Ph.D., Antioch University, 2024, Leadership and Change

The persistent tension and power struggle between healthcare executives and physicians is a prevalent issue in healthcare organizations, often leading to a culture of organizational mistrust. This dynamic stems from perceived conflicting goals: executives are frequently seen as primarily focused on financial outcomes, while physicians are viewed as resistant to change. This study explored how physician fulfillment is experienced at work, with the ultimate goal of identifying potential interventions to bridge the gap between these groups. There is vast research and literature available regarding burnout in healthcare; this research focused on understanding what physicians find fulfilling in their work and identifying actionable factors healthcare system leaders can address to enhance their fulfillment. Key factors identified from the literature include meaningful patient contact, quality of professional relationships, and organizational decision-making input. At the same time, challenges such as administrative burden and loss of autonomy were noted as detriments to fulfillment. After conducting and transcribing semi-structured phenomenological interviews with physicians, the data were coded for meaning, resulting in 169 codes. The prevalence of these broad themes varied concerning each research question, reflecting the complex and multifaceted nature of physician fulfillment. By identifying patterns and connections in the physicians' experiences, this study highlighted the importance of addressing both systemic and individual factors to enhance professional fulfillment. Key findings of the study include the importance of humanizing healthcare goals and several directions for iv healthcare organizations: addressing moral injury, improving patient outcomes, obtaining and utilizing physician input consistently, fostering a supportive culture, and creating time and space for peer support. Targeted interventions to enhance physi (open full item for complete abstract)

Master of Science (M.S.), University of Dayton, 2024, Mechanical Engineering

Injuries to the spinal cord can be debilitating to the function of the upper extremity. Many people with spinal cord injuries (SCIs) undergo rigorous therapies to help preserve range of motion and strength. Task specific training has been shown to offer benefits in upper extremity rehabilitation. In recent years, virtual reality has gained popularity for its ability to offer task specific training in an engaging and immersive environment. This study explores therapeutic virtual reality gaming for people with spinal cord injuries. The first aim of the study is to compare the kinematic performance of individuals with spinal cord injuries to healthy controls. This study's second aim is to characterize the qualities of the movement task, such as movement direction and block position, that generate maximum kinematic responses in the SCI group. Finally, the third study aim is to compare the effects of different movement types on overall kinematic performance. Individuals with spinal cord injuries (n=7) and healthy, age-matched, sex-matched controls (n=7) were asked to play Beat Saber in an immersive virtual reality environment. Participants were equipped with upper extremity motion capture markers, virtual reality trackers, and the virtual reality headset/controllers. Custom levels were created in Beat Saber that had different movement directions (UP, DOWN, IN, OUT) and different block positions (HIGH, LOW, MED, LAT). Trials were composed of either movements with one hand (UNI), movements mirrored about the midline (MIR), or movements in opposing directions about the midline (OPP). Participants completed six randomized trials, repeating each of these movement types twice. Results showed that the joint profiles of the participants with SCIs used less overall shoulder and elbow joint motion to accomplish the tasks, compared to the healthy controls. At the wrist, SCI participants were able to use comparable or greater wrist radial/ulnar deviation than the controls. SCI parti (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)

Doctor of Education , University of Dayton, 2024, Educational Administration

Cardiovascular disease continues to be the number one killer of women in America, yet barriers to lifesaving healthcare increase (Centers for Disease Control and Prevention, 2022). Incidence of sexism in medicine proves to be a leading cause of these barriers including underrepresentation of female patients in crucial research studies, lack of understanding and education of female specific cardiac symptoms, and the underutilization of advanced diagnostic imaging tests for female patients who could produce suboptimal results in lesser diagnostic testing causing misdiagnosis. Feminist critical theories were used to challenge the gender gap within the medical field and research along with the communities of practice theory, showing how embedded sexism to the medical field creates an unconscious social learning upholding norms. Practical action research was used to conduct this study due to the direct connection between testing and diagnosis of patients, having the potential to make an impact on patient care on a larger scale. Research was conducted utilizing HIPAA compliant cardiology patient data obtained to observe the ordering patterns of physicians within cardiology practices. An anonymous Physicians' Knowledge of PET Eligibility and Symptoms for Female Patients scale survey was used to collect data from practicing cardiologists to view opinions, attitudes, and education around female specific cardiac symptoms. This data was analyzed using Chi-square tests to understand the relationship between various factors such as qualifying ICD-10 (diagnosis) codes, sex of the patient, and qualification for a cardiac PET scan. The results show that there was no significant relationship between sex and if the patient qualified for a cardiac PET scan, showing that physicians have a lack of understanding of the incredible benefits of cardiac PET for female patients, who are exceptional candidates for PET due to attenuation artifacts. Results also show a positive statistical rela (open full item for complete abstract)

