Digital Commons Network^™

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 …

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 …

"Living Its Strange Life" A Literary Biography Of Margery Latimer From The Archives In 18 Scenes, Leo Egger

Kaplan Senior Essay Prize for Use of Library Special Collections

Portage, Wisconsin is a place defined by passing through it. It was once a major hub of passage, via river and canal, from the Great Lakes to the Mississippi River. Today, the town, home to just over 10,000 people, is little more than a distant suburb of the state capital, Madison, 35 miles to the south. On the drive up 91-North, billboards advertise Ho-Chunk casinos, water parks in the Wisconsin Dells, and the world’s largest Culver’s, a fast-food chain famous for its frozen custard. There are numerous roadside attractions: outside a gas station, a life-sized statue of a pink elephant …

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 …

Permanent Pacemaker Implantation After Tricuspid Valve Repair Surgery, Alyssa Morrison

Yale Medicine Thesis Digital Library

Recent studies suggest that permanent pacemaker implantation after tricuspid valve repair may be more common than previously thought. Our primary aim was to assess the rates of early (within 30 days of surgery) and late (more than 30 days after surgery) permanent pacemaker implantation (PPI) after tricuspid valve repair (TVr) surgery. Our secondary aims included exploring risk factors for PPI after TVr and assessing outcomes.

We performed a retrospective analysis of 231 isolated and concomitant tricuspid valve repairs for primary and secondary tricuspid valve regurgitation at a single quaternary academic center performed from 2014–2022.

Early pacemaker implantation was performed in …

Maternal And Donor Human Milk Support Robust Intestinal Epithelial Growth And Differentiation In A Fetal Intestinal Organoid Model, Lauren Smith

Yale Medicine Thesis Digital Library

Necrotizing enterocolitis (NEC) is a severe gastrointestinal complication of prematurity. Using small intestinal organoids derived from fetal tissue of a gestational age similar to an extremely preterm infant, this study aims to assess the effect of diet on intestinal epithelial growth and differentiation to elucidate the role nutrition type plays in intestinal development and modifies the risk for NEC.

Organoids were cultured for 5 days in organoid growth media and 5 days in organoid differentiation media supplemented 1:40 with four different diet conditions: maternal milk (MM), donor human milk (DHM), standard formula (SF), or extensively hydrolyzed formula (HF). 4x images …

Diagnostic Stewardship: Changing Behavior One Urine Culture At A Time, Beth Warne

Public Health Theses

Urinalysis and urine cultures are important diagnostic tools for diagnosing urinary tract infections. Often urine cultures are ordered without appropriate clinical indications of infection attributable to the urinary tract. Inappropriate urine culture ordering can have significant downstream effects and contribute to the unnecessary use of antibiotics, increased prevalence of Clostridioides difficile infections and antibiotic resistance, as well as wasted resources. A quality improvement project was undertaken at the Veterans Affairs Connecticut Healthcare System (VACHS) to decrease the ordering of inappropriate urine cultures. A new, optional electronic medical record urine culture ordering note requiring documented indication for the test was implemented …

Ai-Aki: Ai-Consulted Inpatient Care For Acute Kidney Injury, William Jingyi Zhang

Public Health Theses

Acute kidney injury (AKI) increases the risk of death in hospitalized adults, and early medical chart review and involvement by a nephrologist may lead to improved patient outcomes. A Kidney Action Team—comprised of a pharmacist and a board-certified nephrologist or nephrology fellow—can serve as a remote consultation service to deliver recommendations for AKI patient diagnosis, initial work up, and care. We aimed to evaluate whether an AI-automated clinical decision support system for AKI could demonstrate predictive power comparable to that of human specialists, with regards to AKI evaluation and treatment. This study uses data from KAT-AKI (NCT04040296), a triple-masked, randomized …

Naḥwiyyūn And ʿArab In Sībawayh’S Kitāb: A Social Rivalry At The Heart Of Early Arabic Grammar, Kevin Austin Butts

Yale Graduate School of Arts and Sciences Dissertations

This dissertation examines the early development of Arabic grammar, up to its canonical founding text, the Kitāb of Sībawayh (d. c. 180 AH / 796 CE). It centers the competitive relationship between two social groups as key to understanding the beginnings of grammatical inquiry. These are the 'arab (conventionally, "Arabs"), and the naḥwiyyūn (conventionally, "grammarians," though generally with a connotation as well of "non-native speaker"). Sībawayh regards these groups as the two primary authorities of the linguistic data that comprise his Kitāb, and he devotes much of his energy throughout the Kitāb to adjudicating their arguments. Using the Kitāb and …

Microwave Beamsplitters For Oscillator-Based Quantum Information Processing, Stijn De Graaf

