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Classic Article: Steady Flow In A Frictionless Homogenous Ocean, N. P. Fofonoff

Journal of Marine Research

A mathematical model is developed to study the free (frictionless) steady horizontal flow which can occur in a homogeneous ocean of constant depth. The flow satisfies the dynamic constraint that the vertical component of absolute vorticity is constant along a streamline. The conclusion is reached that in an enclosed ocean a free steady circulation cannot have any slow broad eastward currents. The eastward currents must occur as narrow streams of high velocity and high relative vorticity. Intensified currents are present along the eastern and western coasts. The theory which is developed for the homogeneous ocean of constant depth can be …

Classic Article: Effect Of Coriolis Force On Edge Waves (I) Investigation Of The Normal Modes, Robert O. Reid

Journal of Marine Research

Essentially two classes of free edge waves can exist on a sloping continental shelf in the presence of Coriolis force. For small longshore wave length, fundamental waves of the first class behave like Stokes edge waves. However, for great wave lengths (of several hundred kilometers or more) the characteristics of the first class are significantly altered. In the northern hemisphere the phase speed for waves moving to the right (facing shore from the sea) exceeds the speed for waves which move to the left. Also, the group velocity for a given edge wave mode has a finite upper limit. Waves …

Myrf Represses Nodal Signaling Via Furin During Left-Right Patterning And Gastrulation, Sarah Amalraj

Yale Medicine Thesis Digital Library

Congenital heart disease (CHD) is the most common major birth defect in children, affecting nearly 3% of children and is the leading cause of infant mortality. Heterotaxy (Htx) is a disorder of left-right (LR) patterning, in which organs, including the heart, are mispatterned relative to the LR axis. Htx is associated with severe forms of CHD, but its genetic causes remain largely undefined. Exome sequencing studies of large patient cohorts have recently revealed hundreds of CHD/Htx candidate disease genes, which now need to be validated in experimental systems for causality in order to better understand the causes and biological mechanisms …

Editor's Commentary: The Relationship Of Vertical Turbulence And Spring Diatom Flowerings, Peter Franks

Journal of Marine Research

The dynamics of spring blooms of phytoplankton in temperate waters are usually associated with H.U. Sverdrup’s 1953 “critical depth” model. However, more than a decade earlier, Gordon Riley published a statistical and mechanistic analysis of data he had gathered over two spring “flowerings” on Georges Bank...

Classic Article: The Relationship Of Vertical Turbulence And Spring Diatom Flowerings, Gordon A. Riley

Journal of Marine Research

The causes underlying the initiation of the spring diatom flowering have been a subject of vigorous discussion in recent years. With the gradual accumulation of records it has become quite clear that no one factor controls this peculiar phenomenon. The obvious prerequisite, an abundant supply of nutrient salts in the euphotic zone, is generally satisfied during the autumn and early winter, yet a flowering does not in most cases follow immediately. In a few localities, such as Cape Cod Bay and Ipswich Bay (Bigelow 1926), the Woods Hole region (Fish 1925), and Long Island Sound (Riley 1941a), diatom bursts have …

Writing The Gap: The Role Of Clinician-Authored Narratives In Building Structural Competence And Situated Knowledge In Service Of Marginalized Patient Populations, Anusha Singh

Yale Medicine Thesis Digital Library

This thesis analyzes clinician-authored narratives about mental illness. Through this lens, it argues that the writing and reading of medical narratives can facilitate the development of key clinical skills such as structural competence and situated knowledge – terms that this thesis will define and discuss at length. It will argue that clinicians who write about structural barriers to health do so to develop a deeper understanding about their vulnerable and marginalized patient populations. It will assert that clinicians who pursue situated knowledge can positively impact health outcomes. Ultimately, this thesis will compare what clinician-authored narratives can achieve with what patient …

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 …

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 …

Hair Cortisol As A Retrospective Biomarker Of Stress Among Minorities And Immigrants During The First Year Of The Trump Administration, Dennis Wang

