Digital Commons Network^™

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 …

Consequences Of The Clean Water Act And The Demand For Water Quality, David A. Keiser, Joseph S. Shapiro

Cowles Foundation Discussion Papers

Since the 1972 U.S. Clean Water Act, government and industry have invested over $1 trillion to abate water pollution, or $100 per person-year. Over half of U.S. stream and river miles, however, still violate pollution standards. We use the most comprehensive set of files ever compiled on water pollution and its determinants, including 50 million pollution readings from 170,000 monitoring sites, to study water pollution’s trends, causes, and welfare consequences. We have three main findings. First, water pollution concentrations have fallen substantially since 1972, though were declining at faster rates before then. Second, the Clean Water Act’s grants to municipal …

Consequences Of The Clean Water Act And The Demand For Water Quality, David A. Keiser, Joseph S. Shapiro

Cowles Foundation Discussion Papers

Since the 1972 U.S. Clean Water Act, government and industry have invested over $1 trillion to abate water pollution, or $100 per person-year. Over half of U.S. stream and river miles, however, still violate pollution standards. We use the most comprehensive set of files ever compiled on water pollution and its determinants, including 50 million pollution readings from 240,000 monitoring sites and a network model of all U.S. rivers, to study water pollution’s trends, causes, and welfare consequences. We have three main findings. First, water pollution concentrations have fallen substantially. Between 1972 and 2001, for example, the share of waters …

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 …

Three Essays On The Theory Of Money And Financial Institutions Essay 3: The Economy With Innovation, Externalities And Context, Martin Shubik

Cowles Foundation Discussion Papers

This essay is the third of three. The first is nontechnical and in part autobiograhpical describing the evolution of my approach to developing a microeconomic theory of money and.financial institutions. The second essay was devoted to a more formal sketch of a closed economic exchange system with no other externalities beyond money and markets. This essay builds on the existence of monetary exchange but also context, and active government with nonsymmetric information and many externaties indicate that the views of Keynes, Hayek and Schumpeter are all consistent with the next stages of complexity as the logic requires many different arrays …

Engineering A Retinal Progenitor Cell Graft For Transplantation Studies In The Rd10 Mouse Model, Maryam Ghiassi

Yale Medicine Thesis Digital Library

In later stages of retinal degenerative diseases such as age-related macular degeneration (AMD) and retinitis pigmentosa stem cell therapy can be the only viable treatment option due to the loss of photoreceptor and RPE cells. Differentiation of embryonic stem cells (ESCs) towards the desired lineage explicitly requires a microenvironment that mimics the natural tissue that it is intended to regenerate. Developing a planar 3D retinal graft derived from ESCs can be transplanted to treat various retinal degeneration diseases. Our aim was to explore the differentiation and growth of ESCs on a gelatinous scaffold in order to transplant into a retinitis …

Bulletin Of Yale University School Of Nursing 2017-2018, Yale School Of Nursing

Yale School of Nursing Bulletins and Catalogues

Series 113, Number 15

September 5, 2017

Parental Factors Associated With The Request For Resuscitation For Infants Born At Periviability, Abiola Deborah Femi-Abodunde

Yale Medicine Thesis Digital Library

The purpose of this study is to determine factors associated with parental request for aggressive resuscitation for infants born at borderline viability, the period between 22 0/7 and 24 6/7 weeks of gestation. Between 2013 and 2016, 81 women were admitted to Yale New Haven Hospital (YNHH) for a potential delivery in this critical period. Eighty-four percent of patients elected aggressive resuscitation for their newborn and 16% chose comfort care only. Using bivariate analysis to evaluate statistical significance, 5 of 19 possible variables were included in our logistic regression model. This model demonstrated higher likelihood of a request for resuscitation …

Exploring The Role Of Dopamine Circuits In Eating Behavior, Kara Elizabeth Furman

Yale Medicine Thesis Digital Library

In its simplest terms, obesity is a disease of exaggerated food intake. While current treatment of obesity focuses on changing behavior, few successful models of behavior modification have been developed. Even those treatments that are successful in the short-term, have failed to demonstrate lasting effect. The problem of over-eating, then, needs to be studied in terms of basic motivational programs that are encoded by the brain’s reward system. Understanding the way in which reward system activity directs eating behavior will allow more sophisticated and efficacious treatment options in the future. Several studies have focused on the nucleus accumbens (NAc) as …

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 …

Small Estimated Placental Volume Predicts Low Birthweight, Kimberly Marie Murdaugh

Yale Medicine Thesis Digital Library

The objective of the study was to validate Estimated Placental Volume (EPV) in a

population of patients at Yale-New Haven Hospital (YNHH) across a range of gestational

ages, and to evaluate the association between small EPV and low birthweight (BW). From

