Digital Commons Network^™

Modified Extracorporeal Photopheresis As An Immunotherapy In Murine Melanoma, Aaron Nathaniel Vassall

Yale Medicine Thesis Digital Library

Extracorporeal Photochemotherapy (ECP) is a widely used immunotherapy for cutaneous T cell lymphoma, as well as an immunomodulatory treatment for graft versus host disease (GVHD) and rejection of allografts. We hypothesized that ECP’s physiologic induction of large-scale monocyte-to-dendritic antigen presenting cell (APC) conversion is mechanistically responsible for both its anti-cancer effect and its tolerogenic impact in the transplant setting. To interrogate this possibility in an experimental system, we developed an ECP device that is scalable from mouse to man and tested its capacity to produce APCs that, when advantageously tuned and tumor antigen-loaded, can limit the growth of otherwise lethal …

How Roots Do And Don’T Constrain The Interpretation Of Voice, Jim Wood

Linguistics Faculty Publications

A long-standing issue in syntactic theory, and argument structure in particular, involves the relationship between particular lexical items and the syntactic structures they are embedded in. Lexical roots seem to be choosy about the structures they are able to appear in, but are at they same time very flexible. Complicating the matter further, roots are in some cases able to appear in certain structures only with a certain special meaning. In this paper, I focus on the causative alternation in Icelandic, and propose that we can understand root distribution (the inability of certain roots to appear in certain structures) as …

Using “Big Data” To Study Orthopaedic Trauma Populations: Looking At Fractures From A Bird’S Eye View As Illustrated By Three Studies, Andre Michael Samuel

Yale Medicine Thesis Digital Library

Background

“Big data” is increasingly being used for orthopaedic research. However, the acute and complex nature of orthopaedic trauma makes data collection and data analysis difficult. This thesis presents three different clinical studies, which together illustrate how databases may best be used to answer clinical questions in orthopaedic trauma. Specifically the studies aim to show (1) how different databases capture trauma populations, (2) how databases may be used for hypothesis discovery studies, and (3) how databases may be used for hypothesis testing studies.

Study Questions

(1) How do populations of femoral shaft fracture patients differ in three commonly used national …

U.S. Securitization Year In Review, Securities Industry And Financial Markets Association (Sifma)

Documents

Securitization Research Report 2016

Housing Finance At A Glance (A Monthly Chartbook), Housing Finance Policy Center

Documents

Part of a monthly chartbook and data source for policymakers, academics, journalists, and others interested in the government's role in mortgage markets.

Clearinghouse Loan Certificates As Interbank Loans In The United States, 1860– 1913, Christopher Hoag

Documents

No abstract provided.

North Side Community Federal Credit Union 2016 Capital Survey, United States: Department Of The Treasury

Documents

No abstract provided.

The Cost And Burden Of Chikungunya In The Americas, Danielle Bloch

Public Health Theses

Background: Chikungunya virus (CHIKV) is a mosquito-transmitted virus that emerged in the Caribbean in late 2013 and proceeded to spread throughout the Americas. Acute CHIKV disease is characterized by high fever and potentially debilitating arthralgia. In a proportion of cases, serious long-term sequelae following acute disease have been reported. These conditions primarily include chronic inflammatory rheumatisms, but can also involve depression, sensorineural effects, headaches and cognitive delays following neonatal infection.

Methods: We developed data-driven computational simulation models for acute and long-term health conditions associated with CHIKV infection to estimate the economic cost and health burden of the 2013–2015 CHIKV epidemic …

Perceived Discrimination Correlates With Poor Angina Outcomes Among Patients With Acute Myocardial Infarction, Lingling Ji

Public Health Theses

Background: Perceived discrimination (PD) have been previously linked with multiple physiological and behavioral health risks. However, limited data is available on the association between PD and clinically relevant outcomes, such as the frequency and severity of angina.

