Digital Commons Network^™

Exposure To 1,4-Dioxane Dysregulates Stool Metabolomic Network, Yensheng Wang

Public Health Theses

1,4-dioxane is an environmental toxin found in drinking water that is highly associated with liver cancer. The interactions between environmental toxins and the human body can result in the development of tumorigenesis, it can also result in changes to metabolism and thus metabolites that circulate within the body. Some of these metabolites can be procarcinogenic, or can reflect changes to host processes that control metabolism. Stool contains copious information on metabolism that can provide an overview of the well-being of our body, and metabolites in the stool can provide information regarding the pathogenesis of disease and the toxicokinetics of toxicants. …

Evaluation Of The Endocrine Disrupting Potential Of Chemicals Used In Crumb Rubber: A Multi-Factorial Approach, Alexia Sara Akbay

Public Health Theses

Crumb rubber, an infill substance made from repurposed tires, has been examined for its carcinogenic potential but no studies have looked at its endocrine disrupting potential to date. After prioritizing 306 chemical components of crumb rubber using computational models, four endocrine disrupting chemicals (EDCs) thought to possess estrogenic activity were chosen for further in vitro testing. In addition to these chemicals, a crumb rubber concentrated media (CRCM) was created for mixture analysis. Gene expression assays for estrogenic activity were conducted on Ishikawa, HepG2 and MCF-7 immortalized cell lines exposed to 4-tert-octylphenol, dibenz(a,h)anthracene, fluoranthene, chrysene and CRCM. Based on the findings …

Scaling Up Group Prenatal Care: Analysis Of The Current Situation And Recommendations For Future Research And Policy Actions, Allissa Anne Desloge

Public Health Theses

The United States consistently spends more on healthcare than other developed nations, but continues to suffer from inferior outcomes in maternal and infant morbidity and mortality. Innovation is needed within maternal and child healthcare to address these adverse outcomes. One identified innovative approach to tackle these issues is group prenatal care (GPNC). Women who participate in GPNC experience individual clinical care checks to monitor weight, blood pressure, and gestational age in addition to interactive learning and community-building activities and discussions. When compared to those who receive individual prenatal care, GPNC recipients have lower rates of preterm birth, fewer small for …

Yale School Of Medicine Facts & Figures 2019-2020, Yale School Of Medicine Office Of Communications

Facts & Figures – annual Yale School of Medicine numbers

Provided by the Office of Communications, the Facts and Figures brochure is produced annually as a way to provide a snapshot of key facts and data related to the School of Medicine as well as the Medical Campus. This includes enrollment data, research activity, financial summaries, and more.

Assessing Risk Factors For Sudden Infant Death Syndrome And Caregivers’ Perceptions Of The Cardboard Box For Infant Sleep, Nisha Dalvie

Yale Medicine Thesis Digital Library

Some US hospitals are giving out cardboard boxes as a way to address behaviors associated with Sudden Infant Death Syndrome (SIDS). Our goal was to evaluate the cardboard box for this purpose by quantifying current practices and qualitatively assessing caregivers’ perceptions of the cardboard box. Study participants were English or Spanish-speaking caregivers of 2-16 week old infants presenting to primary care clinics in New Haven, CT. Caregivers completed a survey asking about demographic data and SIDS risk factors, such as non-supine positioning and bed-sharing. Some caregivers also participated in a semi-structured interview about the cardboard box, created used a grounded …

Inhibition Of The Akt1-Mtorc1 Axis Alters Venous Remodeling To Improve Arteriovenous Fistula Patency, Arash Fereydooni

Yale Medicine Thesis Digital Library

Arteriovenous fistulae (AVF) are the most common access created for hemodialysis, but up to 60% do not sustain dialysis within a year, suggesting a need to improve AVF maturation and patency. In a mouse AVF model, Akt1 regulates fistula wall thickness and diameter. We hypothesized that inhibition of the Akt1-mTORC1 axis alters venous remodeling to improve AVF patency. Daily intraperitoneal injections of rapamycin reduced AVF wall thickness with no change in diameter. Rapamycin decreased smooth muscle cell (SMC) and macrophage proliferation; rapamycin also reduced both M1 and M2 type macrophages. AVF in mice treated with rapamycin had reduced Akt1 and …

