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Improved Generation Of Anti-Tumor Immunity By Antigen Dose Limitation, Joshua Shofner
Improved Generation Of Anti-Tumor Immunity By Antigen Dose Limitation, Joshua Shofner
Yale Medicine Thesis Digital Library
The malignant cells of cutaneous T cell lymphoma (CTCL) display immunogenic peptides derived from the clonal T cell receptor (TCR) providing an attractive model for refinement of anti-tumor immunization methodology. To produce a clinically meaningful anti-tumor response, induction of cytotoxic anti-CTCL cells must be maximized while suppressive T regulatory cells (Treg) should be minimized. We have demonstrated that engulfment of apoptotic CTCL cells by dendritic cells (DC) can lead to either CD8 anti-CTCL responses or immunosuppressive Treg induction. Treg generation is favored when the number of apoptotic cells available for ingestion is high. In this study, we sought to determine …
Time Interval To Diagnosis Of Bladder Cancer And Its Associated Outcomes, Lara Suh
Time Interval To Diagnosis Of Bladder Cancer And Its Associated Outcomes, Lara Suh
Yale Medicine Thesis Digital Library
The purpose of this study is to investigate whether a prolonged delay in diagnosis of bladder cancer will result in worse outcomes for those patients, compared to those patients with a shorter diagnostic time interval. Data was collected on 247 patients newly diagnosed with transitional cell carcinoma of the bladder from January 1996 to December 2006 (10 years). The medical records of these patients were reviewed for demographics, pathological stage, date of consultation to the genitourinary (GU) service, and date of diagnosis by transurethral resection of bladder tumor (TURBT). The specialty delay was calculated as the time between the date …
Biomechanical Testing Of Charité Disc Replacements Versus Fusion Using Hybrid Testing Protocol And Follower Load, Edward Teng
Biomechanical Testing Of Charité Disc Replacements Versus Fusion Using Hybrid Testing Protocol And Follower Load, Edward Teng
Yale Medicine Thesis Digital Library
Statement of Purpose: To quantify adjacent level effects following Charité disc replacement compared to fusion, using the follower load and the new standard hybrid testing method in flexion, extension, and torsion. Summary of Background Data: As opposed to fusion, artificial discs not only preserve motion, but may diminish adjacent level effects and thus slow adjacent disc degeneration. This study aims to use hybrid test protocol and follower load to perform in vitro multidirectional testing and quantify adjacent- and other- level (AOL) effects following one- and two-level disc implants compared to fusion. Methods: Five intact human cadaveric lumbar specimens underwent multidirectional …
Why Do Patients Seek Emergency Psychiatric Care? Their Reasons And Characteristics, Peter Yang
Why Do Patients Seek Emergency Psychiatric Care? Their Reasons And Characteristics, Peter Yang
Yale Medicine Thesis Digital Library
Many believe that psychiatric emergency services (PES) are misused, but there is little empiric data available addressing this issue. We investigated reasons patients actually sought emergent care, and whether alternative facilities could have addressed their needs. We reviewed 200 consecutive evaluations in a teaching hospital emergency department via chart review. Data collected included psychiatric history, substance use, and contributing etiologies. PES clinicians involved were asked directly about underlying reasons for emergent care and whether suitable care could have been provided in a less acute setting. Acute behavioral disturbances proved to be the most frequent reason for emergency visits. Half of …
Determinants Of Student Preferences For Teaching Behaviors In The Ambulatory Setting, Brian Yablon
Determinants Of Student Preferences For Teaching Behaviors In The Ambulatory Setting, Brian Yablon
Yale Medicine Thesis Digital Library
The purpose of this research was to examine the influence of demographic and cultural factors on learner preferences for teaching behaviors in the ambulatory internal medicine clerkship. To that end, 50 medical students at each of four US institutions (BU, Tufts, UMass, and Yale) and 50 British medical students at the University of Cambridge were invited to complete a survey on teaching behaviors in the ambulatory setting, evaluating items on two scales: one rating the behavior's importance, and one rating how highly the student recommended the behavior. Behaviors rated highly on both scales were considered "valued" by the student. Students' …
