Medicine and Health Sciences Commons^™

Feasibility And Acceptability Of Focused Breathing For Management Of Anxiety In Parkinson’S Disease, Susan K. Chandler

Theses and Dissertations

ABSTRACT

Anxiety is recognized as a predominant nonmotor symptom of Parkinson’s disease (PD) which greatly diminishes quality of life. Current treatment is largely pharmacologic and is recognized as rife with undesirable and unsafe side effects. Reviews commissioned by The Movement Disorder Society Task Force on Evidence-Based Medicine and the American Academy of Neurology revealed there was insufficient evidence to make recommendations for the treatment of anxiety. A review of the literature confirmed anxiety in PD is underdiagnosed, undertreated, and under studied. A common element in many of the non-pharmacologic self-managed interventions used by the studies included in the review was …

The Effects Of An Inflammasome Inhibitor Olt1177 On The Development Of Ischemic Heart Failure, Joseph S. Aliaga

Theses and Dissertations

Thesis Abstract

THE EFFECTS OF AN INFLAMMASOME INHIBITOR OLT1177 ON THE DEVELOPMENT OF ISCHEMIC HEART FAILURE

By Joseph S. Aliaga, BS

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

Virginia Commonwealth University, 2020

Background: Evidence suggests that prolonged and enhanced pro-inflammatory signaling, modulated by the NLRP3 inflammasome, plays a crucial role in the pathophysiology of several different types of cardiovascular diseases such as acute myocardial infarction (AMI), adverse ventricular remodeling, and heart failure (HF). Consequently, we hypothesize that attenuating the enhanced inflammatory response using a pharmacological NLRP3 …

Novel Strategies To Overcome Carboplatin Resistance In Triple Negative Breast Cancer Using Patient Derived Xenografts, Mohammad A. Al Zubi

Theses and Dissertations

Triple-negative breast cancer (TNBC) patients have a poor prognosis and rely on chemotherapeutic treatment as standard of care. Often, they develop chemotherapy resistance, which leaves them without more therapeutic options, like targeted therapy. New models have been developed to test targeted inhibitors in human tumors, and they are known as patient-derived xenografts (PDX). These tumors are obtained from patients, then established and maintained in mice where they areused for tumor studies. In this work, we characterized 14 PDXs for their primary tumor growth rate and investigated metastatic propensity using spontaneous and experiment metastasis models. We utilized RNA-sequencing to characterize contributions …

Quality Of Medical Care For Adults With Intellectual/Developmental Disabilities, Priya Chandan

Theses and Dissertations

QUALITY OF MEDICAL CARE FOR ADULTS WITH INTELLECTUAL/DEVELOPMENTAL DISABILITIES

By Priya Chandan, M.D., M.P.H.

A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of

Philosophy at Virginia Commonwealth University.

Virginia Commonwealth University, 2020.

Director: Director: Gloria J. Bazzoli, Ph.D.

Bon Secours Professor, Department of Health Administration

People with intellectual/developmental disabilities (IDD) are difficult to identify in administrative data, limiting the ability to study the quality of health care provided to this population. This study utilized clinical diagnoses to define a sample of hospitalized patients with IDD in the largest publicly available all-payer inpatient care database—the …

The Role Of Interleukin-18 In Myocardial Ischemia/Reperfusion, Yogesh Dhakal

Theses and Dissertations

Acute Myocardial Infarction (AMI) is one of the leading causes of morbidity for cardiovascular diseases (CVDs) in the western world. While mortality rates for AMI has reduced in the last 20 years due to advancements in clinical interventions, patients who have an AMI are significantly more likely to develop heart failure (HF) in the following years. Reperfusion of the ischemic tissue is a necessary procedure to restore blood delivery to cardiomyocytes, minimize myocardial dysfunction, and reduce infarct size. Still, the step of reperfusion itself induces myocardial damage in a phenomenon known as reperfusion injury. Considering that the degree of myocardial …

Can School Be A Source Of Trauma? Assessing Academic Traumatic Stress As A Mechanism Underlying The Health Outcomes Of Black Undergraduate Students, Ebony A. Lambert

Theses and Dissertations

Research examining Black students’ school experiences demonstrates that exposure to oppressive power dynamics in schools may lead to adverse physiological and psychological consequences. Recent conceptualizations in public discourse further posit that traumatic educational experiences, operationalized here as academic trauma or the cumulative toll of adverse and oppressive experiences in academic settings, may influence Black students’ wellbeing even after they have graduated. However, academic trauma has yet to be investigated empirically, and the health contributions of such educational harm remain unstudied. Moreover, little is known about how culturally-relevant personal characteristics (e.g., emotion regulation strategies) influence Black students’ reactivity to academic trauma. …

