This qualitative descriptive research study was conducted to understand nurses’ experiences caring for patients from communities of low income and low resources in hospital-based ambulatory clinics during the COVID-19 pandemic. Examination of the literature revealed research on the importance of ambulatory care nurses, their bond with the communities they serve, and the need for ambulatory settings for underserved communities. The review also explored the fierce strike of the COVID-19 pandemic on these communities and the social justice implications of serving low-income and low-resource patients. No literature was found on this specific dissertation topic: ambulatory nurses’ experiences working in underprivileged communities during the COVID-19 pandemic. The sample used for this study consisted of 25 registered nurses who worked in ambulatory settings during the inception of the COVID-19 pandemic. In particular, the time period spanned February 2020 through the end of June 2020. The communities consisted of poorly resourced neighborhoods. The narrative description and accounts of nurses interviewed for this study will facilitate an understanding of nurses’ experiences caring for patients from communities of low income and low resources in hospital-based ambulatory clinics during the COVID-19 pandemic. The researcher used a qualitative methodology, qualitative descriptive, to frame the stories. Qualitative content analysis methods, specifically thematic analysis, were used to understand the nurses’ reflections and experiences. Roy’s Adaptation Model (RAM) was the theoretical framework to guide the open-ended interview questions. The researcher developed questions based on the four modes of RAM: the physiologic mode, the self-concept mode, the role function mode, and the interdependence mode. Thematic analysis was used to identify themes from the interview transcripts. A thematic analysis strategy is an approach used to identify and analyze patterns of meaning from interview data (Braun & Clarke, 2006). A thorough overview was made of all the data, including initial notes. The notes were obtained by reading and rereading the transcripts and highlighting interesting phrases or statements called meaningful units. These units were then compiled into sub-themes, and ultimately themes were comprised after highlighting parts of the transcripts that generated similar content. Themes were developed by identifying patterns among meaningful units and data relevant to each theme. Themes were then reviewed to ensure they accurately represented the data after highlighting, constant review, and compounding them in meaningful units that identified and generated the final set of themes. The researcher developed and kept reflexive journal notes, which were reviewed constantly throughout the study to maintain best-practice qualitative methodology (Ortlipp, 2008). The thematic analysis revealed multiple themes. The themes discovered were crying, protector vs. moral distress, resilience vs. compassion fatigue, family vs. bereavement, and self-concept vs. self-care. An overarching theme of struggle was also manifested within this research.

Despite decades of research on school effectiveness and improvement, we continue to struggle to support school improvement at scale. I suggest this is in part due to methodological and theoretical limitations of the extant literature: While there is a growing consensus that leaders should “diagnose” school improvement needs to devise contextually appropriate improvement strategies, no empirical guidance exists to support how to make such diagnoses or which strategies to employ given contextual variation. I address this gap through a mixed methods analysis of how schools with varying improvement capacity at the onset of the COVID-19 pandemic in New York City adapted and learned in response to the pandemic’s challenges. While the COVID-19 pandemic has presented school and district leaders with a more extreme context in which to confront a central problem that has confounded educational researchers and practitioners for decades: How can school and district leaders build the improvement capacity that will enable them to continuously meet the needs of all students in all schools? There are five key findings of the present study. First, using Latent Transition Analysis (LTA), I identified six statistically significant subgroups among all New York City elementary, middle, and high schools serving students in grades 3-8 (n=1225) based on teachers’ perceptions of school improvement capacity. I further described the relationship between this typology and school contextual covariates and student outcomes, depicting the types of schools that are classified in each subgroup and the relationship between subgroup classification and academic outcomes. Second, I demonstrated how teachers’ perceptions of school capacity varied from 2017-2019 and further identified a differential relationship between principal turnover and school improvement trajectories. Third, I found strong qualitative support for the quantitative typology, describing alignment between teachers’ and leaders’ lived experiences of school improvement and change and the quantitative typology and trajectories with one key exception: those schools that experienced a leadership transition after 2019 were most likely to have experienced dramatic change. Fourth, I found teachers’ and leaders’ perceptions of challenges associated with the COVID-19 pandemic varied, in part, as a function of their improvement capacity at the onset of the pandemic. Respondents in schools from high-capacity subgroups were more likely to view pandemic challenges as easy to overcome, while respondents in schools with minimal improvement capacity were more likely to be overwhelmed by the multiple, compounding challenges they faced during the pandemic. Finally, I found key differences in the strategies schools employed to adapt and learn in response to these challenges, which again, varied based on their improvement capacity when the pandemic hit. Together, these findings provide support for a theory of differentiated school improvement.

