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Predictors Of Adverse Outcomes Following Surgical Intervention For Cervical Spondylotic Myelopathy, Samuel Craft

Yale Medicine Thesis Digital Library

As hospital costs associated with spine surgeries continue to climb, length of stay(LOS) and discharge disposition have been utilized as proxies through which these increasing costs can be assessed. Cervical spondylotic myelopathy (CSM) is the most common spinal pathology among older adults. As a result, studies assessing drivers of increased costs, LOS, and discharge disposition following surgery for CSM are needed. Two factors of interest are psychiatric comorbidities and safety net hospital (SNH) status. Psychiatric disorders are common and can have a profound impact on health, while SNHs serve a large proportion of patients with Medicaid or without insurance. However, …

Actigraphy And Symptom Changes With A Social Rhythm Intervention In Young Persons With Mood Disorders, Gabriela De Queiroz Campos

Yale Medicine Thesis Digital Library

Irregularities in rest and activity patterns are being increasingly recognized to play important roles in symptoms of major mood disorders, such as bipolar disorder (BD) and major depressive disorder (MDD). Passive measures obtained from digital wearable actigraph devices have potential to provide scalable methods sensitive to behavioral and symptom changes that could be informative in identifying worsening and assessing effects of interventions. Use in younger individuals can be particularly helpful for identifying targets for early detection, allowing for potential reduction of disorder progression. Through this investigation, we aimed to assess changes in actigraphic measures of rest and activity patterns and …

Childen's Reentry To School After Psychiatric Hospitalization: A Qualitative Study, Madeline Digiovanni

Yale Medicine Thesis Digital Library

School reentry after inpatient psychiatric hospitalization requires careful coordination between multiple stakeholders to ensure stability across transitions, given the documented potential for negative academic and socioemotional impacts in the post-discharge period. Existing studies of lived experiences of school reentry after psychiatric hospitalization are limited, and no study examines the perspectives of multiple stakeholders from the child’s home, school, and psychiatric experiences simultaneously. This study aims to characterizes the dynamics between children and adults in the transition process, to better inform future school-hospital-family partnerships. We conducted a qualitative study based on semi-structured interviews, and utilizing purposive recruitment to assess a spectrum …

Implications Of Acute Brain Injury Following Transcatheter Aortic Valve Replacement, Daniel Grubman

Yale Medicine Thesis Digital Library

Stroke is a feared complication of transcatheter aortic valve replacement (TAVR), affecting 2–8% of patients at 30 days. Beyond clinically evident stroke, covert brain injury (CBI) defined as clinically silent evidence of brain injury on imaging is strikingly prevalent: 70–100% of patients have evidence of new infarcts on diffusion-weighted magnetic resonance imaging (DW-MRI). The clinical significance of these lesions is unknown. Recent guidance has highlighted the importance of imaging in the assessment of cerebral embolic protection (CEP) devices that aim to counter the debris generated during TAVR. This work aims to a) determine the clinical significance of new ischemic lesions, …

The Evolving Landscape Of Academic Plastic Surgery: Understanding And Shaping Future Directions In Diversity, Equity, And Inclusion, Sacha C. Hauc

Yale Medicine Thesis Digital Library

Purpose: This study aims to comprehensively delineate gender and racial disparities in academic plastic and reconstructive surgery by analyzing publication authorship and leadership in academic plastic surgery. We also aim to evaluate the impact of mentorship on diverse representation, examine gender distribution in sub-specialties, and explore the influence of race and sex of plastic surgery leadership on resident/faculty composition. Methods: A comprehensive cross-sectional study investigated sex representation in academic PRS, covering editorial boards, faculty, and leadership positions. The study included 1,918 data points from notable journals and societies, examining names and sex of editorial board members, faculty in PRS residency …

Medicaid Coverage For Undocumented Children In Connecticut: A Political History, Chinye Ijeli

Yale Medicine Thesis Digital Library

In the US, undocumented immigrants are barred from receiving coverage from the federal government for healthcare other than emergency services. States can offer government-funded health insurance to undocumented immigrants, but as of 2021, only six had. Forces standing in the way of other states implementing such coverage include nativism, racism, and fears about immigrants taking scarce jobs during economic downturns.In 2021, Connecticut passed S.B. 956, a bill extending Medicaid coverage to all low-income children up to the age of eight—regardless of immigration status—starting in 2023. This policy was the culmination of a twelve-year-old grassroots movement started by Connecticut Students for …

Effects Of Thoracic Endovascular Aortic Repair On Cardiac Function At Rest, Nabeel Kassam

