Digital Commons Network^™

Polarization Of Cystic Fibrosis Macrophages Is Dysregulated, Evan Jacob Levy

Yale Medicine Thesis Digital Library

We hypothesize that intrinsic defects in cystic fibrosis (CF) macrophages affect their ability to adequately respond to extracellular stimuli, affecting their phenotypic response and contributing to a hyper-inflammatory state.

Peripheral blood-derived monocytes from healthy donors (HD) (n=10) as well as CF subjects (n=10) were differentiated into macrophages using RPMI media with 50 ng/mL of MCSF for 10 days. Cells were treated with 100 ng/mL of LPS plus 20 ng/mL of INF-gamma to activate the M1 phenotype or 20 ng/mL of IL-4 to activate the M2 phenotype. Cells were treated for 24 hours in preparation for RNA isolation and 3 hours …

Pblcloud Virtual Patient Simulator: Enhancing Immersion Through Natural Language Processing, Pierre Rodricus Martin

Yale Medicine Thesis Digital Library

PBLCLOUD VIRTUAL PATIENT SIMULATOR: ENHANCING IMMERSION THROUGH NATURAL LANGUAGE PROCESSING

Pierre Martin M.Ed.(1), Lisa DelSignore M.D.(2), and Traci A. Wolbrink M.D. M.P.H.(2)

(1)Yale School of Medicine (2)From the Division of Critical Care Medicine, Department of Anesthesia, Perioperative and Pain Management, Boston Children’s Hospital and the Department of Anesthesia, Harvard Medical School, Boston, MA, USA. (Sponsored by JH, Department of Pediatrics, Yale School of Medicine)

Virtual patient simulation has been utilized to teach interviewing skills, often employing selection-based methods (e.g., multiple-choice lists and menu-based prompts) to simulate doctor-patient conversations. Users have evaluated these systems as inauthentic, which can diminish user immersion …

Electronic Medical Records For Trauma Surveillance In South Africa: The Case Of Khayelitsha Hospital, Emmanuel Chibuikem Ohuabunwa

Yale Medicine Thesis Digital Library

Electronic Medical Records (EMRs) have shown benefit for clinical, organizational, and societal outcomes(1). In South Africa, the desire for effective record keeping will continue to rise with increasing trauma and infectious disease rates. Recognizing this, the Western Cape government in 1999 signed a tender to rollout Clinicom EMR, an online storage system for paper records, to all hospitals within the province(2).

In 2012, Khayelitsha Hospital (KH) was opened with the Clinicom EMR installed. In 2013, KH received the ministerial award for clinical excellence as a result of the effective EMR rollout. Due to a high incidence of violence around Khayelitsha, …

Investigating Hereditary Breast And Ovarian Cancer (Hboc) Syndrome In Trinidad And Tobago, Gerneiva Parkinson

Yale Medicine Thesis Digital Library

Trinidad and Tobago (T&T) is a Caribbean island with a population of approximately 1.3 million. T&T has one of the highest breast cancer mortality rates in the region. Notably, a large proportion of breast cancer cases in T&T appear to occur at a young age, as nearly 36% of breast cancers are diagnosed under the age of 50. It is known that a younger age at diagnosis can be associated with Hereditary Breast and Ovarian Cancer syndrome (HBOC). However, the prevalence of HBOC mutations remains unknown in T&T, as accessible health services for genetic counseling and testing in T&T currently …

The Impact Of Telemedicine On Teamwork And Communication, Workload, And Clinical Performance: A Randomized Controlled Trial, Lucas Christopher Butler

Yale Medicine Thesis Digital Library

Telemedicine can be used to provide specialty care to critically ill patients in rural and community hospital settings. However, the effects of this technology on quality of care are unclear. The objectives of this study were to evaluate the impact of a telepresent team leader on teamwork and communication, workload, and quality of care during a simulated pediatric resuscitation, and to explore provider perspectives on the use of telemedicine during resuscitations.

