Digital Commons Network^™

A Spatial Transcriptomic Atlas And Cellular Lineage-Based Analysis Of Chondroblastoma, Will Jiang

Yale Medicine Thesis Digital Library

Chondroblastoma is a benign primary bone tumor with controversial cellular origin. Although bearing the name “chondroblastoma”, this musculoskeletal tumor has faced controversy as to whether chondroblasts are chondrocytes. Moreover, its cellular composition can make it difficult to distinguish amongst its mimics including giant cell tumor of bone, chondrosarcoma, and chondromyxoid fibromas.

This thesis aims to characterize the transcriptomic expression atlas of human chondroblastoma to better define the gene expression profile and diagnostic expression markers of chondroblastoma. Secondarily, this thesis aims to identify the lineage progression and cellular composition of chondroblastoma using spatial and temporal patterning analysis.

Histologically confirmed samples of …

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 …

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 …

Improving Patient-Centered Communication To Reduce Falls In A Suburban Community Hospital, Shaun Craig Dickson

Yale School of Nursing Digital Theses

Inpatient falls remain a significant and often preventable patient safety concern that cause harmand increase health delivery costs for health systems across the United States. Communication barriers between bedside clinicians and their patients are a known contributor to falls. This Doctor of Nursing Practice (DNP) quality improvement project evaluated whether a structured communication intervention could reduce falls by improving communication in a suburban community hospital. This project was implemented on a 30-bed Observation-Medical-Surgical unit. Nurses and Patient Care Technicians (PCTs) were trained in using the Plain Language, Engagement, Empathy, Empowerment and Respect (PEEER) Model of Communication to deliver individualized fall …

Social Drivers Of Healthcare Access In Pediatric Autoimmune Disease: A U.S. Analysis (2022–2023), Kevin Okifo

Yale Medicine Thesis Digital Library

Background: Prior studies in adults have demonstrated that social drivers of health contribute to disparities in disease burden, management, and healthcare access among individuals with autoimmune disease (AD). There is emerging pediatric evidence suggesting similar patterns, but national-level data describing how social and structural factors shape healthcare access for children with AD remain limited. The aim of this study is to identify the sociodemographic and structural factors associated with healthcare access among children and adolescents with AD in the United States. Understanding these factors can support meaningful advances that will optimize patient-centered care and wraparound services for pediatric AD.Study Design: …

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 …

Junior Public Health Service Officer Mentor Program: Developing New Leaders In The United States Public Health Service Commissioned Corps For Workforce Retention, Felecia Annetta Bailey

Yale School of Nursing Digital Theses

Junior Public Health Service Officer Mentor Program: Developing New Leaders in the United States Public Health Service Commissioned Corps for Workforce Retention

Mentorship is a critical tool for preparing junior personnel for senior roles, professional development and retention within organizations; however, formal mentorship is often lacking or insufficiently tailored to the needs of diverse workforces, particularly in organizations comprising uniformed service members and civilian employees. This project was designed to provide targeted mentorship for Public Health Service (PHS) Commissioned Corps junior officers and to modify an existing mentoring program that primarily served civilian personnel.

The project aimed to modify the …

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 …

Nursing Primary Care To Better Health, Kristen Dulling

Yale School of Nursing Digital Theses

The national nursing shortage and the rising cost of nursing is threatening sustainability of

the RN role on the care team in ambulatory care settings. There is a critical need to develop a

care model that defines the value of RNs on the primary care team by improving access and

effectively reducing cost by mitigating turnover and role dissatisfaction. This DNP project

developed and implemented a care model across four primary care settings that shifted

workflows for vaccine administration, prior authorizations, and emergency department follow up

calls from RNs to other roles on the care team. Capacity created allowed the …

Addressing Social Determinants Of Health To Reduce Missed Appointments In Primary Care Setting., Omolara Goyea

Yale School of Nursing Digital Theses

Background: Missed appointments impose a significant financial burden on the U.S. healthcaresystem, costing over $150 billion annually, with individual physicians losing an average of $200 per unused time slot (Gier, 2017). Unmet Social Determinants of Health (SDOH), such as transportation barriers, negatively impact primary care services and contribute to missed appointments (Brown et al., 2020; Fiori et al). The missed appointment rate in the United States ranges from 12% to 50% of scheduled appointments (Boone et al., 2023). Objective: This quality improvement project aimed to develop, implement, and evaluate a telehealth protocol specifically tailored for patients who identified transportation as …

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.

