Digital Commons Network^™

Access To Behavioral Health Services: Supply, Coverage, And Health Insurance Literacy, Heather Saunders

Theses and Dissertations

This dissertation examines policy and individual barriers to behavioral health (BH) service utilization. The full reach of federal policies like the Affordable Care Act (ACA) and the Comprehensive Addiction and Recovery Act (CARA) may be limited by state policies and the supply of the workforce available to deliver these services. Further, individual factors, such as low health insurance literacy, may influence patterns of behavioral healthcare utilization. Despite efforts to increase access to behavioral health services, treatment rates remain low, suggesting that barriers remain. To explore the effectiveness of these policies and examine remaining barriers, this dissertation explores three main research …

Development And Evaluation Of A Combinatorial Rt-Qpcr Multiplex For Forensic Body Fluid Identification, Carolyn A. Lewis

Theses and Dissertations

Body fluid identification is essential in the forensic biology workflow that assists DNA analysts in determining where to collect DNA evidence. Current presumptive tests lack the sensitivity and specificity molecular techniques can achieve; therefore, molecular methods, such as microRNA and microbial signatures, have been extensively researched in the forensic community. Limitations of each method suggest combining molecular markers to increase discrimination efficiency of multiple body fluids from a single assay. While microbial signatures have been successful in identifying fluids with high bacterial abundances, microRNAs have shown promise in fluids with low microbial abundance. A disadvantage of RNA analysis in forensic …

Functional Limitations And Well-Being Throughout The Adult Lifespan: The Moderating Role Of Sleep, Claire M. Williams

Theses and Dissertations

Functional limitations represent individuals’ difficulty with completing essential activities of daily living, such as sitting, stooping, and walking. Though functional limitations have been linked to lower well-being outcomes, less is known about potential protective factors for well-being in the experience of functional limitations. The present study used archival data from the MIDUS Refresher study to evaluate how sleep and salient aspects of identity may alter the association between the experience of functional limitations and well-being. In particular, this study had two central aims: to examine the associations between functional limitations, life satisfaction, and affect and detect how aspects of identity …

Another Step In Diagnostics Consultation Model© Actualization: Examining The Impact Of Consultation Workflow Processes On Providers' Clinical Decision Making, Elizabeth K. Leibach

Theses and Dissertations

Background
Communication errors in health services delivery significantly compromise quality in clinical decision making (CDM). Diagnostic information generated by clinical laboratories (CL) accounts for as much as 93% of objective data in the clinical record and therefore is foundational in CDM. This work describes the Diagnostics Consultation Model© (DCM©), a CL communications portal, which supports CDM within interprofessional teams, providers, and institutions. Specific aims were to develop and validate a workflow prediction index (the complexity index, CI) to assign resolution of consultation requests based on an algorithm comprised of characteristics available at the point of consultation initiation. The CI functions …

Live Cell Biomass Tracking For Basic, Translational, And Clinical Research, Graeme Murray

Theses and Dissertations

Single cell mass is tightly regulated throughout generations and the cell cycle, making it an important marker of cell health. Abnormal changes in cell size can be the first indication of dysfunction in response to environmental stimuli such as cytotoxic drugs. Described here is the further development of high-speed live cell interferometry (HSLCI) to concurrently measure the changes in single cell mass of thousands of cells over time. Critically, the high-throughput nature of HSLCI provides realistic pictures of tumor heterogeneity. This throughput enabled HSLCI to correctly predict in vivo carboplatin sensitivity of three triple negative breast cancer patient derived xenografts, …

Examining The Effect Of Item-Writing Flaws On The Psychometric Parameters Of Pharmacy Therapeutics Examinations, Veronica P. Shuford

Theses and Dissertations

Colleges and schools of pharmacy (C/SOP) use direct measures of assessment to provide evidence of student learning, with multiple-choice questions (MCQs) being one the most common formats used in health sciences education to assess students’ knowledge, skills, and abilities (Pate & Caldwell, 2014). This study examined the occurrence of item-writing flaws (IWFs) in the Clinical Therapeutics Module (CTM) sequence of courses at a college of pharmacy at an academic health center in the southeastern United States. The goals of the study were to: (1) identify the most common item-writing flaws on examinations in the CTM sequence of courses, (2) determine …

Bayesian Experimental Design For Bayesian Hierarchical Models With Differential Equations For Ecological Applications, Rebecca Atanga