Yale Medicine Thesis Digital Library

a. Hypothesis: We hypothesize that Thoracic Endovascular Aortic Repair (TEVAR) leads to a decline in cardiac function among post-operative patients. Our primary objective is to identify the changes of cardiac function to post-TEVAR patients at rest using echocardiography studies. With this knowledge, we aim to gain valuable insight into the post-op management of patients with the goal of strategizing post-op care to reduce complications and exacerbation to heart failure.

b. Methods: Chart review of the electronic medical record (EMR) was used to collect patient data, patient history, procedural information, outcomes, and echocardiogram parameters. To assess the impact of TEVAR, the …

Barriers To Mental Health Care In Us Military Veterans, Connor Lewis

Yale Medicine Thesis Digital Library

BARRIERS TO MENTAL HEALTH CARE IN US MILITARY VETERANS. Connor Lewis, Ian Fischer, and Robert Pietrzak. Department of Psychiatry, Yale University, School of Medicine, New Haven, CT.

Objectives: The aims of this study were to analyze data from a nationally representative sample of US veterans to: (1) Determine the prevalence of barriers to mental health care among current US veterans spanning numerous conflicts and generations of service and who have no history of mental health treatment; and (2) Identify predisposing, enabling, and needs factors associated with barriers to care. Aims were examined in both the full sample of veterans and …

The Choroid Plexus Links Innate Immunity To Dysregulation Of Csf Homeostasis In Diverse Forms Of Hydrocephalus, Emre Kiziltug

Yale Medicine Thesis Digital Library

The choroid plexus (ChP) secretes a half-liter/day of cerebrospinal fluid (CSF) and is the blood-CSF barrier with critical immune functions. Hydrocephalus, commonly caused by infection or hemorrhage, lacks non-surgical treatments due to obscure pathobiology. We hypothesize that in acquired hydrocephalus, the dual ChP functions of CSF secretion and blood-CSF barrier maintenance become pathologically entangled in a maladaptive disease state. To test this hypothesis, we created novel rat models of post-infectious (PIH) and posthemorrhagic hydrocephalus (PHH) and conducted a multi-omics investigation of these animals to dissect the cellular, molecular, and physiological pathology underlying PIH and PHH . Our systems approach combined …

Meningioma Relational Database Curation Using A Pacs-Integrated Tool For Collection Of Clinical And Imaging Features, Ryan Mclean

Yale Medicine Thesis Digital Library

Meningiomas are the most common primary intracranial neoplasm seen in adults, and despite the largely benign nature of these tumors, they are associated with significant morbidity and mortality1. Physicians specialized in CNS pathologies, such as neurosurgeons, neuroradiologists, and neuro-oncologists rely on multiparametric MRI (mpMRI) for diagnosis, guidance of management, and response to therapy of CNS lesions. Today, in the era of artificial intelligence, with high-throughput computing and accessibility to massive amounts of data, we see the emergence of new fields in translational science. Proteomics, genomics, metabolomics, and more recently, radiomics are quantitative and analytical fields that are driven by the …

Cerebral Arachnoid Cysts Are Radiographic Harbingers Of Epigenetics Defects In Neurodevelopment, Kedous Mekbib

Yale Medicine Thesis Digital Library

Cerebral arachnoid cysts (ACs) are the most common space-occupying lesion of thehuman brain but we know very little about its pathogenesis and association with other neurological phenotypes complicating clinical management.

To better understand AC pathogenesis and clinical presentation, we conducted wholeexomesequencing of 617 patient-parent trios, analysis of human brain and mouse meningeal single-cell RNA sequencing and natural language processing of patient medical records, the largest and only integrative genomic study of ACs to date.

We found seven genes: ADNP, ARID1B, KDM5C, PURA, FOXP1, MAP2K1 andSCN2A, had an exome-wide statistically significant burden of de novo variants. Our AC candidate genes were …

Dermatologic Infectious Complications And Mimickers In Cancer Patients On Oncologic Therapy, Jolanta Pach

Yale Medicine Thesis Digital Library

Dermatologic infections affecting the skin, hair, mucosae, and nails are common complications of systemic cancer therapy and can impact cancer patients’ quality of life; however, studies investigating these complications are largely lacking. We aimed to characterize dermatologic infectious complications secondary to oncologic therapy and the management of these complications in the outpatient and inpatient settings. We sought to identify how dermatologic infections differ in patients undergoing novel classes of cancer therapy, including targeted therapy and immunotherapy, compared to those on traditional cytotoxic chemotherapy. Second, we aimed to investigate non-infectious dermatologic complications of oncologic therapy which may mimic infectious complications. Here, …

