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Preauthorizations In Orthopaedic Surgery: An Analysis Of A Single Institution’S Spine Center, Kareem Jamal Kebaish

Yale Medicine Thesis Digital Library

Introduction

Preauthorizations are frequently required by commercial insurers before patients can undergo magnetic resonance imaging (MRI) of the spine. In addition to the administrative burden, such processes can lead to delays in care. The current study assessed the rates and eventual disposition of preauthorizations required prior to spine MRIs ordered from an academic spine center.

Methods

Patients from a single academic institution’s spine center who were covered by commercial insurance and referred for a spine MRI between January 2013 and December 2019 were included in the analysis. The requirement for preauthorization and eventual disposition of each of these studies was …

Integrative Genomics Implicates Disruption Of Prenatal Neurogenesis In Congenital Hydrocephalus, Shreyas Panchagnula

Yale Medicine Thesis Digital Library

Congenital Hydrocephalus (CH) affects 1/1000 live births and costs the US healthcare system over $2 billion annually. Mainstay therapies, hinging on surgical cerebrospinal fluid diversion, exhibit high failure rates and substantial morbidity. Limited understanding of pathogenesis warrants identification of crucial genetic drivers underlying CH and their impact on brain development. This pioneering study integrates gene discovery from the largest whole-exome sequenced CH cohort with transcriptional networks (modules) and cell-type markers from the latest transcriptomic atlases of the mid-gestational human brain to uncover the genomic and molecular architecture of CH. Exome analysis of 381 radiographically-confirmed, neurosurgically-treated sporadic CH probands (including 232 …

Somatic Gja4 Mutation In Vascular Malformations Reveals A Novel Pathway For Vascular Neoplasia, Nelson C. Ugwu

Yale Medicine Thesis Digital Library

The term “cavernous hemangioma” has been used to describe vascular anomalies with histology featuring dilated vascular spaces, vessel walls consisting mainly of fibrous stromal bands lined by a single layer of flattened endothelial cells, and a variably irregular outer rim of interrupted smooth muscle cells. Hepatic hemangiomas (HH) and cutaneous venous malformations (cVM) share this histologic pattern, and we examined lesions in both tissues to identify genetic drivers. Paired WES of lesional tissue and normal liver in HH subjects revealed a recurrent GJA4 c.121G>T, p.Gly41Cys somatic mutation in four of five unrelated cases, and targeted sequencing in paired tissue …

Culex Quinquefasciatus: Status As A Threat To Island Avifauna And Options For Genetic Control, Tim Harvey-Samuel, Thomas Ant, Jolene Sutton, Chris Niebuhr, Samoa Asigau, Patricia Parker, Steven Sinkins, Luke Alphey

Biology Department Faculty Works

The avifauna endemic to islands is particularly susceptible to population declines and extinctions resulting from the introduction of non-native pathogens. Three pathogens of concern are the avian malaria parasites, the avian poxviruses, and West Nile virus—each of which can be transmitted by Culex quinquefasciatus, a highly adaptive and invasive mosquito. Culex quinquefasciatus has dramatically expanded its range in recent centuries and is now established throughout much of the tropics and sub-tropics, including on many islands that are remote from mainland landmasses and where this geographic separation historically protected island species from mosquito-borne diseases. The potential for ecological disruption by Cx. …

Morphology And Genetics Concur That Anoura Carishina Is A Synonym Of Anoura Latidens (Chiroptera, Glossophaginae), Camilo Calderón-Acevedo, Miguel Rodríguez-Posada, Nathan Muchhala

Biology Department Faculty Works

Anoura carishina was described based on cranial and dental morphology, but the original analyses did not include Anoura latidens, a similar species of Anoura. We used morphological, morphometric, and genetic analyses to evaluate the taxonomic identity of A. carishina. We performed a principal components analysis to evaluate the correspondence between morphological and taxonomic groups for 260 specimens of large-bodied Anoura (A. carishina, Anoura geoffroyi, A. latidens, and Anoura peruana), and statistically analyzed traits diagnostic for A. latidens, including (1) morphology of the third upper premolar (P4), (2) size of the second (P3) and third (P4) upper premolars, and (3) angle …