Theses and Dissertations

Ecologists are interested in the composition of species in various ecosystems. Studying population dynamics can assist environmental managers in making better decisions for the environment. Traditionally, the sampling of species has been recorded on a regular time frequency. However, sampling can be an expensive process due to financial and physical constraints. In some cases the environments are threatening, and ecologists prefer to limit their time collecting data in the field. Rather than convenience sampling, a statistical approach is introduced to improve data collection methods for ecologists by studying the dynamics associated with populations of interest. Population models including the logistic …

Amixicile, A Novel Antimicrobial Agent, And Its Effect On The Salivary And Subgingival Microbiome In Rhesus Macaque Monkeys, Erin E. Block

Theses and Dissertations

Background/Purpose: Periodontitis is an inflammatory disease with a bacterial etiology in a susceptible host. A selective antibiotic with minimal systemic side effects could be a useful adjunct to traditional periodontal therapy. Amixicile is a novel antimicrobial agent that targets pyruvate: ferredoxin oxidoreductase (PFOR), an enzyme that is critical for anaerobic bacterial metabolism and has been found to have little-to-no side-effects in animal models. The aim of this study was to prospectively evaluate the effect of amixicile on clinical periodontal parameters and the composition of the oral microbiome in rhesus macaque monkeys. It was hypothesized that the amixicile would reduce growth …

Antibiotic-Loaded Dendrimer Hydrogels In Periodontal Bone Regeneration: A Feasibility Study, Nicholas G. Yesbeck

Theses and Dissertations

Purpose: Prescription of a complete course of oral antibiotics following bone grafting procedures is a common clinical practice in surgical periodontics. Prophylactic administration of antibiotics reduces the risk of surgical site infection and systemic administration is preferred over local delivery because of short duration of action in the latter circumstance. The goal of this study is to demonstrate the ability of dendrimer hydrogels (DH) to prolong the release kinetics of antibiotics in-vitro. A secondary goal will be to analyze the effect of different particulate bone allografts on the release kinetics of the antibiotic.

Methods: Dendrimer hydrogels (DH) were synthesized …

Targeting Transferrin Binding Protein A For Vaccine Development In Neisseria Gonorrhoeae, Ashley Greenawalt

Theses and Dissertations

Neisseria gonorrhoeae, the causative agent of the sexually-transmitted infection gonorrhea, has recently been labeled a superbug. With dwindling treatment options, there is urgent need for a gonococcal vaccine. TonB-dependent transporters (TDTs) are important gonococcal virulence factors that allow the gonococcus to pirate metals directly from host proteins. The TDTs, TbpA and TbpB, are promising vaccine targets because both proteins are expressed and highly conserved in gonococcal strains, and they are not subject to high-frequency antigenic variation. Because the Tbps bind to host protein as their natural function, our immune system does not recognize them as foreign antigens; thus, immunogenicity is …

Socio-Ecological Predictors Of Social Connection Among Older Adults, Georganna Amateau

Theses and Dissertations

Decades of research has established an unequivocal link between states of social connection and health status. Lack of social connection, whether construed as social isolation or loneliness, negatively influences health and is highly associated with cardiovascular disease, high blood pressure, fall risk, and premature death. Despite extensive research on social isolation and loneliness, evidence relative to the broader construct of social connection suffers. Few studies inform practice standards for community-based organizations. This study aimed to develop a multidimensional, continuous composite variable of social connection and use the composite variable to examine predictors with a socio-ecological lens.

A secondary data analysis …

The Relationships Between Adolescents’ Future Aspirations And Postsecondary Enrollment: Finite Mixture Models, Chu Yi Lu Qiu

Theses and Dissertations

This study took person-centered statistical approaches to explore the multidimensional construct of adolescents' future aspirations and its associations with three covariates (i.e., gender, race, and SES) and a binary, distal outcome measure, postsecondary enrollment. Fourteen survey items representing the multidimensionality of adolescents' future aspirations were extracted from two-waves of Educational Longitudinal Study:2002 student data. The multidimensionality or the latent construct of the adolescents' future aspirations were explored using two finite mixture models called latent class analysis (LCA) and latent transition analysis (LTA). Based on the students' response patterns on the fourteen indicators, three latent classes representing three levels of aspiration …

