Health Services and Informatics Research (HSIR) at Parkview Health was founded in 2014 – bringing concrete solutions to problems that patients, healthcare providers, the community, and the health care system face through traditional research studies, pilot studies, and program evaluation.

Led by Tammy Toscos, Director of Health Services and Informatics Research, the team researches how to use technology to impact patient behaviors and engagement to improve health outcomes and workflow for providers. Projects focus on social-behavioral, cardiology, public health, data science, and health informatics that are sponsored internally by Parkview Health or externally funded through federal or private grants. The team collaborates with Parkview clinicians, patients, and community partners to conduct research and quality improvement projects ranging from focus groups and online surveys to workflow and technology evaluation, supported by their in-house User Experience lab.

The HSIR team also hosts student interns throughout the year who work directly with research scientists on private and federally funded studies. In this internship program, students gain experience in a variety of aspects of the research process, such as research ethics, the daily management of research studies, observational coding, qualitative coding, data analysis, and the presentation of research findings.

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Submissions from 2023

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Applying Human-Centered Data Science to Healthcare: Hyperlocal Modeling of COVID-19 Hospitalizations, Victoria Chui, Jessica Pater, Tammy Toscos, and Shion Guha PhD

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Does Alcohol Consumption Influence People's Perceptions of Their Own and a Drinking Partner's Ability to Consent to Sexual Behavior in a Non-sexualized Drinking Context?, Kristen N Jozkowski, Tiffany Marcantonio, Malachi Willis, and Michelle Drouin

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Online Risks for Youth and Families, Brandon T. McDaniel PhD and Jessica Pater PhD

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Behavioral Health Grants Overview 2022, Parkview Health

Submissions from 2022

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Evaluation of standardized psychological screening for pediatric inpatients., Dana K. Albright PhD, Allison Gornik, Melissa Andersen, Kimberly Monroe, and Kristin A. Kullgren

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Structured exposure in an unstructured setting: Case study of parental exposure intervention to increase parental mastery of medical care during inpatient hospitalization., Dana K. Albright PhD, Kristin A. Kullgren, and Melissa Andersen

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Human-Centered Data Science: An Introduction, Cecilia Aragon, Shion Guha PhD, Marina Kogan, Michael Muller, and Gina Neff

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Digital distraction or accessible aid? Parental media use during feedings and parent-infant attachment, dysfunction, and relationship quality, Sarah M. Coyne, Jane Shawcroft, Megan Gale, Stephanie M. Reich, Lisa Linder, Brandon T. McDaniel PhD, Laura Stockdale, and McCall Booth

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Digital distraction or accessible aid? Parental media use during feedings and parent-infant attachment, dysfunction, and relationship quality, Sarah M. Coyne, Jane Shawcroft, Megan Gale, Stephanie M. Reich, Lisa Linder, Brandon T. McDaniel PhD, Laura Stockdale, and McCall Booth

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Naturalistic Decision Making in Everyday Self-care Among Older Adults With Heart Failure, Carly Daley MS, Victor P. Cornet MS, Tammy Toscos PhD, Davide P. Bolchini PhD, Michael Mirro MD, and Richard J. Holden PhD

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Designing Displays of Cardiac Implantable Electronic Device Sensor Data with Patients who have Heart Failure with Reduced Ejection Fraction, Carly Daley PhD; Shauna Wagner BSN, RN; Ryan Ahmed MS; Romisa Rohani Ghahari PhD; Tammy Toscos PhD; and Michael Mirro MD, FACC, FHRS, FAHA

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Is chatting with a sophisticated chatbot as good as chatting online or FTF with a stranger, Michelle Drouin

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Differences Between Gender and Relationship Status in Motivations and Consequences of Consensual Sexting Among Emerging Adults, Kirsten M. Greer, Kyla M. Cary, Megan K. Maas, Michelle Drouin, and Tara L. Cornelius

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Respiratory ECMO Survival Prediction (RESP) Score for COVID-19 Patients Treated with ECMO., Hariom Joshi MD, Mindy Flanagan, Rakeshkumar Subramanian MD, and Michelle Drouin

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Health informatics interventions to minimize out-of-pocket medication costs for patients: what providers want., Karalyn A Kiessling, Bradley E Iott, Jessica Pater, Tammy Toscos, Shauna Wagner, Laura M Gottlieb, and Tiffany C Veinot

