Digital Commons Network^™

Compromised Glutathione And Ascorbate Capacities Under Prenatal Alcohol Exposure, And Its Implications For Vulnerable Subpopulations, Reagan Strand

Public Health Theses

Prenatal alcohol exposure (PAE) remains the leading preventable cause of lifelong neurodevelopmental impairment, yet the biological mechanisms underlying differential susceptibility remain poorly understood. The populations most vulnerable to PAE overlap substantially with those bearing the greatest burden of antioxidant insufficiency, including individuals experiencing food insecurity, environmental pollutant exposures, and alcohol use disorder, yet this convergence and its developmental consequences remain poorly characterized. This thesis investigates how dual antioxidant deficiency in both the dam and offspring modulates vulnerability to PAE using a compound heterozygous mouse model (GclmHET/GuloHET) that recapitulates reductions in antioxidants glutathione (GSH) and ascorbic acid (AA, or Vitamin C) …

Effectiveness Of The Release Of Wmel Wolbachia-Infected Aedes Aegypti Mosquitoes On The Incidence Of Chikungunya In Campo Grande, Brazil, Vivienne Zhong Ying Su

Public Health Theses

Chikungunya is a mosquito-borne arboviral disease primarily transmitted by Aedes aegypti and Aedes albopictus that is rapidly emerging in new geographical settings because of climate change, viral adaptation, and globalization. Brazil has experienced the significant expansion of chikungunya over the past decade and has adopted novel vector control interventions, including Wolbachia-based population replacement, as part of its public health response. While the effectiveness of wMel Wolbachia on dengue incidence has been demonstrated across multiple settings, evidence on its effect on chikungunya risk remains limited. Large-scale releases of wMel-infected Aedes aegypti mosquitoes were implemented in the city of Campo Grande, Brazil …

Modeling Pfoa And Pfos Infant Intake Through Breast Milk And Formula In The United States, Ka Hei Tang

Public Health Theses

Background: Per- and polyfluoroalkyl substances (PFAS), including PFOA and PFOS, may reach infants through breast milk and water used to reconstitute infant formula. However, current U.S. evidence is limited, and the absence of nationally representative breast milk PFAS data constrained estimation of early-life infant exposures.Methods: This thesis developed a state-level exposure modeling framework to estimate daily infant PFOA and PFOS intake across U.S. states at 3 and 6 months of age. Modeled intake included two feeding pathways, breast milk and formula-reconstitution water, using national maternal serum PFAS concentrations, state-level public drinking water PFAS concentrations, and infant feeding distributions. A total …

Redefining Hospital-Acquired Rsv: Epidemiologic Burden And Probabilistic Classification In A Large Health System, Anna Trinh

Public Health Theses

Healthcare acquired respiratory syncytial virus (HA RSV) is an important but under recognized infection in adult patients. Current surveillance definitions classify RSV as healthcare acquired when a positive test occurs ≥48–72 hours after admission, despite a broad incubation period of 2–8 days which would allow community acquired infections to present several days into hospitalization. This thesis has two aims: (1) to describe the epidemiology of adult HA RSV cases in the Yale New Haven Health System (YNHHS) from 2021–2025, and (2) to develop an incubation period-based probabilistic model to assess the plausibility of each HA RSV classification. Among 2,905 laboratory-confirmed …

From Genomic Surveillance To Vaccine Efficacy: Assessing The Impact Of Plasmodium Falciparum Rh5 Genetic Diversity On Blood-Stage Malaria Vaccine Performance, Xinyan Wei

Public Health Theses

Malaria remains a major public health burden in sub-Saharan Africa. The development and deployment of effective malaria vaccines is a priority for reducing disease burden and severe outcomes. The protective immunity generated by current malaria vaccines declines over time, requiring booster doses to sustain efficacy. Consequently, next-generation malaria vaccines are under development, including a blood-stage vaccine targeting reticulocyte-binding protein homolog 5 (RH5), the most advanced candidate in clinical development. This study investigates whether genetic diversity in PfRH5 may influence vaccine efficacy using amplicon sequencing and bioinformatic analyses across three complementary approaches. Firstly, this study characterizes PfRH5 genetic diversity across multiple …

Physical Therapy And Length Of Inpatient Stay In Relation To Neuropsychological Functioning Among Childhood Cancer Survivors: A Retrospective Cohort Study From The Heros Registry, Jingyi Zhang

