Medicine and Health Sciences Commons^™

Management Of The Open Apex Using A Bioceramic Apical Barrier: Success And Survival Rates At Virginia Commonwealth University, Adam Sarnowski

Theses and Dissertations

Purpose: The aim of this study was to assess the outcome of treatment of teeth with open apices managed by the orthograde placement of a bioceramic apical barrier as well as to identify potential outcome factors for this type of treatment. Methods: Patient records were pooled from graduate resident cases completed at Virginia Commonwealth University between January 1, 2010 and May 31, 2018. A total of 515 patients were identified using relevant ADA codes and a key word search within the patient record database. A total of 104 patients (119 teeth) had an open apex that had NSRCT utilizing a …

Perception Of Patient Cooperation Among Dentist, Guardian, And Child, Cole A. Staines Dds

Theses and Dissertations

Purpose: Evaluate behavior assessment and agreement among dentist, guardian, and child. Evaluate child behavior by appointment type.

Methods: Patients recruited from the pediatric dental department at Virginia Commonwealth University for this convenience sample. Inclusion criteria: patients presenting for clinical exams and/or restorative treatment without the use of advanced behavior guidance between August 29, 2018, and March 7, 2019; ages 4-12-years-old; and scheduled with a single clinician. Appointments were stratified by difficulty. Behavior was assessed by dentist and caregiver using the Frankl Scale. Patient self-assessed cooperation using an age-appropriate modified Frankl Scale, developed for this study. Agreement assessed among the 3 …

Associations Between Ethnic-Racial Identity, Family Factors And Alcohol Problems Among Diverse Emerging Adults, Chloe Walker

Theses and Dissertations

The current study examined how multiple dimensions of ethnic-racial identity (ERI) were associated with alcohol use and alcohol use disorder (AUD) symptoms and how these relations varied by individuals’ ethnic-racial group among 1850 diverse emerging adults (M = 18.46, SD = .38). Further, measurement invariance of the Ethnic Identity Scale-Brief (EIS-B) was tested across Latinx, White, Black, Asian, and Multiracial students. Additionally, alternative models were examined that tested whether family factors (i.e., parent education and family history of alcohol problems) moderated the relations between ERI and alcohol problems to further examine nuances in these relations. Results indicated that the …

Examining How Primary Care Team Structures Are Used And Their Effect On Cross-Disciplinary Relationships: A Qualitative Study, Matthew J. Depuccio

Theses and Dissertations

Team-based primary care is an innovative care delivery model that has the potential to improve access to comprehensive, coordinated, and high-quality patient care. It is understood that in order for primary care teams to work effectively, health care providers must work across disciplinary boundaries and develop strong relationships that enable them to coordinate their roles and expertise. This research investigated how health care providers make use of different team structures (i.e., tools) to manage their interdependent work, enabling them to deliver team-based primary care. This research also examined how team structures influence the intra-team relationships important for coordinating care. By …

Cellular Mechanisms By Which Alcohol Promotes Hiv Protease Inhibitor-Induced Hepatotoxicity, Michael Hinton

Theses and Dissertations

CELLULAR MECHANISMS BY WHICH ALCOHOL PROMOTES HIV PROTEASE INHIBITOR-INDUCED HEPATOTOXICITY

Michael Hinton, B.S.

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

Virginia Commonwealth University, 2019

Major Director: Huiping Zhou

Professor, Department of Microbiology and Immunology

The development of highly-active-antiretroviral therapy(HAART) has allowed management of HIV and extended the lives of those infected. Alcohol abuse, which is very common in HIV-1 infected patients, is one of the most important co-morbid risk factors for liver injury and has been associated with the occurrence of serious metabolic syndrome and subsequent discontinuation …

Examination Of Strain-Dependent Differences In S. Sanguinis Virulence And Growth, Shannon Baker

Theses and Dissertations

Streptococcus sanguinis, an abundant and benign inhabitant of the oral cavity, is an important etiologic agent of infective endocarditis, particularly in people with pre-disposing cardiac valvular damage. Although commonly isolated from patients with IE, little is known about the factors that make any particular S. sanguinis isolate more virulent than another or, indeed, whether significant differences in virulence exist among isolates. To investigate the virulence of multiple isolates, a variation of the Bar-seq (barcode sequencing) method was employed. A conserved chromosomal site was identified for subsequent insertion of a barcode identifier, unique for each strain. Barcode insertion did not …

The Role Of Syndecan-1 And Extracellular Vesicles In Breast Cancer Brain Metastasis, Megan R. Sayyad

