Digital Commons Network^™

A Mechanical Etiology Of Lateral Patellofemoral Arthritis, Nancy Park

Yale Medicine Thesis Digital Library

The relationship between anatomic risk factors for patellar instability and patellofemoral cartilage loss in the general population remains unclear. This study aimed to determine whether common measures of patellar instability are associated with lateral patellofemoral cartilage loss. A secondary objective was to evaluate the inter- and intra-rater reliability of 21 anatomical landmarks, initially placed using an artificial intelligence algorithm and subsequently verified with human input. We analyzed 389 non-weight-bearing computed tomography scans of knee joints from participants enrolled in the Multicenter Osteoarthritis Study. Baseline and 2-year follow-up knee magnetic resonance images were scored for patellofemoral cartilage morphology using the magnetic …

Tigit And Gdf-15 As Biomarkers And Targets In Renal Cell Carcinoma Resistant To Immune Checkpoint Inhibitors, Oscar Norberto Perales

Yale Medicine Thesis Digital Library

Immune checkpoint inhibitors have become the standard of care treatment for local and systemic clear cell renal cell carcinoma (RCC). However, a subset of patients fail these therapies due to the development of disease refractory to such treatments. Therefore, it is imperative that we study the potential mechanisms of resistance to immune checkpoint inhibition within the tumor microenvironment. Likewise, establishing biomarkers indicative of treatment resistance may benefit clinicians and patients when it comes to the initial selection of treatment. Moreover, biomarkers of resistance might also serve as potential drug targets. In this study we analyzed expression of TIGIT and GDF-15, …

Generative Artificial Intelligence In Clinical Decision Support - Quantitative And Qualitative Analyses, Niroop Rajashekar

Yale Medicine Thesis Digital Library

The application of artificial intelligence (AI) in medicine has the potential to enhance clinical practice. One area of active investigation is clinical decision support systems (CDSS) that supplement physician decision-making. While AI-CDSS development has accelerated, little is known about how physicians and medical students interact with these tools in simulated clinical environments. This study investigates how physician and medical student teams interact with a large language model (LLM)-augmented CDSS, GutGPT, designed to support the management of upper gastrointestinal bleeding (UGIB). GutGPT combines a risk-prediction machine learning model (with an interactive dashboard), trained on data from Yale New Haven Hospital, with …

Cutaneous Fungal Infections In The United States: A Cross-Sectional Analysis Of National Surveys, Sarah Lee Spaulding

Yale Medicine Thesis Digital Library

Superficial cutaneous fungal infections (SCFIs), caused by yeasts, dermatophytes, and nondermatophyte molds, are prevalent skin conditions with substantial economic and quality-of-life implications. This study aimed to evaluate trends in the prevalence of SCFIs in the United States between 2005 and 2016, using data from the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS).We performed a cross-sectional analysis of outpatient visits with SCFIs diagnoses, identified through the International Classification of Diseases, Ninth and Tenth Revisions, Clinical Modification (ICD-9-CM and ICD-10-CM). Diagnoses included conditions such as tinea unguium, tinea pedis, and candidiasis of the skin …

Prognostic Factors In Active Surveillance Of Low-Risk Prostate Cancer: A Future Of Tailored Surveillance, Vinaik Mootha Sundaresan

Yale Medicine Thesis Digital Library

PROGNOSTIC FACTORS IN ACTIVE SURVEILLANCE OF LOW-RISK PROSTATE CANCER: A FUTURE OF TAILORED SURVEILLANCE.

Vinaik M. Sundaresan and Michael S. Leapman. Department of Urology, Yale University, School of Medicine, New Haven, CT.

As most Prostate Imaging Reporting and Data System (PI-RADS) 5 lesions on MRI harbor Gleason grade (GG) group ≥2 disease on biopsy, optimal management of patients with imaging-biopsy discordance remains unclear. To estimate grade misclassification, we evaluated the incidence of Gleason upgrading among patients with GG1 disease in the setting of a PI-RADS 5 lesion.

We conducted a single-institution retrospective analysis to identify patients with GG1 prostate cancer …

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 …

Changes In Healthcare Coverage And Access To Eyecare Among Low-Income Adults After Medicaid Expansion, Elliott Vanderford

Yale Medicine Thesis Digital Library

Introduction: Access to quality eyecare is important for early diagnosis and prevention of vision loss. Understanding the role of Medicaid expansion (as a result of the Affordable Care Act) in improving eye health outcomes has the potential to guide health policy and address disparities in vision care in the United States. Here, we investigate the impact of Medicaid expansion on access to eyecare among low-income adults across the United States.

