Digital Commons Network^™

Forgiveness Of Self And Others: A Group Approach To The Treatment Of Ptsd And Other Trauma Related Experiences, Jarrod A. Mask

Psychology Doctoral Specialization Projects

Forgiveness is often misinterpreted as the act of forgetting what happened or offering one’s offender the ability to redeem themselves for their wrongdoings. This is simply not the case. Rather, forgiveness is the process of the individual making the unprovoked choice to release their resentment in their own voyage towards living a free and happy life without being imprisoned from the emotions un-forgiveness produces. Forgiveness, as it may be a necessary process for the individual is to attain a sense of peaceful acceptance and liberation from their pain, is not an easy process. Providing a peer-based support system in the …

Review Of Platform Power And Libraries, Michael Kirby

Publications and Research

No abstract provided.

Beyond Vulnerability: Climate Change And The Moral Authority Of Youth, Amber Acquaye

Yale Medicine Thesis Digital Library

Young people worldwide demand a voice in climate governance, yet their perspectives remain largely excluded from the moral frameworks that shape climate policy. This exclusion not only marginalizes children’s lived experiences and ethical reasoning but also perpetuates paternalistic norms and dangerous marginalization. To counter this, this thesis study shows that youth are not just passive stakeholders but moral agents whose perspectives yield a more just and comprehensive understanding of climate responsibility. Recognizing their ethical insights is crucial for medicine, especially pediatrics and child psychiatry, given how climate change amplifies health risks like respiratory illnesses, heat-related conditions, and eco-anxiety. Understanding how …

“A Double-Edged Sword”: Influence Of The 21st Century Cures Act On The Childhood Cancer Care Experience, Mona Clappier

Yale Medicine Thesis Digital Library

The 21st Century Cures Act yielded policy change that allows patients toimmediately access components of their electronic health record (EHR) via an online portal. For children, adolescents, and young adults (AYAs) with cancer and their families, this federal mandate has profound implications. We sought to explore how immediate EHR portal access influences the childhood cancer care experience. We conducted semi-structured interviews with key informants, including parents of children with cancer, AYAs with cancer, and pediatric oncology healthcare professionals, at three National Cancer Institute-designated comprehensive cancer centers. Interviews were recorded, transcribed, and thematically analyzed. Across 84 participants, 71% self-identified as women …

Effectiveness Of Interventions For Depressive Symptoms After Spinal Cord Injury: A Systematic Review, Robert Cotter

Yale Medicine Thesis Digital Library

Our aims were to summarize and evaluate evidence regarding the efficacy ofinterventions for depressive symptoms in adults living with spinal cord injury (SCI) and comorbid major depressive disorder or significant depressive symptoms to inform the development of clinical practice guidelines. Articles published since 2013 and available in Medline, The Cochrane Library, Embase, Scopus, CINAHL, or PsycINFO were evaluated. Databases were searched in June 2022 and updated November 2023. Inclusion criteria: age 18 years or older, traumatic SCI, and clinically significant depression (Population), mental health interventions including behavioral, pharmacological, and complementary and alternative medicine (Intervention), inclusion of a control group (Comparator), …

Trends In Missing Race And Ethnicity Data In A National Surgical Database, Kevin Gao Hu

Yale Medicine Thesis Digital Library

Accurate data collection on race and ethnicity is critical to detecting and characterizing disparities in surgical care. This study explores the prevalence and impact of missing race and ethnicity data in the National Surgical Quality Improvement Project Pediatric (NSQIP Pediatric) database. NSQIP Pediatric from 2016-2020 was assessed for patients who were missing data for race (RM), ethnicity (EM), or both (BM). Changes in proportion of RM, EM, and BM patients were assessed with Cochran-Armitage tests. Surgical outcomes were modeled using linear mixed-effects models, treating CPT codes as random effects. Models were bootstrapped with 1000 iterations for each outcome. Of 596,571 …

