Digital Commons Network^™

Traveler's Diarrhea? The Epidemiology Of Enterotoxigenic Escherichia Coli In Connecticut, 2019-2022, Nicole Bramlitt

Public Health Theses

Background: Enterotoxigenic Escherichia coli (ETEC) is known colloquially as “traveler’s diarrhea” in the United States. The state of Connecticut (CT) began collecting data about ETEC in 2019. As few clinical laboratories in CT routinely test for ETEC, it is likely that current detection and reporting methods, in conjunction with trends in healthcare-seeking behavior, only capture a small proportion of ETEC cases. Methods: Data were obtained from the CT Department of Public Health (DPH), the 2019 FoodNet Population Survey, and the 2020 US Census. The demographics of ETEC cases 2019-2022 and the 2020 CT population were compared. A multivariate analysis was …

Impact Of Sars-Cov-2 Variants On Vaccine Breakthrough Infections, Nicholas Francis Guagliardi Chen

Public Health Theses

SARS-CoV-2 variants of concern are defined by their increased intrinsic transmissibility and ability to evade immune recognition and neutralization, yet the relative importance of these factors in determining variant fitness in population settings is unclear. We hypothesize that as population level immunity has increased throughout the course of the pandemic, immune escape has played an increasingly important role in the emergence and sustained circulation of variants. Here, we use logistic regression models to estimate the odds of vaccine breakthrough infections for several major variants of concern in a population of Connecticut residents. We investigate the impact of immune escape on …

Scoping Review On Gonorrhea Vaccines, Linyang Li

Public Health Theses

Gonorrhea infection is caused by Neisseria gonorrhoeae and it is the second most common bacterial sexually transmitted infection around the globe. Although gonorrhea infection is treatable with antibiotics, the level of antimicrobial resistance continues to increase and has become a major public health concern. As options of available treatments are reduced by the emergence of AMR, it has become urgent to develop effective vaccines against gonorrhea infection. The purpose of this scoping review is to describe existing epidemiological evidence in support of gonorrhea vaccine development, to discuss the current vaccine candidates in clinical stages, and to evaluate the theoretical impact …

A Phylogeographic Analysis Of Sars-Cov-2 Variant Introduction, Kien Pham

Public Health Theses

The ongoing SARS-CoV-2 pandemic is marked by continuing emergence of novel Omicron variants. However, the mechanism with which these lineages establish themselves in new geographical areas remains an understudied subject. In this research, we utilized a discrete phylogeographical analysis framework on 19,608 SARS-CoV-2 sequences of the BA.5 Omicron lineages between February and June 2022, in order to better understand how the variant emerged in different regions of the United States. We found that the earliest BA.5 introductions came from Africa, befitting the origin of the lineage. Additionally, we discovered extensive domestic transmission between the Department of Health and Human Services …

Developing And Using Cholera Models In Northwest Syria, Emily Rose Tobik

Public Health Theses

Researchers have utilized transmission dynamic modeling to determine interactions between hosts and pathogens in many humanitarian settings. However, modeling for the cholera outbreak in Northwest Syria (NWS) has yet to be completed. This thesis presents a path towards cholera model building in NWS by investigating the current cholera outbreak, outlining how to create a compartmental model in this region given its complexities, and determining ways potential cholera models could be utilized in NWS. Intricacies involving the region's ongoing civil war, significant internally displaced persons (IDP) population, and the February 2023 earthquake add complexities to modeling in this region. For the …

Association Of Diurnal Temperature Range With Pediatric Influenza Hospitalization Rates In The United States, 2009 – 2019, Khang Duy Tran

Public Health Theses

Introduction: Climate change may have a negative impact on respiratory illnesses, such as influenza. Diurnal temperature range (DTR), an indicator of climate change, is the difference between the maximum and minimum temperature within a day or a week. As the climate warms, global DTR decreases, though there might be regions where DTR increases instead. Previous literature conducted in non-U.S. regions found both positive and negative associations between DTR and influenza infections. A group especially vulnerable to the effects of DTR are children less than 5 years of age due to their less-developed thermoregulation capability. This study thus aimed to explore …

Neurodivergent Transgender And Gender Diverse Youth And Young Adults’ Experiences Of Dual Minority Status In Healthcare Settings In Connecticut, Mac Reutter