Nurturing Novice Nurse Development Through The Legacy Mentor Model: Building The Infrastructure And Stabilizing The Workforce In A Healthcare System, Maureen Scanlan

Yale School of Nursing Digital Theses

There is a historically high nurse turnover rate with a limited supply of experienced registered nurses across healthcare organizations. The retirement of senior nurses, referred to as Legacy Mentors, leaves inexperienced ones without valuable support and guidance. This project aimed to implement and evaluate a mentorship program to improve intent to stay among novice nurses in their first year of practice in an acute care setting. The novice nurses were paired with Legacy Mentors. A total of 32 nurses participated in 16 mentee/mentor pairs. The program consisted of six one-hour sessions over three months, which focused on wisdom sharing, community …

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 …

Dietary, Physical Activity, Mental Health And Substance Use Among Adolescents In American Samoa: A Cross-Sectional Study, Arwen Chen

Public Health Theses

Adolescent mental health is an important public health concern in American Samoa, but limited research has examined how modifiable health behaviors relate to mental health outcomes in this population. This cross-sectional study examined associations of dietary patterns, sugar-sweetened beverage (SSB) consumption, and physical activity with depressive symptoms, anxiety symptoms, and substance use among 449 high school students in American Samoa. Depressive symptoms, anxiety symptoms, substance use, diet, and physical activity were assessed using self-reported survey measures, including the Patient Health Questionnaire-9 for Adolescents (PHQ-9A), Generalized Anxiety Disorder-7 scale (GAD-7), Dietary Screener Questionnaire (DSQ) items, and the Physical Activity Questionnaire for …

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 …

Multi-Level Barriers And Facilitators To Hiv Care Engagement Among Women Exposed To Intimate Partner Violence, Bernard Frempong

Public Health Theses

Background: WLWH face persistent gaps in HIV care engagement, and IPV is a critical determinant of health in this population. Few studies have examined barriers and facilitators to care by current IPV exposure and relationship status using mixed methods.Methods: We analyzed cross-sectional baseline data from 158 WLWH (M age=54.9 years [SD=10.41]) with lifetime IPV exposure enrolled in the I-CARE study in Connecticut. Participants were grouped by: (1) IPV with a current partner (n=74, 46.8%), (2) currently partnered without IPV (n=19, 12.0%), and (3) not currently partnered (n=65, 41.1%). Barriers and facilitators to HIV care engagement were assessed quantitatively and qualitatively …

Ethics Training For Community Researchers Engaged In Participatory Research: An Analysis Investigating Current Practices In Low-Income Countries, Chioma Chukwunedu

Public Health Theses

Participatory Research (PR) involves individuals affected by a research problem as active collaborators rather than passive subjects. While this approach emphasizes ethical and contextually relevant practices, existing literature suggests that ethics training for community researchers in low-income countries is inconsistently implemented and often not culturally adapted. This study examines how ethics training is currently provided to community researchers engaged in PR in low-income countries.A secondary analysis was conducted using manuscripts identified through a prior systematic review of PR studies in low-income settings. Corresponding authors of included studies were invited to complete an online Qualtrics survey regarding ethics training, participatory research …

Physiological Predictors Of Long-Term Diabetes Risk Among Asian Women With Gestational Diabetes: A Scoping Review, Haiyi Guo

Public Health Theses

Objective:To identify risk factors associated with the progression from gestational diabetes mellitus (GDM) to type 2 diabetes mellitus (T2DM) among women in East Asia. East Asian populations were selected as the focus because previous studies suggest that women in this region may experience a disproportionately high risk of progression after GDM, even at lower body mass index levels than those typically observed in Western populations. A clearer understanding of these risk factors may help inform more targeted postpartum prevention strategies. Methods: A scoping review was conducted using PubMed, Embase, the Cochrane Library, CNKI, VIP, and SinoMed databases, covering studies published …

Intergenerational Meaning-Making In Cambodian Americans, Caitlin Gojuk

Public Health Theses

Background: Cambodian Americans face high psychological distress yet remain underrepresented in research, especially second-generation individuals. Intergenerational trauma, stigma, and family dynamics shape mental health understanding and expression. Objective: This study examines how Cambodian American young adults make sense of mental health and distress through cultural identity, family relationships, and inherited meanings of trauma. Methods: In-depth semi-structured interviews were conducted with six second-generation Cambodian American young adults residing in Massachusetts, United States. Participants completed brief measures of depression and anxiety symptoms (PHQ-8; GAD-7) to provide a descriptive context. Interviews were analyzed using inductive thematic analysis informed by relational, narrative, and ecological …

Cost-Effectiveness Analysis Of Twice-Yearly Injectable Lenacapavir Versus Daily Oral Prep For Hiv Prevention Among Men Who Have Sex With Men In China, Xueqing Guo

Public Health Theses

Men who have sex with men (MSM) remain a key at-risk population in China’s HIV epidemic while the real-world effectiveness of daily oral pre-exposure prophylaxis (PrEP) among MSM has been limited by low uptake and suboptimal drug adherence. Lenacapavir, a first-in-class capsid inhibitor administered twice yearly, emerged as a highly efficacious, long-acting prevention strategy with the potential to reduce drug burdens associated with current PrEP strategy. However, its high price ($28,000 per patient per year) raises major affordability concerns, and its economic value in China remains understudied. This study aimed to evaluate the cost-effectiveness of lenacapavir compared with daily oral …

