Developing a Scheduling Method for Animal-Assisted Therapy in Acute Rehabilitation

Animal-Assisted Therapy (AAT) provides meaningful benefits in rehabilitation, including reduced anxiety and improved motivation and physical outcomes (Burres et al, 2016, Denzer-Weiler & Hreha, 2018). However, barriers such as inconsistent scheduling and limited clinician experience hinder implementation in fast-paced healthcare settings. This project took place at a large inpatient acute care hospital where therapy staff sought to integrate AAT more effectively into rehabilitation sessions. The purpose of this quality improvement project was to develop a sustainable scheduling method to facilitate coordination between therapy staff and volunteer animal-handler teams. Goals included improving interdisciplinary communication, enhancing patient engagement through AAT, and creating accessible tools for consistent implementation. Over a four-week period, AAT sessions occurred on nine days, involving 12 therapists, 6 animal-handler teams, and 15 patients. A shared scheduling document was created and refined based on real-time feedback. Post-implementation surveys showed that 100% of clinicians rated the system as “very convenient,” and all volunteers found communication “very effective.” Qualitative feedback indicated AAT increased patient participation, motivation, and morale. Deliverables included a digital scheduling tool, educational materials for staff and volunteers, and an updated therapy animal role description. This project supports AAT integration in acute rehab settings by addressing logistical barriers and promoting interdisciplinary collaboration. References Burres, S., Edwards, N. E., Beck, A. M., & Richards, E. (2016). Incorporating pets into acute inpatient rehabilitation: A case study. Rehabilitation Nursing, 41(6), 336-341. 10.1002/rnj.260 Denzer-Weiler, C., & Hreha, K. (2018). The use of animal-assisted therapy in combination with physical therapy in an inpatient rehabilitation facility: A case report. Complementary Therapies in Clinical Practice, 32, 139-144. 10.1016/j.ctcp.2018.06.00

Home Exercise Program Adherence in Stroke Rehabilitation: Analyzing Barriers and Evaluating the Efficacy of Problem-Solving Consultations

In post-stroke rehabilitation, the high number of task practice repetitions needed for neural plastic recovery cannot be achieved within standard therapy sessions alone. Home exercise programs (HEP) are prescribed to augment the needed repetitions. However, adherence is often poor, leading to suboptimal functional recovery. Our long-term goal is to develop tools to assist with HEP adherence. Toward this goal, the objective of our study is to investigate: (1) common barriers to HEP adherence, (2) problem-solving solutions, and (3) the impact of these solutions on adherence levels. Participants received standardized upper extremity rehabilitation therapy along with HEP for 6 weeks. Barriers to HEP adherence reported by patients, problem-solving solutions provided by therapists, and HEP adherence logs were obtained at each therapy visit. Common barriers were identified as: exercise too hard, fatigue, pain, impatient/frustrated, forgot, time, not in daily routine, and assistance needed. Common solutions were identified as: adapt HEP exercises, education on proper technique, reminders, encourage HEP, and caregiver education. HEP adherence levels tended to improve in response to the provided solutions. The impact of this study is that identification of common barriers and efficacy of solutions to HEP adherence will provide the groundwork to improve HEP adherence and maximize functional recovery post-stroke

The Role of Spinster Homolog 2 (SPNS2) in Cancer Progression and Metastasis

Cancer metastasis remains the leading cause of cancer-related mortality, yet the molecular mechanisms driving this process are incompletely understood. Spinster Homolog 2 (SPNS2) is an important transporter exporting sphingosine-1-phosphate (S1P), a bioactive lipid that regulates cell migration, survival, and immune cell trafficking. Despite emerging evidence linking SPNS2 to tumor progression, conflicting reports suggest it may either promote or suppress metastasis depending on cellular context. This dissertation systematically investigates the role of SPNS2 in cancer metastasis and progression, addressing these discrepancies through an integrated approach combining clinical data analyses, molecular biology techniques, and preclinical models. Kaplan–Meier analyses revealed that high SPNS2 expression is positively correlated with poor overall survival in breast, lung, ovarian, and pancreatic cancers, as well as enhanced lymphatic dissemination in breast cancer. SPNS2 overexpression in cancer cell lines promoted S1P export, activated the S1P receptor 1-AKT pathway, and induced EMT and cancer stemness, thereby increasing cell migration and lung metastasis. In contrast, SPNS2 knockout diminished S1P secretion, EMT, and cancer stemness, leading to impaired cell migration and lung metastasis. Additionally, immunophenotyping and transcriptomic analyses demonstrated that SPNS2 inhibition reprograms the tumor microenvironment by activating systemic anti-tumor immune responses mediated by T cells and myeloid cells, leading to reduced primary tumor growth and spontaneous lung metastases. Mechanistically, SPNS2 inhibition triggers immunogenic cell death (ICD), releasing damage-associated molecular patterns (DAMPs) that prime myeloid cells for antigen presentation and activate T cells to mount an effective anti-tumor response. Notably, pharmacological inhibition using a novel small-molecule SPNS2 inhibitor (SLF82801178) recapitulated the effects observed with genetic ablation by suppressing primary tumor growth and lung metastasis while enhancing T cell-mediated anti-tumor responses. Therapeutic administration of the SPNS2 inhibitor following surgical resection of primary tumors significantly reduced distant metastatic burden, suggesting potential clinical utility in adjuvant settings. Collectively, these findings establish SPNS2 as a pivotal regulator of cancer metastasis that functions through dual mechanisms, driving tumor cell-intrinsic pro-metastatic signaling and orchestrating an immunosuppressive tumor microenvironment. Targeting SPNS2 disrupts these processes and reconditions the immune landscape, offering a potential therapeutic strategy to curb metastatic progression and improve patient outcomes

