Medicine and Health Sciences Commons^™

Economic Development, Political Processes And Climate Change Adaptation In The Solomon Islands, Adam Christopher Ereth

Theses and Dissertations

Climate change exacerbates existing societal inequalities, including those related to uneven adaptation developments. Often, climate change prompts societies in Oceania to implement adaptation strategies to deal directly and indirectly with related issues. The futures of island nation inhabitants have sparked as much curiosity and inquiry as it has fears of diminished futures for Small Island Developing States (SIDS). Narratives and discourse on climate change adaptation range from engineered solutions to address sea level rise and storm wave issues, to pessimistic retreat with claims that islands are sinking and little can be done but move elsewhere. These disparate realities call into …

The Impact Of Cannabis And Alcohol Use On The Management Of Type 1 Diabetes Mellitus, Joshua Eric Sellner

Theses and Dissertations

This dissertation sought to contribute to the evidence-base of diabetes management and acute complications associated with alcohol and cannabis use among individuals with Type 1 Diabetes (T1DM). Three interconnected studies were initiated to complete this goal. First, existing literature surrounding the potential consequences of cannabis consumption among individuals with T1DM were summarized within a systematic review. Study results were combined to provide a single measure of association through a meta-analysis. Second, identified associations were further investigated through a cross-sectional study using the SEARCH for Diabetes in Youth data on alcohol and cannabis use on diabetes management and acute complications including …

Associations Of The Fto Gene And Risk Of Acute Myeloid Leukemia, Avery Ulrich

Theses and Dissertations

Background Acute Myeloid Leukemia (AML) is a blood cancer that affects ~70,000 people each year in the US. The Fat Mass and Obesity (FTO) gene on chromosome 16 has been reported to be associated with obesity, solid tumor cancers (lung, renal, breast, prostate, pancreatic, endometrial), and more recently with hematologic malignancies, like AML. In this thesis, we test the hypothesis that inherited variants within the FTO gene are associated with an increased risk of AML. Methods Using the DISCOVeRY-BMT (Determining the Influence of Susceptibility COnveying Variants Related to one-Year mortality after Blood and Marrow Transplantation), a well-powered genome-wide association study …

Longitudinal Relation Of Dietary Quality And Hemoglobin A1c In Youth And Young Adults With Diabetes, Hope Bercaw

Theses and Dissertations

Background Hemoglobin A1c (HbA1c) is a clinical measure of glycemic control among people with diabetes and is associated with health outcomes such as cardiovascular disease. It is possible to decrease HbA1c by improving diet, but it is largely unknown which dietary components are most important in targeting glycemic control.

Objective This study aims to examine whether changes in diet quality across diabetes duration, assessed with the 2015-Healthy Eating Index (HEI), are associated with HbA1c in youth and young adults (YYA) with type 1 (T1D) and type 2 diabetes (T2D). Additionally, we aim to assess whether these relationships differ when dietary …

Mediator Kinase Inhibitors For Breast Cancer Therapy, Xiaokai Ding

Theses and Dissertations

Breast cancers (BrCa) that overexpress oncogenic tyrosine kinase receptor HER2 are treated with HER2-targeting antibodies (such as trastuzumab) or small-molecule kinase inhibitors (such as lapatinib). However, most patients with metastatic HER2+ BrCa have intrinsic resistance and nearly all eventually become resistant to HER2-targeting therapy. Resistance to HER2-targeting drugs frequently involves transcriptional reprogramming associated with constitutive activation of different signaling pathways. We have investigated the role of CDK8/19 Mediator kinase, a regulator of transcriptional reprogramming, in the response of HER2+ BrCa to HER2-targeting drugs. Selective CDK8/19 inhibitors (senexin B and SNX631) showed synergistic interactions with lapatinib and trastuzumab in a panel …

Assessing Identification Of Newly Diagnosed Breast Cancer Patients For Referral To Genetic Counseling, Corinne Marie Locke

Theses and Dissertations

Since 1998, the National Comprehensive Cancer Network (NCCN) guidelines have specified clinical indications for genetic testing for breast cancer susceptibility genes, but retrospective studies have shown that, despite meeting the NCCN criteria, patients are not always advised of the option of genetic testing. Further compounding this issue, studies have shown that cancer family history intake and documented family history can be incomplete even when taken by oncology providers. At this study site and other cancer centers in the country, patients with a new diagnosis of breast cancer are referred for genetic counseling by their cancer care team if they are …

