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Partial And Total Tonsillectomy For Pediatric Sleep-Disordered Breathing: The Role Of The Cas-15, Jacob Garn Mabey

Yale Medicine Thesis Digital Library

The Clinical Assessment Score-15 (CAS-15) is an office-based tool for assessing the riskof sleep disordered breathing (SDB), a relatively common condition in the pediatric population. Change in CAS-15 following total tonsillectomy (TT) has been shown to have a large effect size, but it is unclear how it varies following partial intracapsular tonsillectomy (PIT). Thus, the objective of the present study is to evaluate the utility of the CAS-15 score in assessing the effectiveness of PIT and how this compares to change after TT. Children ages 2-18 undergoing PIT (N=16) or TT (N=8) with or without adenoidectomy for SDB completed the …

Colonoscopy Withdrawal Time And Dysplasia Detection In Patients With Inflammatory Bowel Disease, Chandler Julianne Mcmillan

Yale Medicine Thesis Digital Library

Compared to the general population, patients with inflammatory bowel disease (IBD) are more at risk for developing colorectal dysplasia and neoplasia in their lifetime. Given this increased risk, current guidelines recommend that patients with IBD involving at least one-third of the colon undergo routine surveillance colonoscopy exams every one to five years to monitor disease activity and severity. Colonoscopy withdrawal time (CWT) is considered an important predictor of adenoma detection and a quality metric of colonoscopy within the general population. Society organizations including the American Society for Gastrointestinal Endoscopy and the American College of Gastroenterology have proposed a minimum average …

Distressed Community Index In Patients Undergoing Carotid Endarterectomy In Medicare-Linked Vqi Registry, Carmen Pajarillo

Yale Medicine Thesis Digital Library

IntroductionThe association between community socioeconomic distress and carotid endarterectomy (CEA) outcomes is understudied. We therefore analyzed the association between the Distressed Community Index (DCI), a zip-code level measure of community distress, with 36-month post-CEA mortality and readmission.

MethodsWe thus examined patients undergoing CEA between 2015-2019 in the Vascular Quality Initiative database linked with Medicare claims outcomes data. Patients’ DCI ranged from 0 (not distressed) to 100 (distressed). The 36-month mortality was assessed by DCI quintiles using the Kaplan-Meir cumulative incidence function (CIF) and for linear DCI, using Cox regression stratified on site. For 90-day readmission, we used CIF curves and …

A Hero's Journey: Experiences Using A Therapeutic Comicbook In A Children’S Psychiatric Inpatient Unit, Idil Yazgan

Yale Medicine Thesis Digital Library

Children’s mental health care has been on the decline since the start of the century. The COVID-19 pandemic further unearthed this significant worsening of mental health in children with heightened levels of anxiety, depression, loneliness, anger, and fatigue leading to an increase in the number of emergency room visits and inpatient hospitalizations. Art and narrative-based interventions are known to improve patient outcomes and are a crucial component of pediatric inpatient psychiatric care. We discuss the process of adoption of a novel therapeutic comic book that was developed for children admitted to the hospital in a psychiatric inpatient unit at Yale-New …

Behavioral Outcomes In Patients With Metopic Craniosynostosis: Relationship With Radiographic Severity, Mariana Almeida

Yale Medicine Thesis Digital Library

Children with metopic nonsyndromic craniosynostosis have been found to have more neurocognitive and behavioral difficulties, when compared to other types of nonsyndromic craniosynostosis. These neurocognitive and behavioral difficulties can be apparent later in life even following surgical correction of the cranial dysmorphology at infancy. The factors that may be contributing to these difficulties have not been fully elucidated. In metopic craniosynostosis, radiographic severity can be measured using computed tomography imaging. Pre-operative radiographic severity has been demonstrated to be associated with worse reading abilities at school age. However, these studies have had limited sample sizes. Furthermore, the impact of radiographic severity …

Ventilator Weaning Parameters Revisited: A Traditional Analysis And A Test Of Artificial Intelligence To Predict Successful Extubation, John James Andrews

