Digital Commons Network^™

Creating A Welcoming, Inclusive, And Affirming Primary Care Environment For Lesbian, Gay, Bisexual, Transgender, Queer, Questioning, Intersex And Asexual Patients, Samantha Korbey

Yale School of Nursing Digital Theses

The LGBTQIA+ community has long faced disparities in healthcare which have had significant consequences including increased cancer risk factors and poorer health outcomes when compared to the cisgender, heterosexual community. Interventions are needed to increase the knowledge and cultural competency of providers, to create welcoming and safe spaces for LGBTQIA+ patients, and to encourage disclosure of sexual orientation and gender identity (SOGI).

The purpose of this DNP project was to adapt, implement, and evaluate an evidence-based model for creating an affirming, inclusive, culturally competent, and safe primary care environment for LGBTQIA+ patients within a family practice center. This quality improvement …

Longitudinal Modeling Of Early Hiv Burden In The Central Nervous System, Victor Diego Armengol

Yale Medicine Thesis Digital Library

The dynamics of plasma HIV replication during early infection including establishment of a viral set-point are well-known. However, the course of HIV in the central nervous system (CNS) after initial entry of HIV into this compartment is less understood. Using longitudinal samples, we modeled the natural history of HIV RNA in the cerebrospinal fluid (CSF) and plasma during early HIV prior to initiation of antiretroviral treatment (ART). Participants with primary HIV infection (PHI, within 12 months of initial infection) were enrolled in prospective studies with paired longitudinal sampling of blood and CSF conducted in San Francisco, USA, and Gothenburg, Sweden …

Amd3100 Administration For The Treatment Of Asherman’S Syndrome In A Murine Model, Pablo Antonio Delis

Yale Medicine Thesis Digital Library

Statement of Purpose

1. Optimize a murine model of Asherman’s Syndrome.2. Assess fertility outcomes in mild Asherman’s Syndrome model mice treated with AMD3100. 3. Determine timing of peak serum and uterine levels of CXCL12 after AS induction. 4. Identify an optimal time point for AMD3100 administration in AS.

Arid1a Deficiency As A Biomarker For Sensitivity To Ionizing Radiation And Atr Inhibition In Gynecologic Malignancies, Jessie Li

Yale Medicine Thesis Digital Library

ARID1A DEFICIENCY AS A BIOMARKER FOR SENSITIVITY TO IONIZING RADIATION AND ATR INHIBITION IN GYNECOLOGIC MALIGNANCIESJessie Y. Li, Shari Damast, MD (Department of Therapeutic Radiology, Yale University, Yale School of Medicine, New Haven, CT), and Gloria Huang, MD (Section of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University, Yale School of Medicine, New Haven, CT) Objective: ARID1A, which encodes a protein that participates in the SWI/SNF chromatin remodeling complex, is frequently mutated in ovarian and endometrial malignancies. The emergence of the role of ARID1A in gynecologic cancer progression reveals potential implications for therapeutic targets. Our primary purpose …

Cryoablation Of Congenital Venous Malformations: A Systematic Review, Alexander Moushey

Yale Medicine Thesis Digital Library

ABSTRACT

ObjectiveTo perform a meta-analysis of cryoablation in the treatment of venous malformations, analyzing the technical success, clinical outcomes, including change in volume of lesion and pain scores, and safety of this procedure.

Materials and MethodsVenous malformations (VMs) are a common slow-flow type congenital vascular malformation made up of a “mass-like” network of dysplastic venous structures. A systematic review was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A search in PubMed and Google Scholar for clinical studies utilizing percutaneous cryoablation of VMs was performed and all relevant articles were then manually reviewed. Prospective, retrospective …

A Nationwide Assessment Of Disparities In Primary Cleft Lip Repair, Connor J. Peck

