Digital Commons Network^™

Navigating The Complexities In Gender-Diverse Counseling: Understanding The Interplay Of Gender Identity, Racial Inequities, Economic Marginalization, And Aging, C. Gerwe

Department of Medicine Faculty Publications

Gender-diverse individuals continue to face unique challenges in daily life, with intersecting identities related to race, socioeconomic status (SES), and age further compounding these barriers. These overlapping factors profoundly impact mental health and wellbeing, especially within environments that may lack inclusive or responsive frameworks. Despite increasing awareness, limited guidance exists for counselors on implementing practices that validate intersecting identities while addressing the cumulative effects of marginalization (Canvin et al., 2022). This article synthesizes current research and case examples to illuminate these challenges and offers insights for fostering more inclusive and supportive counseling approaches.

Psychedelic Minimalism: The Case Against Music In Psychedelic Therapy Settings, Samir A. Nader

Department of Medicine Faculty Publications

[Introduction: reframing the role of setting] In recent years, renewed attention has been given to the centrality of set and setting in psychedelic-assisted therapy. The Reporting of Setting in Psychedelic Clinical Trials (ReSPCT) guidelines reflect an evolving consensus: therapeutic outcomes are not solely pharmacologically determined but are heavily shaped by both the environment and the psychological state of the participant (2). Within this evolving paradigm, music has assumed a privileged role, framed as a therapeutic constant, typically curated to be emotionally supportive or evocative, and especially emphasized during peak psychedelic states (3). The prevailing assumption is that music facilitates safety, …

The Reliability Gap: How Traditional Search Engines Outperform Artificial Intelligence (Ai) Chatbots In Rosacea Public Health Information Quality, Houston C. Nelson, Morgan T. Beauchamp, April A. Pace

Department of Medicine Faculty Publications

Background: The internet has become a primary source of health information for the public, with important implications for patient decision-making and public health outcomes. However, the quality and readability of this content vary widely. With the rise of generative artificial intelligence (AI) tools such as ChatGPT and Gemini, new challenges and opportunities have emerged in how patients access and interpret medical information.

Objective: To evaluate and compare the quality, credibility, and readability of consumer health information provided by traditional search engines (Google, Bing) and generative AI platforms (ChatGPT, Gemini) using three validated instruments: DISCERN, JAMA Benchmark Criteria, and Flesch-Kincaid Readability …

Late Diagnosis Of Klinefelter Syndrome: Overcoming Phenotypic Variability And Diagnostic Oversights, Amna Kamran, Chinelo Okigbo

Department of Medicine Faculty Publications

We report a case of Klinefelter syndrome (KS) diagnosed in adulthood, emphasizing the impact of phenotypic variability and the declining reliance on physical examination in delayed recognition. A 27-year-old male with obesity, low libido, and biochemical and clinical primary hypogonadism was found to have 47, XXY karyotype, consistent with KS. His hypogonadism was initially attributed to obesity and overlooked, despite classic signs of a micropenis and small testes. The case highlights the importance of physical examination, comprehensive history, and clinician awareness in diagnosing KS, particularly in atypical presentations. KS is associated with increased risks of osteoporosis, cardiovascular disease, and psychosocial …

Percutaneous Levoatrial Cardinal Vein Closure For Stroke Prevention, Chee Spencer, Amir Hasani, Alexander Ellis, David Adler

Department of Medicine Faculty Publications

We report 2 cases of cerebral embolism related to congenital levoatrial cardinal vein anomalies. Both patients had positive echocardiographic agitated saline studies but intact interatrial septum on transesophageal echocardiography. Levoatrial cardinal vein was diagnosed using computed tomography angiography. A novel technique for percutaneous levoatrial cardinal vein closure using vascular plug devices was successful in both patients.

