Medicine and Health Sciences Commons^™

Psychological Sense Of Community Among Older Adults In Puerto Rico Two Years After Hurricane María, Thomas D. Buckley

Theses and Dissertations

Hurricane María devastated Puerto Rico in 2017 and resulted in adverse long-term outcomes. Psychological sense of community (PSOC) may serve as a protective factor against the effects of Hurricane María for older adults in Puerto Rico. Using a three-paper format, this dissertation draws on a resilience framework and theories of PSOC and the Ecological Theory of Aging to examine the role of PSOC among older adults in Puerto Rico two years after Hurricane María.

Paper one is a scoping review of the concept of PSOC in research with community dwelling older adults. I begin by presenting findings on study characteristics …

Development Of Sam-Based Chemical Probes For Methyltransferases, Daniel V. Mongeluzi

Theses and Dissertations

Fig.1. SAM analog for the profiling of MTase activity. A. Chemical structure of probe 1; B. General scheme of the labeling and capture strategy.

A

B

Methylation is a fundamental mechanism used in the biological system to modify the structure and function of biomolecules such as proteins, DNA, RNA, and metabolites.¹ Methyl groups are installed by a large and diverse class of S-adenosyl-L-methionine (SAM)-dependent methyltransferases (MTases), which transfer the sulfonium methyl group of SAM to either carbon, nitrogen, oxygen, or other heteroatoms on biomolecules.² Dysregulated MTase activity contributes to numerous diseases, including cancer, metabolic disorders, neurodegenerative diseases. …

Intentions To Use Telerehabilitation For Communication And Treatment For Vision Impairments, Eric E. Hicks

Theses and Dissertations

BACKGROUND: Approximately 8.1 million people in the United States 18 and older have difficulty performing one or more daily activities because of vision impairment or blindness (Erickson, Lee, & von Schrader, 2020; Taylor, 2018). If the impairments caused by vision loss are not addressed, they can result in financial difficulties, suffering, disability, loss of productivity, and decreased quality of life (National Center for Chronic Disease Prevention and Health Promotion, 2011). Currently, in-person low vision rehabilitation services are the gold standard for teaching people how to adapt to and compensate for these deficits, however, the access and utilization of these services …

Impact Of Targeting Glycosylated Ceramides On Tumorigenic Properties, And Characterization Of Sphingolipids In Head And Neck Tumors, Katherine E. Hylton

Theses and Dissertations

Sphingolipids play a crucial role in signaling, membrane structure, and migration, making them important molecules in cancer development, metastasis, and drug resistance. While some sphingolipids have been associated with pro-apoptotic or pro-survival behaviors, the role of many sphingolipids in cancer remains poorly defined. Chapter 1 of this study investigated the impact of three enzymes that compose most of the ceramide to Lc3 ceramide pathway – UGCG, GBA, and B3GNT5 – and how their alteration impacts chemoresistance and basal membrane invasion in vitro. It was found that the CΒE-induced inhibition of GBA, which converts glucosylceramide to ceramide, has no effects on …

The Effects Of Interleukin-1Β On Cardiac Reserve And Exercise Capacity In The Mouse, Habeebah Z. Vohra

Theses and Dissertations

Heart failure (HF) is characterized by dyspnea, fatigue, and exercise intolerance. Clinical evidence points to increased interleukin-1β (IL-1β) activity in patients with HF, with an IL-1 blockade improving the exercise capacity in HF patients. In healthy mice, recombinant-mouse IL-1β (rmIL-1β) induces acute systolic dysfunction, peaking 4 hours after administration. However, the direct effects of rmIL-1β on exercise capacity are unknown. We hypothesized that rmIL-1β diminishes the exercise capacity in the mouse. Adult mice were trained to run on a treadmill and exercise capacity was assessed before, 4 hours, and 96 hours after intraperitoneal administration of rmIL-1β (3 μg/kg) or vehicle …

