found that treatment with SS-31, a mitochondria-targeted peptide, significantly rescued the memory deficits associated with POCD and AD. SS-31 treatment restored mitochondrial structure and function, suggesting that mitochondrial dysfunction plays a key role in the cognitive decline observed in this model. These findings provide compelling evidence that the combination of surgery and morphine exacerbates AD-related cognitive impairments and that mitochondrial-targeted therapies may represent a promising therapeutic approach to alleviate these effects. Overall, this body of work highlights the complex and detrimental interactions between surgery, morphine, and AD-related risk factors in the development and progression of POCD and AD. The ability of mitochondrial restoration to improve cognitive outcomes suggests a potential therapeutic pathway for POCD patients with and without preexisting neurodegenerative conditions. Future st (open full item for complete abstract)

Master of Science, The Ohio State University, 2025, Biomedical Sciences

Internal fixation via intramedullary pins and cannulated shaft screws are existing surgical treatments for bovine capital physeal fractures. Complications such as implant failure via breakage or pullout are common due to the large body size and weight of cattle as well as cyclic loading. Difficult placement of implants further compounds adequate fixation. Human femoral neck fractures repaired using variable pitch screws have shown an increased contact between the threads and the bone offering increased holding force and pull-out strength. This research investigates the biomechanics of 7.3mm, threaded shaft screws (7.3 TSS) and 7.0 mm variable pitch fully threaded compression screws (7.0 VP) for bovine capital physeal fracture fixation. We hypothesize the 7.3 TSS will provide significantly more compression and higher load to failure than the 7.0 VP and that both implants will be suitable for fracture fixation. Compression was measured utilizing wooden fracture simulators that were randomly assigned to be repaired with either 7.3 TSS or 7.0 VP (n=8). Compression was recorded with a FlexiForce sensor. Cadaveric bovine femurs with induced capital physeal fractures were repaired with either 7.3 TSS (n=5) or 7.0 VP (n=5) before being placed through cyclic load and single load to failure. The median (range) compression for the 7.3 TSS (70.15 N, 44.65-76.275) was two times greater (p=0.0521) compared to 7.0 VP screws (33.4 N, 25.55-40.45). No constructs failed during cyclic loading. There was no significant difference between mean force at the time of failure of the 7.3 TSS (6672.2 N ± 1622.9) and 7.0 VP screws (10430 N ± 3728.7). The present study supports the use of 7.3 TSS and 7.0 VP screws to repair bovine capital physeal fractures. Further investigation is needed prior to use of 7.0 VP screws for fracture repair in live bovids.

DNP, Otterbein University, 2026, Nursing

A total hip replacement is a common surgery for the elderly population, as it is a successful treatment option for hip fractures and end-stage osteoarthritis, a common condition associated with aging. Recovery from surgery is critical, and any postoperative complication can delay recovery, increase cost, lengthen hospital stay, and lead to a poorer long-term surgical outcome. One of the most common and severe postoperative complications for elderly patients following general anesthesia is emergence delirium. Traditional practice focuses on treating the symptoms of emergence delirium reactively instead of proactively and lacks standardized guidelines. Recent literature found a promising decrease in the incidence of emergence delirium for elderly patients undergoing a total hip replacement with general anesthesia using evidence-based practice interventions. In this proposed project, after receiving approval from hospital administrators, the project team will educate recovery nurses on appropriate assessment tools to collect baseline data for the current rates of emergence delirium for three months or roughly 50 patients. The project team will then educate staff on changes to practice for the proposed evidence-based practice guidelines and gather data for another three months or approximately 50 patients. After completion of data collection, a data analysis will be used to assess the impact of the proposed guidelines on emergence delirium. The final scholarly project team anticipates a statistically significant reduction in the incidence of emergence delirium using the proposed guidelines. If the desired outcomes are unmet, additional investigation will be necessary to determine causative factors and adjust the guidelines as required.