The Care Of The Sexual Assault Patient, Eun Sook Choi

Yale Medicine Thesis Digital Library

Survivors of sexual assault (SA) experience a range of physical and mental health consequences. Despite universal agreement that follow-up care improves outcomes, studies demonstrate only one-third of survivors receive assault related follow-up care. This study aims to describe the patient population presenting after SA, characteristics of their acute care, and rates of follow-up within one-year at two sites of the Yale New Haven Hospital, which includes an urban tertiary care hospital (York Street Campus, YSC), and its satellite community hospital (St Raphael Campus, SRC). A retrospective medical record review was conducted of patients older than 12 years presenting after sexual …

Social Integration And The Mental Health Needs Of Lgbtq Asylum Seekers In North America, Samara Danielle Fox

Yale Medicine Thesis Digital Library

This study examined the mental health burden of LGBTQ asylum seekers and associated psychosocial risk factors with a focus on barriers to social integration. This study also characterized LGBTQ asylum seekers’ interest in interventions aimed at alleviating mental distress and social isolation. Respondents (n = 308) completed an online survey which included the Refugee Health Screener (RHS-15), the NIH loneliness scale, and an adapted scale of sexual identity disclosure. Most respondents (80.20%) screened positive for mental distress. Loneliness (OR = 1.14, 95% CI = 1.09, 1.19) and LGBTQ identity disclosure (OR = 3.46, 95% CI = 1.01, 12.02) were associated …

A Genomic Approach To Idiopathic Liver Disease In Adults, Aaron Hakim

Yale Medicine Thesis Digital Library

Adult patients suffering from liver disease of unknown cause represent an understudied and underserved population. Over the past 15 years, next-generation sequencing technologies have matured into an inexpensive, effective, and widely available set of tools to do genomic analysis. One of these technologies, whole-exome sequencing (WES), allows for high throughput sequencing of all of the genome’s protein coding regions (exons). In pediatric cohorts, WES combined with deep clinical phenotyping has been shown to be an effective and unbiased method of identifying rare protein-altering coding variants in individual genes. WES has also contributed to the diagnosis and individualization of medical care …

The Reproductive Health Needs Of Women At Risk Of Hiv Infection In Connecticut, Emily Hoff

Yale Medicine Thesis Digital Library

Background: The number of women involved in criminal justice systems (WICJ) and women who use opioids has been dramatically increasing in the United States. An often-overlooked aspect of healthcare for women at risk of HIV infection (either WICJ or women who use drugs) is reproductive health. We aim to provide a framework, informed by a systematic review and primary data, to guide future interventions addressing the sexual and reproductive health (SRH) needs of women at risk of HIV infection.

Methods: We completed a systematic literature review of the pregnancy prevention and planning needs of US WICJ published in English from …

Csf Lymphocyte And Monocyte Activation And Trafficking In Primary Hiv Infection, Aveline Xiang Li

Yale Medicine Thesis Digital Library

Trafficking of immune cells to the central nervous system (CNS) is hypothesized to facilitate HIV entry and immune-induced neuronal injury, and is mediated by cell surface proteins such as chemokine receptors and integrins. We longitudinally assessed immune cell activation and surface marker expression in cerebrospinal fluid (CSF) and blood and their relationship with CSF HIV RNA during primary HIV infection (PHI) before and after combination antiretroviral therapy (ART). Longitudinal paired blood and CSF were obtained in initially ART-naïve PHI (infection) participants; some subjects independently initiated ART during follow up. Multiparameter flow cytometry was used to determine activation (% CD38+HLADR+) and …

The Role Of Traf3 And Cyld Mutationin The Etiology Of Human Papillomavirus Driven Head And Neck Cancers, Tejas Sudarshan Sathe

Yale Medicine Thesis Digital Library

The incidence of HPV-positive head and neck squamous cell carcinoma (HNSCC) con-tinues to rise. Though HPV positivity is correlated with improved survival, up to a quar-ter of these tumors recur or metastasize despite aggressive therapy. Currently, there areno biomarkers that can identify HPV-positive HNSCC patients who would benefit fromreduced doses of radiation–which when given at full dose carries significant morbidity.Through analysis of a limited cohort of The Cancer Genome Atlas (TCGA), we previ-ously showed that two genes, TRAF3 and CYLD, were frequently deleted or mutated inHPV-positive HNSCC. TRAF3 and CYLD are functionally related negative regulatorsof the transcription factor NF-κB. In …

Evaluation Of The Mechanisms Of Anti-Cancer Immune Responses, Noel Turner

Yale Medicine Thesis Digital Library

Metastatic melanoma historically carries a grim prognosis, with a median survival of 9 months and a long-term survival rate of 10%. Melanoma is highly immunogenic, and the development of immunotherapies has dramatically changed the landscape of metastatic melanoma treatment. To study the immune mechanisms engaged by these therapies, the Bosenberg lab developed YUMMER, an immunogenic mouse melanoma line that forms tumors when injected into mice. This and other immunogenic murine cancer models were used to demonstrate that B cell depletion does not impair the anti-PD-1-induced anti-tumor immune response in mice. In addition, supplementing immune checkpoint inhibition with therapies targeting myeloid …

