Digital Commons Network^™

Intergenerational Meaning-Making In Cambodian Americans, Caitlin Gojuk

Public Health Theses

Background: Cambodian Americans face high psychological distress yet remain underrepresented in research, especially second-generation individuals. Intergenerational trauma, stigma, and family dynamics shape mental health understanding and expression. Objective: This study examines how Cambodian American young adults make sense of mental health and distress through cultural identity, family relationships, and inherited meanings of trauma. Methods: In-depth semi-structured interviews were conducted with six second-generation Cambodian American young adults residing in Massachusetts, United States. Participants completed brief measures of depression and anxiety symptoms (PHQ-8; GAD-7) to provide a descriptive context. Interviews were analyzed using inductive thematic analysis informed by relational, narrative, and ecological …

A Mendelian Randomization Study Of Maternal Thyroid Function And Cerebral Palsy, Yuewen Ge

Public Health Theses

Cerebral palsy (CP) is a neuromotor disorder that is strongly associated with adverse perinatal conditions. Thyroid dysfunction in pregnancy was suggested to affect CP risk in a few cohort studies, but the evidence is not yet conclusive. We conducted a two-sample MR study to explore the effect of thyroid function on the risk of CP in offspring, and preterm birth as a potential mediator. Genetic instruments for hyperthyroidism and hypothyroidism were obtained from a large European genome-wide association study (GWAS) by Sakaue et al. (2021), instruments for free thyroxine (FT4) and thyrotropin (TSH) were derived from the ThyroidOmics Consortium, and …

Cost-Effectiveness Analysis Of Twice-Yearly Injectable Lenacapavir Versus Daily Oral Prep For Hiv Prevention Among Men Who Have Sex With Men In China, Xueqing Guo

Public Health Theses

Men who have sex with men (MSM) remain a key at-risk population in China’s HIV epidemic while the real-world effectiveness of daily oral pre-exposure prophylaxis (PrEP) among MSM has been limited by low uptake and suboptimal drug adherence. Lenacapavir, a first-in-class capsid inhibitor administered twice yearly, emerged as a highly efficacious, long-acting prevention strategy with the potential to reduce drug burdens associated with current PrEP strategy. However, its high price ($28,000 per patient per year) raises major affordability concerns, and its economic value in China remains understudied. This study aimed to evaluate the cost-effectiveness of lenacapavir compared with daily oral …

Single-Cell Gene Perturbation Prediction Via Sclambda-Program, Jingyi Guo

Public Health Theses

Predicting single-cell transcriptomic responses to single and multi-gene perturbations is essential for mapping regulatory networks, resolving disease mechanisms and identifying therapeutic targets. Several state-of-the-art deep learning methods, especially scLAMBDA, have demonstrated strong performance in predicting perturbation outcomes. However, computational biology still faces a fundamental trade-off between predictive accuracy and biological interpretability. To reconcile these objectives, there is an urgent need to develop models that can generate accurate perturbation predictions and simultaneously uncover distinct functional pathways. Thus, we introduce scLAMBDA-Program, a novel deep generative variational autoencoder framework that builds upon the robust predictive foundation of the scLAMBDA architecture. scLAMBDA-Program incorporates a …

Water Resource Governance And Health Equity In Angola, Mads Harner

Public Health Theses

AbstractBackground: Angola is confronting a set of intertwined challenges including water insecurity, increasing climate variability, and deep structural inequality that together intensify the burden of waterborne and water-related diseases (Lombana Cordoba et al., 2021; World Health Organization, 2025). Roughly half of the population does not have reliable access to safe drinking water, and gaps in sanitation and hygiene infrastructure, especially in peri-urban and rural areas, facilitate the spread of illnesses such as cholera, diarrheal diseases, and malaria (UNICEF Angola, 2025; Moreira et al., 2012). These issues are further exacerbated by drought and broader climate variability, and underlying them are historical …

Family-Related Stressors And Mental Health Among Internally Displaced Young Adults In Mozambique: A Mixed-Methods Study With Implications For Global Mental Health Interventions, Jaspreet Kandola

Public Health Theses

Mental health outcomes among displaced populations are shaped by post-displacement stressors, yet the role of family dynamics, specifically, remains insufficiently understood. This study examines how family-related stressors are associated with mental health among internally displaced young adults in Nampula Province, Mozambique. Using a convergent parallel mixed methods design, this study integrated survey data from 601 participants with qualitative data from in-depth interviews with a subsample of 16 participants. Quantitative analyses showed that family separation and concern for family members in conflict zones were associated with higher posttraumatic stress disorder (PTSD) symptoms, with family separation also linked to higher anxiety and …

