Digital Commons Network^™

Medicine@Yale February/March 2019 Volume 15, Issue 1, Yale School Of Medicine Office Of Communications

Medicine@Yale - development newsletter

Medicine@Yale : advancing biomedical science, education and health care was a print and online newsletter which published news about academics, research and philanthropy for alumni, donors, faculty, students and the general public. It was initially published 6 times a year and then changed to a quarterly schedule. The first issue came out June/Jul. 2005. The final issue was published in May/June 2022, vol. 17, issue 1. Published by Yale School of Medicine, Office of Communications.

Medicine@Yale November/December 2019 Volume 15, Issue 3, Yale School Of Medicine Office Of Communications

Medicine@Yale - development newsletter

Medicine@Yale : advancing biomedical science, education and health care was a print and online newsletter which published news about academics, research and philanthropy for alumni, donors, faculty, students and the general public. It was initially published 6 times a year and then changed to a quarterly schedule. The first issue came out June/Jul. 2005. The final issue was published in May/June 2022, vol. 17, issue 1. Published by Yale School of Medicine, Office of Communications.

Medication Access Using An Evidence-Based Adaptive Transitional Care Guidance Tool For Planned Release Of Older Inmates, Erin Iturriaga

Yale School of Nursing Digital Theses

The aging population is growing faster in the correctional system than in the overall U.S. population. Yet, an effective geriatric transitional care process is not available for older persons released from jail. This article documents the development and results of an evidence-based, adaptive transitional care tool guided by Meleis’ transitions theory to improve access to medications for older persons released from jail. Three sources of evidence were used to develop the tool: different categories of literature, expert panel determination of the tool’s domain and content relevance and importance, and a focus group interview of five people working in a transitions …

Violence And Postpartum Drug Abstinence Among Substance-Using Mothers, Pooja Reddy Bollampally

Public Health Theses

Background: Substance use during pregnancy can have numerous detrimental effects on maternal and infant health. This knowledge contributes to high rates of abstinence during pregnancy, but pregnant women with substance use disorders are at high risk for relapse postpartum. Experiences of violence can have a substantial impact on the behavioral and mental health of women; its compounded consequences with those of substance use can lead to a population vulnerable to drug relapse and other negative health effects. The objective of this study was to examine the association between experiences of violence and drug abstinence at delivery and postpartum.

Methods: Data …

Prep Uptake, Adherence, And Persistence: Qualitative Interviews With Women Experiencing Ipv, Ipv Service Providers, And Healthcare Providers, Amy Janet Caplon

Public Health Theses

Background: Intimate partner violence (IPV) has been associated with HIV susceptibility and

acquisition. Studies have found that women who had experienced IPV were at least three times more likely to have a diagnosis of HIV. Women are interested in taking PrEP, however barriers to uptake, adherence, and persistence are not widely known, and present knowledge excludes experiences of healthcare providers and IPV service providers. In this qualitative study, we examined the perceived facilitators and possible solutions to PrEP uptake, adherence, and persistence. This was done using a sample of women experiencing IPV, Reproductive Health Providers, PrEP Providers, and IPV service …

Association Of Hpv And Oral Cancer, Qizheng Chen

Public Health Theses

According to the International Research on Cancer (AIRC) oral cancers are a type of cancer that develops in people’s lip linings, mouth, and the oropharynx. Studies have shown that the consumption of alcohol and tobacco products are the primary carcinogens that cause oral cancers. However, increasing cases of young individuals with no previous exposure to alcohol or tobacco who are getting oral cancers have prompted studies to look into the role of other carcinogens, especially viruses. Currently, the IARC presents oral cancers as the sixth most common type of cancer in the world. High-risk human papilloma virus (HPV) types are …

Development And Evaluation Of A Clinical Quality Scorecard For Cornell Scott-Hill Health Center, Hailey Jordan

Public Health Theses

Abstract

Background

Healthcare organizations are making the transition from volume to value-based care, thus relying on standardized performance measures for quality improvement. Some challenges of this strategy include the following: ambiguity and inconsistency of metric definitions across reporting systems, a dearth of measures that are representative of clinical care and patient experience, and unfair or inappropriate comparisons of organizations serving patients exposed to different sociodemographic risk factors.