The Predictive Relationship Of Allostatic Load In Asthma, Mohamed Mustafa Hassan

Walden Dissertations and Doctoral Studies

Research on populations emphasizes the influence of allostatic overload, a marker of biophysical and biochemical stress, in driving adverse health outcomes. Unknown is the impact of allostatic load and its cardiovascular, metabolic, and inflammatory components as they pertain to asthma prevalence in U.S. populations. Specifically, there is a need to understand the nature of the relationship between allostatic load and asthma in light of confounders such as socioeconomic status, race, education, and gender. Using Bronfenbrenner’s bioecological model as a theoretical underpinning and binary logistic regression as a statistical modality, the predictive relationship between allostatic load and asthma was examined in …

Relationship Between Social Support And Childhood Trauma On Resilience, Carol Krieger

Walden Dissertations and Doctoral Studies

People who have not overcome childhood trauma and who have developed mental illnesses have difficulties dealing with life challenges. The purpose of this quantitative study used a correlational design to test any relationship between childhood trauma experience levels and resilience against life challenges in adulthood. The theoretical framework used for this study was Barnes’ social support theory. Data were collected from 104 participants over a 7-week period. Participants voluntarily answered the ACE questionnaire, 2-way support scale, and resilience scale. Key results indicate that people with mental illness who receive social support are positive impacted by that support. Receiving adequate levels …

Staff Education To Improve Pain Management In Skilled Nursing Patients, Keitta Evans

Walden Dissertations and Doctoral Studies

One of the key ethical principles in nursing is the promotion of health and wellness and ensuring that patients are free from unnecessary pain and suffering. It is estimated that at least 65% of patients in skilled nursing centers in the United States report the presence of pain, indicating that there are opportunities for improvement with effective pain management within this practice setting. A key factor that has been identified as an opportunity for improvement is education for clinical staff who practice within this setting. This Doctorate of Nursing Practice (DNP) project provided education to a group of clinical team …

Food Insecurity In Community College Students In The Central Valley Of California, Leah Carter

Walden Dissertations and Doctoral Studies

AbstractMany college students struggle with having enough money to pay for the costs of college and basic necessities, such as adequate food, which leads to food insecurity. Food insecurity results in a more challenging time focusing on studying and less success in school. This study addressed the lack of a profile of a food-insecure California community college student at Hiker’s Community College (HCC; pseudonym) in the Central Valley of California. The purpose of this quantitative study was to determine the profile of a food-insecure student and to determine relationships between food insecurity and ethnicity, gender, being a first-generation college student, …

Co-Taught Inclusive Classrooms And Algebra I Achievement Of Students With Disabilities, Valeree Williams

Walden Dissertations and Doctoral Studies

Co-teaching has become an increasingly important topic for students with disabilities (SWDs) to access to the general education curriculum. The purpose of this quantitative study was to determine the instructional effectiveness of co-teaching versus inclusive non-co-teaching classroom instruction for SWDs using Algebra I End of Course (EOC) scores and whether these effects differed by gender. Cook and Friend’s principles of co-teaching provided the framework for the study. The first research question was: is there a significant difference in EOC scores for male SWDs enrolled in Grade 9 Algebra I who receive instruction in co-taught Algebra I classes as compared to …

Expectations And Outcomes Of Choosing Reiki For Rheumatoid Arthritis, Theresa Jimenez

Walden Dissertations and Doctoral Studies

Little was known about the use of Reiki as an alternative medical treatment for Rheumatoid Arthritis (RA) symptoms and/or side effects. The current study addressed how sufferers of RA made their decision to use Reiki, their experiences using Reiki to treat their symptoms, and changes in their symptoms or side effects from RA. Two sets of in-depth interviews were conducted with 13 participants. The first interview addressed how decisions to use Reiki were made and the second interview addressed participants’ experiences with Reiki to treat their symptoms and side effects. Psychological attribution theory and the covariation attribution model were used …

Coping Strategies Among Disciplined Psychologists Working High-Conflict Custody Cases, Stephanie Joy Norris

Walden Dissertations and Doctoral Studies

Psychologists who work with high conflict custody cases have one of the highest risks of receiving a board complaint against their license. There is no qualitative research specific to psychologists who have been disciplined from their state licensing board because of their work with high conflict custody cases. The purpose of this qualitative study was to explore and understand the meaning of the experiences of psychologists who have worked or are currently working on high-conflict custody cases and have received discipline from their state licensing board. The transactional theory of stress and coping was used as the foundation for which …

