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Exploring The Challenges And Interventions For Type 1 Diabetes In Young Children, Patra Chisom Ezeamii, Nenrot Gopep, Ho-Jui Tung

Eagles Talking About the Public’s Health

No abstract provided.

Quantitative Assessment Of Facial Ptosis In Face Transplantation, Sam Boroumand

Yale Medicine Thesis Digital Library

As a transformative surgical procedure, face transplantation restores form and function to patients with severe facial disfigurements, yet the long-term aging dynamics of transplanted tissues remain poorly characterized. This study aimed to investigate the progression of facial ptosis in transplanted facial allografts over time, addressing a critical gap in the understanding of long-term outcomes following face transplantation. Specific aims include quantifying ptosis progression using cephalometric measurements, identifying regional variations in the degree of ptosis across the face, and comparing changes between face transplant recipients and a non-face transplanted control cohort to contextualize findings.

To assess these aims, standardized frontal headshots …

Exploring Health Professional Student-Led Interventions To Address Gaps In Common Non-Communicable Disease (Ncd) Screening, Management, And Self-Care Education In Ghana., Brian Amu Fleischer

Yale Medicine Thesis Digital Library

BackgroundNon-communicable diseases (NCDs) are expected to become Africa's leading cause of death by 2030. In Ghana, with its limited healthcare resources, hypertension is already the leading cause of death, contributing to 15.3% of total deaths. Student-run free clinics (SRFCs) have become essential components of healthcare systems worldwide, offering primary medical care to underserved populations. This study explores the feasibility of health professional student-led interventions in addressing gaps in NCD screening, early management, and self-care education in Ghana.

MethodsThis research employed an exploratory sequential design, combining qualitative and quantitative phases. Six focus group discussions (FGDs) with 48 health professional students at …

Trends In Missing Race And Ethnicity Data In A National Surgical Database, Kevin Gao Hu

Yale Medicine Thesis Digital Library

Accurate data collection on race and ethnicity is critical to detecting and characterizing disparities in surgical care. This study explores the prevalence and impact of missing race and ethnicity data in the National Surgical Quality Improvement Project Pediatric (NSQIP Pediatric) database. NSQIP Pediatric from 2016-2020 was assessed for patients who were missing data for race (RM), ethnicity (EM), or both (BM). Changes in proportion of RM, EM, and BM patients were assessed with Cochran-Armitage tests. Surgical outcomes were modeled using linear mixed-effects models, treating CPT codes as random effects. Models were bootstrapped with 1000 iterations for each outcome. Of 596,571 …

Maternal Prenatal Anxiety And Child Epigenetic Aging: A Longitudinal Analysis From Childhood To Mid-Adolescence, Shashwat Kala

Yale Medicine Thesis Digital Library

The developmental origins of health and disease posits that in utero exposures and early life experiences increases susceptibility to a host of pathologies. Maternal psychopathology, specifically maternal prenatal anxiety, has been studied as an in utero stressor that can affect childhood development and epigenetic aging. In the current study, we analyzed the longitudinal effects of maternal prenatal anxiety on epigenetic aging, assessed sex-specific effects, and tested the contribution of cellular heterogeneity to these findings. Using the longitudinal Basal Influences on Baby Development (BIBO) cohort, we performed a mixed model for repeated measures to determine how prenatal and postnatal anxiety (State-Trait …

Neighborhood-Level Variation In The Effectiveness Of And Participation In An Intensive Health Behavior And Lifestyle Treatment Program For Pediatric Obesity, Grace Wang

Yale Medicine Thesis Digital Library

Bright Bodies (BB) is a family-based intensive health behavior and lifestyle treatment (IHBLT) for pediatric obesity, with demonstrated efficacy and real-world effectiveness. Our study involved two aims: 1) to assess the extent to which real-world effectiveness varied by participants’ neighborhood characteristics, and 2) to evaluate the impact of the COVID-19-associated transition of BB to virtual delivery on participant engagement, particularly for those disadvantaged by inequities in social determinants of health. To achieve Aim 1, we included first-time BB participants 2008-2018 who had an initial BMI ≥85th percentile and available addresses. Addresses were geocoded using ArcGIS Pro and assigned a Child …

Bipolar Disorder Among Individuals With Atopic Dermatitis: A Case-Control Study In The All Of Us Research Program, Mitchel Wride

