Digital Commons Network^™

Machine Learning Models Leveraging Patient-Similarity And Clinical Temporality For Disease Prognoses, Ahmad F. Al Musawi

Theses and Dissertations

Electronic Health Records (EHRs) constitute a comprehensive and high-dimensional repository of clinical data, encompassing a wide array of patient-level information such as diagnoses, procedures, medications, laboratory results, and unstructured clinical narratives. These data hold immense potential for advancing predictive modeling in healthcare, including tasks such as disease progression modeling, hospital readmission prediction, and length of stay (LoS) estimation. However, the intrinsic complexity of EHR data—manifested in its heterogeneity, sparsity, and temporal dynamics—poses significant analytical challenges that limit the generalizability and interpretability of conventional machine learning models. Recent methodological advancements in deep learning and graph-based learning, particularly Graph Neural Networks (GNNs), …

Treatment Resistant Obesity Among Midlife Women Receiving Care From A Specialized Weight Management Clinic, Emily C. Stevens

Theses and Dissertations

Background: Obesity is a complex chronic disease that conveys significant health risk. Women with obesity are at greater risk for associated conditions including heart disease, hypertension, ischemic stroke, and sex-specific cancers compared to their male counterparts. Midlife may present unique challenges for women as it is during this life phase that they experience an increase in their overall obesity prevalence and severity. Some midlife women experience treatment resistant obesity (TRO), a phenomenon not previously explored in the research literature, conceptualized as failure to achieve clinically meaningful weight loss of ≥ 5% after having received medically specialized obesity care for one …

Characterization Of Nanoplastic-Induced Exacerbation Of Asthmatic Pathophysiology In A Murine In Vivo Model, Keith Li

Theses and Dissertations

As global plastic production increases, so does the environmental and biological presence of nanoplastics (NPs), raising growing concerns about their potential impact on human health. These particles have been detected in various organs, including the lungs, yet their role in respiratory inflammation remains largely unexplored. Emerging evidence suggests that NP exposure may influence immune responses in the lungs, particularly in individuals with preexisting conditions such as asthma. However, the specific ways in which these particles interact with allergen driven inflammation are still unclear.

In this study, a murine model of allergic airway inflammation was used to investigate how surface modified …

Intervertebral Lateral Bending Moment Differences In The Lumbar Spine Of Baseball Pitchers Across Throwing Velocities, Justin Humenay

Theses and Dissertations

Introduction Baseball pitching imposes substantial mechanical demands on the lumbar spine, a crucial link in the kinetic chain responsible for transferring energy from the lower body to the upper extremity. While increased pitch velocity is associated with greater trunk forces the specific intervertebral loading patterns during high-velocity pitching remain unclear. This study investigates differences in lateral bending moments across lumbar spinal segments between collegiate pitchers throwing at high versus low velocities.

Methods Twenty right-handed collegiate pitchers were divided into two groups: high-velocity (n = 10, 90.3 ± 1.6 mph) and low-velocity (n = 10, 81.6 ± 1.1 mph). Motion capture …

Rare Variant Analysis Of Electronic Health Record-Defined Major Depressive Disorder In The All Of Us Research Program, Stephen Emil Vieno

Theses and Dissertations

The underlying pathogenesis of MDD remains poorly understood, with multiple competing hypotheses regarding its exact etiology. As a heterogeneous disorder with relatively low heritability, large-scale genome-wide association studies of MDD have relied on increasingly large sample sizes to identify common genetic variants associated with the disorder. However, the rare variant genetic architecture of MDD is still largely unknown. The aim of the present analysis was to use the AoU—a United States-based biobank that integrates healthcare records from over 50 healthcare systems and possesses whole genome sequencing data for participants—to perform a gene set–based analysis of MDD. This analysis presented several …

Modeling Vaccination Strategies And Intervention Impacts On Infectious Disease Dynamics, Elizabeth B. Amona

Theses and Dissertations

This dissertation explores how mathematical and statistical modeling can inform vaccination strategies and evaluate the impact of interventions during infectious disease outbreaks. Motivated by the challenges observed during the COVID-19 pandemic, the research integrates compartmental modeling, Bayesian inference, and agent-based simulation to assess policy effectiveness and disease control across varying contexts. The first study develops a SEIRDV model that incorporates government interventions and vaccination rollout to examine COVID-19 dynamics in Qatar. A Bayesian approach is used to estimate parameters and compute time-varying transmission rates. The model captures shifts in transmission following policy changes and quantifies the reduction in deaths attributable …

