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How (In)Effective Was Bank Supervision During The 2022 Monetary Tightening?, Yadav Gopalan, Joao Granja

Documents

No abstract provided.

Shifting The Paradigm Toward Intent To Stay: Creating A Nurse Career Crafting Program To Increase Nurse Engagement In An Urban Teaching Hospital, Jaclyn Davis

Yale School of Nursing Digital Theses

Nearly 50% of all RNs experience job disengagement, dissatisfaction, and signs of burnout during their career (National Academy of Medicine, 2019). RN burnout is largely the corollary of two predominant themes: perception of engagement in meaningful and motivating work and perception of personal ability to disconnect and decompress (Press Ganey, 2018). Job crafting skills guide people to make meaning of their work in difficult context, and their experience of work as a job, career, and calling. These skills help nurses align their strengths, motives, and passions within their roles. This DNP Project developed a Career Crafting Program using a modified …

A Project To Improve Advanced Practice Provider Financial Metrics Through A Practice Management Program, Stefanie Anne Generao

Yale School of Nursing Digital Theses

A Project to Improve Advanced Practice Provider Financial Metrics Through a Practice Management Program

This DNP project developed a practice management program for ambulatory Advanced Practice Providers (APPs) practicing in a large academic healthcare system with the goal to improve financial metrics. In 2020, Centers for Medicare and Medicaid Services (CMS) reported $25.74 billion in incorrect payments citing documentation errors and insufficiency as the common cause. The growth of the APP workforce necessitates APP practice management knowledge to avoid significant revenue loss since APPs collectively report lack of healthcare business knowledge. Twenty ambulatory APPs participated in a 12-week practice management …

Multimodal Opioid-Sparing Analgesia: Increasing Regimen Adherence In Minimally Invasive Abdominal Surgery, Panicha F. Kittipha

Yale School of Nursing Digital Theses

Multimodal Opioid-Sparing Analgesia: Increasing Regimen Adherence in Minimally Invasive Abdominal SurgeryIn 2016, the CDC estimated 11.5 million persons in the United States, aged 12 years and older, misused opioids in the past year. The opioid epidemic poses a challenge to the healthcare profession as it continues to care for, treat, and manage pain with associated complications from opioid dependence. Patients who primarily use opioids for pain control postoperatively and at discharge are at a 44% increased risk for opioid dependence after only five days of use. The incorporation of multimodal analgesia and opioid-sparing approaches has led to improved pain management …

Obstructive Sleep Apnea Screening And Sleep Specialist Referral In Outpatient Psychiatric Populations, Jeremy Michael Mills

Yale School of Nursing Digital Theses

Background: Obstructive sleep apnea (OSA) affects approximately 1 billion people globally and is highly prevalent in psychiatric patient populations. Comorbid OSA can worsen psychiatric symptoms and increase suicide risk. Despite calls for OSA screening in psychiatric patient populations, it is currently underrecognized in mental health settings.

Objective: A protocol was created for OSA screening and sleep specialist referral for individuals seeking medication management services at a community mental health center.

Methods: Using the STOP-Bang questionnaire, a well-validated screening tool for OSA, individuals with positive screenings for OSA risk were referred to a sleep specialist during a 10-week implementation period.

Results: …

Reducing 30-Day Readmission Rates For Copd Patients: A Care Standardization & Quality Improvement Project, Oana Raluca Randolph

Yale School of Nursing Digital Theses

Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that affects millions of Americans and accounts for close to 700,000 hospitalizations per year. On average, about 20% of patients hospitalized for acute exacerbation of COPD are readmitted to the hospital within 30 days of discharge. The quality of care delivered to COPD patients is often suboptimal and fragmented, contributing to unfavorable patient outcomes, and high rates of readmissions. The purpose of this DNP project was to reduce 30-day readmissions and improve quality of care by developing and implementing a standardized Discharge Care Bundle for COPD patients in the …

Development Of An Educational Program To Elevate The Financial Cumen Of Nurse Managers, Quyen Wong

Yale School of Nursing Digital Theses

The purpose of this QI project is to elevate the financial acumen of nurse managers (NMs) in a large urban healthcare organization through the development of an educational program to strengthen the science of managing the business, a core AONL competency domain for nurse managers. The nurse manager role has evolved in today’s rapidly changing and demanding healthcare landscape that has been stressed by an increased demand for services and a decrease in resources. The impending nursing shortage that has been accelerated by the COVID-19 pandemic is an added stressor to the workload of nurse leaders as they struggle to …

The Greek Economic Crisis And The Banks, Gikas Hardouvelis, Dimitri Vayanos

Documents

No abstract provided.

