Medicine and Health Sciences Commons^™

Variability In Perceptions Of Complementary Health Approaches Among Graduate Student Trainees, Delaney C. Bilodeau

Theses and Dissertations

Complementary Health Approaches (CHAs) encompass a diverse range of practices which are often used both independently and alongside conventional medical treatments. Understanding how graduate students training in different fields perceive CHAs is important because these professional trainees will go on to occupy roles as healthcare practitioners, researchers, policy makers, and consumers. This study used sequential rank agreement methods (Ekstrøm, Gerds, & Jensen, 2019) to investigate variations in perceptions of CHAs in a sample of graduate students (N = 416) from 140 possible training programs. Ratings of CHA familiarity, perceptions of CHA legitimacy, and willingness to recommend CHAs were compared …

A Learning Health System For Radiation Oncology, Rishabh Kapoor

Theses and Dissertations

The proposed research aims to address the challenges faced by clinical data science researchers in radiation oncology accessing, integrating, and analyzing heterogeneous data from various sources. The research presents a scalable intelligent infrastructure, called the Health Information Gateway and Exchange (HINGE), which captures and structures data from multiple sources into a knowledge base with semantically interlinked entities. This infrastructure enables researchers to mine novel associations and gather relevant knowledge for personalized clinical outcomes.

The dissertation discusses the design framework and implementation of HINGE, which abstracts structured data from treatment planning systems, treatment management systems, and electronic health records. It utilizes …

Protacs – A Novel And Rapidly Developing Field Of Targeted Protein Degradation, Hannah R. Gatley

Theses and Dissertations

There is a continued need for new technology and strategies for tackling cancer and other diseases, and within the current century a novel therapeutic strategy has emerged in the realm of targeted protein degradation called Proteolysis-Targeting Chimeras (PROTACs). This technology specifically targets and degrades disease-causing proteins via the ubiquitin-proteasome system, and has seen an explosion of research and intrigue in both academia and industry over the past two decades. The diversity of PROTAC classes based on the E3 ligase recruiting ligand and the target protein allows for a universal molecular structure that can be customized for a specific target and …

Combining Novel Direction Modulated Brachytherapy Tandem-And-Ovoids Applicators For Treatment Planning Of Multi-Institutional Cervical Cancer Cases: Removing Needles In Intracavitary-Interstitial Techniques, Sharmin Alam

Theses and Dissertations

Lack of standard guidelines for optimal needle insertion during high-dose-rate (HDR) intracavitary-interstitial (IC-IS) brachytherapy of the cervix means a sophisticated and technical skillset of inserting needles next to IC applicators must be developed to enhance plan quality. This study sought to evaluate the performance of two separate direction modulated brachytherapy (DMBT) tandem applicators used in conjunction with one set of novel DMBT ovoids, to effectively obviate the need for IS needles.

A cohort of 32 retrospective clinical HDR brachytherapy plans was re-planned with Varian’s BrachyVision^® treatment planning system, using VEGO^® inverse optimization algorithm, with dose heterogeneity accounted for …

The Impact Of A Parent-Only Pediatric Obesity Intervention Program On Quality Of Life In Racially Diverse Children, Taylor Vashro

Theses and Dissertations

Pediatric obesity has been associated with significant decrements in pediatric quality of life (QOL) comparable with severe pediatric diseases such as cancer. Parenting interventions have yielded health benefits for children with obesity; however, few studies have investigated the impact of parent-focused interventions on QOL in children with overweight and obesity. This study investigated the impact of a 6-week intensive parenting intervention program on the QOL of 5-12 year old, predominantly Black children with overweight and obesity. Parents were randomized into either the parenting intervention (NOURISH+) or a control group, and QOL, as well as variables related to child and parenting …

Characterization And Investigation Of Cold Atmospheric Plasma And Its Effects On Cancer Cell Biology, Thomas M. Ritrosky

Theses and Dissertations

Modern cancer treatment uses radiation therapy in over 50% of patient cases. It is an e↵ective way of treating tumors because the mechanisms of cell killing are well known through the damage that ionizing radiation does to DNA. The amount of radiation can be tracked through measuring the dose of the clinical photon or electron beam used. However, there are limitations in the usage of radiation therapy, for example, a tumor can create hypoxic areas that become radioresistant leading to complete ine↵ectiveness of further radiation treatment. This project looks into the application of cold atmospheric plasma as an adjuvant therapy …

