Digital Commons Network^™

Trends, Predictors, And Cerebrovascular Outcomes Of Vertebral Artery Injury In Cervical Fractures, Rahul Jayaram

Yale Medicine Thesis Digital Library

Background and Scientific Premise: Cervical spine trauma is a common emergencydepartment presentation, and vertebral artery injury (VAI) is a potentially occult but serious complication associated with posterior circulation stroke. Identification of patients at risk remains challenging due to subtle presentations, variable screening practices, and limited prior data. Research Aims: The aims of this study were to characterize temporal trends in VAI detection among adult patients presenting to the emergency department with cervical spine fractures between 2010 and 2022, identify independent demographic, clinical, and injury-related predictors of VAI, and evaluate the association between VAI and ischemic stroke within ninety days of …

Prevalence, Predictors, And Consequences Of Postoperative Dysphagia After Aortic Surgery, Andrew Joseph Johnson

Yale Medicine Thesis Digital Library

Prevalence, Predictors, and Consequences of Postoperative Dysphagia After Aortic SurgeryAndrew Johnson and Ronny Munoz-Acuna, M.D., Department of Anesthesiology, Yale School of Medicine, New Haven, CT 06510. Abstract Background: Postoperative dysphagia is an underrecognized complication following cardiothoracic surgery and is associated with aspiration, prolonged hospitalization, and adverse clinical outcomes. Patients undergoing complex aortic surgery may be at particularly high risk due to prolonged mechanical ventilation, extensive airway instrumentation, and neurologic vulnerability. Data describing the prevalence, predictors, and clinical consequences of postoperative dysphagia in this population remain limited. Research Aim: This study consisted of three aims: first, to determine the prevalence and …

Frailty And Functional Decline After Elective Endovascular Abdominal Aortic Aneurysm Repair, Judy Li

Yale Medicine Thesis Digital Library

Background: Frailty can be used to estimate perioperative and long-term mortality risk in octogenarians undergoing elective endovascular abdominal aortic aneurysm repair (EVAR). Its association with functional decline, an important surrogate of quality of life in older adults, has not been well studied in this population. We aimed to evaluate whether preoperative factors such as frailty are associated with one-year functional decline after elective EVAR in octogenarians and to compare the performance of three different frailty assessments.

Methods: The Vascular Quality Initiative (VQI) database was queried for octogenarians who underwent elective EVAR for an asymptomatic infrarenal abdominal aortic aneurysm (AAA) (2014 …

The New Transgender Tipping Point: Trumpism, Medical Necessity & Gender-Affirming Care, Molly J. Nunn

William & Mary Journal of Race, Gender, and Social Justice

Following the rise and eventual triumph of Trumpism 2024, President Donald J. Trump and his administration have sought to discredit the internationally recognized standards of effective health care practice for gender-affirming care. Now, ten years after Time Magazine published “The Transgender Tipping Point,” the political discourse of transgender identity is tipping again. Under the second Trump Administration, transgender identity sits at the edge of an abyss. Trumpism seeks to eradicate or significantly limit access to gender-affirming care through executive actions and the judiciary, despite the plethora of medical associations stating that that care is medically necessary. Public policies that widely …

Export Controls As Intellectual Property Regulation, Doni Bloomfield

Faculty Scholarship

Export-control laws have long regulated information created outside of the U.S. government. Legal scholars have paid little attention to these national-security laws, and have not recognized that the government uses them specifically to assert a right to suppress information held in patent applications and trade secrets. In this Article, I present a new history of the relationship between export controls and intellectual property to show how the government regulates IP transfers, and how the state uses IP laws to national-security ends. Export-control laws regulate IP by controlling how people in the United States and beyond can share or use inventive …

Passive Communication Across Diverse Swarm Formations And Scales Utilizing Wake Signatures For Messaging And Object Inference, Bryan Varela

Open Access Master's Theses

Passive wake signatures in fluid flows can support perception and low-rate communication in swarms. In cluttered or contested underwater environments, conventional acoustic, radio, and optical links can be power-hungry, intermittent, or undesirable when low observability is required. Wake-mediated cues offer a local, directional channel that does not require line of sight because each agent naturally sheds coherent vortices that persist downstream and can be sampled by followers with only a small number of probes.

