Medicine and Health Sciences Commons^™

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, …

Evaluating Novel Targeted Combination Therapies For Gastrointestinal Cancers, Joseph A. Goode

Graduate Studies Theses and Dissertations 2026

Gastrointestinal (GI) cancers remain among the leading causes of cancer-related mortality worldwide, with therapeutic resistance continuing to limit the effectiveness of current treatments. Three complementary studies were conducted to identify therapeutic vulnerabilities and evaluate novel combination strategies in pancreatic ductal adenocarcinoma (PDAC) and colorectal cancer (CRC).  First, dual inhibition of fibroblast growth factor receptor 4 (FGFR4) and phosphoinositide 3-kinase (PI3K)/mammalian target of rapamycin (mTOR) signaling was investigated in PDAC models. A combination of targeted drug treatments reduced viability, clonogenic survival, migration, and suppressed signaling pathways involved in translational control. This supported a functional interaction between FGFR4 and PI3K-mTOR co-activation in …

Survivors Of Historical Intergenerational And Familial Trauma Scale For Black American Descendants Of Enslaved People: A Development And Initial Validation Study, Loryn Chás Kimbrough

Graduate Research Theses & Dissertations

Despite extensive research documenting cultural and racialized trauma, no validated assessment tool had previously captured the intrafamilial mechanisms of trauma transmission specific to the BADEP population, whose trauma lineage is rooted in slavery. The present study addresses this gap through the development and initial validation of the Survivors of Historical Intergenerational and Familial Trauma Scale (SHIFTS), a culturally grounded instrument designed to measure the transmission of historical trauma (HT) and ongoing intergenerational trauma (IGT) among Black American Descendants of Enslaved People (BADEPs). The SHIFTS examines how HT gives rise to the continued transmission of two interrelated legacies: survival-based and trauma-rooted …

Assessing Sustainable E-Cigarette Prevention Messaging In Public Health Communication, Addo Anim Adinkrah

Graduate Research Theses & Dissertations

This study examines the sustainability of e-cigarette or vaping prevention messaging on X (formerly Twitter) and the message-design strategies used by public health institutions to maintain message visibility over time. Using the McGuire Communication/Persuasion Model and Media Framing theoretical frameworks, the research employs a qualitative thematic analysis based on Braun and Clarke’s six-phase approach to analyze 506 tweets from official accounts affiliated with the Centers for Disease Control and Prevention (CDC) and the U.S. Food and Drug Administration (FDA). The findings reveal that prevention messages are sustained through repeated core warnings and reinforcement of institutional authority rooted in scientific and …

A Multi-Study Examination Of Student-Athlete Mental Health And Mental Health Service Delivery In Mid-Major College Athletic Programs, Grace Louis

Graduate Research Theses & Dissertations

Student-athlete mental health has become a central priority in intercollegiate athletics, with the NCAA emphasizing its Mental Health Best Practices (2016) and strengthening and expanding these standards through updated recommendations in 2024. These efforts reflect a broader cultural shift toward recognizing the unique psychological stressors faced by college athletes, including performance pressure, identity foreclosure, high time demands, and transitions both into and out of sport (Moreland et al., 2018; Hughes & Leavey, 2012). Additionally, student-athletes frequently delay or avoid help-seeking due to stigma, time constraints, identity-protective behaviors, cultural norms emphasizing toughness, and limited mental health literacy (Gulliver et al., 2012; …

The Impact Of Medicaid Policy Limitations On Access To Eating Disorder Treatment: Uncovering The Consequences Of A System Built To Fail, Meghan Frost

DSW Capstone Projects

Individuals who rely on Medicaid face major barriers when trying to access eating disorder (ED) treatment, reflecting broader patterns of structural disadvantage in publicly funded health care. Research shows delayed diagnosis, limited access to ED specialists, and frequent denials for recommended services. These gaps occur because Medicaid policies do not match the needs of evidence based ED care, resulting in delayed or incomplete care for many individuals with eating disorders.