Impact Of Performance-Based Budgeting On Quality Outcomes In U.S. Military Healthcare Facilities, Kimberly L. Decker Virginia Commonwealth University

Theses and Dissertations

Performance-based budgeting (PBB) is a variation of pay for performance that is applicable to government programs. It works by increasing or decreasing funding based on pre-established performance thresholds, which incentivizes organizations to improve performance. In late 2006, the U.S. Army implemented a PBB program in all of its healthcare facilities due to rising concerns over costs and quality in its facilities. The U.S. Army’s PBB program tied hospital-level funding decisions to performance on key cost and quality-related metrics. This study examined the impact of this program and a subsequent PBB program on quality improvement in U.S. Army healthcare facilities. Drawing …

Hospital Investment In Urgent Care: Impacts On Emergent, Outpatient, And Ambulatory Surgery Volumes, Hillary A. Linhart

Theses and Dissertations

As the popularity of urgent care centers (UCCs) has grown, hospitals have increasingly chosen to invest in this care model. Hospital interest in UCCs is largely driven by two key factors. First, hospitals aim to use UCCs to generate referrals, which generate additional patient volume for downstream hospital services. Secondly, hospital UCC investment presents an opportunity to ease the demand for non-urgent care in the emergency department (ED) by diverting low-acuity ED patients to the more appropriate UCC setting. No study to date has evaluated the impact of hospital UCC investment on referrals or downstream service volumes. A few studies …

An Exploration In Accountable Care Organization Structure, Contingency And Performance, 2015-2017, Siriporn P. Satjapot

Theses and Dissertations

The Patient Protection and Affordable Care Act of 2010 enacted one of the most significant reforms seen in the United States healthcare landscape. The Center for Medicare and Medicaid (CMS) led transformation efforts in regulatory reform and coverage expansion across the U.S. population. Since 2010, care delivery systems have been shifting from episodic, decentralized and fee-for-service models to value-based population health models, like accountable care organizations (ACO). ACOs have been specifically primed for local response to improve the health of their communities. ACO research has traditionally focused on performance measures like mortality, readmissions, quality outcomes and savings. ACO organizational characteristics …

Spag17 Is Important For Protein Trafficking In Mammalian Spermiogenesis, Virali Bhagat

Theses and Dissertations

Spermiogenesis is the process through which undifferentiated germ cells develop into mature spermatozoa. While spermiogenesis is a very well-regulated process, the protein-protein interactions regulating it remain poorly understood. A knockout (KO) mouse for the ciliary protein SPAG17 was generated by our lab. Loss of SPAG17 has been shown to disrupt the transport of proteins important for acrosome biogenesis and manchette functions. With this information, we hypothesized that SPAG17 plays an essential role in protein trafficking during mammalian spermiogenesis. To further investigate this, immunofluorescence (IF) studies were performed in germ cells collected from both WT and SPAG17 KO mice to visualize …

Prediction Of The Vaginal Microbiome Using Urine Samples, Christopher R. Diachok

Theses and Dissertations

The vaginal microbiome is associated with women’s health, including but not limited to the pathogenesis of bacterial vaginosis, adverse pregnancy outcomes including preterm birth and sexually transmitted infections. However, there has been very limited research on the urinary microbiome and its relationship to the vaginal microbiome. We sought to predict the vaginal microbiome profile using clean catch urine samples from the same person. Here, paired vaginal and urine samples were collected and sequenced by 16S ribosomal RNA sequencing. Alpha and beta diversity analysis showed that there was no significant difference between the paired vaginal and urine microbiomes. In fact, a …

Anticholinergic Burden And Risk Of Cognitive Impairment In Older Adults, Syeda Hashimi

Theses and Dissertations

Studies reveal that 10-27% of older adults chronically use anticholinergic medications. Increased cumulative anticholinergic burden scores are associated with increased risks of dementia. The mechanisms by which anticholinergic drugs negatively impact cognition remain elusive. However, researchers speculate that the drug’s impairment of cholinergic neurons promotes neuroinflammation.