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Moment-to-Moment Observation of Parental Media Use and Parent-Child Interaction: Quality and Media Multitasking, Lisa Linder, Brandon T. McDaniel PhD, and Heather Jaffe

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Mindful Parenting and Parent Technology Use: Examining the Intersections and Outlining Future Research Directions, Melissa A. Lippold, Brandon T. McDaniel PhD, and Todd M. Jensen

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Self-Regulation as a Protective Factor for Diabetes Distress and Adherence in Youth with Type 1 Diabetes During the COVID-19 Pandemic., Alison L Miller, Dana K. Albright PhD, Katherine W Bauer, Hurley O Riley, Marisa E Hilliard, Julie Sturza, Niko Kaciroti, Sharon L Lo, Katy M Clark, Joyce M Lee, and Emily M Fredericks

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Cultivating the Community: Inferring Influence within Eating Disorder Networks on Twitter, Fayika Farhat Nova, Amanda Coupe, Elizabeth D. Mynatt, Shion Guha PhD, and Jessica Pater

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Uncovering Adverse Childhood Experiences (ACEs) from Clinical Narratives within the Electronic Health Record, Fayika Farhat Nova, Rachel Pfafman, Kelley Kardys, Connie Kerrigan, Shion Guha PhD, and Jessica Pater

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Social media activity: its impact on career-related perceptions, Kimberly W. O'Connor, Kimberly S. McDonald, Brandon T. McDaniel PhD, and Gordon Schmidt

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No Humans Here: Ethical Speculation on Public Data, Unintended Consequences, and the Limits of Institutional Review, Jessica Pater, Casey Fiesler, and Michael Zimmer

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The Work of Digital Social Re-entry in Substance Use Disorder Recovery, Chandra Phelan, Jeremy Heyer, Rachel Pfafman, Connie Kerrigan, Golfo K. Tzilos Wernette, Lynn Dombrowski, Andrew D. Miller, and Jessica Pater

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Neuropsychological Outcomes in Individuals With Type 1 and Type 2 Diabetes., Nathaniel M Putnam, Evan L Reynolds, Mousumi Banerjee, Kara Mizokami-Stout, Dana K. Albright PhD, Joyce Lee, Rodica Pop-Busui, Eva L Feldman, and Brian C Callaghan

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"It's a mess sometimes": patient perspectives on provider responses to healthcare costs, and how informatics interventions can help support cost-sensitive care decisions., Olivia K Richards, Bradley E Iott, Tammy Toscos, Jessica Pater, Shauna Wagner, and Tiffany C Veinot

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Integrating Pharmacists in HFrEF Outpatient Care to Improve Use of Guideline-Directed Medical Therapy, Roy Robertson MD; Mindy Flanagan PhD; Kris Howard PharmD; Elizabeth Meisberger PharmD; Emily Keltner BS, MA; Lovekirat Singh MS; Carly Daley PhD; Shauna Wagner BSN, RN; Tammy Toscos PhD; and Michael Mirro MD, FACC, FHRS, FAHA

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New-onset psychosis following COVID-19 infection in a patient with no psychiatric history: A longitudinal case report., Matthew Runyan, Jay Fawver, Amanda Coupe, and Michelle Drouin

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Unpacking Invisible Work Practices, Constraints, and Latent Power Relationships in Child Welfare through Casenote Analysis, Devansh Saxena, Seh Young Moon, Dahlia Shehata, and Shion Guha PhD

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How to Train a (Bad) Algorithmic Caseworker: A Quantitative Deconstruction of Risk Assessments in Child Welfare, Devansh Saxena, Charles Repaci, Melanie D. Sage, and Shion Guha PhD

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Perhaps It Was Too Soon: College Students' Reflections on the Timing of Their Sexual Debut., Susan Sprecher, Lucia F O'Sullivan, Michelle Drouin, Julie Verette-Lindenbaum, and Marion C Willetts

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Interrogating Human-centered Data Science: Taking Stock of Opportunities and Limitations. In CHI Conference on Human Factors in Computing Systems Extended Abstracts, Anissa Tanweer; Cecilia R. Aragon; Michael Muller; Shion Guha MS, PhD; Gina Neff; and Marina Kogan

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COVID-19 Vaccination Clinic Success: An Interdisciplinary Application of Simulation and Modeling., Tammy Toscos PhD, Victor P. Cornet MS, Michelle Charles, Erica Cumbee MPA, Charlotte Gabet, Ethel Massing, and R. Scott Stienecker MD