Structural Basis Of Bilayer Deformation By Membrane-Associated Scaffolds, Adam Frost
Structural Basis Of Bilayer Deformation By Membrane-Associated Scaffolds, Adam Frost
Yale Medicine Thesis Digital Library
The assembly of amphipathic lipids into fluid bilayers that are impermeable to macromolecules is fundamental to the existence of viruses, organelles, and cells. Conversely, membrane compartmentalization poses problems, since essential processes like cell division, cell migration, endo-, exo-, and transcytosis all require cells to remodel and even break their membranes without opening lethal leaks. Evolutionary forces have consequently generated proteins that can reversibly mold membranes into planes, spheres, cylinders, and saddle-shaped surfaces. Principally, the BAR (Bin, Amphiphysin, RVS) domain superfamily of proteins are recruited from the cytoplasm to induce or stabilize states of high membrane curvature, while the Dynamin superfamily …
Point Source Emissions Of Epa-Monitored Criteria Pollutants And The Rates Of Ed Visits And Hospitalizations For Asthma In Connecticut, 1996-2002, Tiffany S. North
Point Source Emissions Of Epa-Monitored Criteria Pollutants And The Rates Of Ed Visits And Hospitalizations For Asthma In Connecticut, 1996-2002, Tiffany S. North
Yale Medicine Thesis Digital Library
No abstract provided.
Serum Proteomic Profiles In Inflammatory And Non-Inflammatory Cardiomyopathies: A Novel Approach For Diagnostic Biomarker Discovery, Oyere Onuma
Yale Medicine Thesis Digital Library
The aim of this project is to develop a noninvasive serum test that predicts histologic forms of myocarditis (inflammatory) and dilated (non-inflammatory) cardiomyopathy using proteomic techniques to analyze serum proteins. Idiopathic dilated cardiomyopathy (DCM) and myocarditis (myocardial inflammation) represent a spectrum of heart muscle disease of various etiologies that usually present with progressive heart failure. Together, they constitute the leading cause of heart transplantation in the United States. Currently, the gold standard of diagnosis of myocarditis is by endomyocardial biopsy (EMB) and histopathological classification according to the Dallas Criteria ; however this diagnostic technique is severely limited by its invasiveness, …
Platelet-Derived Growth Factor Enables Direct Derivation Of Oligodendrocyte Progenitors From Cns Stem Cells, Rajesh Rao
Platelet-Derived Growth Factor Enables Direct Derivation Of Oligodendrocyte Progenitors From Cns Stem Cells, Rajesh Rao
Yale Medicine Thesis Digital Library
Oligodendrocytes derived in the laboratory from stem cells have been proposed as a treatment for acute and chronic injury to the central nervous system (CNS). Platelet-derived growth factor-receptor alpha (PDGFRα) signaling is known to play an important role for regulation of oligodendrocyte progenitor cell numbers both during development and adulthood. Here, we analyze the effect of PDGFRα signaling on CNS stem cells derived from embryonic day 13.5 murine cortex and cultured in monolayer. Fetal and adult CNS stem cells express PDGFRα, and PDGF-AA treatment increases viability and proliferation of these cells. In the absence of insulin, this effect of PDGF-AA …
Mammalian Dcn-1-Like Proteins Enhance Neddylation Of Cul3, And Vary In Localization And Tissue-Specific Expression, Russell Ryan
Mammalian Dcn-1-Like Proteins Enhance Neddylation Of Cul3, And Vary In Localization And Tissue-Specific Expression, Russell Ryan
Yale Medicine Thesis Digital Library
The Squamous Cell Carcinoma-Related Oncogene (SCCRO/DCUN1D1), located at 3q26.3, is a candidate oncogene that is gene-amplified and overexpressed in squamous-cell carcinomas of the upper aerodigestive tract and lung. The SCCRO protein is a member of a phylogenically conserved protein family, the defective in cullin neddylation - 1 - like domain containing ("Dcun1d") proteins, which have been shown to promote the covalent modification of cullin proteins by the ubiquitin-like protein Nedd8. In this study, we sought to characterize the expression and molecular interactions of vertebrate Dcun1d proteins, in order to better understand the normal function of genes in this family. We …
Epi-Genetic Abnormalities Of Infantile Hemangiomas: Regulation Of The Igf2/H19 Locus, Brent Schultz
Epi-Genetic Abnormalities Of Infantile Hemangiomas: Regulation Of The Igf2/H19 Locus, Brent Schultz
