Digital Commons Network^™

The Importance Of Multi-Component Strategies And Healthcare Worker Compliance In Preventing Healthcare-Associated Infections: A Systematic Review, Michelle Northcut

Theses and Dissertations

Healthcare-associated infections (HAIs) remain a preventable threat to patient safety and are linked to morbidity, mortality, antimicrobial resistance, and increased healthcare costs (CDC, 2024; AHRQ, 2024). Evidence suggests that 30–70% of HAIs may be prevented through consistent application of infection prevention practices; however, implementation and adherence gaps persist (CDC, 2024). This systematic review examined the relationship between healthcare worker compliance with infection prevention practices and infection outcomes and explored how institutional and organizational factors influenced both compliance and infection outcomes.

Following PRISMA 2020 guidelines, searches were conducted in PubMed, CINAHL, ProQuest, and Google Scholar for studies published between 2015 and …

Understanding Maternal Morbidity And Mortality Rates In Georgia, Ebony Hall

Theses and Dissertations

The United States continues to have a significant concern for public health regarding the maternal morbidity and mortality rates. In contrast, women of African American descent and other marginalized populations maintain a disproportionately higher rate of pregnancy-related disparities. More specifically, in Georgia, a persistent number of disparities can correlate to a lack of access to adequate prenatal care, insurance status, and many other social determinants of health that are linked to the contribution of adverse maternal health care outcomes. The purpose of this research study is to evaluate various maternal health experiences during pregnancy, while focusing on the occurrence of …

The Returns On Educational Investment: Military Retention Among Mid-Grade Enlisted Soldiers After Army-Funded Degree Completion, Robert Kenneth Bandy Jr.

Theses and Dissertations

The U.S. Army Tuition Assistance (TA) program represents a substantial investment in the education and professional development of enlisted soldiers, yet limited empirical research has examined retention outcomes among soldiers who complete degrees using TA. The purpose of this quantitative correlational study was to examine the relationship between selected demographic and educational characteristics and time-to-separation among enlisted U.S. Army soldiers who completed a degree using TA between fiscal years 2023 and 2025. Guided by Human Capital Theory, the study used archival administrative data from the Army Continuing Education Division (ACED) and the Integrated Personnel and Pay System-Army (IPPS-A). A stratified …

Analysis Of Risk Factors And Current Programs For Addressing Injuries In Children And Adolescents, Jahfel Nial Jones Iii

Theses and Dissertations

Unintentional injuries are a leading cause of morbidity and mortality among children and adolescents in the United States. These injuries result from various causes, including motor vehicle crashes, falls, suffocation, and poisoning. This capstone project examines the prevalence, risk factors, and prevention strategies for unintentional injuries among infants, children, and adolescents. Using a public health approach, this research explores evidence-based interventions and community-based programs that effectively reduce injury-related mortality. The project also incorporates data and insights from the Safe Kids Columbus program at Piedmont Columbus Regional, where various injury prevention initiatives have been implemented.

Findings revealed that motor vehicle crashes …

An Analysis Of Factors At A Private Liberal Arts College That Affect Student-Athlete Sense Of Belonging, Tamija Shrell Tucker

Theses and Dissertations

This study examined the factors affecting student-athletes sense of belonging at a private liberal arts college using Strayhorn’s Sense of Belonging Framework. The research used a mixed method approach and combined quantitative survey data from 112 undergraduate students with qualitative interviews from seven faculty members to analyze variations in academic readiness, institutional support and a sense of belonging. Despite that fact that non-athletes reported being significantly more academically prepared, quantitative data indicated that there was no statically significant difference in the overall sense of belonging between student-athletes and non-athletes. There was also a negative correlation between a sense of belonging …

Child Maltreatment Risk Identification In Complex Caregiving Environments: A Public Health Review Of Split-Custody And Multi-Household Family Contexts, Makenzie Lee

Theses and Dissertations

Child maltreatment remains a significant public health concern with lifelong consequences for children's health, development, and well-being. As children's caregiving environments become increasingly diverse through split-custody arrangements, blended families, kinship care, and other multi-household contexts, recognizing and assessing child safety concerns may become more complex. Although these family structures are not inherently associated with maltreatment, the distribution of caregiving responsibilities and information across multiple households may complicate child maltreatment risk identification.

