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"I Viewed Them Sick": Photography And Addiction Medicine As Activism During The "Speed Freak" Crisis Of The Long 1960s, Hannah Zornow Alter

Yale Medicine Thesis Digital Library

“Speed freak” was a pejorative term that emerged in the late 1960s to describe young people who binged on amphetamines, often by injection. The accessibility of amphetamines during the 1960s and early 1970s coupled with the emergence of a radical youth movement produced this distinctive subculture. This thesis will address responses to this drug crisis in two parts, from the perspective of two activists working in very different fields. In 1971, Larry Clark, a photographer, and David Smith, a physician, each published their seminal works on “speed freak” culture. Separated by half a country, they had enmeshed themselves in communities …

Simulation-Based Nurse Mentoring To Promote Preeclampsia Care: What Is The Impact In Bihar, India?, Julia Haven Raney

Yale Medicine Thesis Digital Library

Background:

Inadequately treated, severe preeclampsia and eclampsia (PE/E) may rapidly lead to severe complications in both mothers and neonates and are estimated to cause 60,000 maternal deaths globally each year. Simulation-based training where health providers review basic emergency obstetric and newborn care through highly realistic cases have demonstrated promising results in low- and middle-income countries (LMIC). Two international simulation training programs, Helping Mothers Survive and PRONTO International, have demonstrated improved overall use of evidence-based practices (EBPs) in active management of third stage of labor and hemorrhage management, though individual skills varied. However, the impact of simulation training on use of …

Altered Brain Functional Connectivity Varies By Form Of Craniosynostosis, Alexander Haosi Sun

Yale Medicine Thesis Digital Library

This study uses functional MRI (fMRI) to study long-term neurocognitive sequelae of nonsyndromic craniosynostosis (NSC), and understand if these aberrations vary by form of synostosis. Twenty adolescent participants with treated NSC (10 sagittal (SSO), 5 right unilateral coronal (UCS), 5 metopic (MSO)) were matched to controls by age, gender, and handedness. A subgroup of MSO was classified as severe metopic synostosis (SMS) based on the endocranial bifrontal angle. Resting-state fMRI was acquired in a 3T Siemens TIM Trio scanner, and data was motion- corrected, cluster-corrected with nonparametric permutation tests, and analyzed with BioImage Suite. SSO had decreased intrinsic connectivity compared …

Photodynamic Therapy For Cutaneous Squamous Cell Carcinoma In-Situ & Mutation Burden Analysis, Yuemei Zhang

Yale Medicine Thesis Digital Library

PHOTODYNAMIC THERAPY FOR CUTANEOUS SQUAMOUS CELL CARCINOMA IN-SITU & MUTATION BURDEN ANALYSIS. Yuemei (Amy) Zhang, Mei Zhong, Haifan Lin, and Sean Christensen. Department of Dermatology, Yale University School of Medicine, New Haven, CT.

SCC in-situ (SCCIS), or Bowen’s disease, is a precursor to invasive squamous cell carcinoma (SCC) of the skin. Compared to other available treatment modalities, photodynamic therapy (PDT) may offer comparable efficacy with decreased morbidity and better cosmetic and functional outcomes. This retrospective study analyzes the effectiveness and outcomes of photodynamic therapy with aminolevulinic acid (ALA-PDT) treatment of cutaneous squamous cell carcinoma in-situ (SCCIS) with blue light. Data …

Biodegradable Nanoparticles In The Treatment Of Cutaneous Malignancy, Emily Sara Yin

Yale Medicine Thesis Digital Library

Keratinocyte-derived carcinomas represent the most common type of malignancy worldwide, and while surgical removal is a first-line therapy, surgery may be impractical for certain patients and does not completely eliminate risk of recurrence. Previous studies have demonstrated the advantages of biodegradable poly(lactic acid)-hyperbranched polyglycerol non-bioadhesive nanoparticles (NNPs) and bioadhesive nanoparticles (BNPs) as chemotherapeutic drug delivery vehicles for the treatment of internal solid tumors. We are now investigating the use of this delivery system for the treatment of cutaneous malignancies, with the goal of maximizing drug efficacy while minimizing systemic effects and treatment-associated morbidity. After topical application of fluorescent dye-loaded NNPs …

Adherence To Prospective Registration Policy And Implications For Clinical Trial Endpoint Integrity, Anand Gopal

Yale Medicine Thesis Digital Library

Since implementation of the International Committee of Medical Journal Editors’ (ICMJE) prospective registration policy in 2005, trial registration has increased significantly. Registering clinical trials is critical in promoting transparency and integrity in medical research, however trials must be registered in an appropriate manner to deter unaccounted protocol modifications or selection of alternate endpoints that may enhance favorability of reported results. This thesis provides relevant background on clinical trial registration and appropriate reporting in addition to evaluating adherence with the ICMJE’s prospective trial registration policy and the implications of inappropriate adherence for the integrity of reported results. In a cross-sectional, retrospective …

A Novel Staining Method For Detecting Bloodborne Bacteria After Their Dielectrophoretic Isolation, John Gaudet

Yale Medicine Thesis Digital Library

Current methods to diagnose bacteremia typically require 18 to 36 hours to detect positive samples and five days to identify negative ones. This delay stems in part from the incubation time necessary for bacteria to multiply and achieve detectable concentrations. In recent years, microfluidic chips have been developed that isolate and concentrate bacteria from the blood on a time scale of minutes to hours (1). This research seeks to stain and visualize these bacteria after their microfluidic processing thereby significantly shortening the time required to diagnose bacteremia.