Modelling Physico-Chemical Properties Of Binary Nano-Alloys By Nano-Thermodynamics And Machine Learning, Luke David Geoffrion

Theses and Dissertations

Nanoscience and nanotechnology are some of the fastest growing fields of materials science that have given impact to several fields of science including biology, medicine, and catalysis. These applications take advantage of several properties of nanoscale materials that are present at sizes below 100 nm namely the increased surface to volume ratio. From a theoretical point of view, nanoscience research is dominated by Density Functional Theory and Molecular Dynamics. These techniques dominate for good reason, but are not without their own limitations due to their computational complexity which results in very long calculation time to complete on materials whose size …

Evaluating The Military Medical Evacuation Dispatching And Delivery Problem Via Simulation And Self-Exciting Hawkes Process, Virbon B. Frial

Theses and Dissertations

The location, allocation, and utilization of military medical evacuation (MEDEVAC) resources significantly impact the quality and timeliness of medical care to injured troops. In 2009, Secretary of Defense Robert Gates introduced the Golden Hour mandate that entails the evacuation of critically-injured troops to military treatment facilities (MTFs) within an hour to prevent further complications. To develop high-quality policies that improve MEDEVAC system performance, several papers in the current literature assume that MTFs have both the capacity and capability of treating any patient, regardless of the type of injury. However, these assumptions are unrealistic when conducting high-intensity operations. While acknowledging MTF …

Effect Of Covid-19 On The Wellbeing Of Healthcare Professionals In Public Isolation Hospitals In Egypt, Shaimaa Sabbah

Theses and Dissertations

One of the most vulnerable groups severely hit by the COVID-19 pandemic has been the Healthcare Professionals (HCPs), especially the physicians, pharmacists, and nurses who work in public Isolation hospitals. The Egyptian medical syndicate declared the death of more than 600 physicians from February 2020 till January 2022. In the meantime, the Egyptian government has worked on different policies for relieving the negative effects of the pandemic on this vulnerable group; however, easing restrictions, no total lockdown implementation, and monitoring bureaucracy has negatively affected the wellbeing of those HCPs. The study aims to figure out recommended policies to protect HCPs’ …

A Predictive Model For Geographical Location Using Microbiome Composition And Covid-19 Based Analysis, Ahmed Adel Aboushanab

Theses and Dissertations

The human microbiome is a main contributor for the health and welfare of the human body. It is affected by many factors like diet and hygiene. These factors differ between different populations. Testing the population-microbiome differences using healthy samples from different countries is the first objective of this study. This data was then used in training and testing machine learning models (Random Forest and L2-logistic Regression Classifiers) for the prediction of the geographical location based on the microbiome data. Random Forest Classifier had the highest accuracy. Feature importance analysis showed that the data for Proteobacteria, Actinobacteria, and Bacteroidetes improved the …

Selective Gsk3Β Inhibition Mediates An Nrf2-Independent Anti-Inflammatory Microglial Response, Mohamed H. Yousef

Theses and Dissertations

Glycogen Synthase Kinase 3 (GSK3) is associated with the proinflammatory phenotype of microglia and has been shown to act in concert with Nuclear factor kappa B (NF-κB). . GSK3 is also a suppressor of Nuclear factor erythroid 2-related factor 2 (Nrf2), the principal regulator of redox homeostasis. Agreeing with the oxidative paradigm of aging, Nrf2 is often deregulated in parainflammatory and neurodegenerative diseases. In this study, we aimed to explore a multimodal disease-modifying utility of GSK3 inhibition, beyond neuronal proteopathologies, Furthermore, we aimed to underscore the difference in therapeutic value between the two GSK3 paralogs by isoform-selective chemical inhibition.

The …

Repurposing Metformin And Antifolates For The Treatment Of Hepatocellular Carcinoma, Sherouk Mohamed Tawfik

Theses and Dissertations

Hepatocellular carcinoma (HCC), one of the most prevalent types of cancers worldwide, continues to maintain high levels of resistance to standard therapy. As clinical data revealed poor response rates, the need for developing new methods has increased to improve the overall wellbeing of patients with HCC. Due to its safety, wide availability and previously reported anti-cancer effects, metformin (MET) serves to be a possible therapeutic agent when combined with other well-known anti-cancer agents. The aim of this study was to investigate the potential anti-cancer effects of MET, an anti-diabetic agent, when combined with two antifolate drugs: trimethoprim (TMP) or methotrexate …

