Medicine and Health Sciences Commons^™

Policies Addressing Barriers To Low-Income Women And Children’S Health Care Utilization In The United States And Kenya: The Role Of Physician Payments And Cash Transfer Programs, Muloongo Simuzingili

Theses and Dissertations

This dissertation examined two policies to improve low-income women and children’s healthcare utilization: physician payments and cash transfer programs. Higher physician payments increase the supply of healthcare services while cash transfers increase individuals’ demand for healthcare services. Cash transfer programs can improve health outcomes, yet the extent to which they are a cost-effective strategy is largely understudied. Therefore, this dissertation examines three overarching research questions:

1. Are Medicaid physician fees associated with access to substance abuse disorder (SUD) treatment among low-income women of reproductive age?
2. Do economic preferences moderate cash transfer program effects on children’s health care utilization? Evidence from a …

Glycosaminoglycan Modulation Of Key Proteins In Alzheimer's Disease, Tamim Chiba

Theses and Dissertations

Glycosaminoglycans (GAGs) are linear polysaccharides whose disaccharide building blocks consist of an amino sugar (D-glucosamine) and either uronic acid (D-glucuronic acid or L-iduronic acid) or galactose. Nearly all GAGs (with the exception of hyaluronic acid) are covalently attached to proteins, forming proteoglycans, and are ubiquitous in nature. The monomeric units, chain length, degree and pattern of sulfation, and epimerization are important properties that determine the influence of these molecules. Through Coulombic forces, hydrogen bonds and hydrophobic interactions, they regulate many physiological and pathophysiological processes such as blood coagulation, cell growth and differentiation, inflammatory processes, host defense and viral infection mechanisms. …

Regulation Of Osseous Healing By Macrophage-Derived Wnt Ligands, Jefferson Overlin Abaricia

Theses and Dissertations

Osseous healing is regulated by various classes of cells and signaling mechanisms. Of these, Wnt signaling has long been known to be critically important in directing the differentiation of mesenchymal stem cells (MSCs) into osteoblasts during bone healing. However, the source of these Wnt ligands is not known. Recently, a body of literature has arisen finding both beneficial and detrimental effects of macrophage-derived Wnt ligands on the regeneration of other tissues (liver, kidney, heart, and intestine), often by regulating inflammatory activation and stem cell behavior. As macrophages have been well-characterized as orchestrators of healing, their use of Wnt signaling to …

Evaluating The Clinical Utility Of A Novel Electroencephalography System For Assessing Perioperative Neurocognition In Older Surgical Patients, Lloyd H. Barnwell Iii

Theses and Dissertations

Postoperative delirium (POD) is a public health and research priority (American Society of Anesthesiologists, 2019). POD is a risk factor for long-term neurocognitive decline, and the rate of decline is directly proportional to the severity of POD (Vasunilashorn et al., 2018). Baseline cognitive function is a strong, independent predictor for POD (Culley et al., 2017). The International Perioperative Neurotoxicity Working Group recommends baseline cognitive function be assessed for older patients prior to surgery and anesthesia (Berger, et al., 2018). Perioperative cognitive screening tools trialed in anesthesia are not routinely incorporated into clinical practice related to validity, reliability, or practicality problems …

Intermittent Theta Burst Stimulation: Application To Spinal Cord Injury Rehabilitation And Computational Modeling, Neil Mittal

Theses and Dissertations

Loss of motor function from spinal cord injuries (SCI) results in loss of independence. Rehabilitation efforts are targeted to enhance the ability to perform activities of daily living (ADLs), but outcomes from physical therapy alone are often insufficient. Neuromodulation techniques that induce neuroplasticity may push the limits on recovery. Neuromodulation by intermittent theta burst transcranial magnetic stimulation (iTBS) induces neuroplasticity by increasing corticomotor excitability, though this has most frequently been studied with motor targets and on individuals not in need of rehabilitation. Increased corticomotor excitability is associated with motor learning. The response to iTBS, however, is highly variable and unpredictable, …

Stat5a Regulation By Serine Phosphorylation In Breast Cancer, Alicia E. Woock

Theses and Dissertations

The neuroendocrine hormone prolactin (PRL) and its cognate receptor (PRLr) have been implicated in the pathogenesis of breast cancer. PRL signaling relies on activating kinases such as the tyrosine kinase Jak2 and serine/threonine kinases ERK1/2, NEK3, PI3K, and AKT. In the canonical pathway of PRL signaling, JAK2 phosphorylates the transcription factor STAT5a at tyrosine residue 694 (pY694-STAT5a), preceding STAT5a nuclear translocation and transcriptional activity. However, STAT5a exists with functional duality as a transcription factor, having both pro-differentiative and pro-proliferative target genes. Other STAT family members (STATs 1, 3, and 6) have been shown to have transcriptional activity in the un-tyrosine-phosphorylated …

Device-Related Adverse Events From Watchman Flx Implants As Reported By The Food And Drug Administration, Dongjin Suh Bs, Paul Eugene Kim Bs, Emmanuel Magsino Bs, Tae Shik Park

Graduate Research Posters

No abstract provided.

