Digital Commons Network^™

Reducing T Cell-Mediated Cardiac Injury With Cpg Oligodeoxynucleotides, Erik Alexander Barfod Levinsohn

Yale Medicine Thesis Digital Library

Lymphocytic myocarditis is a common condition associated with both infectious diseases and immunological disorders, and is often associated with severe morbidity and mortality, but few effective treatments. In many cases, the pathophysiology involves a failure of central and/or peripheral immune tolerance leading to a cardiac-specific autoimmune T cell response. Previous studies indicate that the PD-1:PD-L1 axis plays an important role in limiting inflammation in the heart. CpG ODN are TLR9 agonists with known immunoregulatory capacity, in part through their potent induction of type I IFN, a known inducer of PD-L1. In this study, we used human tissue to determine the …

Essential Evidence-Based Introductory Bioterrorism Content For Practicing Nurses, Manu Sharma

Yale School of Nursing Digital Theses

Bioterrorism content is too often absent from nursing education post-licensure. According to the Centers for Disease Control and Prevention (CDC), bioterrorism is defined as “the deliberate release of viruses, bacteria, or other germs (agents) used to cause illness or death in people, animals, or plants.” A literature search and a review of available resources elucidated pertinent content items on bioterrorism and its associated precautions for nurses. Next, two rounds of expert panel consisting of five members rated the identified content and proffered comments to validate the curriculum. Finally, a four-hour in-person pilot educational session was implemented based on the results. …

Inter-Rater Reliability Of Physical Abuse Determinations And Abusive Fracture Incidence At A Level 1 Pediatric Trauma Center, Kate Buesser

Yale Medicine Thesis Digital Library

As there is no “gold standard” in determining whether a fracture is caused by accident or abuse, agreement among medical providers is paramount. Using abstracted medical record data from children <36 months of age presenting to a level 1 pediatric emergency department (ED), we examined the extent of agreement between specialists who evaluate children with fractures for suspected abuse. To simulate clinical scenarios, two pediatric orthopaedists and two child abuse pediatricians (CAPs) reviewed the full abstraction and imaging, whereas the two pediatric radiologists reviewed a brief history and imaging.

Each physician independently rated each case using a 7-point ordinal scale designed to distinguish accidental from abusive injuries. For any discrepancy in independent ratings, the two specialists discussed the case and came to a joint rating. We analyzed 3 types of agreement: (1) within specialties using independent ratings, (2) between specialties using joint ratings, and (3) between clinicians (orthopaedists and CAPs) with more versus less experience. Agreement between pairs of …

Syrian Refugee Health: A Qualitative Analysis Of Experiences With The U.S. Healthcare System, Eunice M. M. Defilippo

Yale Medicine Thesis Digital Library

SYRIAN REFUGEE HEALTH: A QUALITATIVE ANALYSIS OF EXPERIENCES WITH

HEALTHCARE IN THE UNITED STATES. Eunice M. M. DeFilippo, Amer Abdullah, Tracy L.

Rabin. Department of Internal Medicine, Yale University School of Medicine, New Haven, CT.

As refugee populations worldwide increase exponentially, there is growing concern for the health needs of these displaced individuals. This qualitative study examines the illness experiences of newly arrived Syrian refugees as they navigate the complex U.S. healthcare system, in an attempt to identify and characterize potential barriers to care that can be addressed. The specific aims of this study are to understand the experiences, beliefs, …

The Impact Of Place-Based Determinants Of Health On Utilization Of Emergency Department Services, Tehreem Rehman

Yale Medicine Thesis Digital Library

The purpose of the study is to investigate whether higher prevalence of place-based structural determinants of health inequity is directly associated with frequent utilization of services in the emergency department. Chi-square and t-test analyses found that compared to non-frequent ED users, frequent ED users were older (mean age 43.18 vs. 35.23, p

Acknowledgements

The student author of this thesis is grateful for all the guidance and support provided by both faculty and community mentors. She is thankful for the time of Mark Abraham, Executive Director of DataHaven, who expressed faith in this project and its potential to inform subsequent initiatives …

Developing And Validating Learning Domains, Competencies, And Evaluation Items For Global Health Clinical Immersion Practicums For Graduate-Level Nursing Programs, Tracy Kelly

Yale School of Nursing Digital Theses

Aim: To identify and validate learning domains, competencies, and evaluation tool for experiential nursing global health programs at the graduate level.

