Digital Commons Network^™

Idiopathic Normal Pressure Hydrocephalus: A Review And A Proposed Role For, Conor Grady

Yale Medicine Thesis Digital Library

Despite nearly five decades of experience treating idiopathic normal pressure hydrocephalus (iNPH), there is still no consensus amongst care providers as to how to reliably identify patients with suspected iNPH who will benefit from shunt surgery, or how to measure post-operative symptom improvement. We performed a selective review of the literature, focusing especially on the role of neuroimaging in aiding in the diagnosis of iNPH, and the various clinical scales that have historically been used to assess outcome. Further, we tested the hypothesis that patient-reported outcomes (PROs) will demonstrate effectiveness of shunt surgery for the relief of iNPH symptoms consistent …

Inception Cohort Study Of Workers Exposed To Toluene Diisocyanate At A Polyurethane Foam Factory, Wei Gui

Yale Medicine Thesis Digital Library

Background: Isocyanates are one of the most commonly reported causes of occupational asthma; however, the risks of developing isocyanate asthma in modern production facilities remain poorly defined. The purpose of the present investigation was to evaluate TDI exposure and respiratory health among an inception cohort of workers during their first year of employment at a new polyurethane foam production factory.

Methods: Forty-nine newly hired workers were evaluated pre-employment, 6-months, and 12-months post-employment through questionnaire, spirometry and TDI-specific serology. Airborne TDI levels were monitored by fixed-point air sampling and limited personal sampling. Qualitative surface SWYPE tests were performed to evaluate potential …

A Rare View Of Coding Mutations And Plasma Lipid Levels, Aniruddh Pradip Patel

Yale Medicine Thesis Digital Library

A RARE VIEW OF CODING MUTATIONS AND PLASMA LIPID LEVELS. Aniruddh P. Patel, Sekar Kathiresan. Center for Human Genetics Research, Massachusetts General Hospital, Harvard Medical School, Boston, MA and Program in Medical and Population Genetics, the Broad Institute of Harvard and MIT, Cambridge, MA (Sponsored by Richard P. Lifton, Department of Genetics, Yale University School of Medicine, New Haven, CT).

Plasma low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG) are quantitative, heritable risk factors for coronary heart disease. Genome-wide association screens (GWAS) of common DNA sequence variants have identified many loci associated with plasma lipid levels. Targeted …

Family Life Events In The First Year Of Acute Lymphoblastic Leukemia Therapy, Samantha Lau

Yale Medicine Thesis Digital Library

Despite remarkable advances in cure rates, childhood acute lymphoblastic leukemia (ALL) may continue to result in considerable family strain. We sought to 1) measure incidence of divorce, reduced career opportunities, changes to work hours, home relocation, and changes to family planning at one year after ALL diagnosis 2) identify family and patient factors associated with these events. We conducted a prospective cohort study of 159 children with average risk-ALL enrolled and treated on COG protocol AALL0331 at 31 selected sites. In the first year of ALL treatment, 46% of parents lost a job, 13% divorced/separated, 22% decided not to have …

Mixing By Microorganisms In Stratified Fluids, Gregory L. Wagner, William R. Young, Eric Lauga

Journal of Marine Research

We examine the vertical mixing induced by the swimming of microorganisms at low Reynolds and Péclet numbers in a stably stratified ocean, and show that the global contribution of oceanic microswimmers to vertical mixing is negligible. We propose two approaches to estimating the mixing efficiency, η, or the ratio of the rate of potential energy creation to the total rate-of-working on the ocean by microswimmers. The first is based on scaling arguments and estimates η in terms of the ratio between the typical organism size, a, and an intrinsic length scale for the stratified flow, l = (νκ/N …

The Relation Between Unstable Shear Layer Thicknesses And Turbulence Lengthscales, Eric Kunze