Public Health Theses

Background: As 5-year survival after childhood cancer exceeds 85%, neuropsychological late effects have emerged as a key issue. Despite this, the impact of modifiable risk factors during cancer treatment on subsequent neuropsychological outcomes remains obscure. This study aimed to evaluate whether physical therapy (PT) and length of inpatient stay are associated with later neurocognitive, emotional, and behavioral outcomes in childhood cancer survivors (CCS).Methods: This study included 92 CCS who had available electronic health records (EHR) for cancer treatment and completed a neuropsychological evaluation 0–5 years after their treatment end date. Information on PT and length of inpatient stay (i.e., the …

Asymptomatic Tb Duration And Transmission Models, Zhichao Zhou

Public Health Theses

Tuberculosis (TB) transmission is sustained in part by asymptomatic disease states that limit the effectiveness of passive case finding interventions that rely on symptom-based diagnosis. Here we develop a transmission model that represents the duration of asymptomatic disease with a gamma-distributed waiting time. By chaining multiple asymptomatic sub-states, we find that the gamma-distributed model provides a better fit to the observed distribution of the duration of asymptomatic disease than a simple one-state model which imposes an assumption of an exponentially-distributed duration of asymptomatic disease. Comparing the fitted gamma-distributed model and the simple model, we quantify how assumptions about the distribution …

Fresh Vs Frozen In Vitro Fertilization Treatment Rules In Multicenter Trials: Machine Learning Under Heterogeneity, Yining Zhou

Public Health Theses

Fresh versus frozen embryo transfer does not have a single answer across all IVF populations, which raises the possibility of individualized treatment selection. This thesis examined whether baseline patient characteristics could be used to develop individualized treatment rules for fresh versus frozen embryo transfer using pooled multicenter randomized trial data.

The analysis used individual-level data from four randomized controlled IVF trials conducted in China, with live birth as the primary outcome. Two primary models were evaluated: a prespecified clinically informed logistic regression model with selected spline terms and treatment interactions, and a neural-network S-learner. Performance was assessed using internal-external cross-validation, …

Gender Gaps And Economic Growth: Why Haven't Women Won Globally (Yet)?, Patrick Agte, Orazio Attanasio, Pinelopi K. Goldberg, Charles Gottlieb, Aishwarya Lakshmi Ratan, Rohini Pande, Michael Peters, Charity Troyer Moore, Fabrizio Zilibotti

Discussion Papers

Globally women’s labor force participation lags that of men and women, on average, have lower labor market earnings than men. Does economic growth reduce gender disparities in labor market outcomes between women and men? Conversely, do gender inequalities in the labor market impede growth? To inform these questions, we conduct two analyses. First, we estimate regressions using harmonized data on gender gaps in a range of labor market outcomes from 153 countries spanning two decades (1998-2018). Second, we conduct a systematic review of the recent economics literature on gender gaps in labor markets, examining 16 journals over 21 years. Our …

Marriage, Labor Supply And The Dynamics Of The Social Safety Net, Hamish Low, Costas Meghir, Luigi Pistaferri, Alessandra Voena

Cowles Foundation Discussion Papers

The 1996 US welfare reform introduced time limits on welfare receipt. We use quasi-experimental evidence and a rich life-cycle model to understand the impact of time limits on different margins of behavior and well-being. We stress the impact of marital status and marital transitions on mitigating the cost and impact of time limits. Time limits cause women to defer claiming in anticipation of future needs and to work more, effects that depend on the probabilities of marriage and divorce. They also cause an increase in employment among single mothers and reduce divorce, but their introduction costs women 0.7% of lifetime …

Performing "Manly" Worship Music: Gender And Timbre At Mars Hill Church, Maren Haynes Marchesini

Yale Journal of Music & Religion

Ten years ago, Mars Hill boasted fifteen campuses and 15,000 members. Amid mounting allegations of abuse and mismanagement leveled against founding pastor Mark Driscoll, the church famously collapsed, closing its doors at the end of 2014. Driscoll had built Mars Hill’s core brand around his opposition to the perceived feminization of the Christian mainstream, and appointing himself the “leader of a heterosexual male backlash” in the church and broader culture. While Driscoll’s muscular Christianity stands in a wide historical stream, Mars Hill long led the charge in establishing a youth-oriented, hipster brand of hypermasculine Calvinism. And while rhetoric and theology …

Ethnic Disparities In Thoracic Aortic Dissection And Rupture: A Retrospective Analysis Of Hispanic And Non-Hispanic White Populations, Manuel Gutierrez

