Digital Commons Network^™

The Spectrum Of Cutaneous And Systemic Manifestations Associated With Anti-Pm/Scl, Sabrina Maariyah Saeed

Yale Medicine Thesis Digital Library

Anti-PM/Scl is a rare anti-nuclear autoantibody first identified in patients with polymyositis and the scleroderma/myositis overlap syndrome. Due to its low prevalence, the clinical manifestations associated with anti-PM/Scl remain incompletely understood. This study aims to further delineate the phenotype associated with anti-PM/Scl. Anti-PM/Scl positive patients treated at Yale New Haven Health Systems between 2012 and 2024 were retrospectively identified. Chart review was conducted to characterize demographics, skin findings, and extracutaneous manifestations associated with the antibody. Anti-PM/Scl was detected in 64 of the 2867 patients tested. Fifty-seven of these patients met inclusion criteria (i.e. sufficient availability of medical records and age …

Predictive Modeling Of Transfusion After Cranial Vault Remodeling For Pediatric Craniosynostosis, Paul Serrato

Yale Medicine Thesis Digital Library

Background: Cranial vault remodeling (CVR) for pediatric craniosynostosis is associated with postoperative blood transfusion, yet determinants of transfusion risk remain incompletely defined. Estimating transfusion risk preoperatively could support more personalized blood management planning for this population.Research Aims: To evaluate whether supervised machine learning models can reliably predict postoperative transfusion risk following CVR compared to traditional logistic regression and to identify the most informative predictors of those models. Hypothesis/Question: We hypothesized that ensemble machine learning approaches (e.g. random forest, extreme gradient boosting) would match or outperform logistic regression in predicting transfusion by leveraging nonlinear associations and higher-order interactions across patient, procedural, …

Vascular Identity And Remodeling: Sox17 Mediates Arteriovenous Fistula Maturation, Andrew William Schwartz

Yale Medicine Thesis Digital Library

Background/Scientific Premise Mature arteriovenous fistulae (AVF) are the gold standard vascular access allowing hemodialysis for patients with end-stage kidney disease. The rate of AVF failure remains high, reflecting an incomplete understanding of the biology of AVF maturation and failure. Sox17 is a transcription factor indispensable for the acquisition and maintenance of endothelial arterial identity. Because endothelial cells (EC) acquire dual arteriovenous identity after AVF creation, we determined whether Sox17 mediates venous remodeling in AVF. Research Aims This study aims to characterize the degree of Sox17 expression within the venous outflow tract after AVF creation in humans and in a mouse …

Leveraging Large Language Models To Augment Emergency Department Chest Pain Decision-Making, Conrad Safranek

Yale Medicine Thesis Digital Library

Background - Large language models (LLMs) can convert unstructured clinical text into structured, computable signals, creating a new class of clinical decision support (CDS) that is tightly coupled to real documentation workflows. This is especially relevant in emergency medicine, where decisions must be made rapidly under uncertainty, often with key information scattered across notes, reports, and prior encounters. Emergency department (ED) chest pain evaluation is a prototypical setting for this problem: it is high-volume, high-stakes, operationally costly, and driven by pathway-based triage and risk stratification, yet care remains heterogeneous across clinicians and teams. As health systems and electronic medical record …

Disparities In Utilization Of Glp-1 Receptor Agonists And Sglt2 Inhibitors Across Social Determinants Of Health: A Systematic Review And Meta-Analysis, Nisarg Shah

Yale Medicine Thesis Digital Library

Background: SGLT2 inhibitors (SGLT2i) and GLP-1 receptor agonists (GLP-1RA) significantly reduce cardiovascular and metabolic risk in type 2 diabetes, cardiovascular disease, and obesity. Yet real-world utilization remains inconsistent, and emerging evidence suggests that social determinants of health (SDOH) may contribute to unequal access and prescribing.Research Aims: The extent and drivers of these disparities have not been systematically characterized, so we conducted a systematic review and meta-analysis to assess whether SDOH—socioeconomic status (SES), insurance status, education, geography, and neighborhood deprivation index (NDI)—and demographic factors—race and sex—are associated with differential utilization of SGLT2i or GLP-1RA. Question: To what extent are SES, insurance …