Addressing Death Distress In Caregivers Of Patients With Malignant Glioma, Kelcie D. Willis

Theses and Dissertations

The field of psychosocial oncology seeks to improve the quality of life of patients and families affected by cancer. This task becomes increasingly important when there are limited, non-curative treatment options, a high probability of recurrence, and rapid functional decline, such as in the case of a malignant glioma (MG). Indeed, the diagnosis of a MG is associated with negative sequalae that often translates to higher caregiver burden. Caregivers—who must manage the functional decline of the patient, changes within the family, and a complicated medical system—often feel overwhelmed, isolated, and ill-equipped to handle these myriad responsibilities. While they also report …

Evaluating The Acute Effect Of Vaping On Food Intake, Gabrielle Maldonado

Theses and Dissertations

Background: Weight control is a common motive for continued cigarette smoking, and weight concerns pose a barrier to quitting. These effects are driven in part by nicotine’s ability to reduce overall appetite and ultimately body weight. Electronic nicotine delivery systems (ENDS) have been marketed and used for weight control, suggesting that the use of these products potentially may share similar effects as well as barriers to quitting as observed for cigarette smoking. However, little to no controlled clinical lab evidence exists supporting ENDS use for weight control. The present study tested the influence of an ENDS on acute eating behavior …

Characterizing The Effects Of Antiandrogens And Senolytics To Enhance The Therapeutic Response To Castration-Resistant Prostate Cancer, Justin M. Silverman

Theses and Dissertations

Prostate cancer is the most frequently diagnosed cancer in males and the second most common cause of cancer deaths. Androgen deprivation therapy, whether through surgical or chemical castration, is the mainstay for treatment of advanced prostate cancer; however, despite an initial response, most patients eventually develop a progressive PSA rise, and castration- sensitive prostate cancer gives rise to castration-resistant prostate cancer. The standard of care therapy includes the antiandrogens such as enzalutamide and abiraterone acetate as well as the microtubule poison, docetaxel, and various immunotherapies; however, while prostate cancer research is progressing, there continues to be a compelling need for …

Food Deserts And Pediatric Oral Health Status In An Under-Resourced Urban Community, Jessica T. Mcauliffe

Theses and Dissertations

Purpose: The aim of this analysis of survey data was to assess the influence of living within a food desert as a predictor of oral health problems among children of East Henrico County, Virginia.

Methods: Survey participants were recruited and questionnaires applied online. Residing in a food desert, using access to affordable produce as a proxy value, was the independent variable, while self- reported assessment of the child’s oral health status was the primary outcome variable. Analyses controlled for other indirect factors of pediatric oral health. Logistic regression was used to model the association between the self-reported access to healthy …

Role Of Histone Deacetylase (Hdac) In Epithelial To Mesenchymal Transition (Emt) In A Human Cholangiocyte Model Of Ischemic Cholangiopathy, Priyanshi Pragnesh Parikh

Theses and Dissertations

Organ transplants are a vital intervention for many diseases that result in end stage organ failure. Currently, the donation pool is not meeting the demands of the transplant list. Expanding this pool to include donation after cardiac death (DCD) is highly sought-after. However, the use of DCD livers can lead to increased odds of graft failure and ischemic cholangiopathy. The loss of epithelialization and fibrosis that occurs during ischemic cholangiopathy is characteristic of these cells undergoing epithelial-to-mesenchymal transition (EMT). The biological changes the cell experiences enhance migratory capacity, invasiveness, and increased resistance to apoptosis. Our earlier studies have shown differential …

Contribution Of Metabolic Cell Swelling On Microcirculatory Perfusion In Septic Shock, Charles E. Payne

Theses and Dissertations

Sepsis, a systemic immunological response that leads to organ-dysfunction, the development of septic shock, and death has mortality rate of 15-25%. A subset of sepsis, septic shock, has an in-hospital mortality rate of 30-50%. Sepsis and its treatment are the most expensive healthcare problem in the United States with the US Agency for Healthcare Research and Quality estimating annual costs over $20 billion. Hypoxia experienced in septic shock induces metabolic cell and tissue swelling leading to further microcirculatory dysfunction and poor tissue perfusion. Reversing metabolic cell swelling corrects these perfusion defects. Two models were used in rats to induce septic …

Exploration Of Dimensional Structure Of Major Psychiatric Disorders Reveals Relationship With Substance Use And Personality, Noah Berley

Theses and Dissertations

Objective: Using a mixture of statistical techniques like structural equation modeling, confirmatory, and exploratory factor analyses, we aimed to determine the genetic factor structure among Externalizing, Internalizing, and Psychotic spectrum disorders through methods that evaluate GWAS-based correlations. Additionally, a subsequent factor analysis based on the most suitable psychiatric model was conducted to understand how non-clinical behavioral traits align with this factor structure.