Method: This thesis explores the association between PD and angina outcomes using data from the Examining Heart Attacks in Young Women (VIRGO) study, which enrolled 2,670 patients with prior acute myocardial infarction (AMI). The Detroit Area Scale and the Seattle Angina Questionnaire (SAQ) were employed to assess perceived discrimination and angina-related outcomes, including its onset frequency and related physical limitation, treatment dissatisfaction and …

Medicine@Yale April/May 2016 Volume 12, Issue 1, Yale School Of Medicine Office Of Communications

Medicine@Yale - development newsletter

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

Unconventional Natural Gas Development And Self-Reported Health Symptoms: A Two-Year Survey In Washington County, Pennsylvania, Weixiong Dang

Public Health Theses

Abstract

Introduction: Natural gas is a cleaner and more efficient energy type compared to coal and oil and could be vital to tackle the global energy crisis. The technical advance of unconventional natural gas development (UNGD) has permitted us to extract natural gas from shale formations, which were previously inaccessible for natural gas drilling. However, the new technology has concerns about its environmental safety and impacts on human health. So far, no definitive conclusion about this issues is reached.

Methods: In this cohort study in Washington County, Pennsylvania, we used an innovative exposure assessment model, integrating local wind flow directions …

Forced Migration & Health: A Course Proposal, Lauren Ashle Gaston-Hawkins

Public Health Theses

Forced migration is poised to be one of the leading public health issues of our time. The Syrian refugee crisis in particular has placed issues of forced migration firmly in the consciousness of everyday people in developed nations in a way that has not occurred arguably since the genocide in Rwanda. Thus it is important to capitalize on this moment of awareness to prepare future leaders and public health advocates to effectively address the host of issues that accompany the forced migration of populations. As the number of forced migrants increase and represents a larger proportion of the world’s population, …

Adolescent Health: Parity And Nutritional Status Among Married Women What Is Unique For Adolescents And What Is Similar To Older Women?, Lindsey Hiebert

Public Health Theses

Abstract

Introduction

In Bangladesh, there is a high prevalence of child marriage, early initiation of childbirth, and high rates of undernutrition among adolescents. Pregnancy and childbirth pose unique risks for adolescents due to the intersection of reproductive and physical development.

Objective

This analysis sought to describe the relationship of parity and other reproductive exposures with nutritional outcomes for adolescents and older women ages 20-35 years, describing both the similarities and differences between the two age groups. The overall objective was to help inform improved adolescent health interventions and direct future needed research.

Methods

A secondary data analysis of the Bangladesh …

Hospital Variation In Performance For Acute Myocardial Infarction With The Ncdr Action Registry-Gwtg "All-Or-None” Composite Measure, Sara Nelson Nelson

Public Health Theses

Background: While mortality rates for cardiovascular disease have declined, many patients still fail to receive effective and timely care. Studies report that characteristics including census region of the United States (Midwest, West, Northeast and South), neighborhood classification (urban, rural, suburban), and teaching status are all associated with the quality of care provided. It has been reported that national quality improvement campaigns have been shown improve the quality of AMI care for these patients and increase compliance to guideline recommended treatment. Use of defect-free composite measures is increasing as they promote full execution of all processes of care, encourage a focus …

“Their Happiness Is My Happiness”--- Chinese Visiting Grandparents Grandparenting In The Us, Mengxin(Christie) Zhu Zhu

Public Health Theses

Purpose of the study: This article focuses on Chinese visiting grandparents who come to the US to help their adult children who are in graduate school care for the grandchild/ren. The aims were to determine: 1) what motivates them to come to the US, 2) what are the challenges and supports of life in the US, and 3) the implications of their experience in the US as caregivers for their well-being.