Yale Medicine Thesis Digital Library
Purpose: To investigate the epi-genetic regulation of Insulin Like Growth Factor 2 (IGF2) and its reciprocally imprinted transcript H19 in infantile hemangiomas. Introduction: Infantile hemangiomas (IH) are the most common childhood tumor of the head and neck. Despite their prevalence and potentially morbid sequelae, little is known regarding the pathogenesis of this disease. However, a tumorigenic molecule, Insulin Like Growth Factor 2 (IGF2), has been implicated by microarray and confirmatory Real-Time PCR studies. There is substantial documentation that methylation abnormalities within the IGF2 and neighboring H19 loci are related to the overproduction of IGF2 in many distinct tumor types. An …
The Immunoepidemiology Of Hookworm Infection In The Peruvian Amazon, Priya Shete
The Immunoepidemiology Of Hookworm Infection In The Peruvian Amazon, Priya Shete
Yale Medicine Thesis Digital Library
Hookworm infection caused by Ancylostoma duodenale or Necator americanus is a significant global health threat, causing chronic anemia, malnutrition, developmental delay, enteritis, and increased susceptibility to non-parasitic diseases. One of the most prevalent of the neglected tropical diseases, hookworm infection affects almost 1 billion people worldwide, particularly in developing countries. Current methods for diagnosis and treatment of hookworm infection are largely the same as they have been for the past century. However, several recent advances in the molecular characterization of hookworm virulence factors now provide researchers with an improved understanding of disease pathogenesis, potential targets for treatment and novel antigens …
Surrogate Markers Of Success In The Bariatric Surgery Population, Alain Ramirez
Surrogate Markers Of Success In The Bariatric Surgery Population, Alain Ramirez
Yale Medicine Thesis Digital Library
Purpose: The purpose of this study was to examine the associations between pre-operative weight loss, weight loss programs, and clinic attendance relative to the success of gastric bypass in class II and III obese patients. Background: The increasing number of obese children and adults in the United States poses an extensive social problem in the era of managed care. Notwithstanding the stigmatization associated with obesity, the considerable health implications along with the financial burden it imposes create a formidable adversary. Surgical procedures have proved to be superior to conservative and pharmacotherapeutic interventions in the morbidly obese. Despite the overall success …
The Impact Of Prenatal Discussion Of Breastfeeding By Health Care Providers On Feeding Choice, Karen Archabald
The Impact Of Prenatal Discussion Of Breastfeeding By Health Care Providers On Feeding Choice, Karen Archabald
Yale Medicine Thesis Digital Library
Breastfeeding initiation rates in the United States remain below the Healthy People 2010 goals. Research indicates patient interaction with health care providers may play an important role in womens ultimate feeding choice. This study sought to examine the impact of provider counseling regarding breastfeeding during the prenatal period on feeding outcome by evaluating: 1) if providers addressed womens concerns regarding breastfeeding; and 2) how providers responded to a womans feeding choice. We also sought to examine whether the type of counseling provided by providers regarding infant feeding is influenced by patient socio-demographics and stated feeding plans. This study is cross-sectional …
The Epidemiology And Incidence Of Visual Deficits Following Ocular Trauma In Pediatric Patients, Viral Virenda Juthani
The Epidemiology And Incidence Of Visual Deficits Following Ocular Trauma In Pediatric Patients, Viral Virenda Juthani
Yale Medicine Thesis Digital Library
Ocular trauma has long been a significant disabling American health problem and a leading cause of unilateral visual loss in children. These injuries have many diverse costs including human suffering, long-term disabilities, loss of productivity, and economic hardship. Although several studies have evaluated the epidemiology of specific types or mechanisms of ocular trauma, there are few that describe the epidemiology and visual outcomes of a comprehensive set of ocular trauma diagnoses. The purpose of this thesis is to describe the incidence of significant deficits in visual acuity following pediatric ocular trauma and to describe the overall epidemiology of pediatric ocular …
