Digital Commons Network^™

The Role Of Climate Change In The Pandemic Agreement Negotiations, Cristina Arnes Sanz

Public Health Theses

Introduction: For over three years, Member States of the World Health Organization (WHO) have been negotiating a treaty to prevent, prepare for, and respond to future pandemics. The Pandemic Agreement is anticipated to be adopted at the World Health Assembly in May 2025. Growing scientific evidence underscores the effects of climate change on infectious diseases, including those that could lead to pandemics. This thesis examines how climate change has been addressed in the drafting and negotiations of the Pandemic Agreement.

Methods: All the references related to climate change in the transcripts of the publicly broadcast Intergovernmental Negotiating Body (INB) meetings …

Modeling Impacts Of Water Improvements On Typhoid In Urban South Asia, Chessley Blacklock-Votava

Public Health Theses

Introduction: Typhoid fever represents a significant burden of disease in urban areas across South Asia. While the recent implementation of routine typhoid conjugate vaccinations (TCVs) has demonstrated significant protective effectiveness against disease, it fails to mitigate environmental transmission through contaminated water, which individuals without access to improved water sources (IWS) may be infected by. Objectives: The primary aim of this study is to estimate the potential reductions to typhoid fever incidence that populations could experience when increasing proportions of the population that have IWS across three high-burden cities in South Asia. The relationship between this reduction and the proportion of …

A Bioluminescent Approach To Coxiella Burnetii Pathogenesis: Development And Utilization Of An In Vivo Imaging Model, Jenna Myr Andrews

Yale Graduate School of Arts and Sciences Dissertations

Coxiella burnetii is a Gram-negative, obligate intracellular bacterium that infects livestock and causes Q fever in humans, which can range from acute flu-like symptoms to severe, persistent infections. C. burnetii relies on a Dot/Icm type IVB secretion system to translocate effector proteins, manipulating host cell processes to support intracellular replication. While axenic media have facilitated in vitro pathogenesis research, in vivo studies remain limited due to the classification of the virulent Nine Mile phase I strain as a category B select agent. Although the avirulent phase II strain RSA493 is exempt from this classification, it is rapidly cleared in immunocompetent …

Investigating The Plasticity And Role Of Peripherally Derived Cd4 T Cells In The Brain At Homeostasis, Tomomi Marie Yoshida

Yale Graduate School of Arts and Sciences Dissertations

Specialized immune cells residing in tissues orchestrate diverse biological functions through communication with parenchymal cells. The contribution of the innate immune compartment in the meninges and central nervous system (CNS) is well-characterized, however, whether T cells as part of the adaptive immune system reside in the brain and are involved in homeostasis is poorly understood. Here, we identify that the subfornical organ (SFO) region of the brain is a nucleus for parenchymal T cells in the steady-state brain in both mice and humans. Using unbiased transcriptomics, we found that these extravascular T cells in the mouse brain are distinct from …

Host Defense Inside & Outside Of The Immune System: Modeling Antimicrobial Immunity By Gbps, Zhongyu Yuan

Yale Graduate School of Arts and Sciences Dissertations

Traditional views of host defense often focus on antibody-mediated neutralization, cytotoxic T-cell plus NK-cell-mediated killing, and phagocytic activities by cell populations originating in the bone marrow as part of the classical immune system. Additional effector activities, however, also operate in non-immune cells which compose the stroma or parenchyma of host tissues. These latter cell populations often mobilize antimicrobial activities in response to cytokines such as type II IFN (IFN-gamma; IFN-) against a wide variety of intracellular pathogens.

Among the most prominent IFN--stimulated genes are a family of immune dynamin-like GTPases termed the Guanylate Binding Proteins (GBPs). GBPs are widely expressed …

Evaluating Saliva Based Glucose Testing For Accessible Diabetes Care In Tanzania, Shannon Dhindsa

Public Health Theses

Background: In Tanzania, limited healthcare infrastructure and reliance on invasive diagnostic methods significantly hinder effective diabetes screening and management. Individuals with diabetes often go undetected and have lower immune systems that make them prone to further infectious complications. Thus, properly managing this chronic condition can prevent additional infectious diseases. Salivary glucose testing offers a non-invasive, innovative alternative with the potential to transform the early detection and management of diabetes, especially in resource-constrained settings.