Screening And Addressing Food Insecurity At Free Clinics: A Scoping Review, Gautam Ramanathan, William Zak, Daiwik Munjwani, Robert Fisher, Esther May Sarino, Mary J. Scourboutakos

Department of Medicine Faculty Publications

Food insecurity (FI) is highly prevalent amongst patients seeking care at free, student-run health clinics. This study sought to examine the existing literature of food insecurity screenings and interventions at free clinics across the U.S. In this review, we provide the rate of FI screenings, the prevalence of FI, demographic information of patients screened, and interventions and barriers faced by clinics while implementing interventions to improve FI. Studies included in this review needed to implement a FI screening and intervention program in a free clinic within the United States. Additionally, eligible studies could address additional social determinants of health or …

Blood Culture Utilization: How Many Follow-Up Cultures Are Needed?, George Jones, Jennifer Hanrahan

Department of Medicine Faculty Publications

Background: Follow-up blood cultures (BCx) are ordered after an initial positive culture in many instances. The number of follow-up cultures needed is not clear. Obtaining unnecessary BCx may cause unintended consequences. The optimal balance between stewardship and patient safety warrants investigation. We sought to assess the frequency with which a third set is positive after a negative second BCx. Methods: We conducted a retrospective study of BCx submitted to the microbiology laboratory from 1/1/18-11/1/23. We included all patients ≥18 years who had at least two follow-up BCx drawn 24-72 hours after an initial positive culture. Data were collected from electronic …

Continuous Quality Improvement In Social Needs Screening: Evaluation Of An Intervention In Bariatric Specialty Care, Claire Chang, Samantha Cooley, Bradley Iott, Jordan Greene, Dilhara Muthukuda, Renuka Tipirneni

Student Publications

_{Introduction:}

With growing recognition of the influence that social risks, such as food insecurity and housing instability, have on individual and population health, social risk screening and social care interventions have proliferated across the health system. Social needs intervention research on screening and referral in specialty care is limited, despite evidence that social needs influence access to and outcomes of surgical and specialty care.

_Methods:

This study is a qualitative, formative evaluation of a quality improvement-oriented social needs screening and referral pilot program implemented in a bariatric surgery practice and aims to share lessons related to the structure and process …

Enhancing The Research Enterprise At A Health Sciences University: A Call For An Institutional Paradigm Shift, Bryan G. Beutel, Taryn Bissing, Aaditya Patel, Nicolette Duong, Jan Talley

Student Publications

Background:

There exists a rapidly growing need for a universally robust research enterprise at health sciences universities because of recent changes in the medical education landscape. This study aimed to evaluate student perceptions of (and challenges conducting) research and to implement effective strategies to expose students to enhanced resources and training.

Materials and Methods:

An anonymous survey developed using participatory research methods was disseminated to all students at a graduate health sciences university in 2023. This measured their engagement in research, resource needs, and barriers. Descriptive statistics quantitively analyzed factors that influence student participation in research, perceived benefits, and obstacles …

Influence Of Faculty-Derived Concept Maps On Student Study Strategies, Kaitlin P. Hardy, Amanda K. Burbage, Julie A. Kerry

EVMS School of Health Professions Faculty Publications

Background

Concept mapping is a well-established tool for students to actively organize information into a visual and spatial framework. However, some students are resistant to adopting concept mapping as a study strategy due to the time and effort involved in generating the maps. In this study, we explored student perceptions of faculty-derived concept maps (FD-maps) developed to accompany content within a Foundational Science module in a medical school curriculum. We subsequently investigated whether student use of FD-maps helped overcome resistance to adoption of concept mapping.

Methods

Student evaluation data was analyzed using a mixed methods approach to explore student perceptions …

Team Science In Interdisciplinary Health Professions Education Research: A Multi-Institutional Case Study, Peggy Gesing, Joni Tornwall, Violet Kulo, Sarah Mcbrien, Thuha Hoang, Hyun-Jin Jun, Amanda Burbage, Yuane Jia, Christina Cestone

EVMS School of Health Professions Faculty Publications

The interdisciplinary nature of health professions education requires exploration of problems by interdisciplinary research teams. Drawing on the Dynamics of Cross-disciplinary Research Development conceptual framework, this study explores the processes and experiences of an interdisciplinary research team, identifying elements of successful collaboration. Case study data were collected from a team of nine researchers from six universities. Data included meeting minutes and researcher reflections. Researcher reflection and meeting minute themes converged within the framework constructs: Contexts and inputs, social learning processes, social capital outcomes, and knowledge and human capital outcomes. This study provides a blueprint for interdisciplinary researchers indicating that successful …

Increasing Serious Illness Conversations In Patients At High Risk Of One-Year Mortality Using Improvement Science: A Quality Improvement Study, Kanishk D. Sharma, Sandip A. Godambe, Prachi P. Chavan, Agatha Parks-Savage, Marissa Galicia-Castillo

