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 …

Tone Matters: Advancing Equity Through A Pilot Intervention To Increase Exposure Of Clinical Findings In Skin Of Color, Lamley Amanuah Lawson

Yale Medicine Thesis Digital Library

Background: The ability to accurately recognize cutaneous manifestations of disease is a foundational clinical skill. However, current undergraduate medical education heavily relies on lighter skin tone prototypes, leaving trainees underprepared to diagnose conditions in patients with melanin-rich skin.Research Aims: This study aimed to evaluate the efficacy of a brief, targeted, visually comparative digital intervention by measuring its impact on medical students' immediate diagnostic accuracy and self-reported clinical confidence in identifying dermatologic conditions across a diverse range of skin tones. Hypothesis: We hypothesized that a brief, targeted digital educational intervention featuring side-by-side visual comparisons of dermatologic conditions across a range of …

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 …

Mr Perfusion In Acute Ischemic Stroke And Neurovascular Conditions: Utilization, Diagnostic Yield, And Implications For Management From An 11-Year Health System Analysis, Richard Julian Lozano

Yale Medicine Thesis Digital Library

Purpose: Cerebral ischemic infarct results in a rapidly developing core of infarcted brain tissue surrounded by hypoxic but potentially salvageable tissue known as a penumbra. MR perfusion (MRP) is an uncommonly used technique that can be used to define ischemic core and penumbra; its utilization, diagnostic yield, and impact on management, however, are not well-described. This study aims to delineate the use of MRP in acute ischemic stroke and related neurovascular conditions.Methods: This retrospective study examines approximately 11 years of patient encounters (January 1, 2014- November 11, 2024) from a single health system to identify all cases where MR perfusion …

"It Made Me Want To Get Into Healthcare Even More": A Simulation-Based Healthcare Mentoring Program, Jack Mccarthy

Yale Medicine Thesis Digital Library

The healthcare industry in the United States continues to experience rapid growth, yet workforce shortages persist across a wide range of medical professions. In order to increase the pool of qualified individuals pursuing healthcare, innovative strategies are needed to increase interest in healthcare fields among youth. Prior research has identified that healthcare career interest is driven in part by motivational characteristics including interest in math and science, self-efficacy, and social factors like the expectations of parents and caregivers. Mentoring, career exploration, and informal learning have been identified as strategies that increase student interest in and commitment towards healthcare careers. This …

Table Of Contents (V. 32, No. 2)

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

No abstract provided.

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 …

Decreasing Work-Related Stress And Burnout In Advanced Practice Clinicians, Laura Vasquez

Doctor of Nursing Practice (DNP) Scholarly Projects

Background

Advanced practice clinicians (APCs) face ongoing job-related stress and career burnout. Work-related stress and burnout affect healthcare quality, safety, and patient satisfaction, yet evidence specific to job-related stress and career burnout from outpatient medical facilities in the South Texas region remains limited.

Purpose

A quality improvement (QI) project was implemented to decrease work-related stress and burnout among APCs working in an outpatient medical facility in the South Texas region.

Methods

Project participants included family nurse practitioners (FNPs) (n=7) and physician assistants (PAs) (n=4). Data was collected between January 2026 and March 2026. An intervention was implemented which included engagement …

Chapter 16 - Representing Clients Who Are Mentally Ill Or Intellectually Disabled, Anthony G. Amsterdam, Randy A. Hertz

Trial Manual for the Defense of Criminal Cases

There are, however, some clients who are not competent to make decisions affecting their own welfare; and counsel may need to take special measures in these cases. If counsel reasonably believes that mental illness or an intellectual disability has so severely “diminish[ed]” the client’s “capacity to make adequately considered decisions in connection with the representation . . . [that] a normal client-lawyer relationship with the client” cannot be maintained, and if counsel furthermore “reasonably believes” that the client “is at risk of substantial physical, financial or other harm unless action is taken and [that the client] cannot adequately act in …

Pride And Portrayal: The Effects Of Gender Identity And Generational Cohort On Lgbtq+ Perceptions Of Media Coverage, Dang H. Le

Communication Theses - Archive

Public debates over LGBTQ+ issues have intensified in the United States in recent years, placing news media at the center of conflicts over representation, fairness, and credibility. While a substantial body of research has analyzed how LGBTQ+ people are portrayed in news coverage, far less attention has been paid to how LGBTQ+ audiences themselves evaluate that coverage. Understanding these perceptions is increasingly important as declining trust in journalism intersects with political polarization and ongoing policy debates surrounding LGBTQ+ rights. This study examines how generational cohorts and gender identity shape LGBTQ+ audiences’ perceptions of news coverage quality, perceived media hostility, and …

Improving Early Detection And Response To Clinical Deterioration Among Nurses Through Competency-Based Interventions, Courtney E. Miller

Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Clinical deterioration among hospitalized patients remained a significant contributor to preventable morbidity and mortality, often due to delayed recognition and response in general care settings (Choi et al., 2025; Chung & Jung, 2024).

