Medicine and Health Sciences Commons^™

Understanding Maternal Morbidity And Mortality Rates In Georgia, Ebony Hall

Theses and Dissertations

The United States continues to have a significant concern for public health regarding the maternal morbidity and mortality rates. In contrast, women of African American descent and other marginalized populations maintain a disproportionately higher rate of pregnancy-related disparities. More specifically, in Georgia, a persistent number of disparities can correlate to a lack of access to adequate prenatal care, insurance status, and many other social determinants of health that are linked to the contribution of adverse maternal health care outcomes. The purpose of this research study is to evaluate various maternal health experiences during pregnancy, while focusing on the occurrence of …

Analysis Of Risk Factors And Current Programs For Addressing Injuries In Children And Adolescents, Jahfel Nial Jones Iii

Theses and Dissertations

Unintentional injuries are a leading cause of morbidity and mortality among children and adolescents in the United States. These injuries result from various causes, including motor vehicle crashes, falls, suffocation, and poisoning. This capstone project examines the prevalence, risk factors, and prevention strategies for unintentional injuries among infants, children, and adolescents. Using a public health approach, this research explores evidence-based interventions and community-based programs that effectively reduce injury-related mortality. The project also incorporates data and insights from the Safe Kids Columbus program at Piedmont Columbus Regional, where various injury prevention initiatives have been implemented.

Findings revealed that motor vehicle crashes …

Enhancing Hospital Length Of Stay Using Ai Agent Modular Capabilities, Dami Fred

Theses and Dissertations

Hospital Length of Stay (LOS) analysis is essential for managing hospital efficiency and financial performance, yet the analytical depth required remains inaccessible to many organizations due to technical and resource constraints. This thesis introduces the AI Agent Modular Capabilities (AIAM) framework, which decomposes LOS analysis into discrete, codifiable capabilities integrated into a single skill activatable with one prompt. Seven AI Agent Modular Capabilities were developed using a Work Breakdown Structure and tested against a simulated hospital scenario across three successive skill versions. Results demonstrate that the packaged AIAM skill produces comprehensive, consistent, multi-section LOS analyses from a single interaction, outperforming …

The Role Of Body Composition In Predicting Fitness Performance Of Law Enforcement Officers, Taylor J. Parmentier

Theses and Dissertations

Law enforcement officers (LEOs) perform physically demanding tasks such as foot pursuits, lifting, carrying, dragging, and physical restraint. Effectively performing these duties requires significant muscular strength, endurance, and cardiorespiratory fitness. Lower fitness levels pose risks for reduced health, performance, slower recovery, increased fatigue, and potentially affecting decision-making under strenuous conditions. The purpose of this study was to identify the strongest predictor of physical fitness performance among active-duty LEOs. Body composition analysis and a comprehensive fitness evaluation of twenty-nine male LEOs (age: 36.2 ± 9.3 years, body mass (BM): 95 ± 13.7 kg, height: 1.8 ± 0.1 m) was completed. The …

Emotion Regulation Difficulties And Substance Use: The Role Of Conscientiousness, Caitlyn M. Donnelly

Theses and Dissertations

Difficulties in emotion regulation have been consistently linked to substance use among college students. However, individual differences may influence this relationship. Conscientiousness, a personality trait characterized by self-control, planning, and goal-directed behavior, has been proposed as a potential protective factor. The present study examined associations among difficulties in emotion regulation, conscientiousness, and substance use behaviors, as well as whether conscientiousness moderates the relationship between emotion regulation difficulties and substance use. Using a quantitative, cross-sectional, correlational design, data was collected from college students recruited through a university participant pool. Participants completed self-report measures of emotion regulation difficulties, conscientiousness, and substance use …

Managing Multi-Drug Resistance: An Evolutionary Game Theory And Optimal Control Approach, Shukhrat Nasrulloev

