Medicine and Health Sciences Commons^™

Corticosteroid-Laba Inhalers Increase Phonation Threshold Pressure (Ptp) And Flow (Ptf) In Rabbits, Christopher Dromey, Kristine Tanner, Heidi J. Robison, Maya Elena Stevens, Ray M. Merrill, Julie Barkmeier-Kraemer, Ben Christensen

Faculty Publications

Objectives: This study examined the effects of a combination corticosteroid plus long-acting beta2-adrenergic agonist inhaler (IC) on rabbit phonation. Methods: White New Zealand male rabbits were assigned randomly to experimental and control groups (n = 11 per group). The experimental group received twice-daily doses of Advair HFA™ (fluticasone propionate 45 mcg and salmeterol 21 mcg) via a veterinary facemask with 1-way valve and spacer; the control group received aerosolized saline. After 8 weeks, animals were euthanized, larynges excised, frozen, and subsequently thawed and mounted on a standard bench apparatus. Phonation was elicited during 15 successive trials, and phonation threshold pressure …

Investigating Relationships Found In The Kidney Microenvironment To Aid In Understanding Malfunctions Of Proteins In Chronic Kidney Disease, Ademide Ogunsina

Holster Scholar Projects

The kidneys are the filtration organ that helps filter out waste from our body. Kidney disease is an ailment that causes damage to the kidney so that it cannot filter our blood and other bodily fluids properly. It is also one of the least researched illnesses in the medical field. And with about 10-15 percent of the American population suffering from kidney disease, there is an urgency in finding more ways to help find a solution.

I examined the damaged kidney environment at the cellular level to find out what protein processes cause the malfunction of the kidneys. Methodologies employed …

Perceptual Ratings Of Pronunciation For L2 Learners Of English As A Function Of Task Type, Word Position, And Listener Expertise, Shawn L. Nissen, Rachel Kemmey, K. James Hartshorn

Faculty Publications

Abstract Second language (L2) learners of English must learn to pro-duce English phonemes, words, and sentences. These L2learners make many errors when learning English; they may change the place or manner of articulation, insert vowels, or delete consonants. Obstruent sounds, such as fricatives, affricates, and stops, can be especially difficult for L2 learners. This study analyzed native English speakers’ perception of the quality of obstruents produced by native Mandarin Chinese and Korean speakers. Target words containing obstruents had been produced in three different tasks: in a carrier phrase, in a paragraph, and in a spontaneous speechsample. Obstruents were produced in …

Teaching Non-Native Sound Contrasts Using Visual Biofeedback, Shawn L. Nissen

Faculty Publications

This demonstration will explain how non-native sound contrasts can be taught to second language (L2) learners using real-time visual biofeedback through an electropalatographic (EPG) sensor. How the EPG sensor is created from a dental mold and is subsequently produced will be shown during the presentation. An explanation of how a student can visualize the contact patterns of their speech and how a tutor might use the various features of the associated software to customize the instruction to an individual speaker will be illustrated during the presentation. Possible limitations, costs, and drawbacks to using the technology will also be discussed.

“For The Future, For Him, And For Our Life Together”: The Relationship Goals And Well-Being Of Persons Living With Dementia And Their Spousal Care Partners, Claire Leigh Szapary

Public Health Theses

Background. Identities and dynamics in relationships can change when one spouse develops dementia. This study aimed to understand the various types of goals both spousal care partners and persons living with dementia (PLWD) have for their relationship, and to explore whether approach or avoidance goals were associated with individual wellbeing and relational support – as well as their partners’ wellbeing and support.

Methods. A secondary analysis of data from sixty-two spousal dyads where one partner has dementia was conducted. Thematic goal-type categories were determined through a card-sort content analysis methodology using participants’ brief qualitative responses to a question asking about …

Perceptions Of Adults With Type 1 Diabetes About Diabetes Management And Exercise, Meera Swaminath

Public Health Theses

This study was conducted to understand participants’ experiences with diabetes management and relationships with exercise for a sample of adults (27-65 years old) with Type 1 diabetes living in the United States and identify potential technological features for a digital health tool supporting physical exercise and diabetes management. The sample consisted of 12 participants living across the nation. Participants were recruited online, through social media and healthcare system platforms. Participant data was collected in the form of surveys and interviews and analyzed using a constructivist framework and thematic analysis. Findings were collapsed into four major themes: 1) making exercise decisions …

