Digital Commons Network^™

Using Natural Language Processing To Understand The Lived Experiences Of People Identifying With Adhd: What Themes Emerge In Social Media Posts?, Gabby C. Scalzo

Theses and Dissertations

Compared to the amount of research conducted on how to identify and understand children with Attention-Deficit Hyperactivity Disorder (ADHD), there has been relatively little work done to understand the lived experiences of adults with ADHD. Increased understanding of how adults with ADHD conceptualize themselves in the context of their diagnosis would help clinical experts tailor research and treatments to better serve these communities. However, there are several barriers towards conducting high-quality qualitative research, including time- and labor-intensity. This study, informed by qualitative research traditions, used innovative data sources (i.e., social media) and analytic techniques (i.e., machine learning) to reduce these …

The Relationship Between Material Circumstances And Primary Care Utilization After Enrollment In Virginia’S Medicaid Expansion, Hannah Shadowen

Theses and Dissertations

Health and health equity encompass not only healthcare but individual level material circumstances like food and housing, neighborhood level conditions like local consequences of residential segregation, and state and federal policies like Medicaid expansion. However, we are just beginning to understand how state level health insurance policy changes operate in the relationship between material circumstances, healthcare use, and health outcomes. This work focuses on newly enrolled Virginia Medicaid expansion members by using both claims data and survey data collected at the point individuals enrolled in Medicaid expansion and a year after Medicaid coverage.

Paper 1 asks if newly enrolled Medicaid …

Dynamic Mathematical Approaches To Understanding Pain In Sickle Cell Disease, Quindel Jones

Theses and Dissertations

In the last 50 years, pain in Sickle Cell Disease (SCD) has become more widely studied thanks to advancements in technology and awareness. Clinical studies, population surveys, pharmaceutical trials, and computational models have been created and conducted to elucidate the mechanisms, treatments, and prediction of Sickle Cell disease pain episodes. Computational models have become quite useful in unraveling disease pathology with the rise in data collection accessibility and advanced computational power. In particular, dynamic mathematical models have been used to investigate Sickle Cell disease pathology and treatment. In this work we conduct a literature review of mathematical models used in …

Correlation Between Intraoral Markers And The Risk Of Obstructive Sleep Apnea In Children, Linda K. Powers

Theses and Dissertations

Specific aims: The purpose of this study was to explore the association between various intraoral markers and the risk of Obstructive Sleep Apnea (OSA) in children. Specifically, nine intraoral clinical characteristics were analyzed: ankyloglossia, palatal vault height, presence and level of dental wear, tonsillar grade, Friedman's classification, skeletal and dental classification, and posterior crossbite. The correlation between these features and the Pediatric Sleep Questionnaire (PSQ) and Pediatric Symptoms Checklist (PSC) scores were assessed.

Methods: Orthodontic patients aged 8-17 were recruited at the VCU Graduate Clinic. Intraoral measurements were collected from patients (n=100) by treating doctors. At this time, the PSQ …

Children With Special Healthcare Needs: The Cost Of Medical Care, Kasey Dye

Theses and Dissertations

The purpose of this study was to explore factors that impact children with special healthcare needs’ (CSHCN) health insurance coverage and out-of-pocket medical expenses. The Ecological Model for Health Promotion developed by McLeroy et al. (1988) was the guiding theoretical framework for this study. Using data from the 2020 National Survey of Children’s Health, I conducted descriptive statistics, logistic regressions, and multilevel modeling analyses to determine if health insurance coverage and out-of-pocket expenses for CSHCN differed by individual, family, and community, organization, and policy factors. Results indicated that race, gender, disorder category, insurance type, and family’s federal poverty level were …

Utilization Of Intraoral Scanners For Fabrication Of Obturators For Patients Born With Cleft Lip/ Palate (Clp), Swara Fadnis

Theses and Dissertations

Objective: The goal of this cross-sectional study was to assess the knowledge and attitude of providers regarding incorporating a digital scanner for impression taking in children born with cleft lip and/or palate (CLP). Methods: A survey was sent out to members of the American Association of Pediatric Dentistry (AAPD). The survey included questions regarding the providers’ perception of incorporating digital intraoral scanners for impressions for fabrication of obturators. The survey also included questions about the providers’ reservations in using this technology in practice, what their experience has been with the incorporation of this technology into practice, and what is …