Background: Standard competencies have not been synthesized and delineated nor have evaluation tools been developed for global health programs at the graduate level.

Design: An integrative review of the literature to identify evidence-based learning domains, competencies, and evaluation items and expert consensus panels to validate the results.

Method: Used the Whittemore and Knafl (2005) integrative literature review methodology to identify learning domains, competencies, and evaluation items. The NLM and CINAHL databases were searched for articles relevant to graduate-level global …

Adolescent Prep Administration: An Education Curriculum For Providers, Caroline Carnevale

Yale School of Nursing Digital Theses

Background: On May 15, 2018, the Federal Drug Administration (FDA) approved once daily tenofovir/emtricitabine (TDF/FTC) for use as preexposure prophylaxis (PrEP) for adolescents (weighing greater than 35kgs) engaging in high-risk sexual behavior (Gilead, 2018). This decision was largely based on the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) 113 which demonstrated that PrEP was well tolerated among the adolescents, age 15-17, enrolled in the study (Hosek, 2017). The use of TDF/FTC for PrEP in adults (18 and older) was approved by the FDA in 2012 after its safety and efficacy had been demonstrated in multiple international clinical trials (FDA, …

Estimated Costs Of Contact In College And High School Male Sports, Ray C. Fair, Christopher Champa

Cowles Foundation Discussion Papers

Injury rates in twelve U.S. men’s college sports and five U.S. boys’ high school sports are examined in this paper. The sports are categorized as “contact” or “non-contact,” and differences in injury rates between the two are examined. Injury rates in the contact sports are considerably higher than those in the non-contact sports and they are on average more severe. Estimates are presented of the injury savings that would result if the contact sports were changed to have injury rates similar to those in the non-contact sports. The estimated college savings are 49,600 fewer injuries per year and 6,000 fewer …

Estimated Costs Of Contact In Men's Collegiate Sports, Ray C. Fair, Christopher Champa

Cowles Foundation Discussion Papers

Injury rates in twelve U.S. men’s collegiate sports are examined in this paper. The twelve sports ranked by overall injury rate are wrestling, football, ice hockey, soccer, basketball, lacrosse, tennis, baseball, indoor track, cross country, outdoor track, and swimming. The first six sports will be called “contact” sports, and the next five will be called “non-contact.” Swimming is treated separately because it has many fewer injuries. Injury rates in the contact sports are considerably higher than they are in the non-contact sports and they are on average more severe. Estimates are presented of the injury savings that would result if …

Reducing Mortality From Septic Shock Using An Interleukin-1 Receptor Antagonist, Juyeon Chung

Yale School of Medicine Physician Associate Program Theses

Septic shock, a severe inflammatory state secondary to a bacterial infection with refractory hypotension and tissue hypoperfusion despite adequate fluid resuscitation, is a leading cause of mortality in intensive care units worldwide. The mortality rate of septic shock patients can exceed 40% in the U.S., highlighting the need for more effective therapies. Anakinra, an inflammatory cytokine inhibitor, has been identified as a potential therapy for reducing various inflammatory states such as sepsis. Our aim is to evaluate the efficacy of anakinra in reducing mortality in patients with septic shock. This double-blind, randomized control trial will compare the 28-day mortality of …

Doctors, Death, And Denial: The Origins Of Hospice Care In 20th Century America, Sarah E. Pajka

Kaplan Senior Essay Prize for Use of Library Special Collections

This essay provides insight into the social and cultural trends that led to the creation of hospice care in the United States. The essay covers the changes in treatment of death by the medical profession, from the discussion of tuberculosis sanatoriums and cancer centers in the early 1900s through the rise of medical authority, and the pivotal role of Yale School of Nursing dean Florence Wald in the 1980 opening of Connecticut Hospice, the first modern American hospice facility.