The Infant And Effects Of Parental Presence In The Operating Room During Induction Of Anesthesia, Deborah Kaplan
The Infant And Effects Of Parental Presence In The Operating Room During Induction Of Anesthesia, Deborah Kaplan
Yale Medicine Thesis Digital Library
Previous studies have investigated the physiological and behavioral effects of parental presence in the operating room during the induction of anesthesia (PPIA) both on the child and the parent. Since the characterization of anxiety in infants presents a unique challenge due to their inability to communicate verbally, these studies have typically focused on children greater than two years old. In the present study we addressed this understudied population directly by using highly reliable and validated behavioral instruments as well as analyzing sleep patterns and signs of distress in the infants. The hypothesis tested was the same as in the older …
Educating Adolescents About Acne Vulgaris: A Comparison Of Written Handouts With Audio-Visual Computerized Presentations, Phoebe Koch
Yale Medicine Thesis Digital Library
This randomized clinical study aimed to compare the efficacy of written handouts with that of audio-visual computerized presentations in educating adolescents about acne vulgaris. The study included 101 adolescent patients, aged 13 to 17 years, presenting to a private dermatology practice or one of three pediatric clinics in New Haven, CT. All participants completed a brief enrollment questionnaire to gauge baseline knowledge about acne vulgaris. Subjects were then randomized to receive either a written handout or an audio-visual computerized presentation. Immediately following the intervention, and again at one month, patients were asked to complete identical questionnaires to assess change in …
Adolescent Medicine: Attitudes, Training And Experience Of Pediatric, Family Medicine And Obstetric-Gynecology Residents, Rebecca Kershanr
Adolescent Medicine: Attitudes, Training And Experience Of Pediatric, Family Medicine And Obstetric-Gynecology Residents, Rebecca Kershanr
Yale Medicine Thesis Digital Library
Several studies have documented a deficiency in the delivery of preventive services to adolescents during physician visits in the United States. In many instances, a correlation has been noted between insufficient training and provision of adolescent medicine services in the practicing physician population. The American Medical Association, American Academy of Pediatrics, American Academy of Family Physicians, American College of Obstetrics and Gynecology and Society for Adolescent Medicine recommend adolescent providers deliver comprehensive health services to teenagers. This study sought to assess and compare Pediatric, Family Medicine and Obstetric-Gynecology resident perceptions of their responsibility, training, experience and comfort with providing comprehensive …
Use Of A Help-Wanted Index To Assess Marketplace Demand For Ophthalmologists, Chukwuemeka Nwanze
Use Of A Help-Wanted Index To Assess Marketplace Demand For Ophthalmologists, Chukwuemeka Nwanze
Yale Medicine Thesis Digital Library
Over the 26 year study period a consistent increase in the demand for academic ophthalmologists was noted (34% of HWI in 1980 to 74% in 2005). There was also a consistent increase in the demand for specialists (31% of HWI in 1980 to 80% in 2005), especially demand for retina specialists. There were no consistent geographical trends in demand. Need for academic ophthalmologists seems to be correlated with national research expenditure and stock market gains (p = 0.00191), while demand for private practice ophthalmologists seems to be correlated with the national economic wellbeing, as measured by Gross Domestic Product (GDP) …
Optic Disc Changes After Pan-Retinal Photocoagulation For Proliferative Diabetic Retinopathy, David Jay-Pei Jeng
Optic Disc Changes After Pan-Retinal Photocoagulation For Proliferative Diabetic Retinopathy, David Jay-Pei Jeng
Yale Medicine Thesis Digital Library
This study aims to examine the possible effect that pan-retinal photocoagulation (PRP) performed as treatment for proliferative diabetic retinopathy (PDR) has on the optic disc. In a retrospective study, photographs of the optic disc before and after PRP, as well as photographs of untreated eyes for the control group, were evaluated for cup-to-disc ratio and optic disc pallor as gross measures of optic nerve health. A 5-grade scheme for optic color was devised for this study by selecting representative photographs for each grade, where 5 indicated the healthiest-appearing color. Kappa statistics indicated strong intra- and inter-observer consistency of observations for …