Influence Of Telephone Preoperative Evaluations On Patient Medication Compliance On Day Of Surgery, Emmanuel Magsino, Michael Jung, Olga Suarez Md

Graduate Research Posters

Patient compliance with medication instructions on day of surgery (DOS) is an important part of the preoperative assessment, as failure to comply with these may lead to serious perioperative consequences. Prior studies have shown that compliance increases with multimodal interventions. However due to the recent COVID-19 pandemic, many in-person visits transitioned to telephone visits and providers had to rely on patients to follow solely verbal instructions.

To determine medication compliance, this study compared the medication instructions provided by the VCU Preoperative Assessment Communication and Education Clinic, per chart review, with each patient’s own report of which medications they took on …

Development Of An Online Warfarin Dosing Platform Using R Programming Language To Facilitate Healthcare Professional Duties And Limit Medication Related Errors., Monther Alsultan

Graduate Research Posters

Development of an online warfarin dosing platform using R programming language to facilitate healthcare professional duties and limit medication related errors.

Monther Alsultan, Joshua M. Morriss, Daniel Contaifer Jr, Suad Alshammari; Silas Contaifer, Rachel W Flurie, Dayanjan S. Wijesinghe^#

Department of Pharmacotherapy and Outcome Sciences

Objective: 1) Gain experience in developing platform agnostic, fully operational and clinically relevant web applications for effective pharmacist led patient care. 2) Create a decision- support tool using open source software to facilitate evidence-based management therapy of warfarin in clinical settings where it is available for everyone to use at anytime and anywhere.

Introduction: …

Selective Gsk3b Deletion In Camk2a+ Forebrain Neurons Or Inhibition Via Tideglusib, Decreases Ethanol Consumption In C57bl/6j Mice, Sam Gottlieb, Andrew D. Van Der Vaart, Brennen O'Rourke, Michael F. Miles

Graduate Research Posters

Purpose: We previously identified glycogen synthase kinase-3 beta (Gsk3b) as a central member of a gene network highly regulated by acute ethanol in medial prefrontal cortex (mPFC) and associated with risk for alcohol dependence in humans. Further, we have demonstrated modulation of Gsk3b alters ethanol consumption in rodent models. GSK3B could thus represent a potential new therapeutic target for the treatment of alcohol use disorder (AUD). Here, we investigate the mechanisms of Gsk3b action in ethanol consumption and report preclinical evidence for the selective GSK3B inhibitor, tideglusib, as a therapeutic agent for AUD.

Methods: (1) Selective Cre-induced Gsk3b …

Validity Of The Actigraph Gt9x Accelerometer Step-Count Function In Adults With Heart Failure With Preserved Ejection Fraction, Jonathan D. Kenyon, Hayley Billingsley, Natalie J. Bohmke, Danielle Kirkman, Salvatore Carbone, Youngdeok Kim

Graduate Research Posters

Low physical activity is associated with heart failure with preserved ejection fraction (HFpEF). Step-counts, a measure of physical activity, can be measured via accelerometry. To date, few studies have examined validity of accelerometer-derived step-counts in the adults with HFpEF.

PURPOSE To assess criterion validity of the Actigraph GT9X accelerometer step-count function in adults with HFpEF via ankle, waist, and wrist placement, compared with manually counted, directly observed steps.

