Medicine and Health Sciences Commons^™

Heme Oxygenase 1 Expression After Traumatic Brain Injury And Effect Of Pharmacological Manipulation On Functional Recovery., Nicholas H. Russell

Theses and Dissertations

Traumatic Brain Injury (TBI) is an increasingly diagnosed constellation of injuries derived from acute mechanical trauma to the brain. With the rise of advanced neuroimaging techniques recent focus has oriented primarily towards the mild-moderate range of TBI which previously was missed diagnostically. Characteristically, these advances have shown increasing areas of micro-hemorrhage in susceptible areas of the brain and to date there are no treatment modalities targeting micro-hemorrhages or their sequelae. This dissertation explores the effects of the resulting heme processing response in the days following injury with a particular focus on inducing early heme clearance from the parenchyma using a …

Nitrosative Stress Sensing In Porphyromonas Gingivalis: Structure And Function Of The Heme Binding Transcriptional Regulator Hcpr, Benjamin R. Belvin

Theses and Dissertations

Porphyromonas gingivalis, a Gram negative anaerobe implicated in the progression of periodontal disease, is capable of surviving and causing infection despite high levels of reactive nitrogen species found in the oral cavity due to its efficient nitrosative stress response. HcpR is an important sensor-regulator that plays a vital step in the initiation of the nitrosative stress response in many Gram negative anaerobic bacteria. We employ a combination of X-ray crystallography, SAXS, resonance Raman spectroscopy, UV-Vis spectroscopy, and molecular biology techniques to better understand this key regulator. Knockout of the hcpR gene in W83 P. gingivalis results in the inability of …

Prevalence And Clinical Characteristics Of Teeth Extracted With A Diagnosis Of Cracked Tooth: A Retrospective Study, Riley B. Sturgill

Theses and Dissertations

The body of knowledge that exists regarding cracked teeth is limited. The purpose of this study was to determine the prevalence of cracks among extracted teeth. This retrospective longitudinal cohort study included patients of the Virginia Commonwealth University School of Dentistry that underwent extraction procedures over a 6 year period. The sample consisted of 20,408 patients and 40,870 teeth. Statistical analysis software was used to identify diagnoses of a crack, fracture, or split tooth prior to extraction of the tooth by analyzing the Electronic Health Record (EHR) (axiUm™, Version 6.03.03.1035, Exan Corporation, Vancouver, BC, Canada). There were 3,228 teeth …

Sleep Disturbances And Depression: The Role Of Genes And Trauma, Mackenzie J. Lind

Theses and Dissertations

Sleep disturbances and insomnia are prevalent, with around 33% of adults indicating that they experience at least one main symptom of insomnia, and bidirectional relationships exist with common psychopathology, particularly major depressive disorder (MDD). However, genetic and environmental (e.g., traumatic event exposure) contributions to the etiology of these phenotypes are not yet well understood. A genetically informative sample of approximately 12,000 Han Chinese women aged 30-60 (50% with recurrent MDD) was used to address several gaps within the sleep literature. Sleep disturbances were assessed in all individuals using a general item addressing sleeplessness (GS). A sleep within depression sum score …

Implementing Integrated Care In Family Medicine: Description And Outcomes In An Underserved Population, Zach Radcliff

Theses and Dissertations

Introduction: Family physicians provide access to medical and behavioral healthcare for many underserved populations. Integrating behavioral health clinicians into primary care practices has been proposed as one of the most effective ways to increase access to necessary behavioral health services for many Americans. Integrated behavioral healthcare (IBHC) has begun to be implemented in family medicine practices but there is limited research examining the impact for patients and clinic staff. This study begins to fill this gap in the literature by examining the effects of implementing integrated behavioral healthcare in an urban family medicine clinic in a medically underserved area.

Objective: …

Health Aid In Africa: Placement, Service Utilization, And Benefit, Carrie Dolan

Theses and Dissertations

While the health sector has attracted significant foreign aid, evidence on the effectiveness of this support is mixed. This dissertation examines the allocation of health aid within the context of placement, service utilization, and benefit. The first paper examined the sub-national allocation of Chinese development aid projects across Africa. I determined how political preferencing of Chinese aid specifically, allocating aid to the birth region of the current political leader differs across sectors such as health, education, and transportation. I find some evidence that aid, more broadly defined, is subject to political preferencing in recipient countries, which could potentially limit its …

Weighted Quantile Sum Regression For Analyzing Correlated Predictors Acting Through A Mediation Pathway On A Biological Outcome, Bhanu M. Evani

Theses and Dissertations

Abstract

Weighted Quantile Sum Regression for Analyzing Correlated Predictors Acting Through a Mediation Pathway on a Biological Outcome

By

Bhanu M. Evani, Ph.D.

