Class of 2021 Outstanding PA Theses Event

December 03, 2021

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To CiteDCA Citation Guide

00:00Good afternoon everyone.
00:02Welcome to the class of 2021's
00:06outstanding thesis presentation.
00:07For those of you at home
00:09who may not know me.
00:16For those of you at home who may not
00:17know me, I'm Alexandria Guerino.
00:18I am the director of the Yale
00:21Physician associate program.
00:23Today's event is a kickoff to graduation,
00:26so we're all very excited to be here.
00:29One of the characteristics
00:30that set that sets the LPA program apart
00:34from other programs is our focus on research.
00:37Our research program is a rigorous one.
00:40We believe that PS need to utilize
00:43principles of research methodology,
00:47public health, and evidence based medicine.
00:51If they're to practice.
00:52To the best of their ability,
00:54this training is one of the reasons why
00:57our graduates here are or soon to be.
00:58Graduates are so highly
01:01sought after this year,
01:02we introduced the alternative
01:04thesis pilot which was developed
01:07by Doctor Gonzalas Colosso.
01:09Several student students took up the
01:11challenge to take the traditional thesis
01:13one step further and collect data,
01:16and they were required to them produce
01:20a manuscript of publishable quality.
01:23So far we have two publications and several
01:26regional and national presentations
01:28that have come out of this pilot,
01:30so I would declare it's a huge success.
01:33We also celebrate the traditional thesis
01:36today and highlight a project that was
01:39funded by the Wilbur Downs Fellowship.
01:41We have many people to thank
01:44for today's presentation.
01:45First,
01:45we thank the students for their dedication,
01:48their flexibility, and their perseverance.
01:51The thesis project is demanding
01:54in the best of years,
01:56but you all accomplished amazing
01:58things with your education being
02:01disrupted because of the pandemic.
02:05I congratulate the entire class
02:07on your hard work and dedication,
02:10so I think that deserves around.
02:17We thank Thesis Advisors whose
02:19expertise and guidance made an
02:21important contribution to the
02:23development of these future clinicians.
02:25We thank Tiffany Chen,
02:26who's with us today and Andrew Arakaki,
02:29our research TAS.
02:31We thank our readers are
02:33dedicated librarian Caitlin Meyer,
02:36who's also with us today.
02:44And the graduate writing tutors,
02:45all without whom these projects
02:48would not be possible. We thank Dr.
02:50Rosanna Gonzalas Colosso for making the
02:53research program really distinctive
02:55piece of the LPA program experience for
02:58our students and Miss Megan Pendergast
03:00for her management of the program.
03:03We also thank Chanel Feliciano
03:05and the entire administration and
03:07administrative staff for their
03:09coordination of today's event.
03:11For those who are in person,
03:13we have some.
03:14Refreshments after the presentation.
03:16So please stop there little signs directing
03:19you to a table with very nice sweet treats,
03:22so please help yourself to that and
03:24I thank you all for joining us today.
03:27I hope you enjoy the thesis presentation.
03:40Hello everyone for those here. Thank
03:43you so much coming to support
03:45the students that went to Extra mile
03:47when everything was done and prepared.
03:49These presentations or poster
03:51presentations for those at home or
03:54somewhere else in the university.
03:56Thank you for joining us and
03:58supporting our efforts here.
04:00Of course, as any already have
04:03given all the thanks and we want to
04:06start the program as soon as possible
04:09before I would like to give you a road map.
04:11Of how we are going to do that.
04:13There will be four presentations
04:15representing the three current
04:18paths to complete API thesis
04:19at Yale at the year. Physician associate
04:20program. So there will be representation
04:22from the Bounce fellowship.
04:24A one way to do it and representation
04:27from the traditional thesis
04:29and representation for the
04:31new alternative thesis.
04:33There were too many outstanding
04:34presentations this year,
04:36way too many and we couldn't
04:39stop by inviting others to share.
04:42Also their projects through
04:44electronic posters presentations.
04:46So first we are going to have four
04:48before presenters live and even
04:51their families are joining us,
04:53so I hope that you appreciate how much
04:55they learned and also we are going
04:58to then acknowledge a group of very
05:01important people that made all these
05:04possible and we will invite then,
05:06especially those in the classes
05:09of 2022 and 2023.
05:11To join a panel of presenters
05:14to discuss their posters, to
05:16find inspiration, there is light at
05:18the end of the tunnel. Believe me,
05:21so I'm going to call the first.