Stress, Coping, And Adjustment Of Young Adults Who Have Transitioned Out Of Foster Care, Helen S. Hogin

Walden Dissertations and Doctoral Studies

Current research lacked information on the stress, coping, and adjustment of individuals transitioning to adulthood from foster care. Transitioning out of foster care when adulthood is reached can be challenging, resulting in mental and physical health problems, decline in overall wellbeing, and poor outcomes. Elevated stress can make coping and adjusting to social life more difficult. The purpose of this study was to explore former foster youths’ perspectives and experiences of stress and what coping strategies were effective as they adjusted to society. The transactional model of stress and coping served as the study’s framework. The research questions focused on …

Social Worker Perceptions Of Lgbt Cultural Competent Practice Within Hospitals, Ronald Davis

Walden Dissertations and Doctoral Studies

Social work cultural competence within a hospital setting has gained importance due to the various changes to how health care is delivered within the United States hospital system. Lesbian, Gay, Bisexual and Transgendered (LGBT) individuals seeking care have reported negative experiences and discrimination, adversely impacting their treatment in a hospital setting. Those experiences have resulted in decreased use of medical treatment. Researchers have established the need for increased levels of cultural competence from social workers within hospital settings to develop rapport with LGBT individuals when delivering social work services as a part of the hospital treatment team. With cultural humility …

Black Mothers’ Birthing Center Experiences And Exclusive Breastfeeding Practices, Natashia King-Conner

Walden Dissertations and Doctoral Studies

The persistence of racial disparities in breastfeeding is associated with a range of interconnected factors, such as historical, cultural, social, social, and psychological. The current gap in the prevalence of exclusive breastfeeding among Black mothers and White mothers has led to rising concerns in the United States. A basic qualitative approach was used to conceptualize the multidimensional constructs of the social–ecological model to investigate the individual, interpersonal, institutional, and community-level structures and existing policies in birthing centers that inadvertently harbor biases that impede care for Black mothers. Data were gathered through purposeful sampling and semistructured interviews with 10 Black mothers …

Adults’ Reflections On Their Lived Experiences With Adolescent Social Anxiety Disorder, Shelley Marie Skelton

Walden Dissertations and Doctoral Studies

Anxiety disorders are the most prevalent mental health disorders for children and youths, and social anxiety disorder (SAD) is the third most common anxiety disorder. SAD can negatively impact school performance, mental health, and healthy social development. In comparison to other forms of anxiety, current treatments for SAD have not been as efficacious. The purpose of this qualitative phenomenological study was to explore other factors of adolescent SAD, such as the role of resilience. The two research questions addressed the lived experiences of adolescents with SAD and how they developed resilience in relation to their SAD. Bronfenbrenner’s bioecological theory of …

Strategies Advanced Placement High School Teachers Use To Teach Diverse Learners, Patti J. Tate

Walden Dissertations and Doctoral Studies

Since Advanced Placement (AP) College Board’s 2002 implementation of the Equity and Access Policy, the number of students enrolled in AP courses has increased, but student success on passing AP exams has dropped. This signifies that the new populations of AP students are not well prepared with the skillsets necessary to succeed on AP exams. This qualitative exploratory case study focused on how high school AP teachers in one southeastern school district provided differentiated instruction (DI) through content and strategies to diverse learners. Data on the use of DI with AP students were collected through interviews of AP teachers at …

Relationship Between Media Coverage And Child Measles Vaccination Uptake, Tanika Ward

Walden Dissertations and Doctoral Studies

Childhood vaccines have been a source of heated debates between both opponents and proponents of vaccination. Childhood immunizations have proven to be effective and save lives, but antivaccine movements continue. The purpose of this retrospective cross-sectional quantitative study was to determine if there was a significant difference in child measles vaccine uptake based on provider facility type and census region, after adjusting for age and education of mother, for the years 2003–2012, pre-and-post 2007 media coverage deeming vaccines unsafe, and for the years 2013–2017, pre-and-post exposure to measles at Disneyland in 2014–2015 for children aged 19–35 months. The social ecological …

