Digital Commons Network^™

Influence Of Demographics On Research Participation In Female Patients Undergoing Ambulatory Surgery, Tiana Fernandez

Yale Medicine Thesis Digital Library

Background: Historically, research on women and minorities has consisted of unethical experimentation, human rights violations, and crimes against humanity. Numerous examples can be found throughout the past two centuries, including the exposure of pregnant women to radioactive iron in the Tennessee-Vanderbilt Nutrition Project (TVNP), failure to treat cervical carcinoma in situ in the Unfortunate Experiment, surgical experimentation on female slaves by Dr. J. Marion Sims, failure to treat syphilis in the Tuskegee Syphilis Study, intentional exposure to and subsequent failure to treat sexually transmitted diseases in Guatemala, collection of biospecimens from Henrietta Lacks, and nontherapeutic experimentation on minority children in …

Repurposing Ezetimibe As A Therapeutic For Parkinson's Disease: Evaluating The Therapeutic Potential And Probing For A Mechanism, Brian Hilton

Yale Medicine Thesis Digital Library

Neurologic disease is the leading cause of disability globally and Parkinson’s disease (PD) has been the fastest growing neurologic brain disease over the last several decades. Despite the immense burden of PD on patients and society, there has yet to be an efficacious disease-modifying therapy. Investigation of candidate pharmaceuticals that have already been approved by the FDA for other conditions might provide an expedited path to the advent of disease-modifying therapy. There is a rich history of drug repurposing for symptomatic therapy for PD, with amantadine as the preeminent example. In order to identify candidate therapeutics for possible repurposing, an …

Rns-Based Early Prediction Of Antiseizure Medication Efficacy, Joshua Hobbs

Yale Medicine Thesis Digital Library

Drug-resistant focal epilepsy accounts for a significant portion of patients with epilepsy. These patients many times experience persistent seizures despite several ASM (anti-seizure medication) trials. RNS (Responsive neurostimulation) has demonstrated efficacy in reducing seizure frequency in patients that are resistant to drug trials, and provide continuous intracranial electroencephalographic monitoring. This longitudinal data may offer an opportunity to identify potential early biomarkers of ASM trial effectiveness, which could lead to quicker optimization of pharmacological therapy. This study in particular evaluated whether early changes in RNS-detection of seizure activity can predict a clinical response to ASMs in patients with drug-resistant focal epilepsy. …

Associating Inflammatory Dermatoses And Gynecological Disorders Using The National Institutes Of Health’S All Of Us Research Program, Christine Myriam Hodelin

Yale Medicine Thesis Digital Library

There remains a gap in the knowledge about the relationship between inflammatory disorders and common gynecological disorders, despite significant quality of life concerns for both. We examined the association between hidradenitis suppurativa (HS) and endometriosis, and the association between atopic dermatitis (AD) and uterine leiomyomas, both with a cross-sectional study using electronic health record and survey data from the National Institutes of Health’s All of Us Research Program.

The All of Us Research Program has a large United States-based cohort and focuses on traditionally underrepresented populations in research. We compared cases and controls, all assigned female at birth, using Pearson’s …

Facial Harmony And Gender Congruence: Patient-Reported Outcomes Of Gender-Affirming Facial Surgery Using The Gender-Q And Gpsq, Helia Hosseini

Yale Medicine Thesis Digital Library

Background:Gender-affirming facial surgery (GAFS) addresses gender dysphoria by aligning facial features with gender identity, with historical emphasis on refining the upper facial third to render patients more attractive and feminine. The GENDER-Q, a novel patient-reported outcome measure (PROM), evaluates aesthetic, functional, and psychosocial outcomes, complementing the Gender Preoccupation and Stability Questionnaire (GPSQ) to assess effects of GAFS in this study. Methodology: Survey data from 86 patients was analyzed using GENDER-Q and GPSQ scores. Higher GENDER-Q scores indicated improved outcomes, whereas lower GPSQ scores reflected reduced gender dysphoria. Pre- and post-operative outcomes were compared using paired and unpaired t-tests. Spearman’s correlation …

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 …

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 …

Cross-Sectional Analysis Of The Hepatitis C Care Cascade Among People Who Use Drugs In New Haven, Ct, Thomas Shaifer Jones

Yale Medicine Thesis Digital Library

People who use drugs (PWUD) are at high risk of contracting Hepatitis C Virus (HCV) and often face significant barriers in accessing healthcare. Treatment of HCV is highly effective, but previous studies show low rates of successful treatment in practice due to multiple points of failure along the treatment cascade. Harm reduction and outreach programs such as syringe services programs (SSPs) and drug treatment programs including medication for opioid use disorder (MOUD) have emerged as possible points of leverage in advancing people through the cascade of care. To better understand how people who use drugs access HCV treatment and elucidate …

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 …

Joint Venture: Curriculum Design, Implementation And Evaluation For A Novel Interdisciplinary Musculoskeletal Medicine Elective, Arielle Richey Levine

Yale Medicine Thesis Digital Library

Background / Scientific Premise: Musculoskeletal medicine is underrepresented in medical education in the United States and internationally; however, it represents an increasingly critical area of patient care. Educational initiatives targeting this area of medicine are complex given its interdisciplinary nature and the challenges faced when adding new material to medical curricula. The application of medical education principles to tackle this challenge remains an area open for further investigation in terms of efficacy and reported student experience.