05:24Well, of course this is the class of 2021.
05:3440 outstanding people that
05:36he looks so eager a 27 months
05:40ago and even before that.
05:42During admissions,
05:44everybody wanted to do their thesis here.
05:48So now we are showing right
05:51what they have produced.
05:52These are the ones that are going to
05:54be taking care of us soon because
05:56many are staying in Connecticut,
05:58so were first presented.
06:00Presenter is Annabelle Wilcox who I invite.
06:04To the podium to take charge.
06:06Thank you.
06:14Hello everyone so I'm Annabelle I
06:18did the alternative thesis project
06:20so I was able to develop a
06:22project and carry it out.
06:23I'm with my advisors and they will be
06:26presenting the manuscripts today so I
06:28just want to thank my fellow Co authors,
06:29Dr Venture I'm doctor Nally and my
06:32advisor Dr Weinzimer without their
06:34support throughout the whole process.
06:36I definitely would not have
06:38made it here today.
06:39So I thank them for their guidance
06:41and constant support.
06:42OK, so here's the outline of the
06:44talk that I'll go through today.
06:46So starting with some background information,
06:49diabetes technology has advanced.
06:51We now have continuous glucose monitors,
06:54insulin pumps,
06:55they connect to wireless devices,
06:57give real time glucose data,
06:58and all this technological advancement
07:00is coming at a time where there's also
07:02increasing prevalence of type one diabetes,
07:04and minority youth.
07:06But despite this,
07:07despite knowing that diabetes
07:09technology results in better outcomes,
07:11lower anyone,
07:12see by better glycemic control,
07:14my minority youth are at higher risk
07:16for work shortcoming outcomes and also
07:19less likely to be using this technology
07:21to manage their glycemic control.
07:24So study found that type one diabetes
07:26exchange pressure registry found that
07:27the odds of a white child being an
07:29insulin pump or 3.6 times higher than
07:31that of a black child and 1.9 times
07:33higher than that of a Hispanic child.
07:35So that really just shows you
07:37the disparity that exists.
07:39There's also a significant difference in
07:41anyone see between the two racial groups.
07:43Even when we control for
07:44socioeconomic status.
07:45So it seems like there's other
07:47factors that are contributing to
07:49this outside of socioeconomic status.
07:51So the question that I wanted to
07:52answer is what could be contributing.
07:54To this disparity and technology
07:56use anyone see and that racial
07:58and ethnic minority adolescents?
08:01So, one thing that's been
08:02associated with decreased adherence to
08:04treatment recommendations and a suboptimal
08:07anyone see his diabetes distress?
08:09So this is a measure of the
08:11negative emotions experience for
08:12managing and living with diabetes.
08:15It's thoughts. We do.
08:16The lack of understand from others
08:17and just the daily demands of
08:19living with a chronic illness.
08:21So there's been no studies
08:22that have directly
08:23compared diabetes distress.
08:24Between non Hispanic youth or sorry,
08:27not Hispanic. White youth and racial
08:29and ethnic minority adolescents.
08:31So the aim of this study was
08:33to describe the differences in
08:34diabetes technology used, IBS,
08:36stress and barriers to management between
08:38adolescents with type one diabetes.
08:40Specifically, comparing between
08:42racial and ethnic minority youth
08:44and then non Hispanic white youth.
08:47Secondarily,
08:47we also wanted to compare on the same
08:49measures between those who are using
08:50technology and not using technology,
08:52and then also between adolescents and
08:55their primary caregiver or parent.
08:57So I hypothesize that diabetes distress
08:59will be negatively associated with
09:01diabetes technology use and will
09:02be higher in the racial and ethnic
09:04minority adolescents with type one diabetes.
09:08So quickly just to go through the
09:09methods it was a cross sectional
09:11study design. We used Qualtrics,
09:12which is a HIPAA compliant software,
09:14and the survey was given both
09:16to parents and adolescents.
09:17Inclusion criteria was type one diabetes.
09:20But sorry, type one diabetes
09:21of at least six months,
09:22and between the ages of 13 and 17.
09:25And we recruited through email
09:26and phone to patients at the
09:29Yale Children Diabetes Center.
09:30We used three scales to measure diabetes,
09:32distress and barriers to management.
09:34For the paid peed scale measures diabetes,
09:37distress, and adolescence.
