Doctor of Philosophy, University of Akron, 2020, Biomedical Engineering

Individuals with Chiari malformation type I (CMI) demonstrate altered physiology that is characterized by the elongation of the cerebellar tonsils into the spinal canal. CMI patients experience many symptoms including occipital headaches, neck pain, and neurological deficits. In addition to the cerebellar tonsils, CMI patients demonstrate altered brain and bone morphology, cerebrospinal fluid (CSF) flow, and neural tissue dynamics. While previous studies identified brain morphology that differed between CMI patients and controls, these studies show inconsistent morphological differences. In Aim 1, we conducted multiple morphological examinations to identify possible sources of the inconsistent findings within the literature. Through quantification of over 50 two-dimensional (2D) morphometrics, we found many that distinguished CMI patients from healthy controls (28-32). However, only three comorbid conditions demonstrated morphology that differed between CMI patients with and without a comorbid condition. Additionally, seven morphometrics were found to differ from controls regardless of CMI comorbid conditions. As such, we identified 12 morphometrics that characterize the altered 2D morphology of CMI patients. Patients may be treated with posterior fossa decompression surgery to alter the physiological state of CMI patients and reduce symptoms. In Aim 2, we investigated the impact of the surgery on brain morphology and tissue dynamics. Surgery primarily impacted cerebellar morphology through reduced cerebellar height and larger CSF spaces around the cerebellum. Additionally, surgery resulted in a significant reduction in cerebellar and brainstem displacement and extension strain. While not significant, more associations were found between tissue dynamics and symptomatology than between brain morphology and clinical outcomes, suggesting that tissue dynamics have more prognostic value than brain morphology. In Aim 3, we investigated possible sources of neural ti (open full item for complete abstract)

Committee: Francis Loth Dr. (Advisor); Rouzbeh Amini Dr. (Committee Member); Lawrence D. Noble, Jr. Dr. (Committee Member); Nic Leipzig Dr. (Committee Member); Philip Allen Dr. (Committee Member) Subjects: Biomechanics; Biomedical Engineering; Biomedical Research; Medical Imaging; Morphology; Scientific Imaging

Psy. D., Antioch University, 2019, Antioch Santa Barbara: Clinical Psychology

While psychiatric medications have been categorized as the same as substances of abuse in Alcoholics Anonymous (AA), medications for common medical disorders were not affected by this disapproval of medication. It may be time for a new dialogue (Woody, 2015). According to Gjersing and Bretteville (2018), there has been a concerning increase in overdose deaths in the last decade. This includes a threefold increase in overdose deaths from prescription narcotics and six-fold increase in overdose deaths from heroin in the United States. When prescription opioid users find difficulty in obtaining pills, they may move on to heroin, which is much more readily available on the streets, in an effort to avoid painful opioid withdrawal. For this study, individuals who had previously achieved long-term abstinence from alcohol or substance use but relapsed after a significant amount of time sober were interviewed in order to better understand their experience with relapse as well as their experience returning to at least partial remission. Thematic analysis was conducted on interview data. The results from this phenomenological analysis of interviews with eight participants identified several themes regarding the experience of being a long-timer, relapsing after a substantial amount of time abstinent, and challenges to as well as factors in returning to AA. These themes are organized as long-term recovery, relapse, and a new beginning. Long-term recovery is further explored as acute treatment only, treatment did not utilize evidence-based interventions, treatment did not address emotional issues, contact with mental health, long-timer, and complacency and drifting. Relapse is further explored as medical issues, new trauma, and justification of the use of medication or marijuana. A new beginning is further explored as recovery challenges such as feelings of ostracism, age-related issues, and shame as well as recovery factors such as finding acceptance and love within the fellowsh (open full item for complete abstract)

Committee: Brett Kia-Keating Ed.D (Committee Chair); Ron Pilato Psy.D (Committee Member); Janice Stimson Psy.D (Committee Member) Subjects: Behavioral Psychology; Clinical Psychology; Cognitive Psychology; Health Care Management; Medical Ethics; Mental Health; Psychology; Psychotherapy

