Digital Commons Network^™

Improving Asthma Management In Schools: A Comprehensive Approach To Education, Environmental Enhancements And Asthma Action Plans, Yesenia Trevino

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Abstract

Introduction

Asthma contributes to school absenteeism, especially in underserved communities. This project aimed to enhance asthma management at a South Texas elementary school through staff and student education, monthly air filter changes, and personalized Asthma Action Plans (AAPs).

Methods

A quality improvement project at a South Texas elementary school involved 40 asthmatic students over eight weeks, using the Plan-Do-Study-Act (PDSA) framework. It included staff and student education, air filter maintenance, and facilitation of Asthma Action Plans (AAPs). Pre/post surveys, custodial logs, AAP audits, and attendance were analyzed, with paired t-tests used to assess changes (N=32).

Results

There was 71.9% …

Starting Strong: Improving Mmr Vaccination Rates In Kindergartners, Regina Bryan

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Abstract

Introduction

During the 2023–2024 academic year, measles, mumps, and rubella (MMR) vaccination coverage among kindergarten students in this school district did not meet the Healthy People 2030 target, thereby elevating the risk of disease outbreaks. This quality improvement project aimed to improve MMR vaccination initiation and completion through coordinated, school-based interventions.

Methods

Guided by the Plan-Do-Study-Act framework, an eight-week immunization bundle was implemented across 14 elementary schools in South Texas. Interventions included reminder calls, multilingual education, districtwide communication, and a partnership with a nonprofit clinic that provides free or reduced-cost vaccines through on-site and community clinics. Pre- and post-intervention …

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 …

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.

Empowering Patient Engagement In Effort To Reduce Readmissions, Derinda Hugaboon, Msn, Rn

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Hospital readmissions among Medicare beneficiaries remain a major quality concern and are often associated with social determinants of health (SDOH) and care transition gaps. Targeted discharge interventions that address self‑management needs and follow‑up barriers may reduce avoidable readmissions. Objective: To reduce readmissions by implementing a bundled intervention addressing social determinants of health (SDOH), care‑transition gaps, and inadequate post‑discharge primary care follow‑up. Methods: Medicare Advantage (MA) members aged ≥45 were included. A total of 249 members accounted for 275 overall admissions during the project period; 191 admissions (69.5%) received at least one intervention component (informational discharge packet, face‑to‑face encounter, and/or …

A Questionnaire Assessing Attitudes And Readiness For Hiv Pre-Exposure Prophylaxis Therapy For Community Members At-Risk For Hiv Acquisition In Liberia, Yishak Bedaso

Yale Medicine Thesis Digital Library

AbstractA Questionnaire Assessing Attitudes And Readiness For HIV Pre-Exposure Prophylaxis Therapy For Community Members At-Risk For HIV Acquisition In Liberia Yishak Bedaso;1 Jessica Tuan, MD, MS;2 Yassah M. Barclay-Korboi;3 Onyema Ogbuagu MBBCh, FACP, FIDSA4 Affiliation: 1. Yale School of Medicine, New Haven, CT, USA 2. Columbia University Vagelos College of Physicians and Surgeons, Department of Infectious Diseases, New York, NY, USA 3. JFK Memorial Hospital, Monrovia, Liberia. 4.Yale Antivirals & Vaccines Research Program, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA; Despite how effective Pre-exposure prophylaxis (PrEP) is in preventing HIV, uptake among women in sub-Saharan …

Estimating Prep And Voluntary Medical Male Circumcision Prevalence In Three High Hiv Burden Countries, Rose Grace Bender

Yale Medicine Thesis Digital Library

Understanding the impact of specific biomedical interventions is crucial for optimizing HIV prevention strategies. In this study, we estimate of the prevalence of voluntary medical male circumcision (VMMC) and lay out a framework for estimating preexposure prophylaxis (PrEP) in the three high-burden sub-Saharan African countries of Malawi, South Africa, and Zimbabwe. For VMMC, we use a cohort-based simulation framework to model circumcision prevalence in all males over time, allocating VMMC count data to cohorts over time. Model outputs are compared with survey and campaign data, and two parameters, the initial background circumcision prevalence and the age distribution of VMMC procedures, …

Epidermal Differentiation Disorders Across The Lifespan: Growth, Ophthalmologic, And Perinatal Manifestations, Caroline Echeandia-Francis

Yale Medicine Thesis Digital Library

Epidermal differentiation disorders (EDDs) are a heterogeneous group of inherited skin diseases characterized by impaired epidermal barrier function, scaling, and erythema. Although substantial progress has been made in identifying the genetic causes of EDD, long-standing clinical observations—including impaired growth, ectropion, and increased rates of preterm birth—remain poorly characterized across genotypes. The prevalence, severity, and clinical significance of these manifestations have not been systematically evaluated in large, genotype-stratified cohorts, limiting the ability to provide anticipatory guidance and tailored clinical care. This thesis seeks to (1) characterize growth trajectories in children with EDD and determine genotype-specific patterns of growth impairment; (2) assess …

Regional Inequities In Colon Cancer Surgical Care: Treatment Delay Patterns Across U.S. Facilities, Rushabh Hemang Doshi

Yale Medicine Thesis Digital Library

AbstractBackground/Scientific Premise: Colon cancer represents a significant public health burden in the United States, ranking as the third most common and second deadliest cancer. Timely surgical resection is critical for optimal survival in non-metastatic disease, yet persistent racial, insurance, and geographic disparities in access to care may contribute to treatment delays. While treatment delay has been established as a critical quality metric, regional variation in surgical delays for colon cancer and how patient-level disparities manifest across different U.S. regions remain poorly understood. Understanding these geographic patterns is essential, as healthcare systems, patient populations, access barriers, and state-level policies differ substantially …