Design: This cross-sectional study, conducted at Muhimbili National Hospital's Diabetes Clinic in Dar es Salaam, evaluates the feasibility of salivary glucose testing using a colorimetric glucose-oxidase-peroxidase point-of-care …

Disability, Cure, And (Anti)Normativity In Modern And Contemporary Spanish Literature, Martha Engvall

Yale Graduate School of Arts and Sciences Dissertations

In my dissertation, I examine the role of disability, diagnosis, and cure in modern and contemporary Spanish novels. In the first three chapters, I show how authors of the late 19th and early 20th century used disability’s relationship to race, gender, and social class to question exclusionary social norms. I analyze critiques of industrialization in Galdós’s Marianela (1878) and Blasco Ibáñez’s Del vivir (1904); examine portrayals of leprosy in Galdós’s Misericordia (1897), Pardo Bazán’s La prueba (1890), Miró’s Del vivir (1904) and El obispo leproso (1926), and Hoyos y Vinent’s El monstruo (1915); and explore connections between disability, sexuality, and …

The Gnda Microprotein Supports Atp Homeostasis In Escherichia Coli During Heat Shock, Jessica Jayne Mohsen

Yale Graduate School of Arts and Sciences Dissertations

Same-strand overlapping, or nested, open reading frames (ORFs) can optimize the information content of size-constrained viral genomes by increasing the number of proteins expressed from a limited nucleotide sequence. However, nested small open reading frames (sORFs) were previously omitted from prokaryotic and eukaryotic genome annotations. It was therefore surprising when numerous nested sORFs were recently discovered in bacteria and eukaryotes. Our case study of the GndA microprotein in Escherichia coli provides evidence of an emerging model that overlapping genes can be expressed from bacterial genomes to contribute to cellular fitness. GndA interacts with the electron transport chain and ATP synthase …

Epidemiologic And Immunologic Characterization Of The Post-Acute Sequelae Of Covid-19, Christine Marie Miller

Yale Graduate School of Arts and Sciences Dissertations

Since its emergence in late 2019, SARS-CoV-2 has infected over 15 million people—and the number continues to rise. The global impact of this novel coronavirus has been profound, reshaping not only public health infrastructure but also our understanding of human biology. The full extent of the virus’s effects on the immune system remains incompletely understood and will likely take years to fully unravel. What is already evident, however, is that SARS-CoV-2 uniquely modulates both innate and adaptive immunity, with consequences that span the developmental spectrum—from fetal and pediatric stages through adulthood. While many individuals recover without overt clinical sequelae, an …

Vaccine-Induced Immunity: Insights Into Sars-Cov-2 And Orthopoxvirus, Valter Monteiro

Yale Graduate School of Arts and Sciences Dissertations

Emerging infectious diseases like SARS-CoV-2 and re-emergent pathogens such asmpox (formally known as monkeypox) have posed substantial challenges to global health, often due to immune escape and antigenic variability. My research addresses these challenges by evaluating and designing vaccine strategies to enhance immune responses and cross-protection, focusing on SARS-CoV-2 variants and members of the Orthopoxvirus family. The central aim of my research is to understand and overcome limitations in immune responses to antigenically variable pathogens. My studies focus on humoral responses to SARS-CoV-2 variants through targeted booster regimens, exploring cross-protective immunity in Orthopoxvirus vaccines, and testing new mRNA vaccines to …

Evaluation Of Passive Sampling And Emerging Bulk Air Disinfection Technologies To Monitor And Mitigate Airborne Viral Exposure In Indoor Environments, Darryl Marissa Angel

Yale Graduate School of Arts and Sciences Dissertations

The COVID-19 pandemic demonstrated the significance of understanding the airborne route of transmission for respiratory viruses and clarified the need to monitor and mitigate the presence of respiratory viral aerosols in indoor congregate settings. The goal of this dissertation is to evaluate the ability of emerging technologies to detect and reduce infectious viral aerosols within occupied indoor spaces. This work first explores the ability of a wearable passive sampler to collect viral aerosols for personal exposure assessments to SARS-CoV-2. The sampling material, polydimethylsiloxane (PDMS), efficiently collected enveloped viral aerosols, with a calculated uptake rate commensurate with previously developed passive aerosol …

A Commitment To Health For All: Reimagining Representation And Participation In The Who Beyond State-Centrism, Yen-Wen Liao

Public Health Theses

Despite its stated commitment to “health for all,” the World Health Organization (WHO) has long been subject to the influence of Member State politics. Specifically, the Organization’s state-based membership model and governance structure have continuously enabled powerful Member States to advance their political interests, leading to the exclusion and marginalization of populations based on the recognition or political status of their representatives. One such example is Taiwan, which has been repeatedly denied membership in the Organization despite the functional independence of its public health authority, leaving over 23 million people neglected amid two major health crises. These forms of exclusion …

