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 …

Microrna In The Mammalian Growth Plate: Matrix Vesicles And 1Α,25-Dihydroxyvitamin D3, Niels C. Asmussen

Theses and Dissertations

Growth plate chondrocytes are the driving force of long bone elongation and they accomplish this vital task, in part, by producing, remodeling, and finally mineralizing the cartilage tissue that makes up the growth plate. This mineralized tissue is turned over again as bone forming cells invade and began the process of turning mineralized cartilage into bone. Chondrocytes undergo a distinct series of observable phases as they move through this process transitioning from a stage of proliferation to one of hypertrophy and finally capillary invasion. Chondrocytes produce matrix vesicles (MVs) that they release into the growth plate and that attach to …

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, …

Black Feminist Thought, Interrupted: Dissecting The Voice Of Black Feminists In The Blogosphere And Their Engagement With Platform Affordances, Dawn G. Johnson

Theses and Dissertations

ABSTRACT

BLACK FEMINIST THOUGHT, INTERRUPTED

DISSECTING THE VOICE OF BLACK FEMINISTS IN THE BLOGOSPHERE AND THEIR ENGAGEMENT WITH PLATFORM AFFORDANCES

By Dawn G. Johnson, Ph.D

A dissertation submitted to the faculty at Virginia Commonwealth University in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Media, Art, and Text Department in the College of Humanities and Sciences

Virginia Commonwealth University, 2021

Dissertation Chair: Dr. Archana Pathak, Associate Professor, Dept. of Gender, Sexuality & Women's Studies, Virginia Commonwealth University

Black women that have long searched for spaces to be creative and have voice due to their …

Prolactin Drives A Dynamic Stat5a/Hdac6/Hmgn2 Cis-Regulatory Landscape Exploitable In Er+ Breast Cancer, Justin M. Craig

Theses and Dissertations

The hormone prolactin has been implicated in breast cancer pathogenesis and regulates chromatin engagement by the transcription factor, STAT5A. STAT5A is known to inducibly bind promoters and cis-regulatory elements genome-wide, though the mechanisms by which it exerts specificity and regulation of target gene expression remain enigmatic. We previously identified HDAC6 and HMGN2 as cofactors that facilitate prolactin induced, STAT5A mediated gene expression. Here, multi-condition STAT5A, HDAC6, and HMGN2 ChIP-seq with parallel condition RNA-seq are utilized to reveal the cis-regulatory landscape and cofactor dynamics underlying prolactin stimulated gene expression in breast cancer. We find that prolactin regulated genes are …

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 …

Efficient Vengeance: The Role Of Processing Fluency In Making Decisions About Retaliation, Samuel J. West

Theses and Dissertations

Aggressive behavior is a harmful and pervasive psychological and behavioral phenomenon. Inherent to every act of aggression are decisions regarding the modality, severity, and timing of such actions. Prevailing theories of aggression emphasize the role of cognitive processes in aggression, especially retaliatory aggression. Despite this emphasis, few cognitive processes have been examined for their possible involvement in making decisions about retaliatory aggression. Across two studies, I examined the role of processing fluency in making decisions about retaliation. I drew from contemporary models of aggression (e.g., the General Aggression Model) and processing fluency (e.g., the Multi-Source Account) to develop hypotheses in …

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 …

First-Year Retention At Virginia Commonwealth University: Understanding Student Departure And The Potential Impact Of Academic Advising, Ben Plache

Theses and Dissertations

This dissertation examines first-year enrollment at Virginia Commonwealth University to determine what factors are associated with an increased likelihood of a student not being retained, and for which of these factors there is evidence that academic advising is an effective intervention. A survey of common retention models identified six factors associated with retention likelihood: student background prior to enrollment (“pre-enrollment factors”), financial support, institutional support, institutional performance, institutional engagement, and student intention. Prior research has shown that academic advising is an effective intervention for two of these factors: institutional performance and institutional support.