METHODS Six adults with HFpEF (age: 57.2 ± 9.4 y; African American: 50%; females: 100%) completed a cardiopulmonary exercise test (CPET) on a treadmill while wearing synchronized GT9X accelerometers on the ankle, …

Radiation Induces Metabolic Dysregulation In Pulmonary Fibroblasts, Josly Pierre-Louis, Margaret A. T. Freeberg, Jane K. Rebman, Thomas H. Thatcher, Patricia J. Sime

Graduate Research Posters

Rationale: Exposure of the lung to ionizing radiation, such as during radiotherapy, can result in pulmonary fibrosis (PF), which has few treatment options. PF is characterized by an accumulation of extracellular matrix proteins that form scar tissue, resulting in dyspnea, disruption of gas exchange, and even death. We and others have shown that metabolic reprogramming is a hallmark of idiopathic pulmonary fibrosis (IPF). IPF lung tissue, and lung fibroblasts treated with TGF-β, exhibit increased aerobic glycolysis with increased expression of lactate dehydrogenase A (LDHA) and excess production of lactate, leading to reduced extracellular pH that activates latent TGF-β. Here, we …

Frequency Of Genetic Polymorphisms Of Cyp2c19 In Native Hawaiian, And Asian And Pacific Islander Subgroups: Implications For Personalized Medicine, Khalifa Y. Alrajeh, Youssef Roman Dr

Graduate Research Posters

Pharmacogenetic testing, where prescriptions are tailored to the individual patient based on his/her genetic makeup, increases the ability to predict individual drug response. However, little is known about the prevalence of clinically actionable pharmacogenes in diverse populations. This study seeks to assess the prevalence of select drug-gene alleles that are implicated in the metabolism of commonly prescribed drugs, so-called Very Important Pharmacogenes (VIPs). The results of this study will fill in the gaps of knowledge of VIPs in underrepresented populations and characterize their potential risk for drug adverse events or due to their underlying genetic polymorphisms, especially in patients of …

Transcriptional Repressor Protein Based Macrolide Biosensor Development With Improved Sensitivity, Jayani A. Christopher

Graduate Research Posters

Macrolide antibiotics are in high demand for clinical applications. Macrolides are biosynthesized via giant assembly line polyketide synthases (PKS) which are arranged in a modular fashion. Combinatorial biosynthetic methods have been used to produce diversified macrolides by reprograming these modules and modifying tailoring enzymes required for post synthetic modifications. However it is challenging due to the size and complexity of PKSs. To overcome this challenge, new enzymes for macrolide diversification could be obtained by directed evolution where a large number of enzyme variants need to be screened. Therefore it is important to develop high throughput screening methods to identify the …

Carotid Artery Dissections From Tcar As Reported By The Food And Drug Administration, Dongjin Suh Bs, Yuchi Ma Bs, Daniel H. Newton Md, Michael F. Amendola Md, Kedar S. Lavingia Md

Graduate Research Posters

BACKGROUND: Transcarotid artery revascularization (TCAR) is hybrid procedure that allows carotid stenting using direct surgical access of the carotid artery to restore blood flow through the carotid artery. It has shown the lowest perioperative stroke rate when compared with any prospective trial of transfemoral carotid artery stenting. However, intraoperative injuries related to the procedure and its management are not well characterized. We anticipate that this analysis will add qualitative insight in further characterizing adverse outcomes of this novel technology.

METHODS: The FDA maintains a database called the MAUDE (Manufacturer and User Facility Device Experience) for surveillance of all medical devices …

Cost-Effectiveness Of Alternative Hiv Testing Strategies Among Hard-To-Reach Populations In East And Southern Africa., Deo Mujwara, Deo Mujwara

Graduate Research Posters

No abstract provided.

Covid-10, Healthcare Interior Design + Provider Experience - How Does Your Space Work For You?, Ruth E.P. Deibler

Graduate Research Posters

The lack of research on healthcare staff experience and interior design of the spaces they work in is evident. A focus on staff perspective is needed, particularly staff who navigated the COVID-19 pandemic. This research seeks to capture those stories to develop further research in order to improve staff experience. The initial phase of this mixed-methods approach is a survey. Hypothetically, by placing providers at the center of qualitative research related to healthcare interior design, we can better understand existing healthcare spaces. Ideally, we can develop additional evidence-based, human-centered solutions to transform interior environments in healthcare.

The 20-year Women’s Health …

Modeling Longitudinal Change In Cervical Length Across Pregnancy, Hope M. Wolf, Shawn J. Latendresse, Jerome F. Strauss Iii, Timothy P. York

Graduate Research Posters

Introduction: A short cervix (cervical length < 25 mm) in the mid-trimester (18 to 24 weeks) of pregnancy is a powerful predictor of spontaneous preterm delivery (gestational age at delivery < 37 weeks). Although the biological mechanisms of cervical remodeling have been the subject of extensive investigation, very little is known about the rate of change in cervical length over the course of a pregnancy, or the extent to which rapid cervical shortening increases maternal risk for spontaneous preterm delivery.

