Digital Commons Network^™

Employment Preferences Of Favela Residents, Mayara Felix, Beatriz Marcoje, Ieda Matavelli, Maria Clara Rodrigues

Cowles Foundation Discussion Papers

We document employment preferences of workers at the margin of informality using open-ended questions and discrete choice experiments in Brazil’s largest favela complex. Stated preferences emphasize pay and tangible job benefits rather than meaning or purpose, while primary complaints center on poor management, customers, and inflexible schedules. Workers exhibit high valuations for all formal sector amenities on average—unemployment insurance, parental leave, and termination notice—as well as for learning opportunities, but lower for non-formal sector amenities such as shorter commutes. Valuations vary systematically by employment sector in ways consistent with sorting: formal workers value formal amenities most, the self-employed value them …

Wedges: A Microeconomic Perspective On Misallocation, Lauren Falcao Bergquist, Danial Lashkari, Eric Verhoogen

Discussion Papers

This chapter takes stock of what has been learned from the recent micro-development literature about wedges—mechanisms generating dispersion in marginal revenue products of factors across firms, which are commonly interpreted as indicators of misallocation. We present a general theoretical framework that allows us to consider several different types of wedges simultaneously. We argue that it is important to distinguish between between technological wedges, which are present even in the efficient allocation that would be chosen by the social planner, and distortionary wedges, which are present in market equilibrium but not the social planner's allocation. Not all wedges, as we have …

Human Capital And Development, Philippe Aghion, Ingvild Almås, Costas Meghir

Discussion Papers

Human capital is central to efforts to promote growth, convergence, and the elimination of poverty. Drawing on the seminal macroeconomic frameworks by Nelson-Phelps, Lucas and subsequent developments, alongside macro and microeconomic evidence, we examine the role of human capital in driving innovation and growth. We highlight how different types of human capital, characterized by education level, matter in different stages of development. Despite documented increases in years of schooling, the world’s poorest regions still see stagnating outcomes in learning and education quality, potentially creating poverty traps where investments in neither physical nor human capital materialize. We discuss obstacles to human …

Green As Cure: The City Beautiful Movement And The Spatial Politics Of Health, 1870-1950, Avi Patel

Library Map Prize

At the turn of the twentieth century, Progressive Era reformers understood the American city not merely as disordered but as pathological—an environment that bred disease and eroded civic life. This thesis argues that the City Beautiful Movement (CBM), embodied in Washington's 1902 McMillan Plan, advanced a spatial logic it terms "green as cure:" the conviction that disciplined landscape design could function as a form of environmental medicine, restoring health to the urban body. Drawing on maps, planning documents, and congressional reports, the thesis shows how plans defined disorder, prescribed intervention, and embedded assumptions about race and belonging into the built …

Clinical Data Integration: Impact On Quality Outcomes, Sora Park Choi

Yale School of Nursing Digital Theses

Clinical Data Integration: Impact on Quality Outcomes

Hospital readmissions continue to contribute substantially to poor patient outcomes and rising healthcare expenditures in the United States, with nearly 20% of Medicare beneficiaries readmitted within 30 days. Fragmented health information systems also impede care coordination and restrict providers’ capacity to deliver timely, high-quality care. This Doctor of Nursing Practice (DNP) project developed, implemented, and evaluated a provider dashboard that integrates real-time clinical and operational data to support primary care providers within a large multistate independent provider association.Guided by the Lean Six Sigma DMAIC framework, this quality improvement project was conducted with 10 …

Health Communication Challenges In The Digital Era: Two Empirical Investigations, Neeraj Gautam Patel

Yale Medicine Thesis Digital Library

Background: The quality and availability of health information consumed by the general public have undergone dramatic changes in the 21st century with the rise of digitization and the internet. These include the growth of direct-to-consumer (DTC) advertising of prescription drugs on television and online media, changes in health content on traditional news media platforms, and the propagation of health misinformation and disinformation on social media and other websites. Understanding the nature and sources of these changes can inform efforts and interventions aimed at improving the general public’s understanding of health information. One area of interest within regulated health communication is …

How Wasteful Is Signaling?, Alex Frankel

Cowles Foundation Discussion Papers

Signaling is wasteful. But how wasteful? We study the fraction of surplus dissipated in a separating equilibrium. For isoelastic environments, this waste ratio has a simple formula: β/(β + σ), where β is the benefit elasticity (reward to higher perception) and σ is the elasticity of higher types’ relative cost advantage. The ratio is constant across types and independent of other parameters, including convexity of cost in the signal. A constant waste ratio characterizes the isoelastic class. In winner-take-all signaling tournaments with N candidates, exactly (N − 1)/N of the surplus dissipates—the same as in Tullock contests.