Exploring The Journey To Heart Failure Diagnosis In Uganda, Teimur Kayani

Yale Medicine Thesis Digital Library

This study sought to explore the healthcare journeys of patients recently diagnosed with heart failure (HF) in Uganda. Using a semi-structured guide developed in collaboration with Ugandan colleagues, we conducted in-depth interviews with 19 patients diagnosed with HF within the past three months across four regional referral hospitals in Uganda. Interviews were conducted in the participant’s preferred language (English, Luganda, Lugbara, Lugisu, or Swahili) using trained research assistants (RAs) and were recorded, transcribed verbatim, and thematically analyzed using the socioecological framework (SEM) to capture individual, interpersonal, community, and systemic-level barriers to HF care.Findings revealed a total of 11 themes spread …

Pre-Admission Sleep Of Patients In The Intensive Care Unit: A Retrospective Observational Study, Siddhi Nadkarni

Yale Medicine Thesis Digital Library

The medical intensive care unit (ICU) can be a challenging place for patients to get adequate sleep. Multiple environmental and pathophysiological factors can cause sleep deprivation in the ICU, which have been associated with adverse short and long-term outcomes. Although various factors have been hypothesized to impact quality of sleep in the ICU, research on the nature of patients’ pre-ICU sleep is very limited. Understanding the role that pre-ICU sleep plays in sleep quality in the ICU has the potential to inform public health measures to improve sleep and risk stratify critically ill patients. The objective of this study is …

The Use Of Biologic Agents In Cutaneous Immune-Related Adverse Events Due To Immune Checkpoint Inhibitors, Kailyn Valido

Yale Medicine Thesis Digital Library

Immune checkpoint inhibitors (ICIs) have transformed the treatment landscape in the field of oncology due to their effective antineoplastic properties for various cancers. Though revolutionary in cancer treatment, their use is limited by various immune-related adverse events (irAE). Cutaneous immune-related adverse events (cirAE) are the most common type of irAE and encompass a spectrum of dermatological manifestations. These include lichenoid reactions, psoriasiform eruptions, eczematous dermatitis, immunobullous disorders, granulomatous reactions, pruritus (with or without a primary eruption), vitiligo, and severe cutaneous adverse reactions such as Stevens–Johnson syndrome and drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome.

The standard approach in …

Catalyzing Engagement: Investigating Factors And Perceptions Shaping Texas High School Landscape Architecture Education, Recruitment, And Outreach, Johnathan A. Hampton

Landscape Architecture Masters & Design Theses - Archive

Socio-economic and environmental pressures have created a demand for landscape architecture practitioners that far outweighs the current supply of students and professionals (Hendricks et al., 2019; U.S. Bureau of Labor Statistics, 2024c). This reality has spurred industry representatives to examine education, recruitment, and outreach strategies (Cardona, 2024, 2021; Davis, 2022; American Society of Landscape Architects, n.d.-a). Investigating the factors that influence landscape architecture (and allied industry) education, recruitment, and outreach may inform the refinement of such strategies. The purpose of this thesis is to examine the factors and stakeholder perceptions that influence landscape architecture education, recruitment, and outreach in Texas …

Achieving Vision Zero On Dr. Martin Luther King Jr. Boulevard: Enhancing Pedestrian Safety And Reclaiming Community Identity In South Dallas, Safa Sayeed Khan

Landscape Architecture Masters & Design Theses - Archive

Fair Park, a neighborhood of South Dallas, has experienced historical displacement, urban neglect, and pedestrian safety inequities, especially along Martin Luther King Jr. Boulevard (MLK Blvd). This boulevard is a vital entryway to Fair Park and a center for local businesses, attracting significant foot traffic. However, it currently lacks essential pedestrian safety improvements. (Dallas Examiner, 2023). Due to its high crash rate, poor sidewalks, lack of crosswalks, and poor lighting, MLK Blvd has been identified as one of Dallas' most dangerous pedestrian areas, despite being an essential vehicle and pedestrian corridor that connects residents to Fair Park (Phillips, 2024; "South …

Correlating Csr Theory And Soil Texture To Bridge The Gap In Ecological Planting Strategies For Landscape Architecture, James E. Theiss

Landscape Architecture Masters & Design Theses - Archive

Many studies are focused on the benefits of including natural and ecoregional landscape design within urban habitats; however, a focused approach to how landscape architects can begin including ecological applications within their planting designs has not been fully assessed. Once the knowledge gap between ecology and how landscape architects plan landscape plantings is fully realized, research on the benefits of bringing nature back to urban environments can be thoroughly assessed. It is common knowledge that landscape design involves creating aesthetically pleasing plant combinations based on simple site characteristics that can influence how a plant grows (Tabassum S. et al., 2020; …