A Deeper Dive Into Food Insecurity Among Women Involved In The Criminal Justice System, Jessica Robles

Public Health Theses

Background: The U.S. has the highest incarceration rate globally and a recent study found that 91% of formerly incarcerated individuals report being food insecure. Given that, women have become the fastest-growing segment in the incarceration system. Women who are involved in the criminal justice system (WICJ) are more at risk for experiencing food insecurity and chronic diseases. Therefore, this study aims to contribute to existing knowledge on the overall health of WICJ by assessing the prevalence of food insecurity and the social determinants of health (SDOH) that may contribute to food insecurity.Objective: To provide information on the overall health of …

Associations Between Involvement In Shared Activities With Plwd, Relationship Closeness, And Loneliness Of Friends And Family, Marielle W. Quinn

Public Health Theses

Objectives. To examine the association between self-reported relationship closeness, loneliness, and engagement in shared activities with a person living with dementia (PLWD) in a community sample of family members and friends of PLWD. Methods. Using data from a Qualtrics-administered online survey, we examined involvement in shared activities of 51 respondents who have or had a family, friend, or intimate relationship with a PLWD. Outcome variables included relationship closeness, measured with the Inclusion of Other (IOS) scale, and loneliness, measured using a revised three-item questionnaire from the UCLA loneliness scale. Results. The main findings of the study were as follows: 1. …

Evaluating The Direct Medication Costs Associated With Advanced Non-Small Cell Lung Cancer (Nsclc) Treatment By Biomarkers In The United States: A Coarsened Exact Matching Retrospective Cohort Study, Juanyi Tan

Public Health Theses

IMPORTANCE Most NSCLC patients are diagnosed at an advanced stage. Given recent advancements in immunotherapy and targeted therapies, identifying the biomarker status—such as targetable gene alterations and immune checkpoints—of patients becomes critical in selecting the appropriate treatment. Despite the substantial economic burden of lung cancer, little is known about the medication costs associated with advanced NSCLC treatment by different biomarkers.OBJECTIVE To investigate the association between biomarker status and first-year direct medication costs associated with advanced NSCLC treatment. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study was conducted using the Flatiron Health electronic health record (EHR)-derived de-identified database. The study population …

Towards A Saliva-Based Pcr Test For The Detection Of Mpox, Russell J. Thomas

Public Health Theses

Current recommendations for the diagnosis of mpox (monkeypox) rely on lesion-swabs as the gold-standard specimen type even though many patients experience symptoms prior to lesion-onset. Earlier detection could bolster the mpox response by mitigating transmission and facilitating access to antiviral treatments. In this study, we validated five PCR assays and compared their detection of mpox virus DNA extracted from 30 saliva specimens collected into Spectrum SDNA-1000 tubes. We found the Logix Smart™ Mpox (2-Gene) RUO assay (Co-Diagnostics, Inc., Salt Lake City, UT) performed statistically significantly better than the other assays. Next, we tested five raw (unsupplemented) known-positive saliva samples in …

“To Live In The Body Of A Survivor ”: Unique And Cumulative Disaster Exposure And Mental Health In A Sample Of Hurricane Katrina Survivors, Noelle Serino

Public Health Theses

Introduction: Fueled by the escalation of climate change, weather-related disasters are increasing in frequency and severity. Existing research has documented the extensive harm induced by such disasters, yet few studies have examined how individuals’ psychological well-being fares when exposed to multiple, diverse threats, including other weather-related and public health disasters (e.g., COVID-19). As such, the present study explores posttraumatic and psychological distress in the context of unique and cumulative disaster exposure.Methods: The data utilized for this study came from the Resilience in Survivors of Katrina (RISK) Project. The sample was comprised of 381 predominantly Non-Hispanic Black (84.5%) women who experienced …

A Robust Bayesian Model Averaging Method For Basket Trials With Different Endpoints, Xueting Wang

Public Health Theses

Oncology drug research in the last few decades has been driven by the development of targeted agents. In the era of targeted therapies, basket trials are often used to test the antitumor activity of a novel treatment in multiple indications sharing the same genomic alteration. As patient population are further fragmented into biomarker-defined subgroups in basket trials, novel statistical methods are needed to facilitate cross-indication learning to improve the statistical power in basket trial design. Here we propose a robust Bayesian model averaging (rBMA) technique for the design and analysis of phase II basket trials. We consider the posterior distribution …