Exploring Collaboration In Interdisciplinary Ei/Ecse Programs: A Qualitative Study On Service Provider Preparation, Meagan Dayton

Theses and Dissertations

Interdisciplinary preparation is critical for early childhood special education professionals, yet few programs are designed to support such collaboration across disciplines. This study aimed to explore how interdisciplinary EI/ECSE preparation programs support collaboration. The study was guided by the following research questions: (1) How are program components designed to support the development of collaboration skills? (2) What is the student experience of collaboration in the program? (3) What connections exist between program components, student experiences, and the development of collaboration skills? Using a qualitative multiple-case study approach grounded in ecological systems theory, data were collected from program documents and interviews …

Automated Treatment Planning Framework For Cervical Cancer In Brachytherapy, Suman Gautam

Theses and Dissertations

Brachytherapy (BT) is a critical treatment modality for cervical cancer that delivers ionizing radiation directly to the tumor using intracavitary (IC) and/or interstitial (IS) applicators. In high dose-rate (HDR) BT, a remote afterloader guides the radioactive source to specific dwell positions for defined durations, known as dwell times, allowing for a conformal dose to the tumor while minimizing exposure to surrounding organs at risk (OAR). However, due to the inherent nature of ionizing radiation, some dose to OARs is unavoidable, creating a fundamentally conflicting objective in treatment planning: maximizing tumor coverage while minimizing OAR dose. This characterizes the problem as …

An Adaptive Method For Covariate Balancing In Block Randomized Clinical Trials, Ren Rasnick

Theses and Dissertations

Clinical trials are randomized in part to limit allocation bias, but also to ensure comparability between treatment arms for a baseline variable of concern. Comparable with regard to a baseline variable of concern is necessary for the validity of statistical methods. However, comparability is not guaranteed for trials of any size and is even more likely in trials with < 200 total participants. We propose a new method for adapting the allocation of participants in a sequentially allocated two-armed study with a small sample size to better ensure comparability.

The proposed method calculates the expected final imbalance (lack of comparability) based on the current participant values. Unlike several other methods, our method ensures the final desired sample size for each treatment arm, utilizes the expected final imbalance, increases comparability between …

Associations Between Community Violence Exposure And Internalizing Outcomes: The Moderating Role Of Racial Identity, Kimberly S. Lazarus

Theses and Dissertations

Community violence continues to be an ongoing public health crisis, driven by structural inequities and systemic disinvestment. Due to historical discriminatory policies and ongoing systemic barriers, Black adolescents are disproportionately affected, placing them at heightened risk for adverse mental health outcomes, particularly post-traumatic stress symptoms (PTSS) and depressive symptoms. While existing literature highlights racial identity as a promotive factor linked to a lower likelihood of negative health outcomes, less is known about its protective role in buffering the mental health effects of adversity. There is an increasing call for public health researchers to consider racial-ethnic factors as potential moderators in …

Characteristics Of Permanent Teeth Undergoing Surgical Endodontic Evaluation: A Retrospective Study, Yasamin Mojarad

Theses and Dissertations

Objective: This study examines the pre-surgical clinical and radiographic characteristics that may influence the choice of apicoectomy over nonsurgical retreatment in a more detailed approach, focusing on the clinical factors that come into the evaluation phase. We hypothesize that there are certain patterns observed through a pre-operative CBCT that may impact the decision for surgical intervention. The study aims to assess patterns in the decision-making in surgical treatment planning.

Methods: Retrospective review analyzing 142 cases treated or planned for apicoectomy by VCU endodontic residents. Data collected from CBCT and PA radiographs included: restorations, quality of prior root canal treatment, presence …

Hyperreality Ain’T Really Real: Postmodernity, Social Media, & Blackness, Micah White

Theses and Dissertations

This qualitative study examines the interplay between postmodernity, social media, and African American identity formation through focus group analysis and Grounded Theory methodology. The research investigates how social media’s postmodern features—fragmentation, hyperreality, commodification, and context collapse—shape identity development among African Americans, who historically navigate cultural disruption and systemic racism. Data from semi-structured interviews with two generational focus groups revealed that participants engaged in sophisticated identity curation to balance authenticity and protection in racially charged digital spaces. Key findings highlight the tension between empowerment and marginalization, as social media served as both a platform for racial affirmation and a source of …

