Digital Commons Network^™

Ask, Advise, And Act: A Smoking Cessation Bundle For Cancer Patients, Crystal Tencate

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Smoking is the number one cause of preventable illness and death in the United States. For patients undergoing cancer treatment, continued tobacco use poses serious risks. In surgical oncology, smoking is associated with poorer treatment outcomes, increased postoperative complications, delayed wound healing, and higher mortality. For patients requiring reconstructive surgery, smoking-related complications can be devastating, sometimes resulting in significant wound complications or loss of the reconstruction. Despite these well-established risks, smoking cessation interventions are not consistently integrated into clinical practice.

To address this gap, a quality improvement project was implemented to strengthen smoking cessation efforts among advanced practice providers (APPs) …

Ambient Listening: Using Artificial Intelligence To Transcribe Provider Office Visits, Odia Russette

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Electronic health record (EHR) documentation burdens contribute to increased “pajama time” or after–hours charting, reduced job satisfaction, and provider burnout. Provider burnout leads to provider and critical access point losses. Ambient–listening artificial intelligence (AI) technologies have emerged as a possible tool to reduce charting burdens; however, evidence from outpatient wellness settings remains limited.

Local Problem: At an urban adult wellness clinic in Texas with limited resources for completing tasks, in-clinic and after-hours “pajama time” charting burdens contributed to provider fatigue, job dissatisfaction, and burnout.

Methods: A quality improvement (QI) project using the Plan-Do-Study-Act (PDSA) framework implemented an AI ambient …

Improving Discharge Delays Through A Real-Time Durable Medical Equipment Tracking System And Enhanced Interdisciplinary Communication, Shonda Houston

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Timely hospital discharge is essential for patient safety, satisfaction and hospital efficiency. Discharge delays, particularly those related to durable medical equipment (DME), increase length of stay (LOS), strain hospital resources and negatively impact patient outcomes. Evidence suggests that structured discharge planning and improved interdisciplinary communication reduce these delays.

Problem: On an acute care stepdown unit inconsistent DME tracking and poor communication among nurses, case managers, physicians, physical therapist, and DME vendors were identified as contributors to prolonged patient stays.

Methods: Guided by the Iowa Model of Evidence- Based Practice a real-time manual DME tracking system and …

Inpatient Stroke Quality Improvement, Briyawna N. Wyatt

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Inpatient nursing documentation for stroke care is essential for meeting quality metrics, maintaining continuity, and supporting timely decisions. Gaps can lead to inconsistent care, metric failures, and reduced staff confidence. This quality improvement initiative aimed to improve metric compliance, documentation consistency, and nursing knowledge and satisfaction. A three-part intervention included targeted education, a standardized documentation verification form, and ongoing feedback from stroke champions. Outcomes measured were metric compliance, knowledge (pre/posttests), documentation completeness (Venous Thromboembolism (VTE), education, Modified Rankin Scale), and staff satisfaction. Results showed significant improvement in nursing knowledge (p < .005), reduced metric fallouts, and better documentation across all indicators. Staff satisfaction increased by about 20%. Overall, combining education, standardized tools, and continuous feedback improved documentation practices, enhanced compliance with stroke metrics, and increased nursing knowledge and satisfaction, supporting better care processes and patient outcomes.

Neighborhood Embeddings And Scalable Learning For Optimal Transport And Unbalanced Optimal Transport, Muhammad S. Rana

Mathematics Dissertations - Archive

Dimensionality reduction techniques are developed from the assumption that high-dimensional data often arises from low-dimensional structures embedded into the high-dimensional ambient space. Classical dimensionality reduction methods rely on the Euclidean distance, which may fail to capture the geometric structures of the datasets. This dissertation includes alternative metrics for dimensionality reduction techniques and challenges in applying these techniques.