We hypothesize that drugs with anticholinergic properties will induce inflammation in the brain. MCP1 and IL 6 are chemokines that contribute to neuroinflammation. We investigated the influence of diphenhydramine (Benadryl) on the production of MCP1 and IL-6 in Normal Human Astrocytes and Paroxetine on the production of MCP1 in Normal Human Astrocytes and Normal …

Adoption Of The Health Information Exchange (Hie) System And The Role Of The Healthcare Leadership, Muhammad Faisal Ashfaque

Theses and Dissertations

The advancement in technology calls for improvement in service delivery in healthcare systems, especially in the present health pandemic of the COVID-19. At present, healthcare systems utilize several electronic health techniques. However, there is a need for the creation of interoperability that can assist healthcare organizations in exchanging data more effectively through the global adoption of healthcare information exchange (HIE). The current research examines the adoption of HIEs and healthcare leadership roles to realize a fully functional interoperable patient HIE. This study utilized the systematic document analysis method to review qualitative data on the different aspects of healthcare leadership, implementation …

Kujdesi Infermieror Te Pacientët Në Dializë, Bukurije Berisha

Theses and Dissertations

Objektivi kryesor i këtij hulumtimi është vlerësimi i cilësisë së jetës në dializë e personave që jetojnë me sëmundje renale kronike (SRK). Përmes këtij hulumtimi janë përcaktuar standardet e kujdesit infermieror për pacientët të cilët janë në dializë. Studimi u realizua në Qendrën e Hemodializës në Ferizaj, në të cilën morrën pjesë 53 pacientë, 59% e tyre meshkuj dhe 41% femra, të përzgjedhur në mënyrë rastësove. Pyetësori mbulon aspekte të ndryshme të shëndetit të pacientëve në dializë duke theksuar edhe sjelljet etike dhe njohuritë e stafit infermieror dhe bashkëpunimin e tyre infermier – pacient.

Nga gjetjet e hulumtimit që i …

College Students’ Perceptions Of Popular Diets And Orthorexia Nervosa, Madison W. Weinstock

Theses and Dissertations

Data suggest that individuals’ purported dietary patterns influence others’ perceptions of them. However, few studies have investigated how adherence to specific popular diets might influence these perceptions. This study investigated female undergraduates’ (n = 463) perceptions of vignette characters described as adhering to specific dietary practices perceptions of a vignette character in a sample of 463 female undergraduates. Characters described as adhering to a Clean Eating diet were viewed most positively, followed by individuals on the Ketogenic diet or nondieters. Characters following an Intermittent Fasting diet, and those with Orthorexia Nervosa were viewed most negatively. These findings support the …

The Effects Of Gspt1 Degradation On Serum Calcium, Parathyroid Hormone, And Fibroblast Growth Factor 23 Concentrations In Human Cereblon Knock-In Mice, Kamran Ghoreishi

Theses and Dissertations

Test article CC-325 is a potent oral cereblon (CRBN) modulator that has shown potent G1 to S phase transition 1 (GSPT1) degradation and anti-tumor activity in pre-clinical models. One of the adverse effects associated with CC-325 was dose dependent hypocalcemia, which was determined to be an on-target toxicity.

To investigate the mechanism of hypocalcemia, we conducted a toxicity study in human cereblon (huCRBN) knock-in (KI) mice with CC-325. The huCRBN KI mice are transgenic mice engineered to express human cereblon that is capable of binding to CRBN and degrading GSPT1. Four groups of mice were treated with vehicle (0 mg/kg), …

Kcc2: A Novel Therapeutic Target To Rescue Gabaergic Dysfunction And Behavioral Deficits Induced By Hiv And Opiate Use, Aaron J. Barbour

Theses and Dissertations

With adherence to combined antiretroviral therapy (cART), HIV infection can be considered a controllable chronic condition, but quality of life issues remain. The preeminent of which, HIV-associated neurocognitive disorders (HAND), encompasses an array of neurological complications and has persisted despite cART implementation. The symptoms of HAND can be exacerbated by opiate use, a common comorbidity for people infected with HIV (PWH). While neurons are not infected by HIV, they incur sublethal damage, with γ-amino butyric acid- (GABA)ergic function being particularly vulnerable to viral and inflammatory factors released by infected/affected glia. This dissertation presents studies on novel organoid and dissociated primary …

A Comparison Of Three-Dimensional Printing Technologies On The Precision, Trueness, And Accuracy Of Printed Retainers, Owais A. Naeem

Theses and Dissertations

Purpose: The aim of this study was to evaluate the differences in the precision, trueness, and accuracy of 3D printed orthodontic clear retainers produced using printer systems with various printing technologies.