Exploring The Journey To Heart Failure Diagnosis In Uganda, Teimur Kayani

Yale Medicine Thesis Digital Library

This study sought to explore the healthcare journeys of patients recently diagnosed with heart failure (HF) in Uganda. Using a semi-structured guide developed in collaboration with Ugandan colleagues, we conducted in-depth interviews with 19 patients diagnosed with HF within the past three months across four regional referral hospitals in Uganda. Interviews were conducted in the participant’s preferred language (English, Luganda, Lugbara, Lugisu, or Swahili) using trained research assistants (RAs) and were recorded, transcribed verbatim, and thematically analyzed using the socioecological framework (SEM) to capture individual, interpersonal, community, and systemic-level barriers to HF care.Findings revealed a total of 11 themes spread …

Cutaneous Fungal Infections In The United States: A Cross-Sectional Analysis Of National Surveys, Sarah Lee Spaulding

Yale Medicine Thesis Digital Library

Superficial cutaneous fungal infections (SCFIs), caused by yeasts, dermatophytes, and nondermatophyte molds, are prevalent skin conditions with substantial economic and quality-of-life implications. This study aimed to evaluate trends in the prevalence of SCFIs in the United States between 2005 and 2016, using data from the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS).We performed a cross-sectional analysis of outpatient visits with SCFIs diagnoses, identified through the International Classification of Diseases, Ninth and Tenth Revisions, Clinical Modification (ICD-9-CM and ICD-10-CM). Diagnoses included conditions such as tinea unguium, tinea pedis, and candidiasis of the skin …

Culture-Free Whole Genome Sequencing Of Mycobacterium Tuberculosis From Clinical Specimens, Chaney Christine Kalinich

Yale Medicine Thesis Digital Library

Tuberculosis (TB) is a leading cause of infection-related mortality worldwide, causing an estimated 1.13 million deaths in 2022. The majority of infections can be successfully treated with antibiotics, but the prevalence of drug-resistant TB and a lack of rapid and cost-effective drug susceptibility tests for many key antibiotics is a significant barrier to treatment. Whole-genome sequencing of Mycobacterium tuberculosis can be used for drug susceptibility testing and can provide valuable insight into transmission patterns. However, M. tuberculosis is slow to grow, meaning traditional sequencing methods which require culture can take many weeks to return results, greatly limiting the potential clinical …

Yale Medicine Magazine December 2025, Issue 175, Yale University. School Of Medicine

Yale Medicine Magazine - alumni bulletin and magazine

This is the December 2025 issue of Yale Medicine Magazine, issue 175. 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).

Men Take Care Of Each Other”: Evaluation Of A Community-Based Model For Pre-Exposure Prophylaxis Services Among Male Bar Patrons In Rural South Africa, Phoebe Chen

Yale Medicine Thesis Digital Library

Low engagement with HIV services persists among young men with harmful alcohol use in South Africa. We previously piloted a rural community-based HIV service delivery model to engage this key population. In the initial study, male nurses visited alcohol-serving venues to provide HIV testing and pre-exposure prophylaxis (PrEP) services. From November 1 to December 30, 2021, we conducted interviews with 17 of 34 male pilot participants to evaluate program barriers, facilitators, and suggestions. All Interviewees were satisfied with HIV testing and PrEP services. Participants overcame testing avoidance through peer influence and enhanced privacy. Barriers for PrEP initiation were stigma (PrEP …

The Development Of A Novel Large Language Model Method For Identification Of Incarceration History Via The Electronic Health Record And Evaluation Of Care Processes In The Emergency Department Setting, Thomas Huang

Yale Medicine Thesis Digital Library

Objective: Incarceration is a significant social driver of health and patients with a history of incarceration face systemic healthcare disparities, higher morbidity, mortality, and racialized health inequities. Incarceration status is largely invisible due to poor electronic health record (EHR) capture. In this thesis, we aim to develop, train, and validate a novel natural language processing technique to more effectively identify incarceration status in the EHR and apply this method in the emergency department setting to demonstrate proof of concept and elucidate care process disparities.Methods: The study population consisted of adult patients (≥ 18 y.o.) who presented to the emergency department …