Department of Family and Community Medicine Faculty Publications

Background: Serious illness conversation (SIC) in an important skillset for clinicians. A review of mortality meetings from an urban academic hospital highlighted the need for early engagement in SICs and advance care planning (ACP) to align medical treatments with patient-centered outcomes. The aim of this study was to increase SICs and their documentation in patients with low one-year survival probability identified by updated Charlson Comorbidity Index (CCI) scores. Methods: This was a quality improvement study with data collected pre- and post-intervention at a large urban level one trauma center in Virginia, which also serves as a primary teaching hospital to …

Strategies For Success: Developing The Hero Within To Increase Persistence Of Community College Students Returning From Academic Dismissal, Angela Cavazos

Electronic Theses and Dissertations

Students are enrolling in college at a higher rate than ever before, yet retention rates continue to be problematic for higher education institutions across the United States. Many students fail to persist beyond their first year and are often forced out due to academic difficulties. Students who return from academic dismissal are likely to be dismissed again. This quasi-experimental quantitative action research study aimed to evaluate the impact that a student success intervention course designed through an asset-based positive self-leadership framework and focused on the development of psychological capital constructs of hope, efficacy, resilience, and self-efficacy (HERO) had on the …

Persistent Reading Deficiencies In Early Education, William Steven Reed

Electronic Theses and Dissertations

This qualitative case study investigated early reading teachers’ perceptions of the instructional practices they use to identify early elementary student reading proficiency, including unique challenges they face when addressing the development of early reading skills. The researcher investigated eight first and second grade teacher classrooms during the 2023–2024 school year through collective interviews, observations, and related school data. The researcher performed a qualitative analysis of the collected data to reveal varying themes that support recommendations to reduce persistent reading problems among early elementary students. Using purposeful sampling to select licensed, experienced participants, the insights of eight early elementary reading teachers …

A Higher Calling: How Christian Student Affairs Administrators Integrate Their Faith While Working At Public Community Colleges, Danielle J. Ward

Electronic Theses and Dissertations

Abstract

The cornerstone of the student affairs field was the intentional focus on holistic student development, their mind and spirit. The problem addressed was that many student affairs professionals felt ill-equipped and uncomfortable discussing and expressing their personal faith at some institutions of higher education. As a result, some were hesitant about integrating faith at work, personally and professionally. The study sought to identify faith's role in Christian student affairs administrators who worked at public open-admission community colleges and the administrators’ perceptions of how their personal faith integration at work impacted their relationships with students and colleagues. The paradigm for …

The Relationship Between Mental Health Disclosures, Employee Sentiments And Turnover Intention In The Workplace, Steve G. Winkel

Open Access Dissertations

Purpose. The purpose of this study is to examine the relationship between employees’ disclosure of mental health conditions in the workplace and these employees’ sentiments, feelings, and associated outcomes. Utilizing constructs of job satisfaction, affective commitment, normative commitment, motivation, and turnover intentions, the research aims to understand quantifiable differences in the employment experience between employees who disclose and do not disclose (non-disclosure) mental health conditions, as well as the mediating roles of human resources management (HRM), supervisors support, and employee authenticity. Through self-reported data detailing employees’ disclosure experiences, the research also aims to understand the disclosure conversation's specific impact …

Incentives, Performance Metrics, And Healthcare Supply Chain Waste, Sharon Ann Franzetta

Open Access Dissertations

Healthcare spending in the United States (US) is increasing at a rate higher than the US gross domestic product while the demand for healthcare services is simultaneously increasing. With supply costs posing as the second highest cost in hospital expenditures, reducing supply expenses by means of eliminating supply management waste could potentially reduce overall healthcare costs. Supported by evidence found through three manuscript studies, this study expounds upon the findings from previous studies to better understand the relationship between medical supply inefficiency due to the influence of stakeholders’ misaligned decision-making in efforts to achieve performance goals. This exploratory, mixed-methods study …

Quantifying Links Between Phytoplankton Physiology And The Environment, Gabrielle M. Armin

Open Access Dissertations

Phytoplankton are microscopic, primary producers in aquatic ecosystems worldwide. They are key links in global biogeochemical cycles, converting inorganic compounds into bioavailable nutrients which fuel fisheries. Through photosynthesis, phytoplankton play an essential role in the carbon cycle and marine biological pump, drawing carbon from the atmosphere, which is eventually sequestered in the oceans, regulating our Earth’s climate. Due to their influential role in large scale processes, there have been many efforts to characterize and quantify phytoplankton impacts to ecosystem health and global nutrient cycles. Often, phytoplankton physiology has been highly simplified in global or ecosystem models, limiting their representation to …

