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Outcomes Following Lumbar And Cervical Spinal Surgery In The Obese: An Acs-Nsqip Database Study, Rafael Antonio Buerba

Yale Medicine Thesis Digital Library

Prior studies on the impact of obesity on spine surgery outcomes have focused mostly on lumbar fusions, do not examine lumbar discectomies or decompressions, and have shown mixed results regarding complications. There is also a paucity of literature regarding the effect of obesity on cervical spinal fusion outcomes. The purpose of this thesis was therefore to analyze whether obesity as measured by BMI influences the complication rates, operation times, and lengths of stay in patients undergoing lumbar or cervical spine surgery.

To this end, we conducted a retrospective cohort analysis of prospectively collected data on lumbar and cervical surgeries using …

Impact Of Gain-Of-Function Mutations In The Low-Density Lipoprotein Receptor Related Protein 5 (Lrp5) On Glucose And Lipid Homeostasis, Dinah Foer

Yale Medicine Thesis Digital Library

IMPACT OF GAIN-OF-FUNCTION MUTATIONS IN THE LOW DENSITY LIPOPROTEIN RECEPTOR RELATED PROTEIN 5 (LRP5) ON GLUCOSE AND LIPID HOMEOSTASIS. Dinah Foer, Meiling Zhu, Christine Simpson, Grace Lee, Rebecca Sullivan, and Karl L. Insogna. Section of Endocrinology, Department of Internal Medicine, Yale University, School of Medicine, New Haven, CT.

Investigations in animal models suggest a physiologic link between LRP5 and glucose and lipid homeostasis. However, the data in human studies is far from consensus. While LRP5 has been shown to be critical to Wnt signaling, the molecular mechanism for the effect on metabolism is unknown. We hypothesize that a high bone …

Barriers To Eye Care Among Patients With Age-Related Macular Degeneration In The Yale Eye Center, Laura Bressler Hall

Yale Medicine Thesis Digital Library

Barriers to obtaining medical care have been studied extensively across the health care realm. Within ophthalmology barriers to receiving care for cataracts and diabetic retinopathy (DR) have been considered. To the best of our knowledge, the barriers to receiving care for those suffering from age-related macular degeneration (AMD) in the United States have not been explicitly studied. AMD is a disease that disproportionally affects the elderly and when left untreated will often cause legal blindness. Early detection and treatment is essential to avert AMD progression. Studying the way in which patients receive their eye care and what barriers or enabling …

Screening Mammography Among Women With A Family History Of Breast Cancer, Lauren Hibler

Yale Medicine Thesis Digital Library

Screening mammography among women with a family history of breast cancer

Lauren Hibler, Anees Chagpar

Women with a first degree family history of breast cancer are at increased risk of developing this disease. Screening with mammography has been demonstrated to detect cancer early, when it is most treatable. We hypothesized that, due to their increased risk, women with a first degree family history of breast cancer would be more likely to obtain screening mammograms than the general population. We further sought to determine the self-reported reasons for failing to adhere to screening guidelines in this high risk population.

The National …

Longitudinal Characteristics Of Depression And Mood States Beginning In Primary Hiv Infection, Jessica Ashley Gold

Yale Medicine Thesis Digital Library

LONGITUDINAL CHARACTERIZATION OF DEPRESSION AND MOOD STATES BEGINNING IN PRIMARY HIV INFECTION. Jessica A. Gold, Marie Grill, Julia Peterson, Christopher Pilcher, Evelyn Lee, Frederick M. Hecht, Dietmar Fuchs, Constantin T. Yiannoutsos, Richard W. Price, Kevin Robertson, and Serena Spudich. Department of Neurology, Yale University, School of Medicine, New Haven, CT.

