Digital Commons Network^™

An Anatomy Based Health Education Curriculum Taught By Medical Students May Improve High School Students Health Knowledge, Jason Knight

Yale Medicine Thesis Digital Library

To date, few high school based interventions have been shown to have lasting effects on adolescents' health behaviors. The need for health interventions targeting adolescents is underscored by data showing that several health behaviors with significant short and long term adverse effects begin in early adolescence and become progressively more prevalent toward late adolescence. This project tested the efficacy of a novel anatomy based health education curriculum at increasing health knowledge. The course was taught by first year Yale medical students. The curriculum placed emphasis on nutrition, physical activity and infectious disease. Forty Juniors from Career High School visited Yale's …

The Epidemiology And Clinical Presentation Of Leprosy In The Pediatric Population Of Paraguay, Jessica Anne Kattan

Yale Medicine Thesis Digital Library

Background: Several aspects concerning the biology and epidemiology of leprosy remain unknown. It has been recognized that the study of children with leprosy could provide important insight into unanswered questions, particularly if disease manifestations are carefully observed. Methods: A retrospective chart review of 308 cases of children aged 0-14 y/o was conducted at the Ministry of Health Leprosy Department in Asuncion, Paraguay. Data regarding age, gender, leprosy classification, transmission, detection, clinical presentation, presence and class of reaction, and disability were abstracted. Results: The study group ranged from 2 to 14 years of age. The incidence rate and the risk of …

The Effects Of Novel Design Strategies On The Risks And Benefits Of Phase I Oncology Trials, Shlomo Koyfman

Yale Medicine Thesis Digital Library

Considerable ethical debate surrounding the risks and benefits of Phase I oncology trials is based on older response and toxicity data that does not account for recent changes in the types of agents and trial design. This study aims to not only update these data, but to investigate the impact of novel trial designs on various clinical outcomes. We performed a review of the literature using the Medline database. Part I included nearly all phase I trials published in 2002. Part II identified phase I studies of cytotoxic agents alone, published from 2002 through 2004. 221 Phase I oncology studies, …

Differentiation Of Appendiceal Carcinoids By Marker Gene Expression, Igor Latic

Yale Medicine Thesis Digital Library

Objective: To utilize differential gene expression of candidate markers to discriminate benign APCs (APCs) from malignant and mixed cell APCs. Background Data: Considerable controversy exists in regard to the appropriate surgical management of APCs since standard clinical and immunohistochemical methods cannot reliably determine whether an APC is indolent or aggressive. We have identified five differentially expressed genes: nucleosome assembly protein 1-like 1 [NAP1L1]; melanoma antigen D2 [MAGE-D2]; metastasis-associated protein 1 [MTA1]; NAcht Leucine-rich-repeat Protein 1 [NALP1] and Chromogranin A [CgA] that define gut neuroendocrine (NE) Enterochromaffin (EC) cell behavior. We hypothesized that APC (APC) malignancy, also derived from EC cells, …

Dysregulation Of Sodium Channels In A Rat Model Of Absence Epilepsy, Davender Khera

Yale Medicine Thesis Digital Library

Absence epilepsy is a generalized form of epilepsy where spike-wave discharges (SWDs) involve both hemispheres of the brain and thereby alter consciousness. Recent evidence by Meeren et al (2002) in the WAG/Rij rat model of absence epilepsy points to a cortical focus of SWDs before rapid generalization of the SWDs. This focus belongs in the peri-oral area of the somatosensory cortex, and it was found to consistently lead SWDs in other cortical and subcortical areas. With this recent finding, it seems plausible that a defect lies in this focal region of the cortex, leading to SWD in the WAG/Rij model. …

Histone Acetylation And Expression Of Smn, The Spinal Muscular Atrophy Gene, Lauren Kernochan

Yale Medicine Thesis Digital Library

Spinal Muscular Atrophy (SMA) is an inherited neuromuscular disorder caused by mutation of the Survival Motor Neuron (SMN1) gene. Embryonic lethality is rescued by a nearly identical copy of the gene, SMN2, which exists in variable copy number and produces a small quantity of functional SMN protein. Because disease severity inversely correlates with SMN2 gene copy number and with SMN protein level, one therapeutic strategy has been to increase SMN2 expression. Previous investigators have demonstrated that SMN promoter activity, transcript, and SMN protein are increased in cells treated with histone deacetylase (HDAC) inhibitors, suggesting a role for histone acetylation in …