The Acute Effects Of Elevated Blood Lipid Levels On Endothelial Function, Alexander Nissen
The Acute Effects Of Elevated Blood Lipid Levels On Endothelial Function, Alexander Nissen
Yale Medicine Thesis Digital Library
The association between prolonged elevation of blood lipid levels and coronary artery disease is well established. Research focusing on the acute effects of hyperlipidemia is not as abundant, and often looks only at large-sized arteries. The purpose of our study was to measure the acute effects of elevated blood lipid levels on microvascular endothelial function, non-invasively, by means of laser Doppler flowmetry and the administration of vasoactive challenges. With IRB approval, six healthy subjects were recruited for a three-session study in which they were given isocaloric meals with variable fat content (non-fat meal = NM; fatty meal = FM; or …
The Use And Safety Of Vascular Occlusion Techniques: A Survey Of Practicing Surgeons, Ryan Kelly
The Use And Safety Of Vascular Occlusion Techniques: A Survey Of Practicing Surgeons, Ryan Kelly
Yale Medicine Thesis Digital Library
Vascular occlusion techniques can be divided into two categories ¡V transfixion and non-transfixion. Transfixion techniques are defined by the passage of suture material or staples through the vascular tissue. Non-transfixion techniques are defined as suture, metal, or polymer material placed solely around the vascular tissue. The purpose of this study was to survey surgeons in various specialties to determine which vascular control technique they believe is safest and most appropriate to manage medium-sized arteries 6-10mm in diameter. A survey was distributed to surgeons in the following specialties: general surgery, urology, thoracic surgery, vascular surgery, obstetrics and gynecology, and colon and …
Nigerian Women Living In The United States Are More Hirsute Than Those Living In Nigeria., Kikelomo Olorunrinu
Nigerian Women Living In The United States Are More Hirsute Than Those Living In Nigeria., Kikelomo Olorunrinu
Yale Medicine Thesis Digital Library
This study was to determine if there exists a difference in the rate of hirsutism in genetically similar women in two different environments. 112 Nigerian women living in the U.S.A and 70 women living in Nigeria were surveyed. All women completed a pictorial survey scoring peripheral hair growth in 6 body areas from 0 (no significant hair growth) to 4 (severe hair growth). Total hirsutism score was calculated as a sum of individual scores. The survey also included demographic data, menstrual history, and data regarding use of hormonal treatments. Statistical comparisons between groups included t-test, nonparametric tests and chi-square test. …
Ct Scan Natural History Of Post-Operative Thoracic Aortic Surgery Patients, Jessica Kirk
Ct Scan Natural History Of Post-Operative Thoracic Aortic Surgery Patients, Jessica Kirk
Yale Medicine Thesis Digital Library
This study evaluated post-operative CT scans to determine the normal postoperative appearance following thoracic aorta surgery. The 188 CT studies in 102 patients were analyzed for presence of perigraft fluid collections and pleural effusions. Fifty-seven of 102 patients (56%) had perigraft fluid at the time of their first postoperative CT scan. The majority of collections disappeared over time but some persisted with 22% scans showing fluid at greater than 24 months post-operatively. Pleural effusions were present on 86% of scans in the first post-operative month and only 9% of scans after 1 year. Pseudoaneurysms occurred in 3 of 48 ascending …
Early Seizure Blockade: Preventing Long-Term Epileptic Activity In Wag/Rij Rats, April Levin
Early Seizure Blockade: Preventing Long-Term Epileptic Activity In Wag/Rij Rats, April Levin
Yale Medicine Thesis Digital Library
The purpose of this study was to determine how early seizure blockade with ethosuximide (ESX) would influence ion channel expression and long-term spike-wave discharge (SWD) activity in epileptic WAG/Rij rats. The goal was to elucidate the question Do seizures beget seizures? in a genetically prone model and if so, to attempt to interrupt this cycle by early intervention. In our first experiment, we used immunocytochemistry to determine the effect of ESX on cortical expression of ion channels in treated and untreated WAG/Rij rats and age-matched Wistar controls. This experiment revealed that treatment with ESX blocked the upregulation of Nav1.1 and …