Yale Medicine Thesis Digital Library

Background: Atopic dermatitis has been associated with psychiatric comorbidities.Objectives: To characterize the association between atopic dermatitis and bipolar disorder with a case-control study of the NIH All of Us Research Program. Methods: Utilizing Systemized Nomenclature of Medicine diagnostic codes, we identified cases of atopic dermatitis. Four age, sex, and race/ethnicity matched controls were found for each case using propensity score matching. After controlling for age, sex, race/ethnicity, income, smoking status, and depression, the relationship between atopic dermatitis and bipolar disorder was evaluated using logistic regression. Results: We identified 13,431 atopic dermatitis cases with 53,724 matched controls. Participants with atopic dermatitis …

Advance Care Planning Utilization Among Non-White Individuals With Heart Disease And Cancer Using Health Retirement Study (Hrs) Data, Trizah M. Njoroge

Nursing Dissertations - Archive

Advance Care Planning (ACP) is a critical component of patient-centered care, yet its utilization remains disproportionately low among Non-White populations in the United States, particularly among individuals with chronic illnesses such as heart disease and cancer. This article explores racial disparities in ACP engagement using secondary analysis of the 2018 and 2020 waves data from the Health and Retirement Study (HRS), guided by Bandura’s self-efficacy theory (SET). The study examines how race, disease type, comorbidity, and survey year predict ACP service utilization, defined as completing five key ACP components: a legal will, a medical care discussion, surrogate assignment (DPOA), a …

Improvement Of Hpv Vaccination Rate In Pediatric Patients In A Clinic Through Implementation Of A Bundle, Macalah Jenschke

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Introduction: Human papillomavirus (HPV) is a major cause of several cancers, and vaccination is a highly effective preventive measure. However, HPV vaccination rates remain suboptimal, particularly in rural pediatric populations. This quality improvement (QI) project aims to enhance HPV vaccination rates through the implementation of a comprehensive vaccination bundle targeting provider education, patient and parent education, appointment reminders, and the use of a vaccine waiver when needed.

Method: This QI project was conducted over twelve weeks in a rural pediatric clinic with approximately 130 patients seen daily. The intervention bundle included provider education on effective communication regarding HPV vaccination, educational …

Improving Glucose Levels In Adults With Type 2 Diabetes, Kaitlin Castillo

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Type 2 diabetes is a growing health crisis, posing significant challenges not only to individual well-being but also to healthcare systems' financial sustainability. The prevalence of type 2 diabetes continues to rise annually, contributing to increased medical costs, hospitalizations, and long-term complications. Houston, Texas, has a diabetes prevalence of 13.5%, exceeding the national average of 10%. A clinical gap exists in providers’ ability to prevent and manage type 2 diabetes. Prioritizing prevention, early intervention, and improved patient monitoring can reduce incidence rates, lower healthcare costs, and enhance overall population health. A Plan Do Study Act model was utilized for the …

Reducing Stress Related To Injection Therapy: A Zen Bundle Approach, Valoree Bowen

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Needle fear and stress are common barriers preventing adults from seeking necessary medical treatments, including intramuscular (IM) injection therapy. Research highlights the need for evidence-based interventions to mitigate this fear and improve patient experience.

Objective: This evidence-based pilot project included a Zen Bundle—an intervention incorporating shared decision-making, aromatherapy, and distraction—to evaluate the impact on stress reduction and patient satisfaction in a retail vitamin shop in North Texas.

Methods: The project utilized a pre-and post-intervention design over eight weeks. Participants completed pre-surveys assessing stress levels using a Visual Analog Scale before choosing an intervention (aromatherapy, distraction, or both) during IM …

Management Of Obesity In Adults 18 And Older, Donna Callicoat

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Obesity is a significant public health concern in the United States, with increasing prevalence and substantial healthcare costs. Despite evidence-based guidelines for obesity management, primary care clinics often fail to implement them effectively, leading to missed opportunities in preventing obesity-related comorbidities such as cardiovascular disease, type 2 diabetes, and certain cancers.

Purpose: This evidence-based project aimed to implement the American Heart Association/American College of Cardiology/Obesity Society (AHA/ACC/TOS) obesity guidelines in a rural Texas primary care clinic. The goal was to assess the effectiveness of these guidelines in reducing weight, body mass index (BMI), and waist circumference among adults with …

Multidisciplinary Approach To Reduce The Heart Failure Readmission Rate, Nisha Thekkedam

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: In the United States, 6.7 million adults have been diagnosed with heart failure (HF), a number projected to rise to 8.5 million by 2030. National data indicate a 30-day readmission rate of 18.2% among HF patients from 2010 to 2017. In Texas, around 12% of the Medicare population in Texas, and specifically 11% of the Medicare population in North Texas County, have been treated for HF. A North Texas hospital reports an 18-20% HF readmission rate over the past several years. Purpose: This EBP project included the implementation of a care bundle using the Dutch Heart Failure …

Evidence-Based Discharge Bundle To Reduce Heart Failure Readmissions, Chelsea Zepeda

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Heart failure (HF) affects over 6.7 million adults in the United States, resulting in frequent hospitalizations and readmissions, increased mortality, and billions of dollars spent annually on healthcare costs. Reducing readmission rates is a priority for the healthcare industry.

Objective: This evidence-based practice project aimed to reduce HF readmission rates through a bundled approach to address socioeconomic factors that place patients at higher risk for readmission, provide patient-centered education for HF management at home, and provide follow-up phone calls after discharge to assess patient symptoms.

Methods: English-speaking patients, aged 65 or older, with any active diagnosis of HF were …

Implementing The Gad-7 Screening Tool In An Adult Outpatient Psychiatric Clinic, Elizabath George

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Abstract

Background: Anxiety disorders are among the leading causes of disability worldwide and the most prevalent mental illness in the United States. Despite affecting 6.8 million adults annually, fewer than half with Generalized Anxiety Disorder (GAD) receive treatment. Many patients present with somatic complaints, leading to underdetection. Standardized screening tools such as the Generalized Anxiety Disorder-7 item (GAD-7) can improve identification and outcomes.

Purpose: This quality improvement (QI) project implemented the GAD-7 screening tool in an adult outpatient psychiatric clinic in North Texas and evaluated its impact on identifying patients with GAD, compared to the prior year without structured screening. …

Association Between Vitamin D Status And Cortisol Concentration Among Pregnant Women, Kenneth Addae

Open Access Master's Theses

Objective: Vitamin D deficiency (VDD) and high circulating cortisol during pregnancy have each been linked to adverse maternal and child outcomes such as preterm birth. However, limited research has explored the association between vitamin D status and cortisol concentration during pregnancy. Our objective for this study was to determine the association between vitamin D status and cortisol concentration among pregnant women.

Methods: The Prenatal Health and Nutrition (PHAN) study was a pilot cross-sectional study of 30 healthy pregnant women conducted in targeted areas in Rhode Island. Data was collected on sociodemographic characteristics, substance use, perceived stress scale, household food security, …

The Role Of Socioeconomic Indicators On Child Behavior And Academic Outcomes During Elementary School, Ashlee Mineau

Open Access Master's Theses

The impact of a child's socioeconomic status (SES) impacts all aspects of development. Children’s SES will be examined to determine the potential impact they may have on children's academics and behavior. The SES variables that will be examined are parent education, parent occupation, and household income. Parent education is one of the strongest predictors of child school achievement (Martinez et al., 2022). Children who come from a lower SES household are more likely to display externalizing behaviors (Barry et al., 2022). This study in particular looks at its impact for academic achievement in reading, math, and science and external problem …

Diet Quality And Quality Of Life Among People With Parkinson’S Disease, Elizabeth Tierney

Open Access Master's Theses

Poor diet quality (DQ) and reduced quality of life (QoL) are concerns for people with Parkinson’s disease (PwPD). Non-motor (NMS) and motor symptoms (MS) significantly impact the DQ and QoL of PwPD which can be alleviated through diet intervention. This study examined the relationship between DQ and QoL in PwPD and investigated participant perspectives to identify themes related to nutrition care. This was a secondary data analysis of EMPOWER PD. Diet intake was assessed via the Dietary Screening Tool (DST). Quality of life was assessed by the Parkinson’s Disease Questionnaire-39-item (PDQ-39). Participant perspectives were collected through 1:1 interviews. Nineteen participants …

Evaluating Yield And Quality Of Heat-Tolerant Broccoli Varieties For Rhode Island Farmers, Calla Pederson

Open Access Master's Theses

In the United States, broccoli is a popular vegetable, important for its nutrition and economic contributions alike. However, its future production is at risk as broccoli prefers cooler climates, with an optimal temperature range of 15 - 23°C (59 - 73°F) for growth, especially in the weeks leading up to harvest. Temperatures above this threshold lead to failure to develop, damage, and unmarketability. There has also been an emphasis on bringing broccoli production back to the East coast from California, as climate events threatened Californian agriculture and local food has become popular, necessitating outside of season broccoli production during times …

Geochemical And Sedimentological Signals Of Bottom Water Oxygen Dynamics From Lake Tanganyika (Zambia), Njahi Mwangala

Theses and Dissertations--Earth and Environmental Sciences

Lake Tanganyika is a large, ancient freshwater body with exceptional biodiversity that is located in the East African Rift System. Lake Tanganyika’s size and longevity make its sedimentary record useful for understanding environmental changes that cross spatial and temporal boundaries. Lake Tanganyika is known to be susceptible to global warming given its tropical location. Over 12 million people living within Lake Tanganyika’s watershed rely on fishing for their income and nutrition. Changes to limnological function driven by climate could therefore have serious implications for human health and biodiversity conservation. This study focuses on using geochemical properties of modern lake bottom …

Plastic Gerontologies: Epigenetic Clocks As Instruments Of The Profitable Medicalization Of Aging, Hans T. Purisch

Theses and Dissertations--Geography

Epigenetic clocks are algorithms that use epigenetic biomarkers of aging to calculate an organism’s ‘biological age.’ Through discursive analysis of commercially available epigenetic clock marketing materials, scientific articles, and interviews with actors in the longevity biotechnology industry, this study examines the commercialization of epigenetic clocks in the form of consumer test-kits. The study argues that longevity biotechnology companies leverage the malleable and fluid qualities of epigenetic markers of biological age to extend the domains of profitable therapies. It shows that epigenetic clock companies market the dynamic qualities of epigenetic biological age measurements to redefine health around the project of optimizing …

Leveraging Clinical Standards To Improve The Translational Relevance Of Therapies For Experimental Spinal Cord Injury, Aaron L. Silverstein

Theses and Dissertations--Neuroscience

Efforts to improve treatment of spinal cord injury (SCI) often use animals to develop effective therapeutics, intending to improve the survival and the quality of life of persons with SCI. Over half of all SCIs in the United States occur at the cervical level and often cause locomotor deficits and life-threatening breathing dysfunction. Thus, my dissertation is focused on this important patient population.

After beginning with a description of translational research and surveying SCI from a clinical standpoint, I turned to describe experimental models of cervical SCI and more detailed neuroimmunological findings relevant to my work. Then, I conducted a …

Practicing Clinicians' Views Of The Life Participation Approach To Aphasia Therapy, Stephanie H. Mays

Theses and Dissertations--Communication Sciences and Disorders

The Life Participation Approach to Aphasia therapy (LPAA) aligns with a person-centered, functional approach to speech therapy. Past research has demonstrated that persons with aphasia (PWA) benefit from this approach and prefer it when compared to the traditional medical model to therapy. However, a disconnect between PWA preferences and SLP treatment approaches in therapy persists. This study aims to identify both barriers and facilitators that SLPs face when implementing LPAA. Five CCC-SLPs practicing in the state of KY with experience working with PWA were recruited as participants. Participants were placed into two focus groups, with each group meeting for 2-3 …

Zebrafish Models To Uncover Targetable Mechanisms Of Self-Renewal In T-Cell Acute Lymphoblastic Leukemia, Majd Al-Hamaly

Theses and Dissertations--Pharmacology and Nutritional Sciences

Relapsed T-cell Acute Lymphoblastic Leukemia (T-ALL) patients have dismal prognosis, with 5-year overall survival rates of 10% for adults and 36% for children. Relapse is attributed to the inability of chemotherapy agents to eliminate Leukemia Stem Cells (LSCs) that can repopulate the leukemia. Those cells exist with a unique genetic, transcriptomic, and metabolic profile compared to the rest of the leukemia and thus, finding targeted therapies toward this population of cells can result in disease eradication and elimination of relapse. However, investigating LSCs is challenging-particularly in T-ALL- for two reasons: 1) the lack of robust surface markers that define LSCs …