Methods: Retainers (n=15) were printed using four different 3D printers: a stereolithography (SLA) printer, two different digital light processing (DLP and cDLP) printers, and a polyjet photopolymer (PPP) printer. The 3D printed retainers were transformed into a digital file through a cone-beam computed tomography scan that was compared to the original image using a 3D superimposition analysis software. At previously chosen landmarks (R6, L6, R3, L3, R1, L1) retainers …

The Functional Importance Of Methyl Cpg Binding Domain Proteins 2 And 3 In Regulating Fetal Hemoglobin Expression In Human Adult Erythroid Cells, Alexander Azzo

Theses and Dissertations

Humans undergo two developmental switches in the predominantly expressed β-like globin chain during embryogenesis and fetal development. The first switch from embryonic (ε) to fetal (γ) occurs around week 5 of embryonic development, while the second switch from fetal to adult (β) globin occurs shortly after birth. By adulthood, fetal hemoglobin represents only 1-2% of total hemoglobin in the blood. As sufficiently elevated levels of fetal hemoglobin are beneficial for improving clinical outcomes in sickle cell disease and β-thalassemia, the mechanisms that enforce silencing of fetal hemoglobin expression postnatally are of great clinical significance. The methyl-CpG binding domain protein MBD2 …

Accounting For The Uncertainty Due To Chemicals Below The Detection Limit In Mixture Analysis, Paul M. Hargarten

Theses and Dissertations

Humans are exposed to multiple chemicals every day. Epidemiological studies have shown that chemical mixtures are associated with cancers, allergies, neurodevelopmental disorders, and other adverse health effects. To assess these associations, investigators are increasingly using chemical mixture approaches like weighted quantile sum (WQS) regression. In these studies, the research objectives are to determine whether a mixture of correlated chemicals is associated with an adverse health outcome and to identify the important chemicals. However, as experimental equipment measures each exposure to a chemical-specific detection limit, the exposures are unknown between zero and the detection limit. Indeed, the number of exposures below …

Non-Invasive Retrieval Of Prefabricated Zirconia Crowns With Er,Cr:Ysgg Laser From Primary And Permanent Teeth, Connor W. Mccall Dds

Theses and Dissertations

Purpose: Compromised tooth structure on permanent and deciduous teeth in the pediatric population is increasingly being restored with tooth-colored prefabricated zirconia crowns. These restorations may need to be removed or replaced with permanent crowns. The purpose of this in vitro study was to explore the use of an Er,Cr:YSGG laser for removal of prefabricated zirconia crowns cemented with RMGI as a non-invasive alternative to rotary instruments.

Methods: Thirteen permanent and 12 primary molars were prepared to dentin and prefabricated zirconia crowns were passively fitted and cemented with two resin modified glass ionomer cements. The irradiation parameters for ErCR:YSGG were 4.5 …

Process Factors Affecting Reperfusion Time In Patients Presenting With St-Segment Elevation Myocardial Infarction (Stemi), Richard R. Wall

Theses and Dissertations

Abstract PROCESS FACTORS AFFECTING REPERFUSION TIME IN PATIENTS

PRESENTING WITH ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION (STEMI) By Richard R. Wall MSRS, RT(R)(CT)(CI), RCIS

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

Virginia Commonwealth University, 2020.

Dissertation Chair: Jeffrey S. Legg Ph.D. Associate Professor and Chair, Department of Radiation Sciences

An ST-segment myocardial infarction (STEMI) occurs when the blood flow to the myocardium is suddenly and completely blocked causing the myocardium to become ischemic. A STEMI is a life-threatening condition that necessitates emergent medical treatment. Research has shown that longer …

Selenomonas Sputigena: Growth Conditions And Projected Virulence Factors Of An Emerging Oral Pathogen, Kayla A. Keller

Theses and Dissertations

Periodontal diseases are ubiquitous diseases. They can affect people through a chronic infection that happens over a lifetime, but also as an aggressive infection that afflicts the younger population. It not only results in tooth loss and a lower quality of life, but it can also lead to fatal secondary infections like cervical cancer, heart disease, and Alzheimer’s disease. This study looks at Selenomonas sputigena, an emerging oral pathogen, that has been hypothesized to contribute to periodontal disease. It has been linked to fatal septicemia and has been found in increased abundance within the oral biofilm during peak infection. …

Enhancing Chemosensitivity Of Lung Cancers By Manipulating The Tumor Microenvironment: Local Lung Delivery And Nanocarrier-Based Therapies, Hanming Zhang