Submissions from 2021

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Simmering on the Back Burner or Playing with Fire? Examining the Consequences of Back-Burner Digital Communication Among Ex-Partners., John A Banas, Jayson L Dibble, Elena Bessarabova, and Michelle Drouin

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Communication and Algorithmic Decision Making in a Virtual Healthcare Context., Lillian Campbell, Amrita George, and Shion Guha PhD

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Organizational Models for Cardiac Implantable Electronic Device Remote Monitoring: Current and Future Directions, Carly Daley, Tammy Toscos PhD, Tina Allmandinger, Ryan Ahmed, Shauna Wagner, and Michael Mirro MD

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Fanning the flames of back burner relationships electronically: Prevalence and implications for romances and well-being among adults., Jayson L. Dibble, John A. Banas, and Michelle Drouin

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Romance and Dating in the Digital Age: Impacts of Computer-Mediated Communication and a Global Pandemic., Jayson L Dibble and Brandon T. McDaniel PhD

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Examining the roles of marital status and sex on communication with backburners on social media, Michelle Drouin, Irum Abbasi, Jayson L. Dibble, and Brandon T. McDaniel PhD

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Technology use during evening routines, bedtime satisfaction, and impacts on individual and relational well-being, Michelle Drouin and Brandon T. McDaniel PhD

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Intimate Partner Violence Screening in Perinatal Facilities Throughout Parkview Health, Lola Giwa, Tammy Toscos, and Shauna Wagner

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Noninvasive Hemoglobin Level Prediction in a Mobile Phone Environment: State of the Art Review and Recommendations., Kamrul Hasan MD, Masanul Aziz MD, Ishrak Islam Zarif MD, Mahmudul Hasan, Mma Hashem, Shion Guha PhD, Richard R Love, and Sheikh Ahamed

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Relational impacts of capitalization in early parenthood., Yunying Le, Steffany J Fredman, Amy D Marshall, Sy-Miin Chow, Brandon T. McDaniel PhD, Jean-Philippe Laurenceau, and Mark E Feinberg

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The impact of parent and child media use on parent-child attachment in early childhood, Lisa K. Linder, Brandon T. McDaniel PhD, Laura Stockdale, and Sarah M. Coyne

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The DISRUPT: A measure of parent distraction with phones and mobile devices and associations with depression, stress, and parenting quality., Brandon T. McDaniel PhD

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Maternal nighttime phone use and impacts on daily happiness and exhaustion., Brandon T. McDaniel PhD, Elizabeth L Adams, Emily E Hohman, Victor P. Cornet MS, Lauren Reining, and Zachary Kaiser

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Are You Going to Delete Me? Latent Profiles of Post-Relationship Breakup Social Media Use and Emotional Distress., Brandon T. McDaniel PhD, Michelle Drouin, Jayson Dibble, Adam M Galovan, and Madison Merritt

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Work-related technoference at home and feelings of work spillover, overload, life satisfaction and job satisfaction, Brandon T. McDaniel PhD, Kimberly O'Conner, and Michelle Drouin

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Work-related technoference at home and feelings of work spillover, overload, life satisfaction and job satisfaction, Brandon T. McDaniel PhD, Kimberly OConner, and Michelle Drouin

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“You phubbed me for that?” Reason given for phubbing and perceptions of interactional quality and exclusion, Brandon T. McDaniel PhD and Eric Wesselmann

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The Relationship between Dark Triad Personality Traits and Sexting Behaviors among Adolescents and Young Adults across 11 Countries., Mara Morelli, Flavio Urbini, Dora Bianchi, Roberto Baiocco, Elena Cattelino, Fiorenzo Laghi, Piotr Sorokowski, Michal Misiak, Martyna Dziekan, Heather Hudson, Alexandra Marshall, Thanh Truc T Nguyen, Lauren Mark, Kamil Kopecky, René Szotkowski, Ezgi Toplu Demirtaş, Joris Van Ouytsel, Koen Ponnet, Michel Walrave, Tingshao Zhu, Ya Chen, Nan Zhao, Xiaoqian Liu, Alexander Voiskounsky, Nataliya Bogacheva, Maria Ioannou, John Synnott, Kalliopi Tzani-Pepelasi, Vimala Balakrishnan, Moses Okumu, Eusebius Small, Silviya Pavlova Nikolova, Michelle Drouin, and Antonio Chirumbolo