Rationale

Developing and evaluating a clinical quality scorecard that is internal to a federally qualified health center will provide insight into its value-based performance. It will also allow for efficient improvement in clinical …

Prevalence Of Asymptomatic Malaria Among Children In Kumasi, Ghana, Natalie Olson

Public Health Theses

As the landscape of malaria in sub-Saharan Africa changes due to improved control efforts, there is increasing interest in elucidating the epidemiology of asymptomatic P. falciparum infection and its role in disease transmission, particularly in school age children. We conducted a cross-sectional survey in the summer of 2018 of children attending 4 primary/junior high schools within a 5 km radius of HopeXchange Medical Centre in Kumasi, Ghana, a city of 2.5 million inhabitants with year-round malaria transmission. Informed consent/assent and demographic information was obtained from 634 subjects (ages 5-17 years), after which measurements of height/weight/body temperature were recorded and a …

Effect Modification Of Greenness In The Residential Environment On Temperature-Mortality Relationship Among Older Adults In China, Chengcheng Qiu

Public Health Theses

Older adults are highly vulnerable to adverse climate-related impacts, with temperature-related mortality that are likely to vary according to geographic characteristics, vegetation abundance and socioeconomic conditions. We examined how mortality among older adults in China was associated with different temperatures over 14 years (2000-2014), and how geolocation, vegetation abundance in the residential environment and socioeconomic conditions modulate this association. We used case-crossover study design with distributed nonlinear modeling method to estimate heat- and cold-related mortality, and stratified the analysis by the level of vegetation abundance, calculated from light reflectance of remotely sensed imagery, and socioeconomic characteristics including education and residence …

Evaluation Of The Ltbi Cascade Of Care At The Winchester Chest Clinic, Alyssa Manni Robinson

Public Health Theses

Background: Latent tuberculosis infections affect around two billion people world-wide. In order to effectively control and reduce TB incidence, latent TB cases must be identified and treated. The latent TB cascade of care involves screening, diagnosis, evaluation, prescription of a treatment regimen, and completion of treatment. Existing studies have identified low rates of LTBI treatment completion among patients in diverse settings.

Objective: The aim of this study was to assess certain steps in the cascade of care among the LTBI-positive patients referred to the Winchester Chest Clinic in order to determine where patients were lost to follow up and potential …

Impacts Of Hepatitis C Virus Infection Treatment For Patients In Treatment For Opioid Use Disorder, Brooke Severe

Public Health Theses

Hepatitis C virus (HCV) infection is common among patients with opioid use disorder (OUD), a population who faces barriers to HCV treatment access. Co-located treatment for HCV within an opioid treatment program (OTP) addresses gaps in the HCV care continuum. Few reports have analyzed outcomes related to OUD, such as OUD treatment retention, associated with onsite HCV treatment. Patients (N=89) treated for chronic HCV infection in a Connecticut OTP from January 2014 through July 2017 were compared to control patients (N=199) with HCV-based ICD10 coding (B18.2) who were not treated during the same period. All patients received opioid agonist treatment …

Time Series Analysis For Effect Of Vaccines On Pneumonia Or Gastrointestinal Disorders In Brazil, Kang Shen

Public Health Theses

It is important for public health professionals to understand the effects of vaccine introduction and compare different types of vaccinations. This study will focus on understanding the pre and post vaccination effects of two different infectious diseases: pneumonia and gastrointestinal disorders. One of approaches of getting the accurate estimate of vaccine impact is by comparing rates or trends of the targeted disease in the years after introduction with rates of trend in the year before introduction using a time-series analysis. Specifically, in this study, the synthetic controls method implements an approach to estimating the causal effect of a designed intervention …

Impacts Of Ambient Temperature On Foodborne Salmonella Infection, Victoria E. Shirriff

Public Health Theses

Foodborne Disease (FBD) impacts individuals through the ingestion of foods contaminated with microbes and can lead to an array of adverse health consequences ranging from mild symptoms such as nausea to those that evolve to become life-threatening (World Health Organization, 2015a). The incidence of FBD is expected to increase in the presence of climate change due to an increase in ambient temperature creating an environment where microbes can rapidly multiply and thrive (Gregory, Johnson, Newton, & Ingram, 2009; Kovats et al., 2004). Foodborne cases of Salmonella make up the second largest cause of gastrointestinal infection in the United States (Scallan …