Theses and Dissertations

Multi-drug resistance is an evolutionary process in which treatment eliminates sensitive cells, allowing resistant clones to dominate. This thesis investigates this process using a framework integrating population dynamics, evolutionary game theory, and optimal control theory. We develop a two-population logistic growth model describing competition between drug-sensitive and drug-resistant cells under treatment, construct dose-dependent payoff matrices and replicator dynamics to characterize evolutionary competition, and derive a critical drug level D_crit = (r_S - rR)/(dS - d_R) at which resistant cells gain a fitness advantage. An optimal control problem is formulated via Pontryagin's Maximum Principle to identify schedules …

Between Tradition And Transition: Cultural Negotiations And Contraceptive Perceptions Among Ghanaian Students In The United States, Beatrice Amissah

Theses and Dissertations

As global mobility continues to rise, international students often encounter new cultural norms and health practices that differ from those in their home countries. While some studies have focused on contraception within the context of gender and types, less focus has been placed on diasporic populations, especially how students navigate tensions surrounding contraception within new cultural environments. This study explores how Ghanaian students in the United States interpret, negotiate, and respond to contraceptive messaging while navigating the cultural transition between their heritage and host societies. Drawing on Berry’s (1980)  Acculturation Theory, the study examines the tensions students experience, the strategies …

Striving To Thrive: Balancing Digital Health Innovation And Patient Protection Under Thailand’S Legal Framework, Thidarat Liamsomboon

Theses and Dissertations

The digitalization of health care has fundamentally transformed how health care services are accessed, delivered, and experienced worldwide. Telemedicine, artificial intelligence–assisted diagnostics, electronic health records, wearables, and mobile health applications are no longer novelties, but have become a substantial part of a modern clinical practice. Although these technologies offer great prospects for making health care more accessible, reducing administrative burden, and improving the quality of care, they also pose significant legal and regulatory challenges. The rate of technological development has far outpaced Thailand’s existing legal frameworks for regulating medical practice, professional accountability, and patient protection. This regulatory “lag” has generated …

Family- And Cultural-Level Influences For Latine Adolescent Nicotine Use: A Qualitative Study Informing Prevention, Cindy M. Hernandez Castro

Theses and Dissertations

Early tobacco use among Latine adolescents represents a critical public health concern, with 23.8% reporting current use and exceeding rates among other racial/ethnic groups (Birdsey et al., 2023; Gaddy et al., 2022). This early initiation elevates risks for nicotine dependence and related morbidity in adulthood (Tsao et al., 2023). Guided by Structural Ecosystems Theory (Szapocznik & Coatsworth, 1999) and contemporary grounded theory analysis (Braun & Clarke, 2006; Charmaz, 2006; Noble & Mitchell, 2016), this study examined multilevel influences on nicotine-related attitudes among Latine youth, including: (1) familial factors (i.e., parental monitoring, caregiver-youth communication), (2) cultural dynamics (i.e., cultural values and …

Absolute Quantification And Identification Of Rna From Rna-Lipid Nanoparticles Using High Resolution Mass Spectrometry, Jason C. Funderburk

Theses and Dissertations

RNA therapeutics are a rising drug category with potential use for a range of conditions encompassing infectious diseases to therapies for cancer, diseases, and genetic disorders. RNA-lipid nanoparticles (RNA-LNPs) are the prominent delivery method for these therapeutics approved products include mRNA vaccines and polyneuropathy treatments. The emergency use authorizations and orphan drug status of current RNA-LNP drugs has allowed approval without finalization of the regulatory analytical procedures for quality monitoring. The objective of the study was to develop an LC-MS assay to simultaneously measure identity and concentration of two therapeutically relevant intact RNA constructs extracted from RNA-LNPs to enhance quality …

A Framework For Digital Energy Modulation And Translation In Projectional X-Ray Imaging, Richard R. Wargo

Theses and Dissertations

In projectional X-ray imaging, acquisition energy fundamentally influences subject contrast, image noise, and radiation dose. While dual-energy techniques exploit spectral differences to optimize contrast and enable material separation, acquiring multiple images of the same anatomy often requires additional exposures and increased system complexity.