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Facebook Promotes More Harassment" Social Media Ecosystem, Skill and Marginalized Hijra Identity in Bangladesh, Fayika Farhat Nova, Michael Ann DeVito, Pratyasha Saha, Kazi Shohanur Rashid, Shashwata Roy Turzo, Sadia Afrin, and Shion Guha PhD

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How Do Age, Sex, Political Orientation, Religiosity, and Sexism Affect Perceptions of Sex Assault/Harassment Allegations?, Kimberly W. OConner, Michelle Drouin, and Tyler Niedermeyer

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Social media activity: its impact on career-related perceptions, Kimberly W. OConner, Kimberly S. McDonald, Brandon T. McDaniel PhD, and Gordan B. Schmidt

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User-Centered Design of a Mobile App to Support Peer Recovery in a Clinical Setting, Jessica Pater, Victor P. Cornet MS, Ryan Ahmed, Sarah Colletta, Chandra Phelan, Erik Hess, Connie Kerrigan, and Tammy Toscos PhD

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Standardizing Reporting of Participant Compensation in HCI: A Systematic Literature Review and Recommendations for the Field, Jessica Pater, Amanda Coupe, Rachel Pfafman, Chanda Phelan, Tammy Toscos, and Maia Jacobs

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Charting the Unknown: Challenges in the Clinical Assessment of Patients’ Technology Use Related to Eating Disorders, Jessica Pater, Fayika Farhat Nova, Amanda Coupe, Lauren Reining, Connie Kerrigan, Tammy Toscos PhD, and Elizabeth D. Mynatt

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Introduction to the special issue on communication technologies and relationships, Daniel Perlman, Susan Sprecher, and Michelle Drouin

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A Framework of High-Stakes Algorithmic Decision-Making for the Public Sector Developed through a Case Study of Child-Welfare, Devansh Saxena, Karla Badillo-Urquiola, Pamela J. Wisniewski, and Shion Guha PhD

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Is it fair to simply tell parents to use their phones less? A qualitative analysis of parent phone use., Chioma Torres, Jenny Radesky, Kimberley J Levitt, and Brandon T. McDaniel PhD

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Social learning in the digital age: Associations between technoference, mother-child attachment, and child social skills., Danielle Zayia, Leandra Parris, Brandon T. McDaniel PhD, Gregory Braswell, and Corinne Zimmerman

Submissions from 2020

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Perceptions on Tailored Educational Messaging to Patients with Atrial Fibrillation: Towards Increased Patient Engagement and Medication Adherence, Ryan Ahmed; Michelle Drouin; Elizabeth Martin; Michael Mirro MD, FACC, FHRS, FAHA; Romisa Rohani Ghahari; and Tammy Toscos PhD

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Assessment in Pediatric Psychology Consultation-Liaison, Dana K. Albright PhD, Teryn Bruni, and William Kronenberger

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54-LB: Control Yourself: Impact of Self-Regulation on Diabetes Management in Adolescents, Dana K. Albright PhD, Hurley O. Riley, Emily Fredericks, Julie Sturza, Sharon Lo, Katy M. Clark, Joyce M. Lee, and Alison L. Miller

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The Role of Parent Self-Regulation in Youth Type 1 Diabetes Management., Katherine W Bauer, Marisa E Hilliard, Dana K. Albright PhD, Sharon L Lo, Emily M. Fredericks, and Alison L Miller

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Consensual Sexting among College Students: The Interplay of Coercion and Intimate Partner Aggression in Perceived Consequences of Sexting., Tara L Cornelius, Kathryn M Bell, Tylor Kistler, and Michelle Drouin

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Design for Self-Care, Victor P. Cornet MS, Carly Daley, Luiz H. Cavalcanti, Amit Parulekar, and Richard J. Holden

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Untold Stories in User-Centered Design of Mobile Health: Practical Challenges and Strategies Learned From the Design and Evaluation of an App for Older Adults With Heart Failure., Victor Philip Cornet, Tammy Toscos PhD, Davide Bolchini, Romisa Rohani Ghahari, Ryan Ahmed, Carly Daley, Michael J. Mirro MD, and Richard J Holden