09:38They paid.
09:39PR is the same,
09:40but for parents and then the
09:42PRISM questionnaire identify
09:43specific barriers to management.
09:45So it is split into five
09:47different categories,
09:47understanding and organizing care regimen,
09:49pain, and bother health care team,
09:51family interactions and peer interactions.
09:54And so each of these questionnaires
09:56were given and they all have an
09:58established cutoff point to measure
10:00clinically significant diabetes distress.
10:01Or as a barrier as a clinically
10:04significant burden to diabetes management.
10:07I'm sorry, independent variables.
10:08We separated the adolescents
10:10into two groups based off of
10:11their self identified race,
10:12race and ethnicity.
10:13So non Hispanic white group and then
10:15the racial or ethnic minority group
10:17adolescence identified both as white
10:19as that minority were placed into
10:21the minority group for analysis,
10:23and then we made the following three
10:25comparisons so non Hispanic white
10:27versus minority diabetes technology
10:28users versus non technology users
10:30and so non or technology users was
10:32using a CGM continuous glucose
10:34monitor and or an insulin pump.
10:36Dementia.
10:36The Technology user group and
10:39then parents versus adolescence.
10:41We measured diabetes,
10:43technology use diabetes outcome
10:46variable SO81C DK and then the
10:49diabetes distress and barrier
10:51scales that I just went through.
10:53And we used SAS for data analysis.
10:59So to go through the
11:01results of the adolescents,
11:02we had 45 complete, the survey,
11:0528 of who identified as non Hispanic,
11:07white and 17 as a racial or ethnic minority.
11:12Comparing the demographics
11:13between the two groups,
11:14there was no significant difference in age,
11:16income or insurance status
11:17between the non Hispanic,
11:18white and minority adolescents.
11:20But it is important to note that
11:23in our sample both groups had as
11:25income on average higher than 75,000
11:28and were most or most commonly
11:30to have private health insurance.
11:35So comparing the diabetes technologies
11:36between our racial ethnic groups,
11:38there was no significant difference
11:40in overall diabetes technology use.
11:42So looking just at whether or not they
11:45used any technology versus no technology.
11:47But when we compare it, specific
11:48diabetes technology combinations,
11:49we did find a significant difference.
11:52So the minority group,
11:53which is highlighted in yellow and then
11:55on spanic white, which is in green,
11:57they might already be for far less likely
11:59to be using diabetes technology for both
12:01aspects of their diabetes management.
12:02So for using both the CGI Vanderpump.
12:05And they're more likely to be using
12:06technology for only one or the other.
12:10We asked adolescents for reasons,
12:12but behind nonuser discontinuation
12:14of diabetes technology and in
12:16the non Hispanic White Group,
12:17it was exclusively due
12:18to personal preference.
12:18But in the minority group,
12:20the reasons were a little bit more complex,
12:22so they cited insurance coverage issues,
12:24provider recommendations,
12:25difficulty with the device,
12:27or difficulty with diabetes management.
12:31So comparing diabetes, distress and outcome
12:33variables between the two groups,
12:35there was a significant difference
12:36in anyone see which is consistent
12:38with previous literature, so or not,
12:40or are minor minority group had a higher A1C,
12:43and then on Hispanic White Group,
12:45but there was no significant difference
12:47in diabetes distress for any of the
12:49barriers on the PRISM questionnaire.
12:51However, there was a very high overall
12:53rate of diabetes distress in both groups,
12:55so 86% of the non Hispanic White Group and
12:5882% of the minority group met clinical
13:00significance for diabetes distress.
13:02And then similarly on the prison question,
13:04there was a high rate of adolescents
13:07that met diabetes distress for all the
13:09categories except for health care team
13:10was only one that wasn't the majority.
13:14Comparing between technology user
13:15versus non technology user groups,
13:17again there was a significant
13:19difference in A1C between the two.
13:21So the non technology users had a
13:23significantly higher A1C but no
13:25difference in diabetes distress and
13:27then looking at specific burdens.
13:28The only significant difference was
13:30understanding and organizing care.
13:32So the non technology user groups
13:34found that as a more significant
13:36burden to their diabetes management.
13:40And then finally comparing
13:41adolescents versus parents.
13:43So there was a significant difference
13:45here between environments distress.