Though depression is known to frequently afflict those with chronic HIV, mood during the early course of HIV is not well characterized. In a prospective study we assessed mood during primary HIV infection (PHI, <1 year duration), its association with neuropsychological performance and markers of neurological disease, and its longitudinal course including effects of highly active antiretroviral therapy (HAART). The Beck Depression Inventory (BDI) and Profile of Mood States (POMS) subscales were longitudinally administered prior to and after HAART in PHI subjects. This evaluation of mood was done concurrently with blood, cerebrospinal fluid (CSF) and neuropsychological (total z and global deficit score, GDS) evaluation at each visit. Analysis employed Spearman's rho, logistic regression, and linear mixed models. 47.7% of the 65 men recruited at a median 3.5 months HIV duration met BDI criteria for clinical depression at baseline, classified as `mild' (n=11), `moderate' (n=11), or `severe' (n=9). Drug, alcohol, and depression history did not associate with BDI score. Proportional somatic-performance scores were worse than cognitive-affective scores (p=. 0045). Vigor subscore of POMS was reduced compared to norms and correlated with total z (r=0.33, p=0.013) and GDS (r=-0.32, p=0.016). BDI and POMS correlated with one another (r=0.85, p< .0001), but not with CSF or plasma HIV RNA, white blood cell (WBC) count, albumin ratio or neopterin. Improvement was not observed in BDI and POMS over 330 total follow-up visits, even after initiation of HAART. Depression was prevalent during PHI in our subjects, associated with abnormal somatic-performance and vigor scores. Neither neuropsychological performance nor disease biomarkers correlated with depressed mood. Mood indices did not improve over time in the presence of HAART.

Genomic Predictor Of Residual Risk Of Recurrence After Chemotherapy In High Risk Estrogen Receptor Positive Breast Cancers, Sabrina Khan

Yale Medicine Thesis Digital Library

Gene signature based prognostic tests can help improve adjuvant treatment decisions in early stage estrogen receptor positive (ER) breast cancers. Available tests in the clinic include Oncotype DX recurrence score (RS), PAM50 molecular class, and the Genomic Grade Index (GGI), which can identify high risk tumors that are likely to recur and have less favorable survival when treated with surgery and endocrine therapy alone. These high risk patients are recommended to also receive chemotherapy to improve their chance of survival. A subset of these "high risk" tumors is highly sensitive to adjuvant chemotherapy due to their high proliferation rates, and …

The Influence Of Regional Health System Characteristics On The Management Of Glioblastoma Multiforme, Dhruv Khullar

Yale Medicine Thesis Digital Library

THE INFLUENCE OF REGIONAL HEALTH SYSTEM CHARACTERISTICS ON THE MANAGEMENT OF GLIOBLASTOMA MULTIFORME. Dhruv Khullar, Sanjay Aneja, James B. Yu. Department of Therapeutic Radiology, Yale University, School of Medicine, New Haven, CT.

Despite a known optimal treatment protocol for the management of glioblastoma multiforme (GBM), many patients fail to receive complete surgical resection or post-operative radiation therapy (PORT). The underlying reasons behind this disparity are unclear. We hypothesize that regional health system resources influence the surgical management and PORT in patients with GBM.

Surgical intervention, PORT receipt, and patient data for patients diagnosed with GBM from 2004 to 2008 were …

Knowledge Of Urinary Incontinence And Pelvic Organ Prolapse In Community-Dwelling Women, Charisse L. Mandimika

Yale Medicine Thesis Digital Library

KNOWLEDGE OF URINARY INCONTINENCE AND PELVIC ORGAN PROLAPSE IN COMMUNITY-DWELLING WOMEN.

Charisse L. Mandimika, William Murk, and Marsha K. Guess. Section of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University, School of Medicine, New Haven, CT.

Urinary incontinence (UI) and pelvic organ prolapse (POP) are common, costly and debilitating problems that have a known negative impact on women's quality of life. Our study assessed women's baseline knowledge, demographic factors associated with a lack of knowledge, and specific areas of knowledge deficiency about UI and POP among White, African American (AA), and Other Women of …

Prospective Trial Comparing Topical Steroid Application To Wet Versus Dry Skin In Children With Atopic Dermatitis, Lucinda Shuangyuan Liu

Yale Medicine Thesis Digital Library

PROSPECTIVE TRIAL COMPARING TOPICAL STEROID APPLICATION TO WET

VERSUS DRY SKIN IN CHILDREN WITH ATOPIC DERMATITIS.