A thesis submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Virginia Commonwealth University.

Virginia Commonwealth University, 2017.

Major Director: Robert A. Perera, Asst. Professor, Department of Biostatistics

This work examines mediated effects of a set of correlated predictors using the recently developed Weighted Quantile Sum (WQS) regression method. Traditionally, mediation analysis has been conducted using the multiple regression method, first proposed by Baron and Kenny (1986), which has since …

Walking In Beauty: Responsive And Responsible Health And Healing Among Virginia American Indian People, Amy J. Prorock-Ernest

Theses and Dissertations

Little is systematically known about the collective health and well-being of Virginia American Indian people. This study sought to explore the meaning of health and healing among Virginia American Indian people in the context of a reservation-based, non-federally funded health clinic. Using an emergent approach to qualitative research grounded in a constructivist inquiry paradigm and guided by Indigenous research principles, a total of 24 in-depth, semi-structured interviews were conducted with 17 American Indian service-users of the Clinic. Through an inductive thematic analysis of participant stories, a framework for understanding responsive and responsible health and healing was derived. The framework includes …

Person-Centered Treatment To Optimize Psychiatric Medication Adherence, Natalie Bareis

Theses and Dissertations

Objectives: Adherence to psychotropic medication is poor among individuals with bipolar disorder (BD). To understand treatment experiences and associated adherence among these individuals, we developed a novel construct of Clinical Net Benefit (CNB) using psychiatric symptoms, adverse effects and overall functioning assessments. We tested whether adherence differed across classes of CNB, whether individuals transitioned between classes over time, and whether these transitions were differentially associated with adherence.

Methods: Data come from individuals aged 18+ during five years of the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Latent class analysis identified groups of CNB. Latent transition analysis determined probabilities of …

Contribution Of Asc-Inflammasome To Vascular Endothelial Dysfunction: Role Of Rna Receptor Rig-I, Ashley Pitzer

Theses and Dissertations

Retinoic acid-inducible gene-I (RIG-I) is a putative RNA helicase and recently identified as a cytosolic RNA receptor in mammalian cells. The role of RIG-I in the regulation of vascular function under physiological and pathological conditions is unknown. Recent studies have shown that the inflammasome serves as a crucial initiator of cytokine-mediated inflammation mediating the pathogenesis of cardiovascular disease. The present study tested whether RIG-I activation triggers inflammasome formation and subsequent cytokine-mediated inflammation in the endothelium of mice coronary arteries. Using both genetic and pharmacological interventions of the RIG-I inflammasome, we first characterized whether specific activation of RIG-I via 3pRNA transfection …

A Biorelevant In Vitro Model To Characterize In Vivo Release Of Bone Morphogenetic Protein-2 (Rhbmp-2), Deblina Biswas

Theses and Dissertations

Biorelevant in vitro release/dissolution tests are designed to predict the in vivo behavior of a drug and are crucial in understanding its in vivo performance. Currently, there is no standardized compendial in vitro release testing methods or regulatory guidance’s for release/dissolution testing of implants due to their complex physiological locations.Furthermore, existing compendial methods do not capture the local release profile of ‘novel’ parenterals in physiological low fluid volume surrounding areas.

Long acting and in situ forming implants with orthobiologic proteins and peptides have increased over the past few decades due to a better understanding of genetic engineering. One of these …

Role Of Translation Initiation In Regulation Of Epithelial Junctions And Cell Motility, Fahda Fawaz Alsharief

Theses and Dissertations

The integrity and barrier properties of intestinal epithelium are determined by specialized adhesive structures known as intercellular junctions; composed of adherens junctions (AJs), tight junctions (TJs) and focal adhesions that mediate cell-cell and cell matrix interactions, respectively. These two types of epithelial cell adhesions regulate each other during disruption and restitution of the epithelial barrier. Inflammatory cytokines such as interferon gamma (IFNγ) and tumor necrosis factor alpha (TNFα) are elevated during intestinal inflammation. The most notable effects of IFNγ and TNFα on intestinal epithelial homeostasis involve disruption of apical junctions and attenuation of cell migration. Although molecular mechanisms underlying these …