Volumetric Assessment Of Imaging Response In The Pnoc Pediatric Glioma Clinical Trials, Divya Ramakrishnan

Yale Medicine Thesis Digital Library

Response assessment in neuro-oncology relies on radiographic assessment of tumor burden on magnetic resonance (MR) imaging. The most widely used criteria were developed by the Response Assessment in Neuro-Oncology (RANO) group. The RANO criteria rely on bidimensional (2D) measurements of tumor on MR images. The RANO criteria were originally developed to assess response in adult high-grade glioma. However, the heterogeneous appearance of pediatric low-grade gliomas make application of RANO criteria challenging. Volumetric assessment of pediatric gliomas may offer a more comprehensive method for characterizing response.

The goal of this thesis was to compare 2D and volumetric assessment methods in two …

Racial And Sex Disparities In Adult Reconstructive Airway Surgery Outcomes: An Acs Nsqip Analysis, Tagan Rohrbaugh

Yale Medicine Thesis Digital Library

Racial and Sex Disparities in Adult Reconstructive Airway Surgery Outcomes: An ACS NSQIP Analysis Tagan Rohrbaugh and Nikita Kohli. Department of Otolaryngology, Yale University, School of Medicine, New Haven, CT.

Previous studies demonstrated postoperative adverse events associated with pediatric airway reconstruction surgery using the National Surgery Quality Improvement Program-Pediatric (NSQIP-P) database. However, postoperative adverse events using the NSQIP database has not yet been described in adults. This study uses the NSQIP database to examine postoperative complications of airway reconstruction surgery in the setting of racial and sex disparities. Current procedural terminology (CPT) codes were used to identify 260 patients 18 …

Somatic Mutations In Aging, Paroxysmal Nocturnal Hemoglobinuria, And Myeloid Neoplasms, Tho Tran

Yale Medicine Thesis Digital Library

Paroxysmal nocturnal hemoglobinuria (PNH) is a clonal blood disorder frequently associated with bone marrow failure that in rare instances can progress to leukemia. PNH clones of varying sizes occasionally present even in patients with hematologic malignancies and no known history of classical PNH, particularly in myelodysplastic neoplasms (MDS). Curiously, somatic driver mutations considered to be pathogenic and likely pathogenic in myeloid leukemias can be found in phenotypically normal, elderly individuals, as well as those with clonal disorders such as PNH, clonal hematopoiesis of indeterminate potential (CHIP), and age-related clonal hematopoiesis (ARCH). These mutations may be the critical link between PNH …

Illness Perception And The Impact Of A Definitive Diagnosis On Women With Ischemia And No Obstructive Coronary Artery Disease: A Qualitative Study, Leslie Yingzhijie Tseng

Yale Medicine Thesis Digital Library

Background: Ischemia and no obstructive coronary artery disease (INOCA) disproportionately impacts women, yet the underlying pathologies are often not distinguished, contributing to adverse health care experiences and poor quality of life. Coronary function testing at the time of invasive coronary angiography allows for improved diagnostic accuracy. Despite increased recognition of INOCA and expanding access to testing, data lack on first-person perspectives and the impact of receiving a diagnosis in women with INOCA.Methods: From 2020 to 2021, we conducted structured telephone interviews with 2 groups of women with INOCA who underwent invasive coronary angiography (n=29) at Yale New Haven Hospital, New …

Regionalization Strategy To Optimize Inpatient Bed Utilization And Reduce Emergency Department Crowding, Ragini Luthra Vaidya

Yale Medicine Thesis Digital Library

Aims:Pooling inpatient bed resources for more efficient bed management is a promising solution to the pervasive problem of Emergency Department crowding. This study aims to characterize a regionalization protocol in place for ED-to-inpatient disposition between a tertiary academic medical center (AMC) and an urban community teaching hospital in an integrated health system, overseen by a single Bed Management Department. An additional purpose of this study is to investigate transfer decisions from a health equity perspective.