Breathing New Life Into Main Street Garden: A Design To Showcase Native Forb Flowering Lawns For A More Sustainable Downtown Dallas, Tx, Peter E. Wagner

Landscape Architecture Masters & Design Theses - Archive

Lawns are a landscape staple that dominate urban and suburban spaces. While they are often criticized, for many good reasons, their general popularity and acceptance are undeniable. Aesthetic preference, simple maintenance, low upfront cost, and high recreational value make lawns a ubiquitous feature in urban design (Ignatieva et al., 2017). However, from an environmental standpoint they are immensely costly and contribute significantly to pollution (Smetana & Crittenden 2014). Ecologically speaking, they contribute very little to local biomes and, with their prevalence in rural and suburban settings, they displace large swaths of native habitat. Despite rigorous research and well-articulated arguments against …

Indirect Requests: Sociopragmatic Aspects Of Non-Conventionalised Indirect Directives, Hammed Mohammadpanah

Linguistics & TESOL Dissertations - Archive

Directives are divided into three types, corresponding to different levels of explicitness. To get a hearer who has left the front door open on a cold winter night while taking off their shoes, one can use a direct directive (e.g., Close the door!), a conventionalised indirect directive (e.g., Can you close the door?), or a non-conventionalised indirect directive (e.g., It’s –15 outside.). Inherently implicit in nature, non-conventionalised indirect directives (NCIDs) have been understudied due to being the most context-dependent and form-independent type of directives, which underscores the central role of context-based inferencing and contextual salience in processing and studying them. …

Advance Care Planning Utilization Among Non-White Individuals With Heart Disease And Cancer Using Health Retirement Study (Hrs) Data, Trizah M. Njoroge

Nursing Dissertations - Archive

Advance Care Planning (ACP) is a critical component of patient-centered care, yet its utilization remains disproportionately low among Non-White populations in the United States, particularly among individuals with chronic illnesses such as heart disease and cancer. This article explores racial disparities in ACP engagement using secondary analysis of the 2018 and 2020 waves data from the Health and Retirement Study (HRS), guided by Bandura’s self-efficacy theory (SET). The study examines how race, disease type, comorbidity, and survey year predict ACP service utilization, defined as completing five key ACP components: a legal will, a medical care discussion, surrogate assignment (DPOA), a …

Improvement Of Hpv Vaccination Rate In Pediatric Patients In A Clinic Through Implementation Of A Bundle, Macalah Jenschke

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Introduction: Human papillomavirus (HPV) is a major cause of several cancers, and vaccination is a highly effective preventive measure. However, HPV vaccination rates remain suboptimal, particularly in rural pediatric populations. This quality improvement (QI) project aims to enhance HPV vaccination rates through the implementation of a comprehensive vaccination bundle targeting provider education, patient and parent education, appointment reminders, and the use of a vaccine waiver when needed.

Method: This QI project was conducted over twelve weeks in a rural pediatric clinic with approximately 130 patients seen daily. The intervention bundle included provider education on effective communication regarding HPV vaccination, educational …

Improving Glucose Levels In Adults With Type 2 Diabetes, Kaitlin Castillo

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Type 2 diabetes is a growing health crisis, posing significant challenges not only to individual well-being but also to healthcare systems' financial sustainability. The prevalence of type 2 diabetes continues to rise annually, contributing to increased medical costs, hospitalizations, and long-term complications. Houston, Texas, has a diabetes prevalence of 13.5%, exceeding the national average of 10%. A clinical gap exists in providers’ ability to prevent and manage type 2 diabetes. Prioritizing prevention, early intervention, and improved patient monitoring can reduce incidence rates, lower healthcare costs, and enhance overall population health. A Plan Do Study Act model was utilized for the …

Reducing Stress Related To Injection Therapy: A Zen Bundle Approach, Valoree Bowen

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Needle fear and stress are common barriers preventing adults from seeking necessary medical treatments, including intramuscular (IM) injection therapy. Research highlights the need for evidence-based interventions to mitigate this fear and improve patient experience.

