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Impact Of Single-Family-Room Nicu Design On Infant Neurodevelopment And Breast Milk Provision, Lucille Kohlenberg

Yale Medicine Thesis Digital Library

NEONATAL INTENSIVE CARE UNIT DESIGN IMPACTING INFANT OUTCOMES AND BREAST MILK PROVISION.

Lucille Kohlenberg and Angela Montgomery, MD, MSEd. Section of Neonatal-Perinatal Medicine, Department of Pediatrics, Yale School of Medicine. New Haven, CT.

Single-family room (SFR) NICUs have gradually replaced open-bay (OB) units over the last three decades. Compared to OB units, SFR units provide increased opportunities for parental rooming and maternal breast milk (MBM) provision; however, they may also present fewer sensory exposures and parental learning opportunities. Due to the presence of potentially beneficial and detrimental effects, it remains uncertain whether the SFR design offers aggregate advantages over the …

Some Notes On The "Needs Washed" Construction, Jim Wood, Josephine Holubkov, Ian Neidel, Kaija Gahm

Yale Working Papers in Grammatical Diversity

This paper describes the geographic and social factors that correlate with the acceptability of the needs washed construction, based on the results of recent survey data. After briefly describing the survey methods, we discuss several ways to analyze the geographic distribution of the construction, focusing on the distribution of “hot” and “cold” spots across different versions of the construction. We find certain core areas where the construction is highly accepted, as well as core areas where the construction is highly rejected. Our survey looks at the effect of verb (need, want, like, and love), tense/modality …

Analyzing Trends In Intermittent Exotropia With Adhd Medication Use, Kevin Wang

Yale Medicine Thesis Digital Library

ANALYZING TRENDS IN INTERMITTENT EXOTROPIA WITH ADHD MEDICATION USE.

Kevin K. Wang, Marez M. Megalla, and Martha A. Howard. Department of Ophthalmology and Visual Science, Yale University, School of Medicine, New Haven, CT.

Objective: This study aims to examine whether ADHD medication usage is associated with changes in intermittent exotropia in children, and whether such ADHD medication use is associated with prevention of strabismus surgery.

Design/Participants: We conducted a retrospective cohort study of children with both ADHD and intermittent exotropia seen at the Yale Eye Center between 2005 and 2020 who were taking medications for ADHD.

Methods: A list of …

Cardiovascular Disease Mortality Among Asian American And Pacific Islander Breast Cancer Survivors In The United States By Socioeconomic Status And Rurality, 2000-2018, Katherine Luis Ho

Public Health Theses

Background: Known racial/ethnic disparities in cardiovascular disease (CVD) mortality among breast cancer survivors exist and it is well-documented that non-Hispanic Black (NHB) breast cancer survivors experience higher incidence of CVD mortality compared to NHW women. However, few studies have examined CVD mortality among Asian American, Native Hawaiian, and other Pacific Islanders (AANHPI) survivors, especially with respect to socioeconomic factors and rurality at the county-level. The aim of this study was to describe how county-level factors influence disparities in CVD mortality among AANHPI breast cancer survivors. Methods: Using Surveillance, Epidemiology, and End Results 18 registries, we analyzed a retrospective cohort of …

A Nonsense Mutation In Gsdmc Is Associated With Cancer Mortality In Dogs, Hang Li

Public Health Theses

Over 400 distinct canine breeds today were result from artificial selection during the last centuries. And due to the selection pressure from human interest and the founder effects, the difference among individual genomes from one same breed is less than the difference between breeds. 446 samples were included in this study to recognize the cancer-associated nonsense mutations in canine genome. 17 of the 446 samples were lab-recruited dogs, and the other 429 samples were downloaded from Sequence Read Archive. One nonsense mutation in GSDMC protein is found significantly associated with cancer risk in dogs. Since nonsense mutations could provide premature …

Factors Associated With Burnout Amongst Medical Students, Residents, And Attendings In Orthopaedics, David S. Kirwin