The Trade-Off Between Quality And Quantity: Evidence From A Field Experiment On Tutoring, Rohen Shaw

Cowles Foundation Discussion Papers

High-dosage tutoring has the potential to substantially raise adolescent academic achievement, but schools may lack the resources to deliver small-group tutoring frequently at scale. This paper studies the relative importance of tutoring group size (quality) versus tutoring frequency (quantity) using a randomized controlled trial in a Midwestern U.S. charter middle school. Students were randomized to a control group, tutoring twice a week in 2-student groups, or tutoring three times a week in 3-student groups, with equal total cost per student across the two treatment arms. The results show that tutoring in 2-student groups led to a statistically significant improvement in …

Optimization Of Social Determinants Of Health Data With Z Code Utilization In Inpatient Care, Felicia Cordia Alleyne

Yale School of Nursing Digital Theses

The U.S. healthcare system is characterized as being costly, wasteful, and fraught with inequity, due to historical disparities and contemporary challenges such as the aftermath of the COVID 19 pandemic and recent international policy changes that raise the costs of materials and imports. There is evidence to support that with the use of social determinants of health screening tools that are associated with a standardized data capture approach can contribute to value-added clinical and financial changes, resulting in improve care, reduce healthcare disparities, and reduce healthcare costs. This DNP project piloted the implementation of a training protocol for a social …

The Effect Of Polypharmacy On Nurse’S Workflow And Healthcare Expenditure In Post-Acute Care, Rachel Hudec

Yale School of Nursing Digital Theses

This DNP project modified a deprescribing initiative to engage frontline nursing staff. The intervention included a comprehensive educational curriculum, clinical guidelines, and a system to track nurse workflow and financial metrics. Guided by Donabedian’s conceptual model, the project was piloted in a large municipal PAC facility. Methods included twelve in-person training sessions for 93 nurses, pre- and post-knowledge tests, a program evaluation, medication pass times, and tracked the costs deprescribed medications over six months.Nursing knowledge significantly improved, with mean test scores rising from 41.39 to 90.64 (p < .001). Medication pass decreased by 18%, reducing the time per resident from 7 to 5.7 minutes. Financially, the initiative saved over $21,000 in six months, with a projected annual savings exceeding $42,000. Integrating nurses as leaders in deprescribing enhances clinical competency and operational efficiency. These findings provide a compelling case for standardizing an interdisciplinary deprescribing program to improve financial sustainability, nursing efficiency and resident safety in the PAC setting.

Implementing Hepatitis C Screening And Treatment In Primary Care, Michele Castellano Wetmore

Yale School of Nursing Digital Theses

AbstractHepatitis C (HCV) is a curable hepatic disease. With direct-acting antivirals, it can be treated in 95% of cases. When left untreated, it can cause severe liver disease, including hepatocellular carcinoma and even death. The World Health Organization’s (WHO) goal is to eliminate HCV by 2030. This Quality Improvement (QI) project, conducted at a Federally Qualified Health Center (FQHC) from 8/4/2025 to 11/4/2025, will address the barriers to elimination and show that providing local services closes gaps. Screening and treating HCV within primary care has become a strategic approach to enhance access to treatment. This involves developing and utilizing a …

The Effect Of Verbal De-Escalation Simulation Training Using Artificial Intelligence On Nurse Leader’S Self-Efficacy, Mary Vitullo

Yale School of Nursing Digital Theses

Per year, rates of verbal workplace violence (V-WPV) are estimated to occur in 38.8 per 100 nurses, which is decreasing leader retention (NIOSH, 2020, Chang, Hsu, & Ouyang, 2022). Increasing the confidence of nurses in handling V-WPV through simulated training programs increases their intent to stay (Ming et al., 2019).

A two-pronged training program allowed nurse leaders to learn de-escalation techniques and then apply that knowledge in a life-like simulated environment. The education included a pre-work module on V-WPV de-escalation and a simulated scenario using an artificial intelligence conversational agent.