Electronic Medical Records For Trauma Surveillance In South Africa: The Case Of Khayelitsha Hospital, Emmanuel Chibuikem Ohuabunwa

Yale Medicine Thesis Digital Library

Electronic Medical Records (EMRs) have shown benefit for clinical, organizational, and societal outcomes(1). In South Africa, the desire for effective record keeping will continue to rise with increasing trauma and infectious disease rates. Recognizing this, the Western Cape government in 1999 signed a tender to rollout Clinicom EMR, an online storage system for paper records, to all hospitals within the province(2).

In 2012, Khayelitsha Hospital (KH) was opened with the Clinicom EMR installed. In 2013, KH received the ministerial award for clinical excellence as a result of the effective EMR rollout. Due to a high incidence of violence around Khayelitsha, …

The Md/Mba Effect: A Study Of How Residency Directors Perceive Applicants With An Mba, A Ten-Year Comparison Study From 2006 To 2016, Jay Pravin Patel

Yale Medicine Thesis Digital Library

Background: Over the past decade, the landscape of healthcare has changed

dramatically, demanding the close integration of business and management with the

delivery of clinical care. In response, there has been a continuation of the trend towards

additional training for physicians through an MBA program that has been seen over the

last thirty years. However, some medical students have encountered some negative

perceptions voiced by senior physicians about MD/MBA training. As most MD/MBA

joint-degree candidates consider clinical careers, it is vital to understand the views of

residency program directors who hold the gates to graduate medical education.

Purpose: Therefore in …

Medicine@Yale November/December 2017 Volume 13, Issue 4, 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 April/May 2017 Volume 13, Issue 2, 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 June/July 2017 Volume 13 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.

Narrative Economics, Robert J. Shiller

Cowles Foundation Discussion Papers

This address considers the epidemiology of narratives relevant to economic fluctuations. The human brain has always been highly tuned towards narratives, whether factual or not, to justify ongoing actions, even such basic actions as spending and investing. Stories motivate and connect activities to deeply felt values and needs. Narratives “go viral” and spread far, even worldwide, with economic impact. The 1920-21 Depression, the Great Depression of the 1930s, the so-called “Great Recession” of 2007-9 and the contentious political-economic situation of today, are considered as the results of the popular narratives of their respective times. Though these narratives are deeply human …

Burdens Beget Burden: Examining The Physiological Links Between Psychological Stress And Cardiovascular Disease, Tsion Medreke Aberra

Yale Medicine Thesis Digital Library

Introduction

Psoriasis is a chronic inflammatory disorder associated with both cardiovascular disease and mood disorders such as depression and anxiety. Multiple behavioral and physiological processes link depression, psoriasis and atherosclerosis, but inflammation is a major player implicated in the pathogenesis of all three. Psoriasis is associated with vascular inflammation, measured by 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT), and an increased risk of myocardial infarction. Vascular inflammation by FDG PET/CT predicts cardiovascular risk and outcomes. Studies have also shown that patients with psoriasis are more likely to suffer from comorbid depression and anxiety. However, whether these comorbidities may accelerate the …

Generic Drug Policy In The U.S. - Impact On Drug Prices And Shortages, Ravi Gupta

Yale Medicine Thesis Digital Library

Generic medicines offer a significantly cheaper alternative to brand-name drugs and have become an indispensable means of maintaining patient access and adherence to treatments. In recent years, as a result of monopolistic and oligopolistic conditions, generic drugs have begun to increase in price, sometimes exorbitantly. The competitiveness of drug markets with respect to the number of generic manufacturers and the implications for drug prices and shortages have not been systematically studied.