Journal of Marine Research

This note explores the connection between the (i) lengthscales of unstable finescale shear layers which are responsible for turbulence production, (ii) turbulence patch thicknesses and (iii) the outer scales of turbulence, that is, the density overturn (Thorpe) and Ozmidov lengthscales, in the stratified ocean interior. Explanations are offered both for why (i) turbulence patches are often observed to be much thicker than outer turbulence scales and (ii) there is a spectral gap between finescale internal waves and the outer scales of turbulence. A finescale parameterization based on unstable shear predicts Ozmidov lengthscales smaller than unstable-shear-layer thicknesses for moderately unstable gradient …

Refraction Of Swell By Surface Currents, Basile Gallet, William R. Young

Journal of Marine Research

Using recordings of swell from pitch-and-roll buoys, we have reproduced the classic observations of long-range surface wave propagation originally made by Munk et al. (1963) using a triangular array of bottom pressure measurements. In the modern data, the direction of the incoming swell fluctuates by about ± 10° on a time scale of one hour. But if the incoming direction is averaged over the duration of an event then, in contrast with the observations by Munk et al. (1963), the sources inferred by great-circle backtracking are most often in good agreement with the location of large storms on weather maps …

Influence Of Mean Circulation On Large-Scale Decadal Basin Modes, Dhouha Ferjani, Thierry Huck, Alain Colin De Verdière

Journal of Marine Research

The effect of large-scale mean circulation on the generic property of intrinsic basin modes of decadal variability is investigated through linear stability analysis of a two-layer shallow water model over a flat- and a variable-bottom topography. The mean circulation is forced through either surface wind stress or vertical velocities at the layers interface representing surface heat flux. Regardless of the type of forcing, the large-scale mean circulation reduces the damping of the decadal basin modes. The wind forcing mostly affects the mode damping, by up to 30% for a climatological amplitude, whereas the heat flux forcing mostly increases the oscillation …

Diatom Control Of The Autotrophic Community And Particle Export In The Eastern Bering Sea During The Recent Cold Years (2008–2010), Matthew S. Baumann, S. Bradley Moran, Michael W. Lomas, Roger P. Kelly, Douglas W. Bell, Jeffrey W. Krause

Journal of Marine Research

The southeastern Bering Sea has exhibited shifts in climate since the start of the 21st century. The regional climate shifts are manifested in the duration and areal extent of seasonal sea-ice coverage. During a recent cold period (2008–2010) with extensive spring sea-ice cover over the southeastern shelf of the Bering Sea, a total of 77 water column and 24 sediment trap profiles were collected over the shelf and shelf break and analyzed for autotrophic pigment concentrations and elemental (carbon, nitrogen, phosphorus, and silicon) concentrations in suspended and exported particulate material. These results are used to establish the seasonal succession of …

The Transport Of Nutrient-Rich Indian Ocean Water Through The Red Sea And Into Coastal Reef Systems, James H. Churchill, Amy S. Bower, Daniel C. Mccorkle, Yasser Abualnaja

Journal of Marine Research

Driven by upwelling-favorable monsoon winds, nutrient-rich Gulf of Aden Intermediate Water (GAIW) enters the Red Sea from the Indian Ocean each summer. Hydrographic and velocity data acquired in autumn 2011 provide the first indication that GAIW is carried rapidly northward along the eastern Red Sea margin in a well-defined subsurface current with speeds >30 cm s^–1. The nutrient-rich (NO₂ + NO₃ concentrations up to 17 μmol l^–1) GAIW overlaps the euphotic zone and appears to fuel enhanced productivity over depths of 35–67 m. GAIW is broadly distributed through the Red Sea, extending northward along …

Group Behavior Among Model Bacteria Influences Particulate Carbon Remineralization Depths, K. A. S. Mislan, Charles A. Stock, John P. Dunne, Jorge L. Sarmiento

Journal of Marine Research

Organic particles sinking from the sunlit surface are oases of food for heterotrophic bacteria living in the deep ocean. Particle-attached bacteria need to solubilize particles, so they produce exoenzymes that cleave bonds to make molecules small enough to be transported through bacterial cell walls. Releasing exoenzymes, which have an energetic cost, to the external environment is risky because there is no guarantee that products of exoenzyme activity, called hydrolysate, will diffuse to the particle-attached bacterium that produced the exoenzymes. Strategies used by particle-attached bacteria to counteract diffusive losses of exoenzymes and hydrolysate are investigated in a water column model. We …