Declines In Human Papillomavirus (Hpv) – Associated High-Grade Cervical Neoplasia By Sociodemographic Factors After Introduction Of Hpv Vaccines In Connecticut, Usa 2008-2017, Mike Yepes

Public Health Theses

Abstract

Background: In 2006, the FDA approved the first vaccine against human papillomavirus. Trends in HPV-related sequalae are an effective method of analyzing HPV vaccine impact. Our primary objective was to measure trends in cervical neoplasia based on sociodemographic characteristics including race, ethnicity, and socioeconomic status.

Methods: Since 2008, Connecticut has required reporting of cervical intraepithelial neoplasia labeled grade 2+ and adenocarcinoma in situ. CIN 2+ diagnoses trends were modeled by area-based measures of age, race, ethnicity, and socioeconomic status using negative binomial regression and change-point analysis. Incidence rate measurements were adjusted to reflect inclusion of women who had completed …

Safety Of Opat In Older Versus Younger Adults, Kaylen Elizabeth Brzozowski

Public Health Theses

Introduction Outpatient parenteral antimicrobial therapy (OPAT) is considered practical, safe, and cost-effective, but roughly 20% of all adult patients on OPAT experience an adverse event (AE). Frequency of AEs and healthcare utilization, defined as emergency department visits and infectious disease office visits, phone calls, and emails, may be greatest in the first two weeks of OPAT. Given that older adults (age ≥ 65) have greater cognitive decline, ADL limitations, and comorbidities than younger adults, we sought to evaluate the frequency and timing of AEs in older adults on OPAT. We examine patients on OPAT at Yale New Haven Hospital (YNHH) …

Quantifying Influenza Exposure Within Hospitals And Nursing Homes, Drew Taylor Dickinson

Public Health Theses

Abstract

Background: Influenza acquisition in hospitals and nursing homes (NHs) highlights the need for infection prevention to protect patients from contagious diseases while under the care of a healthcare facility. We quantified influenza exposure in both settings and compared facility-onset influenza rates in order to determine if risks of acquiring influenza differed by type of healthcare facility since infection prevention practices are less standardized and less rigorous in NHs.

Methods: We conducted a retrospective cohort study of California hospital and NH inpatients during the 2015-2016 influenza season, defined as the peak influenza month, plus the two adjacent months, using claims …

Using Host Response For Respiratory Virus Discovery And Surveillance, Amelia Erin Hanron

Public Health Theses

INTRODUCTION: In 2015 lower respiratory infections (LRI) were the fifth leading cause of

death and the leading cause of death for children under five years old. Despite increasing advances in viral detection technology, etiology is never established for a large portion of viral respiratory infections. The most recent of such advancements- next-generation sequencing (NGS)- has greatly improved the ability to discover and/or identify rare or novel viruses. However, NGS platforms are still not feasible in a clinical laboratory due to cost, complexity, personnel, etc. The ability to screen for unknown viruses using technology that is already present in most clinical …

The Effects Of Rurality And Cost Of Transportation On Time Of Evolution And Disease Complexity At Diagnosis For Cutaneous Leishmaniasis In Colombia, Miguel Paredes

Public Health Theses

Patients in Colombia affected by cutaneous leishmaniasis (CL) face significant geopolitical and socioeconomic barriers to accessing diagnosis and treatment. This study aimed to understand how the geosocial characteristics of a patient’s area of residence affect time to medical consultation and disease status at consultation. An observational cross-sectional study was performed of individuals with CL who consulted at a local clinical referral center (CIDEIM) in Cali and Tumaco, Colombia. Descriptive, bivariate, and multivariable simple and ordinal logistic regression analyses were done to examine how area of residence (urban or rural) and cost of transportation to the nearest urban center may influence …

Quantifying The Burden Of Contact Precautions Of Carbapenem-Resistant Enterobacteriaceae (Cre) In Hospital Settings, Carolyn Park