2009 to 2011, 366 patients at YNHH received ultrasound scans between 11+0 to 38+6

weeks gestational age (GA) to measure placental dimensions from 2009 to 2011. EPVs were

calculated using a previously validated convex-concave shell equation. An EPV vs GA best

fit curve was generated. The relationship between EPV and BW was analyzed. Subgroup

analyses were performed to evaluate …

Insights On Fibrotic Diseases Using Single-Cell Analysis Methods, Azim Munivar

Yale Medicine Thesis Digital Library

Idiopathic pulmonary fibrosis is progressive, fatal lung disease with unclear mechanistic etiology and a dearth of treatment options. Transcriptional profiling has served a valuable tool in understanding the underlying perturbations in the lung tissues of patients and disease model systems, however whole tissue profiling obscures both the contribution of individual cells types in the diseased tissue as well as the contribution of non-fibrotic tissue surrounding the diseased tissue. The averaging effect confounds the ability to extract a strong disease signal and understand the cell-of-origin. Single-cell techniques have recently emerged that allow profiling of the transcriptomes of individual cells. In this …

The Application Of Small Molecule Inhibitors Of Ngr1 And Lpa1 Towards The Goal Of Neuroregeneration In The Central Nervous System, Hiam Naiditch

Yale Medicine Thesis Digital Library

Disorders affecting the CNS are significantly disabling and often carry a poor prognosis of functional recovery. Pharmacotherapies that promote functional improvement via neuroregeneration have proven to be an elusive goal. Factors intrinsic to the neuronal microenvironment, particularly myelin-associated proteins such as Nogo-A, MAG, and OMgp, have been shown to be important in inhibiting such regeneration through neuronal NgR1. Additionally, LPA signaling through LPA1 has also shown to be important in inhibiting neuroregeneration through mechanisms that are currently being researched.

It has been previously shown that application of a NgR1 decoy receptor (AA-NgR(310)ecto-Fc) increases sprouting below the site of the lesion …

Improving Provider Compliance With Adult Inflammatory Bowel Disease Patient Care Guidelines In The Ambulatory Setting Through The Use Of Electronic Health Records, Nana Bernasko

Yale School of Nursing Digital Theses

Electronic Health Record (EHR) systems have the ability to improve the quality of patient care, patient safety and provide benefits to providers and clinic practices. These systems can transform quality measurement and quality improvement methods, facilitate workflow, and track patients over time to ensure that they receive guideline-recommended, and evidence-based, care. Simply having an EHR system, however, may not be enough to improve the quality and safety of healthcare, especially if the system is not designed to include features specific to the treatment population. In terms of the complex care necessary to treat adult patients with inflammatory bowel disease (IBD), …

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).

Novel Application Of Untargeted Metabolomics To Diseases Of Neurosurgical Significance, Alex Yang Lu

Yale Medicine Thesis Digital Library

Metabolomics, an emerging technique to study hundreds of small-molecule metabolites simultaneously, has been seldom applied to diseases of neurosurgical significance. We utilized metabolomics to explore two distinct questions: 1. to identify global metabolic changes and metabolite predictors of long-term outcome in aneurysmal subarachnoid hemorrhage (SAH) patients, 2. to identify differential metabolites profiles of radiation necrosis vs. recurrent tumor of metastatic brain lesions post-Gamma Knife radiosurgery. The first study applied gas chromatography time-of-flight mass spectrometry (GC-TOF) to cerebrospinal fluid samples collected from 15 high-grade aSAH patients (modified Fisher grades 3 and 4). Analysis was performed at two time points; metabolite levels …

Racial Disparities In Renal Cell Carcinoma: A Single Payer Healthcare Experience, Abiodun Mafolasire

Yale Medicine Thesis Digital Library

Introduction: Significant racial disparities in survival for renal cell carcinoma (RCC) exist between whites and blacks. Differences in access to care and comorbidities are possible contributors. To investigate if racial disparities persist when controlling for access to care, we analyzed data from a single payer healthcare system.

Methods: As part of a case-control study within the Kaiser Permanente Northern California system, pathologic and clinical records were obtained for RCC cases (2,152 white, 293 black) diagnosed from 1998 to 2008. Patient demographics, comorbidities, tumor characteristics, and treatment status were compared between whites and blacks. Overall survival and disease specific survival (DSS) …

Concussion Biomarker Discovery For Prognosis In Adolescent Athletes (Compete) Pilot Study, Sean N. Mbachu

Yale Medicine Thesis Digital Library

Concussion management in the ED is inconsistent due to a lack of available empirical testing. This project aims to assess the feasibility of a large multi-centered study for concussion biomarker discovery in the ED.