Yale Medicine Thesis Digital Library

Burnout is an important and timely topic in medicine as a whole and orthopaedics as a specialty. Prior studies analyzing burnout in orthopaedics generally assess for the prevalence of burnout, without using a targeted analysis on possible causes and/or the potential association with work hours. An anonymous survey was given to 24 medical students on surgical rotations, 20 orthopaedic residents, and 20 orthopaedic surgeons between June 2019 and August 2019 at a single academic institution. The survey inquired about demographics, general attributes (job satisfaction, home support, control over life/schedule), work hours, and included the abbreviated Maslach Burnout Inventory [aMBI]. Residents …

Impact Of Covid-19 On The Mental Health Of Resettled Refugee Children, Joseph Lawsel Williams

Public Health Theses

Background: Mental health difficulties disproportionately impact resettled refugee children (RRC). Little is known regarding the impact between COVID-19 and RRC mental health. A mixed-methods retrospective pilot study was conducted to examine the impact of COVID-19 on RRC mental health.

Methods: Families were recruited in partnership with Elena’s Light, a refugee resettlement community-stakeholder. Participants included 20 RRC (N=11 ages 4-11; N=9 ages 11-15; equal gender distribution) from 10 families (N=6 Afghanistan; N=1 Turkey; N=1 Syria; N=2 non-disclosed) resettled to New Haven, CT before March 2019. Pre-Covid (PC) and During-Covid (DC) maternal responses for three Strength and Difficulties Questionnaire (SDQ) dimensions (Emotional, …

“It Takes A Village”: A Qualitative Analysis Of Black Women’S Experiences Navigating Healthcare With High-Risk Perinatal Conditions, Simileoluwa Elizabeth Falako

Public Health Theses

Black women have a likelihood of maternal mortality that is three to four times higher than white women in the United States. In Connecticut, most pregnancy-related deaths are from Black and Latinx women, even though they do not have the majority of live births in the state. This study aims to explore the medical experiences of Black women with high-risk perinatal conditions and their navigation of healthcare at a tertiary care center in Connecticut. A qualitative study was conducted using semi-structured interviews with seven Black women with hypertension and/or diabetes in pregnancy who gave birth at a large, tertiary medical …

The Impact Of Personalized Nursing Care On Anxiety, Depression, Angina Related Life Quality, And Physiological Conditions In Older Adults With Coronary Heart Disease, Qiao Fan

Public Health Theses

AbstractObjective: To study the impact of medical-personalized nursing care on anxiety, depression, BMI, blood pressure, blood lipid and quality of life in elderly patients with coronary heart disease. Methods: In this study, 160 older adults with coronary heart disease had been enrolled and randomized using the random range method. The control group included 80 older adults who received a conventional nursing intervention, and the experiment group included 80 older adults who were treated with a focused and personalized nursing intervention. The two groups of older adults had been compared and evaluated for Self-rating Anxiety Scale (SAS) mark, the Self-rating Depression …

Sleep Apnea In Veterans With Schizophrenia: Estimating Prevalence And Impact On Cognition, Stephen Edward Ghazikhanian

Yale Medicine Thesis Digital Library

The cognitive impairments of schizophrenia drive the functional disability of the illness but are difficult to treat. One barrier to effective cognitive interventions may be medical illnesses that compromise cognition and are over-represented in people with schizophrenia. Obstructive sleep apnea (OSA) is treatable, causes reversible impairments in many cognitive domains also affected by schizophrenia, and is likely under-diagnosed in people with schizophrenia. We have estimated the prevalence of OSA in schizophrenia, both by self-report and with a predictive model, and characterized the associations between OSA and cognition and functional capacity in schizophrenia, using a large dataset of 3942 patients with …

Risk Factors For Venous Thromboembolism In Children After Surgery In General & Specific To Orthopaedics, Elbert Johann Mets

Yale Medicine Thesis Digital Library

Venous thromboembolism (VTE, including deep venous thrombosis and pulmonary embolism) was studied in children undergoing surgery in general, and those specifically undergoing orthopaedic surgery. Due to the low overall incidence of VTE in this population, VTE chemoprophylaxis is not routinely recommended. However, understanding and quantifying risk factors can help define the risk/benefit considerations of these practices.