Public Health Theses

Carbapenem-resistant Enterobacteriaceae (CRE) are a group of multi-drug resistant organisms (MDROs) that is currently considered an important and urgent public health concern due to their high mortality rates, antibiotic resistance, and their potential for rapid transmission. These pathogens are more commonly seen in healthcare-associated infections with some also occurring in the community. This study focused on distinguishing CRE into two distinct groups based on resistance mechanism: carbapenemase-producing CRE (CP-CRE) and non-CP-CRE. In order to determine if testing for carbapenemase can be useful in infection prevention, we aimed to quantify the total hospitalization in days per patient within a 90-day follow-up …

Analysis Of Entomological Surveillance Data To Predict West Nile Virus Cases In Connecticut, Lena Marie Tayo

Public Health Theses

INTRODUCTION: Since 1999, West Nile Virus (WNV) has been identified in a wide variety of mosquito species. Seasonal epidemics occur in the summer in all regions of the United States, with varying degrees of intensity and spread. In Connecticut, the state mosquito surveillance system for WNV has been conducted since 2000, collecting entomological and site data, and acting as an early warning system for potential human disease risk.

AIMS: Re-analysis of the epidemiology of WNV in Connecticut after years of established endemicity will be conducted using recent mosquito surveillance and human case data. A predictive model will also be developed …

Average Time To Negativity Of New Alere Ultra-Sensitive Rapid Diagnostic Test After Treatment For Malaria., Azan Zahir Virji

Public Health Theses

Malaria remains one of the most challenging infections globally. Malaria RDTs have had the largest impact on malaria detection in recent years with almost 245 million RDTs delivered globally. (1) They work by detecting either the histidine-rich protein (HRP2) or the Plasmodium lactate-dehydrogenase (pLDH). (2) Following a malaria infection, the HRP2 and pLDH antigens often circulate in the blood stream for several weeks. (3) As new RDTs are constantly being developed, each with a better sensitivity, specificity and lower limit of detection than its predecessor, the need to understand the persistence of their positivity, following a malaria infection, remains. The …

State Vaccination Policies And Coverage For Adolescent Vaccines In The United States, 2017, Anthony Edward Yakely

Public Health Theses

Background: The wide-ranging nature of state vaccination requirements for school entry allows for suboptimal coverage of adolescent vaccination as well as missed opportunities where some adolescent vaccinations are received but not all of them. Variation exists both in the types of exemptions that are allowed and the process that is required to obtain an exemption. State-level policies have been shown to be associated with childhood vaccination coverage, but far fewer studies have examined adolescent vaccine coverage.

Methods: HPV, MenACWY, and Tdap vaccine receipt and demographic data from the 2017 National Immunization Survey-Teen (NIS-Teen) Public Use Dataset were combined with data …

Yale Medicine Magazine, Autumn 2018, Yale University. School Of Medicine

Yale Medicine Magazine - alumni bulletin and magazine

This is the Autumn 2018 issue of Yale Medicine Magazine, v. 53, no. 1. 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).

Does Use Of A Molecular Rapid Pathogen Kit Improve Outcomes In The Bacteremic And Critically Ill?, Julie P. Gedalecia

Yale School of Medicine Physician Associate Program Theses

Sepsis is a pervasive condition that carries a tremendous burden of disease in the form of financial cost, morbidity, and mortality. Culturing methods slow clinicians’ ability to begin focused treatment, and increased antimicrobial resistance only intensifies the need for improved diagnostic tools. Rapid molecular diagnostic tests can shorten time to identify organisms, reduce inappropriate antibiotic treatment, and improve patient outcomes. A newly approved test has proven fast and accurate for identification and susceptibility, but has not been studied in regard to clinical outcomes. Our study will compare the effect of the Accelerate™ system versus standard identification and susceptibility tests on …

Telehealth-Based Gay-Affirmative Cognitive Behavioral Therapy For Young Gay And Bisexual Men In The Rural South, Andrew Mccormick Cook

