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Characterization Of The Macular Choriocapillaris In Dry Age-Related Macular Degeneration Using Swept-Source Optical Coherence Tomography Angiography, Phillip X. Braun

Yale Medicine Thesis Digital Library

The purpose of this study was to characterize further, using swept-source (SS-) optical coherence tomography angiography (OCTA), the relationship between dry age-related macular degeneration (AMD) and the macular choriocapillaris (CC), which may have pathophysiologic and therapeutic implications. It included (1) a topographic analysis to determine if there is a significant relationship between dry AMD stage and macular CC perfusion, and (2) an investigation of the predictive value of macular CC perfusion with respect to geographic atrophy (GA) growth rate.

Study design was retrospective and cross-sectional. A database of 6x6 mm fovea-centered swept-source OCTA images of the CC from eyes with …

Exploring The Role Of Racial Associations Within Life And Psychiatry: The Dissociation Of Explicit And Implicit, Dervin Junior Cunningham

Yale Medicine Thesis Digital Library

Objective: In the past decade there has been increased interest in understanding racial

disparities throughout the world. In doing so, racial associations and biases have been

found to be one potential etiology of these disparities. Particularly in the medical field,

trainings and institutions often have providers rely on self-reported racial associations as

a means to understanding their biases. However, there is little known on how

explicit/self-reported associations relate to implicit associations and clinical behavior,

specifically within mental healthcare. This study aims to understand the relationship

between explicit/self-reported statements and psychiatric providers’ implicit racial

associations.

Methods: Psychiatric providers were asked to …

Uncovering Intratumoral And Intertumoral Heterogeneity Among Single-Cell Cancer Specimens, William Shelton Chen

Yale Medicine Thesis Digital Library

While several tools have been developed to map axes of variation among individual cells, no analogous approaches exist for identifying axes of variation among multicellular biospecimens profiled at single-cell resolution. Developing such an approach is of great translational relevance and interest, as single-cell expression data are now often collected across numerous experimental conditions (e.g., representing different drug perturbation conditions, CRISPR knockdowns, or patients undergoing clinical trials) that need to be compared. In this work, “Phenotypic Earth Mover's Distance” (PhEMD) is presented as a solution to this problem. PhEMD is a general method for embedding a “manifold of manifolds,” in which …

Development And Validation Of A Predictive Model For Oncology Hospital-At-Home, Keval Niraj Desai

Yale Medicine Thesis Digital Library

Background:

Hospital-at-Home (HaH) is a unique care model that allows for the provision of inpatient level care in the patient’s home. HaH has been used to facilitate early discharge from inpatient care or to substitute entirely for an inpatient admission. Hospital-at-Home has been shown to have similar clinical outcomes to inpatient care, while reducing cost and complications associated with inpatient admission. Application of the HaH model to patients with oncologic disease is a promising avenue to reduce healthcare costs while improving patients’ quality of life by increasing time spent at home. A major challenge to implementing a Hospital-at-Home program for …

Natural History Of Thoracic Aortic Aneurysm Associated With Bicuspid Aortic Valve, Thais Faggion Vinholo

Yale Medicine Thesis Digital Library

Hypothesis: Thoracic aortic aneurysm (TAA) is a silent but virulent disease. Bicuspid aortic valve (BAV) is the most common congenital heart disease. The association between BAV and ascending TAA (ATAA) is well described. However, the guidelines for surgical management to treat patients with thoracic aortic aneurysms associated with bicuspid aortic valve (ATAA-BAV) remains controversial. We hypothesized that the surgical management of patients with ATAA-BAV should not differ from the management of those who have ATAA with a trileaflet aortic valve (TAV). Additionally, we suspected that BAVs that are free of stenosis and regurgitation can be spared in the setting of …

External Validation Of An Electronic Phenotyping Algorithm To Detect Attention To Elevated Bmi And Weight-Related Comorbidities In Pediatric Primary Care., Anya Golkowski Barron