Two main analyses are presented in this study. First, using publicly available information, the timing of generic drug approvals and the total number of generic manufacturers for all small-molecule …

Medical Versus Surgical Management Of Native Joint Septic Arthritis In Adults: A Retrospective Comparison Of Outcomes Within The Va Ct Medical System, Ian Mcconnell

Yale Medicine Thesis Digital Library

Objective: Septic arthritis is a medical emergency with significant associated morbidity and mortality that requires joint drainage in addition to antibiotic therapy. Closed-needle aspiration and surgery (via arthrotomy or arthroscopy) are the standard approaches to joint drainage, though little data exists regarding treatment outcomes with each approach. We compared long-term outcomes for adult patients with septic arthritis of a native joint based on whether they received a ‘medical’ or ‘surgical’ approach to joint drainage.

Methods: We retrospectively reviewed all chart records for patients diagnosed with septic arthritis at the West Haven VA Medical Center between January 2006 and December 2015. …

Ichthyosis: Assessing Severity And Genotype-Phenotype Correlations, Nareh Valerie Marukian

Yale Medicine Thesis Digital Library

The ichthyoses, also known as disorders of keratinization (DOK), encompass a group of genetic skin disorders linked by the common finding of abnormal barrier function, which initiates a default compensatory pathway of hyperproliferation, resulting in the characteristic clinical manifestation of localized or generalized scaling.

Ichthyoses are a highly heterogenous group of disorders, both genetically and clinically. Despite the identification of causative mutations in over 50 genes, clear genotype-phenotype correlations have been difficult to establish due to the rarity of the ichthyoses and because mutations in the same gene can have widely divergent phenotypes, even in individuals with the same disease-causing …

Yale Medicine : Alumni Bulletin Of The School Of Medicine, Winter 2017, Yale University. School Of Medicine

Yale Medicine Magazine - alumni bulletin and magazine

This is the Winter 2017 issue of Yale Medicine: alumni bulletin of the School of Medicine, v. 51, no. 2. 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).

The Natural History And Predictors Of Liver Fibrosis Progression Using The Fib-4 Score Among Hiv/Hcv Co-Infected Adults In An Outpatient Clinic, Bianca Yuh

Yale Medicine Thesis Digital Library

Background: Studies have documented more rapid progression of HCV-associated liver fibrosis in patients co-infected with HIV. However, the natural history of HCV infection in both mono-infected and HIV co-infected patients remains highly variable. The patterns and predictors of fibrosis progression in the HIV/HCV co-infected population are not fully characterized. Given the invasiveness of serial liver biopsies, Fibrosis-4 score (FIB-4), a composite of serum biomarkers that correlate well with fibrosis stage, is increasingly used. We used FIB-4 to study the natural history of liver fibrosis progression among co-infected patients and evaluated predictors of progression to cirrhosis over 5 years prior to …

Longitudinal Assessment Of Blood Brain Barrier Disruption In Primary Hiv Infection And Effect Of Cart Therapy, Elham Rahimy

Yale Medicine Thesis Digital Library

Abnormal blood brain barrier (BBB) permeability has been implicated in the neuropathogenesis of chronic HIV infection. As neurocognitive impairment can persist despite effective combination antiretroviral therapy (cART), it is possible that irreversible central nervous system (CNS) processes are initiated in early infection, before cART is typically initiated. We analyzed the natural history of BBB permeability in primary HIV infection (PHI), and the effects of cART initiated during this period. CSF:Serum albumin quotient (QAlb), a marker of BBB permeability, was measured in longitudinal observational studies of PHI. We analyzed trajectories of QAlb pre- and post-cART using mixed-effects models, and associations between …

Identifying Barriers To Implementing Guidelines For Monitoring Metabolic Syndrome In Patients Prescribed Second-Generation Antipsychotics In Incarcerated Populations, Carol-Ann Margaret Cenac