A Multimethod Approach To Examining Racial Coping Socialization Among Black Adolescents, Rachel J. Davis

Theses and Dissertations

Experiences of racial discrimination are pervasive in the lives of Black youth and result in race-related stress. Racial coping has been found to mitigate the negative physical and mental health effects of racial discrimination; thus, it is imperative that we understand the process that Black youth undertake to navigate racialized experiences by utilizing a person-centered approach. Additionally, parents socialize their Black youth to navigate racialized experiences, indeed, previous research has investigated racial and emotion socialization as separate phenomena, however, this does not reflect the integrated nature by which racial and emotion socialization processes are interconnected during parents’ and youths’ discussions …

A Mixed Methods Study: High School Teachers’ Perspectives On Incorporating Mindful Artmaking In Their Classroom As A Mental Health Resource, Sherry A. Bosarge

Theses and Dissertations

Mental health concerns and the need for mental health resources for high school students continue to rise in Virginia. Some of the reported benefits to the current mental health services and resources offered in Virginia schools are increased academic outcomes, attendance, and positive behaviors. The reported barriers to current mental health services and resources are lack of participation, lack of training, time constraints, funding, and resources. This explanatory sequential mixed methods study examined high school teachers’ perspectives on the benefits and barriers to incorporating mindful artmaking in their classrooms as a mental health resource at a local high school. This …

Still An Athlete? An Exploration Of Athlete Identity, Body Appreciation, And Psychological Flourishing In Middle-Aged Former Collegiate Athletes, Kelly Furr

Theses and Dissertations

Collegiate athletes, upon retirement, are encouraged to develop other interests outside of sport to form a well-rounded identity. Yet middle-aged people often struggle to complete recommended strength training and exercise guidelines, and many continue to struggle with body appreciation and psychological well-being beyond adolescence and young adulthood. Using a cross-sectional survey design, 482 former NCAA athletes completed the Athlete Identity Measurement Scale (AIMS), Exercise Identity Scale (EIS), Body-Appreciation Scale (BAS-2), and Flourishing Scale (FS). The study used Structural Equation Modeling (SEM) to determine if athlete or exercise identity positively affects body appreciation and psychological flourishing through the mediating variable of …

A Mixed Method Case Study Of Leadership For Change: Authentic Transformational Leadership In A Local Baptist Church, Hui Sun

Theses and Dissertations

This convergent parallel mixed methods case study explores how a local Baptist church navigated organizational change during and after the COVID-19 pandemic through the lens of authentic and transformational leadership. Grounded in organizational leadership and open systems framework of organizational change, the study examined two primary hypotheses: (1) RBC demonstrated an authentic transformational leadership paradigm in its change processes since 2020, and (2) this paradigm significantly and positively influenced perceived leadership effectiveness.

Qualitative data were collected through semi-structured interviews with six leaders (three pastors, one minister, one staff leader, and one deacon) and 11 raters (five lay leaders, five congregants, …

Knowing By Heart: Philosophical Dimensions Of Humanistic Mathematics Education, Catherine Henney

Theses and Dissertations

This project seeks to revive interest in late twentieth century humanistic mathematics education (HME) so that its principles might cross the boundary of higher education and settle in corners of the K-12 math education space. In particular, HME’s theme of teaching math humanistically directs attention to features and phenomena that bear strongly on students’ daily classroom experiences. Personhood, agency, inquiry, meaning, environment, feelings, relationships: these elements invite a more thorough meditation and philosophical analysis. Though it is a largely philosophical endeavor, this project is enlivened by classroom vignettes and case studies that bring practical relevance to HME’s core principles. Chapters …

Scopolamine-Induced Modulation Of Serotonin And Dopamine Transporters Activity: Behavioral And Molecular Insights Into Rapid Antidepressant Action, Deepak Karunakaran

Theses and Dissertations

Major depressive disorder (MDD) affects over 350 million individuals worldwide and is characterized by profound dysregulation of serotonin (5-HT) and dopamine (DA) systems that govern mood, reward processing, and motivation. The serotonin transporter (SERT) and dopamine transporter (DAT), both dynamically regulated through phosphorylation, serve as critical determinants of synaptic monoamine signaling. Despite decades of therapeutic development, current antidepressants require 4-6 weeks to achieve efficacy, and approximately one-third to half of patients develop treatment-resistant depression. The emergence of rapid-acting antidepressants like ketamine represents a paradigmatic shift, demonstrating symptom relief within hours; however, ketamine's therapeutic potential remains constrained by abuse liability, dissociative …