Theses and Dissertations

Breast cancer metastasizes to the brain in 15-30% of all breast cancer cases, and metastasis is the predominant cause of breast cancer-related deaths. Patients with HER2-enriched and triple-negative breast cancers (TNBCs) are more likely to develop brain metastases. While targeted therapies exist for HER2-enriched breast cancers, there are no effective treatments for TNBCs. Thus, a greater understanding of how these cancers spread to the brain is critical. In order to spread to the brain, disseminated breast cancer cells must overcome 2 major steps—crossing the blood-brain barrier (BBB) and survival and successful colonization of the distinctive and mostly cellular brain environment. …

Metaproteomic Investigation Of The Vaginal Microbiome In Pregnancy, Zaneera Hassan

Theses and Dissertations

The development of early diagnostics and prevention strategies for preterm birth is an important global health challenge with the potential to impact over 15 million children annually, by improving health outcomes and reducing economic burden. Advances in microbial sequencing technology have opened the door to 16S rRNA gene survey, whole metagenomics, and whole transcriptomics, providing molecular evidence that the composition of the vaginal microbiome affects pregnancy outcomes in women, particularly those of African descent. A current gap in our molecular level understanding of the vaginal microbiome as it relates to healthy pregnancies is the metaproteome which comprises proteins from both …

What's In A Message? The Impact Of Patient-Clinician Email Message Content On Patient Health Outcomes And Healthcare Utilization, Dawn M. Heisey-Grove

Theses and Dissertations

Introduction

In the upcoming chapters, we present our study findings as three papers ready for submission to peer-reviewed journals. The first paper describes the associations between taxa and the characteristics of the patients and clinic staff who exchange those messages. The second paper explores the associations between those taxa and patients’ healthcare utilization. The third paper presents associations between taxa and patient health outcomes for diabetes and hypertension. We conclude with how the three papers are related and highlight the importance of this research.

Across the three papers, we reference a theory-based taxonomy we developed specifically for secure messaging. A …

Impact On Bacterial Micro-Leakage In Exposed Root Canal Obturation Material In Teeth Irrigated With Different Solutions, Khalifa W. Alhaddad

Theses and Dissertations

Purpose: Determine the timeframe of bacterial penetration that occurs to the apex when obturation material (gutta percha) is exposed to bacteria for a set period of time (45 days) and to determine if bacterial penetration of the obturated root is influenced by the type of irrigant used during the final rinse (17% EDTA vs 2% Chlorhexidine vs full strength 5.25% NaOCl). Methods: Thirty-six extracted teeth, including six controls, were instrumented and irrigated with 5.25% NaOCl followed by a final rinse of either: 17% EDTA, 2% Chlorhexidine, or 5.25% NaOCl, and then obturated. Each root was suspended between two chambers: the …

Comparison Of Patient Factors Influencing The Selection Of An Orthodontist, General Dentist, Or Direct-To-Consumer Aligners For Orthodontic Treatment, Jeffrey C. Olson

Theses and Dissertations

Purpose: To evaluate the factors that influence potential orthodontic patients choosing between an orthodontist, general dentist, and direct-to-consumer (DTC) aligners for their treatment, and to determine the demand for each provider type.

Methods: An electronic survey was administered to 250 individuals among the general population of adults in the United States. Questions were designed to determine the respondent’s level of interest in pursuing orthodontic treatment with each provider type, evaluate their current level of knowledge concerning provider options, and identify factors influencing their selection. Pearson’s chi-squared test and ANOVA were used to evaluate the factors influencing patients in …

Evaluation And Comparison Of Periapical Healing Using Periapical Films And Cone Beam Computed Tomography: Post-Treatment Follow Up, Adam S. Polinsky

Theses and Dissertations

Purpose: The purpose of this study was to assess the radiographic changes in periapical status and analysis of healing determined using periapical radiographs (PA) versus cone beam computed tomography (CBCT) pre-operatively and at 3-64 months following endodontic treatment.