Twenty standardized teams (lead MD + bedside MD + two confederate clinical team members) were randomized to have a telepresent or an in-person leader. Telepresent leaders were connected via …

The Md/Mba Effect: A Study Of How Residency Directors Perceive Applicants With An Mba, A Ten-Year Comparison Study From 2006 To 2016, Jay Pravin Patel

Yale Medicine Thesis Digital Library

Background: Over the past decade, the landscape of healthcare has changed

dramatically, demanding the close integration of business and management with the

delivery of clinical care. In response, there has been a continuation of the trend towards

additional training for physicians through an MBA program that has been seen over the

last thirty years. However, some medical students have encountered some negative

perceptions voiced by senior physicians about MD/MBA training. As most MD/MBA

joint-degree candidates consider clinical careers, it is vital to understand the views of

residency program directors who hold the gates to graduate medical education.

Purpose: Therefore in …

Distribution Of Selenium In The Plume Of The Gediz River, Izmir Bay, Aegean Sea, Nihayet Bizsel, Murat V. Ardelan, Kemal C. Bizsel, Ayşin Suzal, Aylin Demirdaǧ, Deniz Y. Sarica, Eiliv Steinnes

Journal of Marine Research

Selenium (Se) variations in the water column, suspended particulate matter, and sediment through the salinity gradient, together with water-quality parameters, were investigated over four different river conditions: lowest–highest runoff and high–low production period between November 2004 and August 2005 in the plume of the Gediz River, Aegean Sea, Turkey. The drainage basin of the Gediz delta is predominantly agricultural and industrial in character. Dissolved Se exceeded the water-quality standard of 5 μg L^–1 during high flow and varied from 9.4 μg L^–1 to 0.02 μg L^–1 through the salinity gradient during the study period. Particulate Se ranged …

From Weather To Ocean Predictions: An Historical Viewpoint, Nadia Pinardi, L. Cavaleri, G. Coppini, P. De Mey, C. Fratianni, J. Huthnance, P. F. J. Lermusiaux, A. Navarra, R. Preller, S. Tibaldi

Journal of Marine Research

This paper reviews the historical development of concepts and practices in the science of ocean predictions. It begins with meteorology, which conducted the first forecasting experiment in 1950, followed by wind waves, and continuing with tidal and storm surge predictions to arrive at the first successful ocean mesoscale forecast in 1983. The work of Professor A. R. Robinson of Harvard University, who produced the first mesoscale ocean predictions for the deep ocean regions is documented for the first time. The scientific and technological developments that made accurate ocean predictions possible are linked with the gradual understanding of the importance of …

Modeling And Forecasting The “Weather Of The Ocean” At The Mesoscale, Anne Marie Treguier, Eric P. Chassignet, Arnaud Le Boyer, Nadia Pinardi

Journal of Marine Research

We present a historical perspective on ocean mesoscale variability and turbulence, from the physical basis and the first numerical models to recent simulations and forecasts. In the mesoscale range (typically, spatial scales of 100 km and time scales of a month), nonlinearity, and energy cascades were well understood in the 1970s, but the emergence of coherent vortices took place much later. New challenges have arisen with the exploration of the submesoscale regime, where frontal dynamics play a key role and the range of flow instabilities is wider than in the quasi-geostrophic regime. Special focus is placed on the interaction of …

Ocean Forecasting For Wave Energy Production, Alexis Mérigaud, Victor Ramos, Francesco Paparella, John V. Ringwood

Journal of Marine Research

There are a variety of requirements for future forecasts in relation to optimizing the production of wave energy. Daily forecasts are required to plan maintenance activities and allow power producers to accurately bid on wholesale energy markets, hourly forecasts are needed to warn of impending inclement conditions, possibly placing devices in survival mode, while wave-by-wave forecasts are required to optimize the real-time loading of the device so that maximum power is extracted from the waves over all sea conditions. In addition, related hindcasts over a long time scale may be performed to assess the power production capability of a specific …

