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“I Didn't Want Them To Feel Like I Was Fragile”: A Qualitative Analysis Of Disability, Intimacy, And Sexual Culture At Yale, Mafalda Von Alvensleben

Public Health Theses

This thesis examines how Yale as an educational institutional shapes disabled students’ sexual and romantic lives. It explores the ways in which the institution's policies, culture, and physical environments influence these experiences via a qualitative and landscape analysis. The analysis was based off nine semi-structured interviews with students who self-identified as disabled from both undergraduate and graduate programs, as well as a landscape analysis that incorporates formal, journalistic style interviews with eleven Yale faculty, staff, and administrators. Taken together, this study illuminates the challenges posed by systemic ableism within the university's academic and social frameworks. It highlights the inadequacies of …

Exploring Out-Of-Distribution Behaviors In Machine Learning Systems, Yutaro Yamada

Yale Graduate School of Arts and Sciences Dissertations

This dissertation investigates the evolving nature of model generalization in machine learning, with a particular focus on out-of-distribution behavior. It begins by examining how feature selection identifies and discards non-generalizable features, then explores the robustness of ImageNet-based models under shifted data distributions and their transfer to downstream tasks. The discussion moves to Vision-Language Models, exposing a "concept association bias'' that stems from contrastive training and exploring why autoregressive methods can offer stronger relational understanding. It then discuss how 3D-based pre-training mitigates spurious background-object correlations, improving generalization. Finally, it examines Large Language Models' spatial reasoning abilities, both in 2D and 3D, …

Neurobiological Markers Of Risk For Psychopathology In Healthy Youth At Familial Risk For Depression, Bailey Holt-Gosselin

Yale Graduate School of Arts and Sciences Dissertations

Family history of depression is a robust predictor of early-onset depression (Elsayed, Fields et al. 2019, Ho, Shah et al. 2022) as well as other types of psychopathology (van Santvoort, Hosman et al. 2015, van Dijk, Murphy et al. 2021) among youth. Youth are at especially high risk when the family members with depression are their parents; youth whose parents have depression are at a 3- to 5-fold increased risk for developing depression themselves (Lieb, Isensee et al. 2002, Williamson, Birmaher et al. 2004). Prior work has indicated that risk may be conferred through alterations in neurodevelopment that precede the …

Risk Factors Of Glioma In Non-Hispanic White And Hispanic Children In California, Lixin Kang

Public Health Theses

Purpose: This study aimed to evaluate the risk of pediatric glioma in relation to multiple birth and parental characteristics as well as environmental exposures, in the overall California population and in racial and ethnic subgroups.

Methods: Leveraging a population-based linkage of statewide birth records and cancer registry data in California, we conducted a case-control study that included 3,244 cases who were born in California during 1982-2015 and diagnosed with first primary glioma at the age of 0-19 years during 1988-2015, and 162,200 controls who were born in California and frequency-matched to cases on year of birth. Odds ratios (OR) and …

Neighborhood Deprivation And Risk Of Readmission Among Young Patients With Ami: Insights From The Virgo Study, Xiaoya Sun

Public Health Theses

Background: Acute myocardial infarction (AMI) is a leading cause of deaths in women younger than 55 years old. However, current knowledge is limited on how neighborhood deprivation influences the risk of AMI readmission in this population. We evaluated the associations of area deprivation index (ADI) on the risk of readmission 1-year post-AMI in young adults with AMI. Methods: We use data from the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study- the largest study of young patients with AMI in the US. Neighborhood deprivation was assessed using an ADI score, which was calculated using …

Association Of Immune Checkpoint Inhibitor Approval On Suicide Rates Among Patients With Cancer: A Pre-Post Analysis With Seer, Rachel Wang

Public Health Theses

Objective: Patients with cancer are at elevated suicide risks compared to the general population, and patients diagnosed with advanced cancers have higher suicide risks compared to those diagnosed with early-staged cancers. Immune Checkpoint Inhibitors (ICIs) were initially approved to treat metastatic melanoma, non-small cell lung cancer (NSCLC), and renal cell carcinoma (RCC), and an unpublished study observed a decreased suicide risk in patients with these cancers at all stages. This study evaluates suicide risks in patients with breast, colorectal, liver, pancreatic, and prostate cancer, of which ICIs have limited effects on, to assess if the lower suicide rates observed previously …