Yale Medicine Thesis Digital Library

Pediatric obesity is a growing national and global concern with nearly 1 in 5 children in the U.S. affected [1].The American Academy of Pediatrics endorsed expert committee recommendations in 2007 to assist clinicians in pediatric weight management; however, adherence to these recommendations among primary care providers is suboptimal, and measuring adherence in feasible and pragmatic ways is challenging[2-4]. Commonly used quality measures that rely on billing data alone are an inadequate measure of provider attention to weight status in pediatric populations as they do not capture whether providers communicate about elevated body mass index (BMI) and associated medical risks with …

Aging With Hiv: Biomarkers Of Inflammation And Incident Rheumatologic Disease, Jennifer Leslie Simon Hanberg

Yale Medicine Thesis Digital Library

Chronic Human Immunodeficiency Virus (HIV) infection results in multimorbidity and shortened lifespan. Inflammation and immune dysfunction contribute to these outcomes. The aim of this thesis is (1) to investigate the utility of two inflammatory biomarkers evaluated in other settings (neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR)) for prognostication in patients living with HIV (PLWH) and comorbid inflammatory states; and (2) to compare the frequency and severity with which rheumatologic disease states occur in PLWH to demographically and behaviorally similar uninfected individuals (“controls”).

Three cohorts were created from the Veterans Aging Cohort Study. In each cohort, patients were stratified by presence …

Cd4+ T Cell Recovery And Cerebrospinal Fluid Escape After Antiretroviral Therapy Initiation In Acute Hiv-1 Infection, Ryan Christopher Handoko

Yale Medicine Thesis Digital Library

Introduction: Up to 30% of individuals treated with antiretroviral therapy (ART) during chronic HIV fail to recover CD4 counts to >500 cells/mm3 and up to 10% have quantifiable HIV RNA in cerebrospinal fluid (CSF), termed CSF escape, despite plasma viral suppression < 50 copies/mL. Previous studies have shown that ART initiation in the earliest stage of identifiable infection, acute HIV infection (prior to antibody seroconversion), may limit viral reservoir establishment and systemic immune activation and may improve clinical outcomes. We investigated the frequency, associations, and outcomes of suboptimal CD4 recovery (Project 1) and CSF escape (Project 2) after ART started during acute HIV infection (AHI).

Methods: Thai participants with laboratory-confirmed diagnosis of AHI (Fiebig stages I to V) were started immediately on ART and followed longitudinally with blood sampling, neuropsychological and neurobehavioral testing, and optional lumbar puncture. For Project 1, participants with ≥48 weeks of documented HIV RNA <50 copies/mL were stratified by CD4 count at latest study visit to suboptimal recovery (SR; CD4<350 cells/mm3), intermediate recovery (IR; 350≤CD4<500), and complete recovery (CR; CD4≥500). To assess determinants of CD4 recovery, clinical and laboratory parameters were evaluated at pre-ART baseline and latest study visit. Additional inflammatory and neurobehavioral endpoints were examined at baseline and 96 weeks. For Project 2, participants who underwent blood sampling and optional CSF sampling at weeks 24 and 96 were assessed for CSF escape. HIV RNA was quantified using Roche Amplicor and COBAS TaqMan assays with a lower limit of quantitation of 20-50 copies/mL in plasma and 80 copies/mL in CSF. Participants with quantifiable CSF HIV RNA greater than that in plasma during ART were identified as cases of CSF escape.

Results, Project 1: Of 304 participants (96% male, median 26 years old) evaluated after median 144 …

Acute And Chronic Liver Disease: Lessons Learned From Retrospective Cohort Studies, Ysabel C. Ilagan-Ying

Yale Medicine Thesis Digital Library

Current trends in liver disease are changing due to increased access to pharmacotherapies and the worsening burden of obesity. Large, observational cohort studies are a common tool in clinical and epidemiological research to determine risk for patients that may have experienced an exposure of interest. Past studies have largely examined risk factors for liver disease in patients with cirrhosis or fatty liver disease. We utilized retrospective cohort studies in a disease-agnostic approach and aimed to characterize risk for two increasingly prevalent populations: patients with severe acute liver injury and those with liver fibrosis progressing to hepatocellular carcinoma (HCC).