The aims of the project were: to develop a model, …

Establishing A Rigorous And Standardized Volunteer-Led Hypertension Screening Program: An Implementation Science Approach Using Cfir, Alexander Boakye

Public Health Theses

Hypertension, or high blood pressure, is a common condition characterized by elevated blood pressure. It is a major risk factor for global cardiovascular disease-related illness and death [1]. Uncontrolled hypertension raises the risk of heart attack, heart failure, kidney disease, stroke, and cognitive decline [2-4]. Although routine blood pressure screening, patient education, and early linkage to care are proven strategies for detecting and managing hypertension, awareness, treatment, and control rates remain suboptimal in the United States and worldwide [5,6]. Community-based hypertension programs involving trained non-clinical personnel have shown effectiveness in increasing screening participation and improving blood pressure control, especially among …

Using Oyster Genomics To Understand Human Health, Walker Daniel Bargmann

Public Health Theses

As sessile filter feeders that experience continuous environmental exposure, oysters—particularly Crassostrea virginica—offer a unique opportunity to understand how environmental exposure alters the genome and influence health. Furthermore, oysters must be sorted by size for market value for premium size and taste. However, it requires intensive labor, specialized equipment (tumblers), and is susceptible to environmental risks like pollution. Therefore, it is desirable to produce uniform oysters without machines. However, limitations in the previous reference genome [2] have constrained our understanding of how genes are organized and maintained in oyster populations. To this end, we harvested 240 adult oysters in same location, …

Implementation Of Digital Interventions To Address Alcohol Use In Primary Care: A Scoping Review, Sean Becker

Public Health Theses

The development and implementation of digital interventions in the identification andmanagement of unhealthy alcohol use (i.e., the spectrum of consumption including at-risk alcohol use and alcohol use disorder) in the primary care setting has seen numerous advancements in recent years. Such rapid change makes it difficult to understand and assess the current state of the literature as it relates to these implementation topics. To better understand the broader research landscape, we (SB, Advised by EJE and BK and with collaboration from AG) conducted a scoping review to: 1) characterize the focus, components, and mode of digital interventions for targeting alcohol …

Stigma, Coping & Resilience Among Hiv+ Pwid In St. Petersburg, Rf, Gabrielle Bogut

Public Health Theses

Russia and the other countries that comprised the Soviet Union constitute the one region in which the HIV epidemic continues to expand. Unlike most other regions, more than a quarter of HIV cases in Russia resulted from unsafe injection among people who inject drugs (PWID), and St. Petersburg is among the cities with the highest rates and case counts of HIV. Our study sought to identify actionable psychosocial characteristics influencing receipt of antiretroviral therapy (ART) in PWID. This study assessed survey results from 225 HIV-positive individuals recruited from a Russian NGO that provides PWID with harm reduction services. Individuals were …

Scaling Up Long-Acting Hiv Prep: Perspectives From Health Practitioners On Implementation Of Twice Yearly Lenacapavir, Taylor Braunstein

Public Health Theses

BackgroundLenacapavir (LEN), a twice-yearly subcutaneous injectable Pre-Exposure Prophylaxis (PrEP) medication for HIV, was approved by the Food and Drug Administration (FDA) in 2025. LEN represents a significant advancement in HIV prevention, demonstrating 99.96-100% efficacy in the PURPOSE 1 and 2 clinical trials12,21. Despite its promise in HIV prevention, high list prices, complex loading regimens, and implementation uncertainties pose barriers to widespread uptake. This study examines provider perspectives on the acceptability, feasibility, and appropriateness of LEN as PrEP, as well as perceived implementation barriers and facilitators. Methods This mixed-methods, cross-sectional study recruited licensed US practitioners (RNs, NPs, PAs, MDs, DOs, and …

Sex Differences In Metabolic Pathways Of Colorectal Cancer Liver Metastases, Yunhan Chen

Public Health Theses

Background: Colorectal cancer liver metastasis (CRLM) is a major cause of death in colorectal cancer, and growing evidence suggests that sex may influence tumor biology and metabolism. However, sex-specific metabolic changes in CRLM remain poorly understood.Method: This study performed sex-stratified metabolomics analysis of CRLM tissue samples using datasets generated from HILIC and RPLC LC-MS acquisition modes. Differential metabolites were identified using Wilcoxon tests with FDR correction, and pathway enrichment analysis was conducted using MetaboAnalyst to compare shared and sex-specific metabolic patterns between male and female samples. Results: Both male and female CRLM samples showed metabolic alterations in shared pathways, including …

The Effect Of Flood Risk Perception On County-Level Excess Mortality Due To Flooding In The U.S., Jane Elise Fortna

Public Health Theses

Introduction: Flood events due to heavy precipitation, hurricanes, rising sea levels, and overflowing rivers are increasing under climate change, resulting in both direct and indirect health impacts. This study investigates the relationship between excess flood mortality and flood risk perception at the U.S. county level. Methods: This study utilizes nationwide, county-level flood mortality data from 2018-2020 and flood risk perception survey data from 2024. We applied a generalized linear model to examine the association between the proportion worried about flooding and the excess flood mortality, while controlling for flood hazard exposure, poverty, disability, health uninsurance rate, and unmeasured spatial confounding …