This dissertation consists of three essays. Each one seeks to add in the understanding, in a small way, of the factors that contribute to the development of societies. The first chapter explores the decisive facts of technological advancements and the ability of trade to shape incentives to create new techniques destined for the open markets. The second chapter examines the electoral consequence of having a conservative biased source of information and its effects on the desired ideology of representatives. The third explores how using violence, illegal groups can reach their population control goals in their territories. These three chapters seek to answer history, and power relations between different groups determine societies' paths. In the first chapter, I study how access to international markets affects the direction of technical change. I use a historical trade shock that transformed the Spanish textile industry at the end of the 19th century. After Spain effectively forced its colonies to buy manufactured cotton goods in 1891, I document an increase in cotton textile innovation relative to other fabrics. After the colonies' independence in 1898, the difference in textile innovation between cotton and different fabric remained significant. This shows that innovation exhibits a path dependence even without the initial conditions that motivated the increase. I provide price evidence of the strength of the technical change indicating that the rise in relative prices of cotton fabrics boosted the rise in cotton innovation. Together, these results provide some of the first causal evidence on how international trade and foreign markets shape the direction of the technical change. Even more, I show that innovation is possible in peripherical countries. Conditions outside the technological leaders determined the incentives of local innovators to develop technologies needed for those local conditions. In chapter 2, written with Haaris Mateen, we study how the introduction of a biased local TV operator affects electoral results. We use Sinclair Broadcasting Group's (SBG) staggered expansion over 2012 and 2017. This is the largest TV operator in the United States and is known for its conservative slant. We find that in areas exposed to SBG biased news coverage in local TV stations the electoral results experienced changes compared to places where the company did not penetrate. First, we find that penetration of SBG decreased the likelihood of a third-party candidate in the House of Representatives elections yet increased the probability of having a republican candidate as the winner of the seat. On the other hand, in the presidential elections after SBG penetration, the republican party was harmed, and its candidate received fewer votes, thanks to an increase in the voting of third parties. Second, when analyzing the ideology of the winner of the local election, we document a movement to the right, partially motivated by an increase in the probability of electing a conservative republican as representative. Finally, when looking at the mechanism that explains these effects, we find no movements on the democrat candidates but changes towards the right on republican candidates. In those areas affected by SBG, the republican candidate had a more significant likelihood to be conservative and not moderate. Evermore, those republican candidates had an increase in the donations coming from PACs. Together, these results prove that media have differential impacts on the election. It can affect beyond the voters' preferences, and it also affects the decision of which type of candidates run on local electoral races. In chapter 3, together with Diego Martin, we study how non-state actors enforce stay-at-home orders to reduce COVID-19 cases. We argue that Colombian-illegal groups used massacres to enforce social distance rules. Massacres are attacks killing at least three defenseless civilians in one operation. We estimate the effect of those violent events using a synthetic control method. To rule out the channel of massacres for other reasons such as coca production, we compare sub-regions with low conflict before the pandemic and where coca is not suitable for growth. We find that places with massacres reduced the pandemic outbreak by 70 cases per 100.000 inhabitants per week after the second month. We show that the principal channel that explains our results is a reduction on mobility indexes. The first massacre decreased infection levels by reducing individuals' mobility at workplaces. Finally, we show that young population groups experienced the earliest reduction in infection rates, while the old group has the highest decline in infection rates after massacres.

