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Monetary Policy Report - March 2020, Bank Of Korea

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No abstract provided.

Corporate Bond Market Reactions To Quantitative Easing During The Covid-19 Pandemic, Yoshio Nozawa, Yancheng Qiu

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No abstract provided.

Optimal Control Of An Epidemic Through Social Distancing, Thomas Kruse, Philipp Strack

Cowles Foundation Discussion Papers

We analyze how to optimally engage in social distancing in order to minimize the spread of an infectious disease. We identify conditions under which any optimal policy is single-peaked, i.e., first engages in increasingly more social distancing and subsequently decreases its intensity. We show that an optimal policy might delay measures that decrease the transmission rate substantially to create herd-immunity and that engaging in social distancing sub-optimally early can increase the number of fatalities. Finally, we find that optimal social distancing can be an effective measure and can substantially reduce the death rate of a disease.

Optimal Control Of An Epidemic Through Social Distancing, Thomas Kruse, Philipp Strack

Cowles Foundation Discussion Papers

We analyze how to optimally engage in social distancing (SD) in order to minimize the spread of an infectious disease. We identify conditions under which the optimal policy is single-peaked, i.e., first engages in increasingly more social distancing and subsequently decreases its intensity. We show that the optimal policy might delay measures that decrease the transmission rate substantially to create “herd-immunity” and that engaging in social distancing sub-optimally early can increase the number of fatalities. Finally, we find that optimal social distancing can be an effective measure in substantially reducing the death rate of a disease.

Characterization Of Temperature Curves In The Intensive Care Unit, Patricia Lourdes Valda Toro

Yale Medicine Thesis Digital Library

Fevers are extremely common in hospitalized patients, particularly in those admitted to the intensive care unit (ICU). Up to 50% of fevers in the ICU are non-infectious in origin. Yet, the development of a fever commonly prompts extensive, costly and invasive infectious workups. Patients with persistent fevers are usually treated with antimicrobials long after infectious workups prove unrevealing. While this is viewed as a ‘safe’ approach, inappropriate antibiotic use has shown to be harmful to patients – even effecting an increase in mortality – in addition to contributing to the spread of antibiotic resistance. The purpose of this study is …

Immunologic Analysis Of Non-Small Cell Lung Cancer In People Living With Hiv, Ramsey Yusuf

Yale Medicine Thesis Digital Library

Among people living with HIV (PLWH), non-small cell lung cancer (NSCLC) has emerged as the most common non-AIDS defining cancer and a leading cause of death. PLWH with NSCLC are diagnosed at younger ages and demonstrate worse outcomes compared to the general population. Global immune dysregulation in the setting of HIV infection may account for these disparities, however little is known about the immunobiology of HIV-associated NSCLC. The goal of this study was to investigate the clinical and pathology of NSCLC in PLWH. This retrospective cohort study examined HIV-associated and uninfected NSCLC cases within Yale-New Haven Hospital between 2000-2016. Medical …

Eastern Equine Encephalitis Amplification And Spillover In New England, Aaron Hentoff

Public Health Theses

Introduction: Eastern Equine Encephalitis (EEE) is an alphavirus spread by the Culiseta melanura mosquitoe. While extremely rare, infection can lead to severe mental sequala and death, making it a public health concern for affected communities. Over the past two decades EEE outbreaks have become more frequent in occurrence and larger in size in the Northeast Region of the United States.

Objectives: The main objectives of this study are to 1) measure the association between mosquito abundance, infection rate, and disease incidence 2) characterize the relationship between seasonal climate variability in New England with Cs. melanura abundance, infection rates, and incidence …

Phylogeographic Insights Into Zika Virus In Puerto Rico, Chaney Christine Kalinich

Public Health Theses

During the larger epidemic in the Americas, Puerto Rico experienced an epidemic of Zika virus (ZIKV) between November 2015 and December 2016. During this period, 39,717 residents tested positive, or 1.1% of the population. Our team sequenced 84 ZIKV genomes directly from archived ZIKV-positive clinical samples from throughout the epidemic period, and from distinct regions of the island, in order to reconstruct the introduction(s) to and geographic spread of ZIKV in Puerto Rico. We found that ZIKV was circulating in the Greater Antilles by April (95% CI: February-June) of 2015, and was introduced to Puerto Rico by August (95% CI: …

Antimicrobial Resistance And Molecular Epidemiology Of Escherichia Coli Isolated From Urban And Rural River Systems, Christopher Robert Jossart