The study populations were identified from 2012-2016 National Surgical Quality Improvement Project Pediatric (NSQIP-P) database. Patient demographics, comorbidity factors, and 30-day postoperative outcomes were defined. The populations were then dichotomized into those that did and not have VTE diagnosed in the first 30 postoperative …

A Nationwide Assessment Of Disparities In Primary Cleft Lip Repair, Connor J. Peck

Yale Medicine Thesis Digital Library

Purpose: This study examined the impact of patient race or ethnicity on the likelihood of experiencing delays to surgery, post-operative surgical complications, or prolonged hospital stays following primary cleft lip (CL) repair.Methods: Patients who underwent CL repair were identified from two large national databases: the Kids Inpatient Database (KID) and the Pediatric National Surgical Quality Improvement Program (NSQIP) database. Primary outcomes were defined as treatment after 6 months of age, the presence of any surgical complication, and a hospital stay greater than 1 day. Chi-squared analyses were performed to compare outcomes across patients of different race/ethnicity, followed by multivariable logistic …

Biomechanical Properties Of Posterior To Anterior Lag Screw Insertion In Fibular Supination-External Rotation Fractures And Effect Of Engaged Cortical Thickness, Adam Sahlstrom

Yale Medicine Thesis Digital Library

The fracture pattern of supination-external rotation injury of the fibula is often reducible by lag screw fixation. This thesis is designed to evaluate biomechanical differences between lag screws inserted from an anterior to posterior direction and from a posterior to anterior direction and if the thickness of the anterior and posterior fibular cortices were similarly correlated. 5 donor-matched pairs of cadaver fibula were harvested and submitted to material testing following 3.5-mm cortical screw insertion from either an anterior to posterior direction or a posterior to anterior direction and screw insertion torque and axial pullout strength were measured. Computed tomography images …

Pre-Operative Urinary Tract Infection And 30-Day Outcomes In Neurosurgery, James Yoon

Yale Medicine Thesis Digital Library

Urinary tract infections (UTIs) are the most common bacterial infection in the United States, placing significant demands on our healthcare system already constrained by rising costs and limited resources. While patient complications occur in all areas of surgery, the issue around neurosurgical patients deserves special attention as treatment of surgical site infections in neurosurgery is the most expensive among all surgical specialties. Complication rates are also disproportionately higher in patients over 65 years old, which are noteworthy in caring for our aging patient population.

While the adverse effects of a post-operative UTI have been well described in the surgical literature, …

Factors Impacting Trauma-Specific Quality Of Life Following Injury: A Multi-Center Assessment In Lebanon, Ali Elreichouni

Yale Medicine Thesis Digital Library

Objective: Injuries account for a large portion of the global burden of disease, representing over 10% of all disability adjusted life years (DALYs). This study analyzes the economic impact of injury for those experiencing moderate-to-severe injury in Beirut, Lebanon. It further examines the impact of different demographic and socioeconomic factors on trauma-specific quality of life 1-2 years following injury.

Methods: This was a prospective cohort study following patients 1-2 years after being treated for injury at one of three hospitals in Beirut, Lebanon. Patients interviewed by phone. In addition to questions on financial impact, access to healthcare, and socioeconomic status, …

Yale Medicine Magazine 2022, Issue 169, Yale University. School Of Medicine

Yale Medicine Magazine - alumni bulletin and magazine

This is the 2022 issue of Yale Medicine Magazine, issue 169. Prepared in cooperation with the alumni and development offices at the School of Medicine. Earlier volumes are called Yale School of Medicine alumni bulletins, dating from v.1 (1953) through v.13 (1965) and Yale Medicine: alumni bulletin of the School of Medicine, v.1 (1965) through v. 52, no.1. (Autumn 2017).