This prospective cohort pilot and feasibility study was conducted in the adult and pediatric EDs of an urban, academic, Level 1 trauma center. Twelve patients with concussions and twelve age- and gender-matched control patients presenting within 6 hours of an injury sustained during recreational activity were enrolled. ED blood specimens were banked for future proteomic analysis. Clinical outcomes were collected via online survey. Patient recruitment strategies …

The Evolution Of Restraint In American Psychiatry, Danilo Alejandro Rojas-Velasquez

Yale Medicine Thesis Digital Library

History/Social Science:

The Evolution of Restraint in American Psychiatry

Author: Danilo Rojas-Velasquez

In psychiatry, restraint generally refers to direct methods such as mechanical restraints or the use of drugs. Despite psychiatrists’ best efforts to utilize restraint judiciously, many patients still view it as the field’s defining feature, especially on inpatient units with involuntary commitment, medications against will, and locked doors. This essay is an attempt to understand the pervasiveness of restraint in psychiatry. It uses changes in the practices of restraint to examine the growth of the field over time. To accomplish this, the paper identifies three distinct regimes of …

Predicting Response To Anti-Pd-1 Immunotherapy In Metastatic Melanoma, James William Smithy

Yale Medicine Thesis Digital Library

Predictive biomarkers for antibodies against programmed death 1 (PD-1) remain a major unmet need in metastatic melanoma. Thus, we evaluated three alternative tissue- and blood based markers biomarkers for response to anti-PD-1 therapy. First, pre-treatment melanoma samples were assayed for expression of: 1) IRF-1, a PD-L1 transcription factor, as a proxy for a tumor’s capacity to express PD-L1, and 2) an immune activation panel consisting of CD3, Ki67, and Granzyme B to distinguish immune-active and immune-quiescent tumors. Additionally, we conducted pilot studies to determine the feasibility of measuring soluble PD-L1 in the plasma of cancer patients.

For tissue-based assays, samples …

Data Assimilation For Initialization Of Seasonal Forecasts, Magdalena A. Balmaseda

Journal of Marine Research

This article reviews the requirements for a data assimilation system from the perspective of initializing seasonal forecasts. It provides a historical perspective of the developments in ocean data assimilation and ocean observing systems. It also discusses the differences between state estimation and initialization, and presents a brief assessment of different initialization strategies. The value of assimilating ocean data to estimate the ocean state and to initialize seasonal forecasts is demonstrated. However, it is also shown that the assumption of unbiased models in conventional data assimilation methods is not suitable for the production of long temporal records of ocean initial states. …

Medicine@Yale January/February 2017 Volume 13, 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.

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 …

Team-Based Care To Support Physiologic Birth: A Review Of Literature, Annemarie Heath

Yale School of Nursing Digital Theses

Abstract

Introduction: Physiologic birth practices support the normal processes of childbirth, are associated with improved outcomes, and can prevent unnecessary intervention. Defensive maternity practice contributes to the overuse of medical interventions and decrease in physiologic birth practices. Team-based maternity care has been studied as a method to improve safety through improved communication and teamwork skills. The purpose of this literature review was to explore whether team-based care can be used as a strategy to promote physiologic birth through decreasing defensive maternity practices.

Methods: The search engines OVID, CINAHL, Pub Med, Google Scholar and the Cochrane Library were used to identify …

Uv-Induced Somatic Mutations Elicit A Functional T Cell Response In The Yummer1.7 Mouse Melanoma Model, Jake Xiao Wang

Yale Medicine Thesis Digital Library

Human melanomas exhibit relatively high somatic mutation burden compared to other malignancies. These somatic mutations may produce neoantigens that are recognized by the immune system, leading to an anti-tumor response. By irradiating a parental mouse melanoma cell line carrying three driver mutations with UVB and expanding a single cell-derived clone, we generated a mutagenized model that exhibits high somatic mutation burden. When inoculated at low cell numbers in immunocompetent C57BL/6J mice, YUMMER1.7 (YUMM Exposed to Radiation) regresses after a brief period of growth. This regression phenotype is dependent on T cells as YUMMER1.7 tumors grow significantly faster in immunodeficient Rag1-/- …

Cooperative And Noncooperative Solutions, And The 'Game Within A Game', Martin Shubik, Michael R. Powers

Cowles Foundation Discussion Papers

In a previous essay, we developed a simple (in)efficiency measure for matrix games. We now address the difficulties encountered in assessing the usefulness and accuracy of such a measure.