Design and Methods: The study uses a mixed-method design. Data were collected with quantitative surveys and qualitative interviews. 35 grandparents living near Yale University, New Haven were surveyed and …

Characterizing Domestic Mosquito Populations In Montserrat, Sarah Abusaa

Public Health Theses

Vector control in the Caribbean Island of Montserrat relies on routine residential inspections to count, identify, and treat standing water sources where mosquito larvae develop. Aedes aegypti, Culex quinquefasciatus, and C. nigripalpus are local domestic pests with competence to transmit several pathogens including dengue, Chikungunya, and Zika viruses. With the recent emergences of Chikungunya and Zika viruses in the Caribbean, evaluating infestation densities is an important step in identifying target areas for increased vector control. The current study aimed to depict the burden of domestic mosquito infestations in Montserrat based on infestation indices and the abundance of containers that serve …

Seroprevalence And Risk Factors For Leptospirosis In An Urban Community Of Puerto Rico, Emily Ann Briskin

Public Health Theses

Introduction: Leptospirosis is an important cause of morbidity and mortality in Puerto Rico, but the full burden remains unknown due to underreporting and misdiagnosis as dengue fever.

Methods: A cross-sectional study paired with rodent trapping was carried out to determine the prevalence and risk factors for prior Leptospira infection in an urban community within San Juan, Puerto Rico. A mixed effect model was built to test for risk factors while controlling for grouping effects across neighborhood blocks.

Results: Among 202 human individuals enrolled, 55 (27.3%, 95% CI: 20.9-33.3%) had Leptospira agglutinating antibodies indicative of previous exposure to the bacteria. MLST …

Saying No To Another Beer: Association Of Positive Age Stereotypes With Lower Prevalence Of Alcohol Use Disorder Among Baby Boomer Veterans, Sabrina Louise Consiglio

Public Health Theses

Alcohol use disorder (AUD) is a problem for older veterans. This study examines whether positive age stereotypes may be associated with lower prevalence of alcohol use disorder in this group. Prevalence estimates of demographic and military characteristics were analyzed by Alcohol Use Disorder status and age group. The cohort consisted of participants in the National Health and Resilience in Veterans Study. The Alcohol Use Disorder Identification Test, that assesses AUD DSM5 symptoms was used to measure AUD prevalence, number of symptoms, an alcohol consumption subscore, and an alcohol consequences subscore. Positive age stereotypes were associated with lower levels of all …

Data Integration And Targeted Anticancer Drug Synergies Prediction, Xiaoting Gao

Public Health Theses

In the past decades, targeted cancer therapies have made considerable achievements in inhibiting cancer progression by modulating specific molecular targets. However, targeted cancer therapies have reached a plateau of efficacy as the primary therapy since tumor cells can achieve adaptability through functional redundancies and activation of compensatory signaling pathways. Therapies using drug combinations have been developed to overcome the bottleneck. Accurate predictions of synergies effect can help prioritize biological experiments to identify effective combination therapies. Data integration can give us a deeper insight into the mechanism of cancer and drug synergies and help to address the challenge in prediction of …

Self-Medication And "Personal Medicine" As Alternatives To Pharmaceuticals Among Young Adults With Mental Health Conditions, Jessica Hahne

Public Health Theses

Background:

Many studies have documented high rates of non-adherence to prescribed psychiatric medications among individuals receiving mental health services. Few studies have sought to understand how young adults with mental health conditions who are not consistently connected to mental health services view psychiatric medications, or what types of self-directed symptom management strategies they might prefer to psychiatric medications.

Methods and Results:

This secondary analysis on 11 pairs of semi-structured interviews with young adults (aged 24-28) used a grounded theory approach to elucidate common themes in self-management of mental health symptoms. Many participants described alcohol or marijuana use as preferred strategies …

Clinical Implications Of Apc-Resistance And Factor 5 Leiden Mutational Testing Over A Five Year Period At Yale-New Haven Hospital, Ezra Baraban

Yale Medicine Thesis Digital Library

An evaluation of the APC resistance and factor five Leiden testing at our hospital between 2010 and 2015 was undertaken. An overabundance of factor five Leiden gene mutation testing and corresponding financial ramifications were considered. Specifically, over 90% of all factor five Leiden mutation tests were negative, representing a potential annual savings of over $40,000. It was also noted that quantitative APC resistance values are directly related to the factor five Leiden genotype. Patients with non-Leiden APC resistance had significantly higher values for APC resistance (1.85 vs. 1.97 with p < 0.005). Discordance between APC resistance testing and factor five Leiden testing was also examined, and autoimmune disease and liver transplantation emerged as common associations. Based on these observations, we propose specific modifications to the thrombophilia diagnostic algorithm that we believe will decrease cost and increase diagnostic clarity.