Nowcasting Dengue Cases In Poor Surveillance Nations Using Meteorology And Climate-Similar Countries, Hanna Kim

Public Health Theses

Dengue fever poses a growing public health burden across the Caribbean, yet surveillance infrastructure remains inconsistent and timely outbreak detection in data-poor nations becomes limited. This study investigates whether shared meteorological patterns between Caribbean countries can be leveraged to nowcast dengue activity in low-surveillance settings using climate-matched, well-surveilled nations as epidemiological proxies. Weekly and monthly dengue case data for six countries, the Dominican Republic, Jamaica, Puerto Rico, Trinidad and Tobago, Cuba, and Haiti, were extracted from the OpenDengue database for 2005–2024, and satellite-derived climate data were obtained from the NASA POWER API. Pairwise climate correlations revealed strong temperature synchrony across …

Indoor Environmental Quality Perceptions And Self-Reported Symptoms Among West Haven Va Healthcare Employees, Joseph Hyong Kim

Public Health Theses

Background: Indoor environmental quality in workplace settings influences worker well-being, yet the relationship between perceived workplace environment and reported symptoms remains less well characterized in heterogeneous healthcare settings. This study describes perceived workplace environmental quality and self-reported symptoms among employees at the West Haven Veterans Affairs (VA) Medical Center.

Methods: An observational, cross-sectional study was conducted of VA employees across clinical and non-clinical roles to assess perceived work environment, symptoms and indoor exposures using an electronic survey and personal and area air monitoring of indoor volatile organic compounds (VOCs) and viruses. Perceived workplace environmental quality was assessed using the MM-40 …

Pediatric Rheumatic Heart Disease Screening For Secondary Antibiotic Prophylaxis: An Explainable Shannon Energy Approach Using Heart Phonocardiogram In Northeast Brazil, Zhuohui Lin

Public Health Theses

Rheumatic Heart Disease (RHD), caused by Group A Streptococcus (GAS), remains a significant global health burden, particularly among children in low- and middle-income countries. Untreated GAS infection can lead to acute rheumatic fever and subsequent chronic valvular damage of RHD, such as mitral valve (MV) regurgitation. Hence, early detection is critical for the administration of Secondary Antibiotic Prophylaxis to prevent disease progression. Although deep learning models demonstrate high diagnostic accuracy, limited explainability restricts clinical adoption, especially in resource-limited settings. In this proof-of-concept study, we evaluated Shannon energy (SE) transformation as a proxy to differentiate holosystolic murmurs associated with RHD-related mitral …

Climate, Land Use, And Lyme Disease Risk In The United States, Mohan Li

Public Health Theses

Lyme disease is the most common vector-borne bacterial infection in the United States. It remains an important public health concern due to its high disease burden, expanding geographic distribution, and complex transmission cycle. Climate change is frequently regarded as a driver of Lyme disease emergence, as many previous studies suggested. However, ongoing debate about the magnitude and mechanisms of climate effects complicates the interpretation of this relationship. This review synthesizes evidence on how climate influences Lyme disease through both direct and indirect pathways, with a focus on studies relevant to the United States and North America.Climate directly affects Lyme disease …

Optimizing Positivity Cutpoints Using Validated Assessment Tools For Osteoporosis And Sarcopenia In Aging People Living With Hiv In Peru, Joselito Malca Hernandez

Public Health Theses

AbstractBackground: People living with HIV (PWH) are at increased risk of osteoporosis and sarcopenia, yet access to gold-standard diagnostic tools remains limited in many settings. Low-cost screening tools such as OST, SCORE, and SARC-F offer practical alternatives, but optimal cutpoints and their implications for clinical decision-making in PWH are not well defined.

Methods: We conducted a secondary analysis of cross-sectional data from 229 PWH aged ≥45 years receiving care in Lima, Peru. Osteoporosis was defined using DXA among postmenopausal women and men ≥50 years, and sarcopenia using AWGS-2019 and EWGSOP2 criteria. We evaluated the diagnostic performance of OST, SCORE, their …

Maternal Sleep, Sleep Medication Use, And Birth Outcomes: A Pilot Study Of The Pregnancy, Environment, And Child Health (Peach) Cohort, Samantha Lydell