The traditional Gram stain is not sufficiently sensitive to detect bacteria in this …

Role Of The Rna Modification N6-Methyladenosine In Normal Hematopoiesis & Disease, Radovan Vasic

Yale Medicine Thesis Digital Library

N6-methyladenosine (m6A) is the most abundant modified nucleotide occurring in mRNA, with key roles in RNA metabolism and regulation of gene expression. Proposed effects of m6A modification of RNA transcripts include effects on transcript half-life, translation efficiency, splicing and miRNA biogenesis. Importantly, m6A is the only known dynamic RNA modification, with deposition mediated by the “writer” METTL3, and demethylation carried out by the “erasers” ALKBH5 and FTO. We hypothesized a role for m6A in hematopoiesis, with potential disease relevance in myeloid malignancies.

To gain an understanding of the effects of m6A on normal hematopoiesis and myeloid malignancies such as the …

Implementation Of New Definitions Of Labor Arrest Disorders And Failed Induction Can Decrease The Cesarean Rate, Jessica Tanzer Wright Greenberg

Yale Medicine Thesis Digital Library

Cesarean delivery for labor arrest currently makes up the largest proportion of

primary cesarean delivery in the United States. Because cesarean delivery is associated

with significant morbidity, it is important to limit its use to ensure the benefits outweigh

the risks. New diagnostic criteria to limit the diagnosis of labor arrest have the potential

to decrease the cesarean delivery rate. To investigate how cesarean delivery for arrest of

dilation or descent and failed induction contributed to the primary cesarean delivery rate,

we analyzed rates of primary cesarean for these indications among 17,864 live births at

our institution from 2010 through …

Reproductive Health And Fertility Among Transgender Adolescents: A Knowledge And Attitudes Survey, Aimee Alphonso

Yale Medicine Thesis Digital Library

The goal of this study was to determine the knowledge and attitudes of transgender adolescents regarding fertility and future parenthood. We developed and administered a cross-sectional questionnaire to a convenience sample of 23 transgender and gender non-conforming adolescents (mean age 16.2 ± 2.6) who attended the Yale Pediatric Gender Program between October 2016 and August 2017. Our results indicate that transgender adolescents have a basic understanding of reproductive health and fertility (mean total knowledge score of 3.78 ± 0.80 out of 5). Knowledge scores were significantly higher in participants with previous information about gender-affirming hormone therapy (GAH; p

Measuring The Burden Of Childhood Cancer Treatment: Decrements In Bone Health And Financial Toxicity, Hadley Bloomhardt

Yale Medicine Thesis Digital Library

With research and clinical advances over the past several decades, survival rates for childhood cancer have improved to greater than 80%. However, the path to survivorship poses a substantial burden to patients and families, with lengthy treatment courses requiring frequent hospital visits, and with late complications of treatment that can present years after therapy ends. This thesis explores each of these areas: one study investigating bone health and morbidity in leukemia and lymphoma survivors, and another study examining the cost burden to families of children during treatment for average-risk acute lymphoblastic leukemia (ALL). We aimed to determine the utility of …

Targeted Nanoparticle Delivery For In Utero Treatment Of Congenital Disorders, Valerie Luks

Yale Medicine Thesis Digital Library

Congenital disorders represent a large unmet clinical need with significant morbidity and premature mortality resulting from mutations and anomalies that can be diagnosed, and eventually treated, in utero. Nanoparticles (NP) have been used as versatile protective vessels for the delivery of a variety of therapeutic agents. Importantly, the potency of NPs can be amplified by modifications to the molecular composition as well as to the delivery to allow targeting to specific tissues. We hypothesize that optimization of NP targeting both by nanoparticle modification and the route of administration can increase overall uptake in specific cells and tissues of interest. To …

Using Art Observation In Museum Education To Broach Topics Of Bias And Power Among Health Professional Trainees, Robert Michel Rock

Yale Medicine Thesis Digital Library

The Liaison Committee on Medical Education has identified training on cross cultural interaction and bias as high-priority topics. There has been little published on the use of fine art, specifically painting or sculpture, as a means of entry into discussion on issues of bias in medicine relating to race, gender, and other identities. Making the Invisible Visible (MIV) is a 3-hour, guided museum tour that uses art observation to facilitate dialogue about biases embedded in Western culture as well as their influence on personal and professional interaction. The tour uses intersectionality and critical pedagogy as theoretical frameworks to approach multiple …

