Digital Commons Network^™

Antibiotic-Resistant Nontyphoidal Salmonella And Campylobacter Isolates Associated With International Travel, Connecticut 2010 – 2023, Shilpa Mudumbe

Public Health Theses

Antibiotics are helpful for limiting duration and complications of Salmonella andCampylobacter isolates in selected age groups and people who are immunosuppressed. However, antibiotic-resistant (AR) foodborne pathogens have been on the rise in the United States over the past 10 years and are often linked to international travel (IT). Long-term trends on AR have not been examined in Connecticut (CT). This study evaluates trends in AR among nontyphoidal Salmonella and Campylobacter isolates in CT from 2010 to 2023 and examines the association between AR and IT. Data from submission of annual systematic samples of CT Salmonella and Campylobacter isolates to the …

Enhancing Dengue Forecasting With Remotely Sensing-Derived Vector Proxies And Random Forest Models: A Case Study For Sri Lanka, Shuyu Ye

Public Health Theses

Dengue fever is a growing global public health threat, especially in tropical and subtropical regions such as Sri Lanka, where seasonal outbreaks impose recurring burdens on health systems. Accurate and timely forecasting of dengue incidence is essential for public health preparedness, yet most existing models suffer from key limitations: they rely on historical case trends without accounting for real-time ecological dynamics, and often require entomological surveillance data that is not consistently available. This thesis addresses these gaps by proposing a machine learning forecasting framework that integrates remote sensing-derived environmental proxies to estimate latent mosquito vector abundance.Using Principal Component Analysis (PCA), …

Economic Burden Of Medically Attended Respiratory Syncytial Virus Illness Among Older Adults, Shirley Zhu

Public Health Theses

ABSTRACTIntroduction: Respiratory syncytial virus (RSV) is a common respiratory pathogen that causes a large burden of disease among older adults. Though there are interventions, the impact and cost-effectiveness of recently licensed RSV vaccines in the United States is not well understood for this population. Thus, reliable estimates on the economic burden of RSV among older adults are needed for future economic analyses.

Objective: The objective of this thesis is to evaluate the cost of medically attended RSV among older adults in the United States.

Methods: Medicare claims data were used to determine average cost per visit for outpatient, inpatient, emergency …

Enhancing Research Utilization Among Health Policymakers: Lessons From An Executive Certificate Program In Liberia, Felicia Annan-Mills

Public Health Theses

Evidence-based decision-making in health policy is a systematic and transparent approach to policymaking and program design using research evidence and other similar sources. It is essential for developing effective health policies and ensuring that programs align with political priorities and community needs and have strong empirical support for their efficacy and impact. Global health agencies like the World Health Organization and the West African Health Organization have developed guidelines for evidence-based decision-making in health for organizations to use as guiding tools in their policymaking. Regardless, there is still a gap in applying research evidence to practice programs for many countries …

Cost-Effectiveness Of New Monoclonal Antibody And Maternal Immunization For The Prevention Of Respiratory Syncytial Virus (Rsv) Disease In Infants: A Systematic Review, Yuwei Che

Public Health Theses

AbstractIntroduction: Respiratory syncytial virus (RSV) remains a major cause of morbidity and mortality among infants and young children worldwide. Given the lack of specific therapeutic treatments for RSV that are suitable for universal use, the development of effective prevention strategies is of paramount importance. Previously, palivizumab was utilized for long-term prophylaxis of RSV infections; however, it was only recommended for specific populations due to its high cost and limited overall effectiveness. In 2023, the U.S. FDA approved RSVpreF maternal vaccine (Abrysvo™, Pfizer), and nirsevimab (Beyfortus™, Sanofi and AstraZeneca) for the prevention of RSV to newborns. Two newly developed interventions have …

Assessing The Costs Of Illness Attributable To Leptospirosis, Alyssa Chetrick

Public Health Theses

Leptospirosis, caused by the spirochetes of the genus Leptospira, is a zoonotic bacterialdisease endemic to tropical regions and lower middle income countries (LMICs). Leptospirosis causes an estimated 1 million cases and more than 58,900 deaths annually.(Costa et al., 2015; Torgeson et al., 2015) In addition to human health, leptospirosis significantly impacts animal health and the livestock industry, particularly through reproductive losses, increased treatment costs, and decreased milk production, which exacerbates global insecurity.(Bennet, 2015; Torgeson et al., 2015) The estimated global cost loss to productivity due to disease is estimated at Int$ 29.3 billion. (Agampodi et al., 2023) Because of its …