Understanding Perceptions Of New-Onset Type 1 Diabetes Education In A Pediatric Tertiary Care Center, Gabriel Betancurvelez

Yale Medicine Thesis Digital Library

Background: Youth newly diagnosed with type 1 diabetes (T1D), and their families, require intensive education on the management of this chronic condition during this overwhelming period. Traditionally, our center conducts training in person during a hospital admission.

Methods: We studied family perceptions of our current patient education methods in an effort to elucidate strategies to augment education in the post-pandemic environment, where provider time in the room and visitation rules may limit face-to-face encounters.

Results: 25 families completed the survey (distributed to 156 in total, with approximately 21% response rate). The mean age at diagnosis was 9.52 ± 4.29 years …

Associations Of Atopic Dermatitis With Neuropsychiatric Comorbidities, Ryan Fan

Yale Medicine Thesis Digital Library

There is incomplete understanding of the association of atopic dermatitis (AD) with neuropsychiatric disorders. This case-control study using the National Institutes of Health All of Us Research Program database aims to evaluate the odds of various neuropsychiatric conditions in patients with AD in a large, diverse cohort of adults in the United States. Comorbidities were compared between cases and controls using statistical hypothesis testing and odds ratios were generated using logistic regression in univariable and multivariable analyses.

In a cohort of 13,433 AD cases with 53,732 matched controls (4:1), patients with AD were more likely to have a diagnosis of …

International Academic Partnerships In Orthopaedic Surgery, Michael Jesse Flores

Yale Medicine Thesis Digital Library

Abstract: INTERNATIONAL ACADEMIC PARTNERSHIPS IN ORTHOPAEDIC SURGERY. Michael J. Flores. Department of Orthopaedics & Rehabilitation, Yale University, School of Medicine, New Haven, CT.

Introduction: Orthopaedic-related disease (ORD) is one of the leading health challenges faced worldwide and is a significant cause of global morbidity and mortality, especially in low- and middle-income countries (LMICs). In recent years, international orthopaedic outreach to address the global burden of ORD has received greater attention due to initiatives such as the Lancet Commission on Global Surgery (LCGS). Many strategies have been considered to address the global burden of ORD, most commonly though volunteer trips by …

The Impact Of Cannabidiol In Patients With Early Psychosis: A Randomized Controlled Trial, Sreeja Kodali

Yale Medicine Thesis Digital Library

We aimed to study the effects of cannabidiol (CBD) in out-patients with early psychosis on clinical metrics of psychosis and cognition and on psychophysiological electroencephalogram (EEG) metrics of psychosis. Adult outpatient subjects with a primary psychotic disorder within approximately five years of psychosis onset were enrolled in a four-week, two-period, randomized, placebo-controlled crossover trial (clinicaltrials.gov NCT02504151). Subjects were randomized in a one-to-one ratio to receive either CBD (oral 800 mg/day) or placebo in the first of two treatment periods in a randomized, double-blind manner. Primary outcome measures assessed were psychosis symptoms measured using the Positive and Negative Syndrome Scale (PANSS); …

Mental Health Service Use Among Immigrant And U.S. Born Asian American Pacific Islanders, Hieronimus Loho

Yale Medicine Thesis Digital Library

Introduction: In the United States, Asian American/Pacific Islander (AAPI) people, and in particular AAPI immigrants, utilize mental health services at consistently lower rates than other ethnic populations, even when adjusting for perceived need or actual diagnoses. Methods: This study used data from the restricted version of the National Epidemiologic Survey on Alcohol and Related Conditions Wave III (NESARC-III) to compare Immigrant AAPIs, U.S. born AAPIs and U.S. born non-Hispanic Whites on mental health service utilization rates as well as examine differences in sociodemographic, behavioral, and psychiatric/substance use disorder (SUD) diagnostic characteristics that may account for these differences. Effect sizes were …

Almajiri Health; A Scoping Review On Disease, Health Literacy And Space For Participatory Research, Muzzammil Imran Muhammad

