Digital Commons Network^™

Assessing Risk Factors For Sudden Infant Death Syndrome And Caregivers’ Perceptions Of The Cardboard Box For Infant Sleep, Nisha Dalvie

Yale Medicine Thesis Digital Library

Some US hospitals are giving out cardboard boxes as a way to address behaviors associated with Sudden Infant Death Syndrome (SIDS). Our goal was to evaluate the cardboard box for this purpose by quantifying current practices and qualitatively assessing caregivers’ perceptions of the cardboard box. Study participants were English or Spanish-speaking caregivers of 2-16 week old infants presenting to primary care clinics in New Haven, CT. Caregivers completed a survey asking about demographic data and SIDS risk factors, such as non-supine positioning and bed-sharing. Some caregivers also participated in a semi-structured interview about the cardboard box, created used a grounded …

Demographics, Mechanism Of Injury, Injury Severity, And Associated Injury Profiles Of Patients With Femoral And Tibial Shaft Fractures: A Study Of The National Trauma Databank, Nidharshan Anandasivam

Yale Medicine Thesis Digital Library

Introduction:

Traumatic injuries, such as fractures, are known for having defined associated

injury patterns. These can alter management and affect outcome if not promptly

recognized and managed. There are limited large-scale studies of demographics,

mechanism of injury, and injuries associated with femoral and tibial shaft fractures.

Objectives:

1. To determine the demographics, mechanism of injury, injury severity score, and

associated injuries in those with femoral and tibial shaft fractures in a large

national sample.

2. To determine the relationship between associated injuries and in-hospital

mortality.

Methods:

In two separate studies, patients in the 2011 and 2012 National Trauma Data Bank …

The Neurological Development Of Sagittal Craniosynostosis Patients Treated With Whole Vault Cranioplasty, Raysa Cabrejo

Yale Medicine Thesis Digital Library

Objective: In this study we seek to clarify the neurological changes before and after whole vault cranioplasty (WVC) in patients born with sagittal craniosynostosis.

Methods: A case control study design was performed that included forty fMRI scans, from thirty-five individual patients. Functional MRI (fMRI) and diffusion tension imaging (DTI) data were analyzed with BioImageSuite (Yale University, USA). All nine functional brain networks were analyzed with appropriate regions of interest.

Results: Comparing functional MRI the infants after WVC vs. infants before WVC group, the after WVC group demonstrated an increased connectivity in the left frontoparietal (LFPN), secondary (V2) and third (V3) …

Insulin And Non-Insulin Dependent Glut4 Trafficking: Regulation By The Tug Protein, Stephen Devries

Yale Medicine Thesis Digital Library

The body tightly regulates glucose production and disposal despite changing metabolic demands, including large post-prandial and fasting fluctuations. Specifically, under the action of insulin, muscle contraction, ischemia, and poor nutrient availability, cells increase the amount of the glucose transporter type 4 (GLUT4) at the plasma membrane by mobilizing a sequestered pool of transporters. In this work, we demonstrate that the TUG (tether containing a UBX domain for GLUT4) protein mediates both insulin-dependent and insulin-independent pathways to increase GLUT4 at the plasma membrane. In mice fed a high fat diet to induce insulin resistance, the regulation of the endoproteolytic cleavage of …

The Reproductive Health Needs Of Women At Risk Of Hiv Infection In Connecticut, Emily Hoff

Yale Medicine Thesis Digital Library

Background: The number of women involved in criminal justice systems (WICJ) and women who use opioids has been dramatically increasing in the United States. An often-overlooked aspect of healthcare for women at risk of HIV infection (either WICJ or women who use drugs) is reproductive health. We aim to provide a framework, informed by a systematic review and primary data, to guide future interventions addressing the sexual and reproductive health (SRH) needs of women at risk of HIV infection.