Understanding Predictors Of Telemedicine Adoption Before, During, And After The Covid-19 Pandemic, Bradford S. Pierce

Theses and Dissertations

This study examined change in physicians’ use of telemedicine before, during, and expectations after the COVID-19 pandemic. It also examined the ability of personal and environmental variables to predict telemedicine adoption, and applied the theory of reasoned action and technology acceptance model to physicians’ adoption of telemedicine during the pandemic. A total of 230 licensed physicians currently practicing in the United States were recruited. Telemedicine accounted for 3.72% of physicians’ clinical work prior to the pandemic, 46.03% during the pandemic, and predicted 25.44% after the pandemic ends. Physicians within hospitals reported less telemedicine use during the pandemic (M = …

Systematic Structure-Activity Relationship Studies Of Nalfurafine, Mengchu Li

Theses and Dissertations

Today’s opioid crisis is one of the most challenging public health emergency. Two million Americans suffer opioid addiction. Over 20 million adults are affected by daily pain without non-addictive analgesics.

Kappa opioid receptor (KOR) is one of the most studied new pain targets void of abuse liability. KOR agonists have shown potent analgesia and also potential in alleviating opioid addiction. The only approved KOR agonist in clinic is nalfurafine (NFU). Though not leading to addiction, the analgesic effects of NFU are accompanied by sedative side effects. Therefore, we designed a systematical structure-activity relationship study of NFU for developing non-addictive analgesics. …

Feeling The Squeeze: The Association Between Multigeneration Caregiving And Informal Caregivers’ Health, Christine L. Patterson

Theses and Dissertations

While U.S. public policy and research has focused on the health needs of the aging population, less attention has been given to the consequences informal caregivers face caring for this generation. With the segment of the population aged 65 years or older growing rapidly, it is important to understand the factors that place informal caregivers at risk for poor health outcomes and health behaviors. Since multigeneration caregivers balance more personal, work, and caregiving demands than single-generation informal caregivers of older adults, they may be at higher risk for poor health outcomes. The aim of this study was to examine the …

Ck2 Phosphorylation Of Human Papillomavirus 16 E2 On Serine 23 Promotes Interaction With Topbp1 And Is Critical For E2 Plasmid Retention Function, Apurva Tadimari Prabhakar

Theses and Dissertations

Human papillomaviruses (HPVs) are the causative agents in most cervical cancers and have been implicated in a rising number of oropharyngeal cancers. HPV positive oropharyngeal cancers have increased significantly over the last two decades with no specific anti-viral therapeutic options for the treatment of HPV diseases. During its lifecycle, HPV16 encoded E2 protein interacts with host cellular factors to regulate viral transcription, replication and genome segregation/retention. Our understanding of the cellular partner proteins that E2 uses to mediate its functions remains incomplete.

Previously, an interaction between E2 and the host protein TopBP1 was identified. In earlier studies, it was also …

Nurse Cognition In Response To Alert Generation During Bar Code Medication Administration (Bcma): An Examination Of Human Factors, Elizabeth A. Sloss

Theses and Dissertations

Introduction: Nurses are at the forefront of care delivery, spending more time with patients than most other providers. Paramount to patient safety is the ability for nurses to make clinical decisions free from human error. Yet, the dynamic clinical environment in which nurses work is characterized by uncertainty, urgency, and high consequence, necessitating that nurses make quick and critical decisions. Notably, medical errors related to clinical decision-making, including medication administration errors, may occur more frequently among new graduate nurses. Therefore, the aims of this dissertation study are to 1) examine patterns of alert generation and alert response decisions (decision outputs) …

Strengthening Mental Health Diagnostic Detection In Integrated Primary Care, Julia Brechbiel

Theses and Dissertations

Primary care behavioral health (PCBH) is crucial for providing mental health treatment to underserved, minority, and uninsured populations. There is a lack of knowledge about accurate mental health diagnoses at PCBH. Underdetection of mental health symptoms has the potential to worsen racial and socioeconomic disparities. Using an expert review process, I developed an abbreviated diagnostic clinical interview (ADCI) for integrated primary care. Next, patients (N = 82) completed the interview after attending PCBH appointments. According to the interview, 63.4% of participants met criteria for a diagnosis, while 64.7% received a diagnosis from their provider. A large portion of patients …

Detrimental Role Of Irf1 In Myeloid Cells During Influenza Infection, Bianca L. Baum