Methods: Pre/post treatment radiograph and CBCT scans of patients who had NSRCT, NSReTx, or SRCT from July 2011-December 2018 at VCU Graduate Endodontic clinic were included in this study. Volumetric and linear measurements of periapical lesions on initial and recall PA and CBCT images were performed using three calibrated examiners. Changes and differences in the estimated area from PA to CBCT were …

Frictional Properties Of Novel Bracket Systems: An In-Vitro Study, Stephen M. Haverkos

Theses and Dissertations

Orthodontic brackets undergo resistance during sliding that includes classical friction, binding, and notching. Current bracket systems are hampered by these challenging forces. As a result, the clinician usually needs to apply additional forces to overcome the resistance which increases the risk of root resorption and discomfort for the patient. This study evaluated frictional properties of a novel bracket that had polytetrafluoroethylene (Teflon™) coated rollers in its design. Five types of brackets (n = 10, each), including a passive self-ligating bracket, a traditional ligated bracket, a three-dimensionally printed direct metal laser sintering (DMLS) bracket with and without Teflon™ rollers, and computer …

Diuretic And Natriuretic Activity Of Faah Inhibition In The Renal Medulla: A Proposed Role Of Palmitoylethanolamide And Its Regulation By Renal Medullary Interstitial Cells, Sara Dempsey

Theses and Dissertations

Hypertension is a critical public health issue worldwide, and in the United States, it is the leading cause of heart disease, stroke, and kidney failure, contributing to more than 1,100 deaths per day. It is proposed that the renal medulla combats increased blood pressure by releasing a neutral lipid from the lipid droplets of medullary interstitial cells, termed medullipin, which induces diuresis- natriuresis and vasodepression. The renal medulla is enriched with fatty acid lipid ethanolamides including the endocannabinoid anandamide (AEA), palmitoylethanolamide (PEA), and oleoylethanolamide (OEA), along with their primary hydrolyzing enzyme fatty acid amide hydrolase (FAAH). Our lab is investigating …

Let’S Face It: The Effect Of Orthognathic Surgery On Facial Recognition Algorithm Analysis, Carolyn Bradford Dragon

Theses and Dissertations

Aim: To evaluate the ability of a publicly available facial recognition application program interface (API) to calculate similarity scores for pre- and post-surgical photographs of patients undergoing orthognathic surgeries. Our primary objective was to identify which surgical procedure(s) had the greatest effect(s) on similarity score.

Methods: Standard treatment progress photographs for 25 retrospectively identified, orthodontic-orthognathic patients were analyzed using the API to calculate similarity scores between the pre- and post-surgical photographs. Photographs from two pre-surgical timepoints were compared as controls. Both relaxed and smiling photographs were included in the study to assess for the added impact of facial pose on …

Design, Synthesis And Pharmacological Characterization Of Potential Mu Opioid Receptor Selective Ligands, Abhishek S. Kulkarni

Theses and Dissertations

Selective Mu Opioid Receptor (MOR) antagonists possess immense potential in the treatment of opioid abuse/addiction. Utilizing the “message-address” concept, our laboratory reported a novel, reversible, non-peptide MOR selective antagonist 17-cyclopropylmethyl-3,14β-dihydroxy-4,5α-epoxy-6β-[(4՛-pyridyl)carboxamido]morphinan (NAP). Molecular modeling studies revealed that the selectivity of NAP for the MOR is because of a π-π stacking interaction of its pyridine ring with the Trp318residue in theMOR. Pharmacological characterization showed that NAP is a P-glycoprotein substrate, thereby limiting its use in the treatment of opioid abuse/addiction. Thus, to modify NAP, we replaced the pyridine ring with its isosteric counterpart thiophene. Isosteric replacement …

The Efficacy Of A Fluoride-Containing Orthodontic Primer In Preventing Demineralization, Alyssa G. Ricci

Theses and Dissertations

Purpose: To evaluate the efficacy of a fluoride-containing orthodontic primer in preventing demineralization adjacent to brackets and compare the quality of enamel on tooth surfaces that received interproximal reduction (IPR).

Methods: Patients at the VCU Orthodontic clinic who consented to orthodontic treatment involving extraction of at least 2 premolars were recruited to this pilot clinical study. Brackets were bonded to premolars using one of two primers, fluoride-containing experimental or control. IPR was also performed, and the experimental primer was applied to randomly selected teeth. Extracted teeth were analyzed visually for the presence of white spot lesions (WSLs). Micro-CT analyses were …

Restoration Of Contractile Protein Expression And Colonic Smooth Muscle Function By Hydrogen Sulfide In Dmd Mice, Kulpreet Singh

Theses and Dissertations

Duchenne Muscular Dystrophy (DMD), characterized by the lack of dystrophin, results from a mutation in the Xp21 gene which encodes for the protein dystrophin that links the extracellular matrix to the actin cytoskeleton in skeletal, cardiac and smooth muscle. Slow colonic transit and chronic constipation are common in DMD patients due to the weakening of the abdominal wall muscles and gut smooth muscle. However, the cause of this hypocontractility in DMD patients and the expression of contractile proteins in smooth muscle are unknown. Expression of contractile proteins is regulated by the signaling pathways activated by excitatory (e.g., acetylcholine, ACh) and …