Selective Small Molecule Targeting Of Mcl-1 In Multiple Myeloma, Omar S. Al Odat

Theses and Dissertations

Multiple Myeloma (MM) is a deadly blood malignancy, characterized by the uncontrolled proliferation of aberrantly differentiated plasma cells. MM is challenging to diagnose and treat, accounting for approximately 12% of hematologic malignancies. The overexpression of anti-apoptotic group of Bcl-2 family proteins, particularly Myeloid cell leukemia 1 (Mcl-1), play a critical role in the pathogenesis of MM. The overexpression of Mcl-1 is associated with drug resistance and overall poor prognosis. Thus, inhibition of the Mcl-1 protein is an attractive therapeutic strategy against myeloma cells. Over the last decade, the development of selective Mcl-1 inhibitors has seen remarkable advancement. In this project, …

Dia.Ries, Katherine A. Doyle

Theses and Dissertations

dia.ries is a pilot episode of an episodic series that offers insight into the lives of a few of the 500 million people around the world with diabetes—otherwise normal, everyday people who happen to be living each day with an “invisible illness.” Produced through video diaries and other user-generated content, the series tells stories from first-person points of view along thematic lines, using a collaborative approach rooted in Third Cinema.

Repurposing Of Small Molecule Inhibitor Ym-155 Inhibits High-Risk Neuroblastoma Growth By Directly Inhibiting Survivin Protein, Danielle Crystal Rouse

Theses and Dissertations

High-risk neuroblastoma (NB) is an aggressive pediatric tumor which develops from the extracranial sympathetic nervous system and accounts for almost 15% of all childhood cancer-related deaths. Current therapies include high-dose chemotherapy and radiation which have long-term toxic side-effects. Despite these intensive therapies, the overall survival rate of NB is less than 50%. Therefore, developing novel therapeutic approaches by directly targeting the molecular mechanisms that drives NB progression is very important. In the present study, we analyzed genomic datasets of 1235 NB patients and discovered that overexpression of survivin coding gene BIRC5 strongly correlates with poor overall and event-free survival of …

Viral Overexpression Of Rprd2 In Mouse Nucleus Accumbens Induces Anxiety-Like Behavior And Regulates Genes Associated With Microtubule Transport, Claire Nuhad Atiyeh

Theses and Dissertations

Anxiety disorders are the most prevalent mental illness in the United States with many individuals underdiagnosed and undertreated (Anxiety & Depression Association of America, 2021; Bandelow et al., 2017). While stress is a known risk factor for developing anxiety disorders, there is emerging evidence that biological variability in the expression of key proteins in the brain may contribute to regulating an organism’s stress-related behaviors. Earlier work from our laboratory identified a protein, called Regulation of Nuclear Pre-mRNA Domain Containing 2 (RPRD2), that was differentially expressed in the brain of mice stratified in terms of their phenotypic response to chronic stress …

Splanchnic Oxygenation And Feeding Intolerance In The Very Low Birthweight Infant, Melissa C. Dollings

Theses and Dissertations

SPLANCHNIC OXYGENATION AND FEEDING INTOLERANCE IN THE VERY LOW BIRTHWEIGHT INFANT

By Melissa C. Dollings, Ph.D.

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

Virginia Commonwealth University, 2022

Major Director: Lisa F. Brown, Ph.D., RN, School of Nursing

Background. Feeding intolerance is common in preterm infants but can be an ominous precursor of necrotizing enterocolitis, a life-threatening gastrointestinal disease. The definition and management of feeding intolerance vary widely. This research examined the relationship

between feeding intolerance, intrauterine factors, extrauterine factors, and intestinal immaturity and circulatory immaturity in the …

Outcome Of Endodontic Microsurgery: Success And Survival Rates At Virginia Commonwealth University, Abdullah Alawadhi

Theses and Dissertations

Introduction: Endodontic microsurgery treatment is an option for teeth with apical periodontitis and may be indicated for teeth with previous endodontic treatment that have not healed, teeth with canal obstructions which would impede a non-surgical approach, and where a biopsy is needed. The purpose of this study is to evaluate healing after endodontic microsurgery in 2-dimensional PA radiographs and 3 dimensional CBCT imaging. Methods: Patient records were pooled from graduate resident cases completed at Virginia Commonwealth University in the Graduate Endodontic Clinic between the years 2010 to 2020. Cases were identified using the CDT codes and a key word search …

Adaptations In Orthodontics For Current And Future Covid-19 Best Practices, Jordan Lamb

Theses and Dissertations

Purpose: To determine what adaptations orthodontists made in their practices during the COVID-19 pandemic in response to safety recommendations and to determine which of these adaptations orthodontists plan to continue to implement after resolution of the COVID-19 pandemic.