Yale Medicine Thesis Digital Library

Purpose: This study examined the impact of patient race or ethnicity on the likelihood of experiencing delays to surgery, post-operative surgical complications, or prolonged hospital stays following primary cleft lip (CL) repair.Methods: Patients who underwent CL repair were identified from two large national databases: the Kids Inpatient Database (KID) and the Pediatric National Surgical Quality Improvement Program (NSQIP) database. Primary outcomes were defined as treatment after 6 months of age, the presence of any surgical complication, and a hospital stay greater than 1 day. Chi-squared analyses were performed to compare outcomes across patients of different race/ethnicity, followed by multivariable logistic …

Factors Impacting Trauma-Specific Quality Of Life Following Injury: A Multi-Center Assessment In Lebanon, Ali Elreichouni

Yale Medicine Thesis Digital Library

Objective: Injuries account for a large portion of the global burden of disease, representing over 10% of all disability adjusted life years (DALYs). This study analyzes the economic impact of injury for those experiencing moderate-to-severe injury in Beirut, Lebanon. It further examines the impact of different demographic and socioeconomic factors on trauma-specific quality of life 1-2 years following injury.

Methods: This was a prospective cohort study following patients 1-2 years after being treated for injury at one of three hospitals in Beirut, Lebanon. Patients interviewed by phone. In addition to questions on financial impact, access to healthcare, and socioeconomic status, …

Changing Selection And Epistasis On Drivers Over Tumorigenesis In Primary And Metastatic Prostate Cancer, Alexander Yang

Yale Medicine Thesis Digital Library

Background: Many attempts have been made to characterize and describe the driver genes and mutations responsible for prostate cancer tumorigenesis. We have quantified the cancer effect size—a direct measurement of the survival advantage a mutation confers—for 2699 primary and metastatic prostate tumor samples. Our measure of cancer effect treats tumorigenesis as an evolutionary process, subject to positive and negative selective pressures. We have applied this metric in a stage-specific manner to elucidate which mutations are selected for as prostate cancer develops.Methods: We analyzed 2699 prostate cancer tumor exomes, genomes, and panel sequences (1648 primary tumors and 1051 metastatic samples). The …

Yale Medicine Magazine 2022, Issue 168, Yale University. School Of Medicine

Yale Medicine Magazine - alumni bulletin and magazine

This is the 2022 issue of Yale Medicine Magazine, issue 168. 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).

Yale Medicine Magazine 2022, Issue 169, Yale University. School Of Medicine

Yale Medicine Magazine - alumni bulletin and magazine

This is the 2022 issue of Yale Medicine Magazine, issue 169. 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).

Presynaptic Plasticity In A Mammalian Synapse Involves Actin Remodeling And Vesicle Recruitment, Shobana Subramanian

Yale Medicine Thesis Digital Library

Short term synaptic plasticity is required for working memory and executive functions, which become impaired in neurodegenerative diseases such as dementia. A form of short-term plasticity that can be induced by repeated stimulation of neurons is called post-tetanic potentiation (PTP). One way in which PTP occurs is through an increase in the number of vesicles at the active zone, the specialized region of the presynaptic terminal where synaptic transmission occurs. The calyx of Held is a large, rapidly firing synapse located in the auditory brainstem that is involved in sound localization. We have previously shown that the dense layer of …

Bulletin Of Yale University School Of Nursing 2022-2023, Yale School Of Nursing

Yale School of Nursing Bulletins and Catalogues

Series 118, Number 16

September 5, 2022

Structural Violence & Small Victories: Political Epidemiology Of Hiv Among Msm In Nigeria, 2000-2010, Debbie A. Dada

Harvey M. Applebaum ’59 Award

No abstract provided.