PICOTS: For registered nurses working on a general level of care inpatient hospital unit (P), how did a competency-based training program bundle incorporating didactic educational intervention of learning how to use technology, machine learning (ML) based early warning system (EWS) of trends and patterns to identify at risk patients, and low-fidelity simulation-based education (SBE) (clinical readiness to improve confidence with education and coaching) (I), …

Implementing A Standardized Resilience Bundle For Neonatal Intensive Care Nurses, Jennifer Bouzid

Doctor of Nursing Practice (DNP) Scholarly Projects

Background: Nurse resilience is associated with improved psychological well-being, professional satisfaction, and retention. Neonatal intensive care unit nurses are frequently exposed to emotionally traumatic clinical events that may contribute to burnout, compassion fatigue, and turnover. A women’s hospital in central Texas identified increased nurse turnover and lower employee engagement scores related to well-being and intent to stay within the neonatal intensive care unit.

Purpose: The purpose of this quality improvement project was to implement and evaluate a standardized resilience support bundle for nurses following traumatic clinical events.

Methods: Guided by the Plan-Do-Study-Act framework, the project implemented a resilience bundle that …

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 …

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 …

Ensemble Dependence Of Mechanical Relaxation In Molecular Dynamics Simulation, Mason E. Hyde

Open Access Master's Theses

This thesis investigates whether the selection of thermodynamic ensemble introduces quantifiable differences in the stress relaxation modulus G(t), storage modulus G”(w), loss modulus G”(w), and phase angle d(w) computed from equilibrium molecular dynamics simulations of the AAA-1 asphalt model. A 72-molecule, 12-component representation of AAA-1 bitumen was simulated under three ensembles (NPT, NVT, and NVE) at three temperatures (400.15 K, 443.15 K, and 533.15 K) with three independent replications at each condition, yielding 27 total simulations. Stress autocorrelation functions were computed from each production trajectory and Fourier-transformed to obtain frequency-dependent rheological properties.

The computed properties …

Kinematic And Muscle Activity Differences During Dual Task Cutting In Ncaa Soccer Players, Abigail Mccarthy

Open Access Master's Theses

Lateral ankle sprains (LAS) are one of the most common musculoskeletal injuries in collegiate soccer, but also in the world. Professional soccer observes a prevalence of around 10-18 percent (Walden et al., 2013). The United States alone reports up to 2 million acute ankle sprains annually (Herzog et al, 2019). LAS ranked top 3 in types of injuries within collegiate soccer with hamstring tears and concussions (Chandran et al., 2021). Around 40 percent of people who experience a lateral ankle sprain will experience chronic ankle instability, and since spraining ankle once at a greater risk now for spraining ankle again. …

Noninvasive Optical Assessment Of Tissue Hemodynamics In Preterm Infants And Mastectomy Skin Flaps, Samaneh Rabienia Haratbar

Theses and Dissertations--Biomedical Engineering

Adequate tissue blood flow and oxygenation are essential for maintaining cellular viability and normal organ function. Disruptions in microvascular perfusion and oxygen delivery contribute to ischemia- and hypoxia-related diseases, including stroke, cancer, retinopathy of prematurity (ROP), and mastectomy skin flap necrosis. Reliable, noninvasive approaches for assessing tissue hemodynamics are therefore critical for improving diagnosis and therapeutic decision-making, particularly in settings where conventional methods are limited. This dissertation investigates the clinical and physiological importance of measuring tissue blood flow and oxygenation across neonatal and surgical applications using both clinical monitoring and advanced optical imaging techniques. In the first study, high-speed pulse …

Evaluating Training Effectiveness And Learning Transfer In The Kentucky Transportation Cabinet Safety Academy, Amanda L. Casolare

Theses and Dissertations--Civil Engineering

Effective evaluation of safety training is crucial to ensure that learning translates into safe work practices, particularly in high-risk public sector environments. The Kentucky Transportation Cabinet (KYTC) is developing a Safety Academy to enhance hazard recognition, risk management, and safety leadership within the organization. However, the Safety Academy has not yet been implemented, and formal evaluation methods for training have not been established. This study aimed to examine evidence-based training evaluation techniques and develop recommendations for evaluating the KYTC Safety Academy prior to program implementation.