Public Health Theses

Pregnancy is often a period of poor sleep quality. Previous research has linked reduced sleep quality and difficulty sleeping during pregnancy to adverse maternal and fetal outcomes. However, little is known about how sleep medication use may influence these associations. This pilot study examines the relationships between poor sleep, sleep medication use, and birth outcomes in the Pregnancy, Environment, and Child Health (PEACH) cohort. This study included 136 participants from the PEACH cohort linked to Yale New Haven Health delivery records. Poor sleep and sleep medication use were self-reported. Outcomes were gestational age at birth (days) and birth weight (grams). …

Successive Blood Meal Feeding And Wolbachia Impact On The Intra-Host Genetic Diversity Of Dengue Virus In Aedes Aegypti Mosquitoes, Braiya Nolan

Public Health Theses

Dengue virus (DENV) is a mosquito-borne RNA virus and increasing public health threat. Due to its error prone replication, single-nucleotide variants (iSNVs) are rapidly generated within the vector, leading to heterogeneity in viral populations, fitness, virulence, and transmissibility, including under vector control interventions. One such control strategy is the large-scale deployment of Wolbachia-infected mosquitoes worldwide. Wolbachia is an endosymbiotic bacterial biocontrol method that provides incomplete inhibition of DENV replication and transmission. Given its incomplete inhibition, it is critical to understand how Wolbachia impacts DENV-2 intra-host viral diversity. Additionally, successive blood meal feeding may influence intra-host viral diversity by supporting increased …

Characterization Of Tick Exoproteins Interacting With Anaplasma Phagocytophilum, Yilei Qin

Public Health Theses

Anaplasma phagocytophilum (Ap) is an Ixodes-transmitted obligate intracellular bacterium thatinfects neutrophils and causes human granulocytic anaplasmosis. Ap alternates between an infectious dense-cored (DC) form and a replicative reticulate cell (RC) form, and successful transmission depends on coordinated interactions at the vector–pathogen interface. Tick extracellular and secreted proteins (the tick exoproteome) likely contribute to Ap survival and transmission, yet many proposed tick factors remain computationally annotated with limited experimental validation. In this thesis, I prioritize candidate tick exoproteins, identified from yeast- display screens using whole Ap organisms, and evaluate them using a two-step validation strategy. First, I quantify tissue-specific expression of …

Protecting Older Individuals From Age Discrimination Harming Psychological Well-Being: Role Of Neighborhood Cohesion, Tongyu Qiu

Public Health Theses

Age discrimination is known to harm older adults’ mental health, yet factors that may protect against this harm have received little attention. Prior studies have focused primarily on individual-level factors rather than community-level characteristics, such as neighborhood cohesion, which may be more amenable to large-scale interventions and policies. To our knowledge, no prior study has examined whether neighborhood cohesion buffers the association between age discrimination and worse psychological well-being in older adults. Participants aged 60 years and older were drawn from the Midlife in the United States (MIDUS) study. We hypothesized that baseline age discrimination would predict worse psychological well-being …

Invasive Pneumococcal Disease: Outcomes And Vaccine Effectiveness By Risk Profiles Among A Pediatric Cohort From 2002 – 2025, Keyner Rojas

Public Health Theses

AbstractBackground: Invasive pneumococcal disease (IPD) remains a significant cause of morbidity and mortality among children globally, despite the widespread use of protein conjugate vaccines (PCVs). While the introduction and implementation of these vaccines have drastically reduced the incidence of vaccine-type invasive disease, shifts in circulating serotypes raise concerns of serotype replacement. Methods: This study is a retrospective observational study of pediatric IPD cases in Massachusetts from 2002 – 2025. Over the course of these 23 years, the Massachusetts Department of Public Health has operated an enhanced population-based, statewide surveillance system for IPD. Isolates of Streptococcus pneumoniae from normally sterile sites …

Compromised Glutathione And Ascorbate Capacities Under Prenatal Alcohol Exposure, And Its Implications For Vulnerable Subpopulations, Reagan Strand

Public Health Theses

Prenatal alcohol exposure (PAE) remains the leading preventable cause of lifelong neurodevelopmental impairment, yet the biological mechanisms underlying differential susceptibility remain poorly understood. The populations most vulnerable to PAE overlap substantially with those bearing the greatest burden of antioxidant insufficiency, including individuals experiencing food insecurity, environmental pollutant exposures, and alcohol use disorder, yet this convergence and its developmental consequences remain poorly characterized. This thesis investigates how dual antioxidant deficiency in both the dam and offspring modulates vulnerability to PAE using a compound heterozygous mouse model (GclmHET/GuloHET) that recapitulates reductions in antioxidants glutathione (GSH) and ascorbic acid (AA, or Vitamin C) …

Effectiveness Of The Release Of Wmel Wolbachia-Infected Aedes Aegypti Mosquitoes On The Incidence Of Chikungunya In Campo Grande, Brazil, Vivienne Zhong Ying Su