Public Health Theses

Introduction The co-occurrence of gender diversity and neurodiversity has received increased attention in recent years. Clinical statistics suggest that transgender and gender diverse (TGD) individuals are more likely to be diagnosed with autism spectrum disorder than their cisgender counterparts, and that transgender and gender diverse neurodivergent (TGD-ND) individuals, particularly autistic individuals or those with ADHD, are at elevated risk of poor mental health outcomes compared to their neurotypical or cisgender counterparts. Thus, the TGD-ND population is both a notable proportion of the TGD population and a contingent of the population facing significant health disparities. A minority stress model is useful …

Associations Of Atopic Dermatitis With Neuropsychiatric Comorbidities, Ryan Fan

Yale Medicine Thesis Digital Library

There is incomplete understanding of the association of atopic dermatitis (AD) with neuropsychiatric disorders. This case-control study using the National Institutes of Health All of Us Research Program database aims to evaluate the odds of various neuropsychiatric conditions in patients with AD in a large, diverse cohort of adults in the United States. Comorbidities were compared between cases and controls using statistical hypothesis testing and odds ratios were generated using logistic regression in univariable and multivariable analyses.

In a cohort of 13,433 AD cases with 53,732 matched controls (4:1), patients with AD were more likely to have a diagnosis of …

The Impact Of Cannabidiol In Patients With Early Psychosis: A Randomized Controlled Trial, Sreeja Kodali

Yale Medicine Thesis Digital Library

We aimed to study the effects of cannabidiol (CBD) in out-patients with early psychosis on clinical metrics of psychosis and cognition and on psychophysiological electroencephalogram (EEG) metrics of psychosis. Adult outpatient subjects with a primary psychotic disorder within approximately five years of psychosis onset were enrolled in a four-week, two-period, randomized, placebo-controlled crossover trial (clinicaltrials.gov NCT02504151). Subjects were randomized in a one-to-one ratio to receive either CBD (oral 800 mg/day) or placebo in the first of two treatment periods in a randomized, double-blind manner. Primary outcome measures assessed were psychosis symptoms measured using the Positive and Negative Syndrome Scale (PANSS); …

Almajiri Health; A Scoping Review On Disease, Health Literacy And Space For Participatory Research, Muzzammil Imran Muhammad

Yale Medicine Thesis Digital Library

Introduction

Almajirai are male children who leave the care of their parents to learn the Qur’an and study Islam under the tutelage of a Mallam or Imam at a Tsangaya. Almajiranci refers to the system of education based on this relationship between almajiri and mallam, and which was the dominant mode of education in precolonial Hausaland – Northern Nigeria and Southern Niger. This system remains widespread and popular in both countries. In recent years, discourse around almajirai has featured prominently in media from and about this region, and has associated almajiranci with non-participation in formal education, abuse, poverty, and underdevelopment. …

Radiomics: A Methodological Guide And Its Applications To Acute Ischemic Stroke, Emily Avery

Yale Medicine Thesis Digital Library

The field of radiomics provides a quantitative approach to medical imaging, wherein a large number of features extracted from medical images are used to detect clinically relevant information that is invisible to the naked eye. This increasingly prevalentmethodology has facilitated improvements in the speed and efficacy of clinical decision-making across specialties. One area where radiomics can make a particular impact is acute stroke imaging. As “time is brain” in acute stroke triage, automated tools for patient evaluation have significant potential to improve outcomes by providing timely, objective data. The present work aimed to create radiomics models from admission CT angiographic …

Characterization Of Cutaneous Immune-Related Adverse Events Due To Immune Checkpoint Inhibitors, Annika Belzer

Yale Medicine Thesis Digital Library

Immune checkpoint inhibitors (ICI) have been associated with a multitude of immune-related adverse events (irAE), which affect multiple organ systems in the setting of increased immune activation. Cutaneous immune-related adverse events (cirAE) are among the most common irAE, occurring in up to 50% of patients treated with an ICI. The most common cirAE are maculopapular eruption, pruritus (with or without primary cutaneous eruption), lichenoid dermatitis, eczematous dermatitis, psoriasiform eruption, and vitiligo. cirAE are of concern to oncologists and dermatologists alike, as cirAE can necessitate interruption or discontinuation of life-prolonging therapy. There is a paucity of data regarding cirAE in specific …

Toll-Like Receptors 2/4 Directly Co-Stimulate Arginase-1 Induction Critical For Macrophage-Mediated Renal Tubule Regeneration, Natnael Beyene Doilicho

Yale Medicine Thesis Digital Library

Background: Following kidney injury, macrophages that have infiltrated the kidney undergo a transition from an initial proinflammatory state to a pro-reparative one characterized by the expression of arginase-1 (Arg 1), mannose receptor (Mrc1) and macrophage scavenger receptor-1 (Msr1). Granulocyte-macrophage colony-stimulating factor (GM-CSF) is an essential tubular-cell-derived determinant of the pro-reparative phenotype. However, it remains unclear what additional, if any, signals macrophages are integrating to maximally induce arginase-1.