Methods: Publicly available GWAS summary statistics for twelve major psychiatric disorders, six substance use measures and two personality domains were incorporated into structural equation models. Using the GenomicSEM software package, GWAS-based correlations were estimated between all twelve disorders …

Molecular Mechanisms Of Prdm16 As A Tumor Suppressor In Pancreatic Ductal Adenocarcinoma, Eric Hurwitz

Theses and Dissertations

The transcription factor Prdm16 functions as a potent suppressor of transforming growth factor-beta (TGF-b) signaling, whose inactivation is deemed essential to the progression of pancreatic ductal adenocarcinoma (PDAC). Using the Kras^G12D-based mouse model of human PDAC, we surprisingly found that ablating Prdm16 did not block but instead accelerated PDAC formation and progression, suggesting that Prdm16 might function as a tumor suppressor in this malignancy. Subsequent genetic experiments showed that ablating Prdm16 along with Smad4 resulted in a shift from a well-differentiated and confined neoplasm to a highly aggressive and metastatic disease, which was associated with a striking deviation …

Development Of A Qa Plan For A 3.0t Cannon Galan Mr-Sim, Nathaniel D. Teague

Theses and Dissertations

Purpose: To develop and incorporate a QA (quality assurance) program for a Canon Galan 3 tesla MR Simulator for applications in radiation therapy.

Methods and materials: The QA program was centered around tests performed with three separate levels of frequency. The daily QA procedure consisted of scanning a vendor provided daily QA cube phantom that measures basic performance parameters. Additionally, a series of basic safety check were performed. The monthly QA procedure consisted of several tests, including scanning the ACR MRI large accreditation phantom and manually performing its corresponding image quality tests. Scanning the MagPhan RT for its detailed geometric …

Role Of The Ormdls In Keratinocytes, Souad Hatmi

Theses and Dissertations

The epidermis, the outermost layer of the skin, serves as a vital barrier protecting the body from environmental stressors, pathogens, and dehydration. Keratinocytes, the predominant cell type in the epidermis, play a central role in maintaining skin integrity and barrier function. In normal human skin, keratinocytes move from the basal layer to the stratum corneum, the top layer of the epidermis. In their travel, keratinocytes undergo a process of terminal differentiation, loss their ability to proliferate, secrete sphingolipids into the extracellular space, and gradually loss their nucleus and organelles. Sphingolipids, particularly ceramides, are key components of the intercellular lipid lamellae …

Effectiveness Of Financial Incentives In Improving Breast Cancer Screening Among Medicaid Recipients, James B. Sherwood

Theses and Dissertations

Breast cancer remains one of the leading causes of death among women. Roughly 2.4 million women are diagnosed annually with breast cancer throughout the world. Although breast cancer survival rates are favorable for the United States compared to other nations (90% 5-year survival for non-metastatic disease), it comes at a high cost. The United States spends an estimated $30 billion annually on breast cancer treatment. In addition, disparities in breast cancer survival rates also exist in the United States. Women Medicaid recipients, who are predominately minorities (60%), are more likely to die of breast cancer due to their high rates …

Analysis Of Referrals To Trauma Psychology And Subsequent Development And Proof-Of-Concept Study Of Provider Mental Health Training At A Level I Trauma Center, Samantha Mladen

Theses and Dissertations

Introduction: Millions of people are traumatically injured each year, with a significant portion going on to develop negative mental health sequelae. Many Level I trauma centers are integrating psychologists to provide acute assessment and intervention to patients at risk for poor outcomes. However, medical providers receive very limited training in how to best refer patients to mental health services and may benefit from such education.

Objective: To characterize current patterns of referral to trauma psychology at a Level I trauma center and to develop, refine, and test proof-of-concept for a new training for referring providers.

Method: One year of patient …

Correlation Between Intraoral Markers And The Risk Of Obstructive Sleep Apnea In Children, Linda K. Powers

Theses and Dissertations

Specific aims: The purpose of this study was to explore the association between various intraoral markers and the risk of Obstructive Sleep Apnea (OSA) in children. Specifically, nine intraoral clinical characteristics were analyzed: ankyloglossia, palatal vault height, presence and level of dental wear, tonsillar grade, Friedman's classification, skeletal and dental classification, and posterior crossbite. The correlation between these features and the Pediatric Sleep Questionnaire (PSQ) and Pediatric Symptoms Checklist (PSC) scores were assessed.