Methods:This is a retrospective observational study utilizing electronic admissions records from the two hospitals’ Emergency Departments to general medicine floors between January 1, 2020 and …

Incorporating Genomic Analysis In The Clinical Practice Of Hepatology, David Hun Chung

Yale Medicine Thesis Digital Library

In the past two decades, whole-exome sequencing has been successfully demonstrated as an indispensable instrument in uncovering the genetic etiology underlying numerous types of unexplained liver disease. Characterization of these illnesses into distinct molecular disease entities has revolutionized understanding of pathophysiology and has translated into improved guidance on management, treatment and prognosis for patients. However, hepatologists have been slow to welcome the technology into their mainstream clinical practice, largely due to inadequate training in genomic medicine. There thus remains a pressing need to create various forums through which clinicians can gain better appreciation for the value of genetic analysis in …

Clinical Trials Related To The Spine & Shoulder/Elbow: Rates, Predictors, & Reasons For Termination, Dennis Louis Caruana

Yale Medicine Thesis Digital Library

Clinical trials are key to the advancement of products and procedures related to musculoskeletal conditions. Unfortunately, many trials are terminated prior to completion. ClinicalTrials.gov is a registry and results database maintained by the National Library of Medicine that catalogs trial characteristics and tracks overall recruitment status (e.g., ongoing, completed, terminated) for each study as well as reasons for termination. Reasons for termination have not been specifically evaluated for musculoskeletal trials and those related to the spine and shoulder/elbow were selected for characterization and assessment of independent predictors of termination by comparing characteristics of completed and terminated trials.

The ClinicalTrials.gov database …

An Examination Of Honor Society Membership, Mistreatment, And Discrimination By Medical Student Demographics, Katherine Ann Hill

Yale Medicine Thesis Digital Library

Purpose: To determine whether the prevalence of honor society membership and self-reported mistreatment and discrimination differs by medical student demographic group.Methods: This cross-sectional study analyzed data from Association of American Medical Colleges data collection instruments and included all students who graduated from LCME-accredited US medical schools and completed the Graduation Questionnaire in 2016-2019 (for honor society membership) or 2016-2017 (for self-reported mistreatment and discrimination). Results: In a sample of 50,384 graduating medical students, membership disparities were found in both Alpha Omega Alpha (AOA) and Gold Humanism Honor Society (GHHS). However, disparities in AOA existed across more identities, were often larger, …

Utility Of Shear Wave Elastography In Breast Cancer Diagnosis: A Systematic Review And Meta-Analysis, Aishwarya Pillai

Yale Medicine Thesis Digital Library

In the United States, breast cancer is one of the most diagnosed cancers in women. Early detection, often via mammography, and intervention have been shown to reduce mortality. However, not all cancers are mammographically evident in early stages, if at all. As a result, ultrasound has been increasingly used to supplement mammography for breast cancer detection and assessment, particularly in dense breasts. Recent advancements in ultrasonography include the ability to characterize the stiffness of biological tissues. Shear Wave Elastography (SWE) is one such development used to quantify tissue stiffness within a region of interest.

The resistance of soft tissue to …

Surgical Outcomes Following Posterior Spinal Fusion For Adolescent Idiopathic Scoliosis, Wyatt Benajmin David

Yale Medicine Thesis Digital Library

Surgical Outcomes Following Posterior Spinal Fusion for Adolescent Idiopathic ScoliosisWyatt B. David and Michael DiLuna. Section of Pediatric Neurosurgery, Department of Neurosurgery, Yale University, School of Medicine, New Haven, CT. Hospital size has previously been shown to impact outcomes in adult spine surgery. However, there is a paucity of studies assessing the impact of hospital size on outcomes in adolescent spine surgery. Furthermore, gender-based differences have been suggested in disease progression and outcomes of adolescent idiopathic scoliosis (AIS), though only a few studies have investigated these disparities. The aim of this study was to determine the impact of hospital size …

International Academic Partnerships In Orthopaedic Surgery, Michael Jesse Flores

Yale Medicine Thesis Digital Library

Abstract: INTERNATIONAL ACADEMIC PARTNERSHIPS IN ORTHOPAEDIC SURGERY. Michael J. Flores. Department of Orthopaedics & Rehabilitation, Yale University, School of Medicine, New Haven, CT.

Introduction: Orthopaedic-related disease (ORD) is one of the leading health challenges faced worldwide and is a significant cause of global morbidity and mortality, especially in low- and middle-income countries (LMICs). In recent years, international orthopaedic outreach to address the global burden of ORD has received greater attention due to initiatives such as the Lancet Commission on Global Surgery (LCGS). Many strategies have been considered to address the global burden of ORD, most commonly though volunteer trips by …

Incarcerated Patients Have Higher Mortality After Trauma: An Unreported Healthcare Disparity, Harry Newmanplotnick