Methods: An original 34-question survey was sent by mail to a randomized and geographically proportionate selection of actively practicing orthodontic specialists (N = 1000). Questions asked orthodontists about the changes they made during the pandemic in four overarching categories (infection control, social distancing, appliance use, and tele-orthodontics) and whether they anticipated keeping those changes post-pandemic. The data were compared between categorical responses …

The Effect Of Er:Yag, Nd:Yag And Co2 Laser Combined With Hydrogen Peroxide, Sodium Hypochlorite, Chlorohexidine Or Fluoride On Reducing Oral Bacterial Count Implicated In Root Caries, Nitya Reddy

Theses and Dissertations

Purpose: Lasers have been used for treatment of dentinal hypersensitivity and for various bacterial reduction indications in periodontology. Their effectiveness in killing oral bacteria is not well known. The compounding effect of the combination of a laser treatment and adjunct antimicrobial agent use on bacterial viability is still evolving. The purpose of this in vitro study was to evaluate the effect of three lasers commonly used in dentistry in conjunction with chlorhexidine (CHX), hydrogen peroxide (H₂O₂), sodium hypochlorite (NaOCl), or sodium fluoride (NaF) on viability of oral bacteria associated with root caries.

Methods: Three …

Changes In Physical Activity And Relationships To Submaximal Exercise Capacity And Cardiac Function During Breast Cancer Therapy, Moriah P. Bellissimo

Theses and Dissertations

Background: Breast cancer (BC) survivors are at high risk for heart failure due to curative cancer therapies. In non-cancer populations, physical activity is a first line treatment for preventing cardiovascular disease. This study examined whether more physical activity was associated with better submaximal exercise capacity and cardiac function during the first three months of cancer therapy.

Methods: Participants included 223 women with stage I-III BC before therapy and after three months of undergoing treatment and 126 controls. Leisure time physical activity was reported using the Godin Sheppard leisure time exercise questionnaire. Cardiac function was assessed by cardiac magnetic resonance, and …

Characteristics Of Posterior Permanent Teeth With A Periradicular Diagnosis Of Symptomatic Apical Periodontitis: A Retrospective Study, Christina A. Martin

Theses and Dissertations

The diagnosis of apical periodontitis is based on radiographic manifestations and the results of the various clinical tests that can be performed as part of a routine dental examination. Apical periodontitis producing clinical symptoms involving a painful response to biting and/or percussion or palpation is given the diagnosis of symptomatic apical periodontitis (SAP). This study aimed to determine associations of SAP with gender, age, radiographic findings, diagnostic testing, pulpal diagnosis, and location of the tooth in the arch. Data for this study were obtained from patients of record treated at Virginia Commonwealth University School of Dentistry in the Department of …

Budget Impact Analysis Of Upadacitinib For The Management Of Moderate-To-Severe Atopic Dermatitis In Patients Treated With Systemic Therapies In The United States, Haya O. Alobaid

Theses and Dissertations

Objective: This study evaluated the budget impact of introducing upadacitinib for patients with uncontrolled moderate-to-severe atopic dermatitis (AD) from a United States (U.S.) private payer perspective.

Methods: The model estimated costs before and after the adoption of upadacitinib for a hypothetical one million covered lives over 3 years. The model included immunosuppressant agents and dupilumab. Market uptake was assumed to be 2% per year. Treatments incur a cost for drug acquisition, and the costs associated with drug administration, laboratory testing, and clinic visits. The model calculated the impact on the budget in 2022 U.S. dollars. Various assumptions on market …

Threshold Levels Of Patient And Parent Esthetic Concern In The Mixed Dentition, Justin Josell

Theses and Dissertations

Purpose: The mixed dentition is a period of unique dental changes for developing children and their parents. The purpose of this study is to determine threshold levels of concern regarding diastema spacing and angulation of maxillary incisors during the “Ugly Duckling Stage” in pediatric patients and their parents.

Methods: This study is modeled as a cross sectional-survey among pediatric patients and parents. The surveys contain photographs of a sex-neutral, mixed-dentition smile with variations of midline spacing and incisal angulation which randomly differ in quantifiable values. Participants were asked to rate each photograph on a visual analog scale.

