Medicine and Health Sciences Commons^™

Combining Novel Direction Modulated Brachytherapy Tandem-And-Ovoids Applicators For Treatment Planning Of Multi-Institutional Cervical Cancer Cases: Removing Needles In Intracavitary-Interstitial Techniques, Sharmin Alam

Theses and Dissertations

Lack of standard guidelines for optimal needle insertion during high-dose-rate (HDR) intracavitary-interstitial (IC-IS) brachytherapy of the cervix means a sophisticated and technical skillset of inserting needles next to IC applicators must be developed to enhance plan quality. This study sought to evaluate the performance of two separate direction modulated brachytherapy (DMBT) tandem applicators used in conjunction with one set of novel DMBT ovoids, to effectively obviate the need for IS needles.

A cohort of 32 retrospective clinical HDR brachytherapy plans was re-planned with Varian’s BrachyVision^® treatment planning system, using VEGO^® inverse optimization algorithm, with dose heterogeneity accounted for …

Characterization Of A Solid-State Detector For Dosimetry In The Diagnostic Energy Range With Verification Via Monte Carlo Estimation Of Average Breast Dose In Mammography, Areej Aljabal

Theses and Dissertations

This dissertation aims to develop a simplified QA metric for estimating radiation dose in mammography. This metric, the Mid-Breast Dose (MDB) Index, maybe be proposed as an alternative dose index, consistent with average glandular dose (AGD), for routine QA. MBD was obtained using “Phantom mid-point Air Kerma (AK) measurement” for conventional mammography. The advantage of this method is that MBD can be measured directly without requiring multiple conversion factors. The accuracy of clinical measurements in computing the MBD was assessed by comparing it with the AGD estimated by the Dance formalism experimentally and Monte Carlo simulation.

MBD methodology relies on …

The Environment Of Interprofessional Education In Graduate Education: Exploring Professional Programs Of Occupational Therapy, Physician Assistant, And Physical Therapy, Allison R. Kaczmarek

Theses and Dissertations

Interprofessional education (IPE) is an educational approach of increasing popularity in professional schools for the preparation of a collaborative ready healthcare workforce. The accrediting bodies of professional education programs in occupational therapy (OT), physician assistant (PA), and physical therapy (PT) have incorporated standards for outcomes addressing IPE. Although they have endorsed the Health Professions Accreditors Collaborative (HPAC) consensus document on quality IPE, we do not have a contemporary snapshot of the IPE environments in the curriculum of their accredited programs. This dissertation, a collection of three distinct inquiries, has two aims: first, to provide a description of IPE as it …

Access To Hiv Prevention, Care, And Treatment Services In The Us: The Role Of Primary Care, Jessica S. Kiernan

Theses and Dissertations

This dissertation examines the role of access to primary care in benefitting HIV outcomes through increased access to HIV prevention, care, and treatment services, among populations disproportionately affected by HIV in the US. Over 30,000 individuals are newly diagnosed with HIV annually in the US and diagnoses are concentrated in specific populations. At an individual-level, ~ 70% of new diagnoses are among gay and bisexual men and of those diagnoses, 70% are among Non-Hispanic Black and Hispanic gay and bisexual men. At a community-level, over 50% of new HIV diagnoses occur in less than 2% of US counties (48), Washington, …

Family-Based Support As Social Determinants Of Health Protective Factor On Depression Of Parents Of Children With Autism Spectrum Disorder, Bisola E. Duyile

Theses and Dissertations

All parents experience challenges in their caregiving roles (Barańczuk & Pisula, 2020). However, parents raising a child/children with disabilities experience different social barriers (Oliver, 1996) that may also contribute to additional stressors in their caregiving role (Tomeny, 2016). Although these parents, on average, have reported greater symptoms of depression than parents of typically developing children, research shows that parents who reported receiving social support had lower symptoms of depression and stress (Das et al., 2017; Singh et al., 2017). Through the social determinants of health (SDOH) framework (ODPHP, 2022), the present study investigated informal/family-based support and its protective impact on …

Addressing Death Distress In Caregivers Of Patients With Malignant Glioma, Kelcie D. Willis

Theses and Dissertations

The field of psychosocial oncology seeks to improve the quality of life of patients and families affected by cancer. This task becomes increasingly important when there are limited, non-curative treatment options, a high probability of recurrence, and rapid functional decline, such as in the case of a malignant glioma (MG). Indeed, the diagnosis of a MG is associated with negative sequalae that often translates to higher caregiver burden. Caregivers—who must manage the functional decline of the patient, changes within the family, and a complicated medical system—often feel overwhelmed, isolated, and ill-equipped to handle these myriad responsibilities. While they also report …