13:46So the adolescents had a much higher
13:49rate of clinically significant,
13:51clinically significant diabetes,
13:52distress, then the parent group did,
13:55and then comparing the specific barriers,
13:57the adolescent scored much higher for
13:59family interactions as a contributing
14:01barrier to their diabetes management.
14:05This is again just shows that
14:06difference between adolescent in Paris,
14:08so adolescent and orange parent and blue.
14:10And then we have positive diabetes distress
14:11on the left hand side of the graph.
14:13So 82% of adolescents and only
14:1515% of parents met clinically
14:17significant diabetes distress.
14:21So the conclusions that we
14:22were able to draw from this our
14:23population show that there was
14:25a difference in technology,
14:26user groups or technology you
14:28use with the minority group less
14:30likely to be using technology for
14:32both aspects of their diabetes
14:33management and having a higher A1C.
14:36This is consistent with
14:37previous literature and so,
14:38and they also cited more complex regional
14:41reasons behind NONUSER discontinuation.
14:43So in the clinical setting it's
14:45important to identify this and identify
14:47reasons behind nonuser discontinuation
14:48in the minority population.
14:50I'm sorry, better.
14:51To understand what's resulting
14:52in that and able to help them
14:55implement technology into their care.
14:57If that will give them,
14:58give them improved management.
15:01And we also saw a very
15:02high frequency of diabetes distress
15:04across both groups of our adolescence,
15:06so this shows that this is a significant
15:09mental burden of managing diabetes,
15:11and it may be impacted glucose control
15:12and quality of life amongst all
15:14adolescents with type one diabetes
15:16and the reason behind this might be
15:18universal stressors that are causing
15:20both racial and ethnic boundaries.
15:23So that might be social stigma or fear
15:27of feeling different from their peers.
15:30And diarrhea stress in these
15:32various management are modifiable,
15:33so we're able to identify them
15:34in the clinical setting,
15:36there's the potential to help improve
15:38support for adolescents with type one
15:40diabetes and identify those that are
15:41having higher rates of diabetes distress,
15:43so we can help give them more support and
15:47improve their glycemic control and then,
15:49between comparing between adolescents
15:51and their parents,
15:52is another tool that can be very
15:54helpful in the clinical setting
15:55on parents are often the primary
15:57caregiver and support for children.
15:59So with this high discrepancy in diabetes.
16:00Stress there's the potential to improve
16:03understanding of that discrepancy and
16:05support for adolescents as they make
16:07that transition from childhood into
16:09adulthood while managing a chronic disease.
16:13And then finally,
16:13it's important to note that while
16:16these the advancements in technology
16:17are improving glycemic control
16:19or associated with a lower A1C,
16:21they're not enough to mitigate
16:23diabetes distress,
16:23and that was seen in our study here.
16:26So family support and
16:28communication remains essential,
16:29even as we continue to advance technology.
16:33So some future directions,
16:35just further research on both patients
16:37and providers to understand why there
16:40may be provider recommendations against
16:42discontinuation of technology and
16:44minority and other reasons that are
16:47resulting in the discrepancy and then
16:49also including a diversity and diabetes
16:51treatment settings and locations.
16:53So we only recruited from Yale,
16:55which is a large academic center
16:57in a high high use of technology,
16:59but comparing other areas would also
17:01benefit to be able to make that comparison.
17:04And understand where the disparities
17:06are occurring.
17:07And then also assessing diabetes
17:09test with a qualitative study can
17:10help understand what specifically
17:12is contributing to the high rate
17:14of diabetes distress.
17:15So here are some strengths and
17:16just to highlight a couple,
17:17it was the first study that compared
17:18diabetes distress between ontspanning
17:20white and minority adolescents.
17:22And then we also included both
17:24parents and adolescents into once
17:26we're able to directly compare
17:28their level of diabetes distress.
17:30Some limitations are here again
17:32just to highlight a couple of them.
17:34We only recruited patients that
17:35had scheduled appointments,
17:36so this may be missing patients
17:37that have high level diabetes,
17:39distress or not using technology
17:41we only recruited from Yale,
17:42so again that has a potentially
17:44has a higher rate of diabetes
17:46technology then it's representative
17:48of the minority population.
17:49Our survey was only in English
17:51so that limits anyone who is non
17:53English speaking and then it was
17:54administered during the pandemic so
17:56that also may be contributing to a
17:58high level of distress in adolescence.
18:01Here are my references.