Evaluation Of The Regional Drug Deposition Of Nasal Delivery Devices Using In Vitro Realistic Nasal Models, Mandana Azimi

Theses and Dissertations

The overall objectives of this research project were i) to develop and evaluate methods of characterizing nasal spray products using realistic nasal airway models as more clinically relevant in vitro tools and ii) to develop and evaluate a novel high-efficiency antibiotic nanoparticle dry powder formulation and delivery device. Two physically realistic nasal airway models were used to assess the effects of patient-use experimental conditions, nasal airway geometry and formulation / device properties on the delivery efficiency of nasal spray products. There was a large variability in drug delivery to the middle passages ranging from 17 – 57 % and 47 …

Recovery From Design, Cassandra J. Ellison

Theses and Dissertations

Through research, inquiry, and an evaluation of Recovery By Design, a ‘design therapy’ program that serves people with mental illness, substance use disorders, and developmental disabilities, it is my assertion that the practice of design has therapeutic potential and can aid in the process of recovery. To the novice, the practices of conception, shaping form, and praxis have empowering benefit especially when guided by Conditional and Transformation Design methods together with an emphasis on materiality and vernacular form.

Type 2 Immune Responses In The Context Of Helminth Infection, Asthma, Dendritic Cells, And Myeloid Derived Suppressor Cell Function, Sheela Ruby Damle

Theses and Dissertations

Type 2 (T_H2) immune responses evolved to respond to helminth parasite infections by the production of T_H2 cytokines, which stimulate anti-helminth immunity. Macrophage migration inhibitor factor (MIF) is a pleiotropic cytokine, which is produced by many cell types. We demonstrate that mice deficient in MIF have enhanced clearance of a helminth parasite. MIF deficiency in CD4⁺ T cells was found to be the most important for mediating parasite clearance. We mimicked MIF deficiency by administering an inhibitor of the MIF tautomerase activity, sulforaphane, and this also increased parasite clearance (Section I).

T_H2 immune …

Depressive Symptoms Among College Students: An Exploration Of Fundamental Cause Theory, Peter A. Carrico

Theses and Dissertations

Fundamental Cause Theory suggests that socioeconomic and demographic factors are causal to various illnesses, including depression. However, no known previously existing research has used Fundamental Cause Theory to create a model of depression among college students. To do this, the present study conducted a stepwise binomial logistic regression to examine how socioeconomic status and the sociodemographic variables of Gender, Race, and Sexual Orientation, and others predict depressive symptoms in a large sample of undergraduates when controlling for stressful life events and social support (N = 2,915). Results support the hypothesis that socioeconomic disparities in depressive symptoms are the result …

Mast Cell Activation By Diverse Stimuli Can Be Suppressed By Steroid Therapy And Targeting The Fyn-Stat5b Cascade, Anuya Paranjape

Theses and Dissertations

Mast cells are critical effectors of allergic disease that can be activated by numerous stimuli. We have examined mast cell control by the inflammatory cytokine, IL-33, as well as IgG. In the first study reported here, we found that the synthetic glucocorticoid, dexamethasone, potently and rapidly suppressed IL-33-induced cytokine production from murine bone marrow–derived and peritoneal mast cells, as well as human mast cells. Dexamethasone also antagonized IL-33-mediated enhancement of IgE-induced cytokine production and migration. Although dexamethasone had no effect on IL-33-induced phosphorylation of MAP kinases or NFκB p65 subunit, it antagonized AP-1 and NFκB-mediated transcriptional activity. Finally, intraperitoneal administration …

Non-Medical Use Of Prescription Drugs, Stress, Cultural Orientation, Utilization Of Healthcare, And Protective Factors Among College Students In China, Cheuk Chi Tam

Theses and Dissertations

Background: Non-medical use of prescription drugs (NMUPD) refers to the use of prescription drugs which are traditionally utilized to manage pain or treat psychiatric problems but without a doctor’s prescription. In 2010, an investigation by the Substance Use and Mental Health Services Administration (SAMHSA) revealed that 5.3% of young adults (18 to 25-year-olds) in the United States reported past-month NMUPD. NMUPD has become a growing concern owing to associations with consequences such as college dropout, poor academic achievement, and health jeopardizing behaviors. College students' NMUPD has been well documented in the United States. Limited studies, however, have been conducted among …