Public Health Theses

Antimicrobial resistance (AMR) is an emerging public health issue that threatens the efficacy of antibiotic treatment for bacterial infections and human health. Sources of antimicrobial resistance genes (ARGs) in the environment include wastewater treatment plants and animal feeding operations that discharge waste into waterways, such as rivers and streams. This retrospective descriptive study describes the presence of AMR, and specific ARGs in Escherichia coli isolates from two distinct watersheds, rural and urban, with the use of antimicrobial susceptibility testing, whole-genome sequencing (WGS) to detect ARGs, and multi-locus sequence typing. Antimicrobial susceptibility testing was performed for 143 E. coli isolates, 73 …

Molecular Epidemiology Of Hookworm Infection In The Ashanti Region, Ghana., Emma Allen

Public Health Theses

INTRODUCTION: Parasitic helminth infections have persisted in resource-limited settings around the world, leading to greater numbers of people experiencing sequelae including malnutrition, anemia, and impaired growth and cognitive function among children. Despite periodic deworming efforts, a high burden of disease remains in sub-Saharan Africa. Establishing baseline prevalence of these infections can inform local and national deworming campaign objectives as well as tailor additional interventions accordingly. Here we describe our efforts to determine baseline prevalence and analyze potential risk factors for infection in Ashanti Region, Ghana.

OBJECTIVES: The primary objective of this study was to characterize the molecular epidemiology of hookworm …

The Impact Of Medicaid Expansion On Childhood Vaccination Rates, 2010-2018, Chandra K. Couzens

Public Health Theses

Background

The relationship between coverage expansions and vaccination coverage is not well characterized, through previous work as linked coverage expansions with insurance rates and insurance rates with vaccination completion. We examined whether Medicaid expansions implemented by the end of 2015 in 29 states and D.C. were associated with changes in MMR vaccination and 7-series vaccination completion among low income children from 2010-2018.

Methods

Changes in mean vaccination coverage were compared between the four years before expansion (2010-2013) and the four years post expansion (2015-2018), using data from the 2010-2018 National Immunization Child Survey. The final study sample (N=36,591) included children …

Human Granulocytic Anaplasmosis In Connecticut, 2014-2019: An Analysis Of Surveillance Data And Future Recommendations, Taylor Eisenstein

Public Health Theses

Human granulocytic anaplasmosis is a tickborne zoonosis caused by the bacterium Anaplasma phagocytophilum and first became a nationally notifiable human disease in 1999. In 2008, the Connecticut Department of Public Health (CT DPH) added it to the list of reportable diseases for the state. In 2019, there was a three-fold increase in case counts compared to previous years. To understand trends in anaplasmosis and generate hypotheses regarding this increase, descriptive analyses were performed on confirmed cases reported to the CT DPH from 2014 to 2019. Percentage of cases by gender, age, county, and month were calculated for each year, and …

Development And Validation Of A Predictive Model For Oncology Hospital-At-Home, Keval Niraj Desai

Yale Medicine Thesis Digital Library

Background:

Hospital-at-Home (HaH) is a unique care model that allows for the provision of inpatient level care in the patient’s home. HaH has been used to facilitate early discharge from inpatient care or to substitute entirely for an inpatient admission. Hospital-at-Home has been shown to have similar clinical outcomes to inpatient care, while reducing cost and complications associated with inpatient admission. Application of the HaH model to patients with oncologic disease is a promising avenue to reduce healthcare costs while improving patients’ quality of life by increasing time spent at home. A major challenge to implementing a Hospital-at-Home program for …

Aging With Hiv: Biomarkers Of Inflammation And Incident Rheumatologic Disease, Jennifer Leslie Simon Hanberg

Yale Medicine Thesis Digital Library

Chronic Human Immunodeficiency Virus (HIV) infection results in multimorbidity and shortened lifespan. Inflammation and immune dysfunction contribute to these outcomes. The aim of this thesis is (1) to investigate the utility of two inflammatory biomarkers evaluated in other settings (neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR)) for prognostication in patients living with HIV (PLWH) and comorbid inflammatory states; and (2) to compare the frequency and severity with which rheumatologic disease states occur in PLWH to demographically and behaviorally similar uninfected individuals (“controls”).