The Effects Of Kt ≠ Ks In A Stommel-Like Model Of The Upper Atlantic Meridional Overturning Circulation Under Steady Surface Flux Forcing, A. E. Gargett

Journal of Marine Research

This study examines a simple 6-box model of a single pole-to-pole ocean basin. Each of a northern "polar gyre," a southern "polar gyre," and an "equatorial gyre," consisting of north and south subtropical gyres plus the equatorial region, is represented by two boxes: a surface box receiving constant fluxes of both temperature (heat) and salt (freshwater) and a deep box. The model includes four dominant processes: surface flux forcing, horizontal meridional advection driven by Southern Ocean winds, horizontal eddy diffusion at gyre boundaries, and convection, as well as the process of vertical diffusion by small-scale processes. Provided that heat loss …

Amazon River Infl Uence On Nitrogen Fi Xation In The Western Tropical North Atlantic, Joseph P. Montoya, Jason P. Landrum, Sarah C. Weber

Journal of Marine Research

We measured rates of N- and C-fixation with a direct tracer method in regions of the western tropical North Atlantic influenced by the Amazon River plume during the high flow period of 2010 (May–June 2010). We found distinct regional variations in N-fixation activity, with the lowest rates in the plume proper and the highest rates in the plume margins and in offshore waters. A comparison of our N- and C-fixation measurements showed that the relative contribution of N-fixation to total primary production increased from the plume core toward oceanic waters, and that most of the C-fixation in this system was …

The Neurological Development Of Sagittal Craniosynostosis Patients Treated With Whole Vault Cranioplasty, Raysa Cabrejo

Yale Medicine Thesis Digital Library

Objective: In this study we seek to clarify the neurological changes before and after whole vault cranioplasty (WVC) in patients born with sagittal craniosynostosis.

Methods: A case control study design was performed that included forty fMRI scans, from thirty-five individual patients. Functional MRI (fMRI) and diffusion tension imaging (DTI) data were analyzed with BioImageSuite (Yale University, USA). All nine functional brain networks were analyzed with appropriate regions of interest.

Results: Comparing functional MRI the infants after WVC vs. infants before WVC group, the after WVC group demonstrated an increased connectivity in the left frontoparietal (LFPN), secondary (V2) and third (V3) …

Insulin And Non-Insulin Dependent Glut4 Trafficking: Regulation By The Tug Protein, Stephen Devries

Yale Medicine Thesis Digital Library

The body tightly regulates glucose production and disposal despite changing metabolic demands, including large post-prandial and fasting fluctuations. Specifically, under the action of insulin, muscle contraction, ischemia, and poor nutrient availability, cells increase the amount of the glucose transporter type 4 (GLUT4) at the plasma membrane by mobilizing a sequestered pool of transporters. In this work, we demonstrate that the TUG (tether containing a UBX domain for GLUT4) protein mediates both insulin-dependent and insulin-independent pathways to increase GLUT4 at the plasma membrane. In mice fed a high fat diet to induce insulin resistance, the regulation of the endoproteolytic cleavage of …

Ossification Of The Phalanges Of The Foot And Its Relationship To Peak Height Velocity And The Calcaneal System, Mekka Garcia

Yale Medicine Thesis Digital Library

Background: There are multiple skeletal maturity grading systems, but none of them utilizes the phalanges of the foot. To minimize radiation, it would be ideal if one could assess the skeletal maturity of a foot based on bones seen on routine foot x-rays, if guided growth is being considered as a treatment option, as in hallux valgus. We developed a system that in combination with the calcaneal system, can closely predict skeletal maturity and help with the timing of surgical interventions of the foot.

Methods: We selected 94 healthy children from the Bolton-Brush study, each with consecutive radiographs from age …

The Application Of Extracorporeal Photochemotherapy To Head And Neck Squamous Cell Carcinoma, Alp Yurter

Yale Medicine Thesis Digital Library

Extracorporeal Photochemotherapy (ECP) is an FDA-approved immunotherapy that has been treating cutaneous T cell lymphoma (CTCL) for over three decades. ECP’s antitumoral effect is a consequence of its generation of functional, physiologic, inflammatory monocyte-derived dendritic cells (MoDCs) and apoptotic, patient-derived tumor, which collectively, stimulate the adaptive immune system. Thus, in CTCL, ECP serves as a therapeutic dendritic cell vaccine against patient-specific neoantigens. This mechanism of action suggests ECP’s potential application to other solid tumors. We tested ECP’s applicability to head and neck squamous cell carcinoma (HNSCC) using a trackable antigen system involving the constitutively expressed HPV16 E7 oncoprotein. We hypothesized …

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.