First, we …

Reversal Of Warfarin-Associated Coagulopathy: Prothrombin Complex Concentrates Versus Fresh Frozen Plasma In Elderly Patients Presenting With Intracranial Hemorrhage, Shunella Grace Lumas

Yale Medicine Thesis Digital Library

Background: Patients on warfarin with traumatic intracranial hemorrhage (ICH) often require pharmacological reversal of warfarin-induced coagulopathy. We compared outcomes among patients who received 4-factor prothrombin complex concentrate (PCC), fresh frozen plasma (FFP) or no reversal to assess the real-world impact of PCC on elderly patients with traumatic intracranial hemorrhage on warfarin.

Study Design: This was a retrospective analysis of 150 patients on preinjury warfarin. Data was abstracted from the electronic medical record (EMR) of an academic level 1 trauma center for patients age 65 years and greater on warfarin therapy admitted with a traumatic ICH between January 2013 and December …

Differential Response To Rituximab In Anti-Achr And Anti-Musk Positive Myasthenia Gravis Patients, Tess Litchman

Yale Medicine Thesis Digital Library

Response to immunomodulatory therapies in myasthenia gravis (MG) can be variable. A subset of MG patients remains refractory to conventional agents. B-cell targeted therapy with rituximab has demonstrated a durable response in treating refractory myasthenia gravis (MG). This study compares the response to rituximab between patients with acetylcholine receptor autoantibody positive (AChR+) and muscle-specific kinase autoantibody positive (MuSK+) MG.

This retrospective study included 33 patients with either AChR+ or MuSK+ MG who were treated with rituximab from 05/31/2003 to 05/31/2017. Pretreatment and post-treatment immunotherapy regimens, clinical symptoms, and examination findings were evaluated.

Median MGFA Class of II at baseline improved …

Cbpr 2.0 - A Community-Based Participatory Research Approach To Program Scaling In Maternal Mental Health: Responding To Community Risk Factors For Maternal Depression While Replicating New Haven Moms To Bridgeport And New York City, Sonia Taneja

Yale Medicine Thesis Digital Library

“Community-Based Participatory Research 2.0” refers to a methodologic framework describing the process of scaling the New Haven MOMS Partnership, an existing participatory intervention, to new sites in Bridgeport, Connecticut and New York City.

Following a community-based participatory approach to the process of program differentiation within implementation science, informal team canvassing identified core components of the program: neighborhood hub sites, community mental health workers, and utilization of incentives. Community needs assessments were prepared, distributed, and analyzed to identify flexible program components. Assessments were tailored to specific communities and included the Center for Epidemiologic Studies-Depression Scale (CES-D), the Oslo-3 perceived social support …

How Exposure To Mass Incarceration Is Associated With The Wellbeing Of Individuals And Families, Ram Sundaresh

Yale Medicine Thesis Digital Library

Mass incarceration in America has far-reaching effects on individuals and their families. Although a large body of evidence has described the effects of incarceration on specific physical and social outcomes, there is almost no research on its effects on broader wellbeing, a more holistic measure of lived experience that can more sensitively reflect social welfare and structural vulnerability. The goal of this thesis is to assess the association between exposure to the American system of mass incarceration and wellbeing. We examine individual-level exposure to the broader criminal legal system (CLS), including police stops, arrests, and incarceration, and family-level exposure to …

Lifestyle Factors Associated With Neoadjuvant Chemotherapy Outcomes In Breast Cancer, Ilana Usiskin

Yale Medicine Thesis Digital Library

Lifestyle factors such as lower BMI, higher levels of physical activity, and increased fruit and vegetable intake, have been shown to benefit breast cancer survival, but the association between these factors and the pathologic complete response (pCR) to chemotherapy, has not been studied. We investigated whether lifestyle factors including BMI, physical activity, diet and alcohol use are associated with pCR from neoadjuvant chemotherapy for breast cancer treatment. Secondarily, we assessed whether the relative dose intensity (RDI) of neoadjuvant chemotherapy is associated with pCR.

We conducted a retrospective study of women treated with neoadjuvant chemotherapy for stage I-III breast cancer between …

The Development And Validation Of A Novel Ichthyosis Severity Assessment Instrument, Qisi Sun

Yale Medicine Thesis Digital Library

Abstract: THE DEVELOPMENT AND VALIDATON OF A NOVEL ICHTHYOSIS SEVERITY ASSESSMENT INSTRUMENT. Qisi Sun, Amy Paller, Keith A. Choate. Department of Dermatology, Genetics & Pathology, Yale University School of Medicine, New Haven, CT.