A Retrospective Cohort Study: Association Of Sex And Race Differences On 30-Day Retention In Addiction Treatment For Substance Use Disorders After Discharge, Bingning Wang

Public Health Theses

Objective: Little is known about the association of sex and racial differences in accessing SUD treatment. little is known whether these disparities continue despite hospitalization. The main objective was to determine the association of race and sex differences on 30-day retention in addiction treatment for all substance use disorders after discharge. Design: A Retrospective Cohort Study using the Yale Addiction Medicine Consult Service databaseSubjects: Patients with SUD who were hospitalized at Yale New Haven Hospital from Oct 26th, 2018 to Jun 30th, 2021 are eligible, which has 2557 observations. Methods: Mixed effect multivariable logistic regression for sex and racial differences …

Hiv Treatment Patterns Across A Us Data Network: 2012-2021, Raechel Elizabeth Davis

Public Health Theses

IntroductionOnce-daily combination antiretroviral therapy is recognized as the standard treatment for people living with Human Immunodeficiency Virus (HIV) in the United States.1,2 Treatment strategies for HIV have changed substantially over the years, influenced by individual and clinical factors, new medication options, and changing clinical guidelines.1–3 Observational data sources provide a unique opportunity to characterize populations and provide insight into medication usage under real-world conditions that differ systematically from controlled trial scenarios.3,4 Methods We evaluated the treatment patterns and characteristics of 12288 individuals diagnosed with HIV and continuously treated with antiretroviral medications across four, US-based observational databases using the Observational Health …

“It’S Like A Partnership”: Exploring The Primary Care Experiences And Self-Defined Goals Of People Who Use Drugs, Katherine Dunham

Public Health Theses

Background: Primary care is an important yet underutilized resource in addressing the overdose crisis. Previous studies that have explored people who use drugs’ (PWUD) experiences in primary care have found patient involvement in care decisions and goal-setting to be especially important. However, there has been limited research describing PWUD’s goals specific to primary care. This study utilized qualitative methods to explore how PWUD navigate primary care with a focus on understanding participants’ primary care goals.

Methods: From June — August 2022, we conducted 17 semi-structured interviews with PWUD currently in care at The REACH Program, a harm reduction-based primary care …

Recommendations For Climate Adaptation To Preserve Connecticut Drinking Water Quality And Quantity, Matthew Salvatore Di Vitto

Public Health Theses

Climate change impacts drinking water both directly and indirectly. Increases in temperature, drought frequency, and precipitation are among the climate impacts which currently and are projected to affect water quality and quantity in the continental United States. These impacts limit access to clean and abundant water sources by damaging habitat, spreading toxic substances via runoff and favoring the growth of harmful algal blooms. States can learn from one another to adopt best practices and policies to increase water resilience around the country. This paper explores how Connecticut can employ strategies from the States of New York, New Jersey, Massachusetts, Minnesota, …

“You Are Just Trying To Make It Work”: A Qualitative Exploration Of Healthcare Provider Implementation Considerations For Integrating Mental Health And Hiv Care In Central Uganda, Divya Gumudavelly

Public Health Theses

There is a growing push to integrate mental health services within HIV care in urban Uganda. Amidst HIV clinics becoming comprehensive healthcare centers, there is a critical need to understand how providers can better adopt and implement mental health specific protocols in HIV practice. Semi-structured interviews were conducted with 16 healthcare providers at two different HIV care centers to understand current practices, routines, barriers, and facilitators to implementing mental health care services within HIV care. Abductive thematic analysis, drawing from Consolidated Framework for Implementation Research (CFIR) and Theoretical Domains Framework (TDF) frameworks, was used in conjunction with constructivist grounded theory …

Understanding The Current Role Of Social Media In American Samoan Adolescent Lives, Mukund Desibhatla

Public Health Theses

Purpose: This exploratory study investigated the social and cultural factors that shape social media use among adolescents in

American Samoa. Methods: This project was a secondary qualitative analysis. Methodological considerations included an

interpretivist approach to epistemology and alignment with the Fa’afaletui Pacific framework. Phenomenology methods were

used to “bracket” researcher biases. A 21st-century flexible coding approach proposed by Deterding et al. 2021 was applied

to the dataset [31]. Transcript excerpts were re-sorted by the index code: social media/technology as a predictor of mental

illness. An abductive thematic analysis, stemming from inductive and deductive reasoning, was used to analyze the codebook …