Lucinda S. Liu, Yanna Kang, and Richard J. Antaya.

Department of Dermatology, Yale University School of Medicine, New Haven, CT.

The aim of this study was to determine whether "soak and smear," a technique where hydration via a 10-minute soak in lukewarm plain water followed by topical corticosteroid application to wet skin, is efficacious for the treatment of atopic dermatitis in pediatric patients. A randomized, investigator-blinded study was conducted with 45 patients, 4 months to 16 years of age, with moderate to severe atopic …

Prevalence Of Tuberculosis Symptoms And Latent Tuberculosis Infection Among Prisoners In Northeastern Malaysia, Benjamin Margolis

Yale Medicine Thesis Digital Library

Background: Tuberculosis (TB) is a known public health threat to prison systems due to poor hygiene, crowded living conditions, poor health of inmates, and poor prison healthcare systems. The large population of HIV-infected people living in prisons is especially susceptible to increased TB transmission and higher mortality. In Northeastern Malaysia, there is no screening for active or latent TB infection (LTBI) in the prison system.

Aims and Hypothesis: This study serves to measure the prevalence and correlates of LTBI and active TB symptoms in HIV-infected and non-HIV-infected prisoners in Northeastern Malaysia. Given the host of factors that contribute to TB …

Role Of Embolic Protection In Transcatheter Aortic Valve Replacement: Results From The Deflect I Study, Stephanie Michelle Meller

Yale Medicine Thesis Digital Library

Utilization of a cerebral protection device during transcatheter aortic valve replacement (TAVR) will reduce the rate of periprocedural stroke as well as the occurrence and volume of new lesions on diffusion weighted magnetic resonance imaging (DW-MRI), which may serve as a potential surrogate endpoint for clinical studies. The DEFLECT I study is a prospective, multi-center, single arm study that aims to demonstrate the safety and performance of the TriGardTM Embolic Deflection Device (EDD) (Keystone Heart, Caesarea Business Park, Israel), among patients undergoing TAVR. Primary endpoints were device performance and in-hospital device-related safety. A powered secondary endpoint was the number and …

Characterization Of The Effect Of Braf Inhibitors On Melanoma Metabolism In Vitro And In Vivo, Alexander Marzuka

Yale Medicine Thesis Digital Library

Vemurafenib is the first FDA-approved personalized treatment for metastatic melanoma to show an improvement in survival. This serine threonine kinase inhibitor targets the mutated BRAF V600E protein, which occurs in approximately 50% of melanomas. The downstream effect of BRAF V600E blockade is inhibition of cell proliferation. Little is known about the effect of vemurafenib on glucose metabolism in melanoma cells. The Warburg effect, or the use aerobic glycolysis to generate energy and building blocks for cell proliferation, is a hallmark of cancer. Normal cells, in contrast, metabolize glucose through oxidative phosphorylation in the presence of oxygen and through glycolysis in …

Extracorporeal Membrane Oxygenation (Ecmo) In Adults In The United States From 2006-2011, Christopher Mark Sauer

Yale Medicine Thesis Digital Library

Objective:

Recent studies have shown the benefits of extracorporeal membrane oxygenation (ECMO) in supporting adults with severe respiratory or cardiac failure refractory to conventional treatments. The purpose of this investigation was to analyze the utilization of ECMO in adults to identify recent trends within the United States.

Methods:

In a serial cross-sectional study, the utilization rate of ECMO in adults in the United States from 2006 to 2011, as well as the survival rates and costs of hospitalization were analyzed using the Nationwide Inpatient Sample (NIS) from the Healthcare Cost and Utilization Project (HCUP). The survival rates were further analyzed …

A Novel Controlled Release Platform For In Situ Vascular Tissue Engineering, Joseph Thomas Patterson

Yale Medicine Thesis Digital Library

Autologous tissue engineered vascular grafts (TEVGs) are limited by graft stenosis. Small diameter TEVGs implanted as unseeded scaffolds are prone to failure by occlusive luminal proliferation of smooth muscle cells derived from endothelial precursors within a critical period of two weeks. The development, validation, and application novel platform for controlling TEVG performance by local delivery of peptide and/or small molecule therapeutic agents from the TEVG scaffold is presented with insights into the autologous TEVG biology and development.