This capstone presents a scoping review of peer-reviewed literature examining child maltreatment risk identification within complex caregiving environments. The review synthesized evidence related to caregiving environments, caregiver relationships, child …

More Than A Seat At The Table: Examining How Psychological Safety, Identity Representation, And Leadership Accountability Impact African American Women In Global Workplace Environments, Shelbi Chandler

Theses and Dissertations

This qualitative phenomenological study examined the lived experiences of African American women working in corporate technology environments, with particular attention to psychological safety, representation, and systemic barriers to advancement. Despite increased organizational commitments to equity and inclusion, research continues to demonstrate that Black women encounter persistent intersectional barriers shaped by race and gender within professional settings (Erskine et al., 2021; Field et al., 2023; Roberson, 2019). Guided by Du Bois’s (2008) theory of double consciousness, Goosby Smith’s (2014a) Ubuntic inclusion framework, and appreciative inquiry (AI; Cooperrider & Whitney, 2005), this study explored how African American women interpret, navigate, and respond …

Restructuring Actor Training For Psychological Wellbeing, Caroline C. Byce

Theses and Dissertations

This thesis highlights the importance of performer mental health as it relates to performance pedagogy. Based on a comprehensive review of traditional western actor training methods, survey data, and interviews, this research proposes a framework through which educators, directors, and performers alike can acknowledge both the artistic value and psychological harm prevalent in many prominent acting techniques. The insights put forth by this thesis extend beyond theatre acting and into television and film acting respectively, culminating in a series of practical steps -transferrable to any medium - for implementing a restructured and more human-centered approach to classrooms, workshops, and rehearsal …

Neoliberalism In Education: Three Studies On The Intersection Of Neoliberalism, Science Of Reading, And Policy, Candace Bechtold

Theses and Dissertations

This dissertation consists of three linking projects that study the intersection of neoliberal ideology, American education policymaking, and the Science of Reading (SOR). I sought to understand how neoliberal mechanisms like standardization and accountability have shaped past and current education policies in the United States. In the first project, I take an historical approach to conceptualize neoliberal ideology to explain how it is manifested in Standards-Based Accountability (SBA) reform and demonstrate how its implications have progressed over time. In the second project, I focus on one state's SOR policy–the Virginia Literacy Act (VLA)– to conduct a discourse analysis of documents …

Substance Use Behaviors And Treatment Engagement In Individuals With Severe Psychopathology With And Without Comorbid Obesity, Rachel M. Madera-Arnold

Theses and Dissertations

Research has found significantly higher rates of both substance use and obesity among individuals with SMI compared to population samples which in turn can lead to worsening health outcomes. Despite this, there is limited research on the co-occurrence of obesity, substance use, and SMI and how these conditions may interact to affect patient outcomes. In addition, there are many gaps in the research regarding the relationship between substance use and body weight, appetite and/or eating behaviors. This study conducted a secondary analysis of the NSDUH 2021 survey that characterized substance use and disorders among individuals who had severe psychopathology, examined …

Connectedness And Help-Seeking Among Veterans: Integrating The Andersen Behavioral Model And The Three-Step Theory Of Suicide, Samuel Ochinang

Theses and Dissertations

Veteran suicide rates remain higher than those of nonveterans, yet many veterans who die by suicide are not engaged in care prior to death. Veteran help-seeking research often focuses on healthcare utilization, overlooking informal sources of support and the decision-making processes that precede service use. Connectedness is a central protective factor in suicide theory but has received limited attention within help-seeking models. This study examined how connectedness influences veterans’ willingness to seek help. Guided by the Andersen Behavioral Model and the Three-Step Theory of Suicide, this secondary analysis used data from the Military Health and Well-Being Project. The analytic sample …

Family- And Cultural-Level Influences For Latine Adolescent Nicotine Use: A Qualitative Study Informing Prevention, Cindy M. Hernandez Castro

Theses and Dissertations

Early tobacco use among Latine adolescents represents a critical public health concern, with 23.8% reporting current use and exceeding rates among other racial/ethnic groups (Birdsey et al., 2023; Gaddy et al., 2022). This early initiation elevates risks for nicotine dependence and related morbidity in adulthood (Tsao et al., 2023). Guided by Structural Ecosystems Theory (Szapocznik & Coatsworth, 1999) and contemporary grounded theory analysis (Braun & Clarke, 2006; Charmaz, 2006; Noble & Mitchell, 2016), this study examined multilevel influences on nicotine-related attitudes among Latine youth, including: (1) familial factors (i.e., parental monitoring, caregiver-youth communication), (2) cultural dynamics (i.e., cultural values and …

Propensity Score Matching Accounting For Longitudinal Trends Before Baseline With Group-Based Trajectory Modeling, Dustin R. Bastaich

Theses and Dissertations

Propensity score matching is used in observational studies to balance baseline attributes between a treatment of interest and a control group. Propensity score matching typically relies on baseline variables, but longitudinal trends in patient characteristics can also influence treatment decisions and subsequent health outcomes. This dissertation extends standard approaches by explicitly incorporating longitudinal trajectories of key variables into the propensity score estimation process.