This study evaluates whether sparse downstream probes are sufficient to infer agent attributes and decode simple messages from wakes generated by established source shapes. Computational fluid …

Sauce For The Gander: The False Symmetry Of Myths And Stereotypes Against The Accused In Sexual Assault Trials, Janine Benedet

Dalhousie Law Journal

As sexual assault laws evolved to be expressed in sex-neutral language, so too have arguments relating to myths and stereotypes in the context of sexual offences. This article evaluates the argument that myths and stereotypes, traditionally a reflection of systemic discrimination against female complainants in rape trials, also operate against male accused. Understood correctly, this trend repackages anti-feminist backlash to early equality reform efforts, ultimately working to revive the belief that women’s accusations of sexual assault are often false. The Supreme Court of Canada’s decision in R v Kruk affirms that this historical context matters when it comes to claims …

Chapter 6 - Interviewing The Client, Anthony G. Amsterdam, Randy A. Hertz

Trial Manual for the Defense of Criminal Cases

The first interview with a criminal client is probably the most important exchange that counsel will have with the client. It largely shapes the client’s judgment of the lawyer. Any initial impressions counsel makes may be indelible. At the least, this interview will strongly affect all future dealings between the two. The lawyer’s primary objective in the initial interview is to establish an attorney-client relationship grounded on mutual confidence, trust, and respect.

Public Utilities Commission, Azad Hassan Khanzadeh Faal, Kelly Downes, Annika Kjos, Marcus Friedman

California Regulatory Law Reporter

No abstract provided.

The Role Of Parenting In Mitigating Epigenetic Cardiometabolic Risk In Predominantly Latino Preschoolers, Adamari López

Open Access Master's Theses

Background: Childhood obesity is a highly prevalent public health concern with significant consequences for health and development across the lifespan. Risk is disproportionately elevated among children from marginalized racial and ethnic groups and socioeconomically disadvantaged backgrounds, highlighting persistent disparities in long-term health outcomes. Epigenomic mechanisms, including DNA methylation (DNAm), have emerged as a promising approach for understanding the biological embedding of metabolic risk; however, prior research has largely emphasized deficit-based models, with limited attention to protective family-level factors. The present study examined whether participation in a positive parenting intervention was associated with epigenetic cardiometabolic risk among preschool-aged children. Methods …

“For Rescuing His Horse”: An Anthrozoological Approach To Dissent In Seventeenth-Century New England, Richard Mcgee

Open Access Master's Theses

The seventeenth-century colonization of New England entailed varying social, political, economic, cultural, and religious processes that were driven by and impacted several peoples. However, the presence of animals is undermentioned. This thesis forms an animal history of seventeenth-century New England, explains how different peoples understood human-animal relations, and evaluates how human-animal connectivity impacted how people conceptualized and conducted settler-colonialism. This thesis especially interrogates why some Puritan colonists limited different understandings of human-animal relations in the 1600s, namely from Indigenous Peoples, Quakers, and dissenting colonists deemed criminals. This thesis proposes that some Puritans restricted different concepts of human-animal relations because those …

Exploratory Investigation Of Greenhouse Gas Emissions In A Natural And Restored Salt Marsh, Sophia Motta

Open Access Master's Theses

Coastal wetlands are typically considered greenhouse sinks, specifically playing an important role in the global carbon cycle (Chmura et al., 2003), but new studies have pointed to anthropogenic interference leading to the understanding that altered tidal salt marshes may also be producers of methane to the atmosphere, contributing to the greenhouse effect. Hydrologic alteration including due to sea level rise (SLR), peat subsidence, impounded water, and decreased accretion rate disruption can have negative effects on marsh biochemistry leading to potential changes in electron acceptor availability, redox gradient shifts, and microbial community structure within the environment. This research is intended to …

Herbivore Cues And Plant Damage-Associated-Compounds Jointly Alter Seed Germination And Seedling Herbivory, Katherine Overstrum

Open Access Master's Theses

While plant defense against herbivory is primarily thought to occur following attack, there is also evidence that plants can detect and respond to pre-attack cues. These cues include chemicals released from damaged conspecifics and kairomones, non-attack-related substances emitted by an herbivore that plants can detect and use to their benefit. It is unknown, however, whether or how plants react to the interaction of these pre-attack cues. We measured germination, growth, and herbivore susceptibility of B. nigra seedlings in an experiment that crossed the presence/absence of crushed B. nigra leaves with the presence/absence of mucus of a generalist herbivore, A. subfuscus …

Unveiling The Shadows: An Exploratory Study On Ghostwriting, Gray Markets, And The Ethics Of Contract Cheating, Micah Crawford

Theses and Dissertations--Educational Policy Studies and Evaluation

Contract cheating has become an increasingly complex challenge for higher education, particularly as digital platforms, global academic labor markets, and generative artificial intelligence reshape the production and detection of academic work. While much of the existing literature examines contract cheating from the perspectives of students, faculty, and institutions, less attention has been given to the individuals who produce ghostwritten academic work. This dissertation addresses that gap by exploring how shadow scholars understand their roles, ethical boundaries, and participation within the academic integrity ecosystem.