Yale School of Nursing Digital Theses

Individuals with serious mental illness (SMI) have increased rates of cardiovascular disease (CVD) and mortality. Also, the evidence indicates that second-generation antipsychotics (SGAs, a conventional treatment) increase the risk of metabolic syndrome (MetS) often leading to weight gain, cardiovascular disease (CVD) and type 2 diabetes (DM 2). U. S. correctional institutions, faced with increased rates of mental illness in its population, are confronted with the need to assure adequate monitoring for its patients treated with SGAs. This paper reviews guidelines for monitoring incarcerated patients to ensure early intervention that can improve clinical outcomes. Characteristics of the incarcerated population and institution-related …

Identifying Barriers To Implementing Guidelines For Monitoring Metabolic Syndrome In Patients Prescribed Second-Generation Antipsychotics In Incarcerated Populations, Carol-Ann Margaret Cenac

Yale School of Nursing Digital Theses

Individuals with serious mental illness (SMI) have increased rates of cardiovascular disease (CVD) and mortality. Also, the evidence indicates that second-generation antipsychotics (SGAs, a conventional treatment) increase the risk of metabolic syndrome (MetS) often leading to weight gain, cardiovascular disease (CVD) and type 2 diabetes (DM 2). U. S. correctional institutions, faced with increased rates of mental illness in its population, are confronted with the need to assure adequate monitoring for its patients treated with SGAs. This paper reviews guidelines for monitoring incarcerated patients to ensure early intervention that can improve clinical outcomes. Characteristics of the incarcerated population and institution-related …

Developing Dual Diagnosis Care Curriculum For Nurses In Acute Psychiatric Inpatient Settings, Kofi Ahumkah Bonnie

Yale School of Nursing Digital Theses

Patients with co-existing substance use and mental disorder (dual diagnosis) have complex and challenging care needs especially in acute psychiatric inpatient settings. Acute psychiatric care plays a vital role in mental health service delivery and there is evidence that nurses working in these settings often have unmet learning needs regarding dual diagnosis care, posing a challenge to nursing practice. The purpose of this project was to develop an educational module which will equip nurses with the skills and knowledge required to deliver evidence-based dual diagnosis care in acute psychiatric settings. A survey of 74 acute psychiatric nurses was initially completed …

Greater New Haven Community Index 2016, Mark Abraham, Mary Buchanan

Reports

No abstract provided.

Malignancies Associated With Inflammatory Bowel Diseases, Nicole Gong Jawitz

Yale Medicine Thesis Digital Library

Inflammatory Bowel Diseases (IBD), specifically Crohn’s disease and ulcerative colitis, have been associated with numerous intestinal and extra- intestinal malignancies. Recent studies have suggested use of immunomodulator therapies has increased risks of malignancies, including melanoma, non-epithelial skin cancers, cervical cancer, and bladder and urinary tract cancers. The question regarding how biologic agents, which became a mainstay therapy of IBD in the early 2000s, have influenced malignancy risk among patients with IBD has yet to be definitely answered.

The aims of this study were to characterize prevalence of comorbid malignancies among hospitalized patients with IBD and how it has changed over …

The Cost And Burden Of Chikungunya In The Americas, Danielle Bloch

Public Health Theses

Background: Chikungunya virus (CHIKV) is a mosquito-transmitted virus that emerged in the Caribbean in late 2013 and proceeded to spread throughout the Americas. Acute CHIKV disease is characterized by high fever and potentially debilitating arthralgia. In a proportion of cases, serious long-term sequelae following acute disease have been reported. These conditions primarily include chronic inflammatory rheumatisms, but can also involve depression, sensorineural effects, headaches and cognitive delays following neonatal infection.

Methods: We developed data-driven computational simulation models for acute and long-term health conditions associated with CHIKV infection to estimate the economic cost and health burden of the 2013–2015 CHIKV epidemic …