This issue is highly relevant to social work practice because the policies shaping these barriers are complex and difficult for clients and ED providers to navigate. Social workers across clinics, …

Seeing Public Health In Color: Phenomenological Perspectives Of Bipoc Women In Leadership, Jasmyn Spicer

All Graduate Theses, Dissertations, and Other Capstone Projects

Public health is a complex, ever-changing industry that holds pivotal capacity to impact society on a larger scale. For the United States, disparities and inequity in public health have had significant consequences for Black, Indigenous, and People of Color (BIPOC) communities. Effective leadership in public health has the potential to impact roles, policy development, and the overall scope of oversight regarding the quality of care that communities are provided in the industry. While BIPOC women are underrepresented in public health leadership roles, they have the capacity to advance equity in the field and contribute to culturally responsive care in foundational …

Effectiveness Of Behavioral Cough Suppression Therapy In A Closed Enrollment Group Telehealth Delivery Model And Comparison To A Rolling Enrollment, Kinsey Louise Roberts

Graduate Student Theses, Dissertations, & Professional Papers

Background:

Refractory chronic cough (RCC) is a subtype of chronic cough (CC) that persists

despite guideline-based treatment and can negatively affect quality of life. Behavioral cough

suppression therapy (BCST), typically delivered by speech-language pathologists (SLPs), is an

effective treatment for RCC. However, access to BCST remains limited due to geographic

barriers and a shortage of trained providers. Group-based telehealth may help expand access to

treatment. This study evaluated the effectiveness of BCST delivered via telehealth using

a closed enrollment group model and compared outcomes to a rolling enrollment group model.

Methods:

In this prospective sequential cohort study 32 participants attended …

Integrating Hippotherapy Into Interprofessional Aphasia Rehabilitation: A Feasibility Pilot Study, Bethany H. Wenger

Graduate Student Theses, Dissertations, & Professional Papers

Background and Significance: Stroke remains a leading cause of disability in the United States, affecting over 2.5 million individuals annually. Stroke-related motor and communication deficits often co-occur, increasing challenges for recovery, increasing social isolation, depression, and dependency. Hippotherapy has emerged as a novel treatment approach for neurorehabilitation; however, its application within interprofessional models for individuals with stroke-related motor and communication impairments remains underexplored. This study examines the feasibility, fidelity, and acceptability of an interprofessional intervention using hippotherapy for adults with chronic post-stroke aphasia, the purpose of which is to generate methodological guidance for future controlled trials.

Methods: A non-randomized, single-group …

An Exploratory Analysis Of The Role Of Sex In Load Carriage, Rachel E. Perez, Dustin R. Slivka, Brent C. Ruby

Graduate Student Theses, Dissertations, & Professional Papers

Axially loaded weight may impose a metabolic demand equivalent to that of fat mass (FM) during load carriage. Males (M) typically have a lower body fat percentage than females (F), resulting in metabolic demand differences during load carriage that may be mitigated by accounting for FM in pack loads. PURPOSE: To determine whether normalizing pack load to FM equalizes metabolic cost across sexes during load carriage. METHODS: Twenty-eight participants (14M, 23 ± 5 y, 1.81 ± 0.07 m, 78.7 ± 10.0 kg, 12.7 ± 5.4% body fat, VO₂peak 4.18 ± 0.54 L·min^-1; 14F, 22 ± 4 …

Predicting Tilt In Esports: A Psychophysiological Approach To Understanding Player Emotional Regulation, Nathan Rhea

University of the Pacific Theses and Dissertations

Emotional regulation and stress management are important to both casual and competitive esports players. When players become dysregulated, they experience a phenomenon known as “tilt” within the gaming community, where they often lose control of their emotions and their performance declines. This study aimed to investigate whether a psychophysiological variable in heart rate variability could predict tilt in college-age esports players. Additionally, the relationship between heart rate variability and emotions predicted by the Tiltometer system with gameplay performance and winning or losing was tested.