Trends in a longitudinal variable prior to baseline were characterized using group-based trajectory modeling. A two-step modeling approach was implemented where trajectory groups of a key variable were first estimated and then included as covariates in the …

Characterization Of Growth, Motility And C-Di-Gmp In Selenomonas Sputigena Atcc 35185, Margaret E J Stiker

Theses and Dissertations

Selenomonas sputigena is an obligate anaerobic, Gram-negative pathobiont that transitions from a low-abundance commensal bacteria to a structural component in dysbiotic oral biofilms associated with early childhood caries and periodontitis. Analysis of S. sputigena ATCC 35185 cultures optimized in TYGVS media revealed robust growth, characteristic crescent morphology with flagellar tuft motility, and strong monospecies biofilm formation comparable to Streptococcus mutans via crystal violet assays.

ELISA quantification demonstrated significantly elevated c-di-GMP levels in sessile biofilm fractions relative to motile planktonic cells (p=0.0009), establishing the secondary messenger’s correlation with the motile-sessile lifestyle switch. Recombinant expression and purification yielded PilZ-domain effector proteins, Selsp_1666 …

Examining Bidirectional Associations Between Mothers’ Beliefs About Emotions And Child Social-Emotional Outcomes, Sydney Sumrall

Theses and Dissertations

Social-emotional (SE) skills encompass the ability to recognize and regulate emotions, manage behavior to act on goals, and maintain social relationships (Abrahams et al., 2019). Parents play a crucial role in child SE skill development. According to theories of emotion socialization (ES), the beliefs parents hold about emotions shape parents’ ES behaviors, including teaching children how to understand and express feelings (Eisenberg et al., 1998; Gottman, 1996). Because emotion socialization practices are influenced by cultural values (Raval & Walker, 2019), the parent beliefs and ES strategies that best support children’s SE skill development may vary across families’ racial backgrounds. Although …

Social And Community Determinants Of Alcohol Use Among Hispanic/Latino College Students: The Role Of Early Adversity And Drinking Motives, Isis A. Garcia-Rodriguez

Theses and Dissertations

Background. Alcohol use remains one of the most prevalent health-risk behaviors among college students in the United States and is associated with a range of academic, physical, and psychological consequences. Hispanic/Latino college students navigate complex social and cultural environments that may influence alcohol use behaviors, including exposure to early-life adversity, sociopolitical stressors, and culturally grounded sources of resilience. Guided by the Healthy People 2030 Social Determinants of Health (SDOH) framework, this study examined how social and community context factors relate to alcohol use among Hispanic/Latino college students and whether drinking motives function as a psychological mechanism linking social experiences to …

Environmental Monitoring In Shallow Lakes: Public Health Threats In Urban Waters, Kyleigh E. Johnson

Theses and Dissertations

Lakes are an integral part of urban and suburban communities, providing ecological, recreational, and public health benefits. Many of these lakes are located in densely populated areas and are subject to urban influences on water quality. Algal toxins and Escherichia coli are two common recreational concerns. Algal toxins come from harmful algal blooms that are influenced by nutrient availability and temperature, while bacteria are often introduced through run-off and animal waste. Sampling every 3-4 weeks from May-October 2025 allowed for the assessment of seasonal patterns and site-specific differences across nine lakes in the Richmond area. The highest bacterial concentrations appeared …

Mathematical Models With Clinical Applications For Improving Health Outcomes, Helen Harris

Theses and Dissertations

In clinical settings, patients are exposed to many risks and stressors that could result in adverse health outcomes. Here we present mathematical models that seek to address these risks. First, we present a Markov Chain model to investigate the effect of medication reconciliation (MR) completion on patient health outcomes in the intensive care unit. Using this model, we simulate the annual incidence of adverse drug events (ADEs) for three different ADE rates. Based on the simulated results, we conduct a cost-benefit analysis for various levels of compliance to determine the financial implications of increasing MR completion depending on the baseline …