Exploring The Factors Of Sleep Quality: An Integrated Analysis Of Data From Questionnaires And Environmental Sensor Data, Jiaqian Xu

Public Health Theses

Sleep quality plays a crucial role in human health, but its determinants remain incompletelyunderstood. This integrated analysis investigates the relationships of demographic characteristics, living habits, as well as psychological factors on sleep quality. It also ranks the importance of sleep discomfort and examines the effect of bedroom air quality on sleep quality. Results showed stress had a significant negative correlation (r = -0.66) with sleep quality. Furthermore, nocturnal bathroom usage was the most influential predictor, contributing approximately 17.5% to sleep quality ratings using random forest classification. Air quality measures, including carbon dioxide (CO2) levels, temperature, relative humidity, and particulate matter …

Bulletin Of Yale University School Of Nursing 2024-2025, Yale School Of Nursing

Yale School of Nursing Bulletins and Catalogues

Series 120, Number 16

September 5, 2024

Yale School Of Medicine Facts & Figures 2024-2025, 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.

Behavioral Outcomes In Patients With Metopic Craniosynostosis: Relationship With Radiographic Severity, Mariana Almeida

Yale Medicine Thesis Digital Library

Children with metopic nonsyndromic craniosynostosis have been found to have more neurocognitive and behavioral difficulties, when compared to other types of nonsyndromic craniosynostosis. These neurocognitive and behavioral difficulties can be apparent later in life even following surgical correction of the cranial dysmorphology at infancy. The factors that may be contributing to these difficulties have not been fully elucidated. In metopic craniosynostosis, radiographic severity can be measured using computed tomography imaging. Pre-operative radiographic severity has been demonstrated to be associated with worse reading abilities at school age. However, these studies have had limited sample sizes. Furthermore, the impact of radiographic severity …

Predictors Of Adverse Outcomes Following Surgical Intervention For Cervical Spondylotic Myelopathy, Samuel Craft

Yale Medicine Thesis Digital Library

As hospital costs associated with spine surgeries continue to climb, length of stay(LOS) and discharge disposition have been utilized as proxies through which these increasing costs can be assessed. Cervical spondylotic myelopathy (CSM) is the most common spinal pathology among older adults. As a result, studies assessing drivers of increased costs, LOS, and discharge disposition following surgery for CSM are needed. Two factors of interest are psychiatric comorbidities and safety net hospital (SNH) status. Psychiatric disorders are common and can have a profound impact on health, while SNHs serve a large proportion of patients with Medicaid or without insurance. However, …

Bringing Large Language Models To Ophthalmology: Domain-Specific Ontologies And Evidence Attribution, Aidan Gilson

Yale Medicine Thesis Digital Library

Background: In the landscape of medical innovation, Large Language Models (LLMs) represent a groundbreaking advancement, holding substantial promise for reshaping healthcare practices. These models demonstrate remarkable proficiency in assimilating and processing extensive medical literature, facilitating rapid information retrieval. Nevertheless, when applied to the specialized domain of ophthalmology, LLMs encounter significant hurdles owing to the intricacies inherent in this field. Ophthalmology, characterized by the intricate interplay of ocular anatomy, diverse disease manifestations, and nuanced diagnostic subtleties, poses considerable challenges for these generalized models. Compounding these challenges is the inherent limitation of the ophthalmological corpus itself, which remains notably narrower compared to …

Janus Kinase Inhibition In Granuloma Annulare: Two Single-Arm, Open-Label Clinical Trials, Erica Hwang

Yale Medicine Thesis Digital Library

Granuloma annulare (GA) is an inflammatory cutaneous granulomatous diseasethat lacks satisfying and effective targeted therapies. Janus kinase (JAK) inhibitors are of interest as they inhibit upregulated cytokines in GA including IFN-γ, IL-4, IL-13, IL-15, IL-21, and oncostatin M. Further investigation is needed to establish the safety profile, optimal route or formulation, and efficacy of JAK inhibitors for GA. We conducted single-arm, open-label clinical trials of abrocitinib, a JAK1-specific inhibitor, and AC- 1101, a topically applied JAK inhibitor, in patients with GA and hypothesized that each medication would be safe, tolerable, and effective at treating GA. In the first study, adult …