Interactions Between The Glut4 Glucose Transporter And Its Regulator, Tug, Stefan Mansourian
Interactions Between The Glut4 Glucose Transporter And Its Regulator, Tug, Stefan Mansourian
Yale Medicine Thesis Digital Library
The glucose transporter 4 (GLUT4) is the major insulin-responsive glucose transporter in adipose and muscle tissues. Although the early steps in the insulin signaling pathway governing translocation of GLUT4 to the plasma membrane are well understood, the final steps in this pathway are not. TUG is a protein which has been shown to affect trafficking of GLUT4 both in the basal state and in response to insulin. One protein-protein interaction between TUG and the large cytosolic loop of GLUT4 has previously been identified. Based on reports of the requirement of the GLUT4 N-terminal domain for its proper targeting to the …
Efficacy Of 180 Versus 360 Degrees Of Selective Laser Trabeculoplasty On Lowering Intraocular Pressure, Robert Mcglynn
Efficacy Of 180 Versus 360 Degrees Of Selective Laser Trabeculoplasty On Lowering Intraocular Pressure, Robert Mcglynn
Yale Medicine Thesis Digital Library
The purpose of this study was to determine if the application of 360° of selective laser trabeculoplasty (SLT) to the trabecular meshwork (TM) is more effective than 180° in the lowering of intraocular pressure (IOP) in glaucoma. This issue was addressed in the form of a retrospective chart review of patients treated consecutively with SLT for primary open angle glaucoma, pseudoexfoliation glaucoma or ocular hypertension. Patients were treated with either 180° of SLT by Dr. Wand or 360° by Dr. Martone using a 532nm, Q-switched, frequency doubled Nd:Yag laser. Only the initial treatment with SLT of a given eye was …
Mechanical Properties Of Aneurysms Of The Descending Human Aorta, Peter Lin
Mechanical Properties Of Aneurysms Of The Descending Human Aorta, Peter Lin
Yale Medicine Thesis Digital Library
Objective: Treatment decisions for aortic aneurysms are currently based on size criteria originally developed in the 1960s, even though we now have more sophisticated methods that can refine interventional criteria. In this project, we applied engineering principles in order to generate a comprehensive picture of the mechanical properties of descending thoracic aortic aneurysms, including their ability to deform in response to pressure, as well as the stresses that cause wall stretch or rupture. Our goal was to use these mechanical properties to understand, explain, and predict the tendency of descending aneurysms to rupture or dissect. Methods: Using an epi-aortic ultrasound …
Cellular And Synaptic Organization Of The Human Olfactory Bulb, Alison Maresh
Cellular And Synaptic Organization Of The Human Olfactory Bulb, Alison Maresh
Yale Medicine Thesis Digital Library
The distribution of cell types and synapses is well characterized in the rodent olfactory bulb (OB), and from that plausible models of odor processing have been constructed. Individual olfactory sensory neurons (OSNs) express only 1 of ~1000 odorant receptors (ORs) and send their axons to specific synaptic targets in the OB glomerular neuropil. Each glomerulus is innervated exclusively by OSN axons expressing the same OR. The distribution of these glomeruli is conserved across animals, as is the numerical relationship between number of expressed ORs and number of glomeruli in the OB. Our objective is to extend such results to the …
Hypnosis For Relief Of Pain And Anxiety In Children Receiving Intravenous Lines In The Pediatric Emergency Department, Maya Maxym
Yale Medicine Thesis Digital Library
Intravenous line placement is one of the most common procedures performed on children presenting to the Emergency Department. Anxiety about needles is widespread, and many children experience high levels of fear and/or pain with their IV line placements. Hypnosis is a behavioral intervention that shows significant promise for alleviating procedure-related pain and anxiety in children. Twenty-five developmentally normal, English-speaking children between the ages of five and fifteen who required IV line placement in the Pediatric Emergency Department at Yale-New Haven Childrens Hospital were randomized to receive either the standard of care or standard of care plus a brief hypnotic intervention. …