Coupled Ocean–Atmosphere Modeling And Predictions, Arthur J. Miller, Mat Collins, Silvio Gualdi, Tommy G. Jensen, Vasu Misra, Luciano Ponzi Pezzi, David W. Pierce, Dian Putrasahan, Hyodae Seo, Yu-Heng Tseng

Journal of Marine Research

Key aspects of the current state of the ability of global and regional climate models to represent dynamical processes and precipitation variations are summarized. Interannual, decadal, and global-warming timescales, wherein the influence of the oceans is relevant and the potential for predictability is highest, are emphasized. Oceanic influences on climate occur throughout the ocean and extend over land to affect many types of climate variations, including monsoons, the El Niño Southern Oscillation, decadal oscillations, and the response to greenhouse gas emissions. The fundamental ideas of coupling between the ocean-atmosphere-land system are explained for these modes in both global and regional …

Issues In Stochastic Ocean Modeling, Cecile Penland, Antonio Navarra

Journal of Marine Research

The general theory of stochastic differential equations is presented in this chapter, including the theoretical background on how measured statistics from time series can be used to develop a stochastic parameterization. The general rules of stochastic calculus, including the important and often overlooked differences between Ito and Stratonovich calculus, are mentioned, and references are provided in which more detail may be found. We discuss how Stratonovich calculus is usually appropriate for fluid systems, whereas Ito calculus is often appropriate for data assimilation. We also discuss some common numerical pitfalls awaiting the unwary modeler, and warn against unsophisticated random number generators. …

Advanced Wave Modeling, Including Wave-Current Interaction, Alexander V. Babanin, Andre Van Der Weshuijsen, Dmitry Chalikov, W. Erick Rogers

Journal of Marine Research

The paper outlines principles of phase-resolving and phase-average wave models, with emphasis on the state of the art of wave-current interaction physics. We argue that these interactions are the least well-developed part of such models. Linear and nonlinear dynamics of waves on currents are discussed; depth-integrated and depth-varying approaches are described. Finally, examples of numerical model performance for waves on currents in realistic oceanic scenarios are presented.

Tidal Prediction, Gary D. Egbert, Richard D. Ray

Journal of Marine Research

Tides are the most predictable of oceanographic phenomena, due both to the simplicity and predictability of the astronomical forcing and to the near linearity of the ocean's dynamical response. In the classical and simplest scenario, tidal prediction is based on harmonic analysis of past measurements at a fixed location. Limits to predictability arise because isolated astronomical spectral lines are broadened into "cusps" of incoherent energy, for example through interactions with non-tidal flows. Tidal prediction at locations without past measurements has historically been a major challenge, but, owing to near-global observations of modern satellite altimeters, the empirical harmonic approach now yields …

Modeling And Forecasting Ocean Acoustic Conditions, Timothy F. Duda

Journal of Marine Research

Modeling acoustic conditions in an oceanic environment is a multiple-step process. The environmental conditions (features) in the area first must be measured or estimated; relevant features include seabed geometry, seabed composition, and four-dimensionally (4D) variable sound-speed and density variations related to evolving or wave motions. Often the dynamical wave modeling depends on first obtaining correct seabed and mean stratification conditions (for example, nonlinear internal wave modeling). Next, this information must be included in sound propagation modeling. A selection of the many methods and tools available for these tasks are described, with a focus on modeling sounds of 20 to 1000 …

Aabw-Transport Variation And Its Effect On Internal Wave Motions Between Top And Bottom Of The Puerto Rico Trench, Hans Van Haren

Journal of Marine Research

Slow subinertial variations in Antarctic Bottom Water (AABW) are investigated interacting with internal waves and associated turbulent mixing in the Puerto Rico Trench (PRT), northwest Atlantic. Just below the PRT's top at 5,500 m, a deep-sea mooring was deployed for 14 months. Around 6,100 m, the line held a 200 m long string of 101 high-resolution temperature sensors and a current meter. Around 8,250 m, a similar string held 102 sensors, of which the lowest was 9 m above the bottom. As was measured with shipborne conductivity-temperature-depth profiling down to 7,150 m, PRT waters are very weakly stratified, with local …