Objective: This evidence-based pilot project included a Zen Bundle—an intervention incorporating shared decision-making, aromatherapy, and distraction—to evaluate the impact on stress reduction and patient satisfaction in a retail vitamin shop in North Texas.

Methods: The project utilized a pre-and post-intervention design over eight weeks. Participants completed pre-surveys assessing stress levels using a Visual Analog Scale before choosing an intervention (aromatherapy, distraction, or both) during IM …

Management Of Obesity In Adults 18 And Older, Donna Callicoat

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Obesity is a significant public health concern in the United States, with increasing prevalence and substantial healthcare costs. Despite evidence-based guidelines for obesity management, primary care clinics often fail to implement them effectively, leading to missed opportunities in preventing obesity-related comorbidities such as cardiovascular disease, type 2 diabetes, and certain cancers.

Purpose: This evidence-based project aimed to implement the American Heart Association/American College of Cardiology/Obesity Society (AHA/ACC/TOS) obesity guidelines in a rural Texas primary care clinic. The goal was to assess the effectiveness of these guidelines in reducing weight, body mass index (BMI), and waist circumference among adults with …

Reducing Caregiver Burden For The Caregivers Of Heart Failure Patients, Joyce W. Kimani

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Family members and friends of heart failure patients serve as informal caregivers for many heart failure patients, helping with the management of day-to-day heart failure care. Many caregivers of heart failure patients experience stressors associated with caregiving, including social, psychological, financial, emotional, and physical stress. Reducing caregiver burden is important in improving both patient and caregiver well-being. Healthcare systems can improve caregiver outcomes and encourage the long-term sustainability of informal caregivers by addressing caregiver needs through focused support strategies. The Agency for Healthcare Research and Quality framework was used to develop an evidence-based guideline that healthcare professionals can follow in …

Efficient Treatment Of Postoperative Nausea And Vomiting In Adults Recovering From General Anesthesia, Peter A. Palko

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

This manuscript explores strategies to address postoperative nausea and vomiting (PONV), a significant complication affecting up to 30% of surgical patients and 80% of those at high risk. Despite its prevalence, appropriate prophylactic administration of antiemetic medications remains suboptimal, with national rates at 67% and certain academic facilities reporting only 32%, far below the 90% recommended threshold. These deficiencies underscore the urgent need for evidence-based interventions to enhance clinical adherence and improve patient care outcomes.

A quality improvement (QI) initiative was implemented to enhance prophylactic treatment and reduce inefficiencies in PONV management. Following a comprehensive literature review, the project employed …

Guideline For The Management Of Immunotherapy-Related Adrenal Insufficiency At A Cancer Center, Rachna R. Patel

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Immunotherapy has become an important treatment option for cancer care and is being utilized more often. Immunotherapy-related adrenal insufficiency (irAI) is a potential adverse effect of immunotherapy that requires endocrine expertise for management. The goal of this project was to create a guideline with an algorithm for the safe and comprehensive management of irAI in an advanced-practice provider-led clinic.

Methods: A guideline project utilizing the Agency for Healthcare Research and Quality (AHRQ) National Quality Measures Clearinghouse (NQMC) Measure Domain Framework was conducted at this cancer care facility. A literature search was conducted to gather the best available evidence and …

Evidence-Based Discharge Bundle To Reduce Heart Failure Readmissions, Chelsea Zepeda

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Heart failure (HF) affects over 6.7 million adults in the United States, resulting in frequent hospitalizations and readmissions, increased mortality, and billions of dollars spent annually on healthcare costs. Reducing readmission rates is a priority for the healthcare industry.

Objective: This evidence-based practice project aimed to reduce HF readmission rates through a bundled approach to address socioeconomic factors that place patients at higher risk for readmission, provide patient-centered education for HF management at home, and provide follow-up phone calls after discharge to assess patient symptoms.

Methods: English-speaking patients, aged 65 or older, with any active diagnosis of HF were …

Implementing The Tips Toolkit To Prevent Falls In Hospitalized Older Adults: A Rural Hospital Approach, Viridiana G. Gonzalez Msn, Rn

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Falls remain the leading cause of injury-related deaths among hospitalized older adults, contributing to significant morbidity, extended hospital stays, and increased healthcare costs. Implementing effective fall prevention strategies is especially challenging in rural hospitals due to staffing shortages, limited funding, and variability in clinical practice.