Yale School of Medicine Physician Associate Program Theses

Background: Aortic dissections and ruptures are even more strongly life-threatening events for patients who are unable to access care promptly. A dissection can reach 50% mortality rate within 24 hours, and a rupture may exceed 90%. Risk factors such as hypertension, genetics, and age play a role in the development of these events; however, few studies have explored whether marginalized groups, such as Hispanics, experience aortic events more frequently. The primary objective of this investigation is to determine whether there is a difference in the frequency of thoracic aortic dissections or ruptures driven by ethnicity in patients from the Yale …

The Effect Of Education Policy On Crime: An Intergenerational Perspective, Ulrika Ahrsjö, Costas Meghir, Mårten Palme, Marieke Schnabel

Cowles Foundation Discussion Papers

We examine the intergenerational effect of education policy on crime. Using administrative data that links outcomes across generations with crime records, we show that the Swedish comprehensive school reform, gradually implemented between 1949 and 1962, reduced conviction rates for both the generation directly affected by the reform and their sons. The reduction in conviction rates occurred in several types of crime. Mediation analysis suggests that key channels include increased parental educational attainment and household income, as well as reduced criminal behavior among fathers.

Decomposing Trends In The Gender Gap For Highly Educated Workers, Joseph G. Altonji, John Eric Humphries, Yagmur Yuksel, Ling Zhong

Cowles Foundation Discussion Papers

This paper examines the gender gap in log earnings among full-time, college-educated workers born between 1931 and 1984. Using data from the National Survey of College Graduates and other sources, we decompose the gender earnings gap across birth cohorts into three components: (i) gender differences in the relative returns to undergraduate and graduate fields, (ii) gender-specific trends in undergraduate field, graduate degree attainment, and graduate field, and (iii) a cohortspecific “residual component” that shifts the gender gap uniformly across all college graduates. We have three main findings. First, when holding the relative returns to fields constant, changes in fields of …

A Stairway To Success: How Parenting Shapes Culture And Social Stratification, Francesco Agostinelli, Matthias Doepke, Giuseppe Sorrenti, Fabrizio Zilibotti

Cowles Foundation Discussion Papers

This chapter argues that parenting choices are a central force in the joint evolution of culture and economic outcomes. We present a framework in which parents-motivated by both their children’s future success and their own normative beliefs-choose parenting styles and transmit cultural traits responding to economic incentives. Values such as work ethic, patience, and religiosity are more likely to be instilled when their anticipated returns, economic or otherwise, are high. The interaction between parenting and economic conditions gives rise to endogenous cultural and economic stratification. We extend the model to include residential sorting and social interactions, showing how neighborhood choice …

Quantile-Optimal Policy Learning Under Unmeasured Confounding, Zhongren Chen, Siyu Chen, Zhengling Qi, Xiaohong Chen, Zhuoran Yang

Cowles Foundation Discussion Papers

We study quantile-optimal policy learning where the goal is to find a policy whose reward distribution has the largest α-quantile for some α P p0, 1q. We focus on the offline setting whose generating process involves unobserved confounders. Such a problem suffers from three main challenges: (i) nonlinearity of the quantile objective as a functional of the reward distribution, (ii) unobserved confounding issue, and (iii) insufficient coverage of the offline dataset. To address these challenges, we propose a suite of causal-assisted policy learning methods that provably enjoy strong theoretical guarantees under mild conditions. In particular, to address (i) and (ii), …

Towards Multi-Modal Multi-Document Understanding Capabilities In Foundation Models, Chuhan Li

Computer Science Theses

Contemporary foundation models are predominantly evaluated on isolated documentor image-understanding tasks, thereby overlooking the inherent multimodal multi-document reasoning that characterizes scientific inquiry. To bridge this gap, M3SCIQA is introduced, aMulti-Modal,Multi-document Scientific Question Answering benchmark crafted to test foundation models in practical scientific research settings. A comprehensive evaluation of 18 leading foundation models shows a substantial performance gap between models and human experts. Detailed error analysis reveals persistent deficiencies in both scientific visual reasoning tasks and long-range retrieval. Addressing the former, SPACECUE offers a concise yet effective visual prompting that overlays grid coordinates and Semantic-SAM masks …

B-Spline Representations For Hyperspectral Inverse Rendering, Rachel Liang

Computer Science Theses

This work explores the use of a B-spline-based approach for hyperspectral inverse rendering from RGB images, experimenting on both spectral and geometric reconstruction. While the B-spline method is less accurate than brute-force optimization, it offers significant improvements in computational efficiency- reducing both runtime and memory usage.