Public Health Theses

Chikungunya is a mosquito-borne arboviral disease primarily transmitted by Aedes aegypti and Aedes albopictus that is rapidly emerging in new geographical settings because of climate change, viral adaptation, and globalization. Brazil has experienced the significant expansion of chikungunya over the past decade and has adopted novel vector control interventions, including Wolbachia-based population replacement, as part of its public health response. While the effectiveness of wMel Wolbachia on dengue incidence has been demonstrated across multiple settings, evidence on its effect on chikungunya risk remains limited. Large-scale releases of wMel-infected Aedes aegypti mosquitoes were implemented in the city of Campo Grande, Brazil …

Modeling Pfoa And Pfos Infant Intake Through Breast Milk And Formula In The United States, Ka Hei Tang

Public Health Theses

Background: Per- and polyfluoroalkyl substances (PFAS), including PFOA and PFOS, may reach infants through breast milk and water used to reconstitute infant formula. However, current U.S. evidence is limited, and the absence of nationally representative breast milk PFAS data constrained estimation of early-life infant exposures.Methods: This thesis developed a state-level exposure modeling framework to estimate daily infant PFOA and PFOS intake across U.S. states at 3 and 6 months of age. Modeled intake included two feeding pathways, breast milk and formula-reconstitution water, using national maternal serum PFAS concentrations, state-level public drinking water PFAS concentrations, and infant feeding distributions. A total …

Redefining Hospital-Acquired Rsv: Epidemiologic Burden And Probabilistic Classification In A Large Health System, Anna Trinh

Public Health Theses

Healthcare acquired respiratory syncytial virus (HA RSV) is an important but under recognized infection in adult patients. Current surveillance definitions classify RSV as healthcare acquired when a positive test occurs ≥48–72 hours after admission, despite a broad incubation period of 2–8 days which would allow community acquired infections to present several days into hospitalization. This thesis has two aims: (1) to describe the epidemiology of adult HA RSV cases in the Yale New Haven Health System (YNHHS) from 2021–2025, and (2) to develop an incubation period-based probabilistic model to assess the plausibility of each HA RSV classification. Among 2,905 laboratory-confirmed …

From Genomic Surveillance To Vaccine Efficacy: Assessing The Impact Of Plasmodium Falciparum Rh5 Genetic Diversity On Blood-Stage Malaria Vaccine Performance, Xinyan Wei

Public Health Theses

Malaria remains a major public health burden in sub-Saharan Africa. The development and deployment of effective malaria vaccines is a priority for reducing disease burden and severe outcomes. The protective immunity generated by current malaria vaccines declines over time, requiring booster doses to sustain efficacy. Consequently, next-generation malaria vaccines are under development, including a blood-stage vaccine targeting reticulocyte-binding protein homolog 5 (RH5), the most advanced candidate in clinical development. This study investigates whether genetic diversity in PfRH5 may influence vaccine efficacy using amplicon sequencing and bioinformatic analyses across three complementary approaches. Firstly, this study characterizes PfRH5 genetic diversity across multiple …

Physical Therapy And Length Of Inpatient Stay In Relation To Neuropsychological Functioning Among Childhood Cancer Survivors: A Retrospective Cohort Study From The Heros Registry, Jingyi Zhang

Public Health Theses

Background: As 5-year survival after childhood cancer exceeds 85%, neuropsychological late effects have emerged as a key issue. Despite this, the impact of modifiable risk factors during cancer treatment on subsequent neuropsychological outcomes remains obscure. This study aimed to evaluate whether physical therapy (PT) and length of inpatient stay are associated with later neurocognitive, emotional, and behavioral outcomes in childhood cancer survivors (CCS).Methods: This study included 92 CCS who had available electronic health records (EHR) for cancer treatment and completed a neuropsychological evaluation 0–5 years after their treatment end date. Information on PT and length of inpatient stay (i.e., the …

Asymptomatic Tb Duration And Transmission Models, Zhichao Zhou

Public Health Theses

Tuberculosis (TB) transmission is sustained in part by asymptomatic disease states that limit the effectiveness of passive case finding interventions that rely on symptom-based diagnosis. Here we develop a transmission model that represents the duration of asymptomatic disease with a gamma-distributed waiting time. By chaining multiple asymptomatic sub-states, we find that the gamma-distributed model provides a better fit to the observed distribution of the duration of asymptomatic disease than a simple one-state model which imposes an assumption of an exponentially-distributed duration of asymptomatic disease. Comparing the fitted gamma-distributed model and the simple model, we quantify how assumptions about the distribution …

Fresh Vs Frozen In Vitro Fertilization Treatment Rules In Multicenter Trials: Machine Learning Under Heterogeneity, Yining Zhou

Public Health Theses

Fresh versus frozen embryo transfer does not have a single answer across all IVF populations, which raises the possibility of individualized treatment selection. This thesis examined whether baseline patient characteristics could be used to develop individualized treatment rules for fresh versus frozen embryo transfer using pooled multicenter randomized trial data.