Cone Beam Computed Tomographic Analysis Of Outcomes In Ridge Augmentation Using Titanium Mesh And Titanium Reinforced Ptfe Membranes, Lina Elnakka

Theses and Dissertations

Objective: The primary goal of this study is to evaluate and compare the average vertical and horizontal bone gain between titanium reinforced polytetrafluoroethylene (Ti-PTFE) and titanium mesh (Ti-mesh) using superimposition of preoperative and postoperative (CBCT). The secondary goal is to evaluate and compare the surgical outcomes between the two techniques.

Methods: A retrospective chart review was completed to assess the clinical and radiographic outcomes of patients who underwent ridge augmentation therapy using either Ti-PTFE or Ti-mesh. Preoperative and postoperative CBCT scans were superimposed using InVivo 3D imaging software. Vertical component of the augmented site (L1) was assessed along a vertical …

Food Deserts And Pediatric Oral Health Status In An Under-Resourced Urban Community, Jessica T. Mcauliffe

Theses and Dissertations

Purpose: The aim of this analysis of survey data was to assess the influence of living within a food desert as a predictor of oral health problems among children of East Henrico County, Virginia.

Methods: Survey participants were recruited and questionnaires applied online. Residing in a food desert, using access to affordable produce as a proxy value, was the independent variable, while self- reported assessment of the child’s oral health status was the primary outcome variable. Analyses controlled for other indirect factors of pediatric oral health. Logistic regression was used to model the association between the self-reported access to healthy …

Role Of Histone Deacetylase (Hdac) In Epithelial To Mesenchymal Transition (Emt) In A Human Cholangiocyte Model Of Ischemic Cholangiopathy, Priyanshi Pragnesh Parikh

Theses and Dissertations

Organ transplants are a vital intervention for many diseases that result in end stage organ failure. Currently, the donation pool is not meeting the demands of the transplant list. Expanding this pool to include donation after cardiac death (DCD) is highly sought-after. However, the use of DCD livers can lead to increased odds of graft failure and ischemic cholangiopathy. The loss of epithelialization and fibrosis that occurs during ischemic cholangiopathy is characteristic of these cells undergoing epithelial-to-mesenchymal transition (EMT). The biological changes the cell experiences enhance migratory capacity, invasiveness, and increased resistance to apoptosis. Our earlier studies have shown differential …

Motivations Of Adult Patients Seeking Orthodontic Retreatment, Scott V. Philips

Theses and Dissertations

Objective: The aims of this study were (1) to compare the reasons adult patients seek orthodontic first-time treatment to the reasons adult patients seek orthodontic retreatment, and (2) to compare the concerns, motivations, and satisfaction levels of adult patients seeking orthodontic retreatment across the different previous treatment provider types of orthodontist, general dentist, and Direct-to-Consumer company.

Methods: At their initial orthodontic visit, adult patients (N=108) were invited to participate in the digital survey (REDCap) study. Subjects were recruited from the graduate orthodontics clinic at Virginia Commonwealth University and seven private orthodontic practices across the United States. Visual Analogue Scales were …

Characterization And Investigation Of Cold Atmospheric Plasma And Its Effects On Cancer Cell Biology, Thomas M. Ritrosky

Theses and Dissertations

Modern cancer treatment uses radiation therapy in over 50% of patient cases. It is an e↵ective way of treating tumors because the mechanisms of cell killing are well known through the damage that ionizing radiation does to DNA. The amount of radiation can be tracked through measuring the dose of the clinical photon or electron beam used. However, there are limitations in the usage of radiation therapy, for example, a tumor can create hypoxic areas that become radioresistant leading to complete ine↵ectiveness of further radiation treatment. This project looks into the application of cold atmospheric plasma as an adjuvant therapy …

The Impact Of A Parent-Only Pediatric Obesity Intervention Program On Quality Of Life In Racially Diverse Children, Taylor Vashro

Theses and Dissertations

Pediatric obesity has been associated with significant decrements in pediatric quality of life (QOL) comparable with severe pediatric diseases such as cancer. Parenting interventions have yielded health benefits for children with obesity; however, few studies have investigated the impact of parent-focused interventions on QOL in children with overweight and obesity. This study investigated the impact of a 6-week intensive parenting intervention program on the QOL of 5-12 year old, predominantly Black children with overweight and obesity. Parents were randomized into either the parenting intervention (NOURISH+) or a control group, and QOL, as well as variables related to child and parenting …