Yale Medicine Thesis Digital Library

While the U.S. has the highest incarceration rate in the world, at nearly 1% of the adult population, or over 2 million people, insight regarding health disparities in this population remains limited, particularly for traumatic injuries and surgical care. Our aims with this paper were two-fold. First, we sought to perform the largest national database analysis of criminal-justice system involved (CJI) trauma patients (specifically incarcerated patients). Second, we planned to investigate if incarceration status was associated with differences in a variety of outcomes after trauma for U.S. adults.To accomplish these aims we analyzed data from the National Trauma Data Bank …

Almajiri Health; A Scoping Review On Disease, Health Literacy And Space For Participatory Research, Muzzammil Imran Muhammad

Yale Medicine Thesis Digital Library

Introduction

Almajirai are male children who leave the care of their parents to learn the Qur’an and study Islam under the tutelage of a Mallam or Imam at a Tsangaya. Almajiranci refers to the system of education based on this relationship between almajiri and mallam, and which was the dominant mode of education in precolonial Hausaland – Northern Nigeria and Southern Niger. This system remains widespread and popular in both countries. In recent years, discourse around almajirai has featured prominently in media from and about this region, and has associated almajiranci with non-participation in formal education, abuse, poverty, and underdevelopment. …

More Than Meets The Eye: Improving Recognition Of Child Abuse In Emergency Departments, May Shum

Yale Medicine Thesis Digital Library

Background: Child abuse guidelines exist to help emergency department (ED) providers evaluate injured children for suspected child abuse. Little is known about the impact of these guidelines on provider decision-making in pediatric (PED) and community EDs (CEDs). Objective: To evaluate the impact of a child abuse guideline in pediatric and community EDs through three primary studies: 1. To examine guideline adherence and the appropriateness of decision-making by CED providers. 2. To determine the impact of the guideline on differences in evaluations of infants for abuse between a PED and three CEDs. 3. To implement and assess the use of a …

Sex Differences In Patients With Deep Vein Thrombosis, Shin Mei Chan

Yale Medicine Thesis Digital Library

Objective: Sex differences in short-term outcomes of patients with deep vein thrombosis (DVT) have been reported but differences in long-term outcomes remain poorly characterized. This study aims to evaluate sex differences in long-term mortality, venous thromboembolism (VTE)-related mortality, and bleeding-related mortality in patients with DVT at a tertiary care center.

Methods: A retrospective chart review from 2012 – 2018 of all consecutive patients diagnosed with DVT was performed. Patients were grouped by sex, and baseline characteristics and treatment modalities were compared. Long-term outcomes of recurrent VTE, bleeding, and related mortalities were analyzed. Multivariable regression analysis was performed to determine factors …

Applying Deep Learning To Identify Imaging Biomarkers To Predict Cardiac Outcomes In Cancer Patients, Aishwarya Kishore Nene

Yale Medicine Thesis Digital Library

Cancer patients are a unique population with increased mortality from cardiovascular disease, however only half of high-risk patients are medically optimized. Physicians ascertain cardiovascular risk from several risk predictors using demographic information, family history, and imaging data. The Agatston score, a measure of total calcium burden in coronary arteries on CT scans, is the current best predictor for major adverse cardiac events (MACE). Yet, the score is limited as it does not provide information on atherosclerotic plaque characteristics or distribution. In this study, we use deep learning techniques to develop an imaging-based biomarker that can robustly predict MACE in lung …

Improving Cancer Classification With Domain Adaptation Techniques, Juliana Veira

Yale Medicine Thesis Digital Library

Background: As the quantity and complexity of oncological data continue to increase, machine learning (ML) has become an important tool in helping clinicians better understand malignancies and provide personalized care. Diagnostic image analysis, in particular, has benefited from the advent of ML methods to improve image classification and generate prognostic information from imaging collected in routine clinical practice [1-3]. Deep learning, a subset of ML, has especially achieved remarkable performance in medical imaging, including segmentation [4, 5], object detection, classification [6], and diagnosis [7].

Despite the notable success of deep learning computer vision models on oncologic imaging data, recent studies …

An Ultrasound Based Femoral Artery Calcification Score Predicts Amputation Free Survival, Ethan Maahs

Yale Medicine Thesis Digital Library

Objectives: Duplex ultrasound (DUS) of the lower extremities is commonly used to assess patients with lower extremity atherosclerosis. Arterial calcification can often be visualized in these images, however efforts to quantify its extent have been limited. We thus sought to develop a new scoring system to measure calcification on duplex US studies of the femoral artery and correlate it with standard CT-based methods. We then made preliminary attempts to correlate US-based femoral artery calcification scores with limb-specific outcomes in patients with peripheral artery disease. Methods: Patients who underwent CT scan evaluation of the lower extremities and arterial duplex US of …