The significance of these factors was tested …

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 …

Fabrication Of Metal-Silicon Nanostructures By Reactive Laser Ablation In Liquid, Eric J. Broadhead

Theses and Dissertations

Metal-silicon nanostructures are a growing area of research due to their applications in multiple fields such as biosensing and catalysis. In addition, silicon can provide strong support effects to metal nanoparticles while being more cost effective than traditionally used supports, like titania. Traditional wet-chemical methods are capable of synthesizing metal-silicon nanostructures with a variety of composition and nanoparticle shapes, but they often require high temperatures, toxic solvents, strong reducing agents, or need capping agents added to stabilize the nanoparticles. Laser processing is an emerging technique capable of synthesizing metal-silicon composite surfaces that offers a faster, simpler, and greener synthesis route …

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 …

Evaluation Of Regional Extrathoracic Deposition Of Low- And High-Momentum Aerosol Using Anatomically-Correct In Vitro Airway Models, Sana Hosseini

Theses and Dissertations

The popularity of pulmonary aerosol delivery is increasing due to numerous advantages including non-invasiveness, fast onset of action, avoidance of the first-pass metabolism, and relatively good patient compliance. However, aerosol delivery to the site of action within the extrathoracic regions is challenging to quantify from a regulatory perspective due to the combined effects of the device and formulation characteristics, complex morphology of the airways resulting in extreme anatomical variabilities, and user dependent administration methods. Besides the therapeutic aerosol delivery, electronic nicotine delivery systems (ENDS) are a user-driven aerosol technology used to deliver nicotine as one of the electronic liquid (e-liquid) …

The Rational Synthesis Of Lanthanum Manganite Nanomaterials For Magnetic Refrigeration Applications, Caitlin Hunt

Theses and Dissertations

Refrigeration systems for the cooling of commercial and residential buildings are a major drain on energy resources and source of greenhouse gas emissions. Magnetic refrigeration, which employs the magnetocaloric effect, has the potential to mitigate the energy drain and greenhouse gas emissions for air conditioning. In order to commercialize magnetic refrigerators, a material with a high magnetic entropy change, ΔS, near room temperature which is simple and inexpensive to create is needed.¹ Current options for this solid refrigerant are either expensive, difficult to synthesize, or have a ΔS or T_c (the Curie Temperature, where ΔS is maximized) below …

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) …

Looking For Hope: The Experience Of Early Career Teachers Engaged In A Collaborative Community Of Reflective Practice As A Model Of Induction And Professional Development, Donia E. Spott

Theses and Dissertations

Teaching has always been an isolated profession and many professional development programs are seen as disconnected from the realities and daily needs of teaching. With the pressures of standards, paperwork, classroom management, and learning to teach, early career teachers can be especially vulnerable to becoming discouraged, disillusioned, and demoralized. This study used a qualitative, narrative inquiry approach to tell the stories of seven early career teachers’ experiences with induction and the development of a reflective community to support early career teachers in their professional practice. As part of the action research approach taken in designing the program, the discussions and …

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 …

Strategies For Resolution Enhancement In Liquid Chromatography, Shelby Lynn Weatherbee

Theses and Dissertations

Recent research in liquid chromatography (LC) has led to the development of new methodologies to further improve sample analysis. Non-uniform stationary phases are one such area that focuses on developments in selectivity and efficiency of stationary phases. Within this subset of stationary phases are two major focuses: two-dimensional liquid chromatography (2D-LC) and continuous stationary phase gradients that are the basis of this work.

In this work, LC simulation software was adapted to simulate chromatograms based on experimental and modeled injection profiles. This was done by measuring the injection profiles from a 2D-LC active solvent modulation valve using a variety of …

Treatment Outcome Of Perforation Repair With Bio-Ceramic Based Materials: A Retrospective Study, Lolwa Alyahya

Theses and Dissertations

INTRODUCTION:

The aim of this retrospective cohort study was to assess the treatment outcome of orthograde perforation repair using bio-ceramic based materials.

METHODs:

Data from the VCU graduate endodontic practice were analyzed retrospectively. Treatment had been conducted by VCU endodontic residents under the supervision of qualified endodontists during the period from August 2014-December 2020. All cases in which a bio-ceramic based material had been used as a perforation repair material were included. Bio-ceramic based materials included MTA, EndoSequence Root Repair Material Putty and Paste (ERRM), and iRoot BP Plus Root Repair Material (BP-RRM). Perforation repair was performed using a dental …

Continual Learning For Multi-Label Drifting Data Streams Using Homogeneous Ensemble Of Self-Adjusting Nearest Neighbors, Gavin Alberghini

Theses and Dissertations

Multi-label data streams are sequences of multi-label instances arriving over time to a multi-label classifier. The properties of the data stream may continuously change due to concept drift. Therefore, algorithms must adapt constantly to the new data distributions. In this paper we propose a novel ensemble method for multi-label drifting streams named Homogeneous Ensemble of Self-Adjusting Nearest Neighbors (HESAkNN). It leverages a self-adjusting kNN as a base classifier with the advantages of ensembles to adapt to concept drift in the multi-label environment. To promote diverse knowledge within the ensemble, each base classifier is given a unique subset of features and …