Using an exploratory qualitative design, this study draws on twelve semi-structured narrative interviews with six freelance academic …

Are Multiple-Choice And Open-Ended Assessments Consistent In Predicting Science Achievement? Multivariate Multilevel Evidence From Chinese Students And Schools, Quan Wu

Theses and Dissertations--Education Sciences

A multivariate multilevel model was developed and applied to secondary data from a large-scale science assessment of Grade 8 students in China to examine the consistency between multiple-choice and open-ended formats of assessment in predicting science achievement at the student and school levels. The sample included 44,534 students from 159 schools across two regions. Multivariate multilevel results indicated a moderately positive consistency between the two formats at the student level and a strongly positive consistency at the school level; these consistencies were stable across regions and did not depend on student and school characteristics. The findings have important practical implications …

Clinical Test Cases For Commissioning, Qa, And Benchmarking Of Model-Based Dose Calculation Algorithms In 1⁹2ir Hdr Gynecologic Tandem And Ring Brachytherapy, Vasiliki Peppa, Maude Robitaille, Fatemeh Akbari, Shirin Enger, Rowan Thomson, Firas Mourtada, Gabriel Fonseca

Department of Radiation Oncology Faculty Papers

PURPOSE: To develop clinically relevant test cases for commissioning Model-Based Dose Calculation Algorithms (MBDCAs) for ¹⁹²Ir High Dose Rate (HDR) gynecologic brachytherapy following the workflow proposed by the TG-186 report and the WGDCAB report 372.

ACQUISITION AND VALIDATION METHODS: Two cervical cancer intracavitary HDR brachytherapy models were developed based on a real patient, using either uniformly structured regions or realistic segmentation. The patient's computed tomography (CT) images were processed, converted to a series of digital imaging and communications in medicine (DICOM) CT images, and imported into two treatment planning systems (TPSs), the Oncentra Brachy and BrachyVision. The original segmentation …

An Examination Of University Students’ Experiences Of Period Poverty And Reusable Period Products, Kate Dolan Crowley Ms, Margaret Linehan Prof, Alison Merrotsy Dr

Irish Journal of Applied Social Studies

Period poverty is a persistent international public health struggle affecting millions of people who menstruate. Most academic studies on how mensuration effects university students have been completed in low-to-middle income countries and, specifically, there is a lack of studies conducted in high-income countries (Ross, 2021). The current study was conducted with students in a multi-campus university in the south and southwest of Ireland during 2024. The study had two main aims, first, to explore the students’ attitudes and experiences of period poverty, and second, to investigate their attitudes towards reusable period products.

A mixed methods study was used to collect …

Role Of Estrogen Receptor Alpha In Modulating The Circadian System In Female Mice, Victoria Alvord

Theses and Dissertations--Biology

Circadian rhythms are approximately 24-hour cycles of physiology and behavior. Circadian rhythms of eating, or meal timing, are linked to cardiometabolic dysfunction in humans. Mistimed eating, such as breakfast skipping and eating late at night, increases the risk of obesity, diabetes, and cardiovascular disease in humans. Likewise, disrupted eating rhythms cause obesity in mice. This dissertation investigates how estrogens regulate eating behavior rhythms and tissue clock timing in female mice. Chapter 1 reviews three key components critical to this work. The first is an overview of the field of chronobiology and the function of the circadian system. The second is …

Visual Genealogies Of Disability In Mexican Visual Culture, Daniela Calvache Garcia

Theses and Dissertations--Hispanic Studies

Disability in Mexico is a visually constructed category, shaped by a long genealogy of representation in which images of bodily difference actively participate in defining power and the management of all bodies. The discursive forces that define disability as unproductivity reduce body-minds to the service of the economic system, affecting our relationship with death, illness, reproduction, size, youth, and beauty. Across the Mesoamerican visual space, such representations have long unsettled dominant systems of truth about bodies. This dissertation examines how conceptions of disability are produced, negotiated, and reimagined through three historical moments and cultural expressions: Pre-Hispanic Mayan imagery, Mexican colonial …

A Framework For Characterizing The Peripheral Immune Isonome Using Long-Read Single-Cell Rna Sequencing And Its Relevance To Neurological Disease, Patricia Hayes Doyle

Theses and Dissertations--Neuroscience

Long-read single-cell RNA sequencing provides an opportunity to understand human health and disease at isoform resolution, revealing cellular diversity and disease mechanisms difficult to resolve with bulk or short-read methodologies.

