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The Effects Of New Onset Medicare Eligibility At Age 65 On Access To Surgical Care At A Large Non-Profit Health System, A Single-Center Regression Discontinuity Analysis, Amanda R. Jankelovits

Yale Medicine Thesis Digital Library

ASSOCIATION OF MEDICARE ELIGIBILITY ON SURGICAL CARE ACCESS, A REGRESSION DISCONTINUITY DESIGN

Amanda Jankelovits, Julian Zhao, Hugo He, Hung-Mo Lin, Robert B. Schonberger, Department of Anesthesiology, Yale University, School of Medicine, New Haven, CT

The widespread onset of Medicare eligibility at age 65 has expanded access to healthcare, particularly among those previously uninsured. However, disparities in healthcare coverage still exist, especially for underrepresented minorities and low-income individuals. In this analysis, we utilize a regression discontinuity design to understand the effects of new onset Medicare eligibility at age 65 on access to surgical care at a large non-profit health system, focusing …

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 …

Investigating The Cooccurrence Of Papillary Thyroid Carcinoma Among Patients With Oncocytic Pathology: Is There Evidence Of Causation?, Forest Seely Mahoney

Yale Medicine Thesis Digital Library

Thyroid neoplasms, both benign and malignant, significantly contribute to healthcare burden in the United States. Oncocytic neoplasms (ON), previously classified as Hürthle-cell neoplasms and comprising oncocytic adenoma (OA) and oncocytic carcinomas (OC), represent a rare subset of follicular cell-derived thyroid pathology, accounting for 3–7% of all thyroid malignancies. OC are considered more aggressive with worse prognosis due to higher rates of recurrence as well as inherent resistance to radioactive iodine, the first line of adjunct therapy for well-differentiated thyroid cancers. Conversely, papillary thyroid carcinoma (PTC), another follicular cell-derived thyroid cancer, constitutes over 90% of thyroid cancer cases and is characterized …

International Structural Magnetic Resonance Imaging Of Cortical Thickness In Older Adults With Bipolar Disorder, Rebecca Brynn Marks

Yale Medicine Thesis Digital Library

The presentation of bipolar disorder (BD) seems to change over the course of a lifetime. In older adults, BD seems to pose novel challenges including decreased cognitive functioning, psychiatric and medical comorbidities, increased susceptibility to medication side effects, and possibly even a shift toward more depressive symptoms. Despite these clinical findings, research into older adults with BD has lagged behind that of adolescents and young adults. As the global population ages, so too do individuals with BD. In fact, it is predicted that by 2030, 50% of patients with BD will be over the age of 60. This emphasizes why …

Tigit And Gdf-15 As Biomarkers And Targets In Renal Cell Carcinoma Resistant To Immune Checkpoint Inhibitors, Oscar Norberto Perales

Yale Medicine Thesis Digital Library

Immune checkpoint inhibitors have become the standard of care treatment for local and systemic clear cell renal cell carcinoma (RCC). However, a subset of patients fail these therapies due to the development of disease refractory to such treatments. Therefore, it is imperative that we study the potential mechanisms of resistance to immune checkpoint inhibition within the tumor microenvironment. Likewise, establishing biomarkers indicative of treatment resistance may benefit clinicians and patients when it comes to the initial selection of treatment. Moreover, biomarkers of resistance might also serve as potential drug targets. In this study we analyzed expression of TIGIT and GDF-15, …

Cutaneous Fungal Infections In The United States: A Cross-Sectional Analysis Of National Surveys, Sarah Lee Spaulding

Yale Medicine Thesis Digital Library

Superficial cutaneous fungal infections (SCFIs), caused by yeasts, dermatophytes, and nondermatophyte molds, are prevalent skin conditions with substantial economic and quality-of-life implications. This study aimed to evaluate trends in the prevalence of SCFIs in the United States between 2005 and 2016, using data from the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS).We performed a cross-sectional analysis of outpatient visits with SCFIs diagnoses, identified through the International Classification of Diseases, Ninth and Tenth Revisions, Clinical Modification (ICD-9-CM and ICD-10-CM). Diagnoses included conditions such as tinea unguium, tinea pedis, and candidiasis of the skin …

Prognostic Factors In Active Surveillance Of Low-Risk Prostate Cancer: A Future Of Tailored Surveillance, Vinaik Mootha Sundaresan

Yale Medicine Thesis Digital Library

PROGNOSTIC FACTORS IN ACTIVE SURVEILLANCE OF LOW-RISK PROSTATE CANCER: A FUTURE OF TAILORED SURVEILLANCE.

Vinaik M. Sundaresan and Michael S. Leapman. Department of Urology, Yale University, School of Medicine, New Haven, CT.