Theses and Dissertations

The influenza virus is constantly evolving new ways to overcome both innate and vaccine-induced host defenses, making the innate immune response a critical therapeutic target for minimizing morbidity and mortality caused by infection. Here we examined the role that interferon regulatory factor 1 (IRF1) plays in regulating host innate immune responses in myeloid cells. We found that knocking out IRF1 from myeloid cells in mice (IRF1^DMy) led to a partial protection during IAV infection. Interestingly, recruitment of bone marrow derived myeloid cells as well as NLRP3 inflammasome expression were decreased in the lungs of IRF1^DMy mice, whereas …

Il-36g Cytokine Induction In Oral Epithelial Cells Triggered By Treponema Denticola And Their Role In Chronic Periodontitis, Christopher Blake

Theses and Dissertations

Periodontal disease is a polymicrobial disease affecting 10-15% of the population. Periodontal disease affects the quality of life by reducing mastication and potentially causing tooth loss. Periodontal disease is also linked to more severe, systemic diseases such as cardiovascular disease and rheumatoid arthritis. Development of the diseased state occurs when the plaque biofilm shifts from healthy to dysbiotic. The shift to a dysbiotic biome brings with it a shift in bacterial presence, specifically an increase in gram-negative bacteria, such as T. denticola. T. denticola is a gram-negative, anaerobic spirochete whose relationship with oral epithelial cells is poorly understood. Preliminary data …

Canalpro Eal Accuracy Compared To The Root Zx Eal, Benjamin T. Brown

Theses and Dissertations

CanalPro Electronic Apex Locator Accuracy Compared to the Root ZX Electronic Apex locator

Benjamin Brown, Garry Myers, Caroline Carrico, Duane Schaefer

Department of Endodontics, Virginia Commonwealth University

Objectives: Electronic apex locators (EAL) are an effective instrument in measuring the working length of a canal. The Root ZX is considered the gold standard by many. The aim of this research is to compare the accuracy of the CanalPro EAL to the Root ZX.

Methods: The actual length of 43 single rooted extracted teeth were measured with a #10 hand file when the tip was visualized at the foramen under a microscope. …

Validation Of A Screening Tool For Pediatric Obstructive Sleep Apnea: A Pilot Study, Julia A. Giardina

Theses and Dissertations

Purpose: The purpose of this study was to evaluate the Pediatric-Modified-STOP-Bang (PM-STOP-Bang) as a screening tool to assess sleep related breathing disorders (SRBD) within a pediatric population. The specific aims of this study were: 1) compare the PM-STOP-Bang scores with those from the validated Pediatric Sleep Questionnaire (PSQ), 2) determine the ability of the PM-STOP-Bang and the PSQ screening tools to accurately detect children of high risk for SRBD from a one-night home sleep apnea test (HSAT).

Methods: Orthodontic patients were screened using the PM-STOP-Bang at VCU Graduate Clinic. Patients (n=10) who were recruited and enrolled. Five were determined to …

Hamburger Helper Recipes, John Alex Goss

Theses and Dissertations

Hamburger Helper Recipes is a collection of essays and public addresses that aim to recuperate castoff and misfit material surrounding industries and tools which produce science-fiction fantasies, specifically videogames and television shows. The following essays confront the normative violence of capitalism, whiteness, and hetero-patriarchy that socially and technologically haunt these imaginary worlds and build hegemonic idealogy into their audiences. This collection takes industrial materials and software from their intended commercial purposes of production and “success” into places of abjection and quiet breakdown. The author’s own proximity to masculine and often toxic "work cultures'' within industrial spaces of coding and manufacturing …

Radiographic Comparison Using Cbct-Pai And Volumetric Analysis Of Endodontically Treated Teeth: A Retrospective Cohort Study, Jeremy Hargrove

Theses and Dissertations

Purpose: To assess the changes in CBCT-PAI score as well as 3-D volume of periapical findings associated with endodontically treated roots and to see how these findings change over time.