Methods: We completed a systematic literature review of the pregnancy prevention and planning needs of US WICJ published in English from …

Csf Lymphocyte And Monocyte Activation And Trafficking In Primary Hiv Infection, Aveline Xiang Li

Yale Medicine Thesis Digital Library

Trafficking of immune cells to the central nervous system (CNS) is hypothesized to facilitate HIV entry and immune-induced neuronal injury, and is mediated by cell surface proteins such as chemokine receptors and integrins. We longitudinally assessed immune cell activation and surface marker expression in cerebrospinal fluid (CSF) and blood and their relationship with CSF HIV RNA during primary HIV infection (PHI) before and after combination antiretroviral therapy (ART). Longitudinal paired blood and CSF were obtained in initially ART-naïve PHI (infection) participants; some subjects independently initiated ART during follow up. Multiparameter flow cytometry was used to determine activation (% CD38+HLADR+) and …

Home Visits In Internal Medicine Graduate Medical Education, Amitte Rosenfeld

Yale Medicine Thesis Digital Library

Home-based care training is largely absent from internal medicine (IM) graduate medical education, and home-based care program evaluation largely focuses on resident attitudes and satisfaction, rather than impact on practice or the patient experience. In the 2015-16 academic year, the Yale Primary Care Internal Medicine residency program (YPC) incorporated required home visits for all PGY-1s and PGY-2s. These visits are intended to build unique clinical skillsets, enhance education about the role of psychosocial determinants of health, and potentially impact resident wellbeing. A qualitative method was used to evaluate this program with the goal of characterizing the impact of one-time home …

The Role Of Traf3 And Cyld Mutationin The Etiology Of Human Papillomavirus Driven Head And Neck Cancers, Tejas Sudarshan Sathe

Yale Medicine Thesis Digital Library

The incidence of HPV-positive head and neck squamous cell carcinoma (HNSCC) con-tinues to rise. Though HPV positivity is correlated with improved survival, up to a quar-ter of these tumors recur or metastasize despite aggressive therapy. Currently, there areno biomarkers that can identify HPV-positive HNSCC patients who would benefit fromreduced doses of radiation–which when given at full dose carries significant morbidity.Through analysis of a limited cohort of The Cancer Genome Atlas (TCGA), we previ-ously showed that two genes, TRAF3 and CYLD, were frequently deleted or mutated inHPV-positive HNSCC. TRAF3 and CYLD are functionally related negative regulatorsof the transcription factor NF-κB. In …

Iatrogenic Complications Of Diabetes Mellitus: An Examination Of Hospital-Acquired Diabetic Ketoacidosis And Severe Outpatient Hypoglycemia, Chloe Zimmerman

Yale Medicine Thesis Digital Library

Patients with diabetes mellitus are at risk for two acute metabolic complications: severe hyperglycemia and hypoglycemia. These acute complications are costly and associated with significant morbidity and mortality, but are preventable with delivery of high-quality care. The purpose of this work is to focus on a subset of these complications which are iatrogenic, i.e., caused by medical treatment. Hospital-acquired diabetic ketoacidosis (DKA) is an iatrogenic complication as it occurs when a patient with known diabetes experiences DKA while hospitalized for other reasons. Hypoglycemia is an adverse effect of treatment and thus, by definition, all hypoglycemia resulting from the use of …

Inhibition Of The Akt1-Mtorc1 Axis Alters Venous Remodeling To Improve Arteriovenous Fistula Patency, Arash Fereydooni

Yale Medicine Thesis Digital Library

Arteriovenous fistulae (AVF) are the most common access created for hemodialysis, but up to 60% do not sustain dialysis within a year, suggesting a need to improve AVF maturation and patency. In a mouse AVF model, Akt1 regulates fistula wall thickness and diameter. We hypothesized that inhibition of the Akt1-mTORC1 axis alters venous remodeling to improve AVF patency. Daily intraperitoneal injections of rapamycin reduced AVF wall thickness with no change in diameter. Rapamycin decreased smooth muscle cell (SMC) and macrophage proliferation; rapamycin also reduced both M1 and M2 type macrophages. AVF in mice treated with rapamycin had reduced Akt1 and …