Presynaptic Plasticity In A Mammalian Synapse Involves Actin Remodeling And Vesicle Recruitment, Shobana Subramanian

Yale Medicine Thesis Digital Library

Short term synaptic plasticity is required for working memory and executive functions, which become impaired in neurodegenerative diseases such as dementia. A form of short-term plasticity that can be induced by repeated stimulation of neurons is called post-tetanic potentiation (PTP). One way in which PTP occurs is through an increase in the number of vesicles at the active zone, the specialized region of the presynaptic terminal where synaptic transmission occurs. The calyx of Held is a large, rapidly firing synapse located in the auditory brainstem that is involved in sound localization. We have previously shown that the dense layer of …

“A Cascade Of Shifts In The Brain”: Kay Ryan’S Poetics, Sarah Gannett

Kaplan Senior Essay Prize for Use of Library Special Collections

In 2015, Kay Ryan wrote in her private journal that “I don’t feel that my poems have really been enjoyed yet, although they have been rewarded” (May 3, 2015 6:29 AM). This essay uses Ryan’s papers, acquired by the Beinecke Library in 2018, to develop an understanding of the poetics of this much-rewarded, but underappreciated two-term poet laureate, MacArthur fellow, and Pulitzer Prize winner. This essay is the first to use Ryan’s archives to analyze her poetic work.

Two poles of the Beinecke’s Kay Ryan Papers ground my discussion: her self-published 1983 debut collection, Dragon Acts to Dragon Ends, …

An Assessment Of Geographic And Taxonomic Biases In Research On Climate Change-Related Range Shifts, Evan J. Parker

Library Map Prize

Geographic and taxonomic biases in ecological literature inhibit the ability of research to be generalized or translated to other systems. This is particularly true with research on climate change-related range shifts, where a diverse and representative set of observations is needed to understand the significant heterogeneity of range shifts and improve models. A literature review was conducted and biases were assessed by examining the geographic location of study areas, the taxonomic makeup of study species, and the location of study areas within species ranges. A substantial geographic skew towards terrestrial, mid-latitude North America and Europe was observed. However, taxonomic coverage …

Reserve Bank Of India Act, 1934, Reserve Bank Of India

Documents

No abstract provided.

Annual Report 2022, Dexia

Documents

No abstract provided.

Pet Imaging Reveals Reduced Synaptic Density In People With Well-Controlled Hiv Infection, Julian Joseph Weiss

Yale Medicine Thesis Digital Library

Background: Synaptic injury is a pathological hallmark of neurological impairment in people living with HIV (PLWH), a common complication despite viral suppression with antiretroviral therapy (ART). However, there are no biomarkers sensitive to neurocognitive impairment in PLWH. Measurement of synaptic density in living humans may allow better understanding of HIV neuropathogenesis and provide a dynamic biomarker for therapeutic studies. We applied novel synaptic vesical protein 2A (SV2A) positron emission tomographic (PET) imaging to investigate synaptic density in the frontostriatalthalamic region in PLWH and HIV-uninfected (HIV-) participants.

Methods: In this cross-sectional pilot study,13 older male PLWH on ART underwent neurocognitive assessments, …

Latvian Privatization Agency 2021 Report, Latvian Privatization Agency

Documents

No abstract provided.

Educational Program For Caregivers Of Children With Tympanostomy Tube Otorrhea: Impact On Caregiver Self-Efficacy And Clinical Outcomes, Wendy Lord Mackey

Yale School of Nursing Digital Theses

There is an overuse of oral antibiotics and acute care visits conducted to treat children with uncomplicated tympanostomy tube otorrhea (TTO), a condition easily identified by the child’s caregiver who can then independently initiate treatment with ototopical antibiotic drops (TAD). Yet, some caregivers seek urgent medical attention for children with TTO, which often results in mismanagement of the condition including the administration of oral antibiotics. This quality improvement initiative involved the development and implementation of an educational program for caregivers of children with tympanostomy tubes (TT). Resources for caregivers included a web-based instructional video, informational pocket-card, and a post-operative text …

Sepsis Discharge Program: An Interdisciplinary Approach To Reduce Sepsis Readmissions, Rex Daniel Demetria Lomboy