First, we investigate the Wasserstein distance based neighbor embeddings for dimensionality reduction methods and compare the classification and clustering performance with the classical Euclidean based methods. The Wasserstein distance models the data as probability distributions and compares two distributions applying optimal transport (OT) …

Prevalence Of K13 Mutant Malaria Parasites In Busia, Uganda, Ahmed Elzamzami

Yale Medicine Thesis Digital Library

Artemisinin derivatives form the backbone of all antimalarial combination therapies usedworld-wide. Resistance to this critical drug class is a growing problem in the highest malaria transmission regions of the world. First detected in southeast Asia, independent mutations conferring partial resistance to artemisinin’s have now emerged in East Africa.27, 32 Retrospectively, these mutations have been detected as early as 2016 in Uganda.36 Previous work by the Parikh lab highlights the efficacy of 3-day vs 5-day artemether-lumefantrine treatment regimen for uncomplicated malarial episodes in Busia, Uganda in 2019.41 Infections were followed and classified as recrudescent, a reinfection, SBP1 slow clearing, or an …

An Exploration Of Student Approaches Towards Note-Taking In Medical School, Salah Eldein Elkattawy

Yale Medicine Thesis Digital Library

During medical school, students are exposed to a vast amount of knowledge they are expected to learn, understand, and apply to the care of patients. Various study strategies have been adopted by students over the years to facilitate this process, such as spaced repetition flashcards, the use of learning aids such as mnemonic devices, and the use of third-party resources to supplement their learning in the classroom. Instructors have also recognized the value in certain formats of classroom instruction, such as case-based learning or team-based learning, in keeping students more engaged and in reinforcing their learning in an interactive manner. …

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

Yale Medicine Thesis Digital Library

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

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

Yale Medicine Thesis Digital Library

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

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

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

Yale Medicine Thesis Digital Library

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

A Spatial Transcriptomic Atlas And Cellular Lineage-Based Analysis Of Chondroblastoma, Will Jiang

Yale Medicine Thesis Digital Library

Chondroblastoma is a benign primary bone tumor with controversial cellular origin. Although bearing the name “chondroblastoma”, this musculoskeletal tumor has faced controversy as to whether chondroblasts are chondrocytes. Moreover, its cellular composition can make it difficult to distinguish amongst its mimics including giant cell tumor of bone, chondrosarcoma, and chondromyxoid fibromas.

This thesis aims to characterize the transcriptomic expression atlas of human chondroblastoma to better define the gene expression profile and diagnostic expression markers of chondroblastoma. Secondarily, this thesis aims to identify the lineage progression and cellular composition of chondroblastoma using spatial and temporal patterning analysis.

Histologically confirmed samples of …

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

Yale Medicine Thesis Digital Library

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

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

Yale Medicine Thesis Digital Library

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

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

Frailty And Functional Decline After Elective Endovascular Abdominal Aortic Aneurysm Repair, Judy Li

Yale Medicine Thesis Digital Library

Background: Frailty can be used to estimate perioperative and long-term mortality risk in octogenarians undergoing elective endovascular abdominal aortic aneurysm repair (EVAR). Its association with functional decline, an important surrogate of quality of life in older adults, has not been well studied in this population. We aimed to evaluate whether preoperative factors such as frailty are associated with one-year functional decline after elective EVAR in octogenarians and to compare the performance of three different frailty assessments.

Methods: The Vascular Quality Initiative (VQI) database was queried for octogenarians who underwent elective EVAR for an asymptomatic infrarenal abdominal aortic aneurysm (AAA) (2014 …

"It Made Me Want To Get Into Healthcare Even More": A Simulation-Based Healthcare Mentoring Program, Jack Mccarthy

Yale Medicine Thesis Digital Library

The healthcare industry in the United States continues to experience rapid growth, yet workforce shortages persist across a wide range of medical professions. In order to increase the pool of qualified individuals pursuing healthcare, innovative strategies are needed to increase interest in healthcare fields among youth. Prior research has identified that healthcare career interest is driven in part by motivational characteristics including interest in math and science, self-efficacy, and social factors like the expectations of parents and caregivers. Mentoring, career exploration, and informal learning have been identified as strategies that increase student interest in and commitment towards healthcare careers. This …

The Deepfake Dilemma: Fake Images, Real Victims, And The Legal Void In Addressing Non-Consensual Deepfake Pornography, Elizabeth A. Safaryn

William & Mary Journal of Race, Gender, and Social Justice

This Note evaluates the various legal remedies available to victims of non-consensual deepfake pornography. As deepfakes are a relatively new but rapidly advancing technology, it is difficult for the law to keep up with the mass creation and distribution of AI-generated images on the Internet. With the competing interest of constitutionally protected speech, current deepfake laws fail to address non-consensual intimate image sharing (NCII) explicitly and lack the necessary deterrent effect to curb their proliferation. With an initial background on deepfakes and machine learning, this Note then explores the strained relationship between the First Amendment and the available civil remedies …