Yale Medicine Thesis Digital Library

The prediction of which patients can be liberated successfully from mechanical ventilation and which patients require continued support remains a challenge for clinicians. While premature extubation comes with many risks, including respiratory distress, loss of airway, complications of reintubation, and increased mortality, delayed extubation comes with risks including ventilator-associated pneumonia, ventilator-induced lung injury, airway trauma, and unnecessary sedation. With such serious clinical implications, there is a strong and persistent interest among clinicians to identify better models to predict extubation success. Multiple respiratory parameters for predicting weaning success have been assessed over the past several decades, with particular attention to respiratory …

A Needs Assessment For Rural Health Education In United States Medical Schools, Kailey Carlson

Yale Medicine Thesis Digital Library

This study is a needs assessment for rural health education at United States medical schools. Health disparities between rural and urban populations are significant and worsening. Rural areas are home to 20% of Americans but just 11% of physicians, contributing to health inequity. Medical schools must produce more future rural physicians to meet the needs of the population. To understand the need for rural health education in medical schools, medical students were surveyed on attitudes toward living and working in rural areas and comfort with clinical competencies important in rural areas. The hypothesis was that medical students at schools focusing …

Genetic Contributions To Thoracic Aortic Disease, Ellelan Arega Degife

Yale Medicine Thesis Digital Library

AimsThoracic aortic aneurysms and dissections are significant yet under-recognized threats in cardiovascular health, often remaining undetected until catastrophic events occur. This study aims to explore the genetic landscape of thoracic aortic diseases, focusing on genetic mutations contributing to thoracic aortic aneurysm (TAA) and dissection. It also seeks to refine the size criteria for surgical intervention in TAA, aiding clinicians in decision-making and improving patient outcomes.

MethodsThe study employed a comprehensive literature review, focusing on the genetic aspects of thoracic aortic diseases. In addition to a systematic MEDLINE search, the investigation used the Genomics England PanelApp to identify genes associated with …

Patient Perceptions Of Machine Learning-Enabled Digital Mental Health, Clara Zhang Guo

Yale Medicine Thesis Digital Library

Objective: The mental health crisis is accelerating, with 55.8M American adults in treatment in 2022. Digital mental health is a growing field with implications for mental health care. The objective of this study was to understand patients’ mental health treatment experience and the relationship with their perspectives of a novel digital health product geared toward improving care quality.

Methods: In December 2023, an IRB-exempt questionnaire was sent to undergraduate and graduate students at campuses across the North-East United States, as well as healthcare-focused Slack® groups.

Results: Of the 1,127 respondents, 28% were actively in treatment for their mental health, 25% …

Association Of Vigorous Physical Activity With Psychiatric Disorders And Participation In Treatment, John L. Havlik

Yale Medicine Thesis Digital Library

This study aimed to compare annual levels of vigorous activity and minutes per episode of vigorous activity among adults with non-substance use psychiatric disorders, especially those participating in treatment, those with no history of psychiatric disorders, prior-to-past-year histories only, or current disorders but no past-year treatment. We used data from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions III (NESARC-III; n=36,309), a nationally representative survey of US adults. Adjusted means testing was used to evaluate differences between groups in annual frequency of vigorous physical activity and mean minutes per session of vigorous activity, with and without adjustment for …

Applying Deep Learning To Derive Noninvasive Imaging Biomarkers For High-Risk Phenotypes Of Prostate Cancer, Sajid Hossain

Yale Medicine Thesis Digital Library

Novel biomarkers can help guide management of Prostate Cancer (PCa) through the identification of high-risk phenotypes among similar patients in traditional National Comprehensive Cancer Network (NCCN) risk groups. We hypothesized that deep learning (DL) models which identified Extraprostatic Extension (EPE) and Seminal Vesicle Invasion (SVI), both pathologies associated with treatment failure, on Magnetic Resonance Imaging (MRI) could provide imaging biomarkers of PCa prognosis. In this study, two deep learning models were trained on axial T2-weighted (T2W) prostate MRI images (n=612) to derive imaging biomarkers of EPE and SVI. Area Under the Receiver Operating Characteristic Curve (AUC) was used to measure …

Janus Kinase Inhibition In Granuloma Annulare: Two Single-Arm, Open-Label Clinical Trials, Erica Hwang