Methods: A cohort of 5,160 unique women carrying 5,971 singleton pregnancies provided two or more measurements of cervical length during pregnancy. Cervical length was measured in millimeters using a transvaginal 12-3 MHz ultrasound endocavity probe (SuperSonic Imagine). Maternal characteristics, including relevant medical history and birth outcome data, were collected for each participant. Gestational age at delivery was measured from the first day of each woman’s last menstrual period and confirmed by ultrasound. Repeated measurements of cervical length during pregnancy were modeled as a longitudinal, multilevel growth curve in MPlus. A three-level variance structure was …

Evaluating Racial And Ethnic Disparities In Access To Primary Care Among Gay And Bisexual Men In The Us, A Population At High-Risk Of Hiv Infection, Jessica S. Kiernan, April D. Kimmel

Graduate Research Posters

BACKGROUND: 69% of new HIV diagnoses in the US are among gay and bisexual men, with disparities by race and ethnicity. Primary care providers increasingly provide HIV prevention. Racial and ethnic disparities in primary care access are well-documented, but their persistence among gay and bisexual men is unknown. We examined racial and ethnic disparities in access to primary care among this population.

METHODS: We used nationally representative person-level sociodemographic, health status and utilization data, and data on organizational- and socially determinant barriers to care, from the National Health Interview Survey, 2013-2018. Outcomes were: 1) general physician visit

RESULTS: The sample …

The Association Of Menthol Cigarette Use With Any Mental Illness (Ami) And Serious Mental Illness (Smi) Among Us Smoekrs, Augustus White

Graduate Research Posters

ABSTRACT

Background: Mental illness affects 1-in-5 adults in the United States (US). Previously, those with mental illness have been shown to be 70% more likely to smoke cigarettes than the general population. However, little is known regarding whether the use of menthol cigarettes (one of only two available “characterizing flavors” of cigarettes) might impact the association between tobacco use and mental illness. Such information is critical in light of the disproportionately high rate of use of menthol cigarettes observed among African American smokers, as well as to inform recent legislative proposals that seek to ban the sale of menthol cigarettes. …

Pharmacogenomics And Ssris Appropriateness In Older Community Dwelling African Americans, Wint War Phyo, Lana Sargent, Elvin T. Price

Graduate Research Posters

Background: Depressive and anxiety disorders are among the most common illnesses experienced by older adults (age > 60). The selective serotonin reuptake inhibitors (SSRIs) are preferred class of antidepressants for these disorders due to their high efficacy and safety profiles among older adults. However, SSRIs are metabolized by highly polymorphic cytochrome P450 enzymes, specifically CYP2D6 and CYP2C19. This can lead to variable dose-response outcomes, especially among older African American population.

Objective: Analyze the frequency of CYP2D6 and CYP2C19 polymorphisms in African American older adults who are taking SSRIs and identify potential inappropriate use of SSRIs in these older adults using the …

Peptidomimetic And Non- Peptidomimetic Derivatives As Possible Sars-Cov-2 Main Protease (Mpro) Inhibitors, Mohammed A. Al Awadh, Mohini S. Ghatge Ph.D, Mona A. Al Khairi, Faik N. Musayev, Akua K. Donkor, Mohammed H. Al Mughram, Abdelsattar M. Omar Ph.D, Moustafa M. El-Araby Ph.D, Martin K. Safo Ph.D

Graduate Research Posters

To design novel inhibitors of the SARS-CoV-2 main protease (Mpro), we investigated the binding mode of the recently reported α-ketoamide inhibitors of this enzyme. Following, we utilized in-silico screening to identify 168 peptidomimetic and non-peptidomimetic compounds that are high probability Mpro binding candidates. The compounds were synthesized in 5 to 10 mg for initial screening for their potential inhibition of Mpro using Fluorescence Resonance Energy Transfer (FRET) assay. The study was conducted using the main protease, MBP-tagged (SARS-CoV-2) Assay Kit (BPS Bioscience, #79955-2), and the fluorescence due to enzymatic cleavage of substrate measured using BMG LABTECH CLARIOstar™, a fluorescent microplate …

Development Of An Online Warfarin Dosing Platform Using R Programming Language To Facilitate Healthcare Professional Duties And Limit Medication Related Errors., Monther Alsultan

Graduate Research Posters

Development of an online warfarin dosing platform using R programming language to facilitate healthcare professional duties and limit medication related errors.