Using Bovid Tribe Proportions To Reconstruct Paleoenvironments Of Eastern African Paranthropus, Lisa Day

Theses and Dissertations

There are conflicting theories about the eating habits and corresponding environmental needs of Paranthropus boisei and Paranthropus aethiopicus, two species of extinct hominins that existed ~2.8 to ~1 Ma in eastern Africa. Paranthropus species are well-known for their unusually large molars and sagittal crest (a bony ridge on their skulls which allowed for large chewing muscle attachments), these skeletal adaptations were once thought to be due to their feeding on hard foods; however, recent isotope data and dental microwear studies question the simplicity of this assumption. This has revealed a gap in our understanding of the environmental needs of …

Effect Of Apical Preparation Size On Endodontic Treatment Outcomes, Joseph Vaughn

Theses and Dissertations

Objective: Previous authors have attempted to identify the ideal apical preparation size needed to achieve endodontic treatment objectives. Despite vast literature on the topic, there exists a lack of consensus on ideal apical enlargement, with few studies discussing the effect of apical prep enlargement on clinical outcomes. The purpose of this retrospective study was to evaluate the effect of final apical preparation size on endodontic outcomes in maxillary and mandibular molars treated in both a graduate endodontic clinic and a private practice.

Methods: A chart review was conducted for patients seen at the VCU graduate endodontic clinic as well as …

Impact Of Portal Of Exit On The Prevalence Of Apical Periodontitis In Root Canal Treated Maxillary Molars With Missed Second Mesiobuccal Canals: A Cbct Study, Jing Ye

Theses and Dissertations

Objective: To evaluate the association of portal of exit (POE) of the second mesiobuccal (MB2) canal with the prevalence of apical periodontitis (AP) in previously treated maxillary molars

Methods: Cone beam computed tomography (CBCT) scans of 106 previously treated maxillary molars seen for either recall or retreatment in the past 3 years were included in the study. Scans were reviewed by one endodontic resident and one board-certified endodontist to determine the POE (separate versus common) of the missed MB2 canal and the presence or absence of a periapical hypo-dense area. Association between AP and portal of exit was assessed using …

How Do Cultural Norms Shape Healthy Eating In African Americans? The Role Of Cultural Congruence And Mindsets Of Health In Healthy Eating Intentions Among African American College Students, Danyel Smith

Theses and Dissertations

Targeting dietary behaviors is a predominant strategy to reduce rates of obesity among African Americans, across the lifespan. Notably, dietary behaviors are shaped by social, cultural and environmental affordances. This study integrated Theory of planned behavior (TPB), identity-based motivation, and mindset theory to unearth cultural mechanisms that inform motivations to eat healthy among African American college students. This project employed a cross-sectional (Study 1) and experimental design (Study 2) to contextualize the antecedents of intentions to eat healthy among African American college students. Recruitment occurred via university-wide digital channels. Eligible participants: were 18+ years; Black/African American; were undergraduate students; and …

Evaluating How Acidic Solutions Affect The Microhardness Of Bioceramic Sealers, Colton Fischer

Theses and Dissertations

Introduction: With growing use of bioceramic sealers (BCS) in root canal therapy, there have been challenges when retreating BCS cases. Weak acids may be effective in removing BCS and their efficacy as a solvent can be measured by their influence on the microhardness of BCS. Microhardness can be used as an indirect measurement of material hardness. The purpose of this study was to investigate the microhardness of BCS when placed in contact with various acidic solutions to assess their potential use as a solvent for retreatment procedures.

Methods: EndoSequence BC Sealer (Brasseler USA) was injected into four 10 × 3mm …

Dental Treatment Planning: Decisions With Interdisciplinary Cases, William W. Porzio

Theses and Dissertations

Purpose: To explore the variance in treatment planning options with interdisciplinary cases that involve a combination of endodontic, periodontic, and prosthodontic factors.

Methods: A REDCap survey was emailed to Virginia based American Academy of Periodontology (AAP) members, American College of Prosthodontists (ACP) members, and periodontal residents to assessing various treatment planning options for six interdisciplinary cases.