Home-based child care providers, including regulated family child care (FCC) providers, have long been the backbone of caregiving in the United States. Throughout the 21st century, federal and state governments have endeavored to enhance the quality of early childhood education and care (ECEC) programs to realize promising impacts on child development and learning, such as through investments in creating quality rating and improvement systems (QRIS). However, QRIS often have center-centric standards, are focused more on structural aspects of programs than caring and teaching processes, have demonstrated limited associations with child outcomes, and struggle to engage FCC providers. As federal and state governments move to incorporate FCC providers more deeply into ECEC systems in the wake of the COVID-19 pandemic, this study explores the components of quality that 169 FCC providers across four states value and how a (mis)alignment in these priorities may relate to their engagement in QRIS. This mixed method study mobilizes institutional and reconceptualist theories to explore how FCC providers adopt and resist institutionalized visions of ECEC quality that largely privilege white, Western, and center-centric perspectives. Findings indicate that FCC providers hold varied perspectives on what makes their programs great. Some providers’ perceptions of quality emphasized more structural and symbolic elements aligned with normative ideas of quality, while other providers’ perceptions balanced professional ideals about things like child-centered pedagogy and skill development alongside a focus on fostering loving, family-like, and culturally sustaining relationships with children and their families. While most providers shared at least one component of quality with their state’s QRIS standards (most often related to pedagogy), they also felt that QRIS and other policy systems placed too much emphasis on more structural and bureaucratic elements of their programs instead of on their relationships with children and families. While a few providers felt genuinely engaged in and satisfied with their QRIS, others faced challenges, intentionally stayed at lower rating levels, or dropped out of the QRIS entirely. Findings from this study have implications for creating more culturally and contextually responsive visions of quality, QRIS standards, and ECEC systems in the United States, all of which can be more attuned to the strengths and needs of children, families, and the FCC providers that care for them.

Understanding “all policy is health policy,” this dissertation explores Black people’s healing and wellbeing with an abolition mindset. Through the lens of arts and culture in public health, the title denotes a pursuit of “healthful narratives” with ethical storytelling, creating, and performing that is conducive to good health. It manifests as public health dreaming in the midst of COVID-19 and state-sanctioned violence resulting from colonialism and racial capitalism—which contribute to racial hierarchies and millions of cross-generational deaths. This mixed-methods study contemplates the future of health promotion with concern for honoring Black creativity’s role in population health, and reckons with racial capitalism as foundational to health inequities and preventable, premature death. The study asks 1) What socio-cultural pathways do or can exist for theatrical and performance productions for health promotion? 2) In the face of racial, gendered capitalism, how does creativity manifest for Black women and/or gender-expansive people when creating or performing art and cultural work related to health promotion goals? Merging arts and culture into traditional public health infrastructure further exacerbates anti-Black harm, because it risks history repeating itself as our contemporary reality. As practice-based evidence, my Black Feminist Performance Auto/ethnography is research-engaged theatre, accompanied by learnings from research partners practicing contemplative arts-based research methodology. The findings are GriefLove, co-conceived with Des Bennett (director and dramaturg), and a narrative analysis of collage-based health mosaics and definitions of healthful narratives as forecasts of community-driven public health dreaming. The final chapter presents three socio-cultural pathways: “Black Embodiment,” “The Aesthetics of Health,” and “Futurity.” In the spirit of healthful narratives, it closes with a letter to Black Public Health Creatives and Cultural Workers in service of cultural and health equity—markers of “Good Health.”