Population Attributable Fraction Of Reproductive Factors In Triple Negative Breast Cancer By Race, Rachel Jaber Chehayeb

Yale Medicine Thesis Digital Library

Age-adjusted incidence rates of triple negative breast cancer (TNBC) are higher in Black women than in non-Hispanic White (White) women. The disproportionate incidence of TNBC in Black women partially drives the 40% higher mortality rate from breast cancer in Black women compared to White women. Several studies have identified lack of breastfeeding and younger age at first birth as risk factors for TNBC. There are large differences in breastfeeding uptake, breastfeeding duration, and the distribution of age at first birth across racial groups in the US: only 44% of Black women breastfeed for 6 months or longer, compared to 60% …

Colonoscopy Withdrawal Time And Dysplasia Detection In Patients With Inflammatory Bowel Disease, Chandler Julianne Mcmillan

Yale Medicine Thesis Digital Library

Compared to the general population, patients with inflammatory bowel disease (IBD) are more at risk for developing colorectal dysplasia and neoplasia in their lifetime. Given this increased risk, current guidelines recommend that patients with IBD involving at least one-third of the colon undergo routine surveillance colonoscopy exams every one to five years to monitor disease activity and severity. Colonoscopy withdrawal time (CWT) is considered an important predictor of adenoma detection and a quality metric of colonoscopy within the general population. Society organizations including the American Society for Gastrointestinal Endoscopy and the American College of Gastroenterology have proposed a minimum average …

Regulation And Payment Of New Medical Technologies, Osman Waseem Moneer

Yale Medicine Thesis Digital Library

Our health care system should promote the development and useof innovative medical products, while simultaneously discouraging the marketing and adoption of unsafe or unnecessary products. In the United States, two federal agencies within the Department of Health and Human Services are responsible for administering policies directed toward these aims. The Food and Drug Administration (FDA) evaluates safety and effectiveness for market authorization of medical technologies while the Centers for Medicare & Medicaid Services (CMS) determines whether coverage is “reasonable and necessary” for its beneficiaries. Through a series of three investigations, this thesis evaluates federal policies for the regulation and payment …

Volumetric Assessment Of Imaging Response In The Pnoc Pediatric Glioma Clinical Trials, Divya Ramakrishnan

Yale Medicine Thesis Digital Library

Response assessment in neuro-oncology relies on radiographic assessment of tumor burden on magnetic resonance (MR) imaging. The most widely used criteria were developed by the Response Assessment in Neuro-Oncology (RANO) group. The RANO criteria rely on bidimensional (2D) measurements of tumor on MR images. The RANO criteria were originally developed to assess response in adult high-grade glioma. However, the heterogeneous appearance of pediatric low-grade gliomas make application of RANO criteria challenging. Volumetric assessment of pediatric gliomas may offer a more comprehensive method for characterizing response.

The goal of this thesis was to compare 2D and volumetric assessment methods in two …

Outcomes Following Hypofractionated Radiotherapy For Patients With Thoracic Tumors In Predominantly Central Locations, Alexander Sasse

Yale Medicine Thesis Digital Library

Hypofractionated radiation therapy (HFRT) is emerging as a preferred treatment for lung cancer patients ineligible for stereotactic body radiotherapy (SBRT). Normally, a standard-dose (SD-HFRT) hypofractionation regimen administers 60 Gy across 15 fractions, equating to a biologically effective dose (BED10) of 84.0, which is less than that of ablative SBRT. The first part of this thesis contrasts the clinical outcomes of patients receiving a high-dose (HD-HFRT) protocol, delivering 72 Gy in 18 fractions with a BED10 of 100.8, against those on SD-HFRT. Our research examines whether HD-HFRT enhances local control (LC) and overall survival (OS) rates while maintaining comparable rates of …

Health-Related Social Needs Before And After Critical Illness Among Medicare Beneficiaries, Tamar A. Kaminski