Yale Medicine Thesis Digital Library

Cortisol is an important part of the body’s physiological response to stress. Chronic exposure to race-based discrimination and stress is thought to explain, in part, minority health disparities. Hair cortisol concentration (HCC) can be used as an objective proxy of a participant’s chronic stress prior to recruitment. It has not to our knowledge been used to investigate stress following an unexpected political event. President Trump issued in his first week in office multiple Executive Orders targeting minorities and immigrants. The Gallup-Sharecare Well-Being Index also showed significant declines in Democrats but not in Republicans, and in women but not in men, …

The Freshair Wristband: Comparison Of Personal Exposure Measured Using Different Wearable Form Factors, Elizabeth Ziying Lin

Public Health Theses

Organic air pollutants are widely used in building materials, personal care and household products. Studies have been linking the exposure to these organic air pollutants with adverse health outcomes, including respiratory, cardiovascular, neurobehavioral outcomes, and cancer. Techniques to measure personal exposure to organic air pollutants include backpacks containing filters/pumps, and a set of single pollutant monitors. These techniques usually involve solvent extraction of filters. They are expensive, time-consuming, and inefficient which are not suitable for large scale, longitudinal exposome studies. The FreshAir samplers were developed to capture a wide range of compounds simultaneously throughout the exposure, its high degree of …

A Feel For The Space: Engagement With The Built Environment Of Treatment Spaces Among Individuals In Recovery, James Richey

Public Health Theses

Background

Treatment spaces for substance use disorders (SUD) are diverse with respect to treatment modality and population served. However, there is a lack of literature describing the design of treatment spaces and treatment engagement. This project aims to identify how the built environment of SUD treatment spaces play a role in treatment acceptability, retention, and outcomes.

Methods

We conducted 15 semi-structured interviews with individuals in outpatient SUD treatment in southern Connecticut. These interviews explored individuals’ experience with the built environment of treatment spaces and facilities, including architectural and design-related features (e.g., functionality, spatial arrangement), and how space influences adherence to …

Bulletin Of Yale University School Of Nursing 2020-2021, Yale School Of Nursing

Yale School of Nursing Bulletins and Catalogues

Series 116, Number 15

September 5, 2020

Procurement Of Housing In Depressed, African-American Homeless Patients In A Large Urban Federally Qualified Health Center: A Pilot To Improve Workflow Processes, Identify Best Practices And Impact Outcomes, Asa Tavares Briggs

Yale School of Nursing Digital Theses

Homelessness is a chronic issue in the United States (US)-impacting individuals from every socio-economic class. African Americans in the US disproportionately experience rates of homelessness higher than those in the general population. These individuals are vulnerable to poor physical and chronic mental health problems, chief among them is depression. African-American homeless individuals have high rates of depression and experience disparities in utilization and access to health care. To address this problem within a healthcare systems level context, this Doctorate of Nursing Practice (DNP) project examined the association between homelessness and depression in African-Americans. A pilot project focused on the targeted …

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 …

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 …

Racial And Ethnic Disparities In Pharmacologic Treatment For Emotional Distress Among Older Adults With Cancer, Saranya Govindaraju

Public Health Theses

Abstract

Objective: Disparities in self-reported emotional distress and subsequent pharmacologic treatment for emotional distress are not well understood among older adults with cancer. The main objective of this study is to understand racial and ethnic disparities in emotional distress medication and the relationship between self-reported levels of emotional distress. We hypothesize that as self-reported levels of emotional distress increase in severity, the race and ethnic disparities in emotional distress medication will diminish or decrease. Our secondary aim was to understand the role of socioeconomic factors on racial and ethnic disparities in medication use.

Methods: In this retrospective cohort study, we …

Fungal Community Characterization And Machine Learning Classification Of Building Mold Status Between Pre- And Post-Remediation, Truc T. Ly

Public Health Theses

As part of a larger sampling campaign with mold inspectors across the US, samples (dust and direct mold) from 11 New York homes during pre- and post-remediation were analyzed by sequencing the interspaced transcribed region of extracted DNA and bioinformatic methods. Overarching findings from this study include: 1) pre/post- remediation fungal communities exhibit subtle differences and 2) larger degrees of fungal community differences exist between direct mold and settled dust. Mainly known as environmentally derived fungal species, Cladosporium ramotenellum and Rhodosporidium diobovatum were the two main taxa to be abundant among post-remediation samples. The thermophilic fungi, Thielavia terrestris, was higher …