Yale Medicine Thesis Digital Library

Introduction

Almajirai are male children who leave the care of their parents to learn the Qur’an and study Islam under the tutelage of a Mallam or Imam at a Tsangaya. Almajiranci refers to the system of education based on this relationship between almajiri and mallam, and which was the dominant mode of education in precolonial Hausaland – Northern Nigeria and Southern Niger. This system remains widespread and popular in both countries. In recent years, discourse around almajirai has featured prominently in media from and about this region, and has associated almajiranci with non-participation in formal education, abuse, poverty, and underdevelopment. …

The Association Between Social Needs Care Coordination And Social Needs Status Amongst Patients In A Federally Qualified Health Center, Autumn Nobles

Yale Medicine Thesis Digital Library

Social needs screenings within healthcare systems have grown more common with increasing discourse around the contribution of systemic determinants to health outcomes. These screenings have been used to describe the prevalence of social needs within communities but have not been evaluated for the impact that they and the interventions to which they are attached may have on health outcomes. Here we evaluate social needs screenings and their potential impact on patient health at a federally qualified health center in New Haven, Connecticut. We describe the baseline needs at the facility, evaluate change in reported social needs among patients undergoing screening, …

More Than Meets The Eye: Improving Recognition Of Child Abuse In Emergency Departments, May Shum

Yale Medicine Thesis Digital Library

Background: Child abuse guidelines exist to help emergency department (ED) providers evaluate injured children for suspected child abuse. Little is known about the impact of these guidelines on provider decision-making in pediatric (PED) and community EDs (CEDs). Objective: To evaluate the impact of a child abuse guideline in pediatric and community EDs through three primary studies: 1. To examine guideline adherence and the appropriateness of decision-making by CED providers. 2. To determine the impact of the guideline on differences in evaluations of infants for abuse between a PED and three CEDs. 3. To implement and assess the use of a …

Family Dyads, Emotional Labor, And The Theater Of The Clinical Encounter: Co-Constructive Patient Simulation As A Reflective Tool In Child And Adolescent Psychiatry Training, Isaiah Thomas

Yale Medicine Thesis Digital Library

Patient simulation has been used in medical education to provide a safe and supportive learning environment for learners to practice clinical and interpersonal skills. However, simulation involving pediatric medicine and child psychiatry is rare and generally does not reflect the child-caregiver dyad or the longitudinal aspects of this care and does not provide learners an opportunity to engage with and reflect on these dynamics. We organized a series of 7 observed patient simulation sessions with a cohort of 7 senior child and adolescent psychiatry fellows as an educational opportunity. In these sessions, we utilized the previously described co-constructive patient simulation …

Radiomics: A Methodological Guide And Its Applications To Acute Ischemic Stroke, Emily Avery

Yale Medicine Thesis Digital Library

The field of radiomics provides a quantitative approach to medical imaging, wherein a large number of features extracted from medical images are used to detect clinically relevant information that is invisible to the naked eye. This increasingly prevalentmethodology has facilitated improvements in the speed and efficacy of clinical decision-making across specialties. One area where radiomics can make a particular impact is acute stroke imaging. As “time is brain” in acute stroke triage, automated tools for patient evaluation have significant potential to improve outcomes by providing timely, objective data. The present work aimed to create radiomics models from admission CT angiographic …

Characterization Of Cutaneous Immune-Related Adverse Events Due To Immune Checkpoint Inhibitors, Annika Belzer

Yale Medicine Thesis Digital Library

Immune checkpoint inhibitors (ICI) have been associated with a multitude of immune-related adverse events (irAE), which affect multiple organ systems in the setting of increased immune activation. Cutaneous immune-related adverse events (cirAE) are among the most common irAE, occurring in up to 50% of patients treated with an ICI. The most common cirAE are maculopapular eruption, pruritus (with or without primary cutaneous eruption), lichenoid dermatitis, eczematous dermatitis, psoriasiform eruption, and vitiligo. cirAE are of concern to oncologists and dermatologists alike, as cirAE can necessitate interruption or discontinuation of life-prolonging therapy. There is a paucity of data regarding cirAE in specific …

Toll-Like Receptors 2/4 Directly Co-Stimulate Arginase-1 Induction Critical For Macrophage-Mediated Renal Tubule Regeneration, Natnael Beyene Doilicho

Yale Medicine Thesis Digital Library

Background: Following kidney injury, macrophages that have infiltrated the kidney undergo a transition from an initial proinflammatory state to a pro-reparative one characterized by the expression of arginase-1 (Arg 1), mannose receptor (Mrc1) and macrophage scavenger receptor-1 (Msr1). Granulocyte-macrophage colony-stimulating factor (GM-CSF) is an essential tubular-cell-derived determinant of the pro-reparative phenotype. However, it remains unclear what additional, if any, signals macrophages are integrating to maximally induce arginase-1.