Master of Arts, Miami University, 2024, History

This thesis argues for an interdisciplinary examination of the origins and subsequent appearance of the Wassermann blood test, the first test developed for detecting syphilis, in eugenics initiatives and medicolegal mandates. When this seemingly impartial medical tool intersected with preexisting social and cultural biases regarding syphilis its story became one of blood purity initiatives for the preservation and proliferation of white normativity. Reframing the Wassermann as more than a passive medical tool highlights how ostensibly impartial medical processes can produce institutional violence in masculinized spaces of control. While the Wassermann offered a source of hope for protecting against syphilitic infection, in application, the serodiagnostic tool served as a source of scientific validation when misapplied as a quantifiable method for justifying medicolegal interventions in the 20th century US. This examination traces the bioethical legacy of the Wassermann from its 1906 development in Berlin to its appearance in eugenics-based legal mandates in the US. Through an analysis of scientific publications and court records at archives across the East Coast this paper centers those who didn't benefit from the Wassermann and investigates how scientific authority derived from an imperfect diagnostic test was harnessed to reproduce and reinforce the sociocultural biases that linger today.

Doctor of Philosophy, Case Western Reserve University, 2024, Molecular Medicine

PTEN hamartoma tumor syndrome (PHTS) is a genetic disorder affecting individuals with germline PTEN variants. The affected individuals have a wide spectrum of clinical features ranging from cancer to neurodevelopmental disorders (NDD), including autism spectrum disorder (ASD). However, factors that underlie such phenotypic variability remain elusive, making it impossible to predict clinical outcomes. Here, we investigate germline genomic diversity as a modulator for the development of NDD versus cancer in PHTS. Genotype data of 376 individuals of European ancestry with PHTS were collected. Study participants included individuals with PHTS and NDD (n=117) and no-NDD (n=259), the former including n=57 with ASD and the latter including n=175 with cancer. Homozygosity burden was measured in sets of functionally relevant genes pertinent to NDD and cancer. Conservative filtration of homozygous variants was applied to identify variants in exonic or splicing sites for pathway analysis and with deleterious effects for collapsed homozygous variants analysis. Logistic regression models were performed with 10-fold cross validation to predict NDD/ASD phenotypes. We found significant enrichment of homozygous common variants (MAF≥0.01) but not rare variants (MAF<0.01) in genes involved in inflammatory processes and NDD-associated genes with low-confidence. Notably, in the ASD subgroup, homozygous common variants were enriched in genes involved in differentiation, inflammatory processes and chromatin structure regulation, NDD-associated genes with high-confidence, and regions with pathogenic copy number variants. Pathway enrichment analysis of genes harboring qualifying homozygous variants revealed pathways germane to NDD/ASD, including neuroinflammation, axonal guidance, and synaptogenesis signaling. Collapsing analysis with stringent filtration of homozygous variants suggested candidate modifier NDD/ASD genes, including GABRA4 (p=0.029) and CX3CR1 (p=0.016). Finally, prediction m (open full item for complete abstract)