Prevalence Of Metabolic Risk Factors With Abnormal Obesity Measures Among The Tobagonian Adult Population, Joanne Cruickshank

Walden Dissertations and Doctoral Studies

AbstractAn increase of metabolic risk factors is a public health threat to the well-being of the population of Tobago; this increase is poorly documented and understood. According to a review of evidence-based research, studies linked metabolic risk factors to the high prevalence of obesity. However, there was a gap specific to the Tobagonian population. This cross-sectional quantitative study assessed the evidence of metabolic risk factors to determine whether obesity measures correlated with metabolic risk factors among a sample from Tobago. Guided by the social-ecological theory, a self-reported survey was used to collect primary data from 270 participants during a workplace …

Exploring Postsurgical Decision Attitudes Among Young Women Electing Hysterectomy, Mary Esther Webb-Tafoya

Walden Dissertations and Doctoral Studies

Over half a million women undergo a hysterectomy procedure for reproductive issues each year. For over a decade, researchers have explored the impact of a hysterectomy on women over age 35 with a diagnosis of malignancy. Much less is known on the impact of an elected hysterectomy over alternative treatments for younger women with benign reproductive issues. The purpose of this study was to understand women’s postsurgical attitude towards an elected hysterectomy. A qualitative phenomenological design was used with purposive sampling to interview 15 women between 18-40 years of age who had a hysterectomy for a benign reproductive issue using …

Identification Of Changes In Sleep Across Pregnancy And The Impact On Cardiometabolic Health And Energy Intake In Women With Obesity, Emily W. Flanagan, Jasper Most, Nicholas T. Broskey, Abby D. Altazan, Robbie A. Beyl, Sarah K. Keadle, Kimberly L. Drews, Prachi Singh, Leanne M. Redman

Clinical Research Faculty Publications

This prospective, observational study investigated changes in sleep and the effect on energy intake, gestational weight gain, and cardiometabolic health across pregnancy in 52 healthy pregnant women with obesity. Habitual sleep was assessed by wrist-worn actigraphy (time spent in bed; TIB, total sleep time; TST, and sleep efficiency) in early (130–156 weeks) and late (350-366) pregnancy. A change to habitual sleep was defined as change of one-half of the standard deviation of TIB and TST across six consecutive nights from early pregnancy. Energy intake and changes in weight, fasting glucose, insulin, and lipids across pregnancy were compared between women who …

The Patriarchy Gives Way To Irish Mothers, Cora Hawn

3690: A Journal of First-Year Student Research Writing

Overview: In Ireland, both the patriarchy and the strong mothers seem to be timeless, but they exist in a delicate balance to one another. The Irish mothers who presented as a strong constant have always been capable of overtaking the patriarchy, yet the patriarchy has been a burden on Irish mothers for much of the nation’s history. The beautiful irony is that this patriarchy, a society where men are granted an inequitable amount of control, is slowly falling victim to the persistent Irish mothers, as fathers continue to fail their children and leave mothers with no choice but to take …

Help Reverse Global Warming: Drive An All-Electric Vehicle, Matt Krusenstjerna

3690: A Journal of First-Year Student Research Writing

Overview: Global warming is one of the biggest challenges facing humanity today, so I wrote this paper primarily to determine what technologies could possibly impact the trend of this global threat enough to help reverse it. Since transportation contributes 29 percent of all greenhouse gas emissions in the United States I chose to focus on this economic sector, and more specifically, light use vehicle alternative fuel technologies. I further narrowed my scope to a discussion of ethanol, bio-diesel, hydrogen and electric fuel technologies because each represents one of the four alternative fuel categories. I evaluated the fuels on the following …

Finding A Middle Ground: Science Vs. Religion And The Harms Of Extremism, Elizabeth Wunsch

3690: A Journal of First-Year Student Research Writing

Overview: Human beings have an innate desire for a sense of purpose. They want to understand the world around them, where they came from, why they exist, and what certain natural events mean. From these desires stem two very different concepts: science and religion. Both religion and science are used to explain where everything came from and to why huge disasters (such as storms or pandemics) occur. Science provides similar explanations for these concepts, However, science and religion provide answers in very different ways: religion is faith based, while science is evidence based. As a result of their differences, scientists …

