Master of Sciences, Case Western Reserve University, 2021, Clinical Research

We compared the safety and efficacy of balloon aortic valvuloplasty (BAV) across a range of presentations including critical illness in an intensive care unit (ICU), heart failure hospitalization in a non-ICU ward, and the outpatient setting. We included patients treated with BAV from 1/1/2012-7/31/2019 and compared outcomes and mortality stratified by presentation acuity. 612 patients underwent BAV; 111 (18.1%) ICU, 297 (48.5%) ward, 204 (33.3%) outpatients. Procedural outcomes were similar and complication rates were low. While ICU patients had higher 30-day mortality than ward and outpatients (31.5%, 5.4%, 3.4%; p<0.001), among patients ultimately treated with transcatheter aortic valve replacement (TAVR) there were no differences in long-term mortality (p=0.74). BAV is safe and effective at temporarily improving aortic valve function in patients with aortic stenosis across the spectrum of acuity of illness. Among critically ill patients with shock, BAV may facilitate recovery to discharge and serve as a bridge to TAVR. 

Committee: Grant Reed (Committee Chair) Subjects: Medicine

Doctor of Philosophy, The Ohio State University, 2020, Biomedical Engineering

In the era of transcatheter aortic valve replacement (TAVR) and especially now with FDA approval for TAVR in low risk patient populations, the need for improved devices, device options, and patient specific pre-planning is especially important. This research uses both experimental and computational methods to study the mechanics and hemodynamics of transcatheter valve replacement with the overarching goal of improving the current technologies towards improved patient outcomes. In order to reduce the risk of fatal coronary obstruction during transcatheter valve replacement in an at-risk patient population, a patient specific 3D computational model to predict risk of coronary obstruction was developed using finite element analysis. The predictive index, DLC/d, was shown to have increased sensitivity and specificity of risk prediction as compared to the clinically used metrics. With the understanding that patient specific computational models are highly time consuming and impractical in a clinical setting, a 2D geometric model to predict risk of coronary obstruction was subsequently developed. Results suggest that while the 3D computational model is the most accurate at predicting risk of coronary obstruction, the 2D geometric model is still superior to the clinically used metrics. For transcatheter valve replacement expansion into lower risk and younger patient populations, durable transcatheter prostheses free from long term structural valve degeneration are needed. A potential solution was developed, in the form of a polymeric transcatheter aortic valve, called HA-TAV. Due to its unique material properties, geometry, and design, the HA-TAV showed reduced levels of blood damage related Reynolds shear stress and durability limiting pinwheeling of leaflets, while maintaining a comparable effective orifice area and regurgitant fraction to the leading commercially available transcatheter aortic valve. Another potential solution to the need for increased durabi (open full item for complete abstract)

Committee: Christopher Breuer (Advisor); Samir Ghadiali (Committee Member); Scott Lilly (Committee Member) Subjects: Biomedical Engineering

Doctor of Philosophy, The Ohio State University, 2019, English

Although the first balloon flights in 1783 created a sensation throughout Europe, human flight had long captured the imaginations of scientific and literary authors alike. Prior histories of flight begin with balloons, but earlier centuries boasted a strange and colorful aviary that shaped thinking about flight long before the first balloon ever left the ground. Taking a cultural materialist approach informed by a broad familiarity with the development of early flight machines and a deep familiarity with the literary conventions of the period, I analyze historical materials ranging from aeronautical treatises to stage pantomimes, from newspaper advertisements to philosophical poems, from mechanical diagrams to satirical cartoons. This earlier culture possessed high hopes and anxieties about human flight. I argue that early flight was lively and varied before the invention of a successful flying machine, and that these early flights were important because they established an aerial tradition astonishingly resistant to change. Rather than revolutionizing the culture, ballooning was quickly incorporated into it. Although ballooning came to be regarded as a failure by many onlookers, the aerial tradition had long become accustomed to failure and continued unabated. Human flight has always promised tremendous and yet debatable utility, a paradox that continues into the present age.

Committee: Roxann Wheeler (Advisor); David Brewer (Committee Member); Sandra Macpherson (Committee Member); Jacob Risinger (Committee Member) Subjects: Aeronomy; Aerospace Engineering; American Literature; Astronomy; British and Irish Literature; Comparative Literature; Engineering; European History; European Studies; Experiments; Folklore; Foreign Language; Germanic Literature; History; Language; Literature; Mechanical Engineering; Museums; Philosophy of Science; Physics; Science History; Technology; Theater; Theater History; World History

Master of Science (MS), Ohio University, 2014, Clinical Psychology (Arts and Sciences)

The Balloon Analogue Risk Task (BART; Lejuez et al., 2002) is a behavioral measure of risk taking that is widely used. Despite widespread use and evidence of mixed findings, a thorough review of the literature pertaining to the convergent and discriminant validity of the measure has not been undertaken, bringing the results of studies using the BART into question. The current study was a meta-analytic review of the literature related to the convergent and discriminant validity of the measure. Using a random effects model the average effects were calculated to determine the strength of the relationship between the BART and other measures of risk taking and constructs related to risk taking. Results of the study indicate that the BART has weak convergent and discriminant validity. Supplemental and moderator analyses were also conducted to explore possible reasons for the weak relationship. However, the supplemental analyses also provided evidence for weak convergent and discriminant validity. These results bring into question the results of the studies that relied on the BART as a measure of risk taking propensity.