Health Outcomes And Utilization Associated With Renal Diseases In Patients With Cancer In The United States, Mitisha Dedhia

Theses and Dissertations

Background: Adverse events and impairments associated with cancer and its treatments causes worse outcomes. Increased incidence of renal diseases among cancer patients is of particular concern. Objective: To determine the risk factors for renal disease in cancer patients and compare healthcare costs, utilization and health-related quality of life (HRQoL) of cancer patients with a renal disease and cancer patients without renal diseases. Methods: Medical Expenditure Panel Survey files from 2009 – 2018 for cancer patients was used for this study. Multiple logistic regression, generalized linear model, Poisson regression and multiple linear regression for analyses after adjusting for demographic, socioeconomic and …

The Impact Of Healthcare Professional Students' Racial, Hiv-Related, And Abortion-Related Biases On Recommendations For Prenatal Care, Alison J. Patev

Theses and Dissertations

Black women and HIV-positive women have increased maternal mortality rates and other negative pregnancy outcomes, in part due to disparate prenatal care. Although women who seek abortions do not have the same negative outcomes, abortion stigma exists and is normalized in healthcare. Limited work has examined prenatal care provision for women in these groups, and even less work has explored the prenatal care provision by healthcare trainees (i.e., medical, nurse practitioner, and physician assistant students). Examining the role of bias on the prioritization of prenatal care items by healthcare trainees is imperative. Healthcare education sets the stage for future practice, …

Nebulizer-Based Systems To Improve Pharmaceutical Aerosol Delivery To The Lungs, Benjamin M. Spence

Theses and Dissertations

Combining vibrating mesh nebulizers with additional new technologies leads to substantial improvements in pharmaceutical aerosol delivery to the lungs across therapeutic administration methods. In this dissertation, streamlined components, aerosol administration synchronization, and/or Excipient Enhanced Growth (EEG) technologies were utilized to develop and test several novel devices and aerosol delivery systems. The first focus of this work was to improve the poor delivery efficiency, e.g., 3.6% of nominal dose (Dugernier et al. 2017), of aerosolized medication administration to adult human subjects concurrent with high flow nasal cannula (HFNC) therapy, a form of continuous-flow non-invasive ventilation (NIV). The developed Low-Volume Mixer-Heater (LVMH) …

Associations Between Social Determinants Of Health And Chlamydia Infections Among Georgia Counties, Bre'auna K. Beasley

Theses and Dissertations

Chlamydia is a growing public health concern that disproportionately impacts southern states. While social determinants of health are not direct causes of chlamydia infections, studies have found that these determinants do influence infections by creating environments that promote or hinder health seeking behaviors, as well as exposure to risk factors. Guided by the Social Ecological Model of Public Health and the Healthy People 2030 Social Determinants of Health Conceptual Framework, this dissertation study aimed to examine the associations between social determinants of health and chlamydia infections among Georgia counties. This study employed a correlational research design. Aggregate-level secondary data for …

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, …

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 = …

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 …

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 …

Validation Of A Screening Tool For Pediatric Obstructive Sleep Apnea: A Pilot Study, Julia A. Giardina

Theses and Dissertations

Purpose: The purpose of this study was to evaluate the Pediatric-Modified-STOP-Bang (PM-STOP-Bang) as a screening tool to assess sleep related breathing disorders (SRBD) within a pediatric population. The specific aims of this study were: 1) compare the PM-STOP-Bang scores with those from the validated Pediatric Sleep Questionnaire (PSQ), 2) determine the ability of the PM-STOP-Bang and the PSQ screening tools to accurately detect children of high risk for SRBD from a one-night home sleep apnea test (HSAT).

Methods: Orthodontic patients were screened using the PM-STOP-Bang at VCU Graduate Clinic. Patients (n=10) who were recruited and enrolled. Five were determined to …

Patient Perspectives On Teledentistry And Face-To-Face Doctor Interaction During Orthodontic Treatment, Jackson K. Griffeth D.M.D.