An Assessment Of Geographic And Taxonomic Biases In Research On Climate Change-Related Range Shifts, Evan J. Parker

Library Map Prize

Geographic and taxonomic biases in ecological literature inhibit the ability of research to be generalized or translated to other systems. This is particularly true with research on climate change-related range shifts, where a diverse and representative set of observations is needed to understand the significant heterogeneity of range shifts and improve models. A literature review was conducted and biases were assessed by examining the geographic location of study areas, the taxonomic makeup of study species, and the location of study areas within species ranges. A substantial geographic skew towards terrestrial, mid-latitude North America and Europe was observed. However, taxonomic coverage …

Using Community-Based Screening To Quantify The Relationship Between Hiv And Hypertension In A Rural South African Community, Jessica Ainooson

Public Health Theses

Background: Over the past three decades, the prevalence of hypertension has increased in sub-Saharan Africa, paralleling the HIV/AIDS epidemic. The aim of this study is to assess the relationship between HIV status and elevated blood pressure in a rural South African community. Methods: A secondary analysis was conducted from a community-based screening program providing TB/HIV/blood pressure/glucose screening in the rural sub-district of Msinga, KwaZulu-Natal, South Africa from 2011 - 2017. Descriptive analyses were used to characterize the frequency of measured and self-reported hypertension, HIV status, and sociodemographic variables. Multivariable logistic regressions were used to estimate the relationship between HIV status …

Association Between Rheumatoid Arthritis Severity And Mental Health In A Prevalent Cohort Of American Adults, 2013-2022, Nicole-Anne Ballesteros

Public Health Theses

Objective/Purpose: The severity of rheumatoid arthritis and its association with depression and anxiety among a prevalent cohort of American adults has been neither well-researched nor backed by real-world data. This investigation seeks to test the hypothesis that there is an association between disease severity and the aforementioned psychological conditions, both of which are commonly observed in patients with rheumatoid arthritis.

Methods: Real-world data from OM1 Inc.’s rheumatoid arthritis registry (2013-2022) was used for this analysis. Disease severity (low, medium, and high), categorized using disease activity scores, was the main exposure, while depression and anxiety were the study’s two primary outcomes. …

Women's Beliefs In Gender Equality And Its Association With Gender Based Violence In Conflict Afflicted Regions Of Uganda, Aishwarya Bhattacharya

Public Health Theses

Gender Based Violence such as Intimate Partner Violence and exposure to armed conflict are exacerbated in Conflict settings and can negatively impact health outcomes among women. Although a significant amount of research has looked at how men’s beliefs in gender equity and male stereotypes can impact engagement in violence against women, there is a dearth of research analyzing how women’s beliefs can impact their exposure to armed violence or IPV. We use the adapted version of the Gender-Equitable Men survey in a population of 606 women and adolescent girls in conflict afflicted regions of Northern Uganda to a) look at …

Circadian Factors And Cancer Survivorship: A Mini Review, Jiaqi Cui

Public Health Theses

Circadian clocks are molecular clocks that govern the temporal control of physiology to preserve homeostasis. The disruption of the circadian rhythm is important in carcinogenesis and aids the development of cancer hallmarks. On the other hand, carcinogenic activities disrupt circadian rhythms directly. In cancer treatment, pharmacological regulation of core clock genes is a novel approach. The use of circadian biology in cancer research opens up new avenues for improving cancer treatment effectiveness. This mini-review provides an overview of relationship between circadian factors including circadian gene expression, circadian genotype, circadian disruption and circadian gene methylation and the cancer survivorship. The review …

“She Trusts Us To Love Her, You Know?”: Using A Love Ethic Framework To Explore Faith Navigation And Acceptance Processes Among Mormon Mothers Of Lgbtq+ Individuals, Nandini Milind Deo

Public Health Theses

Parental acceptance is a key factor in bolstering the health and well-being of LGBTQ+ individuals across their lifespan (Needham & Austin, 2010; Ryan, 2010; Jin, 2020; Clark et al., 2021). One factor known to influence parental acceptance is family religiosity, which has typically been associated with conflict and/or rejection (Ryan, 2010; Johns & Hanna, 2012; Roe, 2017). The purpose of this study was to better understand faith navigation and acceptance processes among active Mormon mothers of LGBTQ+ individuals in an effort to inform public health engagement with highly religious parents of sexual and gender minority children. In-depth qualitative interviews were …