We hypothesized that inhibition of TGF-βR1 by local delivery of SB-431542, a competitive inhibitor of ALK5/TGFβR1 signaling, is superior to systemic administration of …

Evaluation And Characterization Of The Biomechanical Properties Of Tissue Engineered Vascular Grafts Implanted In The Arterial Circulation, Brooks Van Udelsman

Yale Medicine Thesis Digital Library

We used a murine model to assess the in vivo evolving biomechanical properties of tissue engineered vascular grafts (TEVGs) implanted in the arterial circulation. The initial polymeric tubular scaffold was fabricated from (poly)lactic acid (PLA) and coated with a 50:50 copolymer of (poly)caprolactone and (poly)lactic acid (P[PC/LA]). Following seeding with syngeneic bone marrow derived mononuclear cells, the TEVGs (n=50) were implanted as aortic interposition grafts in wild-type mice and monitored serially using ultrasound. A custom biaxial mechanical testing device was used to quantify in vitro the circumferential and axial mechanical properties of grafts explanted at 3 or 7 months. At …

Identification Of Novel Anti-Brain Tumor-Initiating Cell Compounds Using High-Throughput Screening, Garth William Strohbehn

Yale Medicine Thesis Digital Library

Glioblastoma multiforme is the most common malignant primary intracranial tumor in adults. Despite years of advances in basic science knowledge about this disease including but not limited to cellular hierarchy, genetics, and mechanisms of proliferation and spread, overall survival of patients has remained unmoved for the past fifteen years, and long-term survivors are nearly nonexistent. Barriers to improved treatment occur in the realms of engineering and drug discovery: creation of an efficient delivery vehicle and identification of novel, efficacious small molecule compounds are necessary to achieve survival benefit in this disease.

In the following thesis, I describe efforts made by …

Brainstem Auditory Evoked Potentials And Network Dysfunction In Mild Traumatic Brain Injury, Theresa Lynn Williamson

Yale Medicine Thesis Digital Library

Brainstem Auditory Evoked Potentials and Network Dysfunction in Mild Traumatic Brain Injury

Theresa L. Williamson BS1,2, Amanda R. Rabinowitz PhD1, Victoria E. Johnson MD1, John A. Wolf PhD1, Michael L. McGarvey MD3, Douglas H. Smith MD1 University of Pennsylvania Department of Neurosurgery Philadelphia, PA 191041, Yale School of Medicine New Haven, CT 065112, University of Pennsylvania Department of Neurology Philadelphia, PA 191043

Introduction:

Mild traumatic brain injury (mTBI) challenges clinicians as symptoms do not map in a lesion-specific manner and there is no objective diagnostic measure. Diffuse axonal injury is a main mechanism of injury in mTBI [1, 2]. Injury …

Gaming And Strategic Opacity In Incentive Provision, Florian Ederer, Richard Holden, Margaret Meyer

Cowles Foundation Discussion Papers

It is often suggested that incentive schemes under moral hazard can be gamed by an agent with superior knowledge of the environment, and that deliberate lack of transparency about the incentive scheme can reduce gaming. We formally investigate these arguments in a two-task moral hazard model in which the agent is privately informed about which task is less costly for him to work on. We examine two simple classes of incentive scheme that are “opaque” in that they make the agent uncertain ex ante about the values of the incentive coefficients in the linear payment rule. We show that, relative …

Is The Financial Burden Of Cancer Impacting Survivors' Quality Of Life?, Kathleen Fenn

Yale Medicine Thesis Digital Library

ABSTRACT:

Purpose: Little is known about the relationship between the financial burden of cancer and the physical and emotional health of cancer survivors. We examined the association between financial problems caused by cancer and reported quality of life in two samples of cancer patients.