Association Between Baseline Prostate Mri Pi-Rads And Risk Of Gleason Upgrade During Active Surveillance, Shayan Smani

Yale Medicine Thesis Digital Library

Background: Active surveillance (AS) is the preferred management strategy for men with favorable-risk prostate cancer, aiming to avoid overtreatment while preserving oncologic safety. However, a meaningful proportion of patients experience Gleason Grade Group (GG) upgrading during follow-up, reflecting either biological progression or baseline misclassification. Multiparametric prostate magnetic resonance imaging (MRI), interpreted using the Prostate Imaging–Reporting and Data System (PI-RADS), is well established for detecting clinically significant prostate cancer at diagnosis, yet its prognostic role during AS remains incompletely defined. Specifically, whether baseline PI-RADS scores independently predict the risk of GG upgrading among men managed with AS has not been systematically …

Impact Of Pharmacologic Interventions On Cerebral Autoregulation After Aneurysmal Subarachnoid Hemorrhage, Kaitlyn Alana Stoehr

Yale Medicine Thesis Digital Library

Background: Impaired cerebral autoregulation following aneurysmal subarachnoid hemorrhage (aSAH) increases susceptibility to secondary brain injury from systemic blood pressure (BP) fluctuations and is associated with delayed cerebral ischemia (DCI) and poor clinical outcomes. Oral nimodipine is the first-line treatment to prevent DCI after SAH but can result in BP reduction. In cases of refractory vasospasm, endovascular rescue therapy (ERT) with intra-arterial vasodilators or angioplasty may be employed. The effects of these interventions on cerebral autoregulation after aSAH are unknown.

Research Aims: To understand the impact of pharmacologic interventions on cerebral autoregulation following aSAH, we conducted two observational trials. We evaluated …

“Treatment Not Tents:" The Medicalization Of Homelessness In California’S 2022-2025 Legislative Agenda, Elana R. Straus

Yale Medicine Thesis Digital Library

Modern homelessness emerged in the 1980s due to political choices that cut the social safety net and decreased the availability of affordable housing. Medicalized views of homelessness that frame homelessness as driven by individual pathology, particularly mental illness and addiction, emerged in research, media, and politics at this time. Homelessness has persisted since and remains particularly high in regions, including California, where the housing markets are most constrained. In this context, California advanced multiple legislative changes between 2022 and 2025 that increased pathways to involuntary treatment and criminal-legal control over people experiencing homelessness. In this thesis, I demonstrate how legislators …

What You See Is What You Learn: National Variation In Emergency Medicine Residency Environments, Carlisle Topping

Yale Medicine Thesis Digital Library

Background: The evolution of Emergency Medicine (EM) residency programs over the past two decades has been marked by significant growth and changes in clinical practice environments. Concerns have emerged regarding whether recently founded programs, non-teaching status programs, and for-profit institutions provide adequate training for EM residents. This study evaluates EM training programs using clinical education outcomes such as clinical volumes, acuity exposure, and board pass rates based on key program characteristics including founding year, teaching status, hospital ownership, and program duration.Methods: We conducted an observational analysis of linked datasets encompassing EM residency data from the Accreditation Counsil for Graduate Medical …

Evaluating Outcomes Of Coronary Revascularization In Solid Organ Transplantation Candidates, Joshua Stephen Vogel

Yale Medicine Thesis Digital Library

BackgroundKidney and liver transplantation significantly improve life expectancy and quality of life in patients with end-stage renal disease (ESRD) or end-stage liver disease (ESLD). Due to the scarcity of organs, transplant centers face high scrutiny of outcomes and employ thorough preoperative evaluation for potential candidates. Patients with ESRD and ESLD often have high comorbidity burdens, including coronary artery disease (CAD), and since transplant is a major surgery, evaluating and reducing cardiac risk is a key component of preoperative evaluation and optimization. However, the role of coronary revascularization in transplant candidates with stable CAD is uncertain, leading to variation in clinical …