DNP, Otterbein University, 2026, Nursing

Total knee arthroplasty (TKA) is becoming increasingly prevalent, with projections of a significant rise in cases by 2050. Optimal perioperative management is essential for enhancing postoperative recovery, minimizing complications, and supporting early discharge. Spinal anesthesia, particularly with long-acting agents like bupivacaine, is commonly used; however, it may lead to prolonged motor blockade and postoperative urinary retention (POUR), impacting recovery. Recent research suggests that mepivacaine, an intermediate-acting spinal anesthetic, may offer improved recovery outcomes for TKA patients compared to bupivacaine. This evidence-based practice project aims to evaluate the effectiveness of mepivacaine in reducing neurologic recovery time, POUR, and length of stay (LOS) in TKA patients. The proposed project team will collect data from electronic medical records for the previously mentioned metrics and compare the mepivacaine and bupivacaine groups. Descriptive and inferential statistics will assess differences, with successful outcomes marked by significant improvements in each metric. The findings are expected to demonstrate that mepivacaine allows for faster neurologic recovery and earlier discharge readiness, enhancing patient satisfaction, optimizing hospital resource use, and promoting cost-effective care. These results will influence anesthesia protocols for TKA, supporting the adoption of mepivacaine as the preferred option to improve perioperative outcomes.

Doctor of Philosophy, Case Western Reserve University, 2025, Molecular Medicine

Infective endocarditis (IE) caused by Staphylococcus aureus (S. aureus) is associated with invasive pathology, especially with prosthetic valve endocarditis (PVE), which results in worse clinical outcomes. This could be related to virulence factors produced by S. aureus that contribute to persistent infection. The rates of invasive pathology and cavity formation in a cohort of 438 patients who underwent surgery for S. aureus IE at our center during the period 2002 to 2020, were higher in PVE compared to native valve endocarditis “NVE” (76% vs. 40% with p < 0.0001 and 44% v. 10% with p < 0.0001, respectively). This resulted in increased complexity of the surgical procedures and prolonged recovery in patients with PVE compared to NVE. To better understand the in vivo virulence mechanisms of S. aureus in patients with active IE, we collected cardiac valve vegetation samples from 6 patients during surgery for endocarditis (3 PVE and 3 NVE). We also obtained corresponding S. aureus isolates from blood cultures collected from the same 6 patients prior to surgery. Using an RNA-sequencing technique, we showed feasibility of a novel research approach that includes in vivo examination of S. aureus transcriptome in patients with active IE. Comparative transcriptome analysis of S. aureus colonizing cardiac vegetation and blood isolate cultures revealed a differential gene expression profile for stress response, biofilm formation, and virulence factors. Interestingly, the gene aur (encodes for aureolysin) was highly upregulated in prosthetic valve vegetations compared to native valve vegetations (p=0.023). These results provide for the first in vivo transcriptional analysis of biofilm formation by S. aureus in cardiac vegetations during IE and more importantly, a better understanding of S. aureus virulence factors that contribute to the invasive pathology associated with PVE.

Master of Sciences (Engineering), Case Western Reserve University, 2025, Biomedical Engineering

Introduction: Cerebellar pathways are increasingly targeted using non-invasive and invasive neurostimulation-based therapeutic strategies for neurologic disease. Our recent Phase I trial of deep brain stimulation (DBS) of the dentato-thalamo-cortical (DTC) pathway to enhance chronic, post-stroke rehabilitation demonstrated promise for reducing motor impairment. As part of that trial, we acquired data to study the acute electrophysiological effects of cerebellar dentate nucleus (DN) DBS using both scalp electroencephalography (EEG) and upper-extremity electromyography (EMG). Methods: Chronic (>1 yr) post-stroke patients with moderate-to-severe upper-extremity (UE) motor deficits underwent implantation of an 8-channel DBS lead targeting the contralesional DN in a safety/feasibility trial of chronic DN DBS. Ipsilateral UE EMG recordings (biceps, triceps, FCR, and EDC muscles) time-locked to DBS pulse delivery were acquired and averaged to yield myogenic evoked potentials (MEP). Recordings were taken while the participant performed a computer-guided motor task involving alternating rest and active contraction periods. The presence and characteristics of DBS-MEPs were analyzed in relation to motor state. The strength of DBS-MEPs was studied with respect to stimulation location within and around the DN. Results: Four participants contributed data. MEPs were observed in all participants, could be induced in both flexor and extensor muscles, and had onset latencies on the order of 10-30 msec with extended durations of 50-100 msec. MEP strength was higher during active contraction versus rest regardless of DN DBS location. DBS-MEP strength was significantly larger during stimulation of anterior DN as opposed to posterior DN only in the active contraction state. Discussion: To our knowledge, this is the first study to demonstrate the effects of DN stimulation on myogenic activity in humans. Our results are consistent with currently hypothesized functiona (open full item for complete abstract)