Uncovering The Role Of Stress In Craniosynosostosis, Justin Heller

Yale Medicine Thesis Digital Library

Craniosynostosis is the premature fusion of one or more of the cranial sutures resulting in skull deformity and possible brain dysfunction. It occurs in roughly 1 in 2,000 live births.1 It may be associated with syndromes or occur sporadically. Any cranial suture may be involved. The descriptions of the skull dysmorphologies have led to numerous hypotheses regarding the developmental trajectory of the synostosed skull, including the role of the cranial vault and cranial base. As proposed originally by Virchow (1851),2 the shape of the skull in craniosynostosis is usually attributed to a lack of local growth perpendicular to the fused …

Occipital White Matter Volumes Predict Visual Motor Outcome In Preterm Infants With Retinopathy Of Prematurity (Rop), Renu Chundru

Yale Medicine Thesis Digital Library

Although very low birth weight preterm (VLBW) infants with grade 3,4 retinopathy of prematurity (ROP) are at high risk for unfavorable visual outcomes, the middle school vision motor integration (VMI) skills and cognitive outcome scores of these children remain largely unknown. Data for 323 very VLBW survivors of the Multicenter Randomized Indomethacin IVH Prevention Trial (BW 600 1250 g) were analyzed to test the hypothesis that grades 3, 4 ROP would be an important predictor of cognitive and VMI skills. 3 subgroups were evaluated: ROP negative (N = 163), ROP grades 1,2 (N = 137) and ROP grades 3,4 (N …

The Effects Of Cyclic Strain On Rat Tail Tenocytes, Richard James Crockett

Yale Medicine Thesis Digital Library

The purpose of this study was to examine the effects of cyclic tension on the expression of hyaluronic acid, its receptor (CD44), and total glycosaminoglycan content in tendon fibroblasts. An in vitro model was used to analyze tenocytes from the tail tendons of rats. Tenocytes in the experimental group were exposed to cyclic mechanical stress, and using ELISA, western blot, and colormetric dye-binding assays, the effect of strain on cultured tenocytes was examined. Tenocytes exposed to mechanical strain produced 1528 ± 58 ng/mL (mean ± SEM) of hyaluronic acid, while those in a control environment produced only 730 ± 27 …

Macrophage Migration Inhibitory Factor Polymorphisms And Invasive Streptoccus Pneumoniae Infections, Sarah Beth Doernberg

Yale Medicine Thesis Digital Library

Streptococcus pneumoniae[italicized everytime] (S. pneumoniae) causes a spectrum of disease severity, and human host factors likely play a role in this variation. One candidate factor is macrophage migration inhibitory factor (MIF), a pro-inflammatory cytokine and upstream regulator of innate immunity. The MIF[italicized when not in parenthesis] promoter contains two functional polymorphisms, a tetranucleotide (CATT) repeat such that MIF expression increases with repeat number from 5-8 and a single nucleotide polymorphism (SNP) leading to a G-to-C transition, which results in increased MIF expression in cell line reporter assays. Emerging data suggest an association between high-expression MIF alleles and inflammatory disease. This …

Race/Ethnicity As A Moderator In Child And Adolescent Depression And Anxiety Trials, Natalie Guerrier

Yale Medicine Thesis Digital Library

The inclusion of racial/ethnic minorities in treatment outcomes trials for children and adolescents with depression and anxiety is essential, particularly given the assumption, required by the NIH, that racial diversity is important to the generalizability of clinical trial outcomes. A search for randomized clinical trials on the treatment of child and adolescent depression and anxiety was conducted using the Medline and Psychinfo databases. These were then reviewed to determine whether race or ethnicity were 1) factored into recruitment strategies; 2) represented in the trial sample; and 3) included in moderator analyses to determine the extent to which they may influence …

Trends In Usage Of Ct In The Early Detection And Diagnosis Of Adnexal Torsion, Juliana Capatosto

Yale Medicine Thesis Digital Library

Ovarian torsion (OT) is frequently considered in the differential diagnosis of women presenting to the ED with pelvic pain, but is a relatively uncommon occurrence. While ultrasound is considered the test of choice for OT, CT may be used as an initial imaging study with undifferentiated pelvic pain. The aim of this study was to determine the frequency of CT used in the diagnostic evaluation of women with proven OT. We hypothesized that all CTs of the pelvis in women with proven OT would be abnormal. This was a retrospective chart review from 500 bed urban teaching hospital. Patients were …

The Economic Impact Of Aids Treatment: Labor Supply In Western Kenya, Harsha Thirumurthy, Joshua Graff Zivin, Markus Goldstein

Discussion Papers

No abstract provided.

A Note On Fairness, Power, Property, And Behind The Veil, Martin Shubik

Cowles Foundation Discussion Papers

An Axiomatization for Power and for Equity differ only in the addition of a Behind the Veil Axiom.