This dissertation presents a framework for digital energy modulation (DEM), in which computational models are trained to translate projection images between energy domains without requiring additional X-ray acquisitions. DEM is conceived as a generalizable strategy for controlled contrast modulation in projection imaging, with potential applications in image optimization, radiation therapy alignment, and dual-energy applications.

The framework was …

Generating Synthetic Ct From Mri Data, Foysal Ahmed

Theses and Dissertations

Magnetic resonance imaging (MRI) provides excellent soft tissue contrast without ionizing radiation, making it a strong alternative to computed tomography (CT) in medical imaging workflows. However, CT remains essential for applications requiring electron density information, such as radiation therapy treatment planning. This study investigated the feasibility of generating synthetic CT (sCT) images from MRI using a deep learning-based U-Net architecture. A two-dimensional U-Net was trained on paired MRI-CT data from the SynthRAD 2025 dataset, consisting of 120 T1-weighted (T1W) and 60 T2-weighted (T2W) axial cases, including deformed CT (dCT) aligned to MRI. Model testing used an independent dataset of 30 …

Magnetic Resonance Only Planning Validation Using Synthetic Ct By Mvision, Eric D. Brass Sr

Theses and Dissertations

Problems: Adaptive radiotherapy requires clinically practical methods for responding to patient-anatomy changes that occur between the original planning images and the day of treatment delivery. Registering a previously acquired computed tomography scan to a newly acquired magnetic resonance image can introduce cross-modality uncertainty and may delay replanning. This thesis evaluates whether synthetic computed tomography generated from same-day magnetic resonance imaging can reduce registration-related uncertainty while supporting rapid dose recalculation for fraction-level adaptation.

Procedure: Magnetic resonance imaging DICOM data were exported from the ViewRay MRIdian treatment planning system and uploaded to MVision for synthetic computed tomography generation. The synthetic computed tomography …

Development Of A Practical Lu-177 Activity Calibration Protocol For Clinical Nuclear Medicine: Dosimetric Impact Analysis And Implementation Tools, Azam Almolaiki

Theses and Dissertations

Lutetium-177 (Lu-177) is widely used in radionuclide therapy, where accurate activity measurement prior to administration is essential for safe and effective treatment delivery. However, variability in dose calibrator response due to measurement conditions and source geometry remains a practical challenge in routine clinical settings. This study presents a practical clinical calibration strategy under real-world constraints for Lu-177 activity measurement using standard nuclear medicine instrumentation. A vial-based approach was implemented using a well-type ionization chamber (Capintec CRC-15R) to evaluate measurement repeatability, temporal stability, and geometry dependence. All measurements were performed under consistent conditions with appropriate decay correction applied using the physical …

Commissioning & Daily Qa Of Converted Linac For Electron Flash, Tomaj Javidtash

Theses and Dissertations

Ultra-high dose rate (FLASH) radiotherapy has demonstrated promising normal tissue sparing in preclinical studies; however, the lack of standardized dosimetry, commissioning, and quality assurance (QA) methodologies remains a major barrier to its reproducible and safe implementation. In particular, conventional clinical commissioning and QA protocols are not directly applicable at FLASH dose rates due to challenges associated with detector response, dose-per-pulse effects, and beam control limitations.