Three cohorts were created from the Veterans Aging Cohort Study. In each cohort, patients were stratified by presence …

Cd4+ T Cell Recovery And Cerebrospinal Fluid Escape After Antiretroviral Therapy Initiation In Acute Hiv-1 Infection, Ryan Christopher Handoko

Yale Medicine Thesis Digital Library

Introduction: Up to 30% of individuals treated with antiretroviral therapy (ART) during chronic HIV fail to recover CD4 counts to >500 cells/mm3 and up to 10% have quantifiable HIV RNA in cerebrospinal fluid (CSF), termed CSF escape, despite plasma viral suppression < 50 copies/mL. Previous studies have shown that ART initiation in the earliest stage of identifiable infection, acute HIV infection (prior to antibody seroconversion), may limit viral reservoir establishment and systemic immune activation and may improve clinical outcomes. We investigated the frequency, associations, and outcomes of suboptimal CD4 recovery (Project 1) and CSF escape (Project 2) after ART started during acute HIV infection (AHI).

Methods: Thai participants with laboratory-confirmed diagnosis of AHI (Fiebig stages I to V) were started immediately on ART and followed longitudinally with blood sampling, neuropsychological and neurobehavioral testing, and optional lumbar puncture. For Project 1, participants with ≥48 weeks of documented HIV RNA <50 copies/mL were stratified by CD4 count at latest study visit to suboptimal recovery (SR; CD4<350 cells/mm3), intermediate recovery (IR; 350≤CD4<500), and complete recovery (CR; CD4≥500). To assess determinants of CD4 recovery, clinical and laboratory parameters were evaluated at pre-ART baseline and latest study visit. Additional inflammatory and neurobehavioral endpoints were examined at baseline and 96 weeks. For Project 2, participants who underwent blood sampling and optional CSF sampling at weeks 24 and 96 were assessed for CSF escape. HIV RNA was quantified using Roche Amplicor and COBAS TaqMan assays with a lower limit of quantitation of 20-50 copies/mL in plasma and 80 copies/mL in CSF. Participants with quantifiable CSF HIV RNA greater than that in plasma during ART were identified as cases of CSF escape.

Results, Project 1: Of 304 participants (96% male, median 26 years old) evaluated after median 144 …

Reversal Of Warfarin-Associated Coagulopathy: Prothrombin Complex Concentrates Versus Fresh Frozen Plasma In Elderly Patients Presenting With Intracranial Hemorrhage, Shunella Grace Lumas

Yale Medicine Thesis Digital Library

Background: Patients on warfarin with traumatic intracranial hemorrhage (ICH) often require pharmacological reversal of warfarin-induced coagulopathy. We compared outcomes among patients who received 4-factor prothrombin complex concentrate (PCC), fresh frozen plasma (FFP) or no reversal to assess the real-world impact of PCC on elderly patients with traumatic intracranial hemorrhage on warfarin.

Study Design: This was a retrospective analysis of 150 patients on preinjury warfarin. Data was abstracted from the electronic medical record (EMR) of an academic level 1 trauma center for patients age 65 years and greater on warfarin therapy admitted with a traumatic ICH between January 2013 and December …

The Cost-Effectiveness Of Culture Vs Naat Based Screening Of Pregnant Women For Group B Streptococcus To Reduce Early-Onset Sepsis Of The Newborn, Bertie Geng

Yale Medicine Thesis Digital Library

While great progress has been made to reduce its incidence, group B streptococcus (GBS) is still a leading cause of neonatal disease. Current standard of care recommends antepartum rectovaginal GBS culture of all pregnant women at 36 weeks of gestation in order to identify candidates for intrapartum prophylaxis to reduce vertical transmission. The purpose of the study is to assess three alternative nucleic acid amplification (NAAT) screening strategies for GBS: antepartum NAAT at 36 weeks, intrapartum NAAT, or a combined intrapartum and antepartum approach in which patients with penicillin allergies undergo antepartum culture screening and all other patients undergo intrapartum …

Evaluation Of Connecticut Medical Providers Concordance With 2017 Idsa/Shea Clostridioides Difficile Treatment Guidelines In New Haven County, 2017-2019, Casey Morgan Luc

Public Health Theses

Background: Treatment guidelines for Clostridioides difficile infection (CDI) were updated by the Infectious Disease Society of America (IDSA) & the Society for Healthcare Epidemiology of America (SHEA) in 2017 making various modifications, most notably for disease severity & treatment recommendations. Our objectives were to assess Connecticut medical providers’ concordance (2017-2019) to the 2017 SHEA/IDSA clinical treatment guidelines. The effect of guideline concordance on the risk of CDI recurrence was also assessed.