Results: A total of 56 individuals responded to the survey; 10 periodontal residents, 35 practicing periodontists, 11 practicing prosthodontists. Response rate was not able to be evaluated based on the fact that third-party organizations were used to disseminate the survey in …

The Age And Primary Reason For The First Dental Visit In Children With Special Health Care Needs, Amanda Dickerson

Theses and Dissertations

Purpose: The aim of this project is to evaluate the average age and primary reason for the first dental visit among patients with special health care needs as well as to examine socioeconomic factors and other barriers related to children with special health care needs accessing care.

Methods: This is a cross-sectional survey that was distributed to caregivers of children with special health care needs. Study data was collected through REDCap, a secure web-based survey application. The inclusion criteria for participating in the survey included having a child with a special health care need that presented for a recall or …

Provider Racial Concordance And Medical Mistrust In Pediatric Dentistry, Chinelo Eke

Theses and Dissertations

Purpose: Studies have drawn varying conclusions on the importance of a racially concordant patient provider relationship. Medical mistrust has continued to garner attention as healthcare enterprises thread equity, diversity and inclusion throughout their organizational policies, practices and systems.

Methods: Parents/caregivers of pediatric patients at VCU Pediatric Dentistry were invited to participate. Surveys included questions about demographics, racial concordance, language preference, and the validated Group-Based Medical Mistrust Scale.

Results: A total of 246 guardians completed the survey. For guardians, 40% reported Black or African American, 31% Hispanic, and 19% Caucasian. Seventy-one percent of guardians reported speaking English, 18% Spanish, and 11% …

The Use Of Silver Diamine Fluoride In Dentistry In Virginia, Jessica Eisenberg

Theses and Dissertations

Purpose: The purpose of this research was to determine the use of silver diamine fluoride (SDF) in dentistry in Virginia and the factors that affect the practitioners’ decision. Methods: A survey was sent to the members of the Virginia Dental Association (VDA) by email and posted on the VDA social media accounts. The survey questions measured the practitioner’s demographics, knowledge, and factors that affect their utilization of SDF. Results: Most providers were general dentists (77%). The most common clinical situations for SDF use were to arrest caries in children with behavioral issues (77%), to delay restorative treatment (73%), in medically …

Histone Acetylation In Periodontal Diseases, Sarang Saadat

Theses and Dissertations

Background: Emerging data has indicated the significant role of epigenetic control in inflammation. Acetylation of lysine residues on histones is a major epigenetic modification of chromatin, which is required for cytokine gene expression and regulated in inflammatory diseases. It has been shown that periodontal bacteria induce histone acetylation in oral epithelial cells and experimental periodontitis in rodents. In this study, we investigated the acetylation level of histone 3 (H3) in gingival tissue from healthy and periodontitis patients. We hypothesize that cytokine over-production in periodontitis is associated with the hyper acetylation of histones. Methods: Periodontitis and healthy subjects who need periodontal …

A Prevention Strategy For Children Receiving Full Mouth Dental Rehabilitation Under General Anesthesia: A Randomized Controlled Trial, Jessica Gonzalez

Theses and Dissertations

Purpose: This two-arm, parallel-group randomized controlled trial aims to compare the effectiveness of a new prevention strategy versus traditional verbal education and post-operative instructions in increasing caregivers’ compliance to follow-up of their children who have had full mouth dental rehabilitation (FMDR) under general anesthesia (GA). Methods: Caregivers of children who presented for FMDR under GA were recruited and randomly assigned to either the control or treatment groups. Caregivers in the treatment arm received oral health anticipatory guidance through a combination of motivational interviewing, individualized goal setting, visual aids, and verbal education. Caregivers in the control arm received the same information …

The Environment Of Interprofessional Education In Graduate Education: Exploring Professional Programs Of Occupational Therapy, Physician Assistant, And Physical Therapy, Allison R. Kaczmarek

Theses and Dissertations

Interprofessional education (IPE) is an educational approach of increasing popularity in professional schools for the preparation of a collaborative ready healthcare workforce. The accrediting bodies of professional education programs in occupational therapy (OT), physician assistant (PA), and physical therapy (PT) have incorporated standards for outcomes addressing IPE. Although they have endorsed the Health Professions Accreditors Collaborative (HPAC) consensus document on quality IPE, we do not have a contemporary snapshot of the IPE environments in the curriculum of their accredited programs. This dissertation, a collection of three distinct inquiries, has two aims: first, to provide a description of IPE as it …

A Six-Month Comparison Of Orthodontic Pain Associated With Fixed Edgewise Appliances And Clear Aligners, Victor Chan

Theses and Dissertations

Title: A Six-Month Comparison of Orthodontic Pain Associated with Clear Aligners and Fixed Edgewise Appliances

Objective: To document and compare pain perception, intensity, and analgesic use over a sixmonth period between patients treated with fixed appliances (FA) and clear aligners (CA).