This thesis presents the commissioning of a converted Varian 21EX linear accelerator for electron FLASH operation within the Division of Medical Physics at the Virginia Commonwealth University (VCU) Department of Radiation Oncology. Comprehensive beam characterization …

Gz17.602, A Combination Of Three Nutraceuticals, Interacts With Carboplatin And Etoposide To Kill Neuroblastoma, Michael R. Booth

Theses and Dissertations

This study examined the efficacy of GZ17.602, a combination of Harmine, Isovanillin, and Curcumin as a therapeutic for MYCN-amplified Neuroblastoma, both alone and in combination with standard of care chemotherapeutics. This was done due to the low survival rate associated with these neuroblastomas, the large degree of morbidity associated with current treatments, previous experiments in the Dent lab having shown 602 as effective for killing cancers of other types, and the current lack of understanding of the biology of GZ17.602 in solid pediatric cancers. Due to the GZ17.602 components being present at different concentrations in tumors than those administered, the …

Comorbid Psychosis In The General Population, Mariam Sankoh

Theses and Dissertations

Psychosis is a complex psychiatric phenotype characterized by substantial heterogeneity in symptom presentation, psychosis diagnosis, comorbidity patterns, and genetic architecture across diverse populations in the general population. Despite advances in psychiatric epidemiology and genomics, important gaps remain in understanding how psychosis symptoms and psychosis-related diagnoses manifest across racial and ethnic groups and how evolutionary genomic factors may contribute to disease risk and cross-ancestry genetic prediction. This dissertation, Characterizing Comorbidity in Psychosis in the General Population, integrates epidemiological, psychometric, and evolutionary genetic approaches to examine psychosis across diverse populations.

Aim 1 examined racial and ethnic differences in psychosis comorbidity patterns …

Cb1 Allosteric Modulation: Preclinical Insights Into Therapeutic Potential And Misuse Liability, Mohammed A. Mustafa

Theses and Dissertations

Cannabinoid type-1 (CB1) allosteric modulators represent a promising approach to modulate CB1 receptor signaling by binding to distinct receptor sites, without producing adverse cannabimimetic and dependence-related effects associated with Δ9-tetrahydrocannabinol (THC) and other CB1 agonists. This dissertation investigates the pharmacological, behavioral, and dependence-related profiles of CB1 allosteric modulators for their therapeutic potential and misuse liability. Presented here, the chiral CB1 positive allosteric modulator (PAM) ZCZ011 was resolved into its R- and S-enantiomers and characterized across in vitro and in vivo assays. Both enantiomers enhance CB1 agonist activity and produce intrinsic effects in vitro. Behaviorally, they produce antinociceptive effects in the …

Dietary Acculturation, Dietary Inflammatory Potential, And Metabolic Syndrome Among Immigrants In The United States: A Mixed-Methods Approach Using Nhanes And Qualitative Data, Esse G. Foka Nzaha

Theses and Dissertations

Background and Objectives: Immigrants in the United States undergo acculturation — a process of sociocultural and behavioral adaptation to the host country. Increasingly, behavioral adaptations have been associated with cardiometabolic health and chronic disease risk. Metabolic syndrome (MetS), a cluster of conditions including abdominal obesity, elevated blood pressure, impaired fasting glucose, elevated triglycerides, and reduced HDL cholesterol, is a major risk factor for type 2 diabetes mellitus, cardiovascular diseases and other chronic diseases, including cancer. Despite the growing immigrant population in the U.S., the role of diet and dietary acculturation in MetS development remains poorly understood in this population. This …

24-H Circadian Rest-Activity Rhythms And Physical Frailty In Older Adults: A Biopsychosocial Perspective On Sex Differences And Social Capital, Jisu Kim

Theses and Dissertations

Physical frailty is a prevalent geriatric syndrome characterized by age-related decline across multiple physiological systems. Physical frailty is associated with an elevated risk of adverse health outcomes, including chronic disease progression and all-cause mortality, representing a significant and growing public health concern. Disrupted circadian rest-activity rhythms (RARs) are increasingly recognized as clinically meaningful markers of physical frailty in older adults. However, the extent to which biological sex and social determinants of health (SDoH), particularly social capital, contribute to or modify the associations between RARs and physical frailty remains underexplored.