Theses and Dissertations

Purpose: Orthodontic patients were surveyed to determine the perceived value of doctor-to-patient face-to-face interaction, the desire for convenience and attitudes toward specific uses of teledentistry.

Methods: Participating private practice orthodontists emailed the survey to active patients. 75 self-pay patients from VCU Orthodontic clinic were also invited to complete the survey. Patients 18 years or older were asked to complete the survey regarding their own treatment. Parents of patients under age 18 were asked to complete a separate survey regarding their child’s treatment. Questions asked patients about the importance of face-to-face interaction with their orthodontist and their preferences for the inclusion …

Reproducibility And Accuracy Of The Virtual Occlusal Record, Anne M. Harper

Theses and Dissertations

Purpose: To evaluate the reproducibility and accuracy of the virtual occlusal record compared to the gold standard physical bite record

Methods: Two physical bite records of PVS and two virtual bites using an iTero Element scanner were obtained from 22 participants. Intraoral scans were exported as STL files, and virtual occlusal records were created. CBCT images were taken of physical occlusal records and converted to STL files. STL files were superimposed using Geomagic Control X™ Software. Root mean square (RMS) and percent similarity within 0.25 mm tolerance were compared at a significance level of 0.05.

Results: Average …

Radiographic Comparison Using Cbct-Pai And Volumetric Analysis Of Endodontically Treated Teeth: A Retrospective Cohort Study, Jeremy Hargrove

Theses and Dissertations

Purpose: To assess the changes in CBCT-PAI score as well as 3-D volume of periapical findings associated with endodontically treated roots and to see how these findings change over time.

Methods: Retrospective chart review with the following inclusion criteria: 1. At least one tooth was endodontically treated at the endodontic private practice; 2. Patient had a recall examination and the treated tooth was asymptomatic, functional and a CBCT was exposed; 3. CBCT interpretation found a periapical finding associated with the treated tooth; 4. A follow-up recall examination was completed and CBCT exposed. Cases that fulfilled the inclusion criteria had the …

In Vitro Evaluation Of The Solubility Of Endosequence Bc Sealer In Acidic Solutions, Inderpal S. Sappal

Theses and Dissertations

Purpose: In recent years, bioceramic sealers (BCS), such as EndoSequence BC Sealer, have gained popularity in endodontic practices. Previous research has found BCS difficult to remove from canals during retreatments when compared with other endodontic sealers. Acidic solutions have been found to inhibit the set of BCS and increase their solubility. The purpose of this study was to evaluate the efficacy of acidic solutions in the removal of BCS as compared with a traditional retreatment solvent.

Methods: Roots of extracted human single rooted teeth (N=15) were prepared into 17 mm sections, then instrumented with ProTaper Gold (PTG) rotary files up …

Molecular Basis Of Cross-Sensitization In Colonic Inflammation-Induced Somatic Hypersensitivity, Parshva K. Mehta

Theses and Dissertations

A major portion of pain experienced by patients with an Irritable Bowel Disease (IBD) or Irritable Bowel Syndrome (IBS) can be attributed to visceral hypersensitivity. Visceral stimuli transmitted through primary afferent neurons in the dorsal root ganglia (DRG) induce a nociceptive response. Notably, a subset of patients has also experienced the development of somatic pain, such as leg pain, after diagnosis of a bowel disorder. The aim of this investigation is to ascertain which biochemical mediators are involved in the development of such viscerosomatic cross-sensitization. Initially, the Von Frey Test was used to find behavioral evidence of somatic referred pain; …

Modulation In Nmda Receptor Function Alleviates Safety Learning Deficit In Females Who Experienced Chronic Stress During Adolescence, Zuby C. Okafor