Yale Medicine Thesis Digital Library

Health-Related Social Needs (HRSNs), such as financial strain, food insecurity, social isolation, and transportation disadvantage, are unmet social needs associated with poor health outcomes and increased healthcare utilization. In qualitative work, survivors of the intensive care unit (ICU) report financial strain; however, little is known about food insecurity, social isolation, and transportation disadvantage after critical illness. The objectives of this study were twofold: (1) to ascertain changes in three HRSNs—food insecurity, social isolation, and transportation disadvantage—from the year before critical illness to the year following discharge among older adult survivors of critical illness, and (2) to evaluate demographic, pre-admission, and …

A Cost-Effectiveness Analysis Of Oropharyngeal Cancer Post-Treatment Surveillance Practices, Rema Shah

Yale Medicine Thesis Digital Library

Post-treatment surveillance imaging for oropharyngeal squamous cell carcinoma (OPSCC) is guided by the National Comprehensive Cancer Network (NCCN) and often is routinely performed beyond the suggested guidelines. With the advent of biomarker-based disease surveillance, there may be an alternative option that can reduce the cost-burden of post-treatment imaging for OPSCC. This study investigates the comparative cost-effectiveness of a hypothetical miRNA biomarker test for specifically HPV-negative (HPV-) OPSCC post-treatment surveillance and also investigates whether the extra imaging practices that are often employed for both HPV+ and HPV- OPSCC are truly cost-effective in order to inform evidence-based decision making after OPSCC treatment. …

Prevalence Of Metabolic Comorbidities And Viral Infections In Monoclonal Gammopathy, Mansen Yu

Yale Medicine Thesis Digital Library

Monoclonal gammopathy (MG) encompasses a spectrum of related diseases, with monoclonal gammopathy of undetermined significance (MGUS) being the most prevalent, serving as a precursor of smoldering and clinical multiple myeloma. While the association between gammopathies, metabolic conditions and antigenic stimulation has long been recognized, the precise mechanism remains unclear. Prior research has shown that a subset of MGUS and MM is driven by chronic antigenic stimulation of B cells by endogenous lipids and exogenous microbial antigens. The aim of this study is to assess the prevalence of metabolic comorbidities and viral infections in a large population with monoclonal gammopathy, providing …

Preoperative Psychosocial Risk Burden Among Patients Undergoing Major Thoracic And Abdominal Surgery, Emily Park

Yale Medicine Thesis Digital Library

Objective: Patient-related, biological risk factors such as age, diabetes, and smoking are associated with worse outcomes and increased postoperative complications rates in patients. However, not much is known about the effects of psychosocial risk factors on surgical outcomes. This study aimed to characterize the psychosocial risk burden in patients undergoing major surgery for malignant and benign conditions. Methods: A prospective, comprehensive psychosocial risk assessment of adult patients undergoing major thoracic or abdominal surgery within the Yale New Haven Health system was conducted from July 2023 to December 2023. The study was delivered over telephone, and was comprised of validated survey …

Association Between Fine Particulate Matter And Eczema: A Cross-Sectional Study Of The All Of Us Research Program And The Center For Air, Climate, And Energy Solutions, Gloria Chen

Yale Medicine Thesis Digital Library

A chronic inflammatory skin disease characterized by disruption of the epidermal barrier, eczema has increased in prevalence in tandem with industrialization. Ambient air pollution is a ubiquitous exposure resulting from industrial processes that includes fine particulate matter with aerodynamic diameter measuring less than 2.5 µm (PM2.5). Studies on the potential association between PM2.5 and eczema have produced conflicting results. The objective of this study was to determine the risk of eczema with exposure to PM2.5 in a diverse national cohort of American adults.

In this cross-sectional study, eczema cases were identified via electronic health records (EHR) in the All of …

Cerebral Arachnoid Cysts Are Radiographic Harbingers Of Epigenetics Defects In Neurodevelopment, Kedous Mekbib

Yale Medicine Thesis Digital Library

Cerebral arachnoid cysts (ACs) are the most common space-occupying lesion of thehuman brain but we know very little about its pathogenesis and association with other neurological phenotypes complicating clinical management.

To better understand AC pathogenesis and clinical presentation, we conducted wholeexomesequencing of 617 patient-parent trios, analysis of human brain and mouse meningeal single-cell RNA sequencing and natural language processing of patient medical records, the largest and only integrative genomic study of ACs to date.