The Impact Of Hiv-1 Tat And Morphine On Spatial Distribution Of Drugs In The Brain., Austin M. Jones

Theses and Dissertations

Despite combination antiretroviral therapy effectively suppressing HIV within the periphery, the central nervous system (CNS) remains affected by the virus. Approximately half of people living with HIV will experience HIV-associated neurocognitive disorders (HAND) or neuroHIV. Concurrent opioid use exacerbates neuroHIV by promoting neuroinflammation, viral replication, and potentially altering the antiretroviral concentrations within the brain.

Using a transgenic mouse that expresses the HIV-1 Tat protein, we examined the effects of Tat and morphine on antiretroviral accumulation and distribution and the effects of Tat on morphine accumulation within the brain using infrared matrix-assisted laser desorption electrospray ionization with mass spectrometry imaging (IR-MALDESI-MSI). …

Studying Gene Function In Streptococcus Sanguinis Using Rna-Sequencing Analysis, Ahmed Ismail

Theses and Dissertations

The oral cavity hosts hundreds of bacterial species, amongst them are the Streptococci family. More specifically, S. sanguinis is a benign bacteria in the oral cavity to protect the tooth surface from S. mutans. which is a pathogen causing dental caries. While S. sanguinis is harmless in the oral cavity, it becomes pathogenic once entering the bloodstream and causing Infective Endocarditis (IE). To further study S. sanguinis and eventually develop an effective drug to treat IE caused by S. sanguinis, a gene expression study was conducted. In order to study gene expression, RNA-sequencing was conducted, and appropriate methods to remove …

Exploration Of Dimensional Structure Of Major Psychiatric Disorders Reveals Relationship With Substance Use And Personality, Noah Berley

Theses and Dissertations

Objective: Using a mixture of statistical techniques like structural equation modeling, confirmatory, and exploratory factor analyses, we aimed to determine the genetic factor structure among Externalizing, Internalizing, and Psychotic spectrum disorders through methods that evaluate GWAS-based correlations. Additionally, a subsequent factor analysis based on the most suitable psychiatric model was conducted to understand how non-clinical behavioral traits align with this factor structure.

Methods: Publicly available GWAS summary statistics for twelve major psychiatric disorders, six substance use measures and two personality domains were incorporated into structural equation models. Using the GenomicSEM software package, GWAS-based correlations were estimated between all twelve disorders …

Effectiveness Of Financial Incentives In Improving Breast Cancer Screening Among Medicaid Recipients, James B. Sherwood

Theses and Dissertations

Breast cancer remains one of the leading causes of death among women. Roughly 2.4 million women are diagnosed annually with breast cancer throughout the world. Although breast cancer survival rates are favorable for the United States compared to other nations (90% 5-year survival for non-metastatic disease), it comes at a high cost. The United States spends an estimated $30 billion annually on breast cancer treatment. In addition, disparities in breast cancer survival rates also exist in the United States. Women Medicaid recipients, who are predominately minorities (60%), are more likely to die of breast cancer due to their high rates …

Protacs – A Novel And Rapidly Developing Field Of Targeted Protein Degradation, Hannah R. Gatley

Theses and Dissertations

There is a continued need for new technology and strategies for tackling cancer and other diseases, and within the current century a novel therapeutic strategy has emerged in the realm of targeted protein degradation called Proteolysis-Targeting Chimeras (PROTACs). This technology specifically targets and degrades disease-causing proteins via the ubiquitin-proteasome system, and has seen an explosion of research and intrigue in both academia and industry over the past two decades. The diversity of PROTAC classes based on the E3 ligase recruiting ligand and the target protein allows for a universal molecular structure that can be customized for a specific target and …

Analysis Of Referrals To Trauma Psychology And Subsequent Development And Proof-Of-Concept Study Of Provider Mental Health Training At A Level I Trauma Center, Samantha Mladen

Theses and Dissertations

Introduction: Millions of people are traumatically injured each year, with a significant portion going on to develop negative mental health sequelae. Many Level I trauma centers are integrating psychologists to provide acute assessment and intervention to patients at risk for poor outcomes. However, medical providers receive very limited training in how to best refer patients to mental health services and may benefit from such education.

Objective: To characterize current patterns of referral to trauma psychology at a Level I trauma center and to develop, refine, and test proof-of-concept for a new training for referring providers.