Methods: Orthodontic patients aged 8-17 were recruited at the VCU Graduate Clinic. Intraoral measurements were collected from patients (n=100) by treating doctors. At this time, the PSQ …

Assessing The Relationships Between Direct And Vicarious Exposure To Healthcare Discrimination And Erasure, Mistrust In Healthcare, And The Healthcare Utilization Behaviors Among Transgender And Gender Independent Individuals, Kyle L. Mason

Theses and Dissertations

Healthcare inaccessibility through direct exposure (i.e., personal) to myriad forms of gender identity-related discrimination and erasure among the Transgender and Gender Independent (TGI) population has been documented by prior studies. The myriad barriers that individuals who embody TGI identities encounter to accessing healthcare are associated with the underutilization of healthcare, which may further exacerbate the health disparities that exist between this population and cisgender individuals in the United States (U.S.). Although the impacts of the harm that direct exposure to healthcare discrimination and erasure may have on TGI individuals are known, their exposure to such harm vicariously (i.e., through observation …

Treatment Access And Outcomes For Craniofacial Care: Patient And Parent Perspectives, Benjamin F. Lowe Iii

Theses and Dissertations

Objective: The purpose was to evaluate whether craniofacial patients and their parents have adequate access to care, perceive this care as high quality, and believe that the incorporation of telehealth visits would benefit their current system of craniofacial care. Methods: An original survey was developed and sent to families in treatment with the Virginia Commonwealth University craniofacial team. The tool was used to gather demographic information and assess opinions toward access to, outcomes of, and telehealth services for craniofacial care. Patients 18 years and older took the survey for themselves, while patients under 18 years old had a parent/guardian take …

Isoprenylation Inhibition Significantly Reduces Ige Mediated Mast Cell Function And Allergic Disease, Jordan Dailey

Theses and Dissertations

Allergic disease is the 6^th leading cause of chronic illness in the US and accounts for billions of dollars in healthcare annually. Mast cells are tissue resident innate immune cells linked to allergic disease and activated by IgE and other ligands. Upon activation, they release histamine, cytokines, chemokines, proteases, and lipid mediators evoking allergic symptoms. New ways of targeting mast cells could greatly benefit allergic disease therapy. Previous findings supported repurposing statin drugs, such as Fluvastatin, as a therapeutic treatment of allergic disease reduced allergic symptoms in vitro and in vivo. We found that Fluvastatin suppressed IgE-mediated mast cell …

The Environment Of Interprofessional Education In Graduate Education: Exploring Professional Programs Of Occupational Therapy, Physician Assistant, And Physical Therapy, Allison R. Kaczmarek

Theses and Dissertations

Interprofessional education (IPE) is an educational approach of increasing popularity in professional schools for the preparation of a collaborative ready healthcare workforce. The accrediting bodies of professional education programs in occupational therapy (OT), physician assistant (PA), and physical therapy (PT) have incorporated standards for outcomes addressing IPE. Although they have endorsed the Health Professions Accreditors Collaborative (HPAC) consensus document on quality IPE, we do not have a contemporary snapshot of the IPE environments in the curriculum of their accredited programs. This dissertation, a collection of three distinct inquiries, has two aims: first, to provide a description of IPE as it …

Exploring The Effect Of Early Motor Delay And Physical Therapy Interventions On The Parent-Child Relationship, Rebecca Molinini

Theses and Dissertations

Emotional availability (EA) or the ability of the parent-child dyad to engage emotionally and partake in congruent and mutually enjoyable interactions, is essential for familial health and well-being. EA is considered the “connective tissue” of healthy parent-child relationships and is associated with secure attachment, maternal mental health, and children’s adaptive development. Most evidence supporting the integral role of EA on healthy outcomes is supported by typically developing populations in which adults present with a social or biological risk factor such as experiencing past traumas of adversities with mental health. In line with the transactional model of development, children are equal …

Family-Based Support As Social Determinants Of Health Protective Factor On Depression Of Parents Of Children With Autism Spectrum Disorder, Bisola E. Duyile