Yale Medicine Thesis Digital Library

Granuloma annulare (GA) is an inflammatory cutaneous granulomatous diseasethat lacks satisfying and effective targeted therapies. Janus kinase (JAK) inhibitors are of interest as they inhibit upregulated cytokines in GA including IFN-γ, IL-4, IL-13, IL-15, IL-21, and oncostatin M. Further investigation is needed to establish the safety profile, optimal route or formulation, and efficacy of JAK inhibitors for GA. We conducted single-arm, open-label clinical trials of abrocitinib, a JAK1-specific inhibitor, and AC- 1101, a topically applied JAK inhibitor, in patients with GA and hypothesized that each medication would be safe, tolerable, and effective at treating GA. In the first study, adult …

Evaluation Of Gastroesophageal Reflux And Hiatal Hernia As Risk Factors For Lobectomy Complications, Michael Kaminski

Yale Medicine Thesis Digital Library

Up to 40% of lobectomies are complicated by adverse events. Gastroesophageal reflux disease (GERD) and hiatal hernia have been associated with cardiopulmonary pathology across a range of clinical scenarios, yet their relation to complications after pulmonary resection is understudied. We hypothesized GERD and hiatal hernia are predictors of complications after lobectomy for lung cancer. Lobectomy patients at Yale-New Haven Hospital between January 2014 and April 2021 were evaluated for predictors of 30-day post-operative complications, pneumonia, atrial arrhythmia, readmission, and mortality. Multivariable regression models included sociodemographic characteristics, BMI, surgical approach, cardiopulmonary comorbidities, hiatal hernia, GERD, and acid suppressive therapy as predictors. …

Social Determinants Of Health & Barriers To Care In Diabetic Retinopathy Patients Lost To Follow-Up, Thomas Chang

Yale Medicine Thesis Digital Library

SOCIAL DETERMINANTS OF HEALTH & BARRIERS TO CARE IN DIABETIC RETINOPATHY PATIENTS LOST TO FOLLOW-UP

Thomas L. Chang, Akua Frimpong, Kristen Nwanyanwu. Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, CT.

Diabetic retinopathy is the leading cause of blindness in working-age adults in the United States. More than a quarter of patients are lost to follow-up (LTFU) after they receive anti-vascular endothelial growth factor (anti-VEGF) injections as treatment. This study utilized a mixed-methods approach with both a quantitative and qualitative analysis. The specific aims of the quantitative analysis were to identify any potential factors or …

Clinical Decision Support For Emergency Department-Initiated Buprenorphine For Opioid Use Disorder, Wesley Holland

Yale Medicine Thesis Digital Library

Adoption of emergency department (ED) initiation of buprenorphine (BUP) for opioid use disorder (OUD) into routine emergency care has been slow, partly due to clinicians’ unfamiliarity with this practice and perceptions that it is complicated and time-consuming. To address these barriers and guide emergency clinicians through the process of BUP initiation, we implemented a user-centered computerized clinical decision support system (CDS). This study was conducted to assess the feasibility of implementation and to evaluate the preliminary efficacy of the intervention to increase the rate of ED-initiated BUP.An interrupted time series study was conducted in an urban, academic ED from April …

The Hardships Of Healthcare Among People With Lived Experiences Of Homelessness In New Haven, Ct, Brandon James Hudik

Yale Medicine Thesis Digital Library

Objectives: People with lived experiences of homelessness encounter barriers to accessing and maintaining appropriate healthcare. This project aims to: 1) identify how these barriers manifest in New Haven, CT; 2) examine the negative health and healthcare impacts such barriers may incur, including when people adapt to or try to overcome them; 3) examine the characteristics of positive experiences in accessing healthcare in order to inform future approaches to healthcare for this vulnerable population.