Hypothesis: (1) The addition of cellular debris as a tubular cell cast mimetic will augment Arg1 expression in GM-CSF stimulated bone marrow derived macrophages; (2) Toll-like-receptors 2/4 transduce the debris signal from (1) …

Young Adults With Adhd And Their Involvement In Online Communities: A Qualitative Study, Callie Marie Ginapp

Yale Medicine Thesis Digital Library

Attention-deficit/hyperactivity disorder (ADHD) is a common condition that frequently persists into adulthood. Yet, diagnostic criteria for ADHD may not fully reflect how the condition presents in adults. Adults with ADHD have unmet needs and have been found to struggle with interpersonal relationships and stigma about their diagnoses. Online communities are frequently used by adults with ADHD and may be an avenue for building relationships and managing symptoms. We aimed to use qualitative methods to better understand the symptomatology of ADHD in young adults, how young adults with ADHD navigate relationships, the perceived impacts of ADHD online communities, and what adults …

An Examination Of Honor Society Membership, Mistreatment, And Discrimination By Medical Student Demographics, Katherine Ann Hill

Yale Medicine Thesis Digital Library

Purpose: To determine whether the prevalence of honor society membership and self-reported mistreatment and discrimination differs by medical student demographic group.Methods: This cross-sectional study analyzed data from Association of American Medical Colleges data collection instruments and included all students who graduated from LCME-accredited US medical schools and completed the Graduation Questionnaire in 2016-2019 (for honor society membership) or 2016-2017 (for self-reported mistreatment and discrimination). Results: In a sample of 50,384 graduating medical students, membership disparities were found in both Alpha Omega Alpha (AOA) and Gold Humanism Honor Society (GHHS). However, disparities in AOA existed across more identities, were often larger, …

Beta-Catenin Nuclear Transport In Wnt Signaling: Kap-Beta2/Transportin Mediates Nuclear Import Of Beta-Catenin Via A Py-Nls Motif In A Ran Gtpase Dependent Manner, Woong Y. Hwang

Yale Medicine Thesis Digital Library

Wnt signaling is essential for embryonic development and adult tissue homeostasis; mutations in Wnt pathway components are major drivers of multiple diseases especially cancer. β-catenin is a key effector in this pathway that translocates into the nucleus and activates Wnt responsive genes. However, due to our lack of understanding of β-catenin nuclear transport, therapeutic modulation of Wnt signaling has been challenging. Here, we took an unconventional approach to address this long-standing question by exploiting a heterologous model system, the budding yeast Saccharomyces cerevisiae, which contains a conserved nuclear transport machinery. In contrast to prior work, we demonstrate that β-catenin accumulates …

Sociodemographic And Insurance Disparities In Urologic Oncology Care Access And Surgical Outcomes, Folawiyo Laditi

Yale Medicine Thesis Digital Library

Background:While there has been much improvement in urologic cancer care, disparities in access and outcomes persist. These disparities can be attributed to several factors, including insurance status, access to quality healthcare, healthcare utilization, and sociodemographic determinants of health such as patient race. Disparities in patient access and surgical outcomes remain important areas of improvement in urologic oncologic outcomes. To develop strategies to improve healthcare access and understand the effects of sociodemographic factors on patient mortality outcomes, we characterized access to new urologic cancer care for patients with Medicaid insurance in the United States and we assessed the incidence and risk …

Examination For Independent Predictors Of Seasonality Of Birth Across Forty-Nine Low- And Middle-Income Countries: Analyses Of The United States Agency For International Development Demographic And Health Survey Data, Jehanzeb Kayani