Environmental And Health Impacts Of Biobased Polymers, Liora Fiksel

Public Health Theses

The use of biopolymers is predicted to grow in the coming years as the world searches for solutions to its sustainability problems. Pursuing biobased materials is widely thought of as the sustainable response to moving away from petroleum-based materials and the plastic-waste issue; however, its potential environmental and human health impacts are being questioned. Notably, the controversies related to biopolymers' renewable feedstocks include adding pressure to the food economy, land use, occupational hazards, and environmental pollution with potential human exposure and adverse health effects. Other resource burdens include energy and water. Many biopolymers are designed to biodegrade, compost, or be …

Challenges And Prospects: Reducing U.S. Methane Emissions Via Red Macroalgae (Asparagopsis Taxiformis) Feed Additives To Inhibit Enteric Methane Production From Ruminant Livestock, Rebecca Gillman

Public Health Theses

Approximately 27% of U.S. methane emissions are emitted by the agriculture sector annually, primarily by ruminant livestock as a GHG enteric fermentation bi-product (EPA, 2022). This proposed intervention explores the feasibility of scaling up use of anti-methanogenic ruminant feed additives, to directly reduce U.S. agricultural methane emissions at the source. A careful review of in vitro, in vivo and small-scale pilot studies revealed that the potent, anti-methanogenic bioactive compounds in red macroalgae (Asparagopsis Taxiformis) can both safely and effectively inhibit methanogenesis during enteric fermentation, resulting in up to 90% reduction in methane emissions without adverse risk or consequence to animal …

The Gap Between Attitude And Action: A Mixed Methods Study Of Sexual Self-Stigma As A Predictor Of Consent Behavior, Hannah Carolyn Gorman

Public Health Theses

Introduction: More than 1 in 3 women and 1 in 4 men will experience some type of sexual violence in their lifetimes (NISVS | CDC, 2021). While a significant body of research exists on predictors of reporting behavior after sexual assault victimization, far less research has attended to factors that may contribute to perpetration, such as sexual self-concept. The current study investigates sexual self-concept and its relationship to health behavior and notions of sexual consent in a college student sample. Methods: Quantitative and qualitative data were collected from 160 Yale undergraduates 18 years or older with approval from the Yale …

The Role Of Childhood Trauma In Intergenerational Trauma (Igt), Audrey Huang

Public Health Theses

Emerging research has focused on the intersection of personal and parental trauma within intergenerational trauma (IGT) transmission, specifically offspring adverse childhood experiences due to trauma-related parenting behaviors. However, the role that offspring childhood trauma and its various subtypes may play in moderating or mediating IGT transmission, as well as the impact of caregiver sex, are still remains largely understudied. We examined how the transmission of PTSD between survivors of the 1994 genocide to their offspring might be either (a) mediated by overall and subtypes of offspring childhood trauma, or (b) moderated by overall and subtypes of offspring childhood trauma, and …

Stigma, Cisgenderism, And The Pathologization Of Transness, Baqar Husain

Public Health Theses

Cisgenderism is the culture and system, constituted by both ideology and practice, that denies, denigrates, or pathologizes self-identified gender identities that do not align with assigned sex at birth. Medicine and law are jointly deterministic of the wellbeing of transgender people. This analysis seeks to explore how stigma, operationalized by cisgenderism, manifests in legal and medical structures to negatively impact the wellbeing of transgender people. Thus, this analysis begins with the definition of key terms necessary to understanding concepts related to sex, gender, and gender variance. After delineating how stigma operates, the recent history of transness is outlined and is …

Comparing Dog And Owner Pfas Exposures Using Fresh Air Samplers, Emily Elizabeth Johnson