Genomic Characterization Of Sarcomatoid Transformation In Clear Cell Renal Cell Carcinoma, Xiao Bi

Yale Medicine Thesis Digital Library

The presence of sarcomatoid features in renal cell carcinoma (ccRCC) confers a poor prognosis. The mechanisms that account for these sarcomatoid features are unknown. We performed whole exome sequencing of matched normal-carcinomatous-sarcomatoid specimens from 21 subjects. Two tumors had hypermutation and a mutational signature consistent with mismatch repair deficiency. In the remaining 19 tumors, sarcomatoid and carcinomatous elements shared a mean of 45/108 (41.7%) somatic single nucleotide variants (SSNVs). Sarcomatoid elements had a higher overall SSNV burden (mean 90 vs 63 SSNVs, p=4.0x10-4), increased frequency of non-synonymous SSNVs in Pan-Cancer genes (mean 1.4 vs 0.26, p=0.002), and increased frequency of …

Effects Of Race, Socioeconomic Factors On Emergency Management Of Threatened And Early Pregnancy Loss, Connie Yu Heng Cheng

Yale Medicine Thesis Digital Library

Our study aims to determine the effects of race, insurance, and hospital characteristics on the management of threatened abortion and early pregnancy loss. In this retrospective cohort study using the National Hospital Ambulatory Medical Care Survey, patient record files from 2002-2010 with diagnoses of threatened abortion, hemorrhage in pregnancy, or incomplete, inevitable, or unspecified spontaneous abortion were examined using logistic regression. Primary outcomes were rates of admission and active management, defined as surgical termination or use of abortifacients misoprostol or Cytotec. Covariates included race/ethnicity, age, insurance, and hospital location, ownership, and metropolitan status.

Of 5,882,623 ED visits for threatened abortion …

Transitioning Of Hiv-Infected Children From Pediatric To Adult Care: A Jamaican Case Study, Flavia De Souza

Yale Medicine Thesis Digital Library

Successful public access to antiretroviral therapy in resource-limited settings (RLS) has resulted in survival of HIV perinatally infected children into adulthood. There are few studies on transition of care in RLS, where 90% of HIV-infected children reside. We aimed to characterize the current landscape of the transfer process of HIV-infected adolescents in one such RLS, Jamaica. We conducted in-depth interviews of 18 HIV-infected adolescents in pediatric care and 21 health care providers. We analyzed the data using the grounded theory approach. Five themes emerged: 1. Pediatric clinics were like families who provided care-taking and developmental support in addition to HIV …

Language In Schizophrenia: What We Can Learn From Quantitative Text Analysis, Sasha Deutsch-Link

Yale Medicine Thesis Digital Library

LANGUAGE IN SCHIZOPHRENIA: WHAT WE CAN LEARN FROM QUANTITATIVE TEXT ANALYSIS

Sasha Deutsch-Link, Sarah Fineberg, Philip R. Corlett. Department of Psychiatry, Yale University School of Medicine, New Haven, CT.

Background: People living with schizophrenia demonstrate broad language and communication deficits. Prior research has focused on qualitative changes in thought, speech production, and language comprehension. In this thesis I expand upon our understanding of language in schizophrenia, by using a novel, quantitative method for language analysis, Linguistic Inquiry Word Count (LIWC).