Doctor of Nursing Practice , Case Western Reserve University, 0, School of Nursing

Background: Pulmonary embolism (PE) is a common cause of morbidity and mortality and continues to increase in overall incidence. Percutaneous Thromboembolectomy is a less invasive alternative therapeutic strategy that can be used for the treatment of acute pulmonary embolism (PE). This therapy is usually performed in patients with acute high-risk (massive) PE for whom thrombolysis is contraindicated or has failed and for whom surgical intervention is not available or is contraindicated. These patients are at extremely high risk for cardiopulmonary complications and are very challenging to care for from an anesthetic standpoint. Because it is a growing mode of therapy, CRNAs should be educated on how to appropriately care for these patients. Purpose: The purpose of this DNP project was to develop, implement, and evaluate an evidence-based educational module for anesthetic management of minimally invasive catheter-based removal of massive pulmonary embolism (Minimally-Invasive Pulmonary Thromboembolectomy) for CRNAs and SRNAs who practice in the General Adult ORs at a large academic quaternary care center. Methods: This DNP scholarly project was designed as a one-time clinical educational module on the current best practice guidelines for anesthetic management for the minimally invasive removal of massive PE for CRNAs and SRNAs. Keywords: pulmonary embolism, minimally-invasive pulmonary embolectomy, thromboembolectomy, Certified Registered Nurse Anesthetists, Student Registered Nurse Anesthetists

Master of Science, The Ohio State University, 2024, Environment and Natural Resources

Conventional efforts to advance sustainable development often emphasize the “economic” and “environmental” aspects rather than the socio-cultural implications of sustainability. Such approaches overlook how racially, and socioeconomically oppressed communities are disproportionally impacted and involved in sustainability decision- making. Given that the intended goal of sustainability is to make the world a better place for everyone and everything, including non-human animals and the natural world, socio- environmental justice must be the nexus used to connect the tenets of sustainability. This study explores how Black residents in the Near East Side community perceive the City of Columbus' decision-making practices and to what degree these practices incorporate their lived experiences. In doing so, just and transformational sustainability, racialized capitalism, and critical race theory are used as tools to guide this process. The results suggest that the Near East Side's Black residential population perceives major shortcomings in city decision-making practices, as many do not feel that their voices are taken seriously in such processes. Moreover, most participants understand that an improved quality of life for Black folks in their community, and those alike, is contingent on systemic change. Due to such perceptions, it is clear that the city's decisions do not (heavily) incorporate their lived experiences. Regarding sustainability, most participants consider it a “reductive practice” meant to protect the planet, reminding us (humans) to be intentional with everything we do, whether it be the things we consume, dispose of, or the spaces we show up in. Given their lived experiences, many noted that sustainability is important to their lives because they believe it serves as a tool for building resilience, longevity, resourcefulness, and stability within their communities. Albeit this study seeks to assuage the wickedness o (open full item for complete abstract)

Doctor of Philosophy, Case Western Reserve University, 2024, Clinical Translational Science

Ascending aortic dissection is a surgical emergency involving the proximal aorta with an incidence of between 5 and 30 cases per million persons per year and an estimated mortality of 20% within 24 hours. Worryingly, mortality after dissection increases 1–2% per hour following symptom onset. Aortic dissection is closely associated with aortic aneurysm and thus, action to reduce the prevalence of aortic dissection has been primarily directed at improving the management of ascending aortic aneurysms. The morbidity and mortality associated with ascending aortopathy are direct results of the biomechanical dysfunction and failure of aortic tissue. Understanding the complex mechanical behavior of aortic tissue and the influence of microstructural components on its behavior may provide novel insights to better predict ascending aortic dissection and improve clinical decision making surrounding aortopathy. Proteoglycans are an important part of the extracellular matrix of the aorta, whose function is balancing tensile forces within tissue. Aggrecan, a proteoglycan, previously believed to be confined to cartilage tissue, has been identified in massive amounts in diseased aortic tissue. Although beneficial in normal quantities, excess accumulation of proteoglycans, such as aggrecan, may be associated with aortopathy and biomechanical dysfunction. The underlying hypothesis of this dissertation is that increased proteoglycan deposition is correlated with aortopathy-associated biomechanical dysfunction. Using a prospective translation study I demonstrate that: i) aggrecan is a sensitive biomarker of ascending aortopathy and elevated preoperative blood levels are independently associated with aortic disease, ii) blood aggrecan concentration is correlated with aortopathy-associated biomechanical dysfunction, assessed using ex vivo biomechanical testing methods corresponding with aortic dissection, and iii) increased proteoglycan deposition resulting i (open full item for complete abstract)