Yale School of Nursing Digital Theses

The social and economic burden associated with sepsis readmission remains a global healthcare issue. Sepsis survivors are at higher risk for physical debilitation, readmission, and death, yet despite advanced sepsis prevention and interventions, post-sepsis care and sepsis readmission reduction efforts, remain scant. Sepsis readmission costs ($500M /year) are more than the annual cost of acute myocardial infarction ($142M /year) and heart failure ($229M/year) combined. The overall goal of this DNP project was to reduce sepsis readmissions for patients identified as high risk for readmission using a standardized, safe discharge program (SDP) and implement it using a dynamic interdisciplinary collaborative approach. …

Implementation Of A Medication Adherence Protocol In A Large Urban Safety Net Hospital, Carlie Martinez

Yale School of Nursing Digital Theses

Medication nonadherence has a deleterious effect on patients with chronic health conditions, as it contributes to poorer health outcomes and increased healthcare spending. This Doctor of Nursing Practice project sought to improve medication adherence in at-risk patients by enhancing patient-provider communication and improving health literacy in a large, urban, safety net hospital. Utilizing a multi-prong approach, patients were provided with a visual aid – a pill card, in conjunction with the teach-back method, to improve systolic blood pressure (SBP), diastolic blood pressure (DPB) and Hemoglobin A1c (HbA1c) over a 6-month period. Twenty-three patients participated in the project. Participant demographics, attitudes …

Using Telemedicine To Optimize The Delivery Of Care In Patients With Liver Disease, Samantha Ramirez

Yale School of Nursing Digital Theses

Chronic Liver Disease (CLD) is one of the top causes of morbidity and mortality globally. Among the spectrum of liver diseases, non-alcoholic steatohepatitis (NASH) is the most common cause of cirrhosis and one of the top reasons for a liver transplant. Patients with NASH end up with hepatic decompensation and liver-related complications such as malnutrition, sarcopenia, frailty, and death. Telemedicine has transformed health care by improving access, reducing cost, and increasing the quality of care. However, telemedicine has not been widely used to manage patients with CLD. This DNP project created a telemedicine protocol to manage patients with NASH, implemented …

Adoption Of Teamstepps® To Promote Collaboration And Problem-Solving: A Pilot Training Program For Clinical Nursing Leaders, Manvir Nijjar

Yale School of Nursing Digital Theses

Quality improvement, a concept implemented by Florence Nightingale in the 19th century, is now deeply embedded in United States healthcare policy from licensure to payment models (Nightingale, 1863). The culture of safety and the emphasis on process improvement is engrained in high reliability organizations, fostering an environment of collective mindfulness and collective enactment to prevent error. To achieve high quality, healthcare organizations must bridge the core competencies of communication, collaboration, and problem solving taught in pre-licensure and translate them in inter-professional practice using evidence-based approaches. Nurses and nursing leaders must be equipped with the right problem-solving tools to drive efficiency, …

Identification And Correction Of Normalized Deviance In Healthcare Systems To Prevent Healthcare-Associated Infections And Improve Patient Outcomes, Elliana Sophia Barbell

Public Health Theses

Introduction: In healthcare, normalized deviance is characterized by the steady transition away from standard practice toward variations in practice behaviors. This deviation presents minorly at first and is accepted to save time and increase efficiency. However, initial evaluations of innocuity do not represent actual safety. While the deviant practice may not cause immediate patient harm, its alignment with additional system weak points has the potential to lead to poor patient outcomes, including the development of healthcare-associated infections (HAI). One behavior that may influence HAI development and patient outcomes is hair removal during preoperative skin preparation.Methods: An observational study of hair …

Adverse Childhood Experiences & Breastfeeding - Pakistan, Paola Bojorquez-Ramirez

Public Health Theses

Rationale: Prior studies have found that a history of adverse childhood experiences (ACEs) is associated with breastfeeding, but the evidence is inconsistent. Despite low and middle income countries (LMICs) carrying a disproportionate amount of poor maternal and infant health outcomes, little research has assessed the relative impact of ACEs on breastfeeding initiation and exclusive breastfeeding in LMICs.Objective: The study investigates whether maternal ACEs are associated with breastfeeding initiation and exclusive breastfeeding at 3 and 6 months postpartum among a cohort of women from rural Pakistan. Methods: The cross-sectional analysis included 869 women 18-45 years of age from the Bachpan Cohort …