Scale-Up Of Access To Medication For Opioid Use Disorder For People Who Inject Drugs On Parole In Ukraine: A Modeling Analysis, Brendan Caver

Public Health Theses

Background: Human Immunodeficiency Virus (HIV) and opioid-use disorder have long beendescribed as a syndemic; the two health issues go hand-in-hand to exacerbate each other (Perlman & Jordan, 2018). While the HIV pandemic has improved greatly in many regions such as the United States over the past several decades, it continues to become worse in Eastern Europe and Central Asia. HIV prevalence and opioid dependence are particularly high in carceral settings, but access to opioid agonist therapy (OAT) is extremely limited. This paper shows the results of a modeling analysis undertaken to see the impact of opioid agonist therapy (OAT) scale-up …

The Impact Of Climate Change On Japanese Encephalitis Trends In China, Jiayi Du

Public Health Theses

Japanese encephalitis (JE) is a mosquito-borne viral disease that poses a significant public health threat across Asia, including China. Climate change has been increasingly recognized as a key driver of JE transmission dynamics, influencing mosquito vector distribution and virus proliferation. This study aimed to assess how climatic variables affect the ecological suitability for Japanese encephalitis virus (JEV) transmission, using species distribution modeling with MaxEnt.

Using climate data from WorldClim and JE incidence data from published sources, we applied the MaxEnt model to identify the key environmental predictors of JE transmission and project future risk areas under changing climatic conditions. The …

Exploring Harm Reduction In Treatment: A Qualitative Study Of Methods And Perceptions Among People In Substance Use Disorder Care, Carson Francis Ferrara

Public Health Theses

Amidst the ongoing opioid epidemic and rising overdose deaths, substance use disorder (SUD) treatment has historically prioritized abstinence over harm reduction, creating gaps in patient safety. This qualitative study explores harm reduction integration in formal treatment settings and participant perceptions through 48 semi-structured interviews with individuals enrolled in Project RENEW, a larger cohort study examining factors influencing people in treatment for alcohol use across Connecticut and Georgia. Participants (79% inpatient, 51% court-mandated) described their experiences with harm reduction methods and safety strategies while in treatment. Thematic analysis revealed four key findings: 1) inconsistent access to resources like naloxone and fentanyl …

Secondhand Smoke Exposure And The Risk Of Tuberculosis In Children: A Systematic Review And Meta-Analysis, Cenyun Guan

Public Health Theses

ABSTRACT

Introduction: Tuberculosis (TB) remains one of the leading causes of death globally, with children and young adolescents having a significant burden of the disease. Smoking is a well-established risk factor for TB, but the association between secondhand smoke (SHS) exposure and TB remains inconclusive. Pediatric populations are commonly exposed to SHS due to living with smokers in their households. Inconsistencies in the findings of previous systematic reviews on the associations between SHS exposure and TB status (infection and disease) highlight the need for an updated systematic review to better establish these associations and provide evidence-based guidance for reducing the …

Black Lives Matter Paterson’S Harm Reduction Center Program Evaluation, Shreya Jadhav

Public Health Theses

BackgroundThe Substances and Sexual Health (SASH) Lab at the Yale School of Public Health conducts much of its work in Paterson, New Jersey. As part of a community partnership, the lab collaborated with Black Lives Matter (BLM) Paterson to conduct a program evaluation of BLM Paterson’s Harm Reduction Center. BLM Paterson, founded in 2016, offers harm reduction through a wide range of services including survival resources, referrals to treatment, and a touchpoint with the healthcare system, all within a safe, non-judgmental space for individuals to decompress and find support. Evaluation Methods This formative program evaluation assesses the impact of BLM …

Association Between Greenspace And Weight-Related Outcomes In Later Adulthood: A Longitudinal Study Using Uk Biobank Data, Jun Jiang

Public Health Theses

Overweight and obesity are escalating global health concerns, greenspace may support healthierweight, and air pollution may mitigate the effect, but its effects across population subgroups and over time remain underexplored. According to the longitudinal analysis, this study found that greenspace exposure within 300 m was more strongly associated with lower BMI and overweight risk than exposure within 1000 m; for example, the presence of greenspace within 300 m reduced the odds of overweight (OR = 0.791, 95% CI: 0.672–0.933), while the same measure within 1000 m was associated with higher odds of obesity (OR = 1.275, 95% CI: 1.08–1.505). Stratified …

The Evolution And Effectiveness Of Sterile Insect Technique For Vector Control: A Historical And Modern Analysis, Katerina Karaiskos