Theses and Dissertations

Anxiety disorders disproportionately impact women and are more prevalent in people with a history of chronic stress. Post-traumatic stress disorder (PTSD) is a type of stress and trauma-related disorder that is largely characterized by hyperarousal to fear-based cues. The inability to dissociate the fear-response from a non-threatening cue is known as impaired safety learning. Given that N-methyl-D-aspartate (NMDA) receptors are key mediators of learning behaviors, we examined the role of NMDAr function in deficient safety learning. Previous studies have shown that female rats with a history of stress have altered NMDAr gene expression and altered glutamatergic signaling; therefore, we hypothesized …

The Effect Of Local Anesthesia When Used In Dental Restorative Cases Under General Anesthesia On Control Of Intraoperative Physiologic Parameters And Post-Operative Comfort, Kathryn S. Skarda

Theses and Dissertations

Purpose:

To determine the effect of local anesthesia on post-operative pain and physiologic parameters intraoperatively in patients undergoing dental care under general anesthesia.

Methods:

This study was modeled as a double-blinded randomized control trial. Patients included healthy children under the age of six scheduled for restorative dental treatment under general anesthesia. Patient behavior was evaluated pre and post-operatively using the FLACC score and post-operatively using the Parental Pain Score Measure. Intraoperatively, all participants followed a standardized general anesthesia protocol and were given either local anesthetic infiltration by the dental surgeon performing the surgery or no anesthesia was utilized. Intraoperatively physiologic …

Pushing The Limits: Increasing The Speed And Specificity Of Sars-Cov-2 Testing, Grayson Way

Theses and Dissertations

The prevalence and spread of the current COVID-19 pandemic have highlighted the importance of continual improvements upon current microbiological testing methods. Rapid and accurate testing can help mitigate spread by improving on the time to quarantine and quarantine duration required. As of the writing of this thesis, COVID-19 has been responsible for more than 500,000 deaths in the United States of America, and greater than 2 million deaths globally. The work done in this thesis has shown improvements in the current SARS-CoV-2 testing methodology by reducing the time it takes for patient testing while maintaining accuracy and the sensitivity required …

The Harm In Seeking Care: Assessing The Relationship Between Healthcare Discrimination And Healthcare Avoidance Behaviors In The Past Year And Since The Start Of The Coronavirus Pandemic In A Transgender And Gender Independent Sample, Kyle L. Mason

Theses and Dissertations

Background: Gender minorities encounter a myriad of barriers to accessing general and gender affirming healthcare. Financial disparities impacting affordability of healthcare costs and insurance-based denials for gender-affirming care are among prominent barriers discussed. Considerations of the prevalence of stigma, discrimination, and erasure of gender minority identities must not be neglected when seeking to understand healthcare accessibility and utilization in this population. Previous researchers have examined gender minority patients’ experiences of discrimination in healthcare settings and delaying care due to fear of discrimination. There is a dearth of knowledge about the relationship between lifetime exposure to varied forms of healthcare discrimination …

Influence Of Metal Sleeves In The Accuracy Of Dental Implant Placement Using Guided Implant Surgery, Coleman Adams

Theses and Dissertations

The fabrication of implant surgical guides through stereolithographic 3D printing has become a staple in dental implant guided surgery over the last couple decades. These surgical guides have typically utilized metal sleeves to assist in guidance of the drills during osteotome preparation. The metal sleeves can be costly and potentially cause deviations if improperly placed during post-processing of the guide. This research explored a novel method for the utilization of sleeve-free surgical guides by comparing the dimensional and angulational deviations between the implant guides with and without a metal sleeve. To achieve this goal, two separate aims were pursued. Our …

Bisphosohoglycertae Mutase: A Potential Target For Sickle Cell Disease, Anfal S. Aljahdali

Theses and Dissertations

Bisphosphoglycerate mutase (BPGM) is a part of the erythrocyte glycolysis system. Specifically, it is a central enzyme in the Rapoport-Leubering pathway, a side glycolytic pathway involved in the regulation of the concentration of the natural allosteric effector of hemoglobin (Hb), 2,3-bisphosphoglycerate (2,3-BPG). BPGM catalyses the synthesis and hydrolysis of 2,3-BPG through its synthase and phosphatase activities. The synthase activity is the main role of BPGM, while the phosphatase activity is low and is activated by the physiological effector, 2-phosphoglycolate (2-PG) with the latter mechanism poorly understood.