Occupational Therapy’s Role in Palliative Care: Helping Those with Serious Illnesses Participate in Meaningful Activities

Palliative Care (PC) is a service that provides people living with life-limiting illnesses with additional layers of support throughout disease progression. Benefits of PC include improved pain and symptom management, improved Quality of Life, and dying experiences. A Program of S.U.P.P.O.R.T™ (Symptom management, Understanding the disease, Pulmonary rehabilitation, Palliative care, Oxygen therapy, Research considerations, and Transplantation intervention) is an educational program for patients who live with life-limiting pulmonary illnesses to improve understanding of disease progression. While research about occupational therapy’s role in PC is limited, the literature suggests that interventions can positively impact patients\u27 ability to participate in their Activities of Daily Living (ADLs). The occupational therapy (OT) scope of practice includes interventions such as mental health support, durable medical equipment and adaptive equipment utilization and management, home modification, and energy conservation (EC), among others that could be beneficial to individuals receiving PC services. EC consists of modifying daily activities to minimize feelings of fatigue, stress, and breathing difficulty and has benefits in reducing anxiety and stress during ADLs. Survey data collected as part of an OT Doctoral Capstone project revealed that a sample of people living with serious pulmonary diseases felt they would benefit from EC techniques as their disease progresses. Other focus group data revealed that a team of healthcare professionals reported that advocacy for OT’s scope within PC is necessary. The focus group also revealed that OT services would be beneficial to their patients living with pulmonary diseases and/or receiving PC services. These data were used to enhance the Program of S.U.P.P.O.R.T™, to include EC strategies for patients and their caregivers to use, how to ask for rehabilitation services, and the scope of rehabilitation services (OT, physical therapy, and speech-language pathology) within PC. Advocating for OT’s role in PC may empower patients to better participate in ADLs throughout their disease progression

Occupational Therapy Guided Interactive Workbook for College Students with Autism Spectrum Disorder for Transition into the Workplace

The number of students with autism spectrum disorder entering college has been steadily increasing. When these graduates enter the workforce, the support and accommodations available throughout their education may not necessarily be readily available in their new workplace. This quality improvement project aimed to increase the resources of a college program whose purpose is to support autistic and neurodivergent students throughout their college career. The project aims were to create an interactive job readiness and independent living workbook to assist and provide resources for students during their transition into the workforce. The senior cohort completed seventeen fillable workbook pages with various topics to help prepare and equip them for job searching, interviewing, and living independently. After completion of the workbook, all eight seniors completed a post-survey regarding effectiveness of the workbook. On a scale of 1 to 5, all seniors reported a 4 or higher in terms of helpfulness of the workbook. 7 out of 8 seniors reported that they would likely reference the workbook during their transition out of college. Topics that seniors found most help included budgeting, cost of living, and interview preparation. Outcomes indicate that this senior cohort now have an increased awareness of job readiness and facets of living

Sympathetic Neuroeffector Junction: Formation, Maintenance, and Impact on Target Organ Function