Master of Science, The Ohio State University, 2024, Statistics

Principal component analysis (PCA) is a data analysis technique used to reduce the dimension of a data set while retaining key patterns of variation by transforming the data to a lower-dimension space defined by orthonormal basis vectors that capture the directions of maximal variation. A novel technique named logistic PCA (LPCA) was developed that allows researchers to make use of benefits of PCA analysis in the study of data sets containing binary variables, allowing for more widespread use of these methods in areas of study frequently examining binary data, such as biomedical science and healthcare. We apply logistic PCA method to two data sets, the first comprised of data from tissue samples obtained from patients diagnosed with breast cancer and the second comprised of data from select genetic profiles of individuals diagnosed with brain tumor. An initial simulation study was performed to examine randomly-generated binary data from settings with a known clustering structure to evaluate retention of clustering in low-dimension plots created using PCA, LPCA, and t-distributed stochastic neighbor embedding (t-SNE), another frequently-utilized data analysis technique. Results revealed that LPCA consistently outperforms PCA in terms of reconstruction error in settings where probability parameters for clusters are close to 0.5 and that LPCA and PCA perform comparably in settings with more extreme probability parameters. LPCA and t-SNE also show comparable clustering in the two-dimensional plots. In analysis of the cancer-related data, two-dimensional plots for data embedding were generated, and principal component loadings were obtained from each of the data sets using LPCA and PCA, and used to provide interpretations of data patterns in the context of cancer-related biomedical science and healthcare. Analysis revealed that interpretations of LPCA loadings provide information consistent with established biomedical research findings as well as new information and that (open full item for complete abstract)

Doctor of Philosophy, Case Western Reserve University, 2024, Molecular Medicine

BACKGROUND/OBJECTIVES: Clinical trials found the novel class of migraine-specific drugs, anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb), to decrease monthly migraine days (MMD) and be well-tolerated. Large real-world studies are necessary to establish the efficacy and tolerability in a variety of patients of differing ages, ancestries, and comorbidities. Our objective is to evaluate the efficacy and safety in the general Cleveland clinic population, in patients over the age of 65, and in combination with onabotulinumtoxinA. Furthermore, we will investigate the associations between clinical and genetic variables with treatment outcomes. METHODS: Chapter 2 utilizes a cohort of 3,421 patients separated by non-Hispanic white and racially understudied patients with their baseline and post-treatment MMD to establish response to anti-CGRP mAbs. Adverse reactions were recorded during the treatment period. In Chapter 3, patients were separated into age groups over or under 65 years old. Reductions in MMD, quality of life metrics, and side effects were compared between the two groups. Chapter 4 examined differences in monotherapy or dual-therapy (of anti-CGRP mAb and onabotulinumtoxinA). Changes in MMD were examined between the two groups. Lastly, Chapter 5 involved multivariable logistic regression models to determine predictor variables of anti-CGRP mAb response. Additionally, 267 patients were recruited and provided DNA samples. This genetic data was used to generate a polygenic risk score and calculate differences in variant frequencies between patients who did and did not respond to anti-CGRP mAb. RESULTS: Anti-CGRP mAbs significantly reduced MMD and was well-tolerated for non-Hispanic white and diverse patients. Individuals over 65 years old showed comparable outcomes to younger patients. The addition of a concomitant preventative therapy lead to a further reduction in MMD. Daily migraine, unemployment, and more headache preventative tr (open full item for complete abstract)

Master of Science, The Ohio State University, 2024, Anatomy

Introduction Lung cancer is prevalent and deadly and contributes to approximately 25% of all cancer-related mortalities. With incidence rates rising globally, new treatment options have increased patient overall survival. Lung cancer is unique from other cancer types in that there is a correlation between a patient's body mass index (BMI) and overall survival. Sarcopenia is a skeletomuscular system disorder characterized by a loss of skeletal muscle mass, size, and function. It is identified to be correlated with worse treatment outcomes and survival in several cancer types. Thus, this study explored the relationship between anatomically measured sarcopenia and survival. We hypothesized that sarcopenia would be correlated with a worse overall survival among patients with non-small cell lung cancer. Additionally, we tested two anatomically different measurement methods. Methods We abstracted data from both chest and abdominal CT scans from 22 patients consented and enrolled in the FITNESS Study: Longitudinal Geriatric Assessment, Treatment Toxicity, and Biospecimen Collection to Assess Functional Disability Among Older Adults with Lung Cancer at the Ohio State Wexner Medical Center's James Cancer Hospital and Solove Research Institute. Using the NilRead software, the skeletal muscle index (SMI) was analyzed by finding the paravertebral muscles at the T12 level, and the psoas major muscle at the L3 level, and manually tracing it to calculate the SMI. Additionally, the patient's weight, in kg, and height, in meters, were used to calculate their BMI as the same date of their baseline CT scans. The patient's body mass index (BMI) and SMI values for both methods were analyzed and further assessed by patient sex. From there, previously established equations were utilized to calculate the sarcopenic and normal range SMI values for both methods. Next, univariate and multivariate Hazard Cox Ratio tests were run to analyze the impact on survival. A paired samples T-Test wa (open full item for complete abstract)