Hypothesis: (1) The addition of cellular debris as a tubular cell cast mimetic will augment Arg1 expression in GM-CSF stimulated bone marrow derived macrophages; (2) Toll-like-receptors 2/4 transduce the debris signal from (1) …

Young Adults With Adhd And Their Involvement In Online Communities: A Qualitative Study, Callie Marie Ginapp

Yale Medicine Thesis Digital Library

Attention-deficit/hyperactivity disorder (ADHD) is a common condition that frequently persists into adulthood. Yet, diagnostic criteria for ADHD may not fully reflect how the condition presents in adults. Adults with ADHD have unmet needs and have been found to struggle with interpersonal relationships and stigma about their diagnoses. Online communities are frequently used by adults with ADHD and may be an avenue for building relationships and managing symptoms. We aimed to use qualitative methods to better understand the symptomatology of ADHD in young adults, how young adults with ADHD navigate relationships, the perceived impacts of ADHD online communities, and what adults …

Beta-Catenin Nuclear Transport In Wnt Signaling: Kap-Beta2/Transportin Mediates Nuclear Import Of Beta-Catenin Via A Py-Nls Motif In A Ran Gtpase Dependent Manner, Woong Y. Hwang

Yale Medicine Thesis Digital Library

Wnt signaling is essential for embryonic development and adult tissue homeostasis; mutations in Wnt pathway components are major drivers of multiple diseases especially cancer. β-catenin is a key effector in this pathway that translocates into the nucleus and activates Wnt responsive genes. However, due to our lack of understanding of β-catenin nuclear transport, therapeutic modulation of Wnt signaling has been challenging. Here, we took an unconventional approach to address this long-standing question by exploiting a heterologous model system, the budding yeast Saccharomyces cerevisiae, which contains a conserved nuclear transport machinery. In contrast to prior work, we demonstrate that β-catenin accumulates …

Examination For Independent Predictors Of Seasonality Of Birth Across Forty-Nine Low- And Middle-Income Countries: Analyses Of The United States Agency For International Development Demographic And Health Survey Data, Jehanzeb Kayani

Yale Medicine Thesis Digital Library

Although seasonal patterns in the distribution of live births have been well described across distinct populations for centuries, little is known about determinants of birth seasonality, particularly among low- and middle-income countries. Knowledge of determinants of birth seasonality may assist in the timely implementation and distribution of maternal and child health resources that may morbidity and mortality. In this study we examined for maternal and household sociodemographic determinants of birth seasonality in a sample of 3,260,238 live births across 49 nations that are included in the United States Agency for International Development Demographic and Health Survey Program. Our findings demonstrate …

Single-Cell Transcriptomic Atlas Reveals Molecular Drivers Of Human Inner Ear Development, Amar H. Sheth

Yale Medicine Thesis Digital Library

Introduction: Improving the therapeutic landscape for hearing loss necessitates an improved understanding of inner ear biology. Historically, our molecular understanding of inner ear physiology has lagged behind our knowledge of mechanistic understanding of signal transduction due to the rare, diverse, and fragile cell types of the inner ear. However, recent advances in high-throughput sequencing have allowed us to decode the molecular underpinnings of physiologic changes in the murine inner ear. Herein, we single-cell RNA sequence fetal tissue and present a comprehensive atlas of the developing human inner ear. Harnessing newer approaches in computational analysis, we delineate diversity of cell types …

Infectious And Hemorrhagic Hydrocephalus Share Molecular Mechanism Sensitive To Immune Modulation, Benjamin Reeves