Public Health Theses

Sterile Insect Technique (SIT) has emerged as an important tool in the control of vector-borne diseases, providing an alternative to traditional chemical insecticides. Initially based on the irradiation of insects to induce sterility, SIT has proven effective in eradication campaigns, including the cases of the screwworm and tsetse fly. SIT’s primary strengths lie in its species specificity, environmental safety, and the avoidance of pesticide resistance. However, “classic” irradiating SIT is limited by high operational costs, reduced mating competitiveness of sterilized males, and difficulties in addressing high-density vector populations. Recent advancements in genetic-based SIT methods, such as the Release of Insects …

Barriers And Facilitators To Covid-19 Vaccination Access Among Older Adults: A Comprehensive Needs Assessment To Enhance Vaccination Strategies, Jiye Lee

Public Health Theses

Objective: To identify system-specific barriers and facilitators to COVID-19 vaccination among older adults (≥65 years) within a large academic healthcare system and to inform future strategies to enhance vaccine uptake.

Methods: This mixed-methods study included six semi-structured interviews with healthcare leaders and staff, a large-scale survey of 42 clinical leaders across 52 ambulatory sites (20 responses), and analysis of administrative data from Yale New Haven Health (2020–2024). Interviews and survey responses were thematically analyzed. Quantitative data on vaccination rates for COVID-19 and influenza were analyzed by age group and year using descriptive statistics and t-tests.

Results: The semi-structured interviews with …

Assessing The Cross-Species Vaccine Potential Of Pfripr Using Transgenic Chimeric Plasmodium Knowlesi Models, Peiqi Li

Public Health Theses

Malaria remains a major global health burden, with an estimated 263 million cases and597,000 deaths reported in 83 countries in 2023 (1). While P. falciparum is responsible for the most severe cases, non-falciparum species such as P. vivax, P. ovale curtisi, P. ovale wallikeri, P. malariae, and P. knowlesi also pose significant public health risks, particularly in co-endemic regions. Current malaria vaccine efforts mainly focus on P. falciparum which is reasonable because over 90% of the global malaria-related morbidity and mortality are caused by P. falciparum (2). However, laying emphasis on targeting P. falciparum leaves a critical gap in cross- …

Influenza Vaccine Coverage, Effectiveness, And Disease Burden Among Pediatric Sickle Cell Patients In Connecticut From 2021-2024: A Test-Negative Case-Control Study, Precious Nchekwube

Public Health Theses

Background: Vaccination is the primary strategy to reduce influenza burden. Limited data exist on the burden of influenza, vaccine coverage, and seasonal influenza vaccine effectiveness (VE) in children and adolescents with sickle cell disease (SCD).

Aim: To evaluate influenza vaccine coverage, effectiveness, and disease burden among pediatric and adolescent patients living with SCD for the 2021-2024 influenza seasons in Connecticut, USA.

Methods: This was a retrospective, test-negative case-control study to estimate influenza VE against laboratory-confirmed influenza infections among children 6 months to 21 years of age across 2021-2022, 2022-2023, and 2023-2024 influenza seasons (August 1, 2021, to July 31, 2024) …

Characterizing The Genetic Diversity Of Pfrh5 In Plasmodium Falciparum Clinical Isolates From Burkina Faso, Ghana, And Tanzania: A Next-Generation Sequencing Study To Inform Blood-Stage Malaria Vaccine Development, Manuel Emilio Perez

Public Health Theses

The development of a highly effective malaria vaccine is of global health priority, given the persistently high malaria burden in Sub-Saharan Africa (SSA) and growing resistance to antimalarial treatment and vector control measures. P. falciparum reticulocyte-binding protein homolog 5 (PfRH5) has emerged as a leading target among blood-stage malaria vaccine candidates due to its essential role in erythrocyte invasion and initial documentation of limited polymorphisms. However, recent studies have revealed greater PfRH5 genetic diversity than previously believed, raising concerns about potential parasite evasion of vaccine-induced immunity. This study utilized deep targeted amplicon next-generation sequencing to characterize PfRH5 genetic variation in …

New Horizons In Hepatitis B Therapy: Antigen Reduction And Immune Modulation Approaches, Yiyun Pan

Public Health Theses

Chronic hepatitis B (CHB) remains a significant global health burden despite advances in antiviral therapy. Current treatments, including nucleoside analogs (NAs) and pegylated interferon (Peg-IFN), effectively suppress viral replication but rarely achieve functional cure, defined as sustained hepatitis B surface antigen (HBsAg) loss. Emerging therapeutic strategies focus on antigen reduction and immune modulation to overcome the limitations of existing therapies.