As most Prostate Imaging Reporting and Data System (PI-RADS) 5 lesions on MRI harbor Gleason grade (GG) group ≥2 disease on biopsy, optimal management of patients with imaging-biopsy discordance remains unclear. To estimate grade misclassification, we evaluated the incidence of Gleason upgrading among patients with GG1 disease in the setting of a PI-RADS 5 lesion.

We conducted a single-institution retrospective analysis to identify patients with GG1 prostate cancer …

The Use Of Biologic Agents In Cutaneous Immune-Related Adverse Events Due To Immune Checkpoint Inhibitors, Kailyn Valido

Yale Medicine Thesis Digital Library

Immune checkpoint inhibitors (ICIs) have transformed the treatment landscape in the field of oncology due to their effective antineoplastic properties for various cancers. Though revolutionary in cancer treatment, their use is limited by various immune-related adverse events (irAE). Cutaneous immune-related adverse events (cirAE) are the most common type of irAE and encompass a spectrum of dermatological manifestations. These include lichenoid reactions, psoriasiform eruptions, eczematous dermatitis, immunobullous disorders, granulomatous reactions, pruritus (with or without a primary eruption), vitiligo, and severe cutaneous adverse reactions such as Stevens–Johnson syndrome and drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome.

The standard approach in …

Changes In Healthcare Coverage And Access To Eyecare Among Low-Income Adults After Medicaid Expansion, Elliott Vanderford

Yale Medicine Thesis Digital Library

Introduction: Access to quality eyecare is important for early diagnosis and prevention of vision loss. Understanding the role of Medicaid expansion (as a result of the Affordable Care Act) in improving eye health outcomes has the potential to guide health policy and address disparities in vision care in the United States. Here, we investigate the impact of Medicaid expansion on access to eyecare among low-income adults across the United States.

Methods: Survey data was extracted from the National Health Interview Survey (NHIS) for the years 2010 through 2018 for adults aged 18-64 years with a family income less than 125% …

Macrophage Migration Inhibitory Factor And D-Dopachrome Tautomerase As Biomarkers And Key Modulators Of Tumor Progression In Head And Neck Cancer And Melanoma, Caroline Naomi Valdez

Yale Medicine Thesis Digital Library

Macrophage Migration Inhibitory Factor (MIF) and its homolog D-dopachrome Tautomerase (DDT) are pro-inflammatory cytokines implicated in tumor progression across multiple cancers. Both MIF and DDT act through canonical CD74 and non-canonical CXCR2/4/7 signaling pathways, which contribute to immune suppression and tumor progression. Elevated MIF levels are associated with metastasis and poor prognosis in HNC and contribute to immune checkpoint inhibitor (ICI) resistance in melanoma. DDT’s role in cancer is not well understood. This study aims to evaluate the expression and therapeutic potential of MIF and DDT inhibition, focusing on their ability to modulate immune responses and improve survival outcomes as …

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 …

Private Property Vs. Public Access: Socio-Engineering Framework For Managing Non-Meandering Waters In South Dakota’S Prairie Pothole Region, Lydia Loken, Sushant Mehan

The Journal of Undergraduate Research

This study addresses the growing importance of balancing private ownership and public interest of Non-Meandering Waters (NMWs) overlaying private property in the South Dakota Prairie Pothole Region (PPR) through both a legal and socio-engineering lens. This study aims to develop an integrated management framework for Non-Meandering Waters in the South Dakota Prairie Pothole Region that combines water allocation principles, the Public Trust Doctrine, and water quality objectives to guide policy decisions, ensuring equitable access, long-term sustainability, and a balanced approach to both public and private interests. Data collection from October 2024 through February 2025 and included a literature review of …

Forecast, 2025, Illinois State University, College Of Applied Science And Technology

foreCAST

Magazine of the Illinois State University College of Applied Science and Technology

Repressed Memories And The Body Keeps The Score: Public Perceptions And Prevalence, Kris-Ann S. Anderson, Quincy C. Miller, Deryn Strange, Kamala London

Publications and Research

The “memory wars” resurgence has renewed debates over the validity of repressed memories. This revival appears linked to factors such as changing statutes of limitations, confusion about repression, and unchallenged social media content. In a nationally representative online survey of American adults (N = 1581), we examined (a) beliefs in repression and the body keeps the score, (b) the prevalence of recovered memory claims, and (c) the impact of question phrasing on recovered memory reporting. An overwhelming 94% of respondents expressed belief in repressed memory, and 77% endorsed the idea that the body keeps the score. Additionally, 3.6% (n = …