Absolute Quantification And Identification Of Rna From Rna-Lipid Nanoparticles Using High Resolution Mass Spectrometry, Jason C. Funderburk

Theses and Dissertations

RNA therapeutics are a rising drug category with potential use for a range of conditions encompassing infectious diseases to therapies for cancer, diseases, and genetic disorders. RNA-lipid nanoparticles (RNA-LNPs) are the prominent delivery method for these therapeutics approved products include mRNA vaccines and polyneuropathy treatments. The emergency use authorizations and orphan drug status of current RNA-LNP drugs has allowed approval without finalization of the regulatory analytical procedures for quality monitoring. The objective of the study was to develop an LC-MS assay to simultaneously measure identity and concentration of two therapeutically relevant intact RNA constructs extracted from RNA-LNPs to enhance quality …

A Framework For Digital Energy Modulation And Translation In Projectional X-Ray Imaging, Richard R. Wargo

Theses and Dissertations

In projectional X-ray imaging, acquisition energy fundamentally influences subject contrast, image noise, and radiation dose. While dual-energy techniques exploit spectral differences to optimize contrast and enable material separation, acquiring multiple images of the same anatomy often requires additional exposures and increased system complexity.

This dissertation presents a framework for digital energy modulation (DEM), in which computational models are trained to translate projection images between energy domains without requiring additional X-ray acquisitions. DEM is conceived as a generalizable strategy for controlled contrast modulation in projection imaging, with potential applications in image optimization, radiation therapy alignment, and dual-energy applications.

The framework was …

The Impacts Of Mentoring On Mentor Teachers In A Teacher Residency Program, Eric J. Lindley

Theses and Dissertations

Teacher shortages across the United States have made educational researchers consider strategies for teacher retention. Teacher Residency Programs (TRPs) are a compelling focal area in which to study mentorship as it relates to teacher shortages and teacher retention because of their intentional preparation, development, and support for participating mentor teachers. For my dissertation study, I was interested in exploring mentors’ perceptions of their roles, relationships, and preparation as well as the impacts that mentoring had on them beyond what has already been reported in the literature. Using a qualitative interview design study approach, I conducted semi-structured interviews with 13 experienced …

Generating Synthetic Ct From Mri Data, Foysal Ahmed

Theses and Dissertations

Magnetic resonance imaging (MRI) provides excellent soft tissue contrast without ionizing radiation, making it a strong alternative to computed tomography (CT) in medical imaging workflows. However, CT remains essential for applications requiring electron density information, such as radiation therapy treatment planning. This study investigated the feasibility of generating synthetic CT (sCT) images from MRI using a deep learning-based U-Net architecture. A two-dimensional U-Net was trained on paired MRI-CT data from the SynthRAD 2025 dataset, consisting of 120 T1-weighted (T1W) and 60 T2-weighted (T2W) axial cases, including deformed CT (dCT) aligned to MRI. Model testing used an independent dataset of 30 …

Magnetic Resonance Only Planning Validation Using Synthetic Ct By Mvision, Eric D. Brass Sr

Theses and Dissertations

Problems: Adaptive radiotherapy requires clinically practical methods for responding to patient-anatomy changes that occur between the original planning images and the day of treatment delivery. Registering a previously acquired computed tomography scan to a newly acquired magnetic resonance image can introduce cross-modality uncertainty and may delay replanning. This thesis evaluates whether synthetic computed tomography generated from same-day magnetic resonance imaging can reduce registration-related uncertainty while supporting rapid dose recalculation for fraction-level adaptation.

Procedure: Magnetic resonance imaging DICOM data were exported from the ViewRay MRIdian treatment planning system and uploaded to MVision for synthetic computed tomography generation. The synthetic computed tomography …

Development Of A Practical Lu-177 Activity Calibration Protocol For Clinical Nuclear Medicine: Dosimetric Impact Analysis And Implementation Tools, Azam Almolaiki

Theses and Dissertations

Lutetium-177 (Lu-177) is widely used in radionuclide therapy, where accurate activity measurement prior to administration is essential for safe and effective treatment delivery. However, variability in dose calibrator response due to measurement conditions and source geometry remains a practical challenge in routine clinical settings. This study presents a practical clinical calibration strategy under real-world constraints for Lu-177 activity measurement using standard nuclear medicine instrumentation. A vial-based approach was implemented using a well-type ionization chamber (Capintec CRC-15R) to evaluate measurement repeatability, temporal stability, and geometry dependence. All measurements were performed under consistent conditions with appropriate decay correction applied using the physical …