Measurement And Modeling Of Volume Scattering Functions For Phytoplankton From Norwegian Coastal Waters, Endre Marken, Nicolausi Ssebiyonga, Jon K. Lotsberg, Jakob J. Stamnes, Børge Hamre, Øyvind Frette, Arne Skodvin Kristoffersen, Svein Rune Erga

Journal of Marine Research

The volume scattering function (VSF) describes the angular distribution of scattered light, and the VSF of phytoplankton is one of the most important inherent optical properties of oceanic water. Despite its importance, relatively few measurements of the VSF have been carried out in aquatic environments, and we present here data and analyses of measured VSFs at 442, 490, and 550 nm for 15 representative phytoplankton species from Norwegian coastal waters. In addition, the analytic scattering phase functions Henyey-Greenstein (HG) and Fournier-Forand, as well as Mie theory, were fitted and compared to the measured VSFs. The measured VSFs for all the …

Numerical Modelling In A Multiscale Ocean, Dale B. Haidvogel, Enrique N. Curchitser, Sergey Danilov, Baylor Fox-Kemper

Journal of Marine Research

Systematic improvement in ocean modelling and prediction systems over the past several decades has resulted from several concurrent factors. The first of these has been a sustained increase in computational power, as summarized in Moore's Law, without which much of this recent progress would not have been possible. Despite the limits imposed by existing computer hardware, however, significant accruals in system performance over the years have been achieved through novel innovations in system software, specifically the equations used to represent the temporal evolution of the oceanic state as well as the numerical solution procedures employed to solve them. …

Coupled Ice-Ocean Modeling And Predictions, Laurent Bertino, Marika M. Holland

Journal of Marine Research

We review the coupled ice-ocean modeling activities aimed at predictions, both in the near term (days to a week) and in the long term (seasonal to decadal) of the polar oceans. First the state of the knowledge of potential predictability is exposed, then an overview is given of the tools available for carrying out such predictions: the observations that can be used to initialize actual predictions, the coupled ice-ocean–modeling, including the fully-coupled Earth System Models for long-term predictions, and data-assimilation techniques. Finally, the performance of existing prediction systems is reviewed, showing that, although more predictive capability remains than what is …

Non-Ethically Relevant Emotional Content Affects Decision In Difficult Ethical Dilemmas, Brian Marcus

Yale Medicine Thesis Digital Library

Non-ethically relevant emotional content affects decision in difficult ethical dilemmas

Brian S. Marcus, Mark R. Mercurio, Denise Esserman, Gary Kopf

Section of Cardiothoracic Surgery, Department of Surgery, Yale University, School of Medicine, New Haven, CT Objective: To evaluate the cognitive and affective factors which contribute to ethical evaluations by members of ethics committee (EC). Method: A total of 70 EC members at 4 large medical centers were given clinical vignettes and asked to make judgments. Each vignette had two versions and each EC member was randomly assigned one of the two versions to evaluate. The two versions differed only in …

An Idh1 Mutation Prevalent In Glioma Confers Deficient Dna Repair And Sensitivity To Parp Inhibition, Nathaniel David Robinson

Yale Medicine Thesis Digital Library

High-grade gliomas (HGGs) are devastating malignancies of the central nervous system, and few treatment options are available for these tumors. In the most malignant form of the disease, glioblastoma multiforme (GBM), over 90% of patients will succumb to their tumor within 5 years after standard of care treatment, consisting of surgery, radiation therapy, and temozolomide chemotherapy. It is now clear that gliomas are molecularly heterogeneous entities, with mutations in tumor suppressors and oncogenes defining many distinct sub-types with important therapy implications. However, almost all HGGs are treated with a limited array of initial therapies, regardless of these molecular differences. Isocitrate …