BPGM activity and 2,3-BPG levels in red blood cells (RBCs) have a significant role …

A Multilevel Mixed Methods Examination Of Treatment Nonadherence Among Rural Cancer Survivors, Bonny Morris

Theses and Dissertations

While mortality rates have been decreasing over the last 40 years, cancer remains a leading cause of death in the United States. Over 1.7 million people were diagnosed with cancer in 2019, and there were more than 600,000 cancer deaths. Of the 15 million cancer survivors in the US, nearly 3 million reside in rural areas and experience 3% higher cancer incidence and 10% higher cancer mortality compared to their nonrural counterparts. During 2006-2015, the annual age-adjusted mortality rates for all cancer sites combined decreased at a slower pace in rural areas versus nonrural areas (-1.0% vs -1.6% per year, …

Medical Expenditures And Health Care Utilization: A Comparison Among U.S. Adult Tobacco Consumers (I.E. Never Tobacco Users, Cigarette Smokers And Smokeless Tobacco Users), Raheema S. Muhammad

Theses and Dissertations

Introduction

Cigarette smoking poses a great economic cost on the U.S. health care system by incurring high health care expenditure and health care utilization in the adult population. Although there is a sufficient amount of information on the health care cost associated with cigarette smoking there is a gap in how other forms of tobacco use may impact healthcare expenditures and utilization in comparison to cigarette smoking. The main objectives of this study were: 1) to estimate and compare health care expenditure and health care utilization across different tobacco use groups using nationally representative data 2) to estimate and compare …

Influence Of Immigration Status On The 10-Year Trajectories Of Psychosocial Functioning In Individuals With Traumatic Brain Injury, Chimdindu Ohayagha

Theses and Dissertations

The population of racially/ethnically diverse groups within the U.S. is growing at an exponential rate. The U.S. Census Bureau estimated the number of foreign-born individuals in the U.S. to be nearly 40 million or 13% of the total population (Grieco et al., 2012). Racially/ethnically diverse groups in the U.S. have a higher incidence of traumatic brain injury (TBI; Gary et al., 2009). Although racial/ethnic disparities have been documented in numerous outcomes, research has yet to thoroughly explore differences in rehabilitation outcomes for immigrants relative to U.S.-born individuals. The purpose of this study was to compare the functional and mental health …

A Novel Review Of Heat Shock Protein 110 Kda: A Basis For Research And Continued Experimentation Through Biochemical Analysis, Crist W. Cuffee

Theses and Dissertations

Heat shock protein 110 kDa, Hsp110, is a distinct cellular protector, different in form and function from Hsp70, a close relative of Hsp110. Functioning primarily as a holdase or in tandem with other molecular chaperones, a review of current accomplishments elucidates the uniqueness of this protein and the continued mysteries that surrounds it. Found only in eukaryotes, Hsp110 has been linked to many diseases, ranging from parasitic infection to neurodegenerative disorders. While still lacking, studies of this protein have provided much in the realm of speculation on the mechanisms behind Hsp110s’ contribution to different pathologies. This review will serve as …

Evaluating Patient And Health Care Provider Acceptance Of A Personal Health Record In An Integrated Health Care System In The Kingdom Of Saudi Arabia, Consuela C. Yousef

Theses and Dissertations

With the shift to patient- and person-centered care, personal health records (PHRs) have been touted as a strategy to empower patients, improve patient-provider communication, and support self-management. Health care organizations around the world have implemented PHRs in a global push to meet three aims of health care—improve access to care, reduce costs, and increase the quality of care. The capabilities that PHRs support vary by organizations, yet basic functions include allowing patients to view their laboratory results, refill prescription medications, and request appointments. More advanced PHRs enable patient-centered communication through secure messaging.

As the burden of chronic disease grows, PHRs …