A Mutant Perfect, Amelia R. Baxter

Theses and Dissertations

A Mutant Perfect examines how embodied knowledge can be made visible and transmissible through ceramic figures. The research asks what forms emerge when making is understood as a mode of thinking rather than a vehicle for pre-formed ideas, and how those forms might activate somatic recognition in a viewer. The primary method is coil-built ceramic sculpture. Color is applied in layered coats and removed by hand-sanding to expose varying strata beneath, producing a speckled, worn surface. In a second approach, pigment is built directly into the clay body through coil construction, making color structural rather than applied. Narrative prose and …

Characterization Of Microrna Expression In Neuron-Enriched Extracellular Vesicles During Early Life, Allison Molen

Theses and Dissertations

Extracellular vesicles (EVs) are membrane-bound sacs released by cells that carry molecular cargo reflective of their cell of origin. EVs enriched using L1 cell adhesion molecule (L1CAM) as a marker of putative neuronal origin can cross the blood–brain barrier and provide a minimally invasive window into brain-related processes. Exosomal microRNA (miRNA) regulate gene expression and have been implicated in psychiatric disorders, including major depressive disorder (MDD). However, measuring and analyzing miRNA from L1CAM-positive EVs presents substantial analytical challenges due to low abundance and sparse detection across samples.

Plasma samples from participants recruited through the Mid-Atlantic Twin Registry (MATR) were used …

A Qualitative Analysis Of Teacher-Report Modifications Of A Tier 2 Evidence-Based Program In Elementary Schools After Implementation Supports Are Withdrawn, Navneet Kaur

Theses and Dissertations

Growing literature emphasizes the importance of examining modifications (i.e., responses to unforeseen challenges and deliberate changes to a program) made by implementers to understand the long-term outcomes of evidence-based programs (EBPs), particularly after formal implementation supports, such as training and coaching, are withdrawn. Although prior research has documented that they occur during implementation, less is known about whether modifications occur once external supports are no longer available, and if so, what types of modifications are made, and the rationale for them. This gap is especially salient in school settings for teacher-delivered interventions. To address this gap, this study used semi-structured …

Examining The Impact Of Trauma-Informed Mindfulness Meditation On Posttraumatic Growth Following Interpersonal Trauma: A Randomized Controlled Trial, Margaret Poandl

Theses and Dissertations

Research on interventions designed to increase posttraumatic growth (PTG) among interpersonal trauma survivors is limited. The purpose of this study was to examine the impact of a six-week trauma-informed mindfulness meditation intervention on PTG. Additionally, I examined outcomes of posttraumatic stress (PTS) and loneliness, as well as analyzed the variables of dispositional mindfulness, hope, spirituality, and self-compassion to understand their potential role as mechanisms of change within the intervention on PTG. To answer these research questions, I conducted a randomized controlled trial study with 113 adults from a community sample who reported experiencing interpersonal trauma. Utilizing linear mixed modeling and …

Commissioning & Daily Qa Of Converted Linac For Electron Flash, Tomaj Javidtash

Theses and Dissertations

Ultra-high dose rate (FLASH) radiotherapy has demonstrated promising normal tissue sparing in preclinical studies; however, the lack of standardized dosimetry, commissioning, and quality assurance (QA) methodologies remains a major barrier to its reproducible and safe implementation. In particular, conventional clinical commissioning and QA protocols are not directly applicable at FLASH dose rates due to challenges associated with detector response, dose-per-pulse effects, and beam control limitations.

This thesis presents the commissioning of a converted Varian 21EX linear accelerator for electron FLASH operation within the Division of Medical Physics at the Virginia Commonwealth University (VCU) Department of Radiation Oncology. Comprehensive beam characterization …

Within The Ruin: A Modern Brewery Rebirth, Karim Asarzadeh

Theses and Dissertations

This thesis project focuses on the revitalization of the historic ruins of the James River Steam Brewery in Richmond, Virginia. The project transforms the forgotten industrial structure into a modern brewery with a second-floor restaurant addition and community gathering spaces while preserving the historic masonry ruins. It showcases a holistic design approach that considers all aspects of the building, including its connection to the urban context and landscape, as well as its architecture, interiors, and furniture. The project demonstrates how a holistic design approach can create stronger spatial connections and more cohesive environments. In particular, it offers a strategy for …