The sympathetic nervous system (SNS) regulates heart rate and contractility in response to a variety of physical and emotional stresses. Proper formation and maintenance of sympathetic synapses are critical for SNS function, yet the underlying molecular mechanisms remain poorly understood. This dissertation investigates the role of Endothelin Receptor B (Ednrb) in the establishment and preservation of sympathetic synapses, as well as the structural and functional consequences of reduced sympathetic input. We investigate the role of Ednrb using two sympathetic neuron-specific Ednrb knockout mouse models: Th-cre/Ednrb, in which Ednrb is deleted embryonically, and THCreER/Ednrb where deletion is induced postnatally, at 3 weeks of age. We used fluorescence-based markers to visualize functional synapses of the heart and kidneys. Cardiac function was evaluated through electrocardiography, IonOptix imaging of isolated primary cardiomyocytes, and western blot analysis of proteins involved in contractility and calcium handling. Our results indicate that Ednrb deletion in sympathetic neurons significantly reduces functional sympathetic nerves in the heart, regardless of whether Ednrb loss occurs embryonically or postnatally. However, we find divergent outcomes in intrinsic cardiomyocyte function depending on when synaptic transmission at neuroeffector junction is impaired. Loss of communication between sympathetic synapses and developing cardiomyocytes resulted in a failure of cardiomyocyte to acquire normal contractile function, and ultimately led to ventricular arrhythmias. In contrast, elimination of sympathetic synaptic transmission to mature cardiomyocytes led to elevation of beta-adrenergic receptor expression and thereby beta-adrenergic hypersensitivity. These cardiomyocyte-specific responses to loss of local sympathetic neurotransmission are not compensated by systemic catecholamines and are relevant to clinical interventions for heart diseases, such as beta blocker therapy and surgical sympathectomy. Furthermore, our findings reveal that the synaptic phenotype associated with the loss of Ednrb from cardiac sympathetic nerves is not mirrored in the mature renal sympathetic nerves. These results suggest that the mechanisms of synaptic maintenance may vary between organ systems. While further research is essential to elucidate the precise mechanisms underlying Ednrb function in this context, the work presented in this dissertation overall enhances our understanding of the SNS’s role in cardiac physiology and the factors that influence sympathetic synapse formation and maintenance

Influences of Sex, Alcohol, and Stress on Conditioned Fear Responses

Learned fear responses are acquired through the identification and association of threatening stimuli with aversive outcomes. Fear responding and the proper maintenance of defensive behaviors is integral to survival. However, without the homeostasis of such systems, fear responses can become maladaptive and lead to dysregulated behavioral responding. Psychological conditions such as alcohol use disorder (AUD) and post-traumatic stress disorder (PTSD) often lead to impairments in fear learning, deficits in fear memory, and heightened fear responses. While there are clear sex differences in the prevalence of both AUD and PTSD, development of either disorder increases the risk for comorbid AUD/PTSD, leading to exacerbated symptomology of both disorders. The experiments in this dissertation focused on the impact of stress, alcohol, or the combination of these two variables on fear learning and responding in male and female rats. As threat response strategies often diverge between the sexes, both passive and active fear behavior paradigms were utilized in these studies to probe for sex differences in fear-related behaviors. In Chapter 2, male and female Wistar rats were subjected to chronic intermittent ethanol (CIE) vapor exposure, single-prolonged stress (SPS), or both before Pavlovian fear conditioning. The results from these experiments highlight baseline sex differences present in Pavlovian fear conditioning and impairments in fear renewal in males and females as a result of alcohol exposure and stress, respectively. Chapter 3 investigated the effects of chronic ethanol exposure on active avoidance behavior in the Platform Mediated Avoidance (PMA) task in male and female Wistar rats, which resulted in a mild impairment in extinction learning in male rats. Chapter 4 utilized in-situ fluorescent hybridization to characterize a novel population of corticotropin-releasing factor (CRF) neurons in the lateral septum (LS), as these neurons may be involved in fear responding. Overall, the data presented in this dissertation highlight divergent threat response strategies adopted by male and female rats in passive versus active fear paradigms, add to our understanding of the effects of alcohol and stress exposure on fear behavior, and explore novel cell populations that may be responsible for these behavioral effects

Impact of a Case-Based Learning Module: Integrating Authentic Treatment Videos, Electronic Documentation, and Hands-on Simulation