Patterns Of Care And Outcomes Of Patients With Myelofibrosis: A Population-Based Study, Shelby Heath Meckstroth

Public Health Theses

Background: Current treatments for Myelofibrosis (MF) are largely palliative, with ruxolitinib being the breakthrough treatment approved for higher-risk patients by the Food and Drug Administration in November of 2011. Little is known about the “real-world” patterns of care and outcomes of MF patients since the introduction of ruxolitinib. Patients and Methods: The SEER-Medicare database was used to identify older patients diagnosed with MF from 2007 through 2015. Treatment patterns were assessed using Medicare part B and D claims, and multivariate cox proportional hazards regression models were used to assess the effect of ruxolitinib use on survival in MF patients. Results: …

Contraception And Sexual Health Counseling In Adolescent And Young Adult Female Cancer Patients, Sarah Hadassah Abelman

Yale Medicine Thesis Digital Library

Introduction:

Adolescent and young adult women undergoing cancer treatment face unique reproductive health risks. The objectives of this study were to assess the prevalence of sexual health counseling and contraception use in the oncology setting, and to identify factors associated with these outcomes.

Methods:

After institutional review board approval, a retrospective chart review was conducted of female patients ages 15-25 receiving cancer treatment at Yale New Haven Hospital from 2013-2018. Univariate and multivariate analyses were used to assess the relationship between patient variables and the outcomes of counseling and contraception use. Additionally, with institutional review board approval, a cross-sectional survey …

Approaches To Fracture Healing Under Inflammatory Conditions: Infection And Diabetes, Sean Vincent Cahill

Yale Medicine Thesis Digital Library

Non-union is a devastating complication of fracture and can be precipitated by abnormal

inflammatory states including infection and diabetes.

This thesis focuses on four related research problems that are addressed through original

scientific investigation and literature review. In addressing these questions, this dissertation

presents evidence for the following conclusions through in vivo animal models and using methods

including bacterial cell culture and counting, histology, radiography, and micro-computed

tomography:

1. Rifampin-loaded hydrogels decrease bacterial load and improve fracture healing in

a MRSA-infected open fracture model.

2. MRSA-infected nonunion is characterized by impaired chondrocyte maturation and

is associated with IL-1 and NF-KB …

Uncovering Intratumoral And Intertumoral Heterogeneity Among Single-Cell Cancer Specimens, William Shelton Chen

Yale Medicine Thesis Digital Library

While several tools have been developed to map axes of variation among individual cells, no analogous approaches exist for identifying axes of variation among multicellular biospecimens profiled at single-cell resolution. Developing such an approach is of great translational relevance and interest, as single-cell expression data are now often collected across numerous experimental conditions (e.g., representing different drug perturbation conditions, CRISPR knockdowns, or patients undergoing clinical trials) that need to be compared. In this work, “Phenotypic Earth Mover's Distance” (PhEMD) is presented as a solution to this problem. PhEMD is a general method for embedding a “manifold of manifolds,” in which …

Natural History Of Thoracic Aortic Aneurysm Associated With Bicuspid Aortic Valve, Thais Faggion Vinholo

Yale Medicine Thesis Digital Library

Hypothesis: Thoracic aortic aneurysm (TAA) is a silent but virulent disease. Bicuspid aortic valve (BAV) is the most common congenital heart disease. The association between BAV and ascending TAA (ATAA) is well described. However, the guidelines for surgical management to treat patients with thoracic aortic aneurysms associated with bicuspid aortic valve (ATAA-BAV) remains controversial. We hypothesized that the surgical management of patients with ATAA-BAV should not differ from the management of those who have ATAA with a trileaflet aortic valve (TAV). Additionally, we suspected that BAVs that are free of stenosis and regurgitation can be spared in the setting of …

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 …

Acute And Chronic Liver Disease: Lessons Learned From Retrospective Cohort Studies, Ysabel C. Ilagan-Ying

Yale Medicine Thesis Digital Library

Current trends in liver disease are changing due to increased access to pharmacotherapies and the worsening burden of obesity. Large, observational cohort studies are a common tool in clinical and epidemiological research to determine risk for patients that may have experienced an exposure of interest. Past studies have largely examined risk factors for liver disease in patients with cirrhosis or fatty liver disease. We utilized retrospective cohort studies in a disease-agnostic approach and aimed to characterize risk for two increasingly prevalent populations: patients with severe acute liver injury and those with liver fibrosis progressing to hepatocellular carcinoma (HCC).