Method: One year of patient …

The Impact Of Patient Characteristics On Dysphagia Therapy Utilization And Feeding Outcomes For Premature Infants In The Neonatal Intensive Care Unit, Tiana Nguyen

Theses and Dissertations

Medical advances have significantly increased the survival rates of preterm infants at lower gestational ages. However, infants born at lower gestational ages have an increased risk for developmental disabilities and oral feeding difficulties. A stay in the neonatal intensive care unit (NICU) is very costly and inadequate oral feeding is the most common barrier to discharge for premature infants. Infants can receive dysphagia therapy services during their NICU stay that focuses on the development of oral feeding and swallowing skills. However, literature to this date has mainly focused on the impact of therapy services for premature infants after NICU discharge. …

The Presentation And Impact Of Compassion Fatigue And Compassion Satisfaction In Occupational And Physical Therapists Working With People Who Have Sustained Burn Injuries, Miranda L. Yelvington

Theses and Dissertations

Therapists who work with burn survivors are frequently exposed to patients who are undergoing or have undergone severe trauma and pain. This exposure places burn therapists at risk for the development of compassion fatigue and diminished professional quality of life. Alternatively, the sense of purpose and altruism experienced by these same therapists have the potential to foster compassion satisfaction. This dissertation explores the prevalence and presentation of compassion fatigue and compassion satisfaction in burn therapists in the United States. This three-paper design focuses on: 1) a scoping review of current literature, 2) a cross-sectional quantitative survey utilizing the Professional Quality …

Goals Of Care Identification Tool In The Surgical Icu/Neuro-Critical Care Unit: A Tool Exploration, Brandon P. Nugent

Nursing Doctoral

Background: Ischemic strokes affect nearly 795,000 people yearly. Approximately 20% of patients with an acute ischemic stroke (AIS) will need an intensive care unit (ICU) admission, and less than 20% of these patients have a good neurological outcome at six months. In patients with AIS goals of care (GOC) discussions are required to ensure care remains goal concordant. There continues to be a gap of GOC discussions and documentation in the ICU, for which the cause can be multifactorial, but identification of patients in need remains one of the leading factors. Methods: This was a two-stage quality improvement project implemented …

Qvoices: Queer Voices In Oncology Igniting Change Through Empowered Stories Of Survivorship, Viktor Clark

Theses and Dissertations

Background: Each year in the United States there are roughly 2 million new cancer diagnoses, with over 600,000 deaths due to cancer. The National Cancer Institute developed a six-stage cancer control continuum framework ranging from etiology to survivorship to organize the cancer experience. Sexual and gender minorities (SGM) are comprised of multiple communities representing ~23.6 million adults in the US, SGM face disparities at each stage of the cancer control continuum. This study emphasizes three stages, prevention, detection, and treatment. Engagement in prevention can prevent or prolong cancer, early detection through engagement in cancer screening improves cancer trajectories and compliance …

Characterizing The Effects Of Antiandrogens And Senolytics To Enhance The Therapeutic Response To Castration-Resistant Prostate Cancer, Justin M. Silverman

Theses and Dissertations

Prostate cancer is the most frequently diagnosed cancer in males and the second most common cause of cancer deaths. Androgen deprivation therapy, whether through surgical or chemical castration, is the mainstay for treatment of advanced prostate cancer; however, despite an initial response, most patients eventually develop a progressive PSA rise, and castration- sensitive prostate cancer gives rise to castration-resistant prostate cancer. The standard of care therapy includes the antiandrogens such as enzalutamide and abiraterone acetate as well as the microtubule poison, docetaxel, and various immunotherapies; however, while prostate cancer research is progressing, there continues to be a compelling need for …

A Learning Health System For Radiation Oncology, Rishabh Kapoor

Theses and Dissertations

The proposed research aims to address the challenges faced by clinical data science researchers in radiation oncology accessing, integrating, and analyzing heterogeneous data from various sources. The research presents a scalable intelligent infrastructure, called the Health Information Gateway and Exchange (HINGE), which captures and structures data from multiple sources into a knowledge base with semantically interlinked entities. This infrastructure enables researchers to mine novel associations and gather relevant knowledge for personalized clinical outcomes.