This study used a quantitative correlational research design. Participants for this study were college-age players (N=23) …

A Phenomenological Analysis Of Sense Of Belonging Among Community College Educators, Muhammad Owais Aziz

EVMS School of Health Professions Theses & Dissertations

This phenomenological study explored the complex phenomenon of sense of belonging (SB) among diverse health professions educators (HPEs) and non-health professions educators (non-HPEs) at a Canadian community college. SB, as a dynamic construct shaped by an individual's perception of being valued and respected, is influenced by personal preferences and by complex interactions with the individual's surroundings. To better understand SB and foster a more inclusive environment for diverse educators, it is necessary to investigate SB among these educators. This qualitative study used eleven semi-structured interviews and seven steps of data analysis. The results of this study can inform strategies, policies, …

The Experience Of Homelessness Among Older Adults In Bhutan - A Narrative Inquiry Study, Phuntsho Om

Theses: Doctorates and Masters

A shift in the demographics of homelessness started to occur in the 1900s, with a significant increase in the number of middle-aged or elderly men and women being recognised as a part of the homeless population. The rising urgent global concern of homelessness of older adults necessitates a deeper understanding of the lived experience and holistic well-being of these marginalised adults. This thesis aimed to explore the phenomenon of homelessness of older adults in Bhutan, which is an often neglected topic in both national and international gerontological research.

Employing narrative inquiry within the constructivist approach as articulated by Pino Gravidia …

Identifying The Physical Activity Promotion Practices Of Obstetricians And Gynecologists: Patients With Endometriosis And Polycystic Ovary Syndrome, Allison P. Herman

Theses and Dissertations (Comprehensive)

Despite efforts to promote physical activity, many females in Canada do not meet recommended physical activity guidelines. For individuals with gynecological conditions such as endometriosis and polycystic ovary syndrome (PCOS), physical activity may aid in symptom management and improve daily functioning. Healthcare settings, including obstetrics and gynecology, represent an area of opportunity to promote physical activity among this population. This thesis aims to understand the physical activity promotion practices of Ontario-based Obstetricians and Gynecologists (OBGYNs) to patients with endometriosis and/or PCOS. A cross-sectional online survey was conducted to explore OBGYNs promotional practices and perceived factors influencing their engagement in physical …

Error-Driven Density Control For Compact Gaussian Splatting Under Sparse Supervision, Abdelrhman Elrawy

Theses and Dissertations (Comprehensive)

This thesis studies efficiency and stability challenges in Gaussian-splatting-based reconstruction under sparse supervision. In few-shot novel view synthesis, standard 3D Gaussian Splatting (3DGS) can overfit the limited training views and grow an unnecessarily large number of primitives due to limitations in its Adaptive Density Control (ADC) mechanism. This thesis introduces an error-driven reformulation of ADC that triggers densification using opacity gradients as a lightweight proxy for rendering error, and shows that such aggressive densification must be paired with delayed and conservative pruning to prevent destructive create--destroy cycles. When combined with depth-based geometric regularization, the resulting framework produces substantially more compact …

Taylorkan-Vit: Parameter-Efficient Vision Transformers For Medical Image Classification, Kaniz Fatema, Dr. Emad Mohammed, Dr. Sukhjit Singh Sehra

Theses and Dissertations (Comprehensive)

Effective and interpretable classification of medical images remains a critical challenge in computer-aided diagnosis, particularly in data-scarce and resource-constrained clinical settings where traditional deep learning models prove impractical. This study addresses the fundamental barrier to Vision Transformer adoption in medical imaging—massive parameter counts and data requirements—through a systematic two-phase methodology. Phase 1 evaluates three spline-based Kolmogorov–Arnold Network (KAN) variants to identify the optimal nonlinear approximation function for parameter-efficient medical image classification: SBTAYLOR-KAN (B-splines with Taylor series), SBRBF-KAN (B-splines with Radial Basis Functions), and SBWAVELET-KAN (B-splines with Morlet wavelets). Comprehensive experiments across brain MRI, chest X-rays, and tuberculosis datasets—without any image …