18:03Just a big thank you to Rosanna
18:04and Megan for all their support
18:06with alternative thesis.
18:07I really appreciate you giving us the
18:10opportunity to pursue it. Thank you.
18:24He asked. The audience, so it's OK.
18:26We are going to probably get presentations.
18:39So it's my pleasure to introduce Jamie
18:42Conway to present card thesis and we
18:45will let her introduce the topic that
18:48she developed and her adviser. Thank you.
18:58Hi everyone, my name is Jamie.
19:01Thank you all for being here.
19:03It's so nice to see you all in person
19:05and thank you for everyone who's
19:07tuning in online and also special
19:09thanks to my advisor Doctor Nauert.
19:11So my topic is tucked in weighted
19:14blankets to improve sleep in
19:16intensive care unit patients and I
19:18did the traditional thesis route.
19:21So just a quick outline of what
19:23will be going through today.
19:25So sleep in all people,
19:28but especially those in the critically ill,
19:30is incredibly important.
19:31Those in the intensive care unit
19:34have been found to have all domains
19:36of sleep deficiency that would
19:38include abnormal sleep timing,
19:40poor sleep quality, or short sleep duration.
19:44Sleep deficiency can increase the risk
19:46of infectious and inflammatory diseases,
19:49and it has contributions to all 'cause
19:51mortality and it shows that there
19:54are implications up to 12 months.
19:56After both physically and
19:59psychologically with PTSD.
20:02As far as measuring sleep goes,
20:03there are two ways to go about it.
20:05There are objective measures,
20:07which is polysomnography or PSG,
20:09the gold standard.
20:11This is a high cost and
20:14uncomfortable process.
20:15It requires a lot of wires or leads
20:18EKG EG on the head it tracks eye
20:22movements and patients already bogged
20:25down with a lot of Ivs and other wires
20:29and it overall just doesn't bode well.
20:32For a good study, however,
20:34there's actigraphy.
20:35It has a significant correlation,
20:38shown in studies with PSG,
20:40it's less invasive, less cumbersome,
20:42more cost efficient.
20:43It's essentially what we like
20:45to say is a glorified Fitbit.
20:47You wear it on your wrist,
20:48and it can track your total sleep time.
20:51Another way of going about measuring
20:53sleep is a subjective measure.
20:54The Richard Campbell Sleep
20:57Questionnaire is the only validated
21:00questionnaire for ICU patients.
21:02It's significantly.
21:02Has been found to correlate
21:05with PSG measures.
21:06It requires just a simple tickmark by
21:08patients and that are critically ill,
21:11so this works well for them.
21:12They have low stamina,
21:14it just requires a simple tick
21:16mark on a visual analog scale.
21:18So many ways have been trialdb
21:21to enhance sleep,
21:23especially in the critically ill,
21:25but there is no evidence based
21:28pharmacological interventions available.
21:30Oftentimes,
21:30if we try to use pharmacological methods,
21:33there are adverse effects
21:34and there can also be drug,
21:36drug interactions and patients
21:37that are already enduring a large
21:40pharmacological burden norm.
21:42Non pharmacological interventions have
21:44been tried and they show some promise.
21:46Some things like ear plugs, eye masks, music.
21:49Cluster nursing care specifically,
21:51is when nurses tried to do their
21:53best to do all their tasks at once
21:55when entering a room instead of
21:57going in multiple times specifically
21:58at Yale and the medical ICU,
22:01they have the standard of care,
22:03which is a quiet time from midnight
22:06to 4:00 AM and a quiet pack which
22:08is given to all patients and
22:10includes an eye mask and ear buds.
22:12Despite all these interventions
22:13that are tried consistently,
22:15patients report for sleep,
22:16whether it's at Yale or another
22:18hospital and for this.
22:19Reason it's necessary to continue
22:21to evaluate more methods.
22:25Then comes weighted blankets,
22:26blankets of various sizes that are filled
22:29with different materials to evenly
22:32distribute the weight across a body.
22:34The theoretical framework is
22:36that it's deep touch pressure.
22:38It's almost like a hug
22:40or a swaddle for a baby,
22:44and they're ideally 10% of your
22:45body weight and they can be
22:47manufactured in such a way that
22:48they can be wiped down with wipes,
22:50which would be helpful in an
22:52intensive care unit setting they've
22:53been studied in many populations.