Using a modified PIPseq workflow and computational pipeline adapted for Oxford Nanopore (ONT) sequencing, we profiled isoform usage across immune cells, integrating marker expression and isoform discovery, generating the largest long-read single-cell dataset of human immune cells from a single individual to date. We identified non-canonical protein-coding variants of GZMB and CD3G enriched in unexpected cell types. We also discovered novel transcripts from CMC1 and LYAR with cell-type-specific signatures that …

Metabolism As A Regulator Of Sleep And Cortical Activity In Health And Alzheimer’S Disease, Nicholas J. Constantino

Theses and Dissertations--Neuroscience

Metabolic flexibility is essential for maintaining normal physiological function, enabling an organism to sense, flux, utilize, and switch fuel sources in response to changing energetic availability, demand, and cellular needs. Energetic demands are state-dependent, with wake and sleep exhibiting distinct metabolic profiles. Sleep is highly sensitive to changes in metabolism and requires metabolic flexibility to both transition into and maintain sleep stability. Alzheimer’s disease (AD) is increasingly recognized as a disease of altered metabolism yet is often framed as a disease of energetic failure. We instead define AD as a disease of metabolic inflexibility, characterized not by insufficient energy availability, …

Environmental Predictors Of Human Lyme Disease Incidence Across Appalachian Counties In Kentucky, Virginia, And West Virginia, 2000-2019, Karlie D. Rennison

Theses and Dissertations--Epidemiology and Biostatistics

This ecological study examined county-level environmental, landscape, and host-related predictors of Lyme disease incidence across Kentucky, Virginia, and West Virginia from 2000-2019. Lyme disease is an emerging public health concern in the Appalachian region, where geographic expansion and shifting ecological conditions may influence disease risk.

Lyme disease case rates (per 10,000 population) were analyzed in relation to climate variables, land cover metrics, host density measures, and rurality using publicly available data sources. Descriptive and regression analyses were conducted to evaluate associations between candidate predictors and disease incidence.

Substantial geographic variation in Lyme disease incidence was observed, with higher case rates …

Design And Advancement Of Analytical Frameworks For In Vivo Single-Photon Calcium Imaging To Characterize Temporal- And Treatment-Dependent Neural Adaptations To Opioid Exposure And Withdrawal In The Medial Prefrontal Cortex, Alexia R. Alsum Dr.

Theses and Dissertations--Pharmacy

Despite the availability of several approved medications for opioid use disorder (OUD), it remains a significant public health concern characterized by persistent neurobiological adaptations that drive relapse and impede successful recovery. The medial prefrontal cortex (mPFC), a region critical for executive control and decision-making, undergoes pronounced functional changes during chronic opioid exposure and withdrawal, yet the cellular mechanisms underlying these adaptations remain poorly understood. This dissertation aims to investigate longitudinal alterations in mPFC neural activity across opioid exposure and withdrawal using in vivo single-photon calcium imaging and newly developed computational frameworks.

Following standard preprocessing to extract and normalize calcium traces, …

Exploring The Limitations Of Substrate Scope In Dimethylallyltryptophan Synthases, Evan T. Miller

Theses and Dissertations--Pharmacy

Natural products (NPs), are the largest source of bioactive compounds in Nature, and are essential to the treatment of human disease. Nearly 50% of drugs approved for use from 1981 to 2019 owe some aspect of their development to NPs, either in terms of their structure, pharmacophore, or mechanism of action. However, NPs are difficult to structurally optimize. Chemoenzymatic methods for NP derivatization have been increasingly seen as practical alternatives to traditional synthetic methods. Prenyltransferases (PTs) are involved in the primary and secondary metabolism of plants, bacteria, and fungi, and they are key enzymes in the biosynthesis of many clinically …

Investigating The Potential Role Of Toxoplasma Gondii In The Development Of Equine Protozoal Myeloencephalitis, Brooklyn Nicole Shirah