The Dna Methyltransferase Inhibitor, Guadecitabine, Targets Tumor-Induced Myelopoiesis And Recovers T Cell Activity To Slow Tumor Growth, Andrea J. Elkovich

Theses and Dissertations

Myeloid Derived Suppressor Cells (MDSC) represent a significant hurdle to cancer immunotherapy because they dampen anti-tumor cytotoxic T cell responses. Previous studies have reported on the myelo-depletive effects of certain chemotherapies. Using guadecitabine, a next-generation DNA methyltransferase inhibitor (DNMTi), we observed significantly reduced tumor burden in the 4T1 murine mammary carcinoma model. Guadecitabine treatment prevents excessive tumor-induced myeloid proliferation and systemic accumulation, and skews remaining MDSCs toward a beneficial antigen-presenting phenotype. Together, this alters the splenic environment to improve T cell activation and interferon-gamma (IFNg) production. Additionally, guadecitabine enhances the therapeutic effect of adoptively transferred antigen-experienced lymphocytes to diminish tumor …

Patient-Centered Medical Homes And Hospital Value-Based Purchasing: Investigating Provider Responses To Incentives, Lauryn Walker

Theses and Dissertations

Provider incentives are a commonly used policy tool to mold provider behaviors.¹ However, while we frequently measure the change in patient outcomes, failure to consistently produce changes in outcomes does not mean that providers are not changing their behavior. This paper focuses on two programs with null or inconsistent quality outcomes to try to identify why such inconsistency occurs. The two programs, both ratified in the Affordable Care Act, are 1) patient-centered medical homes (PCMHs), and 2) the Medicare Hospital Value-Based Purchasing (HVBP) program.

Chapter 1: Using data from the Medical Expenditure Panel survey (MEPS), I match provider characteristic …

A Qualitative Study Exploring Motivation And Engagement Among Millennial Volunteers In Nonprofit Organizations, Joanne Quinones

Theses and Dissertations

This applied dissertation focused on capturing the lived experiences of Millennials and explore their motivation and engagement for volunteering in a nonprofit organization. This study illustrates the importance of civic and social engagement in our society. The Millennials have been labeled as “Genme or the me generation” (Twenge, Campbell, Hoffman, & Lance, 2010, p. 1117; Twenge, 2006, p. 1), as they have been criticized for focusing on their own self-interest. While millennials have been considered as being technologically savvy, since they grew up with the internet. The millennials, have a social interest in offering support to a cause versus an …

Older Adult Caregivers’ Lived Experiences With Debilitated Chronically Ill Relatives In A Rural Southern County, Nancy J. Dameron

Theses and Dissertations

By 2030, the last of the baby boomer generation will reach the age of 65, which will expand the older adult population to more than 70 million in the United States. Based on the inflated numbers of the older adult population and the noted decreased birth rate in the younger population, fewer health-care providers will be available to teach, prepare, train, and assist caregivers in the ongoing care of their ill relatives.

The problem investigated in the study involved the present upsurge of the older adult population living longer and contributing to a shortage of health-care providers for older adults. …

Effects Of A Sensory Diet On Attention And Participation In Children With Autism, Leighanne Smith-Mrkaja

Theses and Dissertations

This applied dissertation was designed to provide initial knowledge regarding sensory diets and sensory-based interventions. The need for classroom-based sensory interventions are not always considered, especially with the high number of students diagnosed with ASD at the researcher’s school. Often sensory intervention may not be considered educationally relevant, especially in the prekindergarten level. With the proper training and materials, as well as the guidance of the school-based occupational therapist, teachers, other therapists, classroom assistants, parents, and school-based staff might be able to utilize sensory-based activities like sensory diets to increase participation, positive behaviors, and attention. The following applied research study …

Religion In Incarcerated, Jewish, Female Inmates, Marcia Janine Kesner

Theses and Dissertations

This study explored the role religious belief and practice played amongst Jewish, female inmates during their incarceration. A group of ten correctional chaplains who work with Jewish, female, inmates and a comparison group of ten chaplains who work with Protestant, female inmates were interviewed. The study determined the reasons for and benefits of religious observance among these inmates and included assisting in dealing with fear, providing a sense of peace, and deceitful motives for personal gains. Religious practice also assisted inmate populations in healing from trauma, improving self-respect and self-esteem, building support systems, and additionally for Jewish, female inmates constructing …

Predictors Of Experimental And Control Group Attendance: Findings From An Hiv/Std Prevention Rct With Pregnant Women At Risk For Substance Use, Jaclyn S. Sadicario