The New Transgender Tipping Point: Trumpism, Medical Necessity & Gender-Affirming Care, Molly J. Nunn

William & Mary Journal of Race, Gender, and Social Justice

Following the rise and eventual triumph of Trumpism 2024, President Donald J. Trump and his administration have sought to discredit the internationally recognized standards of effective health care practice for gender-affirming care. Now, ten years after Time Magazine published “The Transgender Tipping Point,” the political discourse of transgender identity is tipping again. Under the second Trump Administration, transgender identity sits at the edge of an abyss. Trumpism seeks to eradicate or significantly limit access to gender-affirming care through executive actions and the judiciary, despite the plethora of medical associations stating that that care is medically necessary. Public policies that widely …

The Role Of Prosecutorial Discretion In Criminal Immigration Matters, Brian L. Owsley

William & Mary Journal of Race, Gender, and Social Justice

If the Trump administration’s goal is to remove between fifteen and twenty million undocumented individuals, then it would be far more effective to reduce the incentive of American companies and employers to hire undocumented individuals. Therefore, from a prosecutorial perspective, the federal government should consider whether seeking to charge and prosecute individuals is the most effective approach, or whether they should redirect their effort to the individual’s employer.

In addition to employers engaging in criminal immigration offenses, for several years now, the federal government has notably ignored the action of one person engaged in the smuggling of over 100,000 undocumented …

Dad On Duty: The Potential Of Paid Parental Leave Laws, Laura E. Bates

William & Mary Journal of Race, Gender, and Social Justice

The United States is the only industrialized country in the world that does not guarantee its citizens paid parental leave. While the Family and Medical Leave Act provides some employees up to twelve weeks of unpaid leave, its limitations leave most American parents without adequate support. In the absence of a national paid parental leave system, states are stepping in, enacting laws that provide fully or partially paid parental leave. Private employers are also offering paid parental leave in increasing numbers. Despite these efforts, only 27 percent of private-sector American employees have access to paid parental leave.

Men taking paternity …

Decreasing Work-Related Stress And Burnout In Advanced Practice Clinicians, Laura Vasquez

Doctor of Nursing Practice (DNP) Scholarly Projects

Background

Advanced practice clinicians (APCs) face ongoing job-related stress and career burnout. Work-related stress and burnout affect healthcare quality, safety, and patient satisfaction, yet evidence specific to job-related stress and career burnout from outpatient medical facilities in the South Texas region remains limited.

Purpose

A quality improvement (QI) project was implemented to decrease work-related stress and burnout among APCs working in an outpatient medical facility in the South Texas region.

Methods

Project participants included family nurse practitioners (FNPs) (n=7) and physician assistants (PAs) (n=4). Data was collected between January 2026 and March 2026. An intervention was implemented which included engagement …

Export Controls As Intellectual Property Regulation, Doni Bloomfield

Faculty Scholarship

Export-control laws have long regulated information created outside of the U.S. government. Legal scholars have paid little attention to these national-security laws, and have not recognized that the government uses them specifically to assert a right to suppress information held in patent applications and trade secrets. In this Article, I present a new history of the relationship between export controls and intellectual property to show how the government regulates IP transfers, and how the state uses IP laws to national-security ends. Export-control laws regulate IP by controlling how people in the United States and beyond can share or use inventive …

Chapter 1 - Introduction And Overview, Anthony G. Amsterdam, Randy A. Hertz

Trial Manual for the Defense of Criminal Cases

This Trial Manual is a how-to-do-it guidebook for handling criminal cases from beginning to end. It provides a compact guide through the stages of an ordinary criminal case, from arrest and investigation to appeal. Its focus is upon the key points at which defense counsel must make decisions and take actions. Options and factors to be considered in each decision, and steps that can be taken to assert a client’s rights and protect the client’s interests at each stage, are laid out.