Research Aims: This research aims to understand the needs for improved MSK education at Yale School of Medicine, design an intervention to address the …

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 …

Neurophysiologic Responses To Endovascular Interventions For Delayed Cerebral Ischemia Management, Rafael Seth Maarek

Yale Medicine Thesis Digital Library

Background/Scientific Premise: Delayed cerebral ischemia (DCI) continues to be a leading cause of poor outcomes in hospitalized aneurysmal subarachnoid hemorrhage (aSAH) patients. In addition to cerebral vasospasm, a growing constellation of pathophysiologic processes has been implicated in the development of DCI, including impaired autoregulation, micro-thrombosis, inflammation, and cortical spreading depolarizations. However, management options for patients showing signs of emerging DCI have largely remained spasmolytic in nature, and it remains unclear if reversing cerebral vasospasm in patients with signs of emerging DCI will reliably improve underlying neurophysiology. To our knowledge, no group has reliably shown postprocedural improvements in quantitative EEG metrics …

Clinical And Histopathologic Classification Of Actinic Damage To Predict Risk Of Skin Cancer Development, Madeline Mcnamara

Yale Medicine Thesis Digital Library

BackgroundKeratinocyte carcinoma (KC), including cutaneous squamous cell carcinoma (SCC) and basal cell carcinoma (BCC), is the most common malignancy in the United States and is largely attributable to cumulative ultraviolet radiation exposure. Actinic keratoses (AKs) are premalignant lesions that arise within chronically sun-damaged skin and reflect the broader process of field cancerization. While AKs are recognized as markers of SCC risk, variability in clinical and histopathologic grading systems has limited their utility for standardized risk prediction. Improved classification of AKs may enable more accurate identification of patients at highest risk for KC, particularly SCC.

MethodsWe evaluated the association between AK …

"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 …

Huburban America: New Haven And The Promise Of Mobility, Jhansiddh Setthachayanon

Library Map Prize

This project analyzes micromobility as the emerging solution to New Haven’s incomplete urban transportation project. It argues that micromobility’s legitimization through mobility hubs is key to the city’s modern connectivity. Finally, it proposes a version of new hubs for New Haven.

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 …

Economic Development And The Environment, Kelsey Jack, Nicholas Ryan

Discussion Papers

Economic development relies on and transforms the environment. The transformation is evident in the poor environmental quality in many developing countries. For example, air quality in Southeast Asia is three times worse than in the United States, in sub-Saharan Africa four times worse and in South Asia more than six times worse. We model how environmental quality affects health, productivity and well-being and how individuals privately adapt to environmental hazards. We also model how collective action and formal regulation contribute to environmental quality. We draw three main findings from a review of empirical research on these mechanisms. First, individual adaptation …

Skipping The Factory: Service-Led Growth And Structural Transformation In The Developing World, Michael Peters, Youdon Zhang, Fabrizio Zilibotti

Discussion Papers

In today’s developing world, many economies appear to bypass industrialization and transition directly from agriculture to services. The largest rise in service employment has occurred in non-tradable consumer services, such as retail and hospitality, especially in urban areas, where many cities resemble consumer hubs built around local demand. These patterns of growth raise fundamental questions: Can service-led growth sustain improvements in living standards over time? Is service-led growth inherently biased toward affluent urban consumers? What role should policy play? To address these questions, we propose a parsimonious general equilibrium framework that incorporates non-homothetic preferences and locally non-tradable consumer services in …

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 …

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 …

Increasing Adherence To Cognitive Behavioral Therapy Among Patients With Major Depressive Disorder, Tina Ho

Yale School of Nursing Digital Theses

Major depressive disorder (MDD) is a prevalent psychiatric condition that significantlyimpairs daily functioning, cognitive performance, and overall quality of life. Evidence-based interventions, including pharmacotherapy and psychotherapy, are effective in managing MDD, with cognitive behavioral therapy (CBT) recognized as one of the most empirically supported treatments (Cuijpers et al., 2016). Interventions are needed to improve adherence to CBT to reduce relapse rates by addressing barriers to engagement and supporting sustained participation in treatment. This project developed and implemented a standardized protocol to improve CBT adherence among patients with MDD newly referred for combined CBT and medication management. A new ‘barriers form’ …

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 …

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 …

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 …