Local Problem: A 30-bed Medical-Surgical Unit in a rural Southwest Texas hospital experienced a rise in patient falls among older adults aged 65 and older, including several incidents requiring advanced medical treatment and one resulting in serious injury. A gap analysis revealed inconsistent implementation of tailored fall prevention strategies.

Methods: A quality improvement (QI) …

Bundled Approach To Improve Colorectal Cancer In Primary Care, Elizabeth Reddiar

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Abstract

Background: Colorectal cancer (CRC) remains the second leading cause of cancer-related deaths in the United States, despite being preventable through timely screening. National guidelines recommend regular screening for adults aged 45 to 75; (American cancer Society (ACS), 2025) however, screening rates remain suboptimal, particularly in primary care settings serving diverse and high-volume populations. Local Problem: At the project site, a community-oriented primary care clinic in North Texas, baseline data revealed CRC screening completion rates were below benchmarks set by the organization. Barriers included limited patient awareness, inconsistent provider reminders, and workflow challenges in distributing and tracking fecal immunochemical test …

Implementing The Gad-7 Screening Tool In An Adult Outpatient Psychiatric Clinic, Elizabath George

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Abstract

Background: Anxiety disorders are among the leading causes of disability worldwide and the most prevalent mental illness in the United States. Despite affecting 6.8 million adults annually, fewer than half with Generalized Anxiety Disorder (GAD) receive treatment. Many patients present with somatic complaints, leading to underdetection. Standardized screening tools such as the Generalized Anxiety Disorder-7 item (GAD-7) can improve identification and outcomes.

Purpose: This quality improvement (QI) project implemented the GAD-7 screening tool in an adult outpatient psychiatric clinic in North Texas and evaluated its impact on identifying patients with GAD, compared to the prior year without structured screening. …

Nonlinear Wave Dynamics In Asteroseismology With Application To Delta Scuti Stars, Mohammed Mourabit

Physics Dissertations - Archive

This thesis compiles the collection of works in nonlinear astroseismology and its implication to the δ Sct variable that we carried over the course of five years. With the advent of high-resolution space missions such as the Kepler and TESS telescopes, we were able to see significant progress in the field in recent years. Nonetheless the new technologies also brought an increasing number of observation that are seemingly contradictory to the linear theory of asteroseismology. In particular, we find the δ Sct variable, which eludes our models in terms of how varied we find they spectra for stars with very …

Algebra Structures For The Koszul Homology Of Minimal Intersections, Kathryn A. Grebel

Mathematics Dissertations - Archive

The Koszul homology of a local ring is a powerful tool in commutative algebra as it provides information on the structure and properties of the ring. In this research, we explore the relationship between quotients of regular local rings and their Koszul homology algebra. One such relationship is detailed by the Tate-Assmus theorem, which asserts, in part, that a ring is a complete intersection if and only if the Koszul homology is generated by its degree 1 homology elements. An objective of this research is to examine and identify the properties of a minimal intersection and its Koszul homology algebra. …

Now?, I. Bennett Capers

Faculty Scholarship

This essay brings Afrofuturism, and its notion of the plasticity of time, to imagine how we will think of the past in the future and, more specifically, to consider what will "enrapture, haunt, and/or plague thinkers in the future." Although many answers come to mind, including this country's original sin-slavery-ultimately this essay turns to our current technologies, especially policing technologies. And this essay turns the question around to ask, "How should we in the present think about the future? And what can we do now to change it?"

Soft Prompt Tuning For Augmenting Dense Retrieval With Large Language Models, Zhiyuan Peng, Xuyang Wu, Qifan Wang, Yi Fang

Computer Science and Engineering

Dense retrieval (DR) converts queries and documents into dense embeddings and measures the similarity between queries and documents in vector space. One of the major challenges in DR is the lack of domain-specific training data. While DR models can learn from large-scale public datasets like MS MARCO through transfer learning, evidence shows that not all DR models and domains can benefit from transfer learning. Recently, researchers have resorted to large language models (LLMs) to improve the zero-shot and few-shot DR models. However, the hard prompts or human-written prompts utilized in these works are suboptimal and the generated weak …