Therefore, this dissertation summarizes the existing literature on age-related changes in …

What’S Sleep Got To Do With It? A Mixed Methods Exploration Of The Feasibility, Acceptability, And Initial Outcomes Of Group Cbt For Insomnia In Parkinson’S Disease, Claire M. Williams

Theses and Dissertations

Parkinson’s disease is a progressive neurodegenerative disease that is commonly associated with sleep disturbances, affecting up to 80 percent of individuals with Parkinson’s. Effective and accessible treatments for sleep problems in Parkinson’s disease remain limited. Cognitive Behavioral Therapy for Insomnia (CBTi) is a well-established, non-pharmacological treatment for insomnia but has been minimally studied in Parkinson’s populations. This study evaluated the feasibility, acceptability, and preliminary outcomes of a group-based CBTi intervention adapted for individuals with Parkinson’s disease. Participants engaged in a six-week group intervention that incorporated Parkinson’s-specific adaptations. Preliminary findings indicated that the adapted group CBTi intervention was generally feasible and …

Comparison Of Artificial Intelligence Vs Human Observer For Periapical Radiolucency Detection, Adam J. Pink

Theses and Dissertations

Objective: The aim of this study was to assess the performance of an Artificial Intelligence (AI) program (OverJet AI) with that of experienced endodontic residents, endodontists, a radiologist, and dental students in detecting periapical radiolucencies using radiographic images.

Methods: One hundred and fifty periapical radiographic images were analyzed using the OverJet AI software to determine the presence/absence of a periapical radiolucency as well as the size (small 1-3mm, medium 4-6mm, and large 6+mm). The unaltered images were also evaluated by two endodontic residents, two practicing endodontists, an oral radiologist and two 4th year dental students.

Results: Agreement between the AI …

Endodontic Access Through Zirconia Crowns: A Comparative Evaluation Of 3d Guided Versus Free-Handed Techniques, Maryam Alrughaib

Theses and Dissertations

Objective:

Accessing canals through full-coverage zirconia crowns is challenging and may increase the risk of misdirection, excessive dentin removal, and prolonged chair time. Guided endodontic access has been proposed to improve efficiency and precision. This study compared the accuracy and time efficiency of guided versus free-hand endodontic access through zirconia restorations. The hypothesis was that guided access would enhance canal localization precision and significantly reduce access time.

Methods:

Thirty-two extracted maxillary premolars were restored with 1-mm–reduced monolithic zirconia crowns (3Y-TZP, Katana HTML, Kuraray, Japan) and mounted in Modupro models. Teeth were assigned to two groups (n = 16 each): guided …

Use Of Transcranial Magnetic Stimulation As An Assessment Of Corticospinal Excitability In Individuals With Persistent Postural Perceptual Dizziness, Elizabeth Cornforth

Theses and Dissertations

Persistent postural-perceptual dizziness (PPPD) is a common, disabling, chronic vestibular disorder whereby individuals experience symptoms of non-vertiginous dizziness, unsteadiness, and sway or rocking that are present most hours of the day, most days of the week. Individuals with PPPD have been noted to have an increased burden of dizziness and reduced quality of life compared to other dizziness diagnoses. The cause of PPPD is not well understood which can lead to years of diagnostic testing, failed therapies, and poor symptom management. It is important to understand PPPD pathophysiology so that optimal treatment interventions can be developed for this disorder to …

Local Lung Delivery Of Ginkgetin For Therapeutic Intervention In Lung Fibrosis, Cimone L. Richardson

Theses and Dissertations

Lung fibrosis (LF) is a progressive, irreversible pathological condition in the lungs that is ultimately fatal. Current drug treatments (nintedanib, pirfenidone, and nerandomilast) slow disease progression but cause significant systemic adverse effects due to oral administration. Transient receptor potential vanilloid 4 (TRPV4), a mechanosensitive ion channel, may play a role in LF progression and represent a novel anti-LF target. Ginkgetin (GKT), a natural biflavonoid, is a potent TRPV4 inhibitor with anti-inflammatory and antioxidative properties. Local lung delivery could achieve high local lung concentrations while minimizing systemic exposure. Accordingly, this project evaluates GKT's therapeutic intervention efficacy in LF via local lung …

Implementation Of Tg-351 Reference Dosimetry For A 6 Mv Photon Beam In An Mr-Guided Radiotherapy System, Nicholas A. Castellano Jr.