Development And Deployment Of In Situ Fiber Optic Distributed Temperature Sensing Systems And Data Processing Workflows For Oceanographic Observatories In Coastal And Deep-Sea Environments, Johann Sebastian Becker

Open Access Dissertations

Over the last two decades, fiber optic distributed temperature sensing (DTS) has emerged as a transformative technology capable of providing unprecedented spatiotemporal resolution observations of temperature in a broad range of environmental sensing, industrial, and civil engineering monitoring applications. DTS uses a single interrogator unit to measure temperature continuously along an optical fiber, effectively turning the fiber into the equivalent of an array of temperature probes that can be interrogated synoptically. Modern commercially-available DTS systems are capable of continuous sensing with sampling frequencies up 5 sec, spatial resolution of 0.25 m, and temperature precision up to 0.01 °C) observations, on …

More Than Just Food And Money: An Exploration Of College Students’ Challenges With Food Access And Insecurity, Orianna Duncan Carvalho

Open Access Dissertations

There has long been a popular prototypical image of the starving college student surviving on cheap ramen noodle meals, but research suggests there is more to this than meets the eye. Food insecurity, the condition in which individuals are unable to secure enough food to support a healthy lifestyle, has been investigated and reported with increasing frequency on college campuses, including the university at which the present study is conducted. Thus, the purpose of the present study was to delve further into college student food insecurity to gain a better understanding of how students experience and perceive it. To achieve …

Investigating Mono-Driver Versus Multi-Driver Oncogenesis Via Alterations To Cell Signaling Pathways, Abygail Chapdelaine

Open Access Dissertations

The latest edition of Global Cancer Statistics released by the American Cancer Society reported approximately 20 million newly diagnosed cancer cases worldwide in 2022 with 9.7 million deaths. This ranks cancer as the second leading cause of death worldwide. For the majority of cancer patients, the standard treatment approach is chemotherapy and/or radiation therapy, and while this has been successful in some patients, a lack of specificity to cancer cells causes severe side-effects when these agents damage healthy cells. Despite extensive efforts that have gone into developing targeted cancer therapeutics that block functions specific to cancer, they have not been …

The Effect Of Maternal Diet On Developmental Programming: A Cross Species Analysis, Lindsey Eileen Eaton

Open Access Dissertations

Maternal nutrition plays an important role in shaping offspring health through developmental programming, with lasting implications on metabolic function and disease susceptibility. This dissertation explores the molecular and physical consequences of maternal nutrition, particularly its effects on pancreatic development and function in offspring. Chapter one provides a comprehensive review of the literature, detailing the mechanisms of fetal development, epigenetic regulation, and metabolic programming. It highlights the thrifty phenotype hypothesis, the role of DNA methylation and histone modifications, and the impact of maternal nutrition, emphasizing how nutrient availability during pregnancy influences fetal organogenesis and long term metabolic health.

Chapter two examines …

“Swap What No Longer Serves”: An Exploration Of Zero Waste Fashion Communities Online And Irl, Rosemary Leger

Open Access Dissertations

As sustainability concerns grow within the fashion industry, consumer-based communities play a critical role in shaping more responsible consumption practices. This dissertation explores how individuals engage with zero-waste fashion both online and in physical practice, offering a deeper understanding of their motivations, behaviors, and visions for a more sustainable fashion future.

Through a two-study approach, this research investigates the communication and knowledge-sharing practices within digital zero-waste fashion communities and explores the experiences of individuals participating in offline zero-waste initiatives. Study 1 employs netnography to analyze online zero-waste fashion discourse, identifying how consumers exchange knowledge and promote sustainable practices in digital …

Democratizing Deep-Sea Technology Development Using Rapid Prototyping Techniques, Breanna Motsenbocker

Open Access Dissertations

Deep-sea research and exploration have consistently been inaccessible to a broader oceanographic community due to the lack of affordable technology and resources that are required for this type of work. Traditionally, to investigate the deep sea, large research vessels are required to operate the expensive and massive equipment that can withstand the intense pressure and harsh environment beyond 200 meters of water. Not only does this lessen the capacity for exploring the deep sea but it also introduces an extreme inequity for who can participate and lead these efforts. With a growing demand for the global Blue Economy and a …