Yale Graduate School of Arts and Sciences Dissertations

A single high-Q harmonic oscillator with a fixed `dispersive’ coupling to an ancillary qubit provides a remarkably hardware-efficient platform for a wide range of quantum technologies, capable of acting as a dark matter detector, a simulator of quantum chemistry or a quantum memory with a lifetime longer than its underlying components. The strength of this platform lies in the linearity and favorable decoherence rates of the high-Q oscillator mode. The question then arises: how can we scale this oscillator-based platform to practically useful sizes without compromising a) the speed of operations or b) the properties that make oscillators an attractive …

Probing Galaxy Evolution And The Baryon Cycle Via Novel Statistical Techniques And Instrumentation, Imad Pasha

Yale Graduate School of Arts and Sciences Dissertations

Understanding the formation and evolution of galaxies across cosmic time requires both observations across redshift, wavelength, and method as well as sophisticated machinery for interpreting and carrying out inference on observations. Techniques such Bayesian Inference, Simulation Based Inference, and Machine learning are seeing increased use as attempts are made to extract meaningful results from challenging data. Meanwhile new instrumentation, from spectrographs on major telescopes (e.g., KCWI and MUSE) to new, novel designs (e.g., the Mothra Telescope Array) are providing new observational windows into heretofore invisible portions of the baryon cycle --- a fundamental cycle driving and describing how baryons move …

Constructing The Birthing Body Across The 20th Century: A Thematic Analysis Of Infertility Disorders In The New England Journal Of Medicine, Nicola Davis

Public Health Theses

Obstetrics and Gynecology (OB/GYN) is a medical subspecialty primarily concerned with birth care, reproduction, and gynecological health. OB/GYN practice plays a historically significant role in the treatment of infertility and reproductive disorders as cultural ideologies of fertility and motherhood have been co-constructed alongside the development of OB/GYN medical practice and knowledge. These constructs inform obstetric practice and serve as a framework for contemporary reproductive care. Modern birth care in the medical setting often reinforces a myriad of issues including stigmatization of birthing people’s bodies, over-medicalization of birth, obstetric racism, and obstetric violence. This paper focuses on the evolution of particular …

Chad's Infectious Disease Surveillance In Context: An Analysis Of 2014-2023 Case Report Data, Sophie Licostie

Public Health Theses

Background: Infectious diseases remain a leading cause of mortality and morbidity in Chad. We aimed to assess trends in the most recent ten years of surveillance data collected by the Ministry of Public Health in Chad to characterize the country’s current disease burden.

Methods: In this analysis of Chadian surveillance data, we analyzed reports of suspected cases across seven diseases from 2014-2023. Data included weekly aggregated case counts by district. We used the data to describe temporal and spatial trends, particularly from 2014-2019 compared to 2020-2023.

Findings: Measles case counts showed seasonal peaks of varying intensity throughout most of 2014-2023. …

Exploring Out-Of-Distribution Behaviors In Machine Learning Systems, Yutaro Yamada

Yale Graduate School of Arts and Sciences Dissertations

This dissertation investigates the evolving nature of model generalization in machine learning, with a particular focus on out-of-distribution behavior. It begins by examining how feature selection identifies and discards non-generalizable features, then explores the robustness of ImageNet-based models under shifted data distributions and their transfer to downstream tasks. The discussion moves to Vision-Language Models, exposing a "concept association bias'' that stems from contrastive training and exploring why autoregressive methods can offer stronger relational understanding. It then discuss how 3D-based pre-training mitigates spurious background-object correlations, improving generalization. Finally, it examines Large Language Models' spatial reasoning abilities, both in 2D and 3D, …

Quantum Photonic Devices With Rare Earth Incorporated Thin-Film Lithium Niobate, Likai Yang

Yale Graduate School of Arts and Sciences Dissertations

Quantum information science, offering unprecedented potential compared to classical technologies, has undergone vast growth over the past decades. The proposed quantum computers promise the ability to solve complex problems that are practically intractable for classical computers; long range quantum networks are also envisioned as secure links to distribute both quantum and classical information. The demand to build these large-scale and sophisticated quantum architectures promotes the necessity of hybrid quantum systems, in which different platforms are pursued and interfaced according to specific needs. Among them, the solid state spins have drawn great attention for applications such as spin qubits, single photon …

The Flexible Credit Line (Fcl), International Monetary Fund (Imf)

Documents

No abstract provided.

Enriching An Acute Kidney Injury Prediction Model Among Percutaneous Coronary Intervention Patients: Leveraging Electronic Health Record Data, Enci Cai

Public Health Theses

Background: Percutaneous coronary intervention (PCI) is widely used for treating coronary arterydisease, but carries the risk of acute kidney injury (AKI). Accurate risk stratification for post-PCI AKI is essential for improving patient outcomes. Traditional AKI risk models do not fully account for complex interactions or the breadth of clinical data available in electronic health records (EHRs). Therefore, we sought to enrich an existing AKI risk prediction model, the National Cardiovascular Data Registry (NCDR) model, by integrating additional risk factors derived from EHR data.