Master of Sciences, Case Western Reserve University, 2024, Clinical Research

In 344 patients with non-ischemic cardiomyopathy with a prophylactic implantable cardioverter-defibrillator who underwent cardiac magnetic resonance imaging within 12 months prior to device implantation, significant burden of late-gadolinium enhancement was a strong predictor of appropriate device therapies (hazard ratio 2.99, 95% CI 1.48- 6.02, p=0.002) but not of all-cause mortality, heart transplant, or left ventricular assist device implantation (hazard ratio 1.34, 95% CI 0.78-2.29, p=0.287). This suggests LGE burden is a relatively specific predictor of sudden cardiac arrest risk and therefore could potentially be used during evaluation for prophylactic ICD implantation.

Doctor of Business Administration (D.B.A.), Franklin University, 2024, Business Administration

This qualitative descriptive study explored how healthcare administrators (Pulmonary, Cardiology, or both) describe the influence of Palliative Care on savings for hospitals in the United States. Palliative Care is a supportive service that collaborates with specialists, Primary Care, patients, and families to provide quality care for those with chronic and serious illnesses. Palliative Care is a holistic service that meets physical, social, psychological, and spiritual needs. Patients with congestive heart failure and chronic obstructive lung disease tend to overutilize healthcare services such as the emergency room, admissions, readmissions, and intensive care unit stays. Palliative Care savings are not easily demonstrated on a revenue report but spread across the healthcare system. Hospital leadership may not provide resources for services with a perceived decrease in return on investment. Systems Theory is the central concept used for this study. Systems Theory is how the sum of individual teams or people work together to benefit the patient and, therefore, savings to the hospital. The study's question inquired about the healthcare administrator's experience with Palliative Care and associated hospital savings. The study collected 17 anonymous online surveys utilizing Microsoft Forms from healthcare administrators in the United States. The term healthcare administrators included healthcare administrators, directors, medical directors and managers working in Pulmonology, Cardiology, or both. This researcher invited participants through a recruitment flyer on the investigator's personal Facebook and LinkedIn pages, Facebook and LinkedIn group pages, and Reddit. An invitation was also sent to LinkedIn Connections and Facebook Friends by direct message for those who may be eligible for the study. Participants participated anonymously, and the researcher asked them to refrain from responding over direct messages. The researcher analyzed data using ATLAS (open full item for complete abstract)

Master of Arts, The Ohio State University, 2024, Educational Studies

INTRODUCTION: Emotional intelligence (EQ) and good leadership are two crucial characteristics of an effective physician. Most leadership experiences during residency training are as a senior resident overseeing interns or during mock code simulations. As a modifiable skill, it is important to assess a trainee's leadership skills and their perspective to help them gain insight to their strengths and weaknesses. As fundamental feature of effective leadership, emotional intelligence is essential for physician practice especially in highly charged situations. Simulation has been proposed as an effective setting to perform EQ evaluation but not yet trialed. Thus, the purpose of this study was to discover the relationship between leadership skills during simulated scenarios and emotional intelligence. METHODS: Pediatric trainees performed a simulated resuscitation scenario. Crisis Resource Management (CRM) skills were scored by the instructor and trainees performed a self-evaluation both using the Resuscitation Team Leader Evaluation (RTLE). A performance gap analysis was performed, comparing the self-assessment to the instructor's. Next trainees completed the Trait Emotional Intelligence Questionnaire (TEIQue) which was then compared to their CRM and performance gap analysis with a canonical correlation analysis. RESULTS: Trainees who led simulations included 58 residents and 20 fellows and 26 of those trainees completed the TEIQue. Trainees inaccurately assessed CRM skills with average gap of 3 points. Resident trainees overestimated their CRM skills while fellows underestimated theirs with mean gaps +4 and -3.5 respectively, with larger gaps in the areas of communication and future needs anticipation. In addition thee were a mix of positive and negative correlations between EQ and the CRM skills & gap analysis. CONCLUSION: Pediatric trainees inaccurately assessed their team leadership skills. Certain areas of trait EQ do correlate with CRM skills. Further stu (open full item for complete abstract)