MS, University of Cincinnati, 2024, Medicine: Clinical and Translational Research

Background: Beyond cosmesis, the impact of pectus excavatum on cardiopulmonary function remains controversial. Cardiopulmonary exercise testing (CPET) is often performed to assess functional impact in this patient population. One well-established measure of functional capacity is the percent predicted peak oxygen uptake (VO2). We sought to evaluate the association of predicted peak VO2 extremes (<80% and >95%) with patient and pectus characteristics to better delineate its applicability as a marker of disease or indication for treatment. Methods: A single-center retrospective study was conducted, including patients diagnosed with pectus excavatum between 2017 and 2022. Patient demographics, symptoms, imaging, and cardiopulmonary function were evaluated. Results: Of 678 patients who underwent CPET, 444 were categorized into low <80% predicted (n=257) and high >95% predicted (n=187) VO2 groupings. Patients were mean age 15.3 years, predominantly male (77%), white race (98%), and 594 (75%) were symptomatic. In univariate analysis, male patients, lower long volumes (FVC/FEV1), and severe pectus deformity (Haller and correction index) were related to worse peak VO2 (p<0.05). After adjustment, older patients (>18 years), males, and higher correction index were significantly associated with lower percent predicted peak VO2 (p<0.05). There was no association with symptoms in both univariate and multivariate analyses. Conclusion: In patients with pectus excavatum, peak VO2 differs according to age and gender; however, it also decreases with increased severity of the defect. Symptoms, however, are not predictive. The percentage of predicted peak VO2 may be a helpful indicator of impaired cardiopulmonary function in patients with severe pectus deformities. Further studies are warranted to assess the impact of repair.

MS, University of Cincinnati, 2024, Medicine: Clinical and Translational Research

Background: Transplant surgery is a high stakes and physically demanding field with an irregular call schedule. Physiologic patterns of sleep deprivation and stress are linked to cognitive abilities, medical comorbidities, and burnout. Little is known about the effect of the transplant surgeon call schedule on sleep and stress or associated patient outcomes. The goal of this study was to define sleep patterns amongst on- and off-call transplant surgeons and to compare transplant recipient outcomes by surgeon sleep deprivation status. Methods: Participating attending transplant surgeons at a single, high volume transplant center were asked to wear a biophysical monitor continuously from December 5, 2022, through April 27, 2023. Sleep patterns and heart rate variability were prospectively assessed and used to determine sleep deprivation and stress states. Liver transplants performed during this period were reviewed for outcomes up to 90 days posttransplant. Results: 448 nights were recorded for six transplant attending surgeons (66.7% male, 50% >5 years of practice). Transplant surgeons wore a biophysical monitor for 36 liver transplants. All monitored sleep stages were significantly lower for on-call surgeons compared to off-call (p<0.05 for all). Some amount of sleep deprivation was present 48.8% of the time and experienced equally among on- and off-call surgeons. Surgeons had either moderate or high calculated stress 81.7% of the time, including for 34/36 liver transplants (94.4%). Intraoperative blood product use and bile leak at 90 days posttransplant were higher amongst sleep deprived transplant surgeons (p<0.05 for all). All other liver transplant recipient outcomes were similar between evaluated groups. Conclusions: This is the first study evaluating sleep deprivation and stress amongst attending transplant surgeons using a continuous wearable biophysical monitor. Overall, transplant surgeons experienced persistent burdens of sleep deprivation and (open full item for complete abstract)