Single-Cell Gene Perturbation Prediction Via Sclambda-Program, Jingyi Guo

Public Health Theses

Predicting single-cell transcriptomic responses to single and multi-gene perturbations is essential for mapping regulatory networks, resolving disease mechanisms and identifying therapeutic targets. Several state-of-the-art deep learning methods, especially scLAMBDA, have demonstrated strong performance in predicting perturbation outcomes. However, computational biology still faces a fundamental trade-off between predictive accuracy and biological interpretability. To reconcile these objectives, there is an urgent need to develop models that can generate accurate perturbation predictions and simultaneously uncover distinct functional pathways. Thus, we introduce scLAMBDA-Program, a novel deep generative variational autoencoder framework that builds upon the robust predictive foundation of the scLAMBDA architecture. scLAMBDA-Program incorporates a …

Nowcasting Dengue Cases In Poor Surveillance Nations Using Meteorology And Climate-Similar Countries, Hanna Kim

Public Health Theses

Dengue fever poses a growing public health burden across the Caribbean, yet surveillance infrastructure remains inconsistent and timely outbreak detection in data-poor nations becomes limited. This study investigates whether shared meteorological patterns between Caribbean countries can be leveraged to nowcast dengue activity in low-surveillance settings using climate-matched, well-surveilled nations as epidemiological proxies. Weekly and monthly dengue case data for six countries, the Dominican Republic, Jamaica, Puerto Rico, Trinidad and Tobago, Cuba, and Haiti, were extracted from the OpenDengue database for 2005–2024, and satellite-derived climate data were obtained from the NASA POWER API. Pairwise climate correlations revealed strong temperature synchrony across …

Pediatric Rheumatic Heart Disease Screening For Secondary Antibiotic Prophylaxis: An Explainable Shannon Energy Approach Using Heart Phonocardiogram In Northeast Brazil, Zhuohui Lin

Public Health Theses

Rheumatic Heart Disease (RHD), caused by Group A Streptococcus (GAS), remains a significant global health burden, particularly among children in low- and middle-income countries. Untreated GAS infection can lead to acute rheumatic fever and subsequent chronic valvular damage of RHD, such as mitral valve (MV) regurgitation. Hence, early detection is critical for the administration of Secondary Antibiotic Prophylaxis to prevent disease progression. Although deep learning models demonstrate high diagnostic accuracy, limited explainability restricts clinical adoption, especially in resource-limited settings. In this proof-of-concept study, we evaluated Shannon energy (SE) transformation as a proxy to differentiate holosystolic murmurs associated with RHD-related mitral …

Understanding The Influence Of Hiv Status On Perceived Barriers To Reproductive Care For Pregnant Haitian Women: A Framework-Guided Qualitative Analysis, Olivia Mccarthy

Public Health Theses

Background: Haiti has the highest maternal mortality rate in Latin America and the Caribbean, where pregnant women face substantial structural, social, and economic barriers to care. Women living with HIV encounter additional challenges, including stigma, breaches of privacy, and discrimination within healthcare settings. Although prior research has examined maternal health and HIV related stigma in Haiti, little is known about how HIV status differentially shapes pregnant women’s perceptions of barriers to maternal healthcare.Methods: This study draws on data from seven focus groups conducted in rural communities in Haiti’s Centre Department between 2018 and 2019. Participants included 65 pregnant women, representing …

Successive Blood Meal Feeding And Wolbachia Impact On The Intra-Host Genetic Diversity Of Dengue Virus In Aedes Aegypti Mosquitoes, Braiya Nolan

Public Health Theses

Dengue virus (DENV) is a mosquito-borne RNA virus and increasing public health threat. Due to its error prone replication, single-nucleotide variants (iSNVs) are rapidly generated within the vector, leading to heterogeneity in viral populations, fitness, virulence, and transmissibility, including under vector control interventions. One such control strategy is the large-scale deployment of Wolbachia-infected mosquitoes worldwide. Wolbachia is an endosymbiotic bacterial biocontrol method that provides incomplete inhibition of DENV replication and transmission. Given its incomplete inhibition, it is critical to understand how Wolbachia impacts DENV-2 intra-host viral diversity. Additionally, successive blood meal feeding may influence intra-host viral diversity by supporting increased …

Triangulating Clinical Guideline Recommendations To Map The Standard Of Care For Hypertensive Disorders Of Pregnancy During Pregnancy And Postpartum, Caralie Price

