To my Parents, Husband, Daughter and Friends. Thanks for all the help and support that you provided to me. I love you all. iii ACKNOWLEDGEMENTS First and foremost, I praise God for the wisdom and perseverance that he has bestowed upon me during this research project, and indeed, throughout my life. My sincere gratitude goes to my advisor in this project, Dr. Rodrigo Rocha Maia. I would like to thank him for allowing me to grow and develop as a researcher. He patiently shared his vision,

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... ion and enlightening advice; tools which were imperative for the creation and progression of my thesis. To Dr. Gerald Denehy, it goes without saying that I owe him my heartfelt appreciation on his perpetual guidance, not only in the research, but throughout my entire residency program. To Dr. Frederick Skiff, I extend my truest thanks for helping me to work towards improving the methodology of this research. Indeed, he has made available his support in many ways. I was honored and humbled to learn from his vast expertise and knowledge on the topic. A special thank you goes to Dr. Fang Qian for handling the statistical part of this research and providing me with the analysis in a timely manner in spite of the heavy work load she had.