Monther Alsultan, Joshua M. Morriss, Daniel Contaifer Jr, Suad Alshammari; Silas Contaifer, Rachel W Flurie, Dayanjan S. Wijesinghe

Department of Pharmacotherapy and Outcome Sciences

Objective: 1) Gain experience in developing platform agnostic, fully operational and clinically relevant web applications for effective pharmacist led patient care. 2) Create a decision- support tool using open source software to facilitate evidence-based management therapy of warfarin in clinical settings where it is available for everyone to use at anytime and anywhere.

Introduction: Healthcare …

Alpelisib-Induced Diabetic Ketoacidosis, Maria G. Negron Marte, Angeliki M. Stamatouli

Graduate Research Posters

INTRODUCTION

Alpelisib is a phosphoinositide 3-kinase kinase (PI3K) inhibitor indicated for the treatment of postmenopausal women and men with hormone receptor (HR)- positive, human epidermal growth factor receptor 2 (HER2)-negative, PIK3CA-mutated, advanced, or metastatic breast cancer. In combination with Fulvestrant, it has shown to significantly improved progression-free survival since its approval in May 2019. Frequent, yet reversible, side effects including hyperglycemia, cutaneous reactions, diarrhea, and pneumonitis have been described.

METHODS

Literature on the topic is reviewed.

CASE PRESENTATION

64-year-old female with past medical history of Sjögren syndrome and metastatic breast cancer that presented with progressively worsening fatigue. Admission laboratory results …

A Determination Of The Aerosolization Efficiency Of Drugs Of Abuse In A Eutectic Mixture With Nicotine In Electronic Cigarettes, Laerissa Reveil

Master of Science in Forensic Science Directed Research Projects

Electronic cigarettes (e-cigarettes) were originally advertised as an alternative nicotine delivery system to facilitate smoking cessation. However, their popularity for recreational use has increased due to focuses on their trendiness, convenience, and discreteness along with concerns for its use to consume drugs other than nicotine (DOTN). With the adulteration of e-liquids, usually containing nicotine, with other substances, a greater understanding on how DOTN interact with the e-liquid constituents and how they are delivered to the user is necessary. E-liquids were prepared with 50:50 propylene glycol:vegetable glycerin, pure nicotine, pure methadone hydrochloride, and 1:1 methadone hydrochloride:nicotine and aerosolized via an automated …

The Basic Rules Of Doing A Good Search And Search Tips - Revised, Roy E. Brown

VCU Libraries Faculty and Staff Publications

This is a handout that is used as a reference for those who are learning to more effectively search databases for assignments and evidence-based practice projects. The revised handout contains information related to the databases that may be searched as well as about Google Scholar.

Please contact the author for a version that can be reused and rebranded.

The Evidence Based Practice Question Development & Search Tips Checklist (Revised), Roy E. Brown

VCU Libraries Faculty and Staff Publications

The Evidence Based Practice Question Development and Search Tips Checklist is a tool that is used in instructional sessions with nurses in reference to evidence-based practice and literature searching. It is intended as a reference handout. The revised handout contains information related to the databases that may be searched as well as about Google Scholar.

It is under a creative commons license. If you would like a version that can be rebranded for your organization to use, please contact the author for an editable version.

How Does Direct Volunteering Affect The Onset Of Alzheimer’S Dementia In Elderly Patients With Preexisting Cardiac Comorbidities?, Sneha R. Gade

Undergraduate Research Posters

Alzheimer's Dementia is a disease that affects memory, thinking, and behavior. The Alzheimer's Association reported Alzheimer's as the sixth-leading cause of death in the United States, and a cure does not exist. Donepezil, a cholinesterase inhibitor drug, is frequently prescribed to treat Alzheimer's disease. Still, patients must continuously take the medication for years to receive any measurable improvement in quality of life after developing Alzheimer's Dementia. Further, research shows prolonged use of Donepezil can lead to other health problems, such as QTc prolongation, for cardiac disease patients. Therefore, the effectiveness of non-drug interventions, such as volunteering to prevent the disease's …

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 …

A Mixed Methods Approach To Examine Racial Disparities In Adherence To Surveillance Mammography Among Breast Cancer Survivors, Megan C. Edmonds

Theses and Dissertations

PURPOSE: Annual surveillance mammography is a critical part of routine cancer care for breast cancer (BC) survivors; reducing mortality by 39%. However, disparities exist with regard to adherence to surveillance mammograms among BC survivors; Black women are 44% less likely to adhere than their White counterparts. Despite the existence of this racial disparity for over a decade, little is known about factors that explain reasons for Black BC survivors’ non-adherence. This is because most studies have not evaluated the role of healthcare delivery or psychosocial factors. Guided by the Behavioral Model for Vulnerable Populations, the purpose of this mixed methods …