Yale Medicine Thesis Digital Library

Although seasonal patterns in the distribution of live births have been well described across distinct populations for centuries, little is known about determinants of birth seasonality, particularly among low- and middle-income countries. Knowledge of determinants of birth seasonality may assist in the timely implementation and distribution of maternal and child health resources that may morbidity and mortality. In this study we examined for maternal and household sociodemographic determinants of birth seasonality in a sample of 3,260,238 live births across 49 nations that are included in the United States Agency for International Development Demographic and Health Survey Program. Our findings demonstrate …

Comparison Of The Bone Bruise Patterns In Contact And Non-Contact Acute Anterior Cruciate Ligament Injuries, Jay Thomas Moran

Yale Medicine Thesis Digital Library

Background: Bone bruises are commonly seen on magnetic resonance imaging (MRI) in acute anterior cruciate ligament (ACL) injuries and can provide insight into the underlying mechanism of injury. There are limited reports that have compared the bone bruise patterns between contact and non-contact mechanisms of ACL injury.

Purpose: (1) To examine and compare the number and location of bone bruises in contact and non-contact ACL injuries. (2) To test the reliability of our proposed bone bruise mapping scheme.

Study Design: Case-Control Study, Level of Evidence, 3.

Methods: Three hundred twenty patients who underwent ACL reconstruction surgery from 2015 to 2021 …

Diagnosis Of Polycystic Ovary Syndrome And Non-Hispanic Black Race Are Predictive Of Hypertension In Reproductive Age Women -Analysis Of Real World Electronic Medical Record Data, Nyerovwo Okifo

Yale Medicine Thesis Digital Library

Objective: The primary objective was to examine if blood pressure (BP) indices are higher and if the prevalence of hypertension (HTN), indices of metabolic syndrome (MetS) and severe obesity are greater in women diagnosed with polycystic ovary syndrome (PCOS) versus age comparable Controls without PCOS diagnosis. The secondary objective was to examine if Non-Hispanic Black (NHB) race and Hispanic ethnicity were relevant to the relationship between PCOS diagnosis and outcomes. Methods: This was a case-control study based on retrospective analysis of cross-sectional data available in the electronic health record (EHR) of an academic tertiary care health care system. Utilizing ICD-10 …

“I Was Reaching Out For Help And They Did Not Help Me”: Mental Healthcare In The Carceral State, Anna Grace Preston

Yale Medicine Thesis Digital Library

Background: Despite the limitations the carceral environment may impose on mental wellness, mental healthcare is increasingly becoming a carceral endeavor. Over the course of the last several decades, prisons and jails have become the de facto mental healthcare provider for thousands of incarcerated individuals. Furthermore, practices like mandated mental healthcare for supervised individuals further broaden the population experiencing mental healthcare within the criminal legal system at large. This study examines the perspectives of nine individuals who experienced mental healthcare within the carceral state, whether in prison or on parole or probation, with a special focus on how attributes of the …

Single-Cell Transcriptomic Atlas Reveals Molecular Drivers Of Human Inner Ear Development, Amar H. Sheth

Yale Medicine Thesis Digital Library

Introduction: Improving the therapeutic landscape for hearing loss necessitates an improved understanding of inner ear biology. Historically, our molecular understanding of inner ear physiology has lagged behind our knowledge of mechanistic understanding of signal transduction due to the rare, diverse, and fragile cell types of the inner ear. However, recent advances in high-throughput sequencing have allowed us to decode the molecular underpinnings of physiologic changes in the murine inner ear. Herein, we single-cell RNA sequence fetal tissue and present a comprehensive atlas of the developing human inner ear. Harnessing newer approaches in computational analysis, we delineate diversity of cell types …

Analysis Of Prices And Outcomes For Common Hospitalized Conditions In 2021, Lina Vadlamani

Yale Medicine Thesis Digital Library

Our study seeks to use newly disclosed hospital price transparency data to understand associations between average payer-negotiated prices, outcomes and hospital characteristics. Data on prices, outcomes and hospital characteristics for 4 commonly hospitalized conditions - Acute Myocardial Infarction (AMI), Heart Failure (HF), Chronic Obstructive Pulmonary Disease (COPD) and Hip/Knee Replacements (THR/TKR) - were acquired from publicly available hospital chargemasters and Medicare’s Hospital Compare database. Mann-Whitney U and ANOVA tests were conducted comparing prices and key hospital characteristics (geography, urban/rural location, Medicare percentage, Medicaid percentage, and ownership). Linear regressions were conducted exploring the effect of outcomes (mortality, readmissions) and hospital characteristics …