Results: The interaction …

Exploring Predictors In The Receipt Of Patient/Family-Centered Care, Arami Anwell

Theses and Dissertations

Study 1

OBJECTIVES: The research aim of this study was to identify predictors associated with the receipt of PFCC among U.S. children/families

METHODS: Caregivers of 38,803 non-institutionalized children, aged 0 to 17 years, were surveyed by the National Survey of Children’s Health (NSCH) 2018–20019. Patient/family-centered care (PFCC) was measured using five components of health care delivery that were answered on a 4-point Likert scale. Logistic regression models were analyzed for the overall receipt of PFCC and each component of PFCC, with survey weighting added to adjust for complex sampling design.

RESULTS: Many predictors were associated with the receipt of PFCC. …

The Economic Value Of Pharmacist-Physician Collaborative Care Models In Hypertension Management, Jessica S. Jay

Theses and Dissertations

Background: Hypertension is highly prevalent in the United States, affecting nearly half of all adults (43%). Studies have shown that pharmacy-physician collaborative care models (PPCCM) for hypertension management significantly improve blood pressure (BP) control rates and provide consistent control of BP. Time in target range (TTR) for systolic BP is a novel measure of BP control consistency that is independently associated with decreased cardiovascular (CV) risk. There is no evidence observed improvement in TTR for systolic BP with PPCCM is cost effective.

Objective: This study aimed to compare the cost-effectiveness of PPCCM with usual care for the management of hypertension …

Using Difference-In-Difference To Assess The Impact Of Medicaid Policy On The Addiction Treatment Provider Workforce And Prescribing Behavior In Virginia, Erin Britton

Theses and Dissertations

This dissertation is unified by both policy opportunity and estimation method, examining the impact of Medicaid behavioral health policy in Virginia using a difference-in-differences framework. Medicaid-covered substance use disorder (SUD) treatment benefits in Virginia were significantly enhanced through a Section 1115 SUD waiver, which are required to be budget neutral. Therefore, it is critical to understand whether the objectives of the waiver are met using reliable, unbiased estimation methods. This dissertation includes two empirical research projects evaluating the impact of Medicaid policy on removing barriers in access to care and one methodological project comparing the performance of alternate approaches to …

Tummy Time In Infancy: Real-World Assessments And Associations With Developmental Outcomes In Early Childhood, Ketaki Inamdar

Theses and Dissertations

Tummy time or awake, supervised, prone play is an important developmental play position in infancy. Engaging in more than 15 minutes of tummy time per day is associated with a lower risk of plagiocephaly, lower body mass index, and achievement of higher motor scores in full-term and at-risk preterm infants. However, there are significant gaps in the measurement of tummy time in current literature. Conventionally used subjective parent reports have not been validated against gold standard direct observation, and the feasibility and real-world validity of objective solutions such as wearable sensors has not been examined in full-term and at-risk preterm …

Targeting Bcl-2 Family Proteins In Therapy Induced Senescent Cancer Cell Models, Wade Cook

Theses and Dissertations

Non-small Cell Lung Cancer (NSCLC) originates from numerous different cell types in the lungs and is among the deadliest of cancers. Head and Neck Squamous Cell Carcinomas (HNSCC) are derived from the mucosal membranes of the oral cavity, pharynx, and larynx. Both NSCLC and HNSCC are predominately caused by tobacco smoke inhalation and as such mutations in the tumor suppressor gene TP53 are common. Since similarities exist in the root cause of NSCLC and HNSCC, they may also share similarities in treatment methods. Cisplatin is a platinum-based DNA damaging agent that has been used as a cancer chemotherapy for decades. …

A Technology-Based, Mixed Methods Approach To Examining The Psychosocial Determinants Of Maternal Health Disparities, Hannah M. Ming

Theses and Dissertations

Background: Exposure to racism and discrimination in the U.S. increases Black women’s risk for experiencing maternal health disparities. Additionally, racism and discrimination affect maternal psychosocial well-being, creating evidence for a biopsychosocial relationship between racism and maternal health outcomes. However, current research does not define the psychosocial Black maternal self well. Given the dynamic relationship between racism, psychosocial well-being, and Black maternal health outcomes, research must comprehensively examine the Black maternal self. The operationalization of a comprehensive construct for Black maternal psychosocial well-being can improve understanding of the relationship between racism, psychosocial well-being, and Black maternal health outcomes.

Purpose: …