Theses and Dissertations

All parents experience challenges in their caregiving roles (Barańczuk & Pisula, 2020). However, parents raising a child/children with disabilities experience different social barriers (Oliver, 1996) that may also contribute to additional stressors in their caregiving role (Tomeny, 2016). Although these parents, on average, have reported greater symptoms of depression than parents of typically developing children, research shows that parents who reported receiving social support had lower symptoms of depression and stress (Das et al., 2017; Singh et al., 2017). Through the social determinants of health (SDOH) framework (ODPHP, 2022), the present study investigated informal/family-based support and its protective impact on …

Age-Associated Collagen Crosslinking And Its Role In Skeletal Muscle Regeneration, Lucas C. Olson

Theses and Dissertations

Advanced glycation end-products (AGEs) non-enzymatically accumulate on skeletal muscle collagen in old age via the Maillard reaction, causing an increase in intramuscular collagen and a stiffening of the muscle’s microenvironment. AGEs abrogate muscle regeneration through stiffening the muscle stem cell (MuSC) microenvironment and by binding to the receptor for advanced glycation end products (RAGE). Stiffer substrates promote MuSC proliferation at the expense of differentiation, and soluble AGEs are known to abrogate myogenic differentiation. Previously our group has demonstrated that decellularized muscle matrix (DMM), a type of extracellular matrix (ECM) scaffold extracted from skeletal muscle, encourages regeneration in a challenging rat …

Evaluation Of Spliceai For Improved Genetic Variant Classification In Inherited Ophthalmic Disease Genes, Melissa Reeves

Theses and Dissertations

ABSTRACT

EVALUATION OF SPLICEAI FOR IMPROVED GENETIC VARIANT CLASSIFICATION IN INHERITED OPHTHALMIC DISEASE GENES

By Melissa Jean Reeves, Ph.D.

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

Virginia Commonwealth University, 2023

Major Director: Melissa Jamerson, PhD, MLS(ASCP)

Associate Professor, Department of Medical Laboratory Sciences

Inherited ophthalmic diseases impact individuals around the globe. Inherited retinal diseases (IRDs) are the leading cause of blindness in individuals aged 15 to 45. The personal, social, and economic impact of vision loss is profound. Due to individual differences, symptoms can be variable, and …

The Impact Of Patient Characteristics On Dysphagia Therapy Utilization And Feeding Outcomes For Premature Infants In The Neonatal Intensive Care Unit, Tiana Nguyen

Theses and Dissertations

Medical advances have significantly increased the survival rates of preterm infants at lower gestational ages. However, infants born at lower gestational ages have an increased risk for developmental disabilities and oral feeding difficulties. A stay in the neonatal intensive care unit (NICU) is very costly and inadequate oral feeding is the most common barrier to discharge for premature infants. Infants can receive dysphagia therapy services during their NICU stay that focuses on the development of oral feeding and swallowing skills. However, literature to this date has mainly focused on the impact of therapy services for premature infants after NICU discharge. …

Assessing Drug Development Proporties Of Antithrombotic And Anti - Cancer Agents, Elsamani I. Abdelfadiel

Theses and Dissertations

The current GAG anticoagulants such as heparin, heparin derivatives, and vitamin K antagonists, such as warfarin continue to be the backbone of anticoagulant therapy. These drugs act through an indirect mechanism to convey inhibition of several coagulation enzymes. However, xv their use leads to several serious adverse effects, such as excessive bleeding risk and unpredictability of patient response. Regardless of their clinical achievement, every individual agent is accompanied by several side effects, particularly major/minor bleeding, thrombocytopenia, drug-food or drug-drug interactions, or absence of antidote. Of all these side effects, bleeding, and a lack of an effective antidote to reverse excessive …

Cone Beam Computed Tomographic Analysis Of Outcomes In Ridge Augmentation Using Titanium Mesh And Titanium Reinforced Ptfe Membranes, Lina Elnakka

Theses and Dissertations

Objective: The primary goal of this study is to evaluate and compare the average vertical and horizontal bone gain between titanium reinforced polytetrafluoroethylene (Ti-PTFE) and titanium mesh (Ti-mesh) using superimposition of preoperative and postoperative (CBCT). The secondary goal is to evaluate and compare the surgical outcomes between the two techniques.

Methods: A retrospective chart review was completed to assess the clinical and radiographic outcomes of patients who underwent ridge augmentation therapy using either Ti-PTFE or Ti-mesh. Preoperative and postoperative CBCT scans were superimposed using InVivo 3D imaging software. Vertical component of the augmented site (L1) was assessed along a vertical …