Investigating Tlr-Mediated Cytokine Synergy In Macrophages, Erick Salvador Rocha

Yale Graduate School of Arts and Sciences Dissertations

Cytokine dysregulation during microbial infections can dangerously increase the severity of associated diseases. Non-additive responses to simultaneous activation of toll-like receptor (TLR) signaling pathways are one potential contributor. Here we explored mechanisms underlying the TLR2/MyD88 and TLR3/TRIF-mediated responses in macrophages for canonical pro-inflammatory and antiviral targets including TNF, IL-6, IL-12p40, IFN-β and CXCL10. We found that all targets exhibited characteristic levels of synergistic cytokine activation that varied with TLR-ligand concentration and exposure time. These trends were conserved when the TLR3-ligand polyI:C (PIC) was combined with either of the TLR2-mediated pathogens S. aureus or L. pneumophila. Using pharmacological inhibitors, genetic …

Psychosocial Correlates Of Hiv Prevention, Care, And Well-Being Among Older Women Aging With Hiv, Thi Vu

Yale Graduate School of Arts and Sciences Dissertations

Background: Approximately 54% of the nearly 1.1 million people living with diagnosed HIV in the United States are aged 50 and older. From 2015 to 2019, diagnoses among women ages 55 years and older increased by 7% while diagnoses among other age groups decreased. In 2019, women made up 19% of all HIV diagnoses. Despite advances in HIV science and education, there is still a dearth of research focused on the growing population of older women with HIV. Durvasula’s Contextualized Model for HIV/AIDS Care and Prevention for Older Women highlights that older women with HIV face different barriers to care, …

Antibiotic-Resistant Nontyphoidal Salmonella And Campylobacter Isolates Associated With International Travel, Connecticut 2010 – 2023, Shilpa Mudumbe

Public Health Theses

Antibiotics are helpful for limiting duration and complications of Salmonella andCampylobacter isolates in selected age groups and people who are immunosuppressed. However, antibiotic-resistant (AR) foodborne pathogens have been on the rise in the United States over the past 10 years and are often linked to international travel (IT). Long-term trends on AR have not been examined in Connecticut (CT). This study evaluates trends in AR among nontyphoidal Salmonella and Campylobacter isolates in CT from 2010 to 2023 and examines the association between AR and IT. Data from submission of annual systematic samples of CT Salmonella and Campylobacter isolates to the …

Enhancing Dengue Forecasting With Remotely Sensing-Derived Vector Proxies And Random Forest Models: A Case Study For Sri Lanka, Shuyu Ye

Public Health Theses

Dengue fever is a growing global public health threat, especially in tropical and subtropical regions such as Sri Lanka, where seasonal outbreaks impose recurring burdens on health systems. Accurate and timely forecasting of dengue incidence is essential for public health preparedness, yet most existing models suffer from key limitations: they rely on historical case trends without accounting for real-time ecological dynamics, and often require entomological surveillance data that is not consistently available. This thesis addresses these gaps by proposing a machine learning forecasting framework that integrates remote sensing-derived environmental proxies to estimate latent mosquito vector abundance.Using Principal Component Analysis (PCA), …

Economic Burden Of Medically Attended Respiratory Syncytial Virus Illness Among Older Adults, Shirley Zhu

Public Health Theses

ABSTRACTIntroduction: Respiratory syncytial virus (RSV) is a common respiratory pathogen that causes a large burden of disease among older adults. Though there are interventions, the impact and cost-effectiveness of recently licensed RSV vaccines in the United States is not well understood for this population. Thus, reliable estimates on the economic burden of RSV among older adults are needed for future economic analyses.

Objective: The objective of this thesis is to evaluate the cost of medically attended RSV among older adults in the United States.

Methods: Medicare claims data were used to determine average cost per visit for outpatient, inpatient, emergency …

Enhancing Research Utilization Among Health Policymakers: Lessons From An Executive Certificate Program In Liberia, Felicia Annan-Mills

Public Health Theses

Evidence-based decision-making in health policy is a systematic and transparent approach to policymaking and program design using research evidence and other similar sources. It is essential for developing effective health policies and ensuring that programs align with political priorities and community needs and have strong empirical support for their efficacy and impact. Global health agencies like the World Health Organization and the West African Health Organization have developed guidelines for evidence-based decision-making in health for organizations to use as guiding tools in their policymaking. Regardless, there is still a gap in applying research evidence to practice programs for many countries …

Cost-Effectiveness Of New Monoclonal Antibody And Maternal Immunization For The Prevention Of Respiratory Syncytial Virus (Rsv) Disease In Infants: A Systematic Review, Yuwei Che