The analysis used individual-level data from four randomized controlled IVF trials conducted in China, with live birth as the primary outcome. Two primary models were evaluated: a prespecified clinically informed logistic regression model with selected spline terms and treatment interactions, and a neural-network S-learner. Performance was assessed using internal-external cross-validation, …

Outbound Investment Restrictions And International Law’S Challenge, Harlan Grant Cohen

Faculty Scholarship

The Outbound Investment Rule, restricting U.S. investment in certain Chinese advanced technology sectors, has largely been portrayed as an incremental measure, a modest extension to fill loopholes in the existing investment screening regime. But while perhaps the logical next step in the securitization of the economy, the Outbound Investment Rule actually reflects a momentous shift in the relationship between governments and business, one playing out in the United States and around the world and worth attention. Unlike traditional investment screening, the Outbound Investment Rule operates like a sanctions regime, designed not to protect the U.S. economy, but to hamper the …

Assessment Of The Antimicrobial Properties And Skin Microbiota Of Unisexual (Ambystoma) Salamanders Within Defensive Toxins, Sydney Stanton

Senior Honors Theses and Projects

As antibiotic resistance continues to pose a significant threat to public health, discovery of novel antibiotics could provide tools to combat this threat. Amphibian skin exhibits complex pathogen defense physiology and diverse skin microbiota, which suggests that it could be a potential source of novel antibiotics. A critical feature of amphibian skin is mucus, which is secreted as a defense mechanism and contains many immune system components such as symbiotic microbiota and antimicrobial peptides. To test the antibacterial properties of amphibian mucus, this study assesses whether mucus secretions from unisexual Ambystoma salamanders are effective at inhibiting the growth of safe …

Nicotine, Bdnf, And Ꞵ-Adrenergic Ligand Receptors Regulate Soluble E-Cadherin Signaling In Non-Small Cell Long Cancer, Stuti Goel

Senior Honors Theses and Projects

E-cadherin is a protein that normally helps cells adhere to each other. Sometimes, part of this protein is cleaved off and released outside the cell as soluble E-cadherin (sE-cad). When this happens, there is less E-cadherin left on the cell surface. Enzymes called matrix metalloproteases, especially MMP9, are responsible for this cleavage. In this study, we investigated E-cadherin in two non-small cell lung cancer cell lines, A549 and H1299. We found that treating these cells with brain-derived neurotrophic factor (BDNF), nicotine, or epinephrine increased the amount of MMP9 released into the surrounding media. When the cells were treated with propranolol, …

2024 Annual Operations And Maintenance Report - 2024 Bres Annual Summary Report For Work Completed In Quadrant 4, Butte-Silver Bow Department Of Reclamation And Environmental Services

Silver Bow Creek/Butte Area Superfund Site

No abstract provided.

Exploring The Impact Of Mindful Social Media Literacy Instruction On Self-Regulated Smartphone Use, Catherine Coons

Electronic Theses & Dissertations (2024 - present)

Smartphone and social media addiction, and increasingly high rates of anxiety and other mental health challenges, afflict contemporary undergraduate students more than previous generations of college students. The mental health challenges faced by students directly affect their academic potential, influencing their ability to concentrate, maintain confidence, get adequate sleep, and sustain overall well-being. Despite the increasing prevalence of these issues, universities often lack sufficient resources, services, and trained staff to support this growing student population adequately.

This study examines the impact of mindfulness-based social media literacy instruction on curbing problematic social media use in college students. While extensive research has …

The Influence Of Injury Stimuli On Stress Levels In Female Rugby Players Post Injury., Hannah L. Maycock Miss

CMC Senior Theses

This article is a proposal of a study which explores the relationship between female rugby injuries and stress levels through measuring stress between different stimuli. I will recruit 195 participants from across the country to take part in the study. They will be assigned to one of three groups: no injury, ACL injury, and head injury based on their past injury experience. Their stress levels will be measured using the galvanic skin response measure, which will be used to compare the results of each group's stress throughout the study. The participants will all complete two measures of stress, one comparing …