Digital Commons Network^™

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, …

Predicting Healthcare-Seeking For Childhood Diarrhea Across Low- And Middle-Income Countries, Madi Baltagulov

Public Health Theses

Healthcare-seeking behavior (HSB) for childhood diarrhea is a central but persistently uncertain input for rotavirus burden models and vaccine cost-effectiveness analyses. Demographic and Health Surveys (DHS) provide the only nationally representative measurements, yet they are expensive and absent from the majority of low- and middle-income countries (LMICs). This thesis asks whether publicly available country-level indicators can substitute for DHS data when survey estimates are unavailable.Using the most recent DHS conducted between 2011 and 2024 in 51 LMICs (78,008 children under five with diarrhea), I fit a multilevel modified Poisson regression and a two-stage random-effects meta-regression with four World Bank moderators: …

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 …

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 …

Black Carbon Exposure And Adult Mental Health And Cognitive Function: A Scoping Review, Zhihong Cai

Public Health Theses

Background: Black carbon (BC) is a particulate matter component that is closely linked to combustion and traffic sources, serving as both a short-lived climate pollutant and a potential risk factor for brain health. Despite a substantial burden of adult mental health disorders and cognitive decline, epidemiological evidence on BC exposure and brain health remains scattered.Objective: To systematically map study types, main findings, evidence gaps, and methodological limitations regarding BC exposure and its proxy indicators, such as PM₂.₅ absorbance and elemental carbon in relation to mental health and cognitive outcomes in adults. Methods: Following PRISMA-ScR guidelines, I searched PubMed, Web of …

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 …

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 …

Discrimination And Stress Recovery In Romantic Couples: A Dyadic Analysis Of Vagal Rebound And Stress Appraisal, J. Doris Chi

Public Health Theses

Background: Perceived discrimination is a chronic stressor linked to adverse psychological and physical health outcomes, yet less is known about how it shapes parasympathetic recovery after acute stress within close relationships. The present study examined the direct and vicarious effects of discrimination on vagal rebound and stress appraisal following a social-evaluative speech task, and whether these associations varied by identity attribution.

Methods: Data were drawn from 188 romantic couples (N = 376) from the New Haven area. Participants completed measures of everyday discrimination prior to the laboratory visit and stress appraisal before and after the speech task. Respiratory sinus arrhythmia …

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 …

An Examination Of The Potential Impact Of Herpes Zoster Vaccination Of Younger Adults, Katherine N. Goyette

Public Health Theses

Varicella-zoster virus causes two distinct clinical syndromes, varicella, commonly known as chicken pox, and herpes zoster, commonly known as shingles. Natural varicella infection (as opposed to inoculation) is a necessary precursor to herpes zoster, which can cause serious pain and suffering. There is some evidence that rates of herpes zoster may have increased since the introduction of the varicella vaccine in the United States in younger adults, possibly due to less exogenous boosting by community varicella. However, the vaccine against herpes zoster is only approved for adults ages 50 and above. This paper thus examines the change in rates of …

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 …

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 …

A Mendelian Randomization Study Of Maternal Thyroid Function And Cerebral Palsy, Yuewen Ge

Public Health Theses

Cerebral palsy (CP) is a neuromotor disorder that is strongly associated with adverse perinatal conditions. Thyroid dysfunction in pregnancy was suggested to affect CP risk in a few cohort studies, but the evidence is not yet conclusive. We conducted a two-sample MR study to explore the effect of thyroid function on the risk of CP in offspring, and preterm birth as a potential mediator. Genetic instruments for hyperthyroidism and hypothyroidism were obtained from a large European genome-wide association study (GWAS) by Sakaue et al. (2021), instruments for free thyroxine (FT4) and thyrotropin (TSH) were derived from the ThyroidOmics Consortium, and …

Clostridioides Difficile Infection Trends And Treatment Concordance With Idsa/Shea Guidelines In The Connecticut Emerging Infections Program Catchment Area, 2011-2024, Rachael Hopkins

Public Health Theses

Background: Clostridioides difficile infection (CDI) is a gastrointestinal infection causing colon inflammation, diarrhea, and potential life-threatening complications. In 2021, treatment guidelines for CDI were updated by the Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA). This study analyzed Connecticut Emerging Infections Program (EIP) data to assess CDI incidence trends (2011-2024) and evaluate physician concordance with 2021 guidelines for incident cases (2022-2024). Methods: The Connecticut EIP conducted CDI surveillance in New Haven County (2011-2023) and South Central and Naugatuck planning regions (2024). Incidence rates were calculated using census data. Concordance was defined as treatment …

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 …

Role Of Functional Social Support In Adherence To Hypertension Therapy: A Community-Based Study In Nepal, Shirish Gurung

Public Health Theses

Introduction: Despite evidence that adherence to hypertension therapy is associated with improved blood pressure control and health outcomes, adherence rates remain suboptimal. This study aims to examine the association between perceived functional social support and adherence to hypertension therapy in Nepal.

Methods: This study utilized cross-sectional baseline data collected from an ongoing community health worker-led hypertension prevention and control trial in Sindhupalchok District, Nepal. Adherence to hypertension therapy was measured using the Hill-Bone High Blood Pressure Therapy Compliance Scale, and perceived functional social support was measured using the Medical Outcomes Study Social Support Survey. Modified Poisson regression with robust standard …

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 …

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 …

Does Gender Moderate The Association Between Perceived Choice Of Being A Caregiver And Psychological Well-Being, Ran Huo

Public Health Theses

Background: A substantial proportion of U.S. adults assume informal caregiving roles, yet little is known about whether they perceived a lack of choice when becoming caregivers, or the patterns and outcomes of such perceived choice. In addition, while the caregiving experience is often different by gender, little is known about whether gender influences perceived choice or moderates its association with psychological well-being. This study examines gender differences in perceived caregiving choice and its relationship with mental health outcomes. Methods: We conducted a secondary analysis of nationally representative data from the Understanding America Study - Caregiving, Lifecourse, and Emotion and Aging …