First, we …

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 …

Differential Response To Rituximab In Anti-Achr And Anti-Musk Positive Myasthenia Gravis Patients, Tess Litchman

Yale Medicine Thesis Digital Library

Response to immunomodulatory therapies in myasthenia gravis (MG) can be variable. A subset of MG patients remains refractory to conventional agents. B-cell targeted therapy with rituximab has demonstrated a durable response in treating refractory myasthenia gravis (MG). This study compares the response to rituximab between patients with acetylcholine receptor autoantibody positive (AChR+) and muscle-specific kinase autoantibody positive (MuSK+) MG.

This retrospective study included 33 patients with either AChR+ or MuSK+ MG who were treated with rituximab from 05/31/2003 to 05/31/2017. Pretreatment and post-treatment immunotherapy regimens, clinical symptoms, and examination findings were evaluated.

Median MGFA Class of II at baseline improved …

Lifestyle Factors Associated With Neoadjuvant Chemotherapy Outcomes In Breast Cancer, Ilana Usiskin

Yale Medicine Thesis Digital Library

Lifestyle factors such as lower BMI, higher levels of physical activity, and increased fruit and vegetable intake, have been shown to benefit breast cancer survival, but the association between these factors and the pathologic complete response (pCR) to chemotherapy, has not been studied. We investigated whether lifestyle factors including BMI, physical activity, diet and alcohol use are associated with pCR from neoadjuvant chemotherapy for breast cancer treatment. Secondarily, we assessed whether the relative dose intensity (RDI) of neoadjuvant chemotherapy is associated with pCR.

We conducted a retrospective study of women treated with neoadjuvant chemotherapy for stage I-III breast cancer between …

The Development And Validation Of A Novel Ichthyosis Severity Assessment Instrument, Qisi Sun

Yale Medicine Thesis Digital Library

Abstract: THE DEVELOPMENT AND VALIDATON OF A NOVEL ICHTHYOSIS SEVERITY ASSESSMENT INSTRUMENT. Qisi Sun, Amy Paller, Keith A. Choate. Department of Dermatology, Genetics & Pathology, Yale University School of Medicine, New Haven, CT.

Ichthyosis clinical trials require reliable, validated severity assessments to identify appropriate subjects and quantify treatment outcomes. There is no validated scale to measure ichthyosis severity across the entire body. We aim to create and validate a comprehensive and user-friendly instrument to measure total body ichthyosis severity in adults and children.We divided the body into 10 regions to score special regions of interest. Likert scales (0-4) were established …

Cerebral Autoregulation-Based Blood Pressure Management In The Neuroscience Intensive Care Unit: Towards Individualizing Care In Ischemic Stroke And Subarachnoid Hemorrhage, Andrew Silverman

Yale Medicine Thesis Digital Library

The purpose of this thesis is to review the concept of cerebral autoregulation, to establish the feasibility of continuous bedside monitoring of autoregulation, and to examine the impact of impaired autoregulation on functional and clinical outcomes following subarachnoid hemorrhage and ischemic stroke. Autoregulation plays a key role in the regulation of brain blood flow and has been shown to fail in acute brain injury. Disturbed autoregulation may lead to secondary brain injury as well as worse outcomes. Furthermore, there exist several methodologies, both invasive and non-invasive, for the continuous assessment of autoregulation in individual patients. Resultant autoregulatory parameters of brain …

Context Of Injury Among Abusive And Accidental Injuries In Children, Lindsay Eysenbach

Yale Medicine Thesis Digital Library

Child physical abuse is a significant public health challenge with an incidence of approximately 6.4 hospitalized cases per 100,000 children. Many abused children, however, will go undiagnosed by physicians evaluating these injuries. Assessing whether a child has been abused is a high-stakes decision: a missed case leaves a child vulnerable to future injury, but an inaccurate diagnosis of abuse may be greatly disruptive and stigmatizing to children and their families. Previous research has established key physical examination and radiographic findings that are associated with abusive injury. A gap in the literature, however, is the role of additional injury circumstances and …