Yale School of Medicine Physician Associate Program Theses

Young rural gay and bisexual men suffer a disproportionate burden of psychiatric disorders compared to their urban and heterosexual counterparts because of the increased stigma-related stressors they face. Co-occurring mental and behavioral health problems often affect them, including depression and substance use disorders. In two randomized controlled trials, a gay-affirmative cognitive behavioral therapy called Effective Skills to Empower Effective Men significantly decreased alcohol use, and improved mental health outcomes among urban gay and bisexual men by targeting stigma-related stress responses. However, the intervention’s efficacy has not been studied among rural populations. In a randomized controlled trial, we propose to deliver …

Assessment And Optimization Of Respiratory Syncytial Virus Prophylaxis Regimens In Connecticut, 1995-2013, Ben Artin

Yale School of Medicine Physician Associate Program Theses

BACKGROUND - Respiratory syncytial virus (RSV) causes seasonal respiratory infection with potentially serious complications in children, and leads to hospitalization rates as high as 50% in high-risk infants. Safe and effective immunoprophylaxis (palivizumab) is available, but costly. The American Academy of Pediatrics (AAP) recommends palivizumab only for infants at high risk of complications, and only during the RSV season. Although the current AAP guidelines acknowledge the existence of spatial and temporal variation in RSV incidence, they do not recommend spatial or temporal adjustments to immunoprophylaxis regimen outside of Florida. In this study, we investigate the value of using spatial and …

Lag-3 Mediates Acute Rejection & Memory In Mouse Transplantation, Jeffrey Mark Erfe

Yale Medicine Thesis Digital Library

Lymphocyte Activation Gene-3 (LAG-3) is a soluble protein and transmembrane protein receptor expressed on lymphocytes such as immunosuppressive regulatory T cells. Our goal was to evaluate the effect of LAG-3 on transplantation outcomes, specifically rejection and cellular memory response to donor antigen, by comparing graft survival and IFN-l secretion to donor antigen in C57BL/6 LAG-3-/- versus wild-type mouse recipients of DBA/2 grafts. We found that LAG-3 deletion accelerates rejection time and enhances IFN-l secretion among heart or skin graft recipients. FACS analysis of memory T cells demonstrated disproportionate increases in effector T cell subsets, consistent with a heightened rejection response. …

Medicine@Yale February/March 2018 Volume 14, Issue 1, Yale School Of Medicine Office Of Communications

Medicine@Yale - development newsletter

Medicine@Yale : advancing biomedical science, education and health care was a print and online newsletter which published news about academics, research and philanthropy for alumni, donors, faculty, students and the general public. It was initially published 6 times a year and then changed to a quarterly schedule. The first issue came out June/Jul. 2005. The final issue was published in May/June 2022, vol. 17, issue 1. Published by Yale School of Medicine, Office of Communications.

Evaluation Of Diagnostic Criteria In The Early Identification And Treatment Of Sepsis, Christopher Anzalone Zirker

Yale Medicine Thesis Digital Library

The recently introduced Sepsis-3 guidelines have yet to be applied to the emergency department (ED) setting. To compare these new definitions clinically with those of Sepsis-2, a retrospective analysis was performed using a dual-center ED registry of patients prospectively identified as having sepsis with organ dysfunction as defined by Sepsis-2. Of 446 registry patients meeting Sepsis-2 criteria, 61.0% (n = 272) had an elevated qSOFA score. 28-day in hospital mortality for patients with an elevated qSOFA was 15.8% compared to 10.9% in patients with non-elevation (p = .162). Rates of mechanical ventilation and vasopressor infusion were 38.6% and 36.4% respectively …

The Ecosystem Of Women's Health Social Enterprises Based In The United States, Marquita Kilgore-Nolan

Yale Medicine Thesis Digital Library

The overall objective of this thesis research was to elucidate the ecosystem of women's health social enterprises (WHSEs) based in the United States (U.S.). Aim I was to conduct a secondary data analysis of a random national sample of nonprofit WHSEs based in the U.S. regarding their characteristics and areas of intervention. Aim II was to conduct a qualitative assessment of a sample of women's health social entrepreneurs based in the U.S. regarding their perspectives on the ecosystem of WHSEs. Aim I utilized the GuideStar database and assessed enterprise size, geographic location, financial distress, health intervention area, and health activity …