Hydrogen Sulfide Regulation Of Kir Channels, Junghoon Ha

Theses and Dissertations

Inwardly rectifying potassium (Kir) channels establish and regulate the resting membrane potential of excitable cells in the heart, brain and other peripheral tissues. Phosphatidylinositol- 4,5-bisphosphate (PIP2) is a key direct activator of ion channels, including Kir channels. Gasotransmitters, such as carbon monoxide (CO), have been reported to regulate the activity of Kir channels by altering channel-PIP2 interactions. We tested, in a model system, the effects and mechanism of action of another important gasotransmitter, hydrogen sulfide (H2S) thought to play a key role in cellular responses under ischemic conditions. Direct administration of sodium hydrogen sulfide (NaHS), as an exogenous H2S source, …

The Experiences And Perceptions Of Behavioral Factors That Contribute To Successful Weight Loss In Male Bariatric Patients, Stephen P. Sowulewski

Theses and Dissertations

The purpose of this study was to examine the experiences and perceptions of behavioral factors that contribute to successful weight loss in male bariatric patients. By analyzing participant experiences and perceptions, this study contributes to a better understanding of which factors are most important in the postoperative phase of gastric bypass in males owing to successful weight loss. Although there is a tremendous amount of quantitative research within the bariatric population, there is a significant gap within the qualitative literature as it relates to male outcomes. As such, by conducting interviews with 10 postoperative male gastric bypass patients, this study …

Tissue Factor Expression, Regulation, And Signaling In Human Airway Cells, Michael D. Davis

Theses and Dissertations

Rationale: Tissue Factor (TF) is a transmembrane glycoprotein that canonically functions as the initiator of the coagulation cascade. Increased levels of TF have been associated with inflammatory airway diseases. Since lipopolysaccharide (LPS) is known to elicit and inflammatory response in airway epithelium, we hypothesized that airway epithelial cells release TF when exposed to LPS. Since TF aids in local wound healing, we also hypothesized that inhibition of TF would decrease NHBE growth. The specific aim of this work was to evaluate the effects of LPS exposure on TF production and release from airway epithelia and determine the signaling pathways involved. …

Deletion Of Cardiac Mir-17-92 Cluster Increases Ischemia/ Reperfusion Injury Via Pten Upregulation, Meeta B. Prakash

Theses and Dissertations

The miR-17- 92 cluster is necessary for cell proliferation and development of the cardiovascular system. Deletion of this cluster leads to death in neonatal mice. The role of this cluster still needs to be defined following ischemia and reperfusion. Methods and Results: Adult male mice were injected with Tamoxifen- was to induce inducible cardiac-specific miR-17- 92-deficient (miR-17- 92-def: MCM:TG:miR-17- 92 flox/flox ) and wild type (WT: MCM:NTG:miR-17-92 flox/flox ) mice were subjected to 30 minutes of myocardial ischemia via left anterior descending coronary artery ligation followed by reperfusion for 24 hours. Post I/R survival (48%) and ejection fraction were reduced, …

The Lived Experiences Of Academic Advisors With Counseling Degrees In Addressing Wellness With College Student-Athletes, Jennifer M. Gerlach

Theses and Dissertations

The purpose of this qualitative phenomenological study was to investigate the lived experiences of academic advisors who have master’s degrees in counseling in addressing wellness with college student-athletes. Of particular note was to explore if they addressed wellness and, if so, how they addressed wellness. Extant literature is replete with evidence documenting the numerous challenges and stressors student-athletes experience due to their athlete status. Prior to this study, the role of the academic advisor in addressing wellness has not been represented in the literature. This study examined the lived experiences of 10 academic advisors with counseling degrees, or currently enrolled …

Socioecological Aspects Of Tobacco Use In College Populations, Michael D. Sawdey

Theses and Dissertations

Background: Although cigarette smoking is decreasing in the US and among college students, tobacco use remains a major public health problem. Specific socioecological gaps in the literature related to college tobacco use exist including: trends of tobacco use, combinations of polysubstance use, and availability of tobacco products around college campuses.