Antisense oligonucleotides (ASOs) and small interfering RNAs (siRNAs) offer promising approaches by directly targeting viral RNA to reduce HBsAg levels. Clinical trials of ASOs such as bepirovirsen and siRNAs such as JNJ-3989 and VIR-2218 have shown substantial HBsAg declines, but …

Effectiveness Of Wolbachia Introgression On Dengue Incidence In A Complex Urban Environment, Karthika Satyanarayanan

Public Health Theses

Dengue is an arboviral disease of increasing global public health importance for which more than half the world’s population is at risk. The burden of dengue has increased greatly in the last decade; in 2024, over 14 million cases and 10,000 dengue-related deaths were reported, marking a historical milestone. The endosymbiotic bacterium Wolbachia (wMel strain) offers a promising alternative to traditional control methods through its reduction of Aedes aegypti vector competence and introgression into wild Ae. aegypti populations. This thesis evaluated the dynamics of Wolbachia introgression and its effect on reducing dengue incidence up to 31 months after the completion …

Assessing Environmental And Sociodemographic Risk Factors For Leptospira Infection In A Urban Informal Settlements: A Study In Salvador, Brazil, Sebastian Alonso Salazar

Public Health Theses

Background: Leptospirosis is a neglected zoonotic disease that disproportionately affects people living in areas with poor sanitation, water contamination and rodent infestation such as urban informal settlements. More than one billion people worldwide reside in such communities, and with increasing urbanization, coupled with environmental change, the risk of Leptospira transmission continues to increase. Despite its global burden, this disease is often underreported due to diagnostic challenges and limited healthcare access, particularly in urban informal settlements. Understanding the incidence and risk factors in these settings is essential for improving public health interventions. This study aims to estimate the annual incidence of …

Impact Of Pcv10 On Pediatric Pneumonia In Nepal, Katie Steimel

Public Health Theses

Pneumococcal conjugate vaccines have significantly reduced pneumonia cases, hospitalizations, and deaths worldwide. This study evaluates the impact of 10-valent pneumococcal conjugate vaccine (PCV10) eligibility on pediatric pneumonia hospitalizations in Nepal using administrative hospital data from three major geographically and administratively diverse hospitals. A controlled interrupted time series design was used comparing pneumonia hospitalizations with diarrhea hospitalizations, under the assumption that PCV10 would not influence diarrhea hospitalization rates. A secondary model stratified hospitalizations by age group, assessing differential trends based on vaccine eligibility. Generalized linear models with quasipoisson distributions were used, adjusting for hospital and seasonality.The primary model comparing pneumonia to …

Disparities In Clinical Trial Representation: Bioethical & Human Rights Violations Against The Global Burden Of Disease And Gender Equity, Kaustubha Reddy

Public Health Theses

This investigative thesis seeks to contribute to the understanding of how disparities in the planning, design, and placement of clinical trials perpetuate global health inequities. It will analyze the misalignment between the global burden of disease and research priorities, examining the systemic factors that determine which diseases are prioritized for trials. It will highlight the bioethical and human rights implications of gender exclusion, particularly the underrepresentation of women with HIV, in clinical research. By addressing both the upstream determinants of clinical trial planning and the downstream consequences of exclusionary practices, this work offers a comprehensive critique of the structural inequities …

Under-Five Malaria And Malnutrition Syndemic In Rajasthan, Nandini Sinha

Public Health Theses

Background: The syndemic of severe acute malnutrition (SAM) and malaria in under-five children in Rajasthan presents a critical public health challenge. Current SAM and malaria programs are implemented as siloed interventions despite the potential benefits of integrated approaches. A better understanding of the interactions between these factors is important to strengthen the delivery of integrated services.

Objective: This study investigates the relationship between under-five SAM and malaria infections at the block level in Rajasthan to inform targeted, integrated interventions. By running regression analysis, we will identify associations between these co-occurring health threats to guide state-level policy integration. To the best …

Severe Malaria And Multi-Organ Failure, Abby Lindseth, Md, Stephen Yau, Md

Abstracts, Posters, Presentations

No abstract provided.