Simple Models For The Heat Flux From The Atlantic Meridional Overturning Cell To The Atmosphere, M. Behl, D. Nof, S. Van Gorder

Journal of Marine Research

It has been suggested that a slowdown of the Atlantic meridional overturning cell (AMOC) would cause the Northern Hemisphere to cool by a few degrees. We use a sequence of simple analytical models to show that due to the nonlinearity of the system, the simplified heat flux from the modeled AMOC to the atmosphere above is so robust that even changes of as much as 50% in the present AMOC transport are not enough to significantly change the temperature of the outgoing warmed atmosphere (i.e., the fraction of the atmosphere warmed by the AMOC). Our most realistic model (which is …

Medication Persistence In The Treatment Of Hiv Infection: A New Construct For Hiv Research And Clinical Care, Jason Bae

Yale Medicine Thesis Digital Library

Adherence to therapy has dominated clinical and investigational conversation on how HIV patients take medications. Adherence, although a critical concept in medication-taking behavior, is becoming increasingly limited in its relevance to patient outcomes as treatment regimens and our understanding of antiretroviral resistance development evolve over time. In this thesis, a new construct of HIV medication-taking behavior called `persistence' is introduced and defined, in order to provide researchers and practitioners with a more comprehensive understanding of patient behavior and achieve better health outcomes. Literature review of adherence, persistence, viral suppression, development of antiretroviral resistance is performed here to reveal patient, medication, …

Deep Hypothermic Circulatory Arrest Effectively Preserves Neurocognitive Function, Katherine Hsin-Yu Chau

Yale Medicine Thesis Digital Library

Few (conflicting) studies have quantitatively assessed neurocognitive effects of deep hypothermic circulatory arrest (DHCA), and even fewer have looked at the long-term effects of DHCA. In this study, we aim to determine if DHCA negatively affects neurocognitive function and if so, are the effects long-term. We assess neurocognitive function quantitatively before and after DHCA and also in comparison with non-DHCA patients. 62 aortic surgical patients underwent a battery of neuropsychometric tests, both pre and post-operatively, evaluating multiple aspects of memory, processing speed, executive function, and global cognition. 33 patients did not require DHCA, and 29 underwent DHCA as the sole …

Correlation Of Hospital Pci Process Measures And Association With 30-Day Risk Standardized Outcomes, Philip Chui

Yale Medicine Thesis Digital Library

CORRELATION OF HOSPITAL PCI PROCESS MEASURES AND ASSOCIATION WITH 30-DAY RISK-STANDARDIZED OUTCOMES.

Philip W. Chui, Craig S. Parzynski and Jeptha P. Curtis. Center for Outcomes Research and Evaluation, Yale University, New Haven, CT.

Over the past decade, there has been an explosion of interest in measuring and reporting the quality of care delivered to patients undergoing percutaneous coronary intervention (PCI), with the newest performance metrics just released in December 2013. One aspect of quality measurement that remains poorly understood is the nature of the relationship between individual PCI process measures as well as between process and outcomes measures such as …

The Rising Incidence Of Small Endocrine Cancers In The United States: Effects On Surgical Therapy In An Age Of Imaging, Eric Kuo

Yale Medicine Thesis Digital Library

The increasing utilization of imaging technology has led to the diagnosis of cancers earlier in their clinical course. When small tumor size is coupled with relatively indolent histology, excellent oncologic outcomes require the risks of surgery to be carefully considered. However, characteristics and outcomes of small cancers of the thyroid and endocrine pancreas remain poorly defined, and evidence to guide their management is sparse.