INTRODUCTION: Developing student confidence and competence is essential for effective fieldwork preparation in occupational therapy (OT) education. Educators use diverse instructional methods to foster clinical readiness, including case-based learning (CBL), video cases, documentation practice, and simulation. CBL enhances critical thinking, clinical reasoning, self-awareness, and confidence. With advancements in technology, video CBL has become more accessible, using authentic patient videos to promote higher-level clinical reasoning, documentation, and communication skills, especially when paired with complementary learning activities. CBL video cases offer a logical opportunity to incorporate structured documentation training, an area in which health professions students often report feeling underprepared. Simulation further enhances readiness for practice by fostering communication and clinical judgment. While these strategies are individually supported in the literature, research on how to successfully weave these methods together within one learning module is limited. OBJECTIVE: This mixed methods study examined the effectiveness of a hybrid CBL activity integrating video case studies, electronic documentation, and hands-on simulation. METHODS: Second-year OT doctoral students (n=51) participated in a CBL activity as part of a required course. Asynchronous preparatory work included video cases and documentation practice, followed by a synchronous simulation lab based on the video cases and a clinical reasoning discussion. Students completed an optional anonymous survey following the activity. RESULTS: Students reported high agreement that the CBL activity improved their confidence (92%), reflective thinking (98%), motivation (89%), fieldwork preparation (96%), documentation (89%), and clinical judgment (98%). Students highly valued the preparatory work (100%), video cases (100%), documentation practice (100%), and simulated patient (89%). Themes revealed that students valued practicing documentation, observing authentic videos, and managing unexpected inappropriate behavior. IMPACT: This study offers a practical, evidence-based learning activity integrating video CBL, documentation, and simulation that can be easily adapted across programs to enhance student readiness for clinical practice

Quantifying Trends in Hospital Administrative Costs: Examining Urban-Rural Disparities, Barriers, and Opportunities for Cost Reduction in Healthcare

Administrative and general (A&G) expenses in U.S. hospitals represent a growing financial burden, accounting for 15%–30% of healthcare expenditures. Despite this impact, A&G trends remain underexamined, particularly between rural and urban hospitals. This study used Medicare Cost Report data from over 4,400 short-term acute care hospitals from 2011 to 2022, combined with qualitative interviews with hospital executives, to assess rural-urban differences in A&G expenses. Using an explanatory sequential mixed-methods design, rural hospitals were found to consistently spend a higher proportion of total expenses on A&G salaries—18% more than urban hospitals, even after adjusting for hospital and financial characteristics. Although salary-related expenses declined, non-salary A&G costs increased across all hospitals. Interviews revealed that regulatory burdens, payer fragmentation, and staffing inefficiencies were primary cost drivers. Rural hospitals were especially affected due to limited scale and staffing capacity. Policy reforms that simplify compliance requirements and standardize payer processes could help reduce administrative burdens and improve financial sustainability, especially for rural institutions

Engineering CXCR2-Ligand-Based Fusion Proteins to Modulate Myeloid Cell Trafficking in Pancreatic Cancer

Pancreatic ductal adenocarcinoma (PDAC) has one of the lowest 5-year survival rates of all cancers, and limited treatment options exist. Immunotherapy is effective in some cancer types, but the immunosuppressive tumor microenvironment (TME) of PDAC is a barrier to effective immunotherapy. CXCR2+ myeloid-derived suppressor cells (MDSCs) are abundant in PDAC tumors in humans and in mouse models. MDSCs suppress effector cell function, making them attractive targets for restoring anti-tumor immunity. The studies outlined in this dissertation (1) link tumor-intrinsic oncogenic signaling to dysregulated myeloid activity in PDAC, (2) describe a rationally designed fusion protein and potent inhibitor of CXCR2+ myeloid cell migration in PDAC, and (3) explore CXCL1-Fc as a modular platform for CXCR2-targeted therapeutics. We utilize cytokine arrays and quantitative ELISA to show that the most abundant soluble factors released from a genetically diverse set of human and mouse PDAC cells are CXCR2 ligands, including CXCL8, CXCL5, and CXCL1. Using engineered cell models, we showed that expression of CXCR2 ligands is at least partially driven by mutant KRAS and NF-κB signaling, which are two of the most commonly dysregulated pathways in PDAC. CyTOF and flow cytometry analyses revealed that myeloid cells are the dominant immune cell population in PDAC tumors, with MDSCs expressing high levels of CXCR2. Moreover, we observed that myeloid cells readily migrated toward conditioned media (CM) derived from PDAC cell cultures using Boyden chamber transwell assays. To therapeutically target immunosuppressive myeloid cells, we designed CXCR2 ligand-Fc fusion proteins. Unexpectedly, these fusion proteins were superior to native chemokines in binding and activation of CXCR2 on myeloid cells. These “superkines” were potent inhibitors of PDAC CM-induced myeloid cell migration and were superior to CXCR2 small-molecule inhibitors and neutralizing antibodies. Finally, we demonstrate that CXCL1-Fc can serve as a modular platform for delivering therapeutic payloads to CXCR2+ cells and may have applications beyond cancer, such as in wound healing. Together, these findings provide mechanistic insight into myeloid dysregulation in PDAC and introduce a promising class of immunotherapeutic agents capable of altering the myeloid landscape to improve treatment outcomes