Table Of Contents, Anthony G. Amsterdam, Randy A. Hertz

Trial Manual for the Defense of Criminal Cases

TABLE OF CONTENTS
PART ONE: INTRODUCTION AND OVERVIEW (Chapters 1-2)
PART TWO: INITIAL STAGES OF THE CASE THROUGH ARRAIGNMENT (Chapters 3-16)
PART THREE: PROCEEDINGS BETWEEN ARRAIGNMENT AND TRIAL (Chapters 17-31)
PART FOUR: TRIAL (Chapters 32-46)
PART FIVE: POST-TRIAL (Chapters 47-49)

Chapter 6 - Interviewing The Client, Anthony G. Amsterdam, Randy A. Hertz

Trial Manual for the Defense of Criminal Cases

The first interview with a criminal client is probably the most important exchange that counsel will have with the client. It largely shapes the client’s judgment of the lawyer. Any initial impressions counsel makes may be indelible. At the least, this interview will strongly affect all future dealings between the two. The lawyer’s primary objective in the initial interview is to establish an attorney-client relationship grounded on mutual confidence, trust, and respect.

Chapter 6'S Interview Checklist § 6.15, Anthony G. Amsterdam, Randy A. Hertz

Trial Manual for the Defense of Criminal Cases

The following checklist covers most of what the lawyer will have to learn from a client in order to develop an effective defense at all stages of a criminal case from first contact through trial. It models a thorough interviewing process; more than a single interview will ordinarily be needed to gather all of the information it includes. When the charge is relatively minor, less extensive fact-gathering may be adequate. But counsel will do well to assume at the outset that all of the subjects flagged by this checklist need to be on the agenda; decisions to curtail coverage should …

Chapter 7 - Case Planning, Anthony G. Amsterdam, Randy A. Hertz

Trial Manual for the Defense of Criminal Cases

This chapter is designed to assist counsel in forming a plan of action and implementing it. Every case is unique in its facts and in the series of tasks that must be performed to prepare it for trial. But some generalizations are possible regarding techniques and considerations that can usefully guide counsel’s strategic planning. Section 7.2 describes a process for developing a theory of the case and explains the ways in which counsel can use the defense theory to guide the vital fact-gathering process (§ 7.2.2 infra), the selection and drafting of motions (§ 7.2.3 infra), and the actions that …

Chapter 3 - The Lawyer's Entrance Into The Case – First Steps, Anthony G. Amsterdam, Randy A. Hertz

Trial Manual for the Defense of Criminal Cases

Defense counsel may have occasion to enter a criminal case at almost any of the stages described in Chapter 2. In the early stages, at least, the crucial first steps to be taken are essentially the same. They are, in essence: (1) to make contact with the client, obtain the client’s authorization to represent him or her, warn the client against speaking with the police or others, and obtain information that counsel can use to seek the client’s release; (2) to speak to the investigating officer, find out whatever counsel can about the charges and the availability of release on …

Chapter 5 - State-Paid Assistance For The Defense: Obtaining State Funding For Counsel’S Time And For Defense Services, Anthony G. Amsterdam, Randy A. Hertz

Trial Manual for the Defense of Criminal Cases

As explained in § 2.3.4.2 supra, indigent defendants have a Sixth Amendment right to court-appointed counsel in all felony cases (Gideon v. Wainwright, 372 U.S. 335 (1963); Johnson v. Zerbst, 304 U.S. 458 (1938)) and on any charges of misdemeanors or petty offenses for which a term of imprisonment is going to be imposed as a result of conviction, “‘even for a brief period’” (Alabama v. Shelton, 535 U.S. 654, 657 (2002)), including cases in which the court imposes “a suspended sentence that may ‘end up in the actual deprivation of a person’s liberty’” (id. at 658) in the event …

Chapter 4'S Bail Questionnaire § 4.5, Anthony G. Amsterdam, Randy A. Hertz

Trial Manual for the Defense of Criminal Cases

The following questionnaire is designed principally for counsel’s use in obtaining from a client information pertinent to the amount of bail that should be set. Counsel can, however, easily convert the questionnaire into a form that can be notarized and submitted to a magistrate or judge in support of an application for bail in a manageable amount or for reduction of bail or for release on nominal bail or on recognizance, as is appropriate. Of course, caution must be observed not to use the form in this fashion if a client’s answers may supply incriminating information or investigative leads that …

Chapter 10 - Summary Of Things To Do Before First Court Appearance, Anthony G. Amsterdam, Randy A. Hertz

Trial Manual for the Defense of Criminal Cases

Contains "Checklist of Things to Do for an Arrested Client Between the Time of Arrest and the Client’s First Court Appearance" and "A Note on the Coroner’s Inquest and Similar Institutions."