Master of Arts, The Ohio State University, 1961, Graduate School

Committee: Not Provided (Other) Subjects:

Master of Arts, The Ohio State University, 1970, Graduate School

Committee: Not Provided (Other) Subjects:

Master of Science in Industrial and Human Factors Engineering (MSIHE) , Wright State University, 2020, Industrial and Human Factors Engineering

Emergency Medical Service (EMS) providers are the first responders for an injured patient on the field. Their assessment of patient injuries and determination of an appropriate hospital play a critical role in patient outcomes. A majority of states in the US have established a state-level governing body (e.g., EMS Division) that is responsible for developing and maintaining a robust EMS system throughout the state. Such divisions develop standards, accredit EMS agencies, oversee the trauma system, and support new initiatives through grants and training. But to do so, these divisions require data to enable them to first understand the similarities between existing EMS agencies in the state in terms of their resources and activities. Benchmarking them against similar peer groups could then reveal best practices among top performers in terms of patient outcomes. While limited qualitative data exists in the literature based on surveys of EMS personnel related to their working environment, training, and stress, what is lacking is a quantitative approach that can help compare and contrast EMS agencies across a comprehensive set of factors and enable benchmarking. Our study fills this gap by proposing a data-driven approach to cluster EMS agencies (by county level) and subsequently benchmark them against their peers using two patient safety performance measures, under-triage (UT) and over-triage (OT). The study was conducted in three phases: data collection, clustering, and benchmarking. We first obtained data related to the trauma-specific capabilities, volume, and Performance Improvement activities. This data was collected by our collaborating team of health services researchers through a survey of over 300 EMS agencies in the state of OH. To estimate UT and OT, we used 6,002 de-identified patient records from 2012 made available by the state of Ohio's EMS Division. All the data was aggregated at county level. We then used several clustering methods to group counties us (open full item for complete abstract)

Committee: Pratik J. Parikh Ph.D. (Advisor); Subhashini Ganapathy Ph.D. (Committee Member); Corrine Mowrey Ph.D. (Committee Member) Subjects: Computer Science; Industrial Engineering; Statistics

Doctor of Philosophy, The Ohio State University, 1986, Graduate School

Committee: Not Provided (Other) Subjects: Engineering

Doctor of Philosophy, The Ohio State University, 1965, Graduate School

Committee: Not Provided (Other) Subjects: Biology

Master of Science, The Ohio State University, 2014, Comparative and Veterinary Medicine

Medial coronoid disease (MCD), a component of canine elbow dysplasia, is the most common cause of thoracic limb lameness in juvenile medium- to large-breed dogs. The goal of this study is to describe the magnetic resonance imaging (MRI), arthroscopic and histopathological changes in dogs with medial coronoid disease and to identify potential relationships between these findings. Twenty-five diseased medial coronoid processes (MCP) were collected from 19 dogs with a confirmed diagnosis of medial coronoid disease that underwent surgical management with subtotal coronoid ostectomy. A reference group of normal MCPs was harvested from 9 dogs that were euthanatized for reasons unrelated to elbow disease. MCP specimens were evaluated by magnetic resonance imaging (MRI) using a novel grading scheme (all dogs), arthroscopy using a modified Outerbridge scheme (affected dogs only) and histopathology (all dogs). The common histopathologic findings were subchondral microfractures, subchondral microfractures continuous with cartilaginous fissures, moderate to severe hypercellularity of the marrow space, trabecular bone necrosis and articular cartilage degeneration. The severity of cartilage disease in the MCP was moderate to severe in most of the specimens, even in cases with minimal arthroscopic pathology. Three distinct patterns of bone marrow lesion (BML) were identified adjacent to the MCP, but there was no correlation between BML pattern and either histopathological or arthroscopic findings. There was moderate correlation between modified Outerbridge scores and MRI scores. No correlation was identified between the histopathological changes and either MRI or arthroscopic scores. There was no significant correlation between the clinical scores and histopathological changes. Ongoing improvements in the resolution of noninvasive imaging techniques will likely improve description and understanding of the MCP disease in dogs.

Committee: Matthew Allen (Advisor); Noel Fitzpatrick (Committee Member); Tod Drost (Committee Member); Duncan Russell (Committee Member) Subjects: Scientific Imaging; Surgery; Veterinary Services

Doctor of Philosophy, Case Western Reserve University, 2004, Biomedical Engineering

Individuals with a C5/C6 spinal cord injury (SCI) have paralyzed elbow extensors, yet retain weak to strong voluntary control of elbow flexion and some shoulder movements. They lack elbow extension, which is critical during activities of daily living. This research focuses on development of a synergistic controller employing remaining voluntary elbow flexor and shoulder electromyography (EMG) to control elbow extension with functional electrical stimulation (FES). We hypothesized that the remaining voluntarily controlled upper extremity muscles of a C5/C6 SCI subject could be used as inputs to train a neural network controller to output stimulation to the paralyzed triceps. A biomechanical model of the shoulder and arm was used to estimate the triceps stimulation levels required for a particular subject to achieve a variety of endpoint force vectors of varying location, direction, and magnitude. Surface EMG was collected from SCI subjects while they generated these isometric force vectors using the predicted triceps stimulation levels. The EMG's were used as inputs to train and test an artificial neural network to output triceps stimulation level. A separate synergistic network controller was successfully trained for each subject. The best set of muscle inputs were selected for each subject such that the trained network yielded low error and generalized, the required number of EMG inputs was minimized, the controller effectively learned the relationships between endpoint force direction and required triceps stimulation, and the input (EMG) – output (triceps stimulation) controller space map was smooth with distinct volumes producing stimulation. The synergistic controller was functionally implemented in SCI subjects and compared to constant level and no triceps stimulation during maximum isometric forces, discrete force tracking, and functional overhead reach. The synergistic controller effectively modulated triceps FES and provided the largest range of isometric fo (open full item for complete abstract)

Committee: Patrick Crago (Advisor) Subjects: