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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 …

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 …

Trypanosomatids Detected In The Invasive Avian Parasite Philornis Downsi (Diptera: Muscidae) In The Galapagos Islands, Patricia Parker, Courtney Pike, María Piedad Lincango, Charlotte Causton

Biology Department Faculty Works

Alien insect species may present a multifaceted threat to ecosystems into which they are introduced. In addition to the direct damage they may cause, they may also bring novel diseases and parasites and/or have the capacity to vector microorganisms that are already established in the ecosystem and are causing harm. Damage caused by ectoparasitic larvae of the invasive fly, Philornis downsi (Dodge and Aitken) to nestlings of endemic birds in the Galapagos Islands is well documented, but nothing is known about whether this fly is itself associated with parasites or pathogens. In this study, diagnostic molecular methods indicated the presence …

Planned Behavior And Congolese Physicians’ Practice: Predicting Advanced Preventive Health Services Provision, Jean-Clément Milabu Mumbusi

Walden Dissertations and Doctoral Studies

The provision of preventive services, health promotion, and health maintenance has become the cornerstone of primary care practice in the United States and other Western countries to prevent morbidity and premature mortality and to increase the quality and years of a healthy life. Unfortunately, the delivery of these advanced preventive health services (APHS) has been sporadic in the Democratic Republic of Congo, a country with poor health indicators. The purpose of this cross-sectional mixed-method study was to apply Ajzen’s theory of planned behavior (TPB) to predict the intention of Congolese primary care physicians (PCPs) in the provision of APHS. Using …

Strategies To Reduce Absenteeism In The Public Sector Workplace, Dr. John G. Turner

Walden Dissertations and Doctoral Studies

When unplanned absences occur, employers incur lost productivity and additional costs. In the United States, missed work because of employee absence costs organizations about $202 billion dollars annually. Grounded in Burn’s transformational leadership theory, the purpose of this qualitative single case study was to explore effective strategies public works department leaders use to reduce absenteeism in the workplace. The participants included 9 leaders who worked in a chosen department in the local government who successfully reduced absenteeism in the workplace. The data collection process included conducting semistructured interviews and reviewing organizational documents. The data were analyzed using a thematic analysis …

Strategies For Teaching New Mothers The Importance Of Vaccination, Halimat Akojie

Walden Dissertations and Doctoral Studies

Vaccinations provide protection against a number of severe childhood communicable diseases, such as polio, measles, and pertussis. However, not all parents follow the recommended immunization schedules for their young children, a decision which could lead to increased disease incidence and prevalence. The purpose of this DNP project was to address the gap-in-practice related to ineffective strategies to reduce vaccination refusal among parents. This systematic review sought to understand strategies effective at teaching new mothers the importance of vaccinating their children. The theoretical foundation for addressing this question is Rogers’ protection motivation theory, which explains that sources of information, mediating cognitive …

The Bad, The Ugly, And The Horrible: What I Learned About Humanity By Doing Prison Research, Adelina Iftene

Dalhousie Law Journal

Every Canadian academic conducting research with humans must submit an ethics application with their university’s Research Ethics Board. One of the key questions in that application inquired into the level of vulnerability of the interviewees. Filling in that question, I had to check nearly every box: the interviewees were incarcerated, old, under-educated, poor, Indigenous or other racial minorities, and likely had mental and physical disabilities. However, it was not until I met John that I understood what all those boxes actually meant. They were signalling that I was entering a universe of extreme marginalization—the universe of the forgotten. I learned …

Text Mining Methods For Analyzing Online Health Information And Communication, Sifei Han

Theses and Dissertations--Computer Science

The Internet provides an alternative way to share health information. Specifically, social network systems such as Twitter, Facebook, Reddit, and disease specific online support forums are increasingly being used to share information on health related topics. This could be in the form of personal health information disclosure to seek suggestions or answering other patients' questions based on their history. This social media uptake gives a new angle to improve the current health communication landscape with consumer generated content from social platforms. With these online modes of communication, health providers can offer more immediate support to the people seeking advice. Non-profit …

The Impact Of Bone Marrow Transplantion On Patients With Psychiatric Diagnoses: Medication Adherence Assessment, Brittany Galop

Theses and Dissertations--Pharmacy

Objectives: We investigated whether there is a measurable difference in medication utilization for psychiatric conditions before and after bone marrow transplantation (BMT). Previous studies have identified a potential association between psychiatric conditions and immune function. We hypothesized that medication utilization for psychiatric diagnoses would be impacted by BMT.

Methods: This study was a retrospective, quasi-experimental cohort design. De-identified data was compiled from the Truven database for patients ranging from January 2009 through December 2016. Two measurements of medication utilization, proportion of days covered (PDC) and medication possession ratio (MPR) were calculated for each included Medispan-defined class of medications before analyzing …

Extensively Drug-Resistant Pseudomonas Aeruginosa In Vitro Susceptibility And Mechanisms Of Resistance, Chanah Gallagher

Theses and Dissertations--Pharmacy

Pseudomonas aeruginosa causes severe healthcare-associated infections. Forty-eight extensively drug-resistant (XDR)-P. aeruginosa isolates were selected from 287 isolates collected for evaluation based on clinical susceptibility data. In vitro activity of commonly utilized antimicrobials (i.e. antipseudomonal beta-lactams, aminoglycosides, fluoroquinolones, and polymyxins) plus ceftolozane-tazobactam, ceftazidime-avibactam, and aztreonam-avibactam against XDR-P. aeruginosa were determined. The mechanism of resistance profile was determined through phenotypic expression analysis. Overall, polymyxin B and colistin were 100% susceptible. Apart from the polymyxins, ceftolozane-tazobactam had the highest susceptibility (94%) followed by ceftazidime-avibactam (90%) and amikacin (83%). Ceftolozane-tazobactam activity was not significantly different from ceftazidime-avibactam (p=0.6831). Only 40% of isolates …

Embodying Inequality: Three Papers On The Role Of Gender And Discrimination In The Lives Of Women, Stefana I. Moldovan

Theses and Dissertations--Social Work

Women experience different forms of discrimination throughout their lives such as unfair treatment in interpersonal interactions in the public spheres and in the private sphere, as prescribed by societal gender roles, women can also experience inequality and discrimination as a disproportionate share of household work and caregiving, limited participation in decision making, unequal access and share of financial resources and leisure, and as well as in cases, of emotional, and physical, or sexual abuse. Limited research explored the potential joint effect of these forms of discrimination. The questions explored in this dissertation were: (1) How does gendered intra-household inequality, experienced …

Characterizing The Roles Of Pipecolic Acid And Reactive Oxygen Species Metabolic Enzymes In Plant Systemic Immunity, Ruiying Liu

Theses and Dissertations--Plant Pathology

Systemic acquired resistance (SAR), initiated by a plant upon recognition of microbial effectors, involves the generation of mobile signals at the primary infection site, which translocate to and activate defense responses in distal tissues. Among the signals contributing to SAR include salicylic acid (SA), nitric oxide (NO), reactive oxygen species (ROS), glycerol-3-phosphate (G3P), and pipecolic acid (Pip). Our previous studies show there are two branches of SAR signaling pathways in Arabidopsis: one regulated by NO/ROS-G3P and the other by SA. Both NO/ROS-G3P and SA-mediated signaling branches function in parallel during SAR. To better understand the role of Pip in SAR …

Evaluation Of Rhodococcus Equi Susceptibility To Silver Nanoparticle Antimicrobials, Elizabeth Boudaher

Theses and Dissertations--Veterinary Science

Rhodococcus equi is a significant cause of pneumonia in foals and immunocompromised humans. Antimicrobial resistance among R. equi isolates has developed as a consequence of inappropriate stewardship and bacterial evolution, leading to an increased rate of treatment failures that typically result in foal fatality. In the current study, we evaluated the efficacy of antimicrobial silver nanoparticle (AgNP) complexes in controlling R. equi growth. Previous studies characterizing AgNP-induced antibacterial effects in other Gram-positive pathogens led us to hypothesize that silver nanoparticle antimicrobials impact R. equi viability and intracellular replication. We therefore investigated the effect of silver nanoparticle complexes on R. equi …

Host-Parasite Interaction In Horses: Mucosal Responses To Naturally Acquired Cyathostomin Infections And Anthelmintic Treatment, Ashley Elaine Steuer

Theses and Dissertations--Veterinary Science

Cyathostomins are ubiquitous parasites in equids. In rare cases, cyathostomins lead to a generalized typhlocolitis and death. In healthy horses, local reactions are noted to the mucosal larvae; however, the mechanisms and importance of these reactions have not been elucidated. It has been hypothesized that anthelmintics can alter these reactions. Currently, three drug classes are approved for use in horses against cyathostomins; while all products target the adults, only two products are labeled as larvicidal. Adulticidal therapy is implicated in triggering the typhlocolitis, however, current evidence is contradictory. There is also conjecture that the larvicidal drugs can increase the risk …

Aggregation Behavior In The Bed Bug, Cimex Lectularius L., Paul D. Baker

Theses and Dissertations--Entomology

The bed bug, Cimex lectularius L., is a common household pest that feeds on the blood of its human hosts. Unlike many other hematophagic arthropods, bed bugs have not demonstrated the ability to vector disease; yet its presence in a household often leads to fear and anxiety amongst its human host victims. Bed bugs spend the majority of their time aggregating in enclosed and hidden locations, making it difficult to detect and eradicate them. One of the significant mediators of aggregation behavior is an aggregation pheromone. The pheromone has been identified to be six chemical compounds, five volatile compounds that …

Voices Of Hope: A Randomized Controlled Trial Of A Peer-Delivered Telephone Recovery Support Program, Alex Elswick

Theses and Dissertations--Family Sciences

Substance use disorder (SUD) is one of the most pervasive public health problems in the United States (US Surgeon General, 2016). Addiction (used synonymously with SUDs here) is associated with an abundance of negative outcomes including reduced quality of life, increased criminal activity, spread of infectious diseases, child neglect, job loss, loss of productivity and much more (US Surgeon General, 2016). Despite the detriment that addiction poses to virtually all facets of society, the addiction treatment paradigm in the United States lags significantly behind the research (Kelly & White, 2011; Laudet & Humphreys, 2013). This current system focuses on intensive, …

Changing The Outlook Toward The Problem Of Opioid Addiction: From “War On Drugs” To “Public Health Emergency”, Carola B. Marquez

Student Works

No abstract provided.

The Free Exercise Clause And The Religious Exemption To Vaccinations: Why States Are Allowed To Implement Mandatory Vaccinations, Caroline Braga

Student Works

No abstract provided.

A Public Health Framework For Covid-19 Business Liability, Daniel Hemel, Daniel B. Rodriguez

Public Law and Legal Theory Working Papers

Businesses that reopen amid the COVID-19 pandemic face potential legal liability to customers and workers who contract the coronavirus through those enterprises’ operations. Federal and state lawmakers are actively considering proposals to narrow or expand such liability. These proposals have important economic and public-health implications. This article presents an analytical framework for evaluating liability regimes in the context of a communicable disease. The framework highlights the contrasting public-health consequences of liability before and after a customer or worker is exposed to the virus. Ex ante (before exposure), potential liability generates incentives for businesses to take precautions that reduce the risk …

Non-Linear Inverse Liquid-Solid Chromatography As A Methodology To Characterize Drug Concentration Losses To Polymeric Materials Used In Body-On-A-Chip Devices For Drug Discovery, Mark Schnepper

Electronic Theses and Dissertations, 2020-2023

Body-on-a-chip and human-on-a-chip systems are currently being used to augment and could eventually replace animal models in drug discovery and basic biological research. However, hydrophobic molecules, especially therapeutic compounds, tend to adsorb to the polymer materials used to create these microfluidic platforms, which may distort the dose-response curves that feed into Pharmacokinetic/Pharmacodynamic (PK/PD) models which translate preclinical data into predictions of clinical outcomes. Adsorption of hydrophobic molecules to these polymer materials needs better characterization. Inverse Liquid-Solid Chromatography paired with a numerical optimization based on the Langmuir model of adsorption was used to characterize the adsorption isotherm parameters of selected drugs …

Statistical And Stochastic Learning Algorithms For Distributed And Intelligent Systems, Jiang Bian

Electronic Theses and Dissertations, 2020-2023

In the big data era, statistical and stochastic learning for distributed and intelligent systems focuses on enhancing and improving the robustness of learning models that have become pervasive and are being deployed for decision-making in real-life applications including general classification, prediction, and sparse sensing. The growing prospect of statistical learning approaches such as Linear Discriminant Analysis and distributed Learning being used (e.g., community sensing) has raised concerns around the robustness of algorithm design. Recent work on anomalies detection has shown that such Learning models can also succumb to the so-called 'edge-cases' where the real-life operational situation presents data that are …

The Relationship Between Familism And Social Distancing Behaviors During The Covid-19 Pandemic, Thien-An Le

Electronic Theses and Dissertations, 2020-2023

Transmission of Coronavirus 2019 (COVID-19) occurs efficiently and from symptomatic and asymptomatic individuals, therefore making it highly infectious. As such, social distancing is generally recommended to mitigate the speed of transmission and decrease incidence, hospitalization, and mortality rates. Consistent with other chronic medical conditions, COVID-19 is disproportionately affecting Hispanic/Latinx and black populations. One inherent cultural concept, familism, might also serve to inhibit adherence to social distancing guidelines. Thus, the current study contributes to the growing literature on COVID-19, specifically examining barriers underscoring health disparities. This study evaluated Attitudinal Familism (AFS) and Behavioral Familism (BFS) as predictors of adherence of social …

Medicina Tropical Y Su Proyeccion Actual: Un Breve Panorama [A Brief Overview: Tropical Medicine And Its Current Projection], Nathalie Chacon, Luis Alfonso Colmenares Suárez

Physician Assistant Studies Faculty Publications

La rica tradición histórica y los importantes avances científicos de la Medicina Tropical (MT) han contribuido a su inmensa proyección actual. La literatura consultada así lo refleja. Esta investigación documental apuntó a esa misma dirección y buscó enriquecer el acervo bibliográfico al respecto. Mediante la lectura crítica de referencias y el método cualitativo de Huberman y Miles se estructuró una argumentación discursiva referente a la proyección actual de la MT a lo largo de las tres secciones de este trabajo: su origen histórico, su ulterior desarrollo, sus tendencias y perspectivas futuras. El médico escocés Patrick Manson (1844-1922), es considerado como …

The Biological Manifestation Of Health, Culture, And Disease In Turn Of The Twentieth Century San Francisco, Trisha Walker

All Graduate Theses, Dissertations, and Other Capstone Projects

Between 1880 and 1920, a period known as the Great Migration, the city of San Francisco became one of the most diverse areas in the United States due to the steady arrival of immigrants. These groups of immigrants primarily consisted of individuals from China, Japan, Ireland, Italy, Eastern Europe, and Mexico. However, each of these groups faced various forms of xenophobia from American-born citizens when they tried to either earn a living or assimilate into American society. These immigrant groups were frequently impeded by who was, and who was not, considered to be “white” in the eyes of the dominant …

Utilizing A Formative Program Evaluation Approach And An Application Of Grounded Theory To Assess A Novel Harm Reduction Program, Dia Obonyo

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Formative program evaluation is conducted during development and early implementation to ensure a program is feasible, appropriate, and acceptable. The Harm Reduction Initiative (HRI), a program of KIRP, the Kentucky AIDS Drug Assistance (KADAP) Income Reinvestment Program, seeks to address some of the underlying causes of infectious disease vulnerability resulting from drug use by focusing on infectious disease testing and linkage to care among high risk individuals. The primary objective of the evaluation was to achieve the following aims: 1) characterize the need for the program, 2) clarify the theory and logic of the program, 3) inform implementation, and 4) …

The Cost-Effectiveness Of Culture Vs Naat Based Screening Of Pregnant Women For Group B Streptococcus To Reduce Early-Onset Sepsis Of The Newborn, Bertie Geng

Yale Medicine Thesis Digital Library

While great progress has been made to reduce its incidence, group B streptococcus (GBS) is still a leading cause of neonatal disease. Current standard of care recommends antepartum rectovaginal GBS culture of all pregnant women at 36 weeks of gestation in order to identify candidates for intrapartum prophylaxis to reduce vertical transmission. The purpose of the study is to assess three alternative nucleic acid amplification (NAAT) screening strategies for GBS: antepartum NAAT at 36 weeks, intrapartum NAAT, or a combined intrapartum and antepartum approach in which patients with penicillin allergies undergo antepartum culture screening and all other patients undergo intrapartum …

A Historical Review Of The State Police Powers And Their Relevance To The Covid-19 Pandemic Of 2020, Edward P. Richards

Journal Articles

No abstract provided.

Evaluation Of Connecticut Medical Providers Concordance With 2017 Idsa/Shea Clostridioides Difficile Treatment Guidelines In New Haven County, 2017-2019, Casey Morgan Luc

Public Health Theses

Background: Treatment guidelines for Clostridioides difficile infection (CDI) were updated by the Infectious Disease Society of America (IDSA) & the Society for Healthcare Epidemiology of America (SHEA) in 2017 making various modifications, most notably for disease severity & treatment recommendations. Our objectives were to assess Connecticut medical providers’ concordance (2017-2019) to the 2017 SHEA/IDSA clinical treatment guidelines. The effect of guideline concordance on the risk of CDI recurrence was also assessed.

Methods: Using data from the Connecticut Emerging Infections Program’s CDI surveillance in New Haven County, severity & concordance were defined for CDI cases. For severity, white blood cell count …

The Four Functions Of Management - An Essential Guide To Management Principles, Robert Lloyd, Wayne Aho

Management Open Educational Resources

The purpose of this book is to provide an introduction to the four essential functions of management. The history of management, managerial decision making as well as business strategy are covered in addition to an in depth exploration of the planning, organizing, leading and controlling roles of the contemporary manager. This text was written with simplicity in mind, and a hyper-focus on the four functions. The intended use of this book is to give students a mastery of these fundamentals to prepare them for their more complex applications in subsequent management courses.