Methods: A prospective, parallel, two-arm, multi-center, longitudinal cohort study was conducted with 87 adults treated with CA (n=59) or FA (n=28). Subjects were selected according to inclusion and exclusion criteria. A seven-item, digital survey was sent at three timepoints (preappointment, 2-days post-appointment, and 7-days post-appointment) at each adjustment over a six-month period. The variables measured included pain experience, pain …

Cone Beam Computed Tomographic Analysis Of Outcomes In Ridge Augmentation Using Titanium Mesh And Titanium Reinforced Ptfe Membranes, Lina Elnakka

Theses and Dissertations

Objective: The primary goal of this study is to evaluate and compare the average vertical and horizontal bone gain between titanium reinforced polytetrafluoroethylene (Ti-PTFE) and titanium mesh (Ti-mesh) using superimposition of preoperative and postoperative (CBCT). The secondary goal is to evaluate and compare the surgical outcomes between the two techniques.

Methods: A retrospective chart review was completed to assess the clinical and radiographic outcomes of patients who underwent ridge augmentation therapy using either Ti-PTFE or Ti-mesh. Preoperative and postoperative CBCT scans were superimposed using InVivo 3D imaging software. Vertical component of the augmented site (L1) was assessed along a vertical …

Food Deserts And Pediatric Oral Health Status In An Under-Resourced Urban Community, Jessica T. Mcauliffe

Theses and Dissertations

Purpose: The aim of this analysis of survey data was to assess the influence of living within a food desert as a predictor of oral health problems among children of East Henrico County, Virginia.

Methods: Survey participants were recruited and questionnaires applied online. Residing in a food desert, using access to affordable produce as a proxy value, was the independent variable, while self- reported assessment of the child’s oral health status was the primary outcome variable. Analyses controlled for other indirect factors of pediatric oral health. Logistic regression was used to model the association between the self-reported access to healthy …

Motivations Of Adult Patients Seeking Orthodontic Retreatment, Scott V. Philips

Theses and Dissertations

Objective: The aims of this study were (1) to compare the reasons adult patients seek orthodontic first-time treatment to the reasons adult patients seek orthodontic retreatment, and (2) to compare the concerns, motivations, and satisfaction levels of adult patients seeking orthodontic retreatment across the different previous treatment provider types of orthodontist, general dentist, and Direct-to-Consumer company.

Methods: At their initial orthodontic visit, adult patients (N=108) were invited to participate in the digital survey (REDCap) study. Subjects were recruited from the graduate orthodontics clinic at Virginia Commonwealth University and seven private orthodontic practices across the United States. Visual Analogue Scales were …

Sleep And Health Behaviors In A Safety-Net Primary Care Setting, Sahar Sabet

Theses and Dissertations

Nearly half of all premature deaths in the United States are attributable to preventable and modifiable health risk behaviors. For decades, the leading behavioral health contributors to morbidity and mortality are tobacco use, physical inactivity, and alcohol consumption. Medication adherence is a relatively less studied yet critical interrelated health behavior that is tied to health and treatment outcomes. Sleep, an important pillar of health, is a daily and modifiable behavior that shows promise as a health behavior facilitator. Better understanding the dynamics of these modifiable health behaviors is essential for the improvement of health promotion, particularly among underserved populations (e.g., …

The Effect Of Mild Traumatic Brain Injury On Perineuronal Nets Surrounding Neocortical Parvalbumin Interneurons, Olivia Lowman

Theses and Dissertations

Mild traumatic brain injury (mTBI) is an extremely common affliction with an estimated 42 million people being affected by it worldwide each year. It can lead to a range of long-term chronic issues and the underlying pathology is not well understood. Several previous studies have shown that parvalbumin inhibitory interneurons (PV+) are injured during TBI, therefore altering the excitatory to inhibitory ratio in neural networks which can lead to several neurodegenerative disorders such as epilepsy. Perineuronal nets (PNNs) are an extracellular matrix element that preferentially surround PV+ neurons in the neocortex and are recently thought to have important roles in …