Doctor of Philosophy, University of Akron, 2024, Chemical Engineering

Thermoplastic elastomers (TPE) are a set of materials with characteristics of elastomers and thermoplastics. There is an increasing demand for polymers to be processed into three dimensional porous constructs for tissue engineering. Aliphatic polyester-based, poly(butylene succinate-co-dilinoleic succinate) (PBS-DLS) and polyisobutylene-based, poly(alloocimene-b-isobutylene-b-alloocimene) thermoplastic elastomer copolymers and their development will be presented for end use as biomaterial-based therapies in this dissertation. Electrospun fibrous scaffolds are favored for tissue engineering for their micro-structured networks creating a high surface area to volume ratio and this high interconnected porosity. These properties help mimic natural tissue structure for better tissue integration and diffusion through the network. Applying thermoplastic elastomers as scaffolds offers materials whose material properties can be tailored for specific applications. This dissertation presents work to advance biodegradable aliphatic copolymers for tissue scaffolds, and polyisobutylene copolymers for drug delivery. Cardiac soft tissue regenerations strategies employ biodegradative copolymers for cell delivery. Completely bio-based and biodegradable PBS-DLS copolymers have shown great potential for coiled 3D scaffolds for cardiac applications. This dissertation presents the kinetics of a step enzymatic polycondensation of PBS-DLS copolymers with varying feed ratios. 1H NMR and SEC results found that hydrophobic soft segment DLS was incorporated into the hard segment PBS within the first 3 hours. After which, the pressure was increased during second stage and complete DLS incorporation and high Mn oligomers occurred between 24 and 48 hours. MALDI-ToF analysis showed that the lower molecular weight fractions cyclic formation of long PBS sequences are favored during early stages of reactions. Poly(styrene-b-isobutylene-b-styrene) is currently used as the coating on the Taxus coronary (open full item for complete abstract)

PHD, Kent State University, 2024, College of Public Health

This study focused on evaluating the patient-reported psychological outcomes (PRPOs), including anxiety, depression, cancer-related post-traumatic stress disorder symptoms (CR-PTSD), fear of cancer recurrence (FCR), and post-traumatic growth (PTG), among surgically treated colorectal cancer (CRC) patients. Additionally, this study examined the association between coping strategies and these PRPOs. The research involved 23 CRC patients undergoing curative surgery. With the exception of FCR, which was measured only post-surgery, the study conducted assessments of all PRPOs and coping strategies at two crucial points: before and after the surgical intervention. Results demonstrated a significant reduction in anxiety levels post-surgery, while depression scores remained unchanged. PTG, particularly in the dimensions of Relating to Others and Appreciation of Life, showed significant increases, indicating potential positive psychological adaptation following surgery. In contrast, CR-PTSD symptoms were minor and exhibited negligible changes that were not statistically significant. For coping strategies, there was a significant improvement in problem-focused coping post-surgery, whereas emotion-focused and avoidant coping strategies remained unchanged. Despite improvements in certain psychological outcomes and coping strategies, the study identified a high frequency of FCR among participants post-surgery, with 70% reporting elevated levels (≥12). Regression analysis showed that problem-focused coping strategies were significantly associated with reduced anxiety levels and positively correlated with PTG factors over time. These findings highlight the importance of adaptive coping mechanisms in affecting psychological outcomes after CRC surgery. The persistent high levels of FCR post-surgery underline the need for targeted psychosocial interventions to address this prevalent concern among CRC survivors. In conclusion, this research underscores the complexity of psychological (open full item for complete abstract)

DNP, Otterbein University, 2025, Nursing

In the United States, around 40,000 surgeries are conducted on pediatric patients yearly to address congenital heart disease. These surgeries involve a variety of complications beyond cardiovascular problems, including pain management. Traditional pain management involving intravenous opioids has drawbacks such as sedation, respiratory depression, and prolonged recovery times. As the healthcare industry moves away from opioid-centric pain management, the use of multimodal analgesia, including ultrasound-guided regional anesthesia, is being utilized. Regional anesthesia techniques, such as the transversus thoracis muscle plane block and the thoracic erector spinae block, are being considered for the ability to provide adequate pain relief while reducing opioid usage. The goal of using ultrasound blocks for congenital heart patients is to decrease postoperative opioid consumption and decrease the time to extubation in pediatric cardiac surgical patients in the first 24 hours postoperatively. A 12-month timeline outlines the development of guidelines, staff training, and clinical practice change integration. The project follows the Iowa Model for Evidence-Based Practice to guide its implementation, focusing on reducing opioid use, improving postoperative outcomes, and enhancing patient safety.