Discoid Lupus: Retrospective Analysis Of Epidemiology, Clinical Features, Autoimmunity Profiles, And Treatment Patterns, Aster Workineh

Yale Medicine Thesis Digital Library

Cutaneous lupus erythematosus (CLE) produces lifelong morbidity through visible, functionally consequential skin disease and accrued damage. In discoid lupus erythematosus (DLE), alopecia and dyspigmentation at hair-bearing and cosmetically sensitive sites are frequently cited as major drivers of reduced quality of life1,2. Despite this burden and the risk of progression to systemic lupus erythematosus (SLE), CLE has no FDA-approved therapy, and treatment evidence remains limited by the small number of CLE-specific datasets and trials focused on CLE-trials. Many therapeutic decisions for CLE are extrapolated from SLE despite the fact that CLE subtypes differ in morphology, histopathology, and reported immune signatures3,4. We …

Comparison Of Clinical Outcomes By Tube Type And Size Following Percutaneous Radiologic Gastrostomy: A 10-Year Retrospective Study, Diane Zhao

Yale Medicine Thesis Digital Library

PurposeTo compare the complication rate and time to the first reintervention of pull-type and push-type gastrostomy tubes placed under radiologic fluoroscopy guidance in adults. Materials and Methods During a 10-year period (2012-2022), 2341 adult patients underwent percutaneous radiological gastrostomy at our institution, and their charts were reviewed. 896 (39%) procedures were done with the push method, and 1393 (61%) were done with the pull method. Results Rates of significant hemorrhage at the surgical site, leakage at the site, and malplacement of the g-tube were not found to be statistically different between the two groups. However, push g-tubes were significantly more …

The Strength Of Association Between Surrogate Markers And Clinical Outcomes Used By The Fda For Chronic Disease Indications, Samuel Yoon

Yale Medicine Thesis Digital Library

The U.S. Food and Drug Administration (FDA) has traditionally required the use of clinical outcome measures as clinical trial endpoints to support the approval of new drugs. However, clinical outcome trials are typically large, lengthy, and expensive. To expedite this process, Congress has enacted several regulatory programs to facilitate FDA approval of new drugs on the basis of surrogate markers, endpoints that are reasonably likely to predict clinical benefit, as trial endpoints. However, the evidence demonstrating the validity and reliability is mixed, creating uncertainty for patients and physicians about the true clinical benefits of new drugs approved on the basis …

Prevalence, Reporting, And Management Of Interstitial Lung Abnormalities And Incidental Findings On Lung Cancer Screening, Tian Wei Yu

Yale Medicine Thesis Digital Library

Background: Low dose computed tomography for lung cancer screening frequently identifies incidental findings. The most frequent and consequential thoracic and upper abdominal incidental findings include interstitial lung disease (ILD), interstitial lung abnormalities (ILA), emphysema, coronary artery calcification, aortic calcification, aortic aneurysm, and adrenal lesions. Many of these abnormalities carry prognostic and therapeutic implications. However, the prevalence of these findings, variation in reporting practices, and downstream management within integrated health systems remain incompletely characterized, particularly for ILA and ILD.

Research Aims: We aimed to quantify the prevalence of selected incidental findings on lung cancer screening CT across a large multi-hospital health …

A Questionnaire Assessing Attitudes And Readiness For Hiv Pre-Exposure Prophylaxis Therapy For Community Members At-Risk For Hiv Acquisition In Liberia, Yishak Bedaso

Yale Medicine Thesis Digital Library

AbstractA Questionnaire Assessing Attitudes And Readiness For HIV Pre-Exposure Prophylaxis Therapy For Community Members At-Risk For HIV Acquisition In Liberia Yishak Bedaso;1 Jessica Tuan, MD, MS;2 Yassah M. Barclay-Korboi;3 Onyema Ogbuagu MBBCh, FACP, FIDSA4 Affiliation: 1. Yale School of Medicine, New Haven, CT, USA 2. Columbia University Vagelos College of Physicians and Surgeons, Department of Infectious Diseases, New York, NY, USA 3. JFK Memorial Hospital, Monrovia, Liberia. 4.Yale Antivirals & Vaccines Research Program, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA; Despite how effective Pre-exposure prophylaxis (PrEP) is in preventing HIV, uptake among women in sub-Saharan …