Correlating Csr Theory And Soil Texture To Bridge The Gap In Ecological Planting Strategies For Landscape Architecture, James E. Theiss

Landscape Architecture Masters & Design Theses - Archive

Many studies are focused on the benefits of including natural and ecoregional landscape design within urban habitats; however, a focused approach to how landscape architects can begin including ecological applications within their planting designs has not been fully assessed. Once the knowledge gap between ecology and how landscape architects plan landscape plantings is fully realized, research on the benefits of bringing nature back to urban environments can be thoroughly assessed. It is common knowledge that landscape design involves creating aesthetically pleasing plant combinations based on simple site characteristics that can influence how a plant grows (Tabassum S. et al., 2020; …

Breathing New Life Into Main Street Garden: A Design To Showcase Native Forb Flowering Lawns For A More Sustainable Downtown Dallas, Tx, Peter E. Wagner

Landscape Architecture Masters & Design Theses - Archive

Lawns are a landscape staple that dominate urban and suburban spaces. While they are often criticized, for many good reasons, their general popularity and acceptance are undeniable. Aesthetic preference, simple maintenance, low upfront cost, and high recreational value make lawns a ubiquitous feature in urban design (Ignatieva et al., 2017). However, from an environmental standpoint they are immensely costly and contribute significantly to pollution (Smetana & Crittenden 2014). Ecologically speaking, they contribute very little to local biomes and, with their prevalence in rural and suburban settings, they displace large swaths of native habitat. Despite rigorous research and well-articulated arguments against …

Guideline For The Management Of Immunotherapy-Related Adrenal Insufficiency At A Cancer Center, Rachna R. Patel

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Immunotherapy has become an important treatment option for cancer care and is being utilized more often. Immunotherapy-related adrenal insufficiency (irAI) is a potential adverse effect of immunotherapy that requires endocrine expertise for management. The goal of this project was to create a guideline with an algorithm for the safe and comprehensive management of irAI in an advanced-practice provider-led clinic.

Methods: A guideline project utilizing the Agency for Healthcare Research and Quality (AHRQ) National Quality Measures Clearinghouse (NQMC) Measure Domain Framework was conducted at this cancer care facility. A literature search was conducted to gather the best available evidence and …

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. …

Little Problems: Photosynthetic Textile Treatments As A Source Of Oxygen, Morgan Campbell

Open Access Master's Theses

During human space travel, oxygen (O2) must be stored and carried aboard the shuttle for the entire journey; compressed O2 is highly flammable and combustible, thus doing so puts the crew’s lives at risk in the event of a fire (Mandel, 2019). By creating O2 onsite, the necessity of compressed O2 canisters and the associated risks can be reduced or erased entirely. Photosynthesis, the process through which plants convert atmospheric carbon dioxide (CO2) into O2, is one method of creating O2 (Lorch, 2020). The National Aeronautics and Space Administration (NASA) has experimented with photosynthetic O2 systems since its inception but …

Investigating The Role Of Fnci-1 In The Development And Function Of The C. Elegans Nervous System, Meagan Collins

Open Access Master's Theses

Fanconi Anemia (FA) is a rare human genetic disease caused by mutation of any of twenty-three genes on the FA pathway, which functions in the repair of DNA damage and the maintenance of genome stability. FA is clinically characterized by congenital abnormalities and a predisposition to aplastic anemia and malignancies. Recently, progressive neurological symptoms and abnormal neurological findings on imaging have been noted in FA patients, including cerebral and cerebellar lesions, calcification, necrosis, gliosis, and associated acute and chronic neurological symptoms; this constellation of symptoms has been termed Fanconi Anemia-Associated Neurological Syndrome (FANS).

To elucidate the molecular etiology of FANS, …

Development Of An Autonomous Lab-On-Paper Device For Enzymatic Activity Assays- Proof Of Concept, Cameron Hahn

Open Access Master's Theses

This work aims to build on URI’s autonomous Lab on Paper (LoP) platform technology, which was used to conduct enzyme-linked immunosorbent assays (ELISAs), to conducting enzymatic activity assays. This requires new optimizations and designs to accommodate the test. In this work we use alkaline phosphatase (ALP) enzyme as the model analyte for the proof-of-concept. To accompany the new device, new MATLAB analytical tools were written and tested, to aid in robust colorimetric signal analysis. The test fixture was designed to be reusable, when a new paper circuit and reagent vials are supplied, however, it was assumed that an eventual final …

Metabarcoding-Biomass Relationships And Internal Standards For Quantitative Dna Metabarcoding, Frances Webber