Doctor of Education (Ed.D.) in Organizational Leadership , Franklin University, 2024, International Institute for Innovative Instruction

Physician wellness is an issue of concern especially when it comes to potentially impairing conditions like Substance Use Disorder (SUD). Physician Health Programs (PHPs) exist to help physicians when they are struggling with SUD, but there is reluctance to utilize them because of stigma. Through an action-based qualitative process, this study surveyed PHP director level leaders to gain their perspective on how to overcome stigma and reluctance to ask for help. The feedback from the study's participants developed a proposed training program to enhance PHPs messaging through education and outreach. PHP director level leaders where emailed and opened-ended survey that asked questions around challenges, improvements, and processes in relation to monitoring physicians for SUD. The responses were then analyzed to develop a proposed training program for PHPs. The study concluded that PHPs and physician stakeholders contribute to the stigma physicians feel around SUD and that education to stakeholders and physicians was critical in overcoming the stigma. The education provided by PHPs required to focus on PHP needs from stakeholders, and PHP purpose with physicians.

Doctor of Healthcare Administration (D.H.A.), Franklin University, 2024, Health Programs

The United States pediatric population is unique in that the epidemiological trends differ from those seen in the adult population. When discussing the pediatric emergency department (ED), this is typically a setting with high patient flow which requires swift diagnoses and treatment. Ideally, all patients should have equal opportunity to receive their highest possible level of quality healthcare, regardless of social determinants of health (SDOH) such as patient race/ethnic background, preferred spoken language, socioeconomic status, and insurance status. This is essentially the concept of health equity. The goal is to provide responsible and ethical healthcare to patients. If healthcare delivery is disproportionate, this may result in the overcrowding of EDs, delays in patient care, economic burden on the healthcare system, and increased morbidity and mortality. Some scholars have claimed that both individual and systemic biases have resulted in inequitable healthcare delivery. The following research study investigated health equity in the United States pediatric ED via the following question: What government and organizational policy changes can be made to enhance ED pediatric patient equity by utilizing first-hand information from ED physicians? The selected methodology for this research was qualitative and utilized in-depth semi-structured interviews of 15 pediatric ED physicians via Franklin University's Zoom platform. ATLAS.ti software was used to assist in identifying key themes and sub-themes from the code transcriptions.

Bachelor of Science in Nursing, Wittenberg University, 2024, Nursing

This paper includes a literature review on several aspects of Sudden Unexpected Infant Death Syndrome including types, risk factors, prevention techniques, and nursing roles. This literature review was performed to assist in creating a 14-question survey sent to nurses through Facebook groups, Sigma Theta Tau, and professional connections. The survey was laid out to investigate what the key aspects of SUIDS are, what information is taught well, what information needs to be improved upon, and what personal experience the participants have had. In general, safe sleep was found to be the most essential component of SUIDS education and the lack of standardized protocols causes discrepancies among those providing the education. Researchers concluded that hospitals should implement standardized protocols to make certain that parents and guardians are well prepared in how to prevent SUIDS events when possible.

Ph.D., Antioch University, 2024, Antioch Seattle: Counselor Education & Supervision

This multilevel mixed methods investigation examines the experiences of developing self-evaluation skills for simulation fellows in an interprofessional simulation fellowship program. Interprofessional fellows (N = 12) and faculty (N = 4) engaged in a three-phase study using video-assisted learning tools to explore the differences in self-evaluation (perceived performance) and faculty evaluation (actual performance) in developing debriefing skills. For the quantitative component, fellows and faculty completed the DASH© tool to evaluate the quality of debriefing to help close the gaps between fellow self-evaluation and faculty evaluation. For the qualitative component, video-stimulated think-aloud and video-assisted debriefing the debriefer were utilized to understand how video-assisted learning tools contribute to self-evaluation skills from each level separately. A combined focus group and thematic analysis were utilized to identify facilitators and barriers to self-evaluation. Integrative case examples of developing self-evaluation skills are restoried for mixed analysis and data integration. Through which, meta-inferences are drawn out to understand the experiences, interactions, and mechanisms of the multilevel phenomenon. The results indicated that fellows generally overestimate their skills performance, and video-assisted learning tools support in the development of more realistic self-perception eliminating underestimation and closing the gap between perceived and actual performance. A model for interprofessional collaboration is proposed for scaffolded feedback practices to promote self-evaluation of skills and performance. Implications for counselor education, healthcare simulation, and health professions education are presented.