Cleft Lip And Depression In Adults: A Multi-Ancestry Mendelian Randomization Study, Anne Lyon Havlik

Public Health Theses

Background: Clefting of the lip with or without cleft palate (CLP) is the most common congenital craniofacial abnormality globally, affecting one in 700 live births. Traditional observational studies suggest an increased risk of adult depression among subjects with CLP, but these studies are subject to residual confounding.Objective: We aimed to address residual confounding by evaluating the association between the genetically-predicted risk of CLP on the risk of adult depression in a Mendelian randomization framework. Methods: We used single-nucleotide polymorphisms strongly associated with CLP as genetic instruments. Genetic associations with adult depression were extracted from separate studies. Three ancestry groups were …

Do Longitudinal Trends In Caloric Intake Vary By Income, Education, Or Race?, Daniel Davila

Public Health Theses

Background: The prevalence of obesity in the United States has increased over the last few decades. Reasons for the increases are abundant, but one factor consistently stands out, caloric intake. Cross-sectional data on differences in caloric intake by race/ethnicity and socioeconomic status are common; however, few studies have evaluated the long-term trends in calorie intake by these factors. Methods: We evaluated trends in average calories consumed by adults in the United States by income decile, educational attainment level, and race/ethnicity from 1971 to 2018 using data from the National Health and Nutrition Examination Survey (NHANES), which purposely assessed and recorded …

Genetic Sequencing Of Breakthrough Severe Acute Respiratory Syndrome Coronavirus 2 Infections In Fully Vaccinated Healthcare Workers, Sara Haddad, John Zurlo, Zi-Xuan Wang, Bonnie Richards, Nitika Badjatia, Dagan Coppock

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Introduction

Since the identification of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), several efforts have been made to prevent infection, culminating in the development of highly effective vaccines. However, as genetic variants of the virus have emerged, concerns have arisen regarding potential limitations of available vaccines.

Methods

In this article, we evaluated SARS-CoV-2 breakthrough infections among 520 healthcare workers in a 950-bed hospital from March 1, 2021, to October 31, 2021, and stratified them according to the type of vaccine received. We tested for associations between Alpha and Delta strains of SARS-CoV-2 and clinical characteristics.

Results

During the study period, …

Pre-Admission Depression And 6-Month Post-Discharge Sleep Disorders In Elderly Covid-19 Survivors, Yixiao Zhang

Public Health Theses

ABSTRACTObjective: This study aims to evaluate the association between depression at baseline and presence of three sleep disorder symptoms (fatigue, daytime sleepiness, and insomnia) following 6-month hospital discharge in elderly COVID-19 survivors. It also aims to identify which other baseline patients’ characteristics or post-discharge factors may be associated with these sleep disorder symptoms. Methods: The participant datasets were obtained from VALIANT, a prospective longitudinal study of community-living adults aged ≥ 60 years who were admitted with COVID-19 to hospitals within the Yale New Haven Health System (YNHHS) from June 2020 - June 2021. Multiple logistic regression models were performed to …

Copd And Asthma: Genome-Wide Associations And Genetic Pleiotropy, Yixuan Yang

Public Health Theses

This study aimed to describe the overlap between genetic variants that are independently associated with COPD and asthma, then dissect the cross-phenotype associations to characterize patterns of pleiotropic effects. The COPD and asthma datasets were separately extracted from an aging population consisting of white European subjects from the UK Biobank database. Genome-wide association tests were performed separately with the COPD and asthma data to first investigate significant genetic variants independently associated with each of the two phenotypes. With the GWAS summary statistics, several significant genetic loci that exhibit potential pleiotropic effects on COPD and asthma on a genome-wide significant level …

Effect Of Digital Public Health Campaigns By The World Health Organization On Self-Reported Behavior, Recall/Knowledge, And Attitude Toward Interventions Related To Covid-19: A Meta-Analysis, Zili Zhou

Public Health Theses

The COVID-19 pandemic highlighted the need for effective scientific communication. The success of public health interventions are largely dependent on public knowledge and behavior. With the global rise of social media usage, as well as the increased prevalence of social media advertisement campaigns, the platforms present a tool with the potential to be utilized by public health authorities to deliver information and influence broad populations within a short period of time. From 2020 to 2022, the World Health Organization conducted 58 social media campaigns, totaling 176 brand-lift studies, in partnership with Meta on the subject of COVID-19. The campaigns conveyed …