Beyond Choice: An Intersectional Analysis Of Identity And Labor In Online Sex Work, Shawna F. Felkins

Theses and Dissertations--Gender and Women's Studies

This intersectional project seeks to understand the complex labor, social lives, and community building of online sex workers. Building on the work of foundational sex work researchers, this project utilizes in-depth interviews, a survey, social media posts, and published writing and research from online sex workers to understand how marginalization and identity impacts participation and success in online sex work. Providing analysis on how race, gender, class, and ability intersect in the digital sexual marketplace, this project critiques the rise of neoliberal feminism in sex work spaces that stems from the centering of white and otherwise privileged sex workers using …

"My Gender Is Lesbian": Community Building And The Endurance Of The Lesbian In Queer Times, Adriana Sisko

Theses and Dissertations--Gender and Women's Studies

During 2016, the same year news of lesbian bar closures hit mainstream media, a small cluster of Tumblr users began to discuss a new gender and sexual identity, nonbinary lesbian, to describe those who identify both as nonbinary and as lesbian. Nonbinary lesbians stand at the crossroads of modern and postmodern identity constructs, engaging in contradictions and ambiguities for the sake of authentic self-expression. What does this demonstrate about the evolution of lesbian identity, particularly as lesbian bars continue to close around the United States? This dissertation explores this question by comparing and contrasting the discursive practices and strategies of …

Computer Self-Efficacy And Math Performance In Adult Basic Education Students, Morgan Hilary Dow

Theses and Dissertations--Science, Technology, Engineering, and Mathematics (STEM) Education

Domain-specific self-efficacy is increasingly known to be related to student academic performance. This study investigated the relationship between computer and math self-efficacy, math performance, and guided in-class use of an online educational program for adult basic education students enrolled in classes at an adult education program during the 2019 – 2020 school year. Initial math test scores and pre-survey results indicated no statistically significant relationship between computer self-efficacy and math performance, or math self-efficacy and math performance. After attending between 1 and 15 class sessions where an online educational program was used, post-survey results indicated no statistically significant relationship between …

Transforming Outcomes To Increase Participation In The Independent Living Program Sponsored By Sunrise Children’S Services, Richard R. Burslem

Theses and Dissertations--Educational Leadership Studies

Research demonstrates the transition for aging-out foster youth evidences they are not equipped with the necessary tools to live a self-sufficient adult life. Many children who age-out of the foster system have encountered trauma at multiple levels. Sunrise Children’s Services is an agency in Kentucky committed to changing negative outcomes for this population of individuals.

The optimum goal for children and youth is for them to grow up within their biological family where they receive guidance and support as they mature. For some individuals that is not an option, and the government along with agencies like Sunrise are focused on …

Helping The Have-Nots: Examining The Relationship Between Rehabilitation Adherence And Self-Efficacy Beliefs In Acl Reconstructed Naia And Ncaa Dii And Diii Female Athletes, Myles Tutin Englis

Theses and Dissertations--Kinesiology and Health Promotion

Anterior cruciate ligament injuries are among the most common and traumatic sport-related injuries, and often negatively impact one’s quality of life during and post-rehabilitation. For many NCAA Division I and professional female athletes, rehabilitation is streamlined with a multidisciplinary team, including sport psychology. For others (e.g., NAIA, NCAA Division II, III athletes) this may not always be the case, as many of these athletic programs may not have the resources to meet the various needs of injured and rehabilitating female student-athletes. In these instances, rehabilitation motivation, adherence, and success may be more dependent on the athletes’ individual resources and personalities, …

Mechanical Deviations And Verbal-Cue Altered Gait In The Femoroacetabular Impingement Syndrome Population, Walter Menke

Theses and Dissertations--Kinesiology and Health Promotion

Femoroacetabular impingement syndrome (FAIS) is an abnormal physical hip morphology that causes functional changes and pain during gait. Mechanical gait differences in this population require further biomechanical investigation to elucidate characteristics unique to this group. Fixed speed gait trials were performed on force plates and analyzed in addition to isokinetic strength testing to find a multitude of biomechanical variables including joint moment, joint power, joint work, and peak joint angle. This work has discovered evidence of muscular deficits at the hip, specifically hip extension, as well as knee joint power contributions to gait when compared to controls. These findings suggest …