Factors Surrounding And Influencing The Primary Disclosure In Child Sexual Abuse, Kira O'Neil Bona

Yale Medicine Thesis Digital Library

This study aimed to investigate the context within which children initially disclose their sexual abuse. The study sought to identify triggers that prompted the initial disclosure event, and to investigate the relationship between the choice of initial confidante and the childs age and likelihood of disclosing during formal interview. Data were obtained in a prospective fashion from 60 alleged child sexual abuse victims referred to the Yale Child Sexual Abuse Clinic (CSAC). Inclusion criteria required that a child must have disclosed to a confidante prior to referral to the Clinic; 57 of 60 children met this criterion and are included. …

C-Mpl Expression In Osteoclast Progenitors: A Novel Role For Thrombopoietin In Regulating Osteoclast Development, Calvin Langston Toure Barnes

Yale Medicine Thesis Digital Library

A new paradigm has evolved in which multiple regulatory interactions between the skeletal and hematopoietic systems have been identified. Previous studies have demonstrated that megakaryocytes (MK) play a dual role in skeletal homeostasis by stimulating osteoblast proliferation and simultaneously inhibiting osteoclast (OC) development. Here we identify a novel regulatory pathway in which the main MK growth factor, thrombopoietin (TPO), directly regulates osteoclastogenesis. To study the role of TPO in OC development, spleen or bone marrow (BM) cells (2x106 cells/ml) or BM macrophages (BMM, 1x105 cells/ml) from C57BL/6 mice , as a source of OC precursors, were cultured with M-CSF (30 …

Long-Term Mortality For Older Diabetics Hospitalized With Acute Myocardial Infarction, Marwah Abdalla

Yale Medicine Thesis Digital Library

Diabetics have higher mortality after myocardial infarction (MI), yet little is known regarding the impact of quality of care on long-term survival in older post-MI diabetics. Using data from the Cooperative Cardiovascular Project (CCP), a national cohort of 234,769 Medicare patients aged 65 or older hospitalized with confirmed AMI between 1994-1995, we assessed differences in 10-year mortality outcomes between diabetics and non-diabetics using Cox proportional regression. To account for quality of care, a composite measure among ideal candidates was constructed and entered into the final model adjusting for use of aspirin & beta-blocker on admission/discharge, angiotensin-converting enzyme inhibitors at discharge, …

Yale Medicine : Alumni Bulletin Of The School Of Medicine, Autumn 2006- Spring 2007, Yale University. School Of Medicine

Yale Medicine Magazine - alumni bulletin and magazine

This volume contains Yale medicine: alumni bulletin of the School of Medicine, v.41 (Autumn 2006-Spring 2007). 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).

Digitized with funding from the Arcadia fund, 2017.

Economic Development As Opportunity Equalization, John E. Roemer

Cowles Foundation Discussion Papers

The justification of using GNP per capita as a measure of economic development is utilitarian ethics plus an assumption that no needs are more urgent than others. Here, we advocate a measure of economic development based on the degree to which the society in question has equalized opportunities for the acquisition of income. In highly developed economies, inequality of opportunity accounts for less than 10% of total inequality, while in developing economies, it accounts for over 30%.

Confronting Sustainability: Forest Certification In Developing And Transitioning Countries, Benjamin Cashore, Fred Gale, Errol Meidinger, Deanna Newsom

Yale School of the Environment Publications Series

No abstract provided.

Does The Liberalization Of Trade Advance Gender Equality In Schooling And Health?, T. Paul Schultz

Discussion Papers

No abstract provided.

Molecular Classification And Prediction Of Metastatic Potential In Early Malignant Melanoma: Improvement Of Prognostic Accuracy By Quantitative In Situ Proteomic Analysis, Aaron J. Berger

Yale Medicine Thesis Digital Library

The incidence of cutaneous malignant melanoma continues to increase every year, and remains the leading cause of skin cancer death in industrialized countries. In spite of the aggressive nature of advanced melanoma, there are no standard biological assays in clinical usage that can predict metastasis. This may be due, in part, to the inadequacy of reproducible assessment of protein expression using traditional immunohistochemistry. This dissertation will discuss the use of tissue microarrays combined with quantitative in situ molecular analysis of protein expression to allow prediction of melanoma metastasis. Through the identification and validation of novel prognostic biomarkers, we seek to …

B Cells At The Interface Of Innate And Adaptive Immunity In Systemic Lupus Erythematosus: Requirements For The Activation Of Autoreactive B Cells In Autoimmune Disease, Sean Ryan Christensen

Yale Medicine Thesis Digital Library

Systemic autoimmune disease is characterized by loss of immunologic tolerance to a restricted set of self-nuclear antigens. These macromolecular complexes can be grouped into two categories: DNA-containing autoantigens such as chromatin, and RNA containing autoantigens such as Smith antigen (Sm) and related ribonucleoprotein complexes. Elucidating the mechanism for selective targeting of these molecules in systemic lupus erythematosus (SLE) may provide clues to the etiology of disease. We hypothesized that Toll-like receptors (TLRs), germline-encoded pattern-recognition receptors of the innate immune system, could dictate target antigen specificity in SLE. Using genetic ablation of various TLRs in murine models of SLE, we have …

Gene Modification With Triplex-Forming Oligonucleotides, Jennifer Melissa Kalish

Yale Medicine Thesis Digital Library

No abstract provided.