Estimating Prep And Voluntary Medical Male Circumcision Prevalence In Three High Hiv Burden Countries, Rose Grace Bender

Yale Medicine Thesis Digital Library

Understanding the impact of specific biomedical interventions is crucial for optimizing HIV prevention strategies. In this study, we estimate of the prevalence of voluntary medical male circumcision (VMMC) and lay out a framework for estimating preexposure prophylaxis (PrEP) in the three high-burden sub-Saharan African countries of Malawi, South Africa, and Zimbabwe. For VMMC, we use a cohort-based simulation framework to model circumcision prevalence in all males over time, allocating VMMC count data to cohorts over time. Model outputs are compared with survey and campaign data, and two parameters, the initial background circumcision prevalence and the age distribution of VMMC procedures, …

Infrainguinal Revascularization Outcomes And Frequency Of Reinterventions Using National Registries, Warren James Carter

Yale Medicine Thesis Digital Library

Lower extremity revascularization (LER) is central to the management of peripheral arterial disease (PAD), especially in patients with the most severe form of disease, chronic limb threatening ischemia (CLTI). Conduit selection is critical for durability of infrainguinal bypass with single segment greater saphenous vein (SSGSV) now widely accepted as the gold standard conduit. Published studies of initial LER have largely focused on the durability of the procedures by examining major amputation and reintervention as primary outcomes in addition to mortality. Even though reinterventions are common after LER, differences in the magnitude and frequency of reintervention after initial revascularization have not …

A Machine Learning Tool For Predicting End-Stage Renal Disease Within One-Year Of Heart Transplantation, Cole Tetsuo Cassady

Yale Medicine Thesis Digital Library

End-stage renal disease (ESRD) after heart transplantation is a common complicationwhich increases risk of mortality. Simultaneous heart-kidney transplantation (SHKT) lowers this risk. Eligibility for SHKT relies on pre-transplant estimated glomerular filtration rate (eGFR) with ongoing discussion regarding optimal eligibility guidelines. We present an eXtreme Gradient Boosting Decision Tree (XGBoost) machine learning model for predicting ESRD within one year of heart transplant procedure in candidates ineligible for kidney-alone transplantation. The model was trained using readily available elements from pre-transplant evaluation and performed with an area under the receiver operating characteristic curve (AUROC) of 0.71. The model discrimination was statistically significantly better …

Epidermal Differentiation Disorders Across The Lifespan: Growth, Ophthalmologic, And Perinatal Manifestations, Caroline Echeandia-Francis

Yale Medicine Thesis Digital Library

Epidermal differentiation disorders (EDDs) are a heterogeneous group of inherited skin diseases characterized by impaired epidermal barrier function, scaling, and erythema. Although substantial progress has been made in identifying the genetic causes of EDD, long-standing clinical observations—including impaired growth, ectropion, and increased rates of preterm birth—remain poorly characterized across genotypes. The prevalence, severity, and clinical significance of these manifestations have not been systematically evaluated in large, genotype-stratified cohorts, limiting the ability to provide anticipatory guidance and tailored clinical care. This thesis seeks to (1) characterize growth trajectories in children with EDD and determine genotype-specific patterns of growth impairment; (2) assess …

Regional Inequities In Colon Cancer Surgical Care: Treatment Delay Patterns Across U.S. Facilities, Rushabh Hemang Doshi

Yale Medicine Thesis Digital Library

AbstractBackground/Scientific Premise: Colon cancer represents a significant public health burden in the United States, ranking as the third most common and second deadliest cancer. Timely surgical resection is critical for optimal survival in non-metastatic disease, yet persistent racial, insurance, and geographic disparities in access to care may contribute to treatment delays. While treatment delay has been established as a critical quality metric, regional variation in surgical delays for colon cancer and how patient-level disparities manifest across different U.S. regions remain poorly understood. Understanding these geographic patterns is essential, as healthcare systems, patient populations, access barriers, and state-level policies differ substantially …