Methods: Using data from the Connecticut Emerging Infections Program’s CDI surveillance in New Haven County, severity & concordance were defined for CDI cases. For severity, white blood cell count …

Screening For Legionnaires’ Disease: A Predictive Model For Improving Health And Economic Outcomes, Alyssa K. Amick

Public Health Theses

Introduction: Legionnaires’ disease (LD), caused by the Legionella bacterium, is a rare but serious atypical pneumonia that is often underdiagnosed in the clinical setting. Recent guideline changes by the American Thoracic Society limited use of the urinary Legionella tests, the primary form of diagnosis, due to the excessive costs of regular testing. Delays in testing and diagnosis of LD result in increased cost of treatment and risk of death.

Objective: To develop a predictive model to estimate a patient’s probability of having LD. This model would serve as a screen to better target diagnostic efforts, prevent misdiagnosis, and reduce the …

A Literature Review Of Current Tuberculosis Prophylaxis Strategies For Plhiv In Namibia, Anumita Bajpai

Public Health Theses

INTRODUCTION: The HIV and TB co-epidemic remains a big obstacle in reducing PLHIV mortality and morbidity in Namibia. The solution to that has been the implementation of isoniazid preventative therapy (IPT) alongside ART for PLHIV to prevent the development of active tuberculosis. As newer shorter regimens of IPT (3HP) are released it is important to Namibia’s Ministry of Health to evaluate the efficacy of these newer IPT regimens prior to their implementation.

OBJECTIVES: The objective of this review is to compare the benefit of 3HP to that of 6-month or continuous (36-month) daily IPT for PLHIV to make future TB …

Effect Of Antiretroviral Drug Dolutegravir On Mitochondrial Function, Anthony Chui

Public Health Theses

Background: Though antiretroviral therapy (ART) regimens have become progressively less toxic, ART-associated toxicity is still pervasive. Dolutegravir (DTG) is an HIV integrase strand transfer inhibitor (INSTI), a class of antiretrovirals that are generally well-tolerated by patients. However, in the clinic there are reports of unexpectedly high rates of toxicity in cohorts of pregnant women such as neural tube defects, and in older patients’ adverse effects such as neuropsychiatric disorders. We hypothesized that these adverse effects could be due to DTG-induced mitochondrial toxicity in the central nervous system.

Methods: Human neuroblastoma cells were treated with ART regimens that are currently considered …

Use Of Shotgun Metagenomic Sequencing To Determine How The Human Gut Microbiome And Antibiotic Resistome Influence The Risk Of Recurrent Clostridioides Difficile Infection, Maria Alexandra Correa

Public Health Theses

Clostridioides difficile is an opportunistic enteric pathogen that can cause a range of symptoms in humans from diarrhea to pseudomembranous colitis. The risk of recurrence of C. difficile infection after initial treatment with antibiotics is high. Although prior studies have sought to understand the link between the human gut microbiome and the risk of recurrence, none have utilized shotgun metagenomic sequencing methods to establish a relationship between microbiota diversity and recurrence risk. In this study, stool samples were obtained from 47 patients at Yale New Haven Hospital who tested positive for an incident C. difficile infection. Shotgun metagenomic sequencing was …

An Impact Evaluation Of The Rollout Of The Pneumococcal Conjugate Vaccine In Uttar Pradesh State, India. 2017-2019, Elizabeth Edgerley

Public Health Theses

This paper is aimed toward examining whether methods currently being rolled out to administer the Pneumococcal Conjugate Vaccine to children in the Indian state of Uttar Pradesh is effectively reducing morbidity and mortality. The fundamental question regarding this current effort is if it proves to be useful at reducing the prevalence of Streptococcus Pneumoniae and whether the surveillance methods examining the efficacy of healthcare interventions are helpful. Both rural and urban India are troubling areas for public health surveillance to reach, though many diseases of poverty and respiratory illnesses such as pneumonia flourish there. With no true quantification of burden, …

Trends In Cyclosporiasis In Connecticut, 1997—2019, Alexandra Edmundson

Public Health Theses

Introduction: Cyclosporiasis is a foodborne, parasitic infection, causing prolonged debilitating diarrhea, especially in immunosuppressed persons. Exposure to Cyclospora occurs mainly through ingestion of contaminated fresh produce, often during international travel. Nationally, it has been increasing in the United States. Connecticut surveillance data have yet to be systematically analyzed.