Theses and Dissertations

Magnetic resonance guided radiation therapy (MRgRT) combines magnetic resonance imaging (MRI) and radiation therapy to enable the visualization of anatomy in real time during treatment. The presence of a magnetic field in MRgRT affects charged particle radiation and detector responses, necessitating changes to traditional reference dosimetry procedures. The American Association of Physicists in Medicine (AAPM) Task Group 351 (TG-351) provides a formalism for reference dosimetry in MRgRT. In this study, the TG 351 formalism is used to perform reference dosimetry for a 6 MV flattening filter-free (FFF) photon beam from a Viewray MRIdian MR-Linac radiation therapy system. Beam quality determination, …

Metabolic Syndrome Beyond Diagnostic Criteria: Population-Scale Integrative Metabolomics Characterization, Marwa Talal

Theses and Dissertations

Background: Metabolic syndrome (MetS) is a complex cluster of interrelated metabolic abnormalities associated with elevated cardiometabolic risk. While diagnosis is based on well-established five clinical criteria, these may overlook early or atypical metabolic alterations. Large-scale metabolomic profiling offers an opportunity to identify biochemical signatures of MetS beyond diagnostic bias and to evaluate their relative importance across different presentations of the syndrome.

Methods: Data from 117,147 UK Biobank participants were analyzed in a cross-sectional design. High-throughput NMR quantified 75 circulating metabolites, for. Univariate analyses, MetS subtype stratification, and elastic net models with SHAP interpretation were applied to assess feature …

Hispanic Academic Leadership In The Health And Human Services, Gabriela Elizabeth Rangel

Theses and Dissertations

In the United States, there are 63.7 million Hispanics (U.S. Census Bureau, 2023), making them the largest racial or ethnic minority in the country. National data from 2019 indicates that only 6% of tenured faculty in the U.S. were Hispanic, highlighting a significant underrepresentation of leaders in academia (NCES, 2024). This study employed a phenomenological approach with purposeful sampling, utilizing semi-structured interviews with ten participants who had leadership experience in academia within Health and Human Services (H&HS). The interviews served to explore various aspects, such as what were their aspirations to become leaders, their perceptions of the characteristics and qualities …

A Picture Tells A Thousand Words—, But Ecg Signals Have More To Say, Ashley N. Gomez

Theses and Dissertations

With the increasing adoption of deep learning classification models in the medical domain, a critical challenge remains: achieving high predictive accuracy while maintaining clinical Inter-pretability. This study examines how model architecture, dataset origin, and the use of full versus subset data affect both classification performance and Interpretability in Electrocardiogram (ECG) signal analysis. ResNet18 is evaluated using an open-source ECG Image Dataset, thus a custom dataset derived from digitized ECG images. Post-hoc explainability methods, such as Integrated Gradients, are applied to determine which time steps have the most significant influence on model decisions. The findings demonstrate that model architecture and dataset …

Comparative Assessment Of Lower Limb Neuromusculoskeletal Activation And Joint Kinematics In Normal And Impaired Gait, Jack Ryan Schule

Theses and Dissertations

This thesis evaluates whether accessible and affordable technologies can provide clinically significant, quantifiable gait analysis comparable to traditional marker-based motion capture systems. Modern high-end systems offer excellent accuracy but remain financially and logistically inaccessible to many clinicians and researchers. To address this gap, a framework was developed using markerless pose estimation using the model, MediaPipe, inertial measurement units (IMUs) processed through an Extended Kalman Filter (EKF), and surface electromyography (sEMG) to measure joint kinematics and neuromuscular activity during gait. An experiment was performed where data was collected from participants with both normal gait and pathologies including: Osgood–Schlatter disease, Plica Band …