Microsolvation Effects Of 1,1-Dimethyl-Biguanide (Metformin), Jasmine L. Sanders

Honors Theses

The microsolvation of a 1,1-dimethyl-biguanide hydrochloride molecule in the presence of water molecules illustrates the initial interactions between the common drug metformin and water. This explicit water-solvation approach employs coupled-cluster theory with an explicit-correlation F12 correction and the cc-pVTZ-F12 basis set to determine the optimalgeometry of the molecule and to observe intermolecular interaction energies. 1,1-dimethyl-biguanide hydrochloride (an antidiabetic agent, metformin) is constantly in contact with water molecules in the human body, where it reduces intestinal glucose absorption, lowers hepatic glucose sensitivity, and improves overall insulin sensitivity to lower blood-glucose concentration. The B3LYP method with an aug-cc-pVTZ basis set is used …

Structural Inequities, Environmental Toxicants, And Cardiometabolic Pathways In Cardiovascular Disease: Evidence From A Nationally Representative U.S. Population, Ese F. Oghaghare

Electronic Theses & Dissertations (2024 - present)

Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality in the United States and continues to disproportionately burden racial/ethnic minorities and socioeconomically disadvantaged populations. Traditional risk factors and behavioral explanations fail to fully account for these persistent disparities, motivating increased attention to intermediate biological pathways and environmental toxicant exposures through which structural inequities may become biologically embedded. This dissertation investigates how cardiometabolic biomarkers, diet quality, and exposure to persistent organic pollutants jointly contribute to cardiovascular disease risk in a nationally representative U.S. population.

Using data from the National Health and Nutrition Examination Survey (NHANES), three complementary studies were …

Access To Appropriate Care, Mortality, And Cost Of Inpatient Hospitalization In Infants With Omphalocele And Gastroschisis In The United States, Treeva A. Jaff

Electronic Theses & Dissertations (2024 - present)

Congenital abdominal wall defects (AWDs), including omphalocele (OM) and gastroschisis (GS), are rare but clinically significant conditions that require immediate surgical intervention and prolonged neonatal intensive care. OM is a midline defect in which abdominal organs protrude into the umbilical cord covered by a membranous sac, while GS is a full-thickness defect typically located to the right of the umbilicus through which organs protrude without protective coverage. OM is frequently associated with major co-occurring congenital anomalies and chromosomal abnormalities, while GS more commonly occurs as an isolated defect but requires more intensive surgical management. As survival rates have improved, research …

Specification Of Validated Groundwater Flow And Transport Models For Historical Perfluorinated Compound Dose Reconstruction, Cindy A. Arthur

Electronic Theses & Dissertations (2024 - present)

Per- and polyfluoroalkyl substance (PFAS) contamination in Hoosick Falls, New York, resulted from historical industrial activities, with groundwater transport identified as the primary pathway impacting the municipal wellfield within the Village of Hoosick Falls, whereas atmospheric deposition remains a potential source of private well contamination. This study employed two complementary methodologies to evaluate historical municipal and private well contamination: (i) groundwater flow and transport modeling of PFOA, PFOS, PFHxS, and PFNA within the village, and (ii) Geographic Information Systems (GIS)–based inverse distance weighting (IDW) interpolation of PFOA concentrations in private wells across the broader Town of Hoosick.

Groundwater modeling results …

Development And Applications Of Fluorescence Microscopy Protocol To Investigate Borrelia Burgdorferi Immune Interactions In The Skin, Rebecca V. Landry

Electronic Theses & Dissertations (2024 - present)

The skin is an immunological organ that acts as the hosts’ first line of defense against infectious agents. Infectious disease vectors like ticks breach this barrier by feeding on hosts, transmitting pathogens like Borrelia burgdorferi in the process. Uncleared infection with B. burgdorferi causes Lyme disease, the most prevalent vector-borne disease in the United States. Previous research has explained many elements of Lyme disease pathogenesis and immunity including the dissemination of the spirochete, innate immune cells performing phagocytosis, the production of antibodies by the humoral response, and the impact of prophylactic treatment with monoclonal antibodies. A remaining gap in the …