Patients with tall cell (mTCV) and diffuse sclerosing (mDSV) variants of papillary thyroid microcarcinoma (mPTC), follicular (mFTC) and Hurthle cell microcarcinoma (mHCC), parathyroid carcinoma (PC) and pancreatic neuroendocrine tumors (PNETs) ≤ 2 cm in size were …

Reducing Respiratory Virus Testing In Hospitalized Children With Machine Learning And Text Mining, Mark Mai

Yale Medicine Thesis Digital Library

Despite pressure from the federal government for US hospitals to adopt electronic medical records systems (EMR), the benefits of adopting such systems have not been fully realized. One proposed advantage of EMRs involves secondary use, in which personal health information is used for purposes other than direct health care delivery, particularly quality improvement. We sought to determine whether information recorded in the EMR could improve diagnostic pathways used to diagnose respiratory viruses in children, the most common etiology of diagnoses in the pediatric population. These tests potentially represent a source of unnecessary testing. We performed a retrospective observational study analyzing …

Treating Very Large Non-Small Cell Lung Cancers: A Survival Analysis Using National Cancer Databases, Amy Moreno

Yale Medicine Thesis Digital Library

Very large primary non-small cell lung cancers (NSCLC), defined as those >7 cm, remain a therapeutic challenge due to known survival disadvantage compared to smaller tumors and lack of specific studies in this population. This study compares the effect of various treatment modalities on survival of patients with large NSCLC with none or positive hilar lymph node involvement (T3>7cmN0 and T3>7cmN1, respectively).

The Surveillance, Epidemiology, and End Results (SEER) database was used to identify patients undergoing a lobectomy or pneumonectomy for T3>7cmN0 NSCLC from 1999 to 2008. Patients were categorized into groups based on type of surgery …

Nutritional Status Of Pediatric Inpatients In Kigali, Rwanda, Maria Nardell

Yale Medicine Thesis Digital Library

Background: In many resource-limited hospital settings, families struggle to pay for both food and medical expenses. To date, no study has looked at the nutritional status of pediatric inpatients in resource-limited countries or at factors related to food access in this vulnerable population.

Aims: This study investigates nutritional status and food intake of pediatric inpatients at Centre Hospitalier Universitaire de Kigali (CHUK) in Rwanda to identify children at risk for inpatient food insecurity.

Methods: Caregivers of patients > 6 months of age and hospitalized for at least 1 week completed a validated food diversity survey. Individual Food Consumption Scores (FCS) were …

Yale School Of Medicine Facts & Figures 2014-2015, 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.

Landsbankinn Initial Balance Sheet, Landsbankinn Hf

Documents

No abstract provided.

Medicine@Yale March/April 2014 Volume 10, Issue 1, Yale School Of Medicine Office Of Communications

Medicine@Yale - development newsletter

Medicine@Yale : advancing biomedical science, education and health care was a print and online newsletter which published news about academics, research and philanthropy for alumni, donors, faculty, students and the general public. It was initially published 6 times a year and then changed to a quarterly schedule. The first issue came out June/Jul. 2005. The final issue was published in May/June 2022, vol. 17, issue 1. Published by Yale School of Medicine, Office of Communications.

Medicine@Yale December 2014 Volume 10, Issue 3, Yale School Of Medicine Office Of Communications

Medicine@Yale - development newsletter

Medicine@Yale : advancing biomedical science, education and health care was a print and online newsletter which published news about academics, research and philanthropy for alumni, donors, faculty, students and the general public. It was initially published 6 times a year and then changed to a quarterly schedule. The first issue came out June/Jul. 2005. The final issue was published in May/June 2022, vol. 17, issue 1. Published by Yale School of Medicine, Office of Communications.

Barriers To Intervening Among Witnesses Of Intimate Partner Violence In Scotland, Amy Beth Davis

Public Health Theses

Background: Intimate partner violence (IPV) is a problem in many parts of the world, including Scotland. Bystander interventions can reduce the number and severity of episodes of IPV.

Objective: This study explored the potential barriers to intervening to stop intimate partner violence in Scotland.

Methods: This research is part of a larger study that used a mixed methods approach. Thirty-one people (14 males; an age range of 18-78 years) who participated in five focus groups (each comprising around six people) which were conducted in Alloa, Glasgow, and Kilmarnock, Scotland in July and August of 2013.