Methods: This study is a subanalysis of the Justice, Health, and Housing Study (JustHouHS) and draws on longitudinal, qualitative interviews with low-income New Haven residents who experienced …

Rare And Undiagnosed Liver Diseases: New Insights From Genomic And Single Cell Transcriptomic Analyses, Chigoziri Konkwo

Yale Medicine Thesis Digital Library

Chronic liver disease (CLD) is a major global health problem, leading to an estimatedtwo million annual deaths worldwide. Advances in next generation sequencing (NGS) technologies have revolutionized our ability to diagnose and investigate disease pathogenesis. Our research group has previously shown that genomic analysis is useful in the diagnosis of patients with unexplained CLD, providing a diagnostic yield of up to 30%. Moreover, this approach has revealed a newly described cause of non-cirrhotic portal hypertension and nodular regenerative hyperplasia due to GIMAP5 deficiency, which is recapitulated in a mouse model. Additionally, the growing use of single cell RNA sequencing (scRNA-seq) …

“Teen Health” Empowers Informed Contraception Decision-Making In Adolescents And Young Adults, Christina Lepore

Yale Medicine Thesis Digital Library

Adolescents and young adults (AYAs), here defined as aged 13-25 years, face uniquechallenges in accessing sexual and reproductive health information. Interactive internet resources provide a free, private and personalized opportunity to help AYAs make informed contraception choices. We designed an original website called “Teen Health” to provide age-appropriate and evidence-based SRH education to AYAs, as well as an interactive contraception education tool (CET). We introduced “Teen Health” to AYAs in a clinical setting and observed trends in contraception preference after website exposure. We hypothesized that “Teen Health” would support informed contraception decision-making.

A convenience sample of AYAs were recruited from …

Unheard Voices: The Burden Of Ischemia With No Obstructive Coronary Artery Disease In Women, Marah Maayah

Yale Medicine Thesis Digital Library

Background: Ischemic heart disease (IHD) is a leading cause of morbidity and mortality in women. Up to two-thirds of women with IHD suffer from ischemia with no obstructive coronary artery disease (INOCA), which includes endotypes such as microvascular dysfunction and vasospasm. Due to a lack of clear prognostic data, INOCA has historically been viewed as a benign condition and many women have been dismissed from cardiovascular care, despite refractory symptoms and a risk for adverse outcomes. The objective of this qualitative study is to utilize structured interviews to formally characterize the experience of women with INOCA diagnosed with invasive coronary …

Outcomes Following Hypofractionated Radiotherapy For Patients With Thoracic Tumors In Predominantly Central Locations, Alexander Sasse

Yale Medicine Thesis Digital Library

Hypofractionated radiation therapy (HFRT) is emerging as a preferred treatment for lung cancer patients ineligible for stereotactic body radiotherapy (SBRT). Normally, a standard-dose (SD-HFRT) hypofractionation regimen administers 60 Gy across 15 fractions, equating to a biologically effective dose (BED10) of 84.0, which is less than that of ablative SBRT. The first part of this thesis contrasts the clinical outcomes of patients receiving a high-dose (HD-HFRT) protocol, delivering 72 Gy in 18 fractions with a BED10 of 100.8, against those on SD-HFRT. Our research examines whether HD-HFRT enhances local control (LC) and overall survival (OS) rates while maintaining comparable rates of …

Machine Learning And Risk Prediction Tools In Neurosurgery: A Rapid Review, Josiah Sherman

Yale Medicine Thesis Digital Library

INTRODUCTION: Artificial intelligence (AI) and machine learning (ML) techniques have become highly visible in society and medicine, with some AI/ML-enabled devices receiving approval by the Federal Drug Administration for use in direct patient care. In neurosurgery, ML algorithms have been developed for clinical outcome prediction, many of which have achieved higher predictive ability than standard statistical analysis techniques. However, few have synthesized the ML literature in neurosurgery and its subspecialties. Given the rapid rate at which ML algorithms for outcome prediction and prognostication have developed in neurosurgery, additional synthesis of the current ML landscape in this area is necessary. The …

Imaging Markers Of Microstructural Development In Neonatal Brains And The Impact Of Postnatal Pathologies, Pratheek Sai Bobba

Yale Medicine Thesis Digital Library

Rapid changes in diffusion properties and white matter microstructural integrity in neonatal brains complicates the interpretation of advanced MRI techniques such as diffusion weighted (DWI) and diffusion tensor imaging (DTI). Thus, the goal of this work is to characterize age-related normative diffusion patterns in neonates and determine the impacts of postnatal growth trajectory, delivery method, and hypoxic ischemia on neonatal brain diffusion metrics. From a large cohort of neonates who had received brain MRI within 3 months of birth between January 2013 and March 2021, the following cohorts were identified for individual analyses: a cohort of neonates with no neurological …

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, …

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 …

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 …