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

Individuals diagnosed with ASD often present with high rates of challenging behavior and comorbid psychiatric disorders. Challenging behavior, which can take the form of tantrums, aggression, or self-injury (American Psychiatric Association, 2013) can occur in as many as 75-93% of school-age children with autism spectrum disorders (Chandler et al., 2015; McTiernan, Leader & Mannion, 2011). Age at which children receive a diagnosis of ASD has steadily decreased. Research now supports that a reliable diagnosis can be made by the second year of life (Charman & Baird, 2002; Johnson et al., 2007; Chawarska, Klin, Paul, Macari & Volkmar, 2009; Worley, Matson, Mahan, Kozlowski, & Neal, 2011; Zwaigenbaum et al., 2005). Similar to school-aged children and adolescents, many of these early-identified children present with challenges such as emotional dysregulation and behavior problems (Zwaigenbaum et al., 2015). Co-occurring symptoms and behaviors have been shown to impede successful intervention and effective education (Rojahn, Wilkins, Matson & Boisjoli, 2010). While previous research has adeptly described the wide variety of challenging behaviors' potential occurrence in adults, adolescents and school-aged children, there is inadequate information available on infants and toddlers with ASD. Contributing to the difficulty of collecting reliable data on this population is the variability among instruments used to assess challenging behavior. This study examines the composition of challenging behaviors in infants and toddlers with ASD, predictors of challenging behaviors as well as novel psychometric elements of a commonly used measure of challenging behavior, the Child Behavior Checklist (CBCL). Charts from four-hundred, ninety-six toddlers aged 18-48 months with and without a diagnosis of ASD were examined for information on challenging behavior, cognitive ability, expressive language, adaptive behavior and other demographic information. Results indicate that the CBCL is a (open full item for complete abstract)

Committee: Andrea Witwer PhD (Advisor); Katherine Walton PhD (Committee Chair); Luc Lecavalier PhD (Committee Member) Subjects: Behavioral Psychology; Developmental Psychology; Psychology

Doctor of Philosophy, The Ohio State University, 2018, Nursing

Background & Purpose: In the United States, asthma affects 6.1 million children and is one of the most common causes of school absenteeism. Asthma is also a major public health issue, accounting for more than $56 billion in annual healthcare costs. Children with asthma are at higher risk of having anxiety/depression and subsequently, higher morbidity and mortality. Few intervention studies have specifically targeted children with asthma and anxiety/depressive symptoms and no scalable school-based interventions are in use. The purpose of this pilot study was to assess the feasibility and acceptability of a school-based, cognitive behavioral skills-building intervention on 8 – 12-year-old children with asthma and anxiety/depression. Methods: A one-group, pre/posttest with a 6-week follow-up post intervention was used to assess the feasibility, acceptability and preliminary effects of Creating Opportunities for Personal Empowerment (COPE) for Asthma on anxiety and depressive symptoms, asthma management self-efficacy, symptom perception, asthma illness representations, controller medication in 8 – 12-year old children with asthma and anxiety/depressive symptoms. Repeated measures ANOVA was used for variables using three time-points, while paired t-tests were used for comparisons using two time-points. Results: Thirty-two children participated in COPE for Asthma. Analyses indicated that COPE for Asthma is feasible for 8 – 12 year-old-children with asthma and anxiety. Significant reductions were found in anxiety, missed doses of the asthma controller medication, and the caregiver completed Pediatric Symptom Checklist, all with moderate to large effect sizes. Significant increases were found in Personal Beliefs, Child-Asthma Self Efficacy, Child Asthma Illness Representations, with moderate to large effect sizes. Conclusions: COPE for Asthma is highly feasible for small groups in the school setting and should be tested in a pilot randomized controlled trial to det (open full item for complete abstract)

Committee: Bernadette Melnyk PhD (Committee Chair); Kimberly Arcoleo PhD (Committee Co-Chair); Barbara Warren PhD (Committee Member); Dawn Anderson-Butcher PhD (Committee Member) Subjects: Behavioral Sciences; Health; Health Sciences; Nursing

Doctor of Philosophy, The Ohio State University, 2009, ED Physical Activities and Educational Services

The increasing prevalence of substance use among adolescents is a growing concern across the United States today. Previous researchers have identified risk factors for substance use in the individual, peer, family, school, and community domains. With respect to the individual domain, mental health problems and problem behaviors have been postulated as explanatory variables in adolescent substance use. Although problem behaviors have been consistently identified as powerful explanatory variables in adolescent substance use, research assessing the influence of mental health problems has been equivocal. Investigators have further cited high comorbidity rates between mental health problems and problem behaviors. Therefore, researchers have recently examined the interaction effect between mental health problems and problem behaviors in relation to substance use; however, the findings have produced mixed results. With respect to the etiology of adolescent substance use, researchers have typically investigated risk and protective factors in isolation, which has led to conflicting results over the salience of risk factors in the individual, peer, family, school, and community domains. Thus, a composite risk and protective factor approach has been proposed for investigating the etiology of substance use. The primary purpose of the present study was to examine the explanatory power of mental health problems and problem behaviors in adolescent substance use and to explore the interaction effect between mental health problems and problem behaviors. A secondary aim of the study was to identify risk and protective factors of adolescent substance use, as measured by the Primary Prevention, Awareness, Attitude, and Use Survey (PPAAUS). In addition, protective factors were examined as moderators in the relationship between risk factors and adolescent substance use. Data used for this study came from a triennial survey completed in 2006 by the Franklin County's Safe and Drug Free Sc (open full item for complete abstract)