Yale Medicine Thesis Digital Library

Hydrocephalus, characterized by a pathologic dilation of the brain’s cerebrospinal fluid (CSF)-filled ventricles, may either be primary or acquired. Acquired hydrocephalus, most often caused by ventricular infection or hemorrhage, is currently treated by surgical CSF diversion with either a shunt or endoscopic third ventriculostomy – two procedures plagued by high failure and complication rates. The lack of pharmaceutical treatments is in part due to the obscure pathophysiology of the disease. We created novel rat models of post-infectious (PIH) and post-hemorrhagic hydrocephalus (PHH) and conducted a systems-level, multi-omics investigation of these animals to outline the cellular, molecular, and physiologic pathology of …

The Synergy Between Physiologic Dendritic Cells And Mrna-Loaded Lipid Nanoparticles And Its Potential As A Cellular Immunotherapy, Brian Myles Wei

Yale Medicine Thesis Digital Library

Transimmunization (TI) is a dendritic cell (DC)-based immunotherapy derived from extracorporeal photochemotherapy (ECP), a widely used immunotherapy for cutaneous T cell lymphoma. TI builds upon the mechanistic understanding that ECP inducts large-scale monocyte-to-dendritic cell differentiation through physiologic platelet-monocyte interactions that occur during the passage of cells over a plastic plate. While TI and ECP have used apoptotic tumor cells treated with 8-methoxypsoralen (8-MOP) and ultraviolet-A (UVA) irradiation as the source of antigens by which to target its immunotherapeutic effects, there is investigational interest in alternative antigen sources, including mRNA-containing lipid nanoparticles (LNP). In this work, we developed a modified version …

Improving Delivery Of Immunomodulator Mpla With Biodegradable Nanoparticles, Jungsoo Chang

Yale Medicine Thesis Digital Library

Encapsulation of therapeutic agents within biodegradable nanoparticles (NP) allows for gradual drug release from the nanoparticle core. When injected intravenously, our nonadhesive NPs (NNP) have previously demonstrated longer circulatory time with “stealthy” features, thus allowing for prolonged drug exposure systemically. In the murine transplantable cutaneous squamous cell carcinoma (SCC) PDVC57 model, our bioadhesive NP (BNP) loaded with chemotherapy have shown increased retention of the active agent after intratumoral (i.t.) injection, thus allowing for prolonged drug exposure when locally delivered. Monophosphoryl lipid A (MPLA) is a low-toxicity derivative of LPS with immunomodulating properties. However, MPLA, like other TLR agonists, is a …

Bulletin Of Yale University School Of Nursing 2023-2024, Yale School Of Nursing

Yale School of Nursing Bulletins and Catalogues

Series 119, Number 16

September 5, 2023

Implementing A Prediabetes Screening Algorithm To Improve Identification And Referrals In Primary Care, Katherine Masoud

Yale School of Nursing Digital Theses

Almost half (49%) of the United States population has prediabetes or type 2 diabetes. Type 2 diabetes has many associated comorbidities and is the seventh leading cause of death in the United States. It is also the most expensive chronic condition in the nation. Identifying patients with prediabetes allows for early intervention to prevent or delay the onset of type 2 diabetes. The objective of this quality improvement project was to develop and implement a screening algorithm in the primary care setting using the Prediabetes Risk Test and point of care HemoglobinA1c testing to improve identification of patients with prediabetes …

A Mixed Methods Exploration Of Stigma, Discrimination, And Sleep Among Those On Medication For Opioid Use Disorder, Uzoji Nwanaji-Enwerem

Yale School of Nursing Digital Theses

Insomnia occurs in as many as 75% of people with Opioid Use Disorder (OUD). The prevalence of insomnia is attributable to concurrent factors such as mental health disorders, chronic pain, and medication use; however the contribution of social factors is not well understood. Persistent social factors and concerns within this population include stigma and discrimination. People who use prescribed medication for OUD (MOUD) report stigma and discrimination related to OUD, MOUD, and possibly other characteristics (e.g., race, gender, socioeconomic status, and incarceration history). However, the relationship between OUD-related stigma and discrimination with insomnia and between intersectional experiences, perceptions of stigma, …

“Am I Sick Or Just Discarded?”: Psychiatry, Health Care Reform, And The Rise Of Geriatrics In America, 1931-1954, Sophie E. Edelstein