This study employed an applied pre-implementation research design grounded in a comprehensive review of safety …

Other Eyes: The Dilemma Of Authorship And Autobiography In Sylvia Plath, John Ashbery, And Cristina García, Kevin J.B. O'Connor

Theses and Dissertations--English

This dissertation analyzes authorship in contemporary American literature, harnessing the writings—prose and poetry—of Sylvia Plath, John Ashbery, and Cristina García to challenge traditional classification and periodization schema. Hewing to the notion of authorship as a dilemma—a simultaneity of forces pressing upon the author, demanding a response—each chapter unravels critical moments of authorial expression that continually inscribe the importance of praxis and futurity. Comprehending authorship as a relational dilemma to be brooked, and indeed, overcome in a panoply of gestures, frees it theoretically from the perils of prior models by drawing attention to authorship’s agential and multi-modal aspects. Melding archival research …

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 …

Inside The Box: Containerization And The Limits Of Trade Unionism In The International Longshoremen's Association, 1945-1977, Calvin Horning

Theses and Dissertations--Geography

The International Longshoremen’s Association (ILA), the union of dock workers on the East Coast of the United States, saw a dramatic change in form and fortune in the middle of the 20^th century as the shipping industry and global labor underwent an immense reorganization. In the context of this reorganization, I argue that due to internal conservatism and racism alongside external state pressure, the ILA moved from an unruly, mafia-ruled union to a highly organized, professionalized, well-paid core of workers that served to support the United States’ capitalist-imperialist project.

Through archival material spanning over three decades, I analyze the …

Economic Inequality And Family Formation In The United States, Elizabeth S. Krause

Theses and Dissertations--Economics

This dissertation evaluates economic inequality and family formation in the United States in three essays. In Essay 1, I estimate the effect of providing subsidized access to immediate postpartum contraceptives on birth spacing and infant health among low-income teen mothers. The intent-to-treat estimates indicate a 20% reduction in the monthly short-interval birth rate among teens 12-14 months after policy enactment. I also find evidence that the policy increased the average interval between births and reduced preterm and low-birth weight births and NICU admission rates. In Essay 2, I provide evidence that single mothers and single women without children are important …

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, …

Beyond The Veil: Critical Black Kantianism And The Ethics Of Structural (In)Visibility, Paradise A. Stanford

Theses and Dissertations--Philosophy

This dissertation develops what I call Critical Black Kantianism, a reconstructive approach to Kantian moral philosophy that centers race, recognition, and the structural conditions under which moral agency is formed. While Kantian ethics typically presumes idealized agents operating within just social contexts, this project argues that such abstraction obscures how racial domination actively shapes autonomy, dignity, and self-consciousness. Drawing on W.E.B. Du Bois’ account of double consciousness, Black feminist thought, and contemporary theories of recognition, I show that moral agency is not merely exercised within social environments but is constituted through them—often under conditions of misrecognition that fracture autonomy.

Against …

Linking S‑Pillar Empirical Criteria With Boundary And Finite Element Models For Underground Stone Pillar Analysis, Benjamin Diddle

Theses and Dissertations--Mining Engineering

The objective of this thesis is to strengthen the relationship between empirically based stone pillar design methods and two numerical modeling techniques by calibrating boundary element and finite element models to the S‑Pillar empirical criteria and observed pillar behavior in underground stone mines. The first component of the research investigates the displacement‑discontinuity boundary element method implemented in LaModel, quantifying the influence of the lamination thickness and element size on stone pillar safety factor predictions. Results showed that optimal thickness depends on overburden modulus, while larger element sizes introduce significant SF differences from S-Pillar values once the grid size exceeds 5 …

Reciprocity-Based Transfer Function Techniques For Acoustic Source Reconstruction, Spring Isolator Characterization And Structural Damping Assessment, David Pum Thian Lal Paite Neihguk

Theses and Dissertations--Mechanical and Aerospace Engineering

Reciprocity implies that a system responds identically when the source and receiver positions are interchanged. This dissertation applies this principle to address three practical challenges in noise and vibration characterization, where conventional approaches are limited by inaccessible interfaces, constrained excitation conditions, or metrics that do not fully capture vibroacoustic behavior.

The first study develops and validates an inverse method to characterize ducted acoustic sources using acoustic free velocity. Acoustic reciprocity is applied to simplify transfer function measurements. The method is extended to large cross-section ducts, where the source is reconstructed as a collection of point sources along a plane. Validation …

Human Resource Policy And Practice In The American Regional Theatre: The Intersection Of The Actors’ Equity Association And The League Of Resident Theatres, Kathleen Holland

Theses and Dissertations--Arts Administration

Human resource management plays a critical yet understudied role in the American regional theatre, an industry characterized by project-based labor, mixed union and nonunion workforces, and deeply ingrained cultural norms that prioritize artistic production over worker well-being. This dissertation examines how institutional human resource policies intersect with the Actors’ Equity Association (AEA) collective bargaining agreement and the League of Resident Theatres (LORT), and the implications of these intersections for human resource practice in regional theatre organizations. While entertainment-industry unions predate the formalization of contemporary human resource management, little scholarship has examined how union agreements may shape or substitute for organizational …

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. …