Methods: Retrospective chart review with the following inclusion criteria: 1. At least one tooth was endodontically treated at the endodontic private practice; 2. Patient had a recall examination and the treated tooth was asymptomatic, functional and a CBCT was exposed; 3. CBCT interpretation found a periapical finding associated with the treated tooth; 4. A follow-up recall examination was completed and CBCT exposed. Cases that fulfilled the inclusion criteria had the …

Reproducibility And Accuracy Of The Virtual Occlusal Record, Anne M. Harper

Theses and Dissertations

Purpose: To evaluate the reproducibility and accuracy of the virtual occlusal record compared to the gold standard physical bite record

Methods: Two physical bite records of PVS and two virtual bites using an iTero Element scanner were obtained from 22 participants. Intraoral scans were exported as STL files, and virtual occlusal records were created. CBCT images were taken of physical occlusal records and converted to STL files. STL files were superimposed using Geomagic Control X™ Software. Root mean square (RMS) and percent similarity within 0.25 mm tolerance were compared at a significance level of 0.05.

Results: Average …

Virtual Reality Tool For Visualizing The Oral Microbiome, Alexus M. Harris

Theses and Dissertations

There are limited teaching tools for helping both students and patients understand the oral microbiome. It is important to understand the oral microbiome as it heavily influences the health of your oral cavity and the dysbiosis of disease. The oral microbiome influences other aspects of health and serves as an indicator for health. With a greater understanding of the oral microbiome, patients can make healthier lifestyle changes and dentists can better educate their patients. For that reason, the goal of this project was to create a virtual reality tool for visualizing the oral microbiome. The assets for the VR tool …

Molecular Basis Of Cross-Sensitization In Colonic Inflammation-Induced Somatic Hypersensitivity, Parshva K. Mehta

Theses and Dissertations

A major portion of pain experienced by patients with an Irritable Bowel Disease (IBD) or Irritable Bowel Syndrome (IBS) can be attributed to visceral hypersensitivity. Visceral stimuli transmitted through primary afferent neurons in the dorsal root ganglia (DRG) induce a nociceptive response. Notably, a subset of patients has also experienced the development of somatic pain, such as leg pain, after diagnosis of a bowel disorder. The aim of this investigation is to ascertain which biochemical mediators are involved in the development of such viscerosomatic cross-sensitization. Initially, the Von Frey Test was used to find behavioral evidence of somatic referred pain; …

Modulation In Nmda Receptor Function Alleviates Safety Learning Deficit In Females Who Experienced Chronic Stress During Adolescence, Zuby C. Okafor

Theses and Dissertations

Anxiety disorders disproportionately impact women and are more prevalent in people with a history of chronic stress. Post-traumatic stress disorder (PTSD) is a type of stress and trauma-related disorder that is largely characterized by hyperarousal to fear-based cues. The inability to dissociate the fear-response from a non-threatening cue is known as impaired safety learning. Given that N-methyl-D-aspartate (NMDA) receptors are key mediators of learning behaviors, we examined the role of NMDAr function in deficient safety learning. Previous studies have shown that female rats with a history of stress have altered NMDAr gene expression and altered glutamatergic signaling; therefore, we hypothesized …

In Vitro Evaluation Of The Solubility Of Endosequence Bc Sealer In Acidic Solutions, Inderpal S. Sappal

Theses and Dissertations

Purpose: In recent years, bioceramic sealers (BCS), such as EndoSequence BC Sealer, have gained popularity in endodontic practices. Previous research has found BCS difficult to remove from canals during retreatments when compared with other endodontic sealers. Acidic solutions have been found to inhibit the set of BCS and increase their solubility. The purpose of this study was to evaluate the efficacy of acidic solutions in the removal of BCS as compared with a traditional retreatment solvent.

Methods: Roots of extracted human single rooted teeth (N=15) were prepared into 17 mm sections, then instrumented with ProTaper Gold (PTG) rotary files up …

The Effect Of Local Anesthesia When Used In Dental Restorative Cases Under General Anesthesia On Control Of Intraoperative Physiologic Parameters And Post-Operative Comfort, Kathryn S. Skarda

Theses and Dissertations

Purpose:

To determine the effect of local anesthesia on post-operative pain and physiologic parameters intraoperatively in patients undergoing dental care under general anesthesia.

Methods:

This study was modeled as a double-blinded randomized control trial. Patients included healthy children under the age of six scheduled for restorative dental treatment under general anesthesia. Patient behavior was evaluated pre and post-operatively using the FLACC score and post-operatively using the Parental Pain Score Measure. Intraoperatively, all participants followed a standardized general anesthesia protocol and were given either local anesthetic infiltration by the dental surgeon performing the surgery or no anesthesia was utilized. Intraoperatively physiologic …