Patients and Methods: Data from the 2010 National Health Interview Survey (NHIS) were analyzed. A multivariate regression model was used to examine the relationship between the degree to which cancer caused financial problems and the patients' reported quality of life.

In a separate study, a cross-sectional survey was administered at a large academic breast center. Patients …

Group Based Trajectories Of Blood Pressure Components From Adulthood To Elderly In Chinese Workers, Ji Young Kwon

Public Health Theses

Objective: The study aimed to identify trajectories of systolic blood pressure (SBP),

diastolic blood pressure (DBP), and pulse pressure (PP) in Chinese adult workers from ages 18 to 81 years.

Methods: Analysis was conducted with a longitudinal data from Qingdao Port Health and Nutrition Examination Survey. This is a prospective study of employees of China's Qingdao Port Company that was initiated in 1999 and has been collecting annual measure of blood pressure. For our analysis, we focused on the cohort from 2000 to 2011. A group-based trajectory modeling was adopted to identify patterns of blood pressure over the lifespan. The …

Investigating The Link Between Food Insecurity And Disturbances In Eating And Mood, Tayla Radean Ash

Public Health Theses

Food insecurity, the limited or uncertain availability of food, is paradoxically associated with overweight and obesity in the United States. Mechanisms for this are not well understood, but it is hypothesized that unstable food supply leads to disordered eating, such as binge eating, predisposing individuals to obesity. The current study explored both eating and mood disturbances in the context of food insecurity. The primary hypothesis was that food insecurity would be positively associated with both weight and shape concern. Binge eating, depression, and emotional eating were secondary variables of interest. Participants were 276 community volunteers who completed online surveys. The …

I Want Your Sext: Sexting And Sexual Risk In Young Men, Mikaela Jessica Davis

Public Health Theses

Purpose: Sexting, the act of sending or receiving sexually suggestive or explicit messages, photos or videos via mobile phone, and sexual risk have not been studied extensively within a young adult population. The overall aim of this study is to understand the predictors associated with sexting within a low-income, minority, emerging adult, male population and asses the association between sexting behaviors and sexual risk.

Methods: 119, male, heterosexual, young adults participated in a longitudinal study of social networks, health behavior and health outcomes, which included a questionnaire on sexting behaviors and sexual health outcomes. This study is based on the …

Correlates Of Access To Hiv/Aids Care And Knowledge Of Hiv-Positive Serostatus Among People Who Inject Drugs In St. Petersburg, Russia And Kohtla-Järve, Estonia, Sara Heydari

Public Health Theses

This study examined the accuracy of self-reported HIV-positive status as an indicator of entering HIV/AIDS treatment and determined the characteristics and correlates of receiving regular HIV/AIDS care among people who inject drugs (PWID). Data were collected through 1,412 personal interviews conducted in the cities of St. Petersburg, Russia and Kohtla-Järve, Estonia in 2012 and 2013. Overall, in both cities, 81.3% of PWID were accurately aware of their HIV-positive serostatus; in comparison to individual level correlates, structural and service utilization variables such as history of substance abuse treatment and history of incarceration were better determinants of accurate knowledge of HIV serostatus. …

Crisis In Slovenia: Roots, Effects, Prospects, Marko Krzan

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No abstract provided.

Commission Decisions On Hypo Group Alpe Adria In The Light Of Burden-Sharing, Thomas Waldbauer

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No abstract provided.

Governance Charter, Société Financière De Participations Et D'Investissement

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Orgânica E Funcionamento, Bank Of Portugal: Resolution Fund

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No abstract provided.

Annual Report 2013, Banco Espírito Santo

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Bhutan Rma Ar 2013-14, Royal Monetary Authority Of Bhutan

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The Report Of The Evaluation Committee On The Nationalization Of Sns Reaal, Jean Frijns, Rein Jan Hoekstra

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No abstract provided.