Open Access Master's Theses

DNA metabarcoding has been widely adopted due to its power in investigating the composition of protistan communities, accurately identifying even small and cryptic taxa. However, the compositional nature of DNA metabarcoding results, and the distortion of natural abundances due to variation of the often-used 18S rRNA gene copy number over several orders of magnitude, renders these results semi-quantitative at best, limiting the application of DNA metabarcoding to ecological study. Here, we constructed mock communities from uni-algal cultures of taxonomically diverse phytoplankton and conducted metabarcoding using multiple primer sets and both DNA and cDNA as PCR templates. For each culture, chlorophyll …

A Systematic Review Of The Role Of Emotion Regulation In Predicting Behavioral Inhibition Symptoms Among School-Aged Youth, Anne C. Nields

Open Access Master's Theses

Mental health challenges represent a key construct to focus on in support of childhood and adolescent well-being. Mental health challenges represent the leading cause of disability among children and adolescents. Recent research on critical periods in brain development shows that early childhood and adolescence mark times in which behavioral, neurodevelopmental, and mental health features arise. Anxiety disorders, which involve the excessive presence of fear and anxiety, are among the most common psychiatric disorders affecting youth and adults today. Emotion regulation (ER) and behavioral inhibition are important constructs correlated to anxiety which may be leveraged to predict and intervene on the …

Finite Element Modeling Of Offshore Wind Monopile Impact Pile Driving In Comsol Multiphysics, Brendan J. Giordano

Open Access Master's Theses

The primary foundation type for offshore wind farms are large-diameter monopiles, which are installed with an impact hammer that produces a high-intensity, broadband impulsive signal that radiates acoustic energy in the water column and seafloor. This signal generates multiple waves such as compressional, shear and Scholte (or interface) waves. Scholte waves travel on the water-sediment interface and contain high-intensity, low-frequency energy that benthic species of fish and invertebrates could possibly detect. COMSOL Multiphysics, which is a finite element modeling software, was used to develop two transient models of impact pile driving to measure Scholte wave particle motion (displacement, velocity, acceleration) …

Predicting Evapotranspiration, Quick Flow, And Recharge In The Contiguous United States Through 2100, Paige Aldenberg

Open Access Master's Theses

Groundwater pumping has more than doubled since 1950 across the United States and now accounts for more than 50% of water use in much of the country. These high pumping rates have exceeded recharge in many aquifers, especially in the dry Western United States. As a result, water levels are declining, increasing water scarcity for humans, and causing various adverse ecosystem impacts. So, predictions of future groundwater recharge rates, especially in the face of changing climates, are necessary for informing future water management practices. While historical groundwater recharge rates have been estimated across broad geographic regions, high-resolution predictions of future …

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 …

Best Methods For Establishment And Maintenance Of Pollinator Plantings In Highway Rights-Of-Way, Sophia Lopardo

Open Access Master's Theses

This study explores the potential of highway rights-of-way (ROWs) to serve as habitats for native New England grasses and flowering plants, while also enhancing resources essential for native pollinator communities. This project emphasizes the adaptability of regionally native and insect-pollinated wildflowers and grasses to periodically mowed ROWs; the research assesses various establishment methods that are commonly used in new roadside construction. The study aims to evaluate the effectiveness of different establishment methods for developing roadside pollinator meadows within ROW settings, using species richness (separated into forbs, grasses, insect pollinated functional groups), bare ground percentage, and seed mix germination and persistence …

Herbivore Kairomones Affect Germination Speed, Seedling Growth, And Herbivory, Brooke Pellegrini

Open Access Master's Theses

Seeds and seedlings are particularly vulnerable to herbivory. Unlike mature plants, which can wait until herbivory is experienced to induce defense, seeds and seedlings face mortality if they wait. Slug mucus functions as a kairomone, a non-attack-related substance emitted by consumers that is detected by a prey species (in this case, plants). While snail mucus has been shown to induce defense in seedlings, it is not widely confirmed whether slugs have the same effect and whether seeds can also detect and react to such herbivore cues. We investigated how exposure to Arion subfuscus mucus affected growth and defense in Brassica …

Field Performance Evaluation Of Selectively Bred Eastern Oyster Lines In New Jersey And Rhode Island, Seraphina Satkowski

Open Access Master's Theses

Eastern oyster aquaculture has increased steadily over the last three decades, but the industry has yet to achieve its full potential. In the Northeast USA, production is limited in part by a lack of high performing stocks suited to the geographically broad and heterogenous growing environments. For this study, hatchery lines from Maine, New York, and New Jersey as well as crosses between each hatchery line and the selectively bred Northeast high survival (NEHÒ) line, were deployed at oyster farms in Rhode Island and New Jersey for performance evaluation. Replicate bags of each line were stocked and maintained according to …