Interrupted Time Series Analysis To Evaluate Regional Greenhouse Gas Initiative Health Impacts, Julia Sweatman

Public Health Theses

Abstract

Background & Aims: Fossil fuel combustion emits a spectrum of ambient air pollutants, with the most harmful health effects seen from particulate matter 2.5 μm or less in diameter (PM2.5). Pricing carbon can reduce PM2.5 emissions and yield co-benefits for public health. The Regional Greenhouse Gas Initiative (RGGI) is a cooperative carbon pricing initiative among twelve states aiming to curb carbon dioxide emissions from the power sector. This preliminary analysis explores methodological approaches to quantify the health benefits associated with PM2.5 changes after RGGI was first implemented in 2009.

Methods: An interrupted time series analysis was performed to compare …

Urban Air Pollution Exposure Of Children In Dwight Neighborhood In New Haven, Ct, Weixi Wu

Public Health Theses

Air pollution remains to be one of the leading causes of morbidity and mortality, especially in the urban environment. Airborne contaminants exposure differs across different communities and in the US, low-income, racial minority communities bear the burdens of high exposure and adverse health outcomes. Therefore, we conducted a study among children living in the Dwight neighborhood in New Haven, CT, where the community is mainly low-income and consist of a large number of immigrants and racial minorities. The objectives of the study were 1) to characterize the distribution and magnitude of individual level of airborne contaminants exposure; 2) to determine …

Estimating Urinary Nitrate Excretion In Rural Iowans From Dietary And Drinking Water Sources, Timothy Skalaban

Public Health Theses

Nitrate levels are increasing in our environment, and epidemiological studies have found evidence of adverse health risks from this exposure. Therefore, it is important to characterize the magnitude of nitrate exposure from food and drinking water sources. This study assesses the magnitude of nitrate exposure for 47 farmers from the Agricultural Health Study (AHS) in 2018-2019. The participants in our study use private wells as their main drinking water source and live in agricultural area of Iowa (10 counties) where ground water is vulnerable to nitrate contamination. The extent of nitrate exposure is determined by several factors, including the types …

Analyzing Pediatric Department Documentation Of Patient Social Needs With Icd-10 Z-Codes, 2019-2020, Oluwatofunmi Jummie Akinwunmi

Public Health Theses

The 10th revision of the International Classification of Diseases (ICD-10) allows healthcare professionals to document social needs with ICD-10 Z-codes. Data derived from documentation of ICD-10 Z-codes can be leveraged to identify at-risk populations for targeted intervention. However, there remains concern for underutilization of these codes particularly in the pediatric population. We sought to examine the documentation of ICD-10 Z-codes in the pediatric outpatient setting of the largest Connecticut hospital network by specialty type and age group. We examined deidentified electronic health records of pediatric outpatient patients from 2019-2020. We used descriptive statistics to measure the proportion of patients with …

The Ticking Clock: Understanding Time Toxicity While Treating Older Patients With Metastatic Breast Cancer, Swarali Atre

Public Health Theses

Aim: We aimed to investigate the association between age at diagnosis and time spent seeking care for Metastatic Breast Cancer (MBC) and to identify the major components of acute and outpatient care contributing towards time lost in seeking cancer treatment i.e., time toxicity. Methods: We conducted a longitudinal retrospective cohort study in MBC patients aged 67 or older who initiated treatment from 2010-2017 using the SEER-Medicare linked database. We calculated the cancer-related encounter days by summing up the patients' healthcare system interactions within one year of initiating cancer treatment for each category. We used a Poisson model with days alive …

Exploring The Perceptions Of Genetics, Genetics Testing, And Science In People Of African Descent, Maame-Owusua Boateng

Public Health Theses

Background: Historical injustices towards Black populations in the United States have impacted how communities interact with medicine and public health such as medical experimentations, scientific racism, medical racism, and eugenics. Black communities are underrepresented in human genomics projects compared to those that identify as white or of European ancestry. Prior research has demonstrated that Black people are less likely to know about the availability of genetic testing for diseases and have less confidence in the benefits of genetic testing. These disparities make it imperative to understand the perspectives of people of African descent. Methods: The Black Genome Project is an …