Results: Five key themes emerged …

The Correlation Between Snakebites And Meteorological Variations, Chang Na

Public Health Theses

Background: In the United States, approximately 45,000 snakebites occur annually and affect many people including veterinarians and farmers.1 Snakebites can cause significant pain and morbidity such as severe bleeding and skin necrosis. Better predictive information on snakebite risk could help prevent snakebites by identifying high risk time periods, weather patterns, and locations.

Methods: This was a retrospective analysis of the New Mexico State Poison Control Center data between January 1998 and December 2012. Monthly average meteorological data were obtained from the Parameter-elevation Regressions on Independent Slopes Model climate group. Locations of the bites were categorized as urban or rural based …

Breakfast Consumption Patterns And Obesity Risk Among Students In New Haven Public Schools, Sisi Wang

Public Health Theses

Objectives. We examined breakfast consumption patterns in a longitudinal sample of fifth to seventh grade students and the relationship between the different consumption patterns and weight status over time.

Methods. 1,534 fifth to seventh grade students from 12 randomly selected public schools in New Haven, Connecticut, completed school-based student surveys and physical measures during 2011 to 2013. We also identified students that participated in Breakfast in the Classroom (BIC) program.

Results. Using latent transition analysis, we identified four qualitatively different patterns of breakfast consumption: frequent skippers or infrequent eaters, non-skipping mixed eaters, regular home eaters, and regular school or double …

Geospatial Analysis Of Violent Crime And Premature Mortality From Chd, Sarah Elise Conderino

Public Health Theses

Background: Cardiovascular disease (CVD) is the leading cause of death in the United States and many of these deaths are preventable. Studies have shown that neighborhood-level characteristics may contribute to health outcomes, but no study has yet examined whether neighborhood crime contributes to early mortality from CVD.

Objective: We examined geographic trends in the association between neighborhood crime rates and premature mortality from coronary heart disease (CHD) using New Haven, CT USA as a model city.

Methods: Neighborhoods in New Haven were established by existing census tracts. CHD deaths were identified from the Connecticut Master Death Files and violent crime …

Why Is Housing Finance Still Stuck In Such A Primitive Stage?, Robert J. Shiller

Cowles Foundation Discussion Papers

The institutions for financing owner-occupied housing have not progressed as they should, and the financial innovation that has followed the financial crisis of 2007-9 has not been focused on improving the risk management of individual homeowners. This paper lists a number of barriers to housing finance innovation, and in light of these barriers, the problems of some major innovations of the past and future: self-amortizing mortgages, price-level adjusted mortgages (PLAMs), shared appreciation mortgages (SAMs), housing partnerships, and continuous workout mortgages (CWMs).

Prediction Of Feeding Difficulties In Post-Operative Neonates, Alexandra Adler

Yale Medicine Thesis Digital Library

The purpose of this study was to determine whether feeding difficulties in post-operative neonates correlate with intraoperative findings.

A retrospective study of neonates undergoing gastrointestinal surgery between January 2002 and December 2005 was performed. Operative notes were used to classify infants into four groups based on post-operative anatomy and anticipated intestinal function: class 1: anatomically normal/normal function (n=22); class 2: anatomically normal/dysfunction (n=21); class 3: anatomically short/normal function (n=31); and class 4: anatomically short/dysfunction (n=21). Class 3 was further divided into two subgroups based on ostomy location: proximal ostomy (class 3a, n=11) vs. distal ileostomy (class 3b, n=21). Anatomically short …

Alcohol Use Disorders And Antiretroviral Therapy Among Prisoners With Hiv/Aids In Argentina, Michael Drake Alpert

Yale Medicine Thesis Digital Library

While Argentina has significantly improved access to HIV care and antiretroviral therapy (ART) for both the general population and prisoners, the prevalence of alcohol use disorders (AUDs) among HIV-infected prisoners and their relationship to accessing ART in Argentina is currently unknown. This study aims to characterize the substance abuse patterns of HIV-infected prisoners in Argentina and to assess the independent correlates of receipt of pre-incarceration ART.

An anonymous, cross-sectional survey of 100 HIV-infected federal prisoners was conducted in the Buenos Aires municipality from July-December 2010. AUDs were assessed using the AUDIT scale.

A majority (63 per cent) of participants met …