Theses and Dissertations

Cancer is the second leading cause of death in United States causing an estimated six hundred thousand death in 2019. Among different types of cancer, lung cancer is the leading cause of cancer related death in both male and female. While targeted therapy and immunotherapy have shown promising clinical outcomes, currently there remain a significant proportion of patients who do not benefit from these strategies or who cannot tolerate them, making Pt based doublet chemotherapy still an indispensable component in almost all stages of treatment. However, partially due to the poor tumor distribution of small molecule drug, the development of …

Reducing Disparities In Smoking For Adults With Mental Illness: Are U.S. Tobacco Prevention Policies Effective?, L. Morgan Snell

Theses and Dissertations

One in five people in the U.S. are estimated to experience “any mental illness” (AMI); however this group represents an estimated 40% of the annual, adult cigarette consumption in the U.S. Tobacco prevention policies have been successful at reducing smoking prevalence among the U.S. population as a whole, however it is unclear whether these efforts have had significant impact on tobacco use rates among individuals with AMI. The three papers that comprise this project combined longitudinal, nationally-representative data and online behavioral experiments from U.S. adults to compare demand for cigarettes among adult smokers with and without AMI. Taken together, our …

Exploring The Use Of A Mindfulness Based Yoga Intervention For Children With Severe Asthma, Sharon Lack

Theses and Dissertations

Introduction: A diagnosis of severe asthma greatly impacts the physical and psychological health of children. Often experiencing increased stress, decreased physical activity, and increased exacerbations, children with severe asthma frequently exhibit poor health outcomes. Mindful yoga is a complementary health approach that may improve the physical and psychological well-being of children with severe asthma. The aims of this research were to evaluate the tolerability, feasibility, acceptability, and preliminary effects of a mindful yoga intervention in children with severe asthma. A novel theoretical framework encompassing concepts from three vulnerability nursing theories guided the research.

Methods: A mixed methods pilot …

Impact Of Sickle Cell Disease On Executive Functioning In An Adult Population, Christina Wade

Theses and Dissertations

Children diagnosed with sickle cell disease (SCD) struggle with executive functions (EF); however, there is a paucity of research on neuropsychological outcomes in adults with SCD. This study aimed to examine differences in EF between adults with SCD and healthy controls. Thirty- one patients with SCD and 34 healthy controls (ages 18-45) participating in an IRB-approved Children’s Hospital Los Angeles (CHLA) study of cerebral blood flow underwent neuropsychological evaluation using the Delis–Kaplan Executive Function System (D-KEFS) Trail Making and Color Word Interference Tests and the Wechsler Adult Intelligence Scale - Fourth Edition (WAIS-IV) Digit Span subtest to assess various aspects …

Job Stress Effects On Job Satisfaction And Attrition In 9-1-1 Call Centers, Damarys Jaile Gilligan

Theses and Dissertations

In 9-1-1 call centers across the nation the personnel shortage has become a crisis. The nature of the job of a 9-1-1 telecommunicator is stressful due to the high volume of emergency calls. This applied dissertation was designed to learn if there is a relationship between job stress, burnout levels, and job satisfaction in 9-1-1 telecommunicators. This was a nonexperimental quantitative survey research with a correlational approach. The population was a nonprobability convenience sample recruited through the Survey Monkey Audience platform. Data was collected at one point in time. A total of 37 participants took part in the study. All …

Doctor-Patient Communication: The Experiences Of Black Caribbean Women Patients With Diabetes, Rosanne Paul-Bruno

Theses and Dissertations

This applied dissertation was designed to examine the verbal and non-verbal communication experiences of Black Caribbean diabetic women patients with their doctors, in order to provide a better understanding of the essential aspects of doctor- patient communication and their experiences as they managed their condition. Black Caribbean women have been disproportionately impacted by medical conditions such as diabetes. It has been a documented fact that minorities experience disparities in the health care system at different levels and doctor-patient communication is no exception. Poor doctor-patient communication has been known to hinder patients’ health outcomes, and therefore warrants such studies to increase …

Bridging The Digital Divide: A Risk-Based “Telehealth Needs” Scoring Model For Patient Outcome Prediction, Cindy Ann Crump

Theses and Dissertations

The purpose of the research was to develop a predictive model of the effect of patient characteristics on outcomes and resource utilization in telehealth interventions for chronic disease management. Clinical studies have shown high variability in telehealth across settings and populations. The central hypothesis of this study was that patient characteristics, including disease type, illness severity, demographic information, and socio-technical preferences play a role in determining telehealth intervention outcomes. A non-experimental, retrospective study evaluated the feasibility of creating a Telehealth Needs score using Medicare and Medicaid claims data from 2016 to 2017. Claims were summarized into de-identified cases to train …