Harvey M. Applebaum ’59 Award

Between 1931 and 1941, the United States population over the age of sixty-five increased by over 35 percent. These individuals, however, did not receive increased support. Rather, American politicians and society at large labeled the elderly a ‘burden,’ and passed off their care to the overworked medical personnel of state and federal mental institutions. Sparked by clinical exposure to the influx of elderly patients to mental institutions, Massachusetts psychiatrist David Rothschild identified an erroneous assumption in care practices for senile patients. In many cases, physicians preemptively diagnosed those admitted to state and federal institutions with some form of senile dementia, …

Harnessing Citizen Science And Collections Data For Invasive Plant Surveillance, Adin L. Ring

Library Map Prize

Our main source of information about the distribution of invasive plants in the United States comes from occurrence records in three categories: biological collections (physical plant specimens in museums), citizen science (opportunistic observations by untrained civilians), and invasion monitoring (structured observation by government or non-profit agencies). This study compiles a set of 3.1 million occurrence records of 3,578 introduced plant species in the continental United States, and infers spatial, temporal, and taxonomic biases by comparing the three categories of data. We find that citizen science contributes the largest bulk of records, and does better capturing visually conspicuous plants and very …

Perceptions Of Adults With Type 1 Diabetes About Diabetes Management And Exercise, Meera Swaminath

Public Health Theses

This study was conducted to understand participants’ experiences with diabetes management and relationships with exercise for a sample of adults (27-65 years old) with Type 1 diabetes living in the United States and identify potential technological features for a digital health tool supporting physical exercise and diabetes management. The sample consisted of 12 participants living across the nation. Participants were recruited online, through social media and healthcare system platforms. Participant data was collected in the form of surveys and interviews and analyzed using a constructivist framework and thematic analysis. Findings were collapsed into four major themes: 1) making exercise decisions …

Association Between Inflammatory And Metabolic Biomarkers And Lymphedema In Women With Ovarian Cancer, Kimberly Elizabeth Reinhart

Public Health Theses

Background: There is currently no cure for lymphedema, thus being able to predict who islikely to develop lymphedema will allow for early intervention. To date, no study has examined the association between metabolic and inflammatory biomarkers and lower limb lymphedema (LLL) in women with ovarian cancer. This secondary analysis seeks to explore the association between serum blood biomarkers and LLL in women with ovarian cancer and determine if the change in biomarkers over time is associated with a change in lymphedema status. Methods: Data from the Women’s Activity and Lifestyle Study in Connecticut (WALC), a 6- month exercise intervention randomized …

“To Live In The Body Of A Survivor ”: Unique And Cumulative Disaster Exposure And Mental Health In A Sample Of Hurricane Katrina Survivors, Noelle Serino

Public Health Theses

Introduction: Fueled by the escalation of climate change, weather-related disasters are increasing in frequency and severity. Existing research has documented the extensive harm induced by such disasters, yet few studies have examined how individuals’ psychological well-being fares when exposed to multiple, diverse threats, including other weather-related and public health disasters (e.g., COVID-19). As such, the present study explores posttraumatic and psychological distress in the context of unique and cumulative disaster exposure.Methods: The data utilized for this study came from the Resilience in Survivors of Katrina (RISK) Project. The sample was comprised of 381 predominantly Non-Hispanic Black (84.5%) women who experienced …

Detecting Disease-Related Changes In Intercellular Communications, Nating Wang

Public Health Theses

Diverse types of cells interact and communicate with each other to maintain tissue homeostasis and perform biological functions. Perturbations to these interactions can break the homeostasis of the tissue microenvironment, leading to disease. Understanding intercellular communication changes in disease is critical for therapeutic development. Cell-cell communication networks (CCCNs) inferred from single-cell RNA sequencing data are highly variable and only capture a snapshot of the dynamic intercellular communication system. We develop a graphical generative model to compare CCCNs between disease and control samples to identify disease associated perturbations to intercellular communications. The distribution of CCCNs is learned using variational graph autoencoder …

A Robust Bayesian Model Averaging Method For Basket Trials With Different Endpoints, Xueting Wang

Public Health Theses

Oncology drug research in the last few decades has been driven by the development of targeted agents. In the era of targeted therapies, basket trials are often used to test the antitumor activity of a novel treatment in multiple indications sharing the same genomic alteration. As patient population are further fragmented into biomarker-defined subgroups in basket trials, novel statistical methods are needed to facilitate cross-indication learning to improve the statistical power in basket trial design. Here we propose a robust Bayesian model averaging (rBMA) technique for the design and analysis of phase II basket trials. We consider the posterior distribution …