Methods: This retrospective cohort study utilized data from the CathPCI registry and the Yale NewHaven Hospital (YNHH) …

Trauma-Informed Digital Health Interventions: A Scoping Review, Amelea Lowery

Public Health Theses

Background: Trauma exposure is a pervasive issue around the world and the impacts of trauma can be long lasting and detrimental to individual and population health outcomes. Trauma responses can influence and determine an individual or community’s approach in seeking supportive resources. Given the critical role of supportive resources and the prevalent use of technology and internet use, it is essential to understand how digital health interventions contribute to addressing trauma explicitly. This scoping review aims to explore the landscape of trauma-informed digital health interventions for adults, assess their outcomes, and identify their measurable impacts across various settings.Methods: A scoping …

Community Health Workers To Strengthen Hiv Care Continuum And Prep Delivery In The Us/Hics: A Scoping Review, Vanessa Abigail Nunez

Public Health Theses

Introduction: With the ongoing global HIV/AIDS burden, community-based service delivery models are increasingly recognized, with community health workers (CHWs) at the forefront. In high-income countries (HICs) like the United States, CHWs have long served marginalized communities, gaining recent legislative attention. Despite this, there's still a need for comprehensive evidence on CHW integration in healthcare delivery.

Methodology: We conducted a scoping review to gather available evidence on community health workers (CHWs) and their impact on HIV outcomes in HICs, and to identify evidence gaps in the use of community-based HIV/PrEP services in HICs. Using the American Public Health Association’s definition of …

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 …

Radiology Education For U.S. Medical Students In 2024: A State-Of-The-Art Analysis, Ryan Bahar

Yale Medicine Thesis Digital Library

Radiology is essential to the practice of clinical medicine, with ever-increasing volumes of diagnostic imaging studies and image-guided procedures across the U.S. healthcare system. Yet, radiology education has received criticism for its under-representation in formal U.S. medical school curricula, coupled with variable requirements and offerings among institutions. Recent national calls for medical education reform (e.g., the 2010 Carnegie report) and the emergence of new teaching tools (e.g., e-learning, simulation) have led to paradigm shifts in medical education delivery that have been further accelerated by the unprecedented alterations to educational environments catalyzed by the COVID-19 pandemic. In this landscape of profound …

Bringing Large Language Models To Ophthalmology: Domain-Specific Ontologies And Evidence Attribution, Aidan Gilson

Yale Medicine Thesis Digital Library

Background: In the landscape of medical innovation, Large Language Models (LLMs) represent a groundbreaking advancement, holding substantial promise for reshaping healthcare practices. These models demonstrate remarkable proficiency in assimilating and processing extensive medical literature, facilitating rapid information retrieval. Nevertheless, when applied to the specialized domain of ophthalmology, LLMs encounter significant hurdles owing to the intricacies inherent in this field. Ophthalmology, characterized by the intricate interplay of ocular anatomy, diverse disease manifestations, and nuanced diagnostic subtleties, poses considerable challenges for these generalized models. Compounding these challenges is the inherent limitation of the ophthalmological corpus itself, which remains notably narrower compared to …

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. …

“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 …

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 …

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 …

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 …

A Cost-Effectiveness Analysis Of Oropharyngeal Cancer Post-Treatment Surveillance Practices, Rema Shah

Yale Medicine Thesis Digital Library

Post-treatment surveillance imaging for oropharyngeal squamous cell carcinoma (OPSCC) is guided by the National Comprehensive Cancer Network (NCCN) and often is routinely performed beyond the suggested guidelines. With the advent of biomarker-based disease surveillance, there may be an alternative option that can reduce the cost-burden of post-treatment imaging for OPSCC. This study investigates the comparative cost-effectiveness of a hypothetical miRNA biomarker test for specifically HPV-negative (HPV-) OPSCC post-treatment surveillance and also investigates whether the extra imaging practices that are often employed for both HPV+ and HPV- OPSCC are truly cost-effective in order to inform evidence-based decision making after OPSCC treatment. …

Racial Disparities In Behavioral Crisis Care: Investigating Restraint Patterns In Emergency Departments, Erika Chang-Sing

Yale Medicine Thesis Digital Library

AbstractImportance: Black patients were more likely than White patients to be brought to the hospital by police, and they were also more likely to be restrained and sedated during behavioral crises in emergency departments (EDs). Although the perils of policing mental health conditions for Black individuals are recognized, it is unclear whether or to what extent police transport mediates the relationship between Black race and physical restraint use in emergency departments. Hispanic/Latino patients were less likely than White patients to be restrained in Emergency departments but more likely to be brought to the hospital by police. They were also less …