Therapy-Induced Senescence In Cancer: Developing Senolytic-Based Combination Strategies To Delay Re-Emergence Of Triple-Negative Breast Cancer, Eesha Chakraborty

Theses and Dissertations

Therapy-induce senescence (TIS) represents a major biological outcome of many anticancer treatments and is increasingly recognized as a strategic vulnerability in triple negative breast cancer, which is a highly aggressive subtype with limited therapeutic options and frequent relapse. Here, we probed TIS as a primary cellular response that may ultimately compromise long-term outcomes using standard chemotherapeutic agents in TNBC as well as the antibody-drug conjugate sacituzumab govitecan (SG). Both chemotherapy and SG reliably induced pronounced senescence across TNBC models, yielding durable growth arrest, however, also generating a persistent reservoir of viable tumor cells capable of eventual proliferative recovery, a hallmark …

Effectiveness Of Immersive Virtual Reality Combined With Task-Specific Training On Hemiplegic Arm Function Following Stroke: A Single Case Series Study, Rahsaan J. Holley

Theses and Dissertations

Motor recovery of the arm following a neurological injury is a common goal of the rehabilitation process for individuals impacted by the condition . Due to the long-term functional implications of impaired arm movement, individuals are often trained to use compensatory strategies to complete functional tasks without incorporating the weakened limb. While compensatory strategies offer stroke survivors the opportunity to regain a level of independence, such approaches fail to directly address the underlying causes of the disability (i.e., limited range of motion, decreased strength, poor coordination, motor planning difficulties) which can unfortunately result in long-term impairment and functional disability.

Motor …

Swarming Segregation: Leveraging Swarm Intelligence And Regionalization As Instruments For School District Desegregation, Jeffrey Wooten

Theses and Dissertations

Even after Brown led to the South briefly having the most diverse schools in the nation, schools throughout the Northeast have remained the most segregated in the nation for decades. While federal jurisprudence has made compelling desegregation pursuant to the Equal Protection Clause more challenging, New Jersey has a particularly favorable landscape to address severe segregation. With a highly diverse, densely populated public enrollment, favorable state constitutional precedent, and a history of successfully compelling desegregation, New Jersey is fertile ground exploring regional desegregation. Scholars, judges, and even plaintiffs in ongoing litigation (Latino Action Network v. N.J.) have called for New …

Place, Culture, And Care: A Socioecological Examination Of Type 2 Diabetes Among Hispanics In The U.S., Danielle Montoya

Theses and Dissertations

Introduction: Type 2 diabetes (T2D) disproportionately affects U.S. Hispanic populations. This dissertation examined whether structural determinants fundamentally drive T2D disparities among Hispanics, with attention to within-group racial heterogeneity.

Methods: Three studies utilized nationally representative data. Study 1 examined neighborhood segregation and ethnic enclave residence associations with T2D using restricted NHANES data (2011-2018, n=5,056). Study 2 investigated acculturation and T2D associations using restricted NHANES data (2011-2018, n=4,540). Study 3 analyzed patient-provider racial/ethnic concordance and adequate diabetes care using MEPS data (2008-2021, n=17,138).

Results: Structural factors demonstrated primacy across all studies. Neighborhood segregation (aOR=1.17, p>0.05) and ethnic enclave residence showed no …

Exploring The Role Of Host Immune Responses And Bacterial Sensory Pathways In The Development Of Treponema Denticola-Mediated Periodontal Disease, Annie N. Hinson

Theses and Dissertations

Periodontitis is a chronic inflammatory disease driven by dysbiotic microbial communities and maladaptive host responses. Treponema denticola, a spirochete pathobiont, is strongly associated with disease severity. However, the molecular mechanisms underlying its interaction with host tissues and regulation of virulence remain incompletely understood. This work examines both the epithelial immune responses and bacterial transduction systems that shape T. denticola pathogenesis. Transcriptomic analysis of gingival keratinocytes revealed IL-36γ as the most highly induced cytokine following infection with T. denticola. Functional studies demonstrated that IL-36γ induction occurs in a dose- and time-dependent manner through TLR2/6 signaling, requiring the NF-κB, PI3K/Akt, and …

Relationship Extraction Using Retrieval Augmented Generation For Biomedical Dataset, Jannat .