Nurses have been on the front line of the COVID-19 pandemic and experienced direct impacts over the last few years. Many encountered additional stressors of isolation from loved ones and the challenges of parenting school-age children. Additionally, due to the recent and significant departure of nurses from bedside nursing, there has been greater need for remaining nurses to precept new staff coming into the hospital. Some nurses assumed a preceptor role in addition to their direct care responsibilities. It has been reported that combined home and work-life burdens put nurses at higher risk of burnout, resulting in poor health outcomes and increased depression, anxiety, and stress. Mindfulness meditation is an evidenced-based tool to help acknowledge surroundings and to help to lower or decrease perceived stress. A randomized controlled design with a two-group pretest-posttest was used to evaluate the impact of a mindfulness smartphone application on the perceived levels of burnout, stress, anxiety, depression, and mindfulness of nurses. After taking a pretest, participants were randomized to either a waitlist control group or an intervention smartphone group. The waitlist group did not have any intervention during the 30 -day study period. The intervention group was asked to complete sessions via a smartphone mindfulness app for 30 days. The instruments used in this study were the Maslach Burnout Inventory (MBI), Depression, Anxiety, and Stress Scale 21 questions (DASS-21), Mindfulness Attention Awareness Scale (MAAS), and the Mobile Device Proficiency Questionnaire 16 questions (MDPQ-16). This dissertation includes three reports based on the same dataset. The first report analyzed the effects of a smartphone mindfulness application on burnout in nurse preceptors. Results of the study indicated that a smartphone application can reduce burnout in the subscales of Personal Accomplishment and Depersonalization but not in Emotional Exhaustion. The second report examined the impact of a smartphone mindfulness application on scores of depression, anxiety, and stress of nurses. The study results indicated a significant improvement in the smartphone application group compared to the waitlist group for the variables of depression and stress. The third report evaluated the impact of the smartphone mindfulness application on the mindfulness levels of participants and the relationship between their technology proficiency to their interaction with the application. The smartphone group's mindfulness scores increased significantly compared to the waitlist group. However, mobile proficiency was not significantly related to the participants’ use of the mindfulness application. The findings of this study indicate that the use of a smartphone application can effectively increase mindfulness when used by nurses at the bedside. The smartphone mindfulness app also showed potential benefits in reducing self-perceived levels of several aspects of burnout, depression, and stress in nurses. Hospitals could choose to embed mindfulness principles into the hospital environment's culture or provide staff opportunities to practice mindfulness through a smartphone application during the day. Such mindfulness may decrease the consequences of burnout, which include increased nurse turnover, decreased quality of care, and high costs of recruiting and training new nurses. Further research is needed to study the long-term impact of using the smartphone application and the time required daily to show results

The COVID pandemic led to a sudden expansion of telehealth in the delivery of nursing services. At the same time, nursing education was forced to extend clinical learning to online approaches. However, telehealth clinical experiences are limited in the nursing curricula of entry-level programs. Nursing simulation is an educational activity that prepares students for clinical practice by supporting the learning of fundamental clinical competencies. This study was designed to explore prebriefing methods for simulation to prepare entry-level nursing students for telehealth patient care visits. Standardized patient (SP) methodology was used to simulate a telehealth video conferencing call for an infectious disease case interview. Simulations were conducted remotely using Zoom technology with breakout rooms adhering to Healthcare Simulation Standards of Best PracticeTM, and informed by NLN Jeffries Simulation Theory and Experiential Learning Theory. The experiment compared two different methods for prebriefing: traditional prebriefing with a narrated script and structured prebriefing with a narration script plus learners viewed a role modeling video and participated in guided reflection. Participants from one private university in the Northeast (N =126) were randomized and simulations took place over one semester. In conclusion, the standardized patient simulations were an effective teaching strategy for developing fundamental telehealth skills of therapeutic communication and confidence with patient safety. Learners in the structured prebriefing group had significantly higher scores for confidence in quality and safety, faculty assessed therapeutic communication, and simulation effectiveness. There were significant improvements of therapeutic communication scores over time for both groups, but there were no differences between groups. Future research might extend the explanations of how to best prepare learners for telehealth experiences; it is important to further explore telehealth clinical competencies with entry-level nursing students.