Assessing The Effectiveness Of A Modified Cook Together Eat Together Program On Food Resource Management Behaviors In A Rural Setting, Johanna K. Poysti

Theses and Dissertations--Nutrition and Food Systems

This study evaluated the effectiveness of a modified, hybrid Cook Together, Eat Together (CTET) program on food resource management behaviors in a rural setting. A six-week intervention combining virtual and in-person sessions aimed to improve health behaviors, food resource management skills, and self-efficacy. Although most behavioral changes were not statistically significant, participants reported increased confidence in cooking healthy meals on a budget. Positive qualitative feedback from focus group discussions indicated program feasibility and engagement. Strengths and limitations of the study were discussed as well as recommendations for future research were given.

Causes And Consequences Of Reproductive Plasticity In The Seed Beetle, Callosobruchus Maculatus, Josiah P. Ritchey

Theses and Dissertations--Entomology

Competition for resources has direct effects on traits that can influence an individual’s reproductive success in competitive mating environments. When population density is high during development, competition for resources can reduce growth and body size at maturation, influencing resources available for reproduction. In this thesis, I investigate how the developmental environment affects plasticity in male reproductive traits, as well as the consequences of male reproductive plasticity on female reproductive behavior, in the seed beetle, Callosobruchus maculatus. My results show that increasing larval density causes male beetles to emerge small and transfer small ejaculates to females. However, small males transfer …

Dinotefuran Resistance In The German Cockroach (Blattella Germanica L.), Hannah F. Blevins

Theses and Dissertations--Entomology

German cockroaches (Blattella germanica L.) are one of the most prevalent and pervasive indoor pest species in the world. Infestations can lead to many negative impacts on humans, including sensitization to allergens, increase in asthmatic symptoms, mental health declines, and potentially, the spread of diseases. While insecticides remain the most effective and affordable option for German cockroach control, resistance to many commonly used insecticide active ingredients (AIs), such as pyrethroids, has been observed globally at high levels across different populations. Given such resistance to pyrethroids, inclusion of insecticides with alternative modes of action into insecticidal treatments could potentially improve cockroach …

Bed Bugs: Health Risks And Control, Simona Principato

Theses and Dissertations--Entomology

Bed bugs are blood-feeding hemipterans strongly associated with humans. Their detection in indoor environments, such as homes, hotels, trains, and public facilities, has increased gradually over the past 20 years. The exact cause of their resurgence is still unclear, but the increase of international travel and insecticide resistance are thought to have contributed to it.

Although bed bugs are not known to transmit diseases, the EPA, CDC, and USDA have classified them as a pest of significant public health concern, mainly due to the dermatitis that they can cause. Beyond the dermatological burden of the bites, other health implications often …

The Role Of Nutrition In Managing Honey Bee Viral Pathogen, Caroline Wylie Kane

Theses and Dissertations--Entomology

This study evaluated the impact of nutritional supplements on viral infections in honey bee colonies, focusing on Lake Sinai Virus 2 (LSV2), Deformed Wing Virus A (DWVA), and Deformed Wing Virus B (DWVB). I partnered with 32 hobbyist beekeepers across Kentucky, who volunteered 138 colonies for a month-long field study. Half of the colonies received weekly commercial supplements, while the other half served as controls. Viral titers were measured before and after the supplementation period using qPCR. Supplements did not significantly reduce viral titers for any of the three viruses, suggesting that short-term supplementation may not be effective in lowering …

Gene Expression In Relation To Bone Fractures In Throughbred Racehorses, Anna M. Rauber-Ramos

Theses and Dissertations--Veterinary Science

Evidence that fractures in Thoroughbred racehorses are outcomes of chronic bone microdamage has led to extensive research into identifying horses at increased risk of fracture. This includes the use of biomarkers and messenger RNA (mRNA) as a measure of bone turnover. Previous research has found expression differences in horses with fractures compared to controls. Utilizing pre-race whole blood samples collected over an 18-month period from Thoroughbred racehorses in Southern California, RNA-sequencing was conducted on horses with bone fractures and race-matched controls to identify differences in gene expression. Focusing on third metacarpal (MC3) and proximal sesamoid bone (PSB) fractures, differentially expressed …