Theses and Dissertations

Efforts to improve inclusion in research have included mandating the recruitment of ethnic minorities and women into NIH funded studies. However, little research has been completed on who attends such interventions. This is particularly worrisome in populations for which attendance to interventions can have dire consequences. HIV is a public health concern for pregnant women in substance using communities, as pregnant women are much less likely to use condoms during intercourse to prevent HIV. Group modular HIV prevention interventions have long been the standard for HIV prevention. However, little attention in research on HIV prevention interventions RCTs has been focused …

Diuretic, Natriuretic, And Vasodepressor Activity Of A Lipid Fraction Enhanced In Medium Of Cultured Mouse Medullary Interstitial Cells By A Selective Faah Inhibitor, Zdravka P. Daneva

Theses and Dissertations

The relationship between the endocannabinoid system in the renal medulla and the long-term regulation of blood pressure is not well understood. To investigate the possible role of the endocannabinoid system in renomedullary interstitial cells, mouse medullary interstitial cells (MMICs) were obtained, cultured and characterized for their responses to treatment with a selective inhibitor of fatty acid amide hydrolase (FAAH), PF-3845. Treatment of MMICs with PF-3845 increased cytoplasmic lipid granules detected by Sudan Black B staining and multilamellar bodies identified by transmission electron microscopy. HPLC analyses of lipid extracts of MMIC culture medium revealed a 205nm-absorbing peak that showed responsiveness to …

National And Local Antibiotic Prescribing Trends And Prescribing Appropriateness In Older Adults, Fawaz M. Alotaibi

Theses and Dissertations

Background: Antibiotic overuse/misuse has been documented in several reports to increase the risk of Clostridioides difficile (C.diff) infection and antibiotic resistance. The older adult population is more prone to use antibiotic medications than any other age group due to decreased immune function, use of urinary catheters, ventilation during hospitalization and other factors. Antibiotic resistance and C.diff are major public health problems. However, studies examining the trends of antibiotic use and the association between the antibiotic use and negative health outcomes among older adults in the outpatient and emergency department settings are limited.

Objectives: The main objectives of this …

Conjugated Bile Acid And Sphingosine 1-Phosophate Prompt Cholangiocarcinoma Cell Growth Via Releasing Exosomes, Waad A. Alruwaili

Theses and Dissertations

Cholangiocarcinoma (CCA) is a fatal primary malignancy that is formed in the bile ducts. Cancer-associated myofibroblasts play a crucial role in CCA proliferation and invasion. Furthermore, there is a growing interest in the role of the exosome in the interaction between the cancer-associated myofibroblasts and cholangiocarcinoma which lead to CCA growth. However how cholangiocarcinoma-derived exosome affect the cancer-associated myofibroblasts in the tumor microenvironment remain unknown. In this study, we examined whether exosome produced by cholangiocarcinoma could involve in the prompt of CCA cells growth by regulation of myofibroblast. We found that cholangiocarcinoma-derived exosome could prompt elevated α-smooth muscle actin and …

Understanding Medication Self-Management Capacity Among Older Adults Living In Low-Income Housing Communities, Amal M. Badawoud

Theses and Dissertations

Understanding Medication Self-Management Capacity among Older Adults Living in Low-Income Housing Communities

ABSTRACT

Background: Medication self-management capacity (MMC) is an individual’s cognitive and functional ability to self-administer a medication regimen as prescribed. Poor MMC is an issue in older adults often resulting in negative health outcomes and loss of independence. Therefore, understanding low-income older adults’ capacity to manage their medications may help identify individuals who are at risk for developing medication mismanagement and guide future intervention strategies based on an individual need to promote safe medication use and healthy aging in place in the community.

Objectives: 1) To determine the …

Perceived Stress, Salivary Cortisol, And Depression In Adults Diagnosed With Postconcussion Syndrome; A Pilot Study, Christine Fish-Huson

Theses and Dissertations

Traumatic Brain Injury (TBI) affects approximately 1.7 million persons in the United States annually, 75% are categorized as mild (mTBI). Most persons who experience mTBI will recover, however an estimated 10% will develop Postconcussion Syndrome (PCS). Evidence supports a relationship between perceived stress, salivary cortisol, and depressive symptoms in persons after TBI; however, there are no known studies exploring these relationships in the PCS patient population. A sample of 17 men and women diagnosed with PCS were recruited from Southwest and Central Virginia. Data collection included the Rivermead Postconcussion Questionnaire, Perceived Stress Scale-10, Center for Epidemiological Studies-Depression Scale and the …