Methods: Survey data was extracted from the National Health Interview Survey (NHIS) for the years 2010 through 2018 for adults aged 18-64 years with a family income less than 125% …

Neighborhood-Level Variation In The Effectiveness Of And Participation In An Intensive Health Behavior And Lifestyle Treatment Program For Pediatric Obesity, Grace Wang

Yale Medicine Thesis Digital Library

Bright Bodies (BB) is a family-based intensive health behavior and lifestyle treatment (IHBLT) for pediatric obesity, with demonstrated efficacy and real-world effectiveness. Our study involved two aims: 1) to assess the extent to which real-world effectiveness varied by participants’ neighborhood characteristics, and 2) to evaluate the impact of the COVID-19-associated transition of BB to virtual delivery on participant engagement, particularly for those disadvantaged by inequities in social determinants of health. To achieve Aim 1, we included first-time BB participants 2008-2018 who had an initial BMI ≥85th percentile and available addresses. Addresses were geocoded using ArcGIS Pro and assigned a Child …

Macrophage Migration Inhibitory Factor And D-Dopachrome Tautomerase As Biomarkers And Key Modulators Of Tumor Progression In Head And Neck Cancer And Melanoma, Caroline Naomi Valdez

Yale Medicine Thesis Digital Library

Macrophage Migration Inhibitory Factor (MIF) and its homolog D-dopachrome Tautomerase (DDT) are pro-inflammatory cytokines implicated in tumor progression across multiple cancers. Both MIF and DDT act through canonical CD74 and non-canonical CXCR2/4/7 signaling pathways, which contribute to immune suppression and tumor progression. Elevated MIF levels are associated with metastasis and poor prognosis in HNC and contribute to immune checkpoint inhibitor (ICI) resistance in melanoma. DDT’s role in cancer is not well understood. This study aims to evaluate the expression and therapeutic potential of MIF and DDT inhibition, focusing on their ability to modulate immune responses and improve survival outcomes as …

Bipolar Disorder Among Individuals With Atopic Dermatitis: A Case-Control Study In The All Of Us Research Program, Mitchel Wride

Yale Medicine Thesis Digital Library

Background: Atopic dermatitis has been associated with psychiatric comorbidities.Objectives: To characterize the association between atopic dermatitis and bipolar disorder with a case-control study of the NIH All of Us Research Program. Methods: Utilizing Systemized Nomenclature of Medicine diagnostic codes, we identified cases of atopic dermatitis. Four age, sex, and race/ethnicity matched controls were found for each case using propensity score matching. After controlling for age, sex, race/ethnicity, income, smoking status, and depression, the relationship between atopic dermatitis and bipolar disorder was evaluated using logistic regression. Results: We identified 13,431 atopic dermatitis cases with 53,724 matched controls. Participants with atopic dermatitis …

Maternal-Infant Attachment, Depression, Anxiety, And Breastfeeding Self-Efficacy Among Marginalized Populations, Leslie B. Lantz, Merilyn Arikkat, Amy Salisbury, Sara Moyer, Sally Russell, Leroy Thacker, Candice Gault, Josselyn Valenzuela, Kimberly Cruz-Lopez, S Bodnar-Deren, Patricia Kinser

School of Nursing Publications

No abstract provided.

Private Property Vs. Public Access: Socio-Engineering Framework For Managing Non-Meandering Waters In South Dakota’S Prairie Pothole Region, Lydia Loken, Sushant Mehan

The Journal of Undergraduate Research

This study addresses the growing importance of balancing private ownership and public interest of Non-Meandering Waters (NMWs) overlaying private property in the South Dakota Prairie Pothole Region (PPR) through both a legal and socio-engineering lens. This study aims to develop an integrated management framework for Non-Meandering Waters in the South Dakota Prairie Pothole Region that combines water allocation principles, the Public Trust Doctrine, and water quality objectives to guide policy decisions, ensuring equitable access, long-term sustainability, and a balanced approach to both public and private interests. Data collection from October 2024 through February 2025 and included a literature review of …

Department Of English Newsletter, Winter 2024-2025, Illinois State University, Department Of English

Department of English Newsletter

Newsletter of the Illinois State University Department of English

Forecast, 2025, Illinois State University, College Of Applied Science And Technology

foreCAST

Magazine of the Illinois State University College of Applied Science and Technology

Repressed Memories And The Body Keeps The Score: Public Perceptions And Prevalence, Kris-Ann S. Anderson, Quincy C. Miller, Deryn Strange, Kamala London

Publications and Research

The “memory wars” resurgence has renewed debates over the validity of repressed memories. This revival appears linked to factors such as changing statutes of limitations, confusion about repression, and unchallenged social media content. In a nationally representative online survey of American adults (N = 1581), we examined (a) beliefs in repression and the body keeps the score, (b) the prevalence of recovered memory claims, and (c) the impact of question phrasing on recovered memory reporting. An overwhelming 94% of respondents expressed belief in repressed memory, and 77% endorsed the idea that the body keeps the score. Additionally, 3.6% (n = …

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 …

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 …

Multidisciplinary Approach To Reduce The Heart Failure Readmission Rate, Nisha Thekkedam

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: In the United States, 6.7 million adults have been diagnosed with heart failure (HF), a number projected to rise to 8.5 million by 2030. National data indicate a 30-day readmission rate of 18.2% among HF patients from 2010 to 2017. In Texas, around 12% of the Medicare population in Texas, and specifically 11% of the Medicare population in North Texas County, have been treated for HF. A North Texas hospital reports an 18-20% HF readmission rate over the past several years. Purpose: This EBP project included the implementation of a care bundle using the Dutch Heart Failure …

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 …