Theses and Dissertations

With the increasing number of structured and unstructured data, obtaining reliable information effectively has become crucial. In the biomedical domain, extracting information from the scientific papers is crucial in order to stay up-to-date with accurate information, given the increased pace by which new research studies are published. This work focuses on identifying relationships between entities that are extracted from the abstracts and titles of biomedical research papers. In this work, we developed a Retrieval Augmented Generation (RAG) based system to automatically identify relations between biomedical entities. We evaluate multiple open source Large Language Models (LLMs) and the number of examples …

Characterization Of Outer Surface Protein C Of Borreliella Role In Host Tropism, Kathryn Mf Chambers

Theses and Dissertations

The Lyme disease spirochetes, Borreliella spp., are maintained in nature through a complex enzootic cycle involving Ixodes ticks and a diverse set of reservoir hosts. The outer surface protein C (OspC) of the bacterium is an essential virulence factor required for transmission from ticks and early infection of mammals. Deletion of ospC abolishes infectivity, yet the precise molecular mechanisms underlying OspC function remain incompletely defined. In this dissertation, I examined the contribution of OspC type identity to host specificity. OspC is highly diverse, with over 30 genetically stable types described. While intra-type sequences are conserved (>95% amino acid …

Genetic Studies At The Intersection Of Alcohol Use And Pain, Walker Rogers

Theses and Dissertations

Alcohol use disorder and pain are complex public health concerns affecting millions of people, and these conditions are often characterized by a bidirectional relationship. People experiencing pain may drink alcohol for its analgesic effects. In turn, excessive consumption of alcohol can lead to conditions that cause pain, leading to an escalating feedback loop of pain and alcohol use. Negating this cycle requires a nuanced understanding of the mechanisms underlying alcohol analgesia, which are presently not fully understood. The Miles and Damaj labs have previously shown that ethanol-induced antinociception is moderately heritable in mice, indicating a genetic component to the trait. …

The Design Of A House, Lars Mattingly

Theses and Dissertations

Photography lends itself to both damaging and facilitating connection, the camera at once a weapon of destruction and a catalyst for change. The Design of a House is a call to love deeply. In the aftermath of body trauma, I use portrait photography to reconnect with myself and others. Through making portraits, I bridge my own gap between fear and intimacy. Primarily working with film-based cameras and hand-sensitized photographic materials, I reintroduce touch through process. The slowness, delicacy, and tactility of these acts offer a safety I am learning to trust. When photographing myself, my mother, and my partner, I …

Opioid Tolerance And Withdrawal In The Mouse Colon, James Fune

Theses and Dissertations

Constipation is a major clinical obstacle associated with opioids, prompting patients to discontinue treatment due to pain, discomfort, and psychosocial stressors. Moreover, chronic users become tolerant to the analgesic effects of opioids, but not to their constipating effects. Upon cessation of long-term treatment, serious diarrhea–among other somatic signs of withdrawal–may ensue. These symptoms become a driving factor for relapse, causing patients to restart opioid treatment. In this study, we aim to understand mechanisms that contribute to opioid tolerance and withdrawal in the colon. Previous findings suggest that constipation occurs partly due to the colon’s lack of tolerance to opioids’ inhibitory …

Exploring Western Clinicians’ Treatment Of Cultural Concepts Of Distress, Lisa Y. Chung

Theses and Dissertations

As the rates of diverse ethnic populations and therefore cultural concepts of distress continue to grow in the United States, it becomes critical to learn and understand how western-trained mental health professionals are selecting treatments and implementing them. However, there is a paucity of research on cultural concepts of distress as a whole and much less on the psychotherapy of cultural concepts of distress in the United States. This exploratory study aimed to explore the treatment plan of mental health clinicians in the United States when encountering the Korean cultural concept of distress, hwabyung. Ninety-eight clinicians were recruited from Arkansas, …

Exploring The Development Of Students' Calling To The Work Of An Hod Practitioner In An Undergraduate Hod Degree Program, Neil Dana Rahbar-Daniels

Theses and Dissertations

This dissertation project consisted of a multiple case qualitative study to explore indications of cross-influences between students’ experiences of learning takeaways as participants in one or more HOD undergraduate degree courses and accompanying experiences (if any) of perceiving and/or living a calling to work as HOD practitioners. This phenomenological inquiry involved four undergraduate students who had completed one or more HOD degree courses at Mid-Atlantic States University (MSU as a pseudonym) during a two-year period. Each participant attended a single interview of about 90 minutes in duration, responded to a short vocational calling survey as a guide for interview questioning, …