Methods: Active surveillance of cyclosporiasis in Connecticut has been conducted since 1997, including follow up of laboratory-confirmed cases by chart review and interview. Data collected include patient demographics, symptoms, severity of illness, and exposures. Data from 1997-2019 were analyzed to identify trends in incidence and changing demographics and sources of exposure.

Results: …

Covid-19 Risk Among Temporary Protected Status Beneficiaries, Diana Estefania Estrada Alamo

Public Health Theses

The current federal response of the United States to the COVID-19 pandemic has created conditions and resulted in unintended consequences that may be disproportionately increasing the risk of COVID-19 infection and sequelae for immigrant populations. This investigative thesis explores whether states with a greater percentage of Temporary Protected Status beneficiaries experience more COVID-19 related deaths as compared to the rest of the United States. Using a multiple linear regression model for statistical analysis, covariates under consideration include the number of COVID-19 confirmed cases, tests performed, hospitalizations reported, as well as the population density of each state and the proportion of …

Ethnic Differences And Risk Of Early-Onset Hodgkin Lymphoma, Connor Ashton Graham

Public Health Theses

Ethnic differences in the risk of early-onset Hodgkin lymphoma (HL) have been understudied. We evaluated potential associations between birth characteristics and early-onset HL in the California Linkage Study of Early-onset Cancers, a population-based case-control study that included a large number of non-Hispanic white and Hispanic subjects. This analysis included 2,819 HL cases (non-Hispanic white: 1651, Hispanic: 1168) diagnosed at the age of 0-37 years in California during 1988-2015 and 140,950 controls matched on race/ethnicity and year of birth. Odds ratios (OR) and 95% confidence intervals (CI) were estimated from multivariable logistic regression models. Among non-Hispanic whites, a birthweight of ≥4,000g …

“Malicious Medicine”: A Qualitative Study Of Medical Mistrust And Prep Perceptions For African American And Hispanic Men And Women In New Haven, Ct, Alexandra Lee Grimaldi

Public Health Theses

Objective: To understand how medical mistrust impacts perceptions of PrEP and willingness to use PrEP for African American and Hispanic men and women in New Haven, Connecticut.

Methods: This qualitative study utilized semi-structured interviews to examine medical mistrust, PrEP awareness, and willingness to use PrEP amongst African American and Hispanic men and women in New Haven, Connecticut.

Results: The majority of participants did not know about PrEP before their first interview of this study and the majority of participants did not decide to use PrEP over the course of this study. For those who are not interested in using PrEP, …

Creating An Antibody Digestive Curve In Cx. Quinquefasciatus Mosquitoes, Christina Ann Harden

Public Health Theses

Eastern Equine Encephalitis virus (EEEV) is an endemic arbovirus of increasing importance

in the United States. It is perpetuated via an enzootic cycle between Culiseta melanura

mosquitoes and avian reservoirs. In the northeast, transmission has distinct seasonality

and its overwintering mechanism is unknown. Xenosurveillance has been identified as a

possible way to elucidate viral circulation dynamics in states such as Connecticut that are

experiencing a resurgence of human EEE cases, potentially exacerbated by factors

associated with global climate change. This study sought to experimentally create an

antibody digestive curve for both mammalian and avian bloodmeals in Cx. quinquefasciatus

mosquitoes. Using …

Measuring Tb Stigma In Kampala, Uganda, Amber James

Public Health Theses

Tuberculosis (TB) is one of the leading causes of death worldwide and adversely affects persons living with HIV. TB is a highly stigmatizing disease and has been shown to interfere in household TB contact investigation. The objective of this study was to investigate the severity and characteristics of TB stigma through a multiple methods approach. Quantitative methods involved distributing Van Rie Stigma Scales validated in Southeast to household contacts of Index TB patients during routine household TB contact investigation. Qualitative methods involved interviewing household contacts about their attitudes towards household contact investigation, knowledge of TB transmission and treatment, and perceptions …

Development Of A Comprehensive Sexual Education Curriculum For A Private, Independent Day School For Students Pre-K Through 8th Grade, Haja I. Kamara

Public Health Theses

This paper describes the development of a comprehensive sex education (CSE) curriculum for The Country School (TCS), a coeducational, independent school in Madison, CT that serves approximately 200 students in Pre-Kindergarten through 8th grade. CSE describes a wide array of sex education programs and curricula that are scientifically accurate, culturally and age-appropriate, gender-sensitive and life skills-based. The goal for this project is multi-pronged: adapt existing health education programming, build out a new health and wellness program with a distinct scope and sequence for each grade level that includes resources and supports for ongoing parent education and professional development. To inform …