Water Resource Governance And Health Equity In Angola, Mads Harner

Public Health Theses

AbstractBackground: Angola is confronting a set of intertwined challenges including water insecurity, increasing climate variability, and deep structural inequality that together intensify the burden of waterborne and water-related diseases (Lombana Cordoba et al., 2021; World Health Organization, 2025). Roughly half of the population does not have reliable access to safe drinking water, and gaps in sanitation and hygiene infrastructure, especially in peri-urban and rural areas, facilitate the spread of illnesses such as cholera, diarrheal diseases, and malaria (UNICEF Angola, 2025; Moreira et al., 2012). These issues are further exacerbated by drought and broader climate variability, and underlying them are historical …

Using The Behavior Change Wheel To Understand The Role Of Antimicrobial Stewardship Programs, Siqi Jiang

Public Health Theses

Objectives: This review aimed to summarize recent antimicrobial stewardship programs (ASPs) implemented in pediatric outpatient settings and analyze how these interventions influence appropriate antibiotic use.Methods: PubMed and Scopus were searched for studies published between 2016 and 2026 globally. Studies were included if they evaluated an antimicrobial stewardship intervention in a pediatric outpatient setting. Only English studies are included. Studies that describe the results of implementations and policies related to ASP are included, including randomized controlled trials, quasi-experiments, natural experiments, quality improvement studies and observational studies, and longitudinal studies. Interventions in selected articles were analyzed using the COM-B (Capability, Opportunity, Motivation-Behavior) …

Family-Related Stressors And Mental Health Among Internally Displaced Young Adults In Mozambique: A Mixed-Methods Study With Implications For Global Mental Health Interventions, Jaspreet Kandola

Public Health Theses

Mental health outcomes among displaced populations are shaped by post-displacement stressors, yet the role of family dynamics, specifically, remains insufficiently understood. This study examines how family-related stressors are associated with mental health among internally displaced young adults in Nampula Province, Mozambique. Using a convergent parallel mixed methods design, this study integrated survey data from 601 participants with qualitative data from in-depth interviews with a subsample of 16 participants. Quantitative analyses showed that family separation and concern for family members in conflict zones were associated with higher posttraumatic stress disorder (PTSD) symptoms, with family separation also linked to higher anxiety and …

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 …

Telehealth Adaptation Of Bright Bodies Program, A Pediatric Intensive Lifestyle Intervention For Obesity: Caregiver Experiences And Implications For Future Implementation, Xiayu "Katniss" Ni

Public Health Theses

Introduction: The Virtual Bright Bodies Program is a telehealth adaptation of Yale's evidence-based family-based intensive lifestyle intervention targeting pediatric obesity, delivered through video conferencing during and following the COVID-19 pandemic. This retrospective cross-sectional study evaluated caregiver experiences with the telehealth-adapted program among 25 caregivers of children aged 7-16 years who completed a post-program survey.

Method: Caregiver perceptions were assessed using the adapted Telehealth Satisfaction Questionnaire (TSQ, 13 items), the adapted Telemedicine Satisfaction and Usefulness Questionnaire (TSUQ, 4 items), and the Acceptability of Intervention Measure (AIM, 4 items). Quantitative data were analyzed descriptively, followed by exploratory subgroup analyses examined whether acceptability …

Protecting Older Individuals From Age Discrimination Harming Psychological Well-Being: Role Of Neighborhood Cohesion, Tongyu Qiu

Public Health Theses

Age discrimination is known to harm older adults’ mental health, yet factors that may protect against this harm have received little attention. Prior studies have focused primarily on individual-level factors rather than community-level characteristics, such as neighborhood cohesion, which may be more amenable to large-scale interventions and policies. To our knowledge, no prior study has examined whether neighborhood cohesion buffers the association between age discrimination and worse psychological well-being in older adults. Participants aged 60 years and older were drawn from the Midlife in the United States (MIDUS) study. We hypothesized that baseline age discrimination would predict worse psychological well-being …

Perceptions Of Sexual Health Stigma Among Adolescents And Pediatric Primary Care Providers In The United States: A Qualitative Exploration, Avanti Shah

Public Health Theses

Background: In the United States (U.S.), young people aged 13–24 experience disproportionately poor sexual health outcomes. Sexual health stigma has been identified as a key barrier to uptake of sexual health services (e.g., STI/HIV testing), particularly for adolescents younger than age 18. This study aimed to describe and compare how U.S. adolescents and pediatric primary care providers perceive sexual health stigma and its potential influence on adolescent sexual health service access and utilization.

Methods: The study utilized existing data from two qualitative studies that explored pediatric primary care providers’ awareness of state laws regulating minors’ access to confidential sexual health …