ScholarWorks@Georgia State University
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Publication Embargo Using NTDB Data to Examine Variables Predictive of Survival in Severely Injured Trauma Patients(2025-12)In the United States, traumatic injuries are the leading cause of death among adults under the age of 45, and account for at least 69 billion dollars of lost income and 327 billion in medical care and expenses annually. This project examines whether trauma survival among severely injured trauma patients has improved between 2017-2022 and identifies variables most strongly associated with survival among trauma patients. Data were obtained from the National Trauma Data Bank (NTDB) data set, a national registry of demographic, injury, and outcome data on trauma patients cared for in U.S. trauma centers. Analyses included Random Forest, a variety of machine ensemble learning, as well as logistic regression.Publication Open Access Nutrition Education Materials for Families of Children with Graft Versus Host Disease After Hematopoietic Cell Transplant(2025)While diet modifications are routinely used to support gut function and tolerance during graft versus host disease (GVHD), institutional practices vary and standardized, evidence-based guidance remains limited. Many centers offer resources for hematopoietic cell transplant (HCT) recipients who develop GVHD, but there is no standardized approach for post-transplant diet management. Many resources list food options but lack tailored recipes and guidance on managing symptoms. To help address this gap, this project synthesizes evidence on pediatric GVHD nutrition management to create two resources: an updated GVHD tip sheet for Children's Healthcare of Atlanta (CHOA) and a cookbook featuring GVHD-appropriate recipes, symptom management strategies, nutrition tips, food safety guidelines, and texture modification techniques for families.Publication Open Access Disease Risk Perceptions, Culture, Body Image, and Self-Efficacy as Predictors of Dietary Intake in Young African American Women(2025-12-05)African American (AA) women have a higher prevalence of overweight, obesity, and related chronic diseases compared to women of other racial or ethnic groups. Eating a healthy diet is critical to achieving and maintaining a healthy weight and reducing the risk of obesity and its related diseases. There is limited literature on relevant factors that influence dietary intake among young adult AA women. The purpose of this study was to examine perceived risk of cardiometabolic disease, body image, family and culture, and self-efficacy as predictors of intentions to eat a healthy diet and current dietary intake among young adult AA women. A non-experimental, descriptive, correlational design was used. Participants were recruited using paper and electronic flyers distributed at two Universities in Atlanta, Georgia. Data were collected by surveys administered through Qualtrics XM and in person measures of height, weight, and waist circumference. Data were primarily analyzed using descriptive statistics and multiple linear regression. Participants (N = 97) ranged in age from 18-30 years (M = 23, SD = 3.3), and most had a college degree (57.7%), were employed part-time (52.6%), and lived at home with parents or family (44.3%). Their body mass index (BMI) categories varied; 36.5% were normal weight, 28.1% overweight, and 26.8% obese. Most participants (58.8%) had an accurate estimation of their BMI status (58.8%) and were unsatisfied with their body image (64.9%). On average, participants perceived a moderate risk of cardiometabolic disease, believed family and culture had a moderate influence on their diet, and had moderate intentions to eat healthy in the next 3 months. The regression model did not explain dietary intake but significantly explained 29% of the variance in their intentions to eat healthy, with self-efficacy and being unsatisfied with their body image identified as significant predictors. Overweight and obesity were prevalent in this convenience sample of young, mostly college-educated AA women, and they associated weight with cardiometabolic disease risk and had moderate intentions to eat healthy. Findings indicate an opportunity to intervene with this population utilizing self-efficacy and body image satisfaction, which may motivate behavior change. Further research should examine these factors in greater depth, along with other variables that may more fully explain dietary intentions and actual intake.Publication Open Access COVID-19 Pandemic Mortality at the Country Level: A Functional Analysis of Vaccination Trajectories Accounting for Socioeconomic and Demographic Characteristics(2025)The COVID-19 pandemic has caused substantial global morbidity and mortality, with considerable variation in outcomes across countries. This ecological study investigates the association between country-level COVID-19 vaccination rates and mortality, considering socioeconomic and demographic factors, using Functional Data Analysis. A scalar-on-function regression framework was applied to analyze 77 countries across six pandemic periods, encompassing the Delta and Omicron variant waves. The response variable was the log-transformed COVID-19 death rate, modeled as a scalar outcome. The primary predictor was the cumulative daily vaccination rate, while covariates included log-transformed population size, percent of adults aged 65 years and older, life expectancy at age 60, and health expenditure in USD. Analysis showed that higher vaccination rates were associated with lower mortality during the initial vaccine rollout phase and during the beginning of the late Delta and Omicron periods, after accounting for socioeconomic and demographic covariates. Results also indicate that the percent of the population aged 65+ and life expectancy at age 60 were consistently significant determinants of COVID-19 mortality, whereas the vaccination rate coefficients varied across periods and were not consistently statistically significant. Model R² values ranged from weak to moderate, suggesting that selected statistical methods and additional contextual factors—such as outbreak timing, containment policies, and healthcare system differences—likely influenced mortality outcomes. This study highlights that while vaccination remains a key tool in mitigating COVID-19 mortality, demographic and structural characteristics play substantial roles in shaping outcomes at the country level. The findings underscore the importance of integrating temporal modeling with contextual considerations in assessing global pandemic responses and can inform future strategies to enhance preparedness and equity in public health interventions.Publication Embargo Development of mRNA Vaccine Platforms Targeting Spike and Non-Spike SARS-CoV-2 Antigens(2025)Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of Coronavirus Disease 2019 (COVID-19), has continued to circulate globally since its emergence in 2019, leading to recurrent waves of infection and the emergence of multiple variants of concern (VOCs). Successive viral evolution has introduced extensive mutations, particularly in the spike (S) glycoprotein, which remains the primary target of most mRNA vaccine strategies. Early vaccines encoded the ancestral S protein and provided significant protection during the initial pandemic phases. However, as viral evolution progressed, the effectiveness of ancestral formulations declined. Current vaccine strategies rotate full-length S protein constructs adapted to the variant dominant at the time, providing improved but still limited breadth and durability of immune protection. This underscores the need for vaccine approaches that extend beyond the full-length S protein. T-cell responses play a critical role in controlling viral replication and preventing severe disease by eliminating infected cells and supporting long-term immune memory. Structural proteins such as nucleocapsid (N) and membrane (M) are highly conserved across Sarbecoviruses, abundantly expressed, and are capable of eliciting strong immune responses in prior studies. Incorporating these non-S protein antigens into vaccine designs provides an opportunity to evaluate their role in shaping broader immune responses. This dissertation focuses on the development of mRNA vaccine platforms encoding both S and non-S protein SARS-CoV-2 antigens. One construct employed a chimeric S protein design, in which the backbone of one variant was combined with the receptor-binding domain (RBD) of another, to explore how such configurations influence immune recognition while maintaining overall structural integrity. Additional constructs included N and M proteins to investigate their potential roles in cellular immunity. These immunogens were encoded in nucleoside-modified mRNA and formulated with lipid nanoparticles (LNPs) to enable efficient encapsulation and delivery. Evaluation in a human angiotensin-converting enzyme 2 (ACE2) transgenic mouse model compared these mRNA-LNP vaccines against LNP-only controls, assessing humoral and cellular responses to explore potential for cross-protection. Findings from these studies provide insights into the potential of using both S-based and non-S protein–based antigens within mRNA platforms to broaden immune coverage and inform future vaccine development against current and emerging SARS-CoV-2 variants.
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