Ichthyosis clinical trials require reliable, validated severity assessments to identify appropriate subjects and quantify treatment outcomes. There is no validated scale to measure ichthyosis severity across the entire body. We aim to create and validate a comprehensive and user-friendly instrument to measure total body ichthyosis severity in adults and children.We divided the body into 10 regions to score special regions of interest. Likert scales (0-4) were established …

Statin Therapy Associated With Improved Thrombus Resolution In Patients With Deep Vein Thrombosis, Charles Hsu

Yale Medicine Thesis Digital Library

Objectives: Statin therapy has been associated with a decreased incidence of venous thromboembolism (VTE) in clinical trials and enhanced thrombus resolution in animal models. The effect of statins on thrombus resolution has not been reported clinically. This study investigates the association of statins with thrombus resolution or improvement in patients with deep vein thrombosis (DVT).

Methods: A retrospective study of the electronic medical records of consecutive adult patients presenting with lower extremity DVT was performed. Patients were divided into two groups based on statin therapy (statin group) or lack thereof (non-statin group). The two groups were compared with respect to …

Developing Normal Placental Growth Curves Using 2-D Ultrasound In A Zimbabwe Maternity Hospital, Belinda Juliana Nhundu

Yale Medicine Thesis Digital Library

The placenta aids in providing nutrients and oxygen from the mother to the developing fetus. Using a validated tool to measure Estimated Placenta Volume (EPV) prior studies have shown a small EPV predicts low birthweight in pregnant women in US institutions. The aim of this study was to develop Estimated Placental Volume (EPV) normative curves for a population of women in Zimbabwe across a range of gestational ages. Additionally, to determine if low EPV measurements were predictive of IUFD or stillbirth. From January to June of 2019 a total of 150 women at Mbuya Nehanda Maternity Hospital in Harare Zimbabwe …

Cerebral Autoregulation-Based Blood Pressure Management In The Neuroscience Intensive Care Unit: Towards Individualizing Care In Ischemic Stroke And Subarachnoid Hemorrhage, Andrew Silverman

Yale Medicine Thesis Digital Library

The purpose of this thesis is to review the concept of cerebral autoregulation, to establish the feasibility of continuous bedside monitoring of autoregulation, and to examine the impact of impaired autoregulation on functional and clinical outcomes following subarachnoid hemorrhage and ischemic stroke. Autoregulation plays a key role in the regulation of brain blood flow and has been shown to fail in acute brain injury. Disturbed autoregulation may lead to secondary brain injury as well as worse outcomes. Furthermore, there exist several methodologies, both invasive and non-invasive, for the continuous assessment of autoregulation in individual patients. Resultant autoregulatory parameters of brain …

Cash Reserve And Liquid Asset Requirements, Bank Of Jamaica

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No abstract provided.

Denmark's Guarantee Scheme (Denmark Gfc), Keni Sabath

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No abstract provided.

Main Street Lending Program Overview, Federal Reserve System: Federal Reserve Bank Of Boston

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No abstract provided.

Vendors Used For Mslp, Federal Reserve System: Federal Reserve Bank Of Boston

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No abstract provided.

Municipal Liquidity Facility, Federal Reserve System: Federal Reserve Bank Of New York

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No abstract provided.

Municipal Liquidity Facility Form Documents And Certifications, Federal Reserve System: Federal Reserve Bank Of New York

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No abstract provided.

Main Street Lending Program - Landing Page, Federal Reserve System: Federal Reserve Bank Of Boston

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No abstract provided.

Instructions For Sveriges Riksbank, Sweden: Riksdag

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No abstract provided.

Operations, Bank Of Canada/Central Bank Of Canada/La Banque Du Canada

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data showing the allotments and auctions results for the BAPF

Transaction-Level Data, Bank Of Canada/Central Bank Of Canada/La Banque Du Canada

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data showing the Bankers' Acceptances purchased under the BAPF

Cash Management Bond Buyback Results, Bank Of Canada/Central Bank Of Canada/La Banque Du Canada

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data showing the GoC securities purchased and operations conducted under cash management buybacks

First Draw Ppp Loan, Small Business Administration

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No abstract provided.