Age-Associated Alterations In Immune And Inflammatory Responses In Captive Olive Baboons (Papio Anubis), Michele M. Mulholland, Bharti P. Nehete, Ashley Delise, Angela M. Achorn, Lisa M. Pytka, Pramod N. Nehete

Anthropology Faculty Publications

Introduction: Advanced age is a primary risk factor for many chronic diseases and conditions; however, age-related immune dysregulation is not well understood. Animal models, particularly those that resemble human age-related physiological changes, are needed to better understand immunosenescence and to improve health outcomes. Here, we explore the utility of the olive baboon (Papio anubis) in studying age-related changes to the immune system and understanding mechanisms of immunosenescence.

Methods: We examined immune cell, inflammatory responses, cytokines, and cortisol levels using hematology and flow cytometry, mitogen stimulation, multiplex cytokine assay, and cortisol immunoassay.

Results and Discussion: Our results reveal significant age effects …

Examining Drug Policy In Portugal And Greece, Collin Fernandes

Dissertations and Theses

This thesis examines the divergent drug policies implemented in Portugal and Greece, analyzing why Portugal's comprehensive decriminalization model has been more successful than Greece's partial approach. Since 2001, Portugal has pioneered a drug policy that decriminalizes all drugs for personal use while investing in harm reduction services, rehabilitation, and social reintegration. In contrast, Greece maintained criminalization while implementing more limited harm reduction measures, particularly through OKANA (the Organization Against Drugs). The research highlights how economic factors, particularly the 2008 financial crisis and austerity measures, negatively affected both countries' programs but hit Greece's initiatives with greater severity. Portugal's programs have remained …

An Exploration Of Drivers Of Sepsis Outcomes In Racial & Ethnic Minority Populations, Providence Svmc Gme

Abstracts, Posters, Presentations

No abstract provided.

Naïve Bayes Based Android Adaptive User Authenticationprototype For Young Internet Of Medical Things Users, Prudence Munyaradzi Mavhemwa Mavhemwa, Marco Zennaro, Philibert Nsengiyumva, Frederic Nzanywayingoma

All Rsif Scholars' Publications

The increasing use of the Internet of Medical Things (IoMT) in healthcare highlights privacy and security concerns surroundingsensitive health data. This research focuses on enhancing the security and usability of IoMT for young users through arobust, adaptive continuous authentication model using physiological biometrics on Android devices and heart rate data fromsmartwatches. By integrating user behavior, environmental context, and health conditions, the model dynamically determinesrisk, trust, and authorization decisions. Machine learning techniques analyse data related to devices, networks, locations, anduser habits while considering demographics like age and medical conditions to assign suitable authenticators. The model balancesaccuracy and usability, favouring correct positive …

Effect Of Aflasafe Tz01® On Aflatoxin Reduction And Emerging Challenges With Fusarium Mycotoxins In Maize From Rural Tanzania, Sambwe Fundikira, Martin Kimanya, Rashid Suleiman, Marthe De Boevre, Kokeb Tesfamariam Kokeb Tesfamariam, Sarah De Saeger

All Rsif Scholars' Publications

Aflatoxins are carcinogenic secondary metabolites produced by Aspergillus species and are common contaminants of many crops including maize. Atoxigenic Aspergillus flavus strains, formulated as biocontrol products such as Aflasafe® TZ01, that comprises a mixture of four native atoxigenic strains, are used as pre-harvest agents to suppress toxigenic strains and reduce aflatoxin levels. This study assessed the intended and potential unintended impacts of Aflasafe® TZ01 on mycotoxin contamination in maize. A total of 158 samples 79 from treated and 79 from untreated fields were collected from Chemba and Kiteto districts in Tanzania. Multi-mycotoxin analysis was conducted using liquid chromatography coupled with …

Molecular Evidence Of Brucella Abortus Circulating In Cattle, Goats, And Humans In Central Equatoria State, South Sudan, Emmanuel Philip Lasuba Lita, Ernatus M. Mkupas, Erneo B. Och, Gerald Misinzo, Henriette Van Heerden, Robab Katani, Jacques Godfroid, Coletha Mathew

All Rsif Scholars' Publications

Brucellosis is a neglected zoonotic disease in most developing countries, including South Sudan. Precise identification of Brucella species is crucial for addressing public health and epidemiological concerns associated with brucellosis. The study aimed to identify Brucella species using real-time polymerase chain reaction (qPCR) from seropositive samples that were acquired from an earlier investigation. A total of 143 genomic DNA samples were extracted from brucellosis Rose Bengal plate test (RBPT) seropositive samples from humans (n=7), cattle (n=103) and goats (n=33). The samples were collected from Terekeka and Juba counties, Central Equatoria State (CES), South Sudan. The qPCR targeting the Brucella-specific IS711 …