Objectives: The main goal of this research was the understand interrelationships that exist within a socioecological framework of college tobacco use. Specifically, this project aims to: 1) examine trends of tobacco and polytobacco use by gender and associations of polytobacco use and perceived peer tobacco use, 2) examine …

The Effect Of Saha On The Expression Of Genes In Wild Type And Hdac2 Knockout Mouse Models And Its Potential Use As Treatment For Schizophrenia, Maryum K. Ijaz

Theses and Dissertations

The symptoms of schizophrenia have been categorized into three subsets including positive, negative, and cognitive symptoms. Although atypical antipsychotic use has shown promising reduction in positive and negative symptoms of schizophrenia, such as hallucination, delusions and flat affect, the cognitive subset of symptoms remains and has an adverse impact on those affected. Chronic treatment with the atypical/secondary antipsychotic clozapine is one example that has ameliorated hallucinations and delusions but results in cognitive memory deficits. When chronically given in conjunction with the HDAC inhibitor, SAHA, the cognitive memory deficits of mouse models decline. HDAC2KO mice were bred and used in chronic …

An Investigation Of Surface Characteristics Of Enamel Treated With Infiltrative Resin: A Scanning Electron Microscopy Study, Danielle E. Easterly

Theses and Dissertations

AN INVESTIGATION OF SURFACE CHARACTERISTICS OF ENAMEL TREATED WITH INFILTRATIVE RESIN: A SCANNING ELECTRON MICROSCOPY STUDY

Danielle E. Easterly, Doctorate of Dental Surgery.

A thesis submitted in partial fulfillment of the requirements for the degree of Master of Science in Dentistry at Virginia Commonwealth University.

Virginia Commonwealth University. 2017.

Director: Dr. Eser Tüfekçi

D.D.S., M.S., Ph.D., M.S.H.A.

Objective: To evaluate the microstructural changes of a resin infiltrant (ICON®, DMG America LLC, Englewood, NJ) after six months of simulated toothbrushing.

Materials and Methods: Ten extracted third molars (n=10) were collected. Artificial white spot lesions were created and resin applied. Environmental SEM …

Silver Diamine Fluoride And Oral Health-Related Quality Of Life, Nazafarin Javdan

Theses and Dissertations

Purpose: The purpose of this study was to study the association between Silver Diamine Fluoride (SDF) and Oral Health-Related Quality of Life as assessed by “The Early Childhood Oral Health Impact Scale” questionnaire. Methods: Parents of healthy children (ASA I and II) ages 1-5 with early childhood caries with reversible pulpitis who had application of SDF filled out a questionnaire at baseline and again after one month. The questionnaire was designed to evaluate the child’s behavior, physical abilities, pain, temperament, and how well the child gets along with others. Results: Wilcoxon Signed Rank Test was used to …

Provider Appearance: A Survey Of Guardian And Patient Preference, Joshua Westphal

Theses and Dissertations

Purpose: To understand guardian and child preferences for the appearance of their pediatric dentist. This was a cross-sectional descriptive study using survey methodology with patients and parents that attended the VCU Pediatric Dental clinic.

Methods: A total sample of 100 guardians and 97 pediatric patient participants completed the computer-based questionnaire. Four subjects were asked to pose for photographs wearing various combinations of attire (professional, casual, white coat, scrubs).

Results: Among guardians, 56% reported preferring a provider in scrubs, with white coat the second most preferred attire (39%) for their children. For pediatric patients, scrubs were still most often selected, …

Role Of The Pediatric Dental Provider In Human Papillomavirus (Hpv) Education, Meredith L. Dugoni

Theses and Dissertations

Purpose: This study investigates knowledge about HPV and examines if pediatric dental providers should include HPV education for guardians of patients 10-18 years.

Methods: Legal guardians of 10-18 year-old patients of the Virginia Commonwealth University Pediatric Dental Clinic were enrolled in this prospective cohort study. Participants completed a baseline survey, were provided HPV education, completed an initial follow-up survey, and then completed a 6-month follow-up survey.

Results: A total of 54 participants completed the baseline and initial follow-up surveys and 17 completed the 6-month follow-up survey. The average number of correct responses was 3.4 of 6 knowledge questions, which significantly …

Evaluation Of Volumetric Change Of Periapical Lesions After Apicoectomy As A Measure Of Postsurgical Healing Utilizing Cone Beam Computed Tomography, Eshwar Arasu

Theses and Dissertations

The aim of this study was to evaluate whether volumetric changes in persistent periapical lesions can be detected in follow-ups six months to five years after apicoectomy using cone-beam computed tomography. Patients with a previous treatment history of apicoectomy and for whom a pre-surgical CBCT scan was taken between November 2010 and December 2015 were invited to participate in the study. A post-surgical CBCT image of the treated tooth was obtained at the recall visit. Volumetric and linear measurements of periapical lesions on initial and postoperative CBCT images were performed using DiThreshGUI software and two calibrated examiners—a board-certified endodontist and …