Orally-Dosed Citalopram Stimulates Small Intestinal Mucosal Growth, Lucy Zhang

Yale Medicine Thesis Digital Library

Parenterally-administered selective serotonin reuptake inhibitors (SSRI), such as citalopram, increase intestinal mucosal absorptive surface by day 7 of treatment. We hypothesized that enteral citalopram would also induce intestinal mucosal growth, thus allowing for therapy with an oral agent. In the study’s first phase, C57BL/6 mice received peanut butter (PB) pellets containing 10, 50, or 100 mg/kg/day citalopram for 7 days; or 25 mg/kg/day citalopram for 14 or 21 days; or plain PB pellets for 7, 14, or 21 days. In the second phase, C57BL/6 mice received 0, 10, 25, or 50 mg/kg/day citalopram in drinking water for 2, 3, 6, …

Sex Disparities In St-Elevation Myocardial Infarction Care And Outcomes: A Global Systematic Metaanalysis, Ido Haimi

Yale Medicine Thesis Digital Library

Background: Cardiovascular disease is the leading cause of death worldwide. Outcomes of patients with ST-segment–elevation myocardial infarction (STEMI) have improved through widespread implementation of systems-of-care, yet sex disparities continue to be reported. A comprehensive, global study of sex disparities in contemporary STEMI care and outcomes has not been undertaken.

Objective: To examine whether sex differences in STEMI management and mortality outcomes persist worldwide and by geographic region.

Methods: A systematic PubMed literature search was performed using search terms “sex” or “gender” and “STEMI” for studies in English from 2000 to present reporting sex-based STEMI mortality. Articles with primary data on …

The Impact Of Place-Based Determinants Of Health On Utilization Of Emergency Department Services, Tehreem Rehman

Yale Medicine Thesis Digital Library

The purpose of the study is to investigate whether higher prevalence of place-based structural determinants of health inequity is directly associated with frequent utilization of services in the emergency department. Chi-square and t-test analyses found that compared to non-frequent ED users, frequent ED users were older (mean age 43.18 vs. 35.23, p

Acknowledgements

The student author of this thesis is grateful for all the guidance and support provided by both faculty and community mentors. She is thankful for the time of Mark Abraham, Executive Director of DataHaven, who expressed faith in this project and its potential to inform subsequent initiatives …

Long-Term Survival Of De Novo Stage Iv Human Epidermal Growth Factor Receptor 2 (Her2)-Positive Breast Cancers Treated With Her2 Targeted Therapy, Yao Wong

Yale Medicine Thesis Digital Library

Background: An increasing number of metastatic HER2 positive cancers are diagnosed as de novo stage IV disease. We hypothesize that a subset of these patients, who achieve complete clinical response or no evidence of disease (NED) status after multi-agent HER2-targeted treatments may have long progression free (PFS) and overall survival (OS).

Methods: 483 patients with de novo stage IV HER2 positive breast cancer diagnosed between 1998-2015 were identified through the medical records at Yale and MD Anderson Cancer Centers. Treatment, clinical variables and survival were extracted and compared between those who achieved NED status and those who did not.

Results: …

"I'M Used To Doing It By Myself": Exploring Self-Reliance In Pregnancy, Blair Mcnamara

Yale Medicine Thesis Digital Library

The goal of this thesis is to characterize self-reliance during pregnancy as described by a diverse urban cohort of women. We report on qualitative findings from a study conducted to explore the impact of a new pregnancy on women's lives based in New Haven, CT from June 2014 to June 2015. Each participant completed an enrollment survey and an in-depth semi-structured interview about intentions, thoughts, and feelings about her new pregnancy. We used framework analysis to identify concepts from our data and to assess thematic relationships. Eighty-four English-speaking women completed qualitative interviews. Participants averaged 26 years of age, and their …

Syrian Refugee Health: A Qualitative Analysis Of Experiences With The U.S. Healthcare System, Eunice M. M. Defilippo

Yale Medicine Thesis Digital Library

SYRIAN REFUGEE HEALTH: A QUALITATIVE ANALYSIS OF EXPERIENCES WITH

HEALTHCARE IN THE UNITED STATES. Eunice M. M. DeFilippo, Amer Abdullah, Tracy L.

Rabin. Department of Internal Medicine, Yale University School of Medicine, New Haven, CT.

As refugee populations worldwide increase exponentially, there is growing concern for the health needs of these displaced individuals. This qualitative study examines the illness experiences of newly arrived Syrian refugees as they navigate the complex U.S. healthcare system, in an attempt to identify and characterize potential barriers to care that can be addressed. The specific aims of this study are to understand the experiences, beliefs, …