This thesis titled ``Essays in Private Capital" comprises of three essays focused on various parts of private capital. Private capital, also known as alternative assets are non-traded, broadly defined as private equity, real estate, venture capital, hedge funds, infrastructure and natural resource investments. The first chapter studies private equity, the second focuses on residential real estate, and the third is on commercial real estate. These are important asset classes given the low interest rate environment, and the recent COVID-19 and Silicon Valley Bank crisis which had large exposures to private assets. The first essay titled ``Desperate Capital Breeds Productivity Loss: Evidence from Public Pension Investments in Private Equity" studies investor heterogeneity in private equity and its ultimate effect on target firms. Using novel micro-data on individual investments in private equity funds funds and buyout deals combined with confidential Census data, I show that capital contributed by the most underfunded U.S. public pensions decreases efficiency at target firms, as pensions fuel the growth of low quality, new entrant private equity funds. These results get stronger post the financial crisis, when underfunded positions and their subsequent investments in private equity increased. The paper shows that traditionally positive post buyout efficiency results turn negative in recent years, as marginal investors matching with marginal private equity funds pull down the average. The most underfunded pensions also realize lower total private equity returns relative to the least underfunded ones. These results suggest possibility of a ``funding doom loop" as currently public pensions use assumed return on assets to calculate liabilities. The second essay titled ``Flattening the Curve: Pandemic-Induced Revaluation of Urban Real Estate" focuses on work from home with the onset of the COVID-19 pandemic and its effect on residential real estate prices across the U.S. We show that the COVID-19 pandemic brought house price and rent declines in city centers, and price and rent increases away from the center, thereby flattening the bid-rent curve in most U.S. metropolitan areas. Across MSAs, the flattening of the curve is larger where working from home is more prevalent, housing markets are more regulated, and supply is less elastic. Using a model predicting future residential price and rent evolution, we show urban revival in housing markets for the foreseeable future with urban rent growth exceeding suburban rent growth, as working from home recedes. In the third essay titled ``Work From Home and the Office Real Estate Apocalypse", we show remote work led to large drops in lease revenues, occupancy, lease renewal rates, and market rents in the commercial office sector. We revalue New York City office buildings taking into account both the cash flow and discount rate implications of these shocks, and find a 39% decline in long run value. For the U.S., we find a $413 billion value destruction. We show evidence of flight to quality, as higher quality buildings are buffered against these trends, while lower quality office is at risk of becoming a stranded asset. These valuation changes have repercussions for local public finances and financial stability.

The primary focus of this thesis is on the causes and macroeconomic implications of inequality. The first two chapters of this thesis concern firm size (measured by sales) inequality. The rise in inequality in the upper tail of firm size distribution has important macroeconomic implications on the product market, the labor market and aggregate productivity growth. In Chapter 1, I seek to understand how acquisition and innovation drive the rise in the upper tail firm size inequality. This question is motivated by the fact that as top firms pull increasingly farther from the rest of the firms, they did not grow into superstar firms on their own. I construct a new dataset to track the dynamic ownership of firms and their patents to identify the mechanisms through which acquisitions drive the growth of the acquiring firms via innovation. I then examine the implications of these innovation mechanisms on upper tail firm size inequality — in terms of both stationary distribution and transition dynamics — using a range of firm random growth models. In chapter 2, I study what do changes in top sales shares signal about changes in large firm dynamics. I use an accounting decomposition to identify two sources of top sales shares growth: (i) incumbent top firms grow bigger; (ii) new top firms replace old top firms. I then build a continuous-time random growth model to infer the growth dynamics of firms at the upper tail of firm size distribution. In Chapter 3, in collaboration with Tam Mai, Istudy the implications of occupational and regional inequality on the labor market after the breakout of the COVID-19 pandemic.

This study examined the differences in racial groups across perceived stress and perceived disruption during the COVID-19 pandemic among undergraduate and graduate students at a Northeastern Predominantly White Institution (PWI). The sample consisted of 268 students who completed a Qualtrics survey measuring perceived stress, perceived disruptions during COVID-19, symptoms of anxiety and depression, motivation approach and sustained attention in addition to demographics. Results indicated a significant difference in disruption as reported by Non-Hispanic White students with more sources of disruption than non-White and Hispanic students. When rating the extent of disruption, non-White and Hispanic students reported significantly greater levels of disruption. While there were no significant differences between racial groups in reports of perceived stress, all racial groups reported moderate levels of perceived stress, consistent with other researchers in the pandemic. Increased levels of perceived stress were correlated to higher levels of symptoms of depression and anxiety, greater difficulty sustaining attention and a stronger likelihood of using both prevention and promotion approaches. Those with lower economic circumstances reported higher levels of anxiety, greater difficulties sustaining attention, and were more likely to be motivated to not fail. Graduate students demonstrated significantly higher symptoms of anxiety than undergraduates and international students were more likely to be motivated to not fail than domestic students. These results demonstrate a need for university wide support to address student stressors.