Light, Symbiosis, And The Biology Of Corals, Taylor R. Lindsay

Open Access Dissertations

Light is critical for the survival of most shallow water scleractinian corals. Corals are mixotrophs, acquiring energy via both feeding on water column plankton and photosynthesis via a symbiotic relationship with dinoflagellates living within their tissues. Corals rely heavily on photosynthetically derived metabolites through this symbiotic relationship, intrinsically linking their biology to light availability. Corals are known to modulate their biology to maximize light capture. However, there is a limited understanding of the interaction between morphology, physiology, and energetic strategy, as well as how light may affect these relationships. In Chapter 1, we quantified the morphology, physiology and energetic …

Development And Characterization Of Polysaccharide-Based Controlled Drug Delivery Platforms, Amanda Pepler

Open Access Dissertations

Drug delivery research focuses on overcoming challenges in patient treatment. Most therapeutics are delivered systemically through oral or intravenous routes. However, these administration methods are often inefficient due to therapeutic hydrophobicity, poor bioavailability, and liver metabolic clearance, necessitating frequent dosing. When treatment plans require frequent dosing, patients experience significant fluctuations in therapeutic concentration in the bloodstream, which can increase adverse side effects. These factors contribute to low patient compliance. Therefore, the core focus of drug delivery research is to develop new administration routes for therapeutics. Drug delivery systems (DDS) that can target therapeutics to a localized region offer advantages over …

A Qualitative Case Study Exploring The Implementation And Influence Of An Inter/Intragenerational Digital Equity Training Program, Josie Santilli

Open Access Dissertations

Background: Many older adults are unable to fully engage in society because of the digital divide, leaving them disconnected from essential services, social networks, and community engagement. This lack of access to technology leads to greater isolation and loneliness, significantly increasing their risk of physical and mental health issues. It also threatens their ability to age in place, as they struggle to navigate everyday tasks like managing healthcare, finances, and communication. Without digital literacy, maintaining independence becomes an increasingly difficult challenge, leaving them vulnerable and reliant on others for support. The purpose of the research completed in manuscript 1 …

Novel Methodology And Proof-Of-Concept For Proton Ct Using Spot Profile Rather Than Bragg Peak Location, Brett Albert Ruben

Open Access Dissertations

Proton radiation therapy offers a highly precise method for cancer treatment, theoretically providing superior dose deposition characteristics compared to conventional X-ray radiation therapy. Its steep and finite dose fall-off region allows for superior tumor coverage while reducing, though not eliminating, dose to surrounding healthy tissue. However, its full potential is limited by range uncertainties, particularly those arising from the reliance on X-ray-based imaging methods called computed tomography (CT) for proton-based treatment. CT image Hounsfield Units (HU) must be converted to stopping power ratios (SPR) as these ratios are the clinically relevant value for accurately planning particle interactions during proton therapy. …

The Effects Of Ph And Oncometabolites On Dna Repair Mediated By Alkb Family Enzymes, Quentin Mylie

Open Access Dissertations

Modifications of DNA and RNA, in particular methylations - such as N⁶-methyladenine (m6A), 5-methylcytosine (m5C), 1-methyladenine (m1A), and 3-methylcytosine (m3C) are crucial for gene regulation, genome integrity, and cellular adaptation. This dissertation investigates the role of the ALKB family of alpha-ketoglutarate (αKG) and iron-dependent dioxygenases in modulating these modifications, with a focus on how their activity is influenced by pH and metabolic factors, underscoring the connection between environmental conditions and epigenetic and genetic stability.

Chapter 1 provides a comprehensive literature review on the epigenetic and genetic regulation of DNA and RNA modifications, with a particular focus on methylation …

Intersections Of Inattention: A Qualitative Inquiry Into The Experiences Of Multiply Marginalized Students In Community College Settings, Jana N. Knibb

Open Access Dissertations

Educational research has examined the impact of expanded access to higher education for historically marginalized groups. However, research on the experiences of students who are both racially minoritized and dis/abled is limited. Findings suggest that, due to their intersectional identities, multiply marginalized dis/abled students (MMDS) navigate policies and practices related to racist ableism, which further marginalize them and create additional barriers in their higher education experiences. Expanding this research requires theoretical frameworks that account for students' identities, experiences, and barriers in higher educational spaces and contexts. This qualitative study, grounded in Dis/ability Studies and Critical Race Theory in Education (DisCrit), …