This study uses a quasi-experimental design to determine if a solution-focused therapy (SFT) approach to couples counseling can be effective in improving an individual's marital satisfaction, and if a SFT approach to couples therapy can be improved upon by adding a one-time, psycho-educational intervention (i.e. Video #2 from the Fighting for your Marriage series: The Speaker/Listener Technique) that is normally not a part of the model. Nine male-female couples participated in the project. One group (n = 8) completed treatment without viewing the communication skills video while the other group (n = 10) viewed the video at week two of treatment. Three questions were asked when analyzing data: 1. Do individuals who receive both solution-focused therapy and the speaker/listener tape end therapy reporting a greater increase in marital satisfaction than individuals who receive solution-focus therapy only? 2. Do individuals who receive both solution-focused therapy and the speaker/listener tape end therapy reporting a greater increase in satisfaction with their couple communication than those who receive solution-focused therapy only? 3. Do individuals who receive both solution-focused therapy and the speaker/listener tape end therapy reporting more satisfaction with the therapy process than those who receive solution-focused therapy only? No significant difference in marital satisfaction or communication satisfaction was found between the two groups. However, individuals who viewed the video reported being significantly more satisfied with therapy. In addition, both groups reported significant improvement in their relationships which suggests that SFT promotes change. Evidence also suggests that males and females respond to SFT in significantly different ways. The study was limited by its small sample size and one measure that was deemed unreliable. Findings suggest that integration of models and/or interventions is a delicate balance of art and design, and can be altered by such things as dose, philosophy, and placement of psychosocial treatments. / Master of Science

Background: Histotripsy is a non-thermal, non-invasive high-intensity focused ultrasound (HIFU) ablative technique that causes mechanical fragmentation of tissue, resulting in liquefied acellular debris with histologically clear demarcated boundaries between treated and non-treated tissues. The acellular debris may include tumor antigens with preserved immunogenicity and the potential to generate systemic immune response against tumor cells. Soft tissue sarcomas (STS) are a common form of cancer in dogs with biological behavior similar to STS in humans. Long-term tumor control requires complete removal with extensive surgical resection, which in many cases is not feasible. As a result, there is need for alternative therapies. Objectives: The primary objective of this study was to demonstrate safety and feasibility of histotripsy in a small animal model of spontaneous STS. The secondary objective was to characterize the impact of histotripsy on the immunologic response. Materials and methods: Pet dogs diagnosed with spontaneous STS were recruited. CT scan of the chest, abdomen, and the tumor was performed for staging and treatment planning. Pretreatment biopsies were obtained. Safety was monitored with physical examinations, owner reports, and CBC/serum biochemistry. Partial tumor ablation was performed using a 500 kHz prototype histotripsy system. A spherical treatment zone of up to 3 cm diameter in each tumor was treated with histotripsy according to the patient-specific treatment plan using 1-2 cycle pulses applied at a pulse repetition frequency (PRF) of 500 Hz. Anatomical ablation zones were evaluated with contrast CT at 1- and 4-days post-treatment, with tumor resection at 4-6 days post-treatment. Tumor microenvironment (TME) gene expression was evaluated with the Nanostring Canine IO panel, and the systemic immune response was evaluated using multiplex serum cytokine levels. Results: Ten dogs were recruited and treated. Tumor histologies included 3 grade III STS, 4 grade II STS, 2 grade I STS, and 1 malignant mesenchymoma. Six dogs were alive, three dogs were euthanized due to disease progression, and one dog was lost to follow up. Histotripsy-related complications were generally self-limiting, with only one patient having increased cutaneous injury score from 1 to 2 (scale 1-5) post-treatment, likely due to prefocal cavitation at the skin. No significant adverse events impacting patient outcome were noted in any of the patients. Visible histotripsy cavitation bubble clouds were seen on real-time ultrasound imaging in nine of ten treatments. Post-treatment histopathology indicated sharply defined regions of ablation that were clearly identifiable grossly and histologically in all samples. Treatment zones were characterized by loss of cell viability, hyalinization, and acute hemorrhage. Post-treatment contrast-enhanced CT images revealed clear, demarcated regions of histotripsy ablated tissue in seven of ten patients. Differential gene expression analysis identified 79 genes with at least 2-fold change following treatment. Genes associated with inflammation, immune cell migration, and immune cell interactions were the highest upregulated. Amongst the gene set analyses, the myeloid compartment gene sets obtained the highest significance score. There were no statistically significant differences between pre- and post-treatment cytokine concentrations for any of the analytes. Conclusions: Histotripsy can achieve safe and effective tumor ablation in dogs diagnosed with STS. Histotripsy induced pro-inflammatory changes within the tumor microenvironment. Histotripsy as an immunotherapeutic treatment option needs to be further investigated. Histotripsy has a potential to be a precise, non-invasive treatment for canine STS. / Master of Science / Histotripsy is a non-thermal high-intensity focused ultrasound (HIFU) ablative technique that uses controlled acoustic cavitation to cause mechanical fragmentation of tissue. To date, there are no reports investigating histotripsy for the treatment of soft tissue sarcoma (STS). This study aimed to investigate the in vivo feasibility of ablating STS with histotripsy and to characterize the impact of partial histotripsy ablation on the acute immunologic response in canine patients with spontaneous STS. CT of the chest, abdomen, and the tumor was performed for staging and treatment-planning. Pretreatment biopsies were obtained. Safety was monitored with physical examinations, through owner reports, and CBC/serum biochemistry. A custom 500 kHz histotripsy system was used to treat ten dogs with naturally occurring STS. Anatomical ablation zones were evaluated with contrast CT at 1- and 4-days post-treatment, with tumor resection at 4-days post-treatment. Safety was determined by monitoring vital signs during treatment and post-treatment physical examinations, routine lab work, and owners' reports. Ablation was characterized using radiologic and histopathologic analyses. Systemic immunological impact was evaluated by measuring changes in cytokine concentrations, and tumor microenvironment changes were evaluated by characterizing changes in infiltration with tumor-associated macrophages (TAMs) and tumor-infiltrating lymphocytes (TILs) using multiplex immunohistochemistry and differential gene expression. Results showed histotripsy ablation can achieve safe and effective tumor ablation in all ten dogs. Immunological results showed histotripsy induced pro-inflammatory changes in the tumor microenvironment. Histotripsy as an immunotherapeutic treatment option needs to be further investigated. Overall, this study demonstrates histotripsy's potential as a precise, non-invasive treatment for STS.