Committee: Michael Klein (Advisor); Bruce Growick (Committee Member); Bruce Walsh (Committee Member) Subjects: Education; Psychology; Rehabilitation

Doctor of Philosophy, The Ohio State University, 2008, ED Physical Activities and Educational Services

Parents of children diagnosed with Tourette's Syndrome (TS) cope with a myriad of problems associated with this condition, as these children often experience significant behavioral, social-emotional, and academic problems in multiple ecologies. These problems are often exacerbated by commonly occurring comorbid conditions, which may include, among others, Attention Deficit Hyperactivity Disorder (ADHD), Obsessive-Compulsive Disorder (OCD), anxiety disorders, mood disorders, learning disorders, and various behavioral problems, such as Conduct Disorder (CD), sleep disorders, and sexually inappropriate behavior. Tourette's Syndrome Plus (TS+), a term coined by Dr. Leslie Packer, a noted author in the field of TS, refers to cases in which TS is accompanied by comorbid disorders. The purpose of this study was to examine the lived experience of parenting a child with TS+. A descriptive phenomenological approach was used to guide the research. Primary parents of children diagnosed with TS+, who were students in a public school system, were recruited through state chapters of the national Tourette Syndrome Association, via purposive sampling. Data were collected through semi-structured interviews. Transcriptions were derived from the audio tapes of the interviews. Data analysis revealed parents of children with severe TS+ experience suffering as a result of their child's behaviors and special needs, as follows: 1) Parents feel irritated, deeply troubled, embarrassed, or frightened for their child when witnessing their child's TS+ symptoms and are troubled by the negative impact these behaviors have on family functioning and relationships. 2) These parents mourn the absence in their child of normal social relationships and social/emotional development, and feel deep anguish when their child is a victim of bullying, teasing, or ostracism. 3) Parents are fearful at times that their child is being poorly educated, misunderstood, or mistreated at school. 4) Parental suffering, r (open full item for complete abstract)

Committee: Antoinette Miranda (Advisor); Adrienne Dixson (Committee Member); Kisha Haye (Committee Member) Subjects: Education; Educational Psychology; Elementary Education; Families and Family Life; Health; Health Education; Mental Health; Neurology; Personal Relationships; Psychology; Social Psychology; Special Education; Teacher Education

Doctor of Philosophy (PhD), Ohio University, 2012, Clinical Psychology (Arts and Sciences)

Both neuropathic and non-neuropathic pain conditions (e.g., arthritis and lower back pain) are common in adults with type 2 diabetes (T2DM) and are associated with higher levels of depression, lower quality of life (QOL), and less efficacious self-care. The current study sought to (a) examine the prevalence, chronicity, severity, and interference of comorbid pain conditions in a clinical sample of adults with T2DM, (b) explore the psychosocial correlates of pain conditions in adults with T2DM, and (c) examine the relationship between pain severity and self-care behaviors in adults with T2DM and determine whether or not self-efficacy mediates this relationship. Ninety-four adults with T2DM attending endocrinology clinics completed interviews and questionnaires about their experience of pain, psychiatric symptoms, quality of life, and self-care activities. Over 72% of patients endorsed symptoms of chronic pain. Of these patients, 60.3% reported non-neuropathic pain only, 5.9% reported having only neuropathic pain, and 33.8% endorsed having both neuropathic and non-neuropathic pain. Patients with both neuropathic and non-neuropathic pain had significantly lower QOL, higher levels of depression and anxiety, and lower levels of self-care activity than patients with no pain or non-neuropathic only pain. Pain-related self-efficacy was found to mediate the relationship between pain severity and diabetes self-care activities. Findings suggest that assessment of pain, particularly non-neuropathic pain, is important to consider in endocrinology settings. Treatment and recommendations to increase pain management self-efficacy may facilitate self-care practices in patients with T2DM and comorbid chronic pain conditions.

Committee: Bernadette Heckman Ph.D. (Committee Chair); Christine Gidycz Ph.D. (Committee Member); Julie Suhr Ph.D. (Committee Member); Stephen Patterson Ph.D. (Committee Member); Jay Shubrook D.O. (Committee Member) Subjects: Clinical Psychology