Public Health Theses

Per- and polyfluoroalkyl substances (PFAS) have gained attention given their prevalence and persistence in the environment and in our bodies. PFAS have been detected in water, food products, and consumer products. Furthermore, companion animals may be exposed to elevated PFAS levels due to sources from pet products as well as household items. A growing number of studies have been conducted to better understand the toxicological and public health impacts of legacy PFAS resulting from ingestion and dermal exposure pathways in both humans and domesticated animals. As alternative replacement PFAS emerge in the market, these compounds are shorter chain which allows …

Understanding The Effects Of Endocrine Disruptors On The Glucocorticoid Signaling Pathway, Dana Norbert Joseph

Public Health Theses

Endocrine disruptors are exogenous chemicals that interfere with the functions of the endocrine system and can cause adverse developmental, reproductive, and neurological effects. Unlike toxic effects that may be evident immediately, disruption to the endocrine system may impact complex signaling pathways that take years or generations to discover. Current toxicology testing does not routinely incorporate endpoints that would identify potential endocrine disruptors. The objective of this study was to evaluate the endocrine disrupting potential of a broad range of industrial chemicals, specifically focusing on four chemicals with predicted activity on the glucocorticoid receptor (GR): 4-nonylphenol, bisphenol A (BPA), butylated hydroxytoluene …

The Politics Of Sexuality Education Policy In Texas, Caroline Alexandra Magee

Public Health Theses

This thesis applies social science research, historical and cultural analysis, and legislative review to understand the relationship between Texas’s school-based sexuality education policies and public health and, in so doing, lay the groundwork for policy change that will better promote sexual and reproductive health, health equity, and health justice in Texas. The thesis first situates Texas state-level sexuality education policy within a larger US political, historical, and legal context, highlighting the key roles of race, class, gender, and sexuality stereotypes and of “morality politics.” It then examines the political history of Texas sexuality education debates within this national context, revealing …

Epidemiology Of Covid-19 Hospitalizations In New Haven And Middlesex Counties, Connecticut, July - September 2021, Caroline Mary Mcwilliams

Public Health Theses

Abstract:Background. This thesis explores the epidemiology of COVID-19 hospitalization among residents of New Haven County and Middlesex County, Connecticut from July - September 2021 with an emphasis on quantifying racial/ethnic and SES disparities. Two previous studies, the first conducted from March - May 2020 and the second conducted from July - December 2020, used COVID-NET Surveillance data from New Haven and Middlesex counties to explore the same questions. This thesis will compare findings with these previous studies to better understand how the epidemiology of COVID-19 hospitalization and racial/ethnic and SES disparities have changed in New Haven and Middlesex counties. Methods. …

Prognostic Effects Of Different Tp53 Mutations In Lung And Pancreatic Adenocarcinomas, Carlos Mauricio Mejia-Arbelaez

Public Health Theses

Cancer patients with similar clinical and pathologic characteristics may have different response to treatments and survival, which may be attributable to distinct molecular properties of their tumor. The most common forms of lung and pancreatic tumors, the adenocarcinomas, often have mutations in the TP53 gene. It is not clear, however, how mutations in this gene may provide prognostic information and/or inform the clinical management of patients with lung adenocarcinoma (LUAD) and pancreatic ductal adenocarcinoma (PDAC). Despite previous studies suggesting that all mutations in TP53 are associated with worse prognosis, it is now known that not all TP53 mutations lead to …

Potential Impact Of Covid-19-Related Disruptions To Cervical Cancer Screening On Future Disease Burden: A Modeling Study, Guinevere Oliver

Public Health Theses

INTRODUCTION: Cervical cancer is almost entirely preventable through a combination of vaccination, timely screening, and treatment. There is strong evidence that cervical cancer screening services were disrupted during the COVID-19 pandemic; these disruptions may lead to preventable increases in cases of high-grade squamous intraepithelial lesions of the cervix (HSIL cases), cervical cancer cases, and cervical cancer deaths. OBJECTIVE: The objective of this analysis was to offer insight into possible future trends in HSIL cases, cervical cancer cases, and cervical cancer deaths. METHODS: A model was built to simulate cervical cancer progression and was fit to data on HSIL cases, cervical …