Constraining Bubble Dynamics And Mixing With Dissolved Gases: Implications For Productivity Measurements By Oxygen Mass Balance, Roberta C. Hamme, Steven R. Emerson

Journal of Marine Research

We used a dynamic mixed layer model to determine carbon export by the oxygen mass balance method from a time series of O₂/Ar, N₂/Ar and Ne measurements collected at station ALOHA near Hawaii from July 2000 to June 2001. The inert gas measurements constrain the flux of oxygen into the mixed layer from small, collapsing bubbles (injection) to be greater than or equal to the flux from larger bubbles (exchange), with mean estimates of the ratio in the range of 1–2. We also show that monthly observations of temperature and inert gases cannot constrain the rate …

Generalized Inversion Of The Gent-Cane Model Of The Tropical Pacific With Tropical Atmosphere-Ocean (Tao) Data, A. F. Bennett, B. S. Chua, H. E. Ngodock, D. E. Harrison, M. J. Mcphaden

Journal of Marine Research

We here describe the results of our latest effort to reanalyze TAO monthly mean surface and subsurface temperature observations constrained by a tropical Pacific ocean model, and simultaneously to evaluate the physical consistency of the observations and the model. Both tasks are executed by weak–constraint, four–dimensional variational assimilation of the observations into the model. In this study our reanalysis employs the reduced–gravity Gent–Cane model, combined with the 'KPP–interior' parameterization of vertical turbulent fluxes. With the limited vertical resolution adopted in previous studies of this model, the 'W4DVAR' or inverse method fails to produce an acceptable reanalysis, as the dynamical residuals …

Shear And Turbulence Production Across Subtidal Channels, David K. Ralston, Mark T. Stacey

Journal of Marine Research

In intertidal regions with subtidal channels, effects of bathymetry on overlying flow vary greatly with tidal stage. Around low water when mudflats and marsh are exposed, flow is constrained to channels, but when water depths are greater, tidal forcing may not necessarily be aligned with meandering channel axes. Flow across the channel can generate strong shear and turbulence at the elevation of the channel banks and can significantly increase turbulent energy in the middle of the water column. Field observations in a mudflat channel of San Francisco Bay indicate that cross-channel shear regularly occurs there early in ebb tides. With …

Physical-Biological Interactions And Their Effect On Phytoplankton Blooms In Fjords And Near-Coastal Waters, Lars Erik Holmedal, Torbjørn Utnes

Journal of Marine Research

A one-dimensional flow model which accounts for turbulence and stratification in the upper ocean has been applied in conjunction with a one-dimensional production-advection-diffusion model to predict the initial evolution of the phytoplankton biomass concentration under given biological and physical conditions. Here the stratification is caused by the salinity which is modeled by a one-dimensional diffusion equation; the density is related to the salinity by a linear relation (state equation). The resulting one-dimensional model has been applied to investigate how local physical conditions affect the initiation of phytoplankton blooms in nutrition rich waters characterized by wind driven currents and salinity stratification. …

An Estuarine Box Model Of Freshwater Delivery To The Coastal Ocean For Use In Climate Models, Richard W. Garvine, Michael M. Whitney

Journal of Marine Research

Present day climate models employ a coarse horizontal grid that is unable to fully resolve estuaries or continental shelves. The importation of fresh water from rivers is critical to the state of deep ocean stratification, but currently the processing of that fresh water as it passes from the river through the estuary and adjacent shelf is not represented in the coastal boundary conditions of climate models. An efficient way to represent this input of fresh water to the deep ocean would be to treat the estuary and shelf domains as two coupled box models with river water input to the …

On The Mechanism Of Centennial Thermohaline Oscillations, Florian Sévellec, Thierry Huck, Mahdi Ben Jelloul

Journal of Marine Research

Centennial oscillations of the ocean thermohaline circulation are studied in a 2-D latitude-depth model under mixed boundary conditions (i.e. restoring surface temperature and prescribed freshwater flux). The oscillations are revealed through linear stability analysis of a steady state obtained in a single hemisphere configuration. A density variance budget is performed and helps determine the physical processes sustaining these oscillations: the restoring surface temperature appears as a source of density variance – this is a consequence of positively-correlated temperature and salinity anomalies. A minimal model, the Howard-Malkus loop oscillator, enables us to understand physically the oscillatory and growth mechanisms. The centennial …