DNP, Kent State University, 2024, College of Nursing

The management of dementia is a difficult task in all healthcare settings. Behavioral and psychological symptoms of dementia (BPSD) affect 90% of individuals with dementia. One-third of older individuals living with dementia are regularly prescribed antipsychotic medications to handle dementia-related behaviors. For six decades the FDA has been aware that antipsychotics were being used in nursing homes to sedate residents for BPSD, without dementia being an approved diagnosis. The serious side effects and increased risk of death have led to changes in nursing home policy and regulation. The Centers for Medicare and Medicaid (CMS) teamed up with Federal and State agencies and proposed dementia care planning that involves assessing BPSD and utilizing non-pharmacologic interventions. The primary objective of this project is to determine if educating staff in non-pharmacological management of BPSD will reduce antipsychotic medication use. Method This evidence-based quality improvement (QI) project is based on Lewin's Change Theory of unfreezing, moving, and refreezing. Using the PDSA method to move the process forward, a team was established, and a plan of action was developed to reduce the administration of antipsychotics by educating staff in non-pharmacological interventions. Sixteen nursing staff (n-16) were trained over four days in nonpharmacologic dementia care management. A pre-and-post-assessment questionnaire was conducted. Twenty-two resident participant's medications were reviewed by the Psychiatric Mental Health Nurse Practitioner (PMHNP), and gradual drug reductions (GDRs) were ordered. GDRs are a CMS compliance requirement for nursing homes conducted as standard practice based on the pharmacist recommendations and an important recommendation by CMS in antipsychotic reduction are conducted and documented by the consulting PMHNP. Nursing responses to patients with GDRs who presented with behaviors and antipsychotic dose reduction (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)

Doctor of Education , University of Dayton, 2024, Educational Administration

The development of leadership skills and promotion of Professional Identity Formation (PIF) are expected among residents who will soon enter the field of medicine as practicing physicians. This action research study aimed to bridge the gap among what is taught and what leadership skills are expected of Internal Medicine residents in the Multispecialty Residency Program (MRP) as well as enable the promotion of PIF to take place. This study engaged in qualitative data collection and analysis to identify what leadership focused educational activities could be used to develop leadership skills and promote PIF among MRP residents. Through purposeful convenience sampling, one observation, two focus groups, and two 1:1 interviews, participants expressed what leadership skills and PIF mean to them. A combination of in vivo coding, open-coding, axial coding, and selective coding occurred, and a deductive analysis approach took place using two established frameworks. The data yielded that Feedback & Reflection, Coaching, Culture, and Mentoring & Role-Modeling influence the development leadership skills and promotion of PIF among MRP's residents. Four activities related to each theme have been identified to mend this leadership gap.

Master of Sciences, Case Western Reserve University, 2024, Clinical Research

Rationale: Surgical lung biopsy offers the highest histopathologic yield to diagnose ILD, which affects treatment decisions and informs prognosis. It is associated with morbidity and non-negligible mortality. Methods: Single center retrospective study of 231 patients who underwent SLB. Patient characteristics were analyzed to evaluate association with complications measured by hospital LOS. Results: 59 (25%) of our patients had a LOS >2 days in the first 90 post-procedure days. 13 (5.6%) patients had a LOS >6 days, which included 8 (3.4%) exacerbations and 5 (2.2%) deaths. FVC% was independently associated with LOS (OR of 0.98, 95% CI 0.97- 0.99). RVSP was independently associated with LOS > 2 days (OR 1.47, 95% CI (1.01, 2.24)) by standard logistic regression, and 1.51 (1.09, 2.14) with a Bayesian approach. A model to predict LOS > 2 days performed modestly (AUC 0.69) in our training (75%) sample, but poorly (AUC 6.0-6.1) in our testing (25%) sample.