Our experiments show that the B-spline representation can approximate smooth spectral data effectively but struggles with sharper spectral features unless more knots are introduced. Notably, wavelengths near the edges of the visible spectrum (around 400 nm and 700 nm) were less stable during optimization, reflecting lower convergence reliability. Despite these challenges, the final RGB …

Gene X Environment Interactions: Polygenic Scores And The Impact Of A Early Childhood Intervention In Colombia, Orazio Attanasio, Gabriella Conti, Pamela Jervis, Costas Meghir, Aysu Okbay

Discussion Papers

We evaluate impacts heterogeneity of an Early Childhood Intervention, with respect to the Educational Attainment Polygenic Score (EA4 PGS) constructed from DNA data based on GWAS weights from a European population. We find that the EA4 PGS is predictive of several measures of child development, mother’s IQ and, to some extent, educational attainment. We also show that the impacts of the intervention are significantly greater in children with low PGS, to the point that the intervention eliminates the initial genetic disadvantage. Lastly, we find that children with high PGS attract more parental stimulation; however, the latter increases more strongly in …

The Movement Ecology, Ranging Patterns, And Territoriality Of Azara’S Owl Monkeys (Aotus Azarae) In The Argentinean Chaco Forest, Jeremy D. Pustilnik

Master of Environmental Science Theses

Azara’s owl monkeys (Aotus azarae) are small, pair-living, socially monogamous primates that inhabit the Chaco Forest of South America. Their activity and life history patterns have been particularly well studied, however, their movement ecology and ranging patterns within their home ranges remains largely unknown. Herein I descriptively analyze these patterns with respect to time, space, ambient environment, and physical environment using spatial information on five owl monkey groups that were followed over the course of a year between 1998 and 1999 at a multi-decade-operating field site near Formosa, Argentina. Analysis of distance and speed moved during different diel …

Reclaiming The Body: A Womanist Bioethics Approach To Christian Authoritarianism, Laron Bryant Dowdell

Yale Divinity School Theses

This paper uses womanist bioethics as a theoretical lens to explore how authoritarian leadership practices violate Black women's well-being and autonomy. Womanist bioethics uniquely centers Black women's lived experiences, integrating spiritual, historical, and social dimensions of justice that mainstream bioethics often ignores. The womanist bioethics framework is applied to critique religious authoritarianism and to propose alternative leadership models rooted in shared leadership and communal accountability. The discussion unfolds in four parts: (1) how womanist bioethics critiques the bodily and moral harm authoritarian leadership inflicts on Black women, (2) testimonials of Black women who resisted high-control church systems, (3) an exploration …

Yale Medicine Magazine Spring 2025, Issue 174, Yale University. School Of Medicine

Yale Medicine Magazine - alumni bulletin and magazine

This is the Spring 2025 issue of Yale Medicine Magazine, issue 174. 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) and Yale Medicine: alumni bulletin of the School of Medicine, v.1 (1965) through v. 52, no.1. (Autumn 2017).

The Effect Of Education Policy On Crime: An Intergenerational Perspective, Ulrika Ahrsjö, Costas Meghir, Mårten Palme, Marieke Schnabel

Cowles Foundation Discussion Papers

We study the intergenerational effect of education policy on crime. We use Swedish administrative data that links outcomes across generations with crime records, and we show that the comprehensive school reform, gradually implemented between 1949 and 1962, reduced conviction rates both for the generation directly affected by the reform and for their sons. The reduction in conviction rates occurred in many types of crime. The key mediators of this reduction in child generation are an increase in education and household income and a decrease in crime among their fathers.

Persistent Symptoms In Endoscopic Remission: Social Determinants & Non-Medical Interventions In Inflammatory Bowel Diseases, Hang Phuong Nguyen

Yale Medicine Thesis Digital Library

Inflammatory Bowel Diseases (IBD) are chronic gastrointestinal disorders, namely Crohn's disease (CD) and ulcerative colitis (UC), affecting ~1.6 million people in the U.S. Gastrointestinal (GI) symptoms such as abdominal pain, diarrhea, and rectal bleeding may persist even when endoscopic and histologic findings appear normal (i.e., endoscopic-histologic remission). However, the prevalence of GI symptoms despite endoscopic-histologic mucosal healing remains unclear. Additionally, there is limited research on the impact of non-clinical factors, such as social determinants of health (SDOH), on persistent GI symptoms in patients with endoscopic remission. SDOH refers to conditions in environments—including, but not limited to, housing, transportation, neighborhoods, income, …

Website Accessibility Of Largest Health Insurers In Medicare Advantage Market, Alicia Stephan