Theses and Dissertations--Veterinary Science

Equine protozoal myeloencephalitis (EPM) is a neurologic disease of horses prevalent in the Americas, caused by the coccidian parasites Sarcocystis neurona and Neospora hughesi. Toxoplasma gondii is a related parasite that infects nearly all warm-blooded animals, including horses. Prior studies show conflicting results on whether T. gondii contributes to EPM, in part because no validated T. gondii serologic assay exists in horses. This study developed a recombinant TgSAG1 ELISA and confirmatory Western blot. These assays evaluated T. gondii seropositivity in 789 serum samples from healthy and neurologic horses across multiple geographic regions and examined 31 paired serum:CSF samples for …

Molecular Mechanisms And Metabolic Consequences Of Glucocorticoid Resistance, Genesee J. Martinez

Theses and Dissertations--Pharmacology and Nutritional Sciences

Glucocorticoids are vital steroid hormones that govern metabolism, stress responses, and immune functions through intricate, tissue-specific mechanisms, both genomic and non-genomic. These hormones bind to the glucocorticoid receptor (GR), which then acts as a transcription factor to modulate gene expression. Chronic elevation of glucocorticoid levels may lead to glucocorticoid resistance, resulting in adiposity, inflammation, and insulin resistance, thereby adversely affecting multiple metabolic tissues. Whether produced endogenously or administered exogenously, excessive, chronic glucocorticoid concentrations impair glucocorticoid signaling. Although there are two primary isoforms of the receptor, GR⍺ and GRβ, only GR⍺ interacts with glucocorticoids.Through the research conducted in this dissertation, we …

Expanding The Role Of Muscle Stem Cell Fusion In Muscle Under Hypertrophic Stimulus, Jensen Goh Zhong Sheng

Theses and Dissertations--Physiology

Muscle stem cells (MuSCs) are a unique stem cell population that can activate in response to both injury and growth stimuli. Studies on muscle regeneration have shown MuSC activation follows a uniform progression through proliferation, differentiation, and fusion. Therefore, to determine whether MuSC replication is a prerequisite for differentiation under hypertrophic stimulus, I used a lineage-tracking mouse model (Pax7^rtTA; TRE-H2B-GFP) to label MuSC nuclei and simultaneously tracked DNA synthesis via EdU incorporation. This dual-labeling approach allowed us to not only distinguish MuSC-derived nuclei but also demarcate which MuSC had proliferated prior to fusion. I then employed a mechanical …

A Tale Of Two Serpins: Pathologic And Protective Roles Of Agt And Pai-1 In Metabolic And Cardiovascular Disease, Alex C. Pettey

Theses and Dissertations--Physiology

Metabolic and cardiovascular diseases are leading causes of morbidity and mortality worldwide. Conditions such as metabolic dysfunction-associated steatotic liver disease (MASLD), aortic aneurysm, and cardiac fibrosis have limited pharmacological therapies, underscoring the need for deeper mechanistic investigations. Serine protease inhibitors (serpins) have been implicated in these pathologies and represent potential therapeutic targets. Despite structural homology, serpins regulate diverse physiological processes through both protease inhibition and non-inhibitory mechanisms. This dissertation examines the roles of two serpins, angiotensinogen (AGT) and plasminogen activator inhibitor-1 (PAI-1), in preclinical models of metabolic and cardiovascular disease to identify novel mechanisms that may inform future therapeutic strategies. …

Investigation Into The A/Ss Of Cervical Cancer And Its Effects On Tumor Control Probability In Radiation Therapy, Cameron Thayer-Freeman

Theses and Dissertations--Radiation Medicine

The standard of care for locally advanced cervical cancer is chemoradiation, consisting of conventional external beam therapy (EBT) followed by a boost of high dose rate (HDR) brachytherapy. These two radiation treatments will illicit different degrees of biological response depending on the tissue in question, and quantifying the overall effect the combined treatments will have require some form of biological modeling. The linear quadratic (LQ) model of cell survival is the most widely used radiobiological model in clinics across the nation.

It is quantified by the parameters a and ß, which model how radiation generates lethal damage in a population …

Seasonal Population Dynamics And Interspecific Interactions Of Drosophila Suzukii, Eleanor Mccabe

Theses and Dissertations--Entomology

Invasive species are a growing problem, and it is important to investigate how invasives interact with novel ecosystems, which are characterized by distinct abiotic and biotic factors. In this dissertation, I investigate abiotic and biotic factors affecting two invasive pests in central Kentucky, Drosophila suzukii and Zaprionus indianus. In Kentucky, seasonality, and landscape features on population dynamics and fitness are unknown. I found that D. suzukii overwinters in Kentucky and that wild berry species improve winter survival. I used local weather data to identify meteorological variables that best predict D. suzukii populations. I tested the extent to which D. suzukii …