Prevalence Of K13 Mutant Malaria Parasites In Busia, Uganda, Ahmed Elzamzami

Yale Medicine Thesis Digital Library

Artemisinin derivatives form the backbone of all antimalarial combination therapies usedworld-wide. Resistance to this critical drug class is a growing problem in the highest malaria transmission regions of the world. First detected in southeast Asia, independent mutations conferring partial resistance to artemisinin’s have now emerged in East Africa.27, 32 Retrospectively, these mutations have been detected as early as 2016 in Uganda.36 Previous work by the Parikh lab highlights the efficacy of 3-day vs 5-day artemether-lumefantrine treatment regimen for uncomplicated malarial episodes in Busia, Uganda in 2019.41 Infections were followed and classified as recrudescent, a reinfection, SBP1 slow clearing, or an …

An Exploration Of Student Approaches Towards Note-Taking In Medical School, Salah Eldein Elkattawy

Yale Medicine Thesis Digital Library

During medical school, students are exposed to a vast amount of knowledge they are expected to learn, understand, and apply to the care of patients. Various study strategies have been adopted by students over the years to facilitate this process, such as spaced repetition flashcards, the use of learning aids such as mnemonic devices, and the use of third-party resources to supplement their learning in the classroom. Instructors have also recognized the value in certain formats of classroom instruction, such as case-based learning or team-based learning, in keeping students more engaged and in reinforcing their learning in an interactive manner. …

Influence Of Demographics On Research Participation In Female Patients Undergoing Ambulatory Surgery, Tiana Fernandez

Yale Medicine Thesis Digital Library

Background: Historically, research on women and minorities has consisted of unethical experimentation, human rights violations, and crimes against humanity. Numerous examples can be found throughout the past two centuries, including the exposure of pregnant women to radioactive iron in the Tennessee-Vanderbilt Nutrition Project (TVNP), failure to treat cervical carcinoma in situ in the Unfortunate Experiment, surgical experimentation on female slaves by Dr. J. Marion Sims, failure to treat syphilis in the Tuskegee Syphilis Study, intentional exposure to and subsequent failure to treat sexually transmitted diseases in Guatemala, collection of biospecimens from Henrietta Lacks, and nontherapeutic experimentation on minority children in …

Repurposing Ezetimibe As A Therapeutic For Parkinson's Disease: Evaluating The Therapeutic Potential And Probing For A Mechanism, Brian Hilton

Yale Medicine Thesis Digital Library

Neurologic disease is the leading cause of disability globally and Parkinson’s disease (PD) has been the fastest growing neurologic brain disease over the last several decades. Despite the immense burden of PD on patients and society, there has yet to be an efficacious disease-modifying therapy. Investigation of candidate pharmaceuticals that have already been approved by the FDA for other conditions might provide an expedited path to the advent of disease-modifying therapy. There is a rich history of drug repurposing for symptomatic therapy for PD, with amantadine as the preeminent example. In order to identify candidate therapeutics for possible repurposing, an …

Rns-Based Early Prediction Of Antiseizure Medication Efficacy, Joshua Hobbs

Yale Medicine Thesis Digital Library

Drug-resistant focal epilepsy accounts for a significant portion of patients with epilepsy. These patients many times experience persistent seizures despite several ASM (anti-seizure medication) trials. RNS (Responsive neurostimulation) has demonstrated efficacy in reducing seizure frequency in patients that are resistant to drug trials, and provide continuous intracranial electroencephalographic monitoring. This longitudinal data may offer an opportunity to identify potential early biomarkers of ASM trial effectiveness, which could lead to quicker optimization of pharmacological therapy. This study in particular evaluated whether early changes in RNS-detection of seizure activity can predict a clinical response to ASMs in patients with drug-resistant focal epilepsy. …

Associating Inflammatory Dermatoses And Gynecological Disorders Using The National Institutes Of Health’S All Of Us Research Program, Christine Myriam Hodelin

Yale Medicine Thesis Digital Library

There remains a gap in the knowledge about the relationship between inflammatory disorders and common gynecological disorders, despite significant quality of life concerns for both. We examined the association between hidradenitis suppurativa (HS) and endometriosis, and the association between atopic dermatitis (AD) and uterine leiomyomas, both with a cross-sectional study using electronic health record and survey data from the National Institutes of Health’s All of Us Research Program.