We found seven genes: ADNP, ARID1B, KDM5C, PURA, FOXP1, MAP2K1 andSCN2A, had an exome-wide statistically significant burden of de novo variants. Our AC candidate genes were …

Illness Perception And The Impact Of A Definitive Diagnosis On Women With Ischemia And No Obstructive Coronary Artery Disease: A Qualitative Study, Leslie Yingzhijie Tseng

Yale Medicine Thesis Digital Library

Background: Ischemia and no obstructive coronary artery disease (INOCA) disproportionately impacts women, yet the underlying pathologies are often not distinguished, contributing to adverse health care experiences and poor quality of life. Coronary function testing at the time of invasive coronary angiography allows for improved diagnostic accuracy. Despite increased recognition of INOCA and expanding access to testing, data lack on first-person perspectives and the impact of receiving a diagnosis in women with INOCA.Methods: From 2020 to 2021, we conducted structured telephone interviews with 2 groups of women with INOCA who underwent invasive coronary angiography (n=29) at Yale New Haven Hospital, New …

Yale Medicine Magazine Autumn 2024, Issue 173, Yale University. School Of Medicine

Yale Medicine Magazine - alumni bulletin and magazine

This is the Autumn 2024 issue of Yale Medicine Magazine, issue 173. Prepared in cooperation with the alumni and development offices at the School of Medicine. Earlier volumes include Yale School of Medicine alumni bulletins, dating from v.1 (1953) through v.13 (1965), and Yale Medicine: alumni bulletin of the School of Medicine, v.1 (1965) through v. 52, no.1 (Autumn 2017).

Yale Medicine Magazine Spring 2024, Issue 172, Yale University. School Of Medicine

Yale Medicine Magazine - alumni bulletin and magazine

This is the Spring 2024 issue of Yale Medicine Magazine, issue 172. Prepared in cooperation with the alumni and development offices at the School of Medicine. Earlier volumes include Yale School of Medicine alumni bulletins, dating from v.1 (1953) through v.13 (1965), and Yale Medicine: alumni bulletin of the School of Medicine, v.1 (1965) through v. 52, no.1 (Autumn 2017).

The Struggle For Eudaemonia: The Eugenics Movement In Psychology And Community Resistance In Connecticut, Eve Galanis

Academic Articles

Throughout the twentieth century, the eugenics movement dominated medical discourses in the state of Connecticut. From deportations, coerced institutionalizations and sterilizations, to proposed executions of people with mental illness, eugenic policies were deployed in an attempt to control and direct populations. The state collaborated with academic institutions like Yale University, and agencies like The Eugenics Record Office at Cold Spring Harbor, to endorse pseudo-scientific techniques of surveilling and administering bodies across intersecting lines of race, ability, gender, sexuality, class, and citizenship status. This research examines the biopolitics of eugenics and the contest for economic, geographic, social, and ideological space. Using …

Whaling Logbooks: Colonial Knowledge Acquisition In The Pacific World, Aj Laird

Kaplan Senior Essay Prize for Use of Library Special Collections

Sometime in 1846, the cooper onboard the whaling bark Acushnet used the final pages of his sea journal to write up a list of the workers onboard the ship. The cooper, who was called Resolvid W. Bowles, appears ninth on his list, which he titled “Crew and Officers on Board Ship Acushnet Sailing from N.B. July 17th, 1845 - for the Pacific Ocean.” Bowles appears to have modeled this crew list off the official crew lists that were signed at the start of whaling voyages – a contract that both ensured the crew members’ share in profits from the whale …

My Identi T: Improving Mental Health Outcomes Through Group Support In Pre-Treatment Transgender Teens, Jill Day

Yale School of Nursing Digital Theses

Transgender youth (TGY) are at an increased risk for depression, anxiety, and suicidality; delaying transition can worsen this. Nationally, gender programs have waitlists beyond a year. In conservative states, providers are fewer in number, and legislation may prohibit services. Thus, gender programs rely on mental health and primary care providers to assist youth who express a strong desire to be a gender other than that assigned at birth, and who endure protracted wait times to start treatment. This DNP project developed and implemented an evidence-based, gender-affirming peer support group to improve patient experience and mental health outcomes by providing information …