Public Health Theses

Hypertensive disorders of pregnancy (HDP) are one of the leading causes of maternal morbidity and mortality in the United States. HDP represent a severe health equity issue and present concerns for the health of mother and child, highlighting the importance of early detection and management. This paper systematically documented current clinical practice guidelines from the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) for preventing, identifying, and treating HDP during the prenatal, intrapartum, and postpartum periods. ACOG provides recommendations for HDP across different types of clinical guidance documents. Overall, 60 recommendations were extracted across …

Compromised Glutathione And Ascorbate Capacities Under Prenatal Alcohol Exposure, And Its Implications For Vulnerable Subpopulations, Reagan Strand

Public Health Theses

Prenatal alcohol exposure (PAE) remains the leading preventable cause of lifelong neurodevelopmental impairment, yet the biological mechanisms underlying differential susceptibility remain poorly understood. The populations most vulnerable to PAE overlap substantially with those bearing the greatest burden of antioxidant insufficiency, including individuals experiencing food insecurity, environmental pollutant exposures, and alcohol use disorder, yet this convergence and its developmental consequences remain poorly characterized. This thesis investigates how dual antioxidant deficiency in both the dam and offspring modulates vulnerability to PAE using a compound heterozygous mouse model (GclmHET/GuloHET) that recapitulates reductions in antioxidants glutathione (GSH) and ascorbic acid (AA, or Vitamin C) …

Effectiveness Of The Release Of Wmel Wolbachia-Infected Aedes Aegypti Mosquitoes On The Incidence Of Chikungunya In Campo Grande, Brazil, Vivienne Zhong Ying Su

Public Health Theses

Chikungunya is a mosquito-borne arboviral disease primarily transmitted by Aedes aegypti and Aedes albopictus that is rapidly emerging in new geographical settings because of climate change, viral adaptation, and globalization. Brazil has experienced the significant expansion of chikungunya over the past decade and has adopted novel vector control interventions, including Wolbachia-based population replacement, as part of its public health response. While the effectiveness of wMel Wolbachia on dengue incidence has been demonstrated across multiple settings, evidence on its effect on chikungunya risk remains limited. Large-scale releases of wMel-infected Aedes aegypti mosquitoes were implemented in the city of Campo Grande, Brazil …

Influenza-Associated Hospitalizations And Socioeconomic Status In Southern Connecticut, 2022-2025, Allison Traiger

Public Health Theses

Background: Influenza is a common respiratory illness in the United States responsible for hundreds of thousands of influenza-associated hospitalizations each year. To implement effective preventative interventions, it is crucial to understand which populations are most at risk of severe illness and hospitalization. Prior studies have found that increased rates of poverty and crowding are associated with increased rates of hospitalization.Methods: This study explores the connection between neighborhood poverty, crowding, and influenza-associated hospitalization through the connection of hospitalized influenza cases with their census tract-level socioeconomic indicators. Addresses of hospitalized cases were geocoded and linked to data on poverty and crowding from …

Assessing Cardiovascular Disease Risk And Healthcare Access Barriers To Identify Prevention Strategies Among Market Vendors In Uganda, Yumi Yang

Public Health Theses

Background: Cardiovascular disease (CVD) accounts for 10% of all deaths in Uganda, making it the leading cause of death among non-communicable diseases (NCDs) in the country. Across sub-Saharan Africa, urban market vendors serve as key participants in the informal workforce. Research from West Africa suggests that vendors, many of whom are women, are a vulnerable population with high prevalence of CVD risk factors and structural barriers to healthcare access. However, limited research has examined this population in East Africa, and the present study is the first to characterize 10-year CVD risk and assess healthcare barriers among market vendors in Uganda.Methods: …

Gerd Mastery For The Advanced Practice Provider: A Train-The Trainer Program, Gwen M. Cassidy

Yale School of Nursing Digital Theses

AbstractGERD Mastery for the Advanced Practice Provider: A Train-The Trainer Program

Background: This Doctor of Nursing Practice (DNP) project addressed a specialty-care gap in gastroenterology driven by the projected U.S. shortage of ~1,630 gastroenterology physicians. Gastroesophageal reflux disease (GERD) has a high prevalence and cost burden as is, but delayed treatment can further increase costs (Barrett’s esophagus ~$8,755/year; esophageal adenocarcinoma ~$146,391/year) and patient morbidity.

Purpose: To develop and implement “GERD Mastery for the Advanced Practice Provider,” an evidence-based train-the-trainer (TTT) program to increase guideline-concordant GERD knowledge and train others. Methods: In partnership with a national organization, a Plan–Do–Study–Act framework guided …