The All of Us Research Program has a large United States-based cohort and focuses on traditionally underrepresented populations in research. We compared cases and controls, all assigned female at birth, using Pearson’s …

Facial Harmony And Gender Congruence: Patient-Reported Outcomes Of Gender-Affirming Facial Surgery Using The Gender-Q And Gpsq, Helia Hosseini

Yale Medicine Thesis Digital Library

Background:Gender-affirming facial surgery (GAFS) addresses gender dysphoria by aligning facial features with gender identity, with historical emphasis on refining the upper facial third to render patients more attractive and feminine. The GENDER-Q, a novel patient-reported outcome measure (PROM), evaluates aesthetic, functional, and psychosocial outcomes, complementing the Gender Preoccupation and Stability Questionnaire (GPSQ) to assess effects of GAFS in this study. Methodology: Survey data from 86 patients was analyzed using GENDER-Q and GPSQ scores. Higher GENDER-Q scores indicated improved outcomes, whereas lower GPSQ scores reflected reduced gender dysphoria. Pre- and post-operative outcomes were compared using paired and unpaired t-tests. Spearman’s correlation …

A Spatial Transcriptomic Atlas And Cellular Lineage-Based Analysis Of Chondroblastoma, Will Jiang

Yale Medicine Thesis Digital Library

Chondroblastoma is a benign primary bone tumor with controversial cellular origin. Although bearing the name “chondroblastoma”, this musculoskeletal tumor has faced controversy as to whether chondroblasts are chondrocytes. Moreover, its cellular composition can make it difficult to distinguish amongst its mimics including giant cell tumor of bone, chondrosarcoma, and chondromyxoid fibromas.

This thesis aims to characterize the transcriptomic expression atlas of human chondroblastoma to better define the gene expression profile and diagnostic expression markers of chondroblastoma. Secondarily, this thesis aims to identify the lineage progression and cellular composition of chondroblastoma using spatial and temporal patterning analysis.

Histologically confirmed samples of …

Trends, Predictors, And Cerebrovascular Outcomes Of Vertebral Artery Injury In Cervical Fractures, Rahul Jayaram

Yale Medicine Thesis Digital Library

Background and Scientific Premise: Cervical spine trauma is a common emergencydepartment presentation, and vertebral artery injury (VAI) is a potentially occult but serious complication associated with posterior circulation stroke. Identification of patients at risk remains challenging due to subtle presentations, variable screening practices, and limited prior data. Research Aims: The aims of this study were to characterize temporal trends in VAI detection among adult patients presenting to the emergency department with cervical spine fractures between 2010 and 2022, identify independent demographic, clinical, and injury-related predictors of VAI, and evaluate the association between VAI and ischemic stroke within ninety days of …

Prevalence, Predictors, And Consequences Of Postoperative Dysphagia After Aortic Surgery, Andrew Joseph Johnson

Yale Medicine Thesis Digital Library

Prevalence, Predictors, and Consequences of Postoperative Dysphagia After Aortic SurgeryAndrew Johnson and Ronny Munoz-Acuna, M.D., Department of Anesthesiology, Yale School of Medicine, New Haven, CT 06510. Abstract Background: Postoperative dysphagia is an underrecognized complication following cardiothoracic surgery and is associated with aspiration, prolonged hospitalization, and adverse clinical outcomes. Patients undergoing complex aortic surgery may be at particularly high risk due to prolonged mechanical ventilation, extensive airway instrumentation, and neurologic vulnerability. Data describing the prevalence, predictors, and clinical consequences of postoperative dysphagia in this population remain limited. Research Aim: This study consisted of three aims: first, to determine the prevalence and …