Differentiation Control In Tissue-Engineered Vascular Grafts With Oxygen & Small Molecule Inhibitors, Joshua Morgan Arthur Siewert

Yale Medicine Thesis Digital Library

Tissue-engineered vascular grafts (TEVGs) have the potential to provide life-saving arterial replacements to patients requiring vascular bypass, hemodialysis access, and pediatric coronary surgery. Recent years have seen impressive strides towards widespread clinical use, but significant work still remains in optimizing cell source and graft growth, including the suppression of unwanted calcification during culture.

In this study, I examine oxygen concentration and two small-molecule bone morphogenic protein (BMP) inhibitors, DMH-1 and LDN193189, as potential avenues of increased control over mesenchymal stem cell (MSC) differentiation of into vascular smooth muscle cells (SMCs). Applying BMP-inhibitor concentrations from 0.01 to 10 µM at oxygen …

Yale School Of Medicine Facts & Figures 2017-2018, 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.

Genetics Of Chemotherapy Response In Triple Negative Breast Cancer, Charles Li

Yale Medicine Thesis Digital Library

Triple Negative Breast Cancer (TNBC) encompasses a wide range of treatment responses, however there are no predictive biomarkers approved for clinical use to target therapy. With a novel exome analysis method, we discovered that the overall proportion of the homologous recombination repair (HRR) genes affected by structural variation can accurately predict both positive and negative chemotherapy response prior to initiation of therapy in the large majority of patients in our cohort.

We analyzed exome sequences of unpaired tumor samples, collected prior to ACT chemotherapy, in 17 TNBC patients who exhibit complete pathologic response to neoadjuvant chemotherapy (pCR) and 15 patients …

Medicine@Yale November/December 2017 Volume 13, Issue 4, 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 April/May 2017 Volume 13, Issue 2, 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 June/July 2017 Volume 13 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.

Improving Community Healthcare: A Qualitative Evaluation Of The Neighborhood Team Model In West Essex, Jude Alawa, Yuhao Qian

Public Health Theses

A qualitative study was conducted to evaluate the Neighbourhood Team Model of the National Health Service in West Essex. The West Essex Clinical Commissioning Group (CCG) initiated the community healthcare-based neighbourhood teams in West Essex in October 2015. A neighbourhood team consists of all levels of health and social care providers but is concentrated on a smaller, local population. The proposed Neighbourhood Team Model was developed to allow providers to better deliver efficient patient-centred healthcare. For the past six months, the West Essex CCG encountered challenges in implementing the model to seven local areas within West Essex. To evaluate the …

Narrative Economics, Robert J. Shiller

Cowles Foundation Discussion Papers

This address considers the epidemiology of narratives relevant to economic fluctuations. The human brain has always been highly tuned towards narratives, whether factual or not, to justify ongoing actions, even such basic actions as spending and investing. Stories motivate and connect activities to deeply felt values and needs. Narratives “go viral” and spread far, even worldwide, with economic impact. The 1920-21 Depression, the Great Depression of the 1930s, the so-called “Great Recession” of 2007-9 and the contentious political-economic situation of today, are considered as the results of the popular narratives of their respective times. Though these narratives are deeply human …

Consequences Of The Clean Water Act And The Demand For Water Quality, David A. Keiser, Joseph S. Shapiro

Cowles Foundation Discussion Papers

Since the 1972 U.S. Clean Water Act, government and industry have invested over $1 trillion to abate water pollution, or $100 per person-year. Over half of U.S. stream and river miles, however, still violate pollution standards. We use the most comprehensive set of files ever compiled on water pollution and its determinants, including 50 million pollution readings from 170,000 monitoring sites, to study water pollution’s trends, causes, and welfare consequences. We have three main findings. First, water pollution concentrations have fallen substantially since 1972, though were declining at faster rates before then. Second, the Clean Water Act’s grants to municipal …