Committee: Steven Evans (Advisor); Julie Owens (Committee Member); Wymbs Brian (Committee Member) Subjects: Psychology

Master of Science, The Ohio State University, 2008, Pathology

Percutaneous transluminal coronary angioplasty (PTCA) has greatly benefited patients with occluded coronary arteries, but its benefits have been undermined by a high incidence of restenosis. The introduction of coronary stents has significantly improved the short and long term outcome but restenosis still occurs in approximately 15-30 % of patients within 6 months. Research efforts are now being directed toward combination stenting and drug delivery. Among the therapeutic targets being pursued are agents which can impede smooth muscle cell (SMC) migration and proliferation as these processes are critical components of restenosis injury. We propose that inhibiting the conversion of ribonucleotides to deoxyribonucleotides will impede cell proliferation and as such limit the degree of restenosis. Therefore, we tested whether the potent Ribonucleotide Reductase (RR) inhibitors, Didox and Imidate, can limit the neointimal proliferation associated with restenosis using rat, rabbit and porcine models of vascular injury. Results demonstrated that systemic administration of the RR inhibitors Didox, Imidate and Hydroxyurea significantly reduced intimal thickening, intima/media ratio and lumen loss. Results from cell proliferation studies suggest that the mechanism of protection is inhibition of SMC proliferation and decreased number of circulating leukocytes. These results suggest that inhibition of Ribonucleotide Reductase may provide a potent strategy to prevent post PTCA restenosis.

Committee: James Waldman Phd (Advisor); Arturo Cardounel Phd (Committee Member); Guanglong He Phd (Committee Member) Subjects: Pathology

Bachelor of Fine Arts, Miami University, 2008, School of Fine Arts - Architecture

Movement, scale, orientation, dimension, sense... What if these tenets of life's linearity were suddenly interrupted? Pause-eject-flip the disk. What if all of a sudden you encounter a moment - a space - and it is looking at you with the same amount of curiosity that you are looking at it. Maybe you walk away. But maybe you start a conversation. And maybe the linear and the interrupter begin to shift in their seats, tap their feet, dive in, retreat. I would like to create a series of such interactive "installations" that begin to deconstruct social/spatial perception and embody an architecture of agitation and reciprocity. In referring to such installations, I will use the word deconstruct as a noun, visually represented as "deCONstruct". A deCONstruct is a three-dimensional arrangement that serves to instigate reaction to cultural criticism. One example of a deCONstruct could be a pile of metal shopping carts welded together in the middle of a parking lot, hinting at the exaggeration, futility, and eventual collapse of consumer culture. Another could be a gas nozzle posing as a remote control for a TV streaming footage from the war in Iraq. By visually deconstructing the normalized environment, I hope to provoke a rethinking of the way we perceive everyday life, prove the fluidity of spatial meaning, realize the susceptibility of space to be affected by those who inhabit it, and elicit spontaneous response, whether thought or action; spatial or social. Each deCONstruct could produce specific patterns in movement, interaction or thought processes, which have the potential to be digitally mapped and animated as a way to visualize the effects of social/spatial interruption. Such animations could emulate collision, conversation, hesitance, embrace. The deCONstruct is based on the post-structural methodology of disturbing and interrupting existing perceptions of the world while stressing the subjectivity and fluidity of meaning in culture. This series of experiments is (open full item for complete abstract)

Committee: Thomas Dutton (Advisor); Robert Benson PhD (Committee Co-Chair); Christie Lear (Committee Co-Chair) Subjects: Architecture

Master of Science in Biomedical Sciences (MSBS), University of Toledo, 2012, College of Medicine

Accelerated partial breast irradiation (APBI) is a popular method of adjuvant radiation therapy after tumor resection for early-stage breast cancer due mainly to the reduced total treatment time. Despite the successes of APBI, many patients do not qualify, and local control rates for APBI may be half that of WBI. Improvements to the APBI technique should be sought to allow more patients to qualify and to improve clinical outcomes. We propose the addition of partial-breast hyperthermia therapy to accelerated partial-breast irradiation (PBHI) to provide additional benefits. A prototype PBHI system was developed at the University of Toledo. The PBHI device uses a removable heating element to heat the balloon fill solution and surrounding tissue. System feasibility was verified through modeling using the finite-element partial differential equation solver package COMSOL Multiphysics (COMSOL Inc., Burlington, MA). We modeled our balloon as a 6 cm diameter inner sphere within a 20 cm diameter sphere of breast tissue. The temperature at the balloon surface was kept at 46 0C for one hour. A temperature of 41 0C is reached at the 1 cm margin of the balloon in approximately 30 minutes. The attenuation of the PBHI balloon applicator was measured using gafchromic film and compared to a standard Mammosite applicator. The PBHI applicator shows increased attenuation, estimated at 3.5 % radially, with a maximum increase in attenuation of 10% in a small region off the tip of the applicator. The homogeneity of the balloon surface temperature was investigated during heating at 4 locations on the balloon surface. A temperature gradient of 2 0C was observed from the top of the balloon (46 0C) to the bottom (44 0C) due to convection. Tissue heating in a porcine tissue model was performed. A balloon temperature of 46 0C was used to reach a temperature of 41 0C at 1 cm depth in approximately 30 minutes. PBHI may expand the patient population qualifying for PBI, or improve (open full item for complete abstract)

Committee: E. Ishmael Parsai PhD (Committee Chair); Diana Shvydka PhD (Committee Member); John Feldmeier DO (Committee Member) Subjects: Medicine