Public Health Theses

AbstractIntroduction: Respiratory syncytial virus (RSV) remains a major cause of morbidity and mortality among infants and young children worldwide. Given the lack of specific therapeutic treatments for RSV that are suitable for universal use, the development of effective prevention strategies is of paramount importance. Previously, palivizumab was utilized for long-term prophylaxis of RSV infections; however, it was only recommended for specific populations due to its high cost and limited overall effectiveness. In 2023, the U.S. FDA approved RSVpreF maternal vaccine (Abrysvo™, Pfizer), and nirsevimab (Beyfortus™, Sanofi and AstraZeneca) for the prevention of RSV to newborns. Two newly developed interventions have …

Assessing The Costs Of Illness Attributable To Leptospirosis, Alyssa Chetrick

Public Health Theses

Leptospirosis, caused by the spirochetes of the genus Leptospira, is a zoonotic bacterialdisease endemic to tropical regions and lower middle income countries (LMICs). Leptospirosis causes an estimated 1 million cases and more than 58,900 deaths annually.(Costa et al., 2015; Torgeson et al., 2015) In addition to human health, leptospirosis significantly impacts animal health and the livestock industry, particularly through reproductive losses, increased treatment costs, and decreased milk production, which exacerbates global insecurity.(Bennet, 2015; Torgeson et al., 2015) The estimated global cost loss to productivity due to disease is estimated at Int$ 29.3 billion. (Agampodi et al., 2023) Because of its …

Scale-Up Of Access To Medication For Opioid Use Disorder For People Who Inject Drugs On Parole In Ukraine: A Modeling Analysis, Brendan Caver

Public Health Theses

Background: Human Immunodeficiency Virus (HIV) and opioid-use disorder have long beendescribed as a syndemic; the two health issues go hand-in-hand to exacerbate each other (Perlman & Jordan, 2018). While the HIV pandemic has improved greatly in many regions such as the United States over the past several decades, it continues to become worse in Eastern Europe and Central Asia. HIV prevalence and opioid dependence are particularly high in carceral settings, but access to opioid agonist therapy (OAT) is extremely limited. This paper shows the results of a modeling analysis undertaken to see the impact of opioid agonist therapy (OAT) scale-up …

The Impact Of Climate Change On Japanese Encephalitis Trends In China, Jiayi Du

Public Health Theses

Japanese encephalitis (JE) is a mosquito-borne viral disease that poses a significant public health threat across Asia, including China. Climate change has been increasingly recognized as a key driver of JE transmission dynamics, influencing mosquito vector distribution and virus proliferation. This study aimed to assess how climatic variables affect the ecological suitability for Japanese encephalitis virus (JEV) transmission, using species distribution modeling with MaxEnt.

Using climate data from WorldClim and JE incidence data from published sources, we applied the MaxEnt model to identify the key environmental predictors of JE transmission and project future risk areas under changing climatic conditions. The …

Exploring Harm Reduction In Treatment: A Qualitative Study Of Methods And Perceptions Among People In Substance Use Disorder Care, Carson Francis Ferrara

Public Health Theses

Amidst the ongoing opioid epidemic and rising overdose deaths, substance use disorder (SUD) treatment has historically prioritized abstinence over harm reduction, creating gaps in patient safety. This qualitative study explores harm reduction integration in formal treatment settings and participant perceptions through 48 semi-structured interviews with individuals enrolled in Project RENEW, a larger cohort study examining factors influencing people in treatment for alcohol use across Connecticut and Georgia. Participants (79% inpatient, 51% court-mandated) described their experiences with harm reduction methods and safety strategies while in treatment. Thematic analysis revealed four key findings: 1) inconsistent access to resources like naloxone and fentanyl …

Secondhand Smoke Exposure And The Risk Of Tuberculosis In Children: A Systematic Review And Meta-Analysis, Cenyun Guan

Public Health Theses

ABSTRACT

Introduction: Tuberculosis (TB) remains one of the leading causes of death globally, with children and young adolescents having a significant burden of the disease. Smoking is a well-established risk factor for TB, but the association between secondhand smoke (SHS) exposure and TB remains inconclusive. Pediatric populations are commonly exposed to SHS due to living with smokers in their households. Inconsistencies in the findings of previous systematic reviews on the associations between SHS exposure and TB status (infection and disease) highlight the need for an updated systematic review to better establish these associations and provide evidence-based guidance for reducing the …