Methods: I examined essays by four groups of authors: people with schizophrenia (n=77), family history of schizophrenia (n=25), psychiatric controls …

Upper Cervical Spine Fracture At Yale: Factors Associated With Management And Outcomes, Erica M. Giles

Yale Medicine Thesis Digital Library

Traumatic fractures of the upper cervical spine are a diverse group of injuries with high morbidity and mortality. Guidelines for treatment of these injuries have been based off limited medical literature; the factors associated with the management decisions and the outcomes associated with those decisions have not been well described. In particular, recent literature supports the idea that nonclinical factors such as race and insurance may affect treatment decisions for all spine fractures.

The electronic medical record was queried for trauma patients admitted to Yale New Haven Hospital diagnosed with an upper cervical spine fracture using relevant ICD-9 codes. Information …

Viral Causes Of Gastroenteritis In The Era Of Widespread Rotavirus Vaccination, Dame Idossa

Yale Medicine Thesis Digital Library

Background: It is unknown if widespread use of Rotavirus (RV) vaccine will impact the primary causative agent of viral gastroenteritis (VGE).

Objective: To identify changes in epidemiology of VGE affected by vaccination, determine factors associated with higher severity of illness, and assess agreeability between two clinical severity-grading scales; Clark and Vesikari.

Methods: We analyzed fecal samples of children, 6 months-5 years of age, evaluated at YNHH for VGE. Fecal samples were tested using a real-time PCR assay. Primer and probe sequences targeted conserved regions of the genome for RV, Norovirus GI/GII, Adenovirus, Astrovirus, and Sapovirus. Data were analyzed using SPSS. …

Outcomes Following Heart Transplantation In A National Cohort: An Analysis Of The Organ Procurement And Transplantation Network’S Database, Oliver Kayden Jawitz

Yale Medicine Thesis Digital Library

In this analysis, we examine a large national cohort within the Organ Procurement and Transplantation Network’s (OPTN) United Network for Organ Sharing (UNOS) database for the purpose of determining the impact of a recipient history of myocarditis as well as donor/recipient ABO compatibility on outcomes following heart transplantation. We used a nationwide sample with primary stratification between ABO identical and compatible heart transplantations or transplant recipients diagnosed with myocarditis and those diagnosed with ischemic or idiopathic cardiomyopathy. The primary end-point was graft failure from all causes. Post-transplant survival was compared between groups using univariate Kaplan-Meier as well as multivariate Cox …

Carboplatin And Cyclosporin A In The Treatment Of Recurrent Epithelial Ovarian Cancer, Eve Elizabeth Overton

Yale Medicine Thesis Digital Library

The aim of this study is to report our institutional experience with the use of carboplatin (carbo) and concurrent cyclosporin A (CsA; combined

treatment abbreviated as carbo/CsA) for recurrent epithelial ovarian cancer (EOC) and to assess the efficacy and tolerability of this regimen in treatment of the treatment of EOC. The medical records of patients diagnosed with ovarian cancer and treated with carbo/CsA from 2000 to 2015 at Yale New Haven Hospital were reviewed. Histological classification and staging were determined by the World Health Organization and Ann Arbor systems, respectively. Kaplan-Meier was used to calculate progression free survival (PFS) and …

Clinical Studies Conducted Over The Total Product Life Cycle Of High-Risk Therapeutic Medical Devices Receiving Us Food And Drug Administration Premarket Approval In 2010 And 2011, Vinay Kumar Rathi

Yale Medicine Thesis Digital Library

The US Food and Drug Administration (FDA) approves high-risk medical devices, those that support or sustain human life or present potential unreasonable risk to patients, via the Premarket Approval (PMA) pathway. In recent years, the FDA has begun shifting premarket evidentiary requirements to the postmarket period as part of a broader effort to continually evaluate device safety and effectiveness throughout the total product life cycle. We therefore sought to characterize the clinical evidence generated for high-risk therapeutic devices over the total product life cycle. In October 2014, we identified all clinical studies of high-risk therapeutic devices receiving initial market approval …