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Focused Ion Beam (FIB) technology is a versatile tool that can be applied in many fields to great effect, including semiconductor device prototyping, Transmission Electron Microscopy (TEM) sample preparation, and nanoscale tomography. Developments in FIB technology, including the availability of alternative ion sources and improvements in automation capacity, make FIB an increasingly attractive option for many tasks. In this thesis, FIB systems are applied to photonic device fabrication and modification, semiconductor reverse engineering, and the production of structures for the study of nanoscale radiative heat transfer. Optical facets on silicon nitride waveguides were produced with plasma FIB (PFIB) and showed an improvement of 3 ± 0.9 dB over reactive ion etched (RIE) facets. This process was then automated and is capable of producing a facet every 30 seconds with minimal oversight. PFIB was then employed to develop a method for achieving local backside circuit access for circuit editing, creating local trenches with flat bases of 200 x 200 μm. Gas assisted etching using xenon difluoride was then used in order to accelerate the etch process. Finally, several varieties of nanogap structure were fabricated on devices capable of sustaining temperature gradients, achieving a minimum gap size with PFIB of 60 nm. / Thesis / Master of Applied Science (MASc)

The current study identified attachment injuries in couples and developed a preliminary model for the resolution of attachment injuries using Emotionally Focused Therapy (EFT). An attachment injury occurred when one partner betrayed or broke the trust of the other in a specific incident and that incident became a clinically recurring theme or stuck-point of task resolution. Couples with attachment injuries were identified by an expert clinician and the researcher. Subjects were couples with moderate to mild distress. The attachment injuries were resolved using EFT, an empirically validated approach to couples therapy. The model (N = 3) was developed using task analysis. Audiotaped segments of "best sessions" of marker events were reviewed by raters to determine change events throughout the therapy process. A rational, conceptual map of expected change was compared to an empirically developed map. The marker events emerged at the assessment, de-escalation, and resolution phases of treatment. Pre- and post-tests measured overall resolution of the attachment injury and process measures identified in-session changes. The results of this study yield a proposed theoretical model of change for couples who sustain an attachment injury. / Ph. D.

Healthcare agencies and researchers identify several areas in which healthcare disparity affects elder, African-American diabetics including higher rates of diagnosis, higher limb amputation, increased kidney failure, and stroke. While the disparities have been documented, elder, African-American diabetics rarely have been invited into discussions concerning these disparities, research questions, project or program design, and results. They are not asked to be stakeholders in health care or health policy discussions. This study used grounded theory as a participatory action research method to invite elder, African-American, diabetics into the discussion using focus groups. The patient participants then suggested providers they believed to be "successful" in their care who were then interviewed. The analysis suggests that where patient/ provider communication has been peripheral that care and perception of care and patient suffer. Where successful communication was central to the patient/provider relationship, provider preconceptions lessened and patient compliance levels rose. This dissertation offers several downstream, midstream, and upstream recommendations using a patient-focused lens. / Ph. D.