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 …

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 …

Repurposing Ezetimibe As A Therapeutic For Parkinson's Disease: Evaluating The Therapeutic Potential And Probing For A Mechanism, Brian Hilton

Yale Medicine Thesis Digital Library

Neurologic disease is the leading cause of disability globally and Parkinson’s disease (PD) has been the fastest growing neurologic brain disease over the last several decades. Despite the immense burden of PD on patients and society, there has yet to be an efficacious disease-modifying therapy. Investigation of candidate pharmaceuticals that have already been approved by the FDA for other conditions might provide an expedited path to the advent of disease-modifying therapy. There is a rich history of drug repurposing for symptomatic therapy for PD, with amantadine as the preeminent example. In order to identify candidate therapeutics for possible repurposing, an …

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 …

Trends, Predictors, And Cerebrovascular Outcomes Of Vertebral Artery Injury In Cervical Fractures, Rahul Jayaram

Yale Medicine Thesis Digital Library

Background and Scientific Premise: Cervical spine trauma is a common emergencydepartment presentation, and vertebral artery injury (VAI) is a potentially occult but serious complication associated with posterior circulation stroke. Identification of patients at risk remains challenging due to subtle presentations, variable screening practices, and limited prior data. Research Aims: The aims of this study were to characterize temporal trends in VAI detection among adult patients presenting to the emergency department with cervical spine fractures between 2010 and 2022, identify independent demographic, clinical, and injury-related predictors of VAI, and evaluate the association between VAI and ischemic stroke within ninety days of …

Prevalence, Predictors, And Consequences Of Postoperative Dysphagia After Aortic Surgery, Andrew Joseph Johnson

Yale Medicine Thesis Digital Library

Prevalence, Predictors, and Consequences of Postoperative Dysphagia After Aortic SurgeryAndrew Johnson and Ronny Munoz-Acuna, M.D., Department of Anesthesiology, Yale School of Medicine, New Haven, CT 06510. Abstract Background: Postoperative dysphagia is an underrecognized complication following cardiothoracic surgery and is associated with aspiration, prolonged hospitalization, and adverse clinical outcomes. Patients undergoing complex aortic surgery may be at particularly high risk due to prolonged mechanical ventilation, extensive airway instrumentation, and neurologic vulnerability. Data describing the prevalence, predictors, and clinical consequences of postoperative dysphagia in this population remain limited. Research Aim: This study consisted of three aims: first, to determine the prevalence and …

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 …

Tone Matters: Advancing Equity Through A Pilot Intervention To Increase Exposure Of Clinical Findings In Skin Of Color, Lamley Amanuah Lawson

Yale Medicine Thesis Digital Library

Background: The ability to accurately recognize cutaneous manifestations of disease is a foundational clinical skill. However, current undergraduate medical education heavily relies on lighter skin tone prototypes, leaving trainees underprepared to diagnose conditions in patients with melanin-rich skin.Research Aims: This study aimed to evaluate the efficacy of a brief, targeted, visually comparative digital intervention by measuring its impact on medical students' immediate diagnostic accuracy and self-reported clinical confidence in identifying dermatologic conditions across a diverse range of skin tones. Hypothesis: We hypothesized that a brief, targeted digital educational intervention featuring side-by-side visual comparisons of dermatologic conditions across a range of …

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 …

Neurophysiologic Responses To Endovascular Interventions For Delayed Cerebral Ischemia Management, Rafael Seth Maarek

Yale Medicine Thesis Digital Library

Background/Scientific Premise: Delayed cerebral ischemia (DCI) continues to be a leading cause of poor outcomes in hospitalized aneurysmal subarachnoid hemorrhage (aSAH) patients. In addition to cerebral vasospasm, a growing constellation of pathophysiologic processes has been implicated in the development of DCI, including impaired autoregulation, micro-thrombosis, inflammation, and cortical spreading depolarizations. However, management options for patients showing signs of emerging DCI have largely remained spasmolytic in nature, and it remains unclear if reversing cerebral vasospasm in patients with signs of emerging DCI will reliably improve underlying neurophysiology. To our knowledge, no group has reliably shown postprocedural improvements in quantitative EEG metrics …

"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 …

From Advocacy To Inaction: Paradoxes Of The United States And The Convention On The Rights Of Persons With Disabilities, Elizabeth W. Raymakers

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

This Note utilizes an analytical lens to consider why the United States never ratified the Convention on the Rights of Persons with Disabilities (CRPD). The Note first establishes the history of the CRPD and turns to the history of attempted ratification by the United States. By examining the legislative history of the Convention, as well as the U.S. engagement internationally leading up to and subsequent to the ratification attempts, this Note establishes a more nuanced understanding of the United States’ stance on the CRPD. Subsequently, by applying an analytical framework intended to identify manifestations of support for aspects of international …

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 …

Sauce For The Gander: The False Symmetry Of Myths And Stereotypes Against The Accused In Sexual Assault Trials, Janine Benedet

Dalhousie Law Journal

As sexual assault laws evolved to be expressed in sex-neutral language, so too have arguments relating to myths and stereotypes in the context of sexual offences. This article evaluates the argument that myths and stereotypes, traditionally a reflection of systemic discrimination against female complainants in rape trials, also operate against male accused. Understood correctly, this trend repackages anti-feminist backlash to early equality reform efforts, ultimately working to revive the belief that women’s accusations of sexual assault are often false. The Supreme Court of Canada’s decision in R v Kruk affirms that this historical context matters when it comes to claims …