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The heart didn’t know enough to stop”: Insights from patient metaphors about living with cardiac implantable electronic devices, Carly Daley, Jennifer J. Bute PhD, Tammy Toscos PhD, Davide P. Bolchini PhD, Michael Mirro MD, and Richard J. Holden PhD

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Involving Patients as Key Stakeholders in the Design of Cardiovascular Implantable Electronic Device Data Dashboards: Implications for Patient Care, Carly Daley, Romisa Rohani Ghahari, Michelle Drouin, Ryan Ahmed, Shauna Wagner, Lauren Reining, Amanda Coupe, Tammy Toscos PhD, and Michael Mirro MD

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How Parents and Their Children Used Social Media and Technology at the Beginning of the COVID-19 Pandemic and Associations with Anxiety., Michelle Drouin, Brandon T. McDaniel PhD, Jessica Pater, and Tammy Toscos PhD

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The association of COMT genotype with buproprion treatment response in the treatment of major depressive disorder., Jay Fawver MD, Mindy Flanagan, Thomas Smith, Michelle Drouin, and Michael Mirro MD

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Parents’ Feelings about School Reopening during COVID-19: Survey Results from Northeast Indiana, Mindy Flanagan PhD, Brandon T. McDaniel PhD, Michelle Drouin PhD, Jessica Pater PhD, and Tammy Toscos PhD

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Patient ergonomics: 10-year mapping review of patient-centered human factors., Richard J Holden, Victor P. Cornet MS, and Rupa S Valdez

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Patient decision-making personas: An application of a patient-centered cognitive task analysis (P-CTA)., Richard J Holden, Carly Daley, Robin S Mickelson, Davide Bolchini, Tammy Toscos PhD, Victor P Cornet, Amy Miller, and Michael Mirro

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Nothing New Under the Sun: How Existing Screening Programs can Inform the Design of Social Determinants of Health Screening in Health Care., Bradley Iott, Denise Anthony, Jessica Pater, Shauna Wagner, Tammy Toscos PhD, and Tiffany Veinot

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Improving Social Determinants of Health Screening Implementation Through Collaboration: Leveraging a Clinical-Academic Partnership., Bradley E. Iott MPH, MS; Jessica Pater PhD, MS; Shauna Wagner BSN, RN; Tammy Toscos PhD; and Tiffany Veinot PhD, MLS

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Determining the Prevalence and Impact of Bullying and Cyberbullying as a Contributing Factor in Patients Who Have Been Admitted Into an Inpatients Facility., Kelley Kardys, Rachel Pfafman, Connie Kerrigan, Lauren Reining, Michelle Drouin, and Jessica Pater

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Technoference: Parent mobile device use and implications for children and parent-child relationships., Brandon T. McDaniel PhD

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Young Children and Screens During COVID-19: Virtual Workshop, Brandon T. McDaniel PhD

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Technology interference in the parenting of young children: Implications for mothers’ perceptions of coparenting, Brandon T. McDaniel PhD and Sarah M. Coyne

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Daily technoference, technology use during couple leisure time, and relationship quality, Brandon T. McDaniel PhD, Adam M. Galovan, and Michelle Drouin

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Longitudinal Associations Between Early Childhood Externalizing Behavior, Parenting Stress, and Child Media Use., Brandon T. McDaniel PhD and Jenny S Radesky

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Adolescent Interventions to Manage Self-Regulation in Type 1 Diabetes (AIMS-T1D): randomized control trial study protocol., Alison L Miller, Sharon L Lo, Dana K. Albright PhD, Joyce M Lee, Christine M Hunter, Katherine W Bauer, Rosalind King, Katy M Clark, Kiren Chaudhry, Niko Kaciroti, Benjamin Katz, and Emily M Fredericks

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The role of HEXACO personality traits in different kinds of sexting: A cross-cultural study in 10 countries, Mara Morelli, Antonio Chirumbolo, Dora Bianchi, Roberto Baiocco, Elena Cattelino, Fiorenzo Laghi, Piotr Sorokowski, Michal Misiak, Martyna Dziekan, Heather Hudson, Alexandra Marshall, Thanh Truc Nguyen, Lauren Mark, Kamil Kopecky, René Szotkowski, Ezgi Toplu Demirtaş, Joris Van Ouytsel, Koen Ponnet, Michel Walrave, Tingshao Zhu, Ya Chen, Nan Zhao, Xiaoqian Liu, Alexander Voiskounsky, Nataliya Bogacheva, Maria Ioannou, John Synnott, Calli Tzani-Pepelasi, Vimala Balakrishnan, Moses Okumu, Eusebius Small, Silviya Pavlova Nikolovas, and Michelle Drouin