The dissertation discusses the design framework and implementation of HINGE, which abstracts structured data from treatment planning systems, treatment management systems, and electronic health records. It utilizes …

Impact Of Portal Of Exit On The Prevalence Of Apical Periodontitis In Root Canal Treated Maxillary Molars With Missed Second Mesiobuccal Canals: A Cbct Study, Jing Ye

Theses and Dissertations

Objective: To evaluate the association of portal of exit (POE) of the second mesiobuccal (MB2) canal with the prevalence of apical periodontitis (AP) in previously treated maxillary molars

Methods: Cone beam computed tomography (CBCT) scans of 106 previously treated maxillary molars seen for either recall or retreatment in the past 3 years were included in the study. Scans were reviewed by one endodontic resident and one board-certified endodontist to determine the POE (separate versus common) of the missed MB2 canal and the presence or absence of a periapical hypo-dense area. Association between AP and portal of exit was assessed using …

Utilization Of Occupational Therapy Services For Patients With Cancer In Acute Care Settings, Christine Mcnichols

Theses and Dissertations

For patients with cancer diagnoses, effects from the disease or as a result of cancer treatments can cause profound impairments impeding patient functioning and independence. These assaults to the independent achievement of activities have far reaching implications and linkages to a patient’s length of stay and their likelihood of a hospital readmission. Unfortunately, occupational therapy services have frequently been found not to be ordered for patients with cancer, even when there have been demonstrated functional deficits and needs. Through the analysis of patient records from a National Cancer Institute hospital over 5 years, the current study investigated occupational therapy services …

Effect Of Apical Preparation Size On Endodontic Treatment Outcomes, Joseph Vaughn

Theses and Dissertations

Objective: Previous authors have attempted to identify the ideal apical preparation size needed to achieve endodontic treatment objectives. Despite vast literature on the topic, there exists a lack of consensus on ideal apical enlargement, with few studies discussing the effect of apical prep enlargement on clinical outcomes. The purpose of this retrospective study was to evaluate the effect of final apical preparation size on endodontic outcomes in maxillary and mandibular molars treated in both a graduate endodontic clinic and a private practice.

Methods: A chart review was conducted for patients seen at the VCU graduate endodontic clinic as well as …

Vulnerability And Adaptation Of Neocortical Neuron Subtypes In Models Of Concussive Traumatic Brain Injury And Multiple Sclerosis, Alan C. Harris Jr.

Theses and Dissertations

The pathognomonic sequela of traumatic brain injury is traumatic axonal injury, the

burden of which correlates with less favorable outcomes. Elucidation of

the intrinsic variables that endow delineated neuronal subgroups and microanatomical domains with outsized vulnerability to injury represents a critical domain of inquiry toward the successful translation of disease-modifying therapeutics. To this end, we studied mild traumatic brain injury (mTBI) within the central fluid percussion model to examine the consequences of mTBI on the morphology and functional integrity of the axon initial segment (AIS) and the relative contributions to network homeostasis mediated by distinct populations of inhibitory interneurons. One …

Methodological Considerations In Pisces 3: A Randomized, Placebo-Controlled Study Of Intracerebral Stem Cells In Subjects With Disability Following An Ischemic Stroke, Daniel T Laskowitz, Keith W Muir, Sean I Savitz, Lawrence R Wechsler, Julie G Pilitsis, Scott Y Rahimi, Richard L Beckman, Vincent Holmes, Peng R Chen, Laura Juel, Deborah Koltai, Brad J Kolls

Faculty, Staff and Student Publications

Background and hypothesis: At present, there are no medical interventions proven to improve functional recovery in patients with subacute stroke. We hypothesize that the intraparenchymal administration of CTX0E03, a conditionally immortalized neural stem cell line, linked with a standardized rehabilitation therapy regimen for the upper limb, would improve functional outcomes in patients 6-12 months after an index ischemic stroke.

Study design: PISCES III was designed as a multicenter prospective, sham-controlled, outcome-blinded randomized clinical trial. Eligibility required a qualifying ischemic stroke 6-12 months prior to surgical intervention. Patients must be between 35 and 75 years of age and have residual moderate …

The Relationship Between Gluteus Maximus Activation And Running Economy In Recreational Distance Runners, Carlos Hernandez

Cal Poly Humboldt theses and projects

Within the running community, there are strategies that a trainer will utilize to improve the performance of an athlete. One of these strategies suggests that an increase in activation of the Gluteus Maximus (GM) muscle will result in an increase in the efficiency of runners. The primary purpose of this study is to examine the relationship between GM activation and running economy (RE).

Methods: Three female and seven male recreational runners (27±8 yrs) from California Polytechnic State University, Humboldt and the local community. A Pearson product-correlation was used to determine the strength of the relationship between Gluteus Maximus activation and …