Ranging And Behavior Of Black And Gold Howler Monkeys In Formosa, Argentina, Claire Rossi De Leon

Library Map Prize

Howler monkeys (Alouatta spp.) are known for their adaptability, allowing them to inhabit a large range of forest types and driving high levels of variation in ranging and behavioral patterns. I address a series of hypotheses relating these relationships: 1) If an energy minimizing lifestyle is an adaptation to eating high quantities of leaves, then howler groups that have a high proportion of leaves in their diet will occupy smaller home ranges, have shorter daily path lengths, and spend more time resting, 2) if temperature is the primary driver of high levels of resting, then howlers will conserve energy and …

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 …

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 …

Symptom Clustering And Decision Tree Analysis Within The Vast-D Randomized Clinical Trial, Yangmin Chen

Public Health Theses

As a secondary analysis of the VAST-D clinical trial data, we employed a multi-layered strategy to describe the complicated clinical features of Major Depressive Disorder (MDD) and the heterogeneity among depressive symptoms, using the following analytical approaches:

(1) Cluster analysis was used to transform a large and heterogenous mix of survey questions into a small number of correlated MDD symptom clusters: Four robust and highly-interpretable MDD symptom clusters (core emotional, appetite and weight, sleep disorders, atypical) were identified within the VAST-D trial, consistent with the findings from other relevant studies.

(2) Decision tree analysis was used to identify symptom thresholds …

Spatiotemporal Investigation Of Opioid-Involved Fatalities In Connecticut, 2009-2017, Natalee Frances Robson Desotell

Public Health Theses

Over the past two decades, overdose deaths involving pharmaceuticals, heroin and, more recently, synthetic opioids such as illicitly manufactured fentanyl have increased in the United States. Connecticut has one of the highest opioid-involved mortality rates when compared to other states, and between 2009 and 2017, the incidence of opioid-involved fatal overdoses in Connecticut increased by about 350%. We examined opioid-involved fatality data from the Connecticut Office of the Chief Medical Examiner over a 9-year period, from January 1st, 2009 and December 31st, 2017, to better understand the granular spatiotemporal trends of the crisis within CT with an eye toward informing …

The Estimation Of Age, Period And Cohort Effects For Lung Cancer, Yijie Li

Public Health Theses

Lung cancer is one of the most fatal diseases in the world, so it is important to understand the pattern of lung cancer trends at population level. The age-period-cohort model (APC model) is used in this article to analyze the effects of age, year at diagnosis and year at birth on lung cancer in the U.S. The results suggest the age, period and cohort curvature effects are all significant on the lung cancer incidence and mortality. By looking at the plot of the age, period and cohort effects, we found historical events of interest like world war, sales strategies by …

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 …

Medical Education And The Stigmatization Of Mental Illness In The Philippines, Candice Mae Taguibao

Public Health Theses

BACKGROUND:

Mental health stigma is a worldwide problem that affects health care providers, as well as the general population. The current study used survey data from students and physicians in the Philippines to examine the association of higher levels of medical education with levels of

stigma. Further, attitudes among medical students in the Philippines were compared with levels among medical students in the US, Brazil, Ghana, Nigeria and China. Qualitative interviews were used to further understand these data.

METHODS:

A convenience sample was collected from medical students before and after medical school psychiatric training from the University of the Philippines …

Intergenerational Effects Of Adverse Birth Outcomes Of Parents And Offspring Autism Spectrum Disorder (Asd) Risk In Denmark: A Population-Based Cohort Study, Jingyuan Xiao

Public Health Theses

Abstract

Introduction: Animal studies have suggested that exposure-induced epigenetic reprogramming of the germlines affects neurodevelopmental outcomes in the next generation, but possible transgenerational effects of parental adverse birth outcomes and offspring autism spectrum disorder (ASD) risk have not been studied in humans.

Objective: To evaluate whether parents being born preterm or low birth weight were associated with risks for ASD in their offspring.

Methods: We conducted a Danish population-based cohort study including mothers and fathers born since 1978 who also have had an offspring registered in Denmark during 1990-2013. Information on gestational age and birth weight were recorded in the …