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Problematic phone use, depression, and technology interference among mothers., Genni Newsham, Michelle Drouin, and Brandon T. McDaniel PhD

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GROUP4Good: Exploring Positive Impacts of GROUP Research, Jessica Pater, Karla Badillo-Urquiola, Pamela Wisniewski, Nicolas Lalone, and Maia Jacobs

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Design Opportunities and Challenges for App-Based Telemental Health Technologies for Teens and Young Adults, Jessica Pater, Amanda Coupe, Andrew D. Miller, Lauren Reining, Michelle Drouin, and Tammy Toscos

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Validation Methods to Promote Real-world Applicability of Machine Learning in Medicine, Riyad Bin Rafiq, Francois Modave, Shion Guha PhD, and Mark V. Albert

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Technology and workflow recommendations to improve use of guideline directed medical therapy for heart failure with reduced ejection fraction., Roy Robertson MD, Ryan Ahmed, Tammy Toscos PhD, Victor P. Cornet MS, Shauna Wagner, Sarah Colletta, Carly Daley, and Michael Mirro MD

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Successful Pharmacist Intervention To Optimize Guideline Directed Medical Therapy in Heart Failure Patients, Roy Robertson MD; Kris Howard; Elizabeth Meisberger; Emily Keltner BS, MA; Mindy Flanagan; Shauna Wagner; Carly Daley; and Tammy Toscos PhD

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Methods for Generating Typologies of Non/use, Devansh Saxena, Patrick Skeba, Shion Guha PhD, and Eric P.S. Baumer

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Mixed method study focusing on cost effectiveness of utilizing Guideline Directed Medical Therapy using Secondary and Primary Data, Lovekirat Singh; Carly Daley; Shauna Wagner; Roy Robertson MD; and Michael Mirro MD, FACC, FHRS, FAHA

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Engaging Patients in Atrial Fibrillation Management via Digital Health Technology: The Impact of Tailored Messaging., Tammy Toscos PhD, Amanda Coupe, Shauna Wagner, Ryan Ahmed, Amelia Roebuck, Mindy Flanagan, Michelle Drouin, and Michael Mirro MD

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Can nurses help improve self-care of patients living with atrial fibrillation? A focus group study exploring patients' disease knowledge gaps., Tammy Toscos PhD, Amanda Coupe, Shauna Wagner, Michelle Drouin, Amelia Roebuck, Carly Daley, Maria D. Carpenter, and Michael Mirro MD

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Patient responses to daily cardiac resynchronization therapy device data: a pilot trial assessing a novel patient-centered digital dashboard in everyday life, Tammy Toscos PhD, Carly Daley, Shauna Wagner, Amanda Coupe, Ryan Ahmed, Richard Holden PhD, Mindy Flanagan, Rachel Pfafman, Romisa Rohani Ghahari, and Michael Mirro MD

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Medication Adherence for Atrial Fibrillation Patients: Triangulating Measures from a Smart Pill Bottle, e-prescribing Software, and Patient Communication through the Electronic Health Record, Tammy Toscos PhD, Michelle Drouin, Jessica Pater, Mindy Flanagan, Shauna Wagner, Amanda Coupe, Ryan Ahmed, and Michael Mirro MD

Submissions from 2019

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Neuroticism and Facebook Addiction: How Social Media can Affect Mood?, Irum Abbasi and Michelle Drouin

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The protective influence of relationship commitment on the effects of Facebook addiction on marital disaffection, Irum Saeed Abbasi, Michelle Drouin, Jayson L. Dibble, and Brandon T. McDaniel PhD

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Visualization of Cardiac Implantable Electronic Device Data for Older Adults Using Participatory Design., Ryan Ahmed, Tammy Toscos PhD, Romisa Rohani Ghahari, Richard J Holden, Elizabeth Martin, Shauna Wagner, Carly Daley, Amanda Coupe, and Michael Mirro MD

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Patient-centered Design Grounded in User and Clinical Realities Towards Valid Digital Health, Victor P. Cornet, Carly Daley, Davide Bolchini, Tammy Toscos PhD, Michael Mirro MD, and Richard J. Holden