Mechanistic Insight Into Traumatic Brain Injury Induced Neuronal Membrane Disruption: Cathepsin B Relocalization And A Neun Negative Cortical Neuron Subpopulation, Martina L. Hernandez

Theses and Dissertations

Traumatic brain injury (TBI) is a mechanical insult to the head that leads to brain damage and, in turn, causes long-term sensory, motor, cognitive, and affective dysfunction. Diffuse pathologies seen following such injury are associated with these life-altering outcomes that impact the daily lives of TBI survivors. The diffuse pathology that this body of work focuses on is neuronal membrane disruption; it is characterized by increased permeability of the neuron’s plasma membrane. Moreover, our lab had previously found that membrane disruption is exacerbated with intracranial pressure (ICP) elevation. We set out to measure the duration of membrane disruption following injury …

Treatment Access And Outcomes For Craniofacial Care: Patient And Parent Perspectives, Benjamin F. Lowe Iii

Theses and Dissertations

Objective: The purpose was to evaluate whether craniofacial patients and their parents have adequate access to care, perceive this care as high quality, and believe that the incorporation of telehealth visits would benefit their current system of craniofacial care. Methods: An original survey was developed and sent to families in treatment with the Virginia Commonwealth University craniofacial team. The tool was used to gather demographic information and assess opinions toward access to, outcomes of, and telehealth services for craniofacial care. Patients 18 years and older took the survey for themselves, while patients under 18 years old had a parent/guardian take …

Morphometric Analysis Of Premolars And Its Relevance To Root Canal Anatomy, James Degracie

Theses and Dissertations

Introduction: Premolars are especially challenging to treat endodontically due to their small size and often-intricate anatomy. While the majority of premolars present with one or two root canals, the presence of three root canals has been reported. The aim of this study was to investigate the correlation between the root-to-crown width ratio (RCWR) and number of root canals in maxillary and mandibular premolars.

Methods: Data was retrieved from the electronic health records of patients treated at Virginia Commonwealth University School of Dentistry. A total of 100 premolars which had both periapical radiograph (PA) and cone beam computed tomography scans (CBCT) …

Underrepresentation Of Black Participants In Drug Court: Reasons Reported For Non-Admission In Six Jurisdictions, Kathryn J. Genthon

Theses and Dissertations

Despite the beneficial impacts of drug court participation, access to these programs may not be equitable across racial groups. The reasons behind racial disparities in access to these programs are not well-documented in the current literature. This study investigates disparities in access to drug court and the possible reasons they occur. Chi-square tests are used to assess for disparities in admissions between Black and White individuals referred to drug court. Additional statistical analyses addressed the association of sex and age with admission to provide a broader picture of the impact of a variety of demographic characteristics on admission to drug …

Motivations And Conflicts In Prison Medical Contracting, Meagan D. Sok

Theses and Dissertations

State correctional departments are responsible for all medical care incarcerated individuals require. Many systems outsource their medical

State correctional departments are responsible for all medical care incarcerated individuals require. Many systems outsource their medical program. Literature indicates that many of these contracts experience significant issues that negatively impact state resources, including both personnel and money.

This dissertation explores the relationship between prison administrators' motivations and the structure, outcomes, efficiencies, and partner conflicts that arise in the contractual process. Using a framework developed from Incomplete Contract Theory, Contracts as Reference Points Theory and the concept of “essential tension,” this dissertation hypothesizes …

Clear Aligner Therapy In The Mixed Dentition: Indications And Practitioner Perspectives, Nicholas M. Lynch

Theses and Dissertations

Introduction: This study evaluated current trends and perspectives among orthodontists regarding clear aligner therapy in the mixed dentition (CAMD), including insights into perceived indications, compliance, oral hygiene, and other factors.

Methods: An original, 22-item survey was mailed to both a randomized, nationally representative sample of practicing orthodontic specialists (n = 800) and to a specific, randomized sub-sample of high-aligner-prescribing orthodontists (n = 200). Questions assessed respondents’ demographic information, experience with clear aligner therapy, and perceived advantages/disadvantages of CAMD compared to fixed appliance therapy (FA). Responses were compared using McNemar’s chi-squared and paired t-tests to assess CAMD versus FA. …