Yale Medicine Thesis Digital Library

Website accessibility is essential to ensure equitable healthcare access, especially for individuals with disabilities. This study evaluated the accessibility of health insurance websites for the ten largest Medicare Advantage insurers by market share. Using three free, publicly available automated accessibility checkers—WAVE, Axe-Core, and Skilltide—we systematically identified five URLs per insurer based on specific webpage keywords. These tools adhere to the Web Content Accessibility Guidelines (WCAG) Version 2.1 Level AA, the technical standard referenced in the most recent U.S. legislation.A total of 1,223 accessibility errors were identified across 50 webpages, with Skilltide detecting the most errors (588), followed by WAVE (502) …

Evaluating Nebulizer Efficiency For Phage Therapy In Drug-Resistant Pseudomonas Infections, Daniel Thompson

Yale Medicine Thesis Digital Library

Background

The global rise of multidrug-resistant (MDR) Pseudomonas aeruginosa necessitates novel therapeutic approaches, particularly for patients with cystic fibrosis (CF). Bacteriophage therapy, delivered via inhalation, offers a targeted and potentially transformative treatment for pulmonary infections caused by MDR pathogens. This study aimed to evaluate the effects of nebulizer type and bacteriophage morphology on viable phage recovery and aerosol particle size distribution, hypothesizing that nebulizer-phage compatibility significantly influences the delivery of viable phages to the lower respiratory tract.

Methods

We conducted an in vitro study utilizing two clinically relevant nebulizer systems: the Pari LC Plus jet nebulizer and the Altera eFlow …

Contraceptive Counseling For Transgender & Gender Diverse Patients: Provider Knowledge & Experience, Kathryn Callahan

Yale Medicine Thesis Digital Library

Many transgender and gender diverse (TGD) individuals have contraceptive needs. Contraceptive counseling in this population is often nuanced due to the diverse experiences and healthcare goals of TGD individuals. Testosterone therapy is an important component of gender affirming care for some transgender and gender diverse (TGD) individuals. A common misconception among patients and providers is the role of testosterone in pregnancy prevention. Testosterone is not an effective form of contraception due to its inconsistent suppression of ovulation. Previous studies have shown that some patients who use testosterone for contraception do so based on guidance from their healthcare provider. Therefore, this …

Atrial Myocyte Ampk Deletion Alters Single Nuclear Profiles In Mice, Julia Nicole Eisen

Yale Medicine Thesis Digital Library

Atrial fibrillation (AF) is the most common arrhythmia worldwide with about 1 in 4 adults expected to develop the condition in their lifetime. AMP-activated kinase (AMPK) is a critical energy sensor and regulates tissue energy and substrate metabolism. Our lab has previously shown that atrial cardiomyocyte-specific cardiac AMPK deletion induces electrophysiologic changes, left atria structural remodeling and spontaneous AF. The mechanism by which loss of AMPK and consequent metabolic stress leads to AF has not yet been elucidated. Using single nuclear RNA sequencing (snRNA sequencing) of mouse heart atria from mice with atrial cardiomyocyte AMPK deletion, we begin to investigate …

Pregnancy Outcomes After Glp-1 Receptor Agonist Exposure And Ethical Considerations, Nishita Pondugula

Yale Medicine Thesis Digital Library

The objective of this study is 1) to understand the effect of GLP-1 receptor agonist (GLP-1RA) use in the year prior to conception on risk of developing hypertensive disorders of pregnancy (HDP) and on gestational weight gain (GWG), and 2) to analyze important ethical considerations relevant to research in pregnancy and specifically related to GLP-1RAs.All patients delivering between 2014-2024 with evidence of GLP-1RA exposure in the year prior to conception were identified through electronic medical record (EMR) query with hand review to confirm exposure. GLP-1RA exposed patients were classified according to GLP-1RA indication for use: 1) pregestational diabetes mellitus (PGDM) …

Macrophage Migration Inhibitory Factor And D-Dopachrome Tautomerase As Biomarkers And Key Modulators Of Tumor Progression In Head And Neck Cancer And Melanoma, Caroline Naomi Valdez

Yale Medicine Thesis Digital Library

Macrophage Migration Inhibitory Factor (MIF) and its homolog D-dopachrome Tautomerase (DDT) are pro-inflammatory cytokines implicated in tumor progression across multiple cancers. Both MIF and DDT act through canonical CD74 and non-canonical CXCR2/4/7 signaling pathways, which contribute to immune suppression and tumor progression. Elevated MIF levels are associated with metastasis and poor prognosis in HNC and contribute to immune checkpoint inhibitor (ICI) resistance in melanoma. DDT’s role in cancer is not well understood. This study aims to evaluate the expression and therapeutic potential of MIF and DDT inhibition, focusing on their ability to modulate immune responses and improve survival outcomes as …