22:55They've been studied in
22:57adult psychiatric centers,
22:58children with autism neonates in the ICU,
23:02those with breast cancer in
23:05inpatient and outpatient settings.
23:07These studies have often been flawed
23:10in certain ways or have not had
23:13significant sample sizes show bias,
23:15but overall results have showed an
23:17increase in total sleep time and
23:20consistently show a high user satisfaction.
23:23However, weighted blankets have not
23:25been tried in the critically ill.
23:27So as far as the problem goes,
23:30sleep deficiency is pervasive
23:31in the critically ill,
23:33with no evidence based pharmacological
23:35interventions shown to be effective.
23:37For this reason,
23:38non pharmacological strategies
23:40must be continued to be explored.
23:42Weighted blankets have been shown
23:43to help with sleep and anxiety in a
23:46variety of settings and populations.
23:47However,
23:48there's a lack of literature
23:50in this population where sleep
23:52is vital and jeopardized.
23:54So we hypothesize that weighted
23:56blankets used in hospital lies patients
23:58over 50 years old in intensive care
24:00units will have different mean
24:02total sleep time when compared to
24:05baseline of those with usual care.
24:08This will be a randomized controlled trial.
24:11It will have two arms,
24:12weighted blankets and usual
24:14or standard of care.
24:15We will study adult critically
24:17ill patients over 50 years old.
24:19The reason we specify 50 years old
24:21is that they are most susceptible
24:23to the adverse effects of low sleep,
24:25including things like delirium,
24:27which is rampant in the ICU.
24:29The exclusion criteria will include
24:31those in respiratory failure,
24:32so those on, say,
24:33a ventilator or those with active wounds,
24:35whether they're pressure wounds
24:37or recent surgeries.
24:38And those expected to leave within
24:40the next 24 hours by staff.
24:42We will evaluate all patients
24:44admitted to the MCU daily as
24:47potential subjects for this study.
24:51The key variables the
24:52intervention will be the weighted
24:54blanket plus standard of care and
24:56like I mentioned earlier at Yale,
24:57the standard of care is that
24:59quiet pack in those quiet hours,
25:01the control will be standard of care alone.
25:04The primary outcome will be total sleep
25:06time via actigraphy that glorified Fitbit.
25:09On night two of the blanket use and
25:11the secondary outcome will be the
25:13Sleep Questionnaire the next morning.
25:14Based on that night,
25:16two of the study we will come.
25:18Get consent from all patients to videotape
25:21to ensure that the blanket is used
25:23for at least one hour on that night.
25:26Two of the study and only those
25:28that use the blanket for one
25:30hour will qualify for analysis.
25:33Blinding the intervention
25:34to the participants.
25:35We will phrase it as a non pharmacological
25:38sleep study and we will leave out
25:40the fact that the intervention of
25:42interest is the way to blanket because
25:45standard of care as well also has
25:48non pharmacological interventions,
25:49the ear buds.
25:50Then the eye mask.
25:52Finding the outcome.
25:53The research assistant interpreting the data
25:55will not have access to the allocation.
26:00So, yells, Mccue admits 4000 patients per
26:03year, and the median stays three nights,
26:06which allows us to determine that this would
26:09be a feasible study to carry out at Yale.
26:12We calculated the sample size based
26:14on data historical data in the
26:16Yale ICU based on Dr. Narcs lab.
26:19They found that the average is
26:2194 minutes of total sleep time,
26:23with variants of 61 minutes willpower.
26:25The study to 80% affect size of
26:2820% or 18 minutes.
26:30So given all this data historical
26:32data based on Doctor Notes Lab,
26:35we will have a calculated sample
26:37size of 324 and will round up to
26:393:30 to allow for correction.
26:43So this is just a graphic
26:46kind of outlying everything.
26:48I already said patients will be admitted
26:51to the hospital later admitted to the MCU.
26:54They'll be randomized either
26:56to control or intervention,
26:57and they'll wear actigraphy on night one,
27:00though the night of interest is night two,
27:02once they're accustomed to all of
27:03these things being on their body,
27:04and they've adjusted to being on the unit,
27:07so night two will collect
27:09the actigraphy data,
27:10and the next morning will do
27:13the Sleep questionnaire.
27:14Based on night, two of the study.
27:17So. The impact that this
27:19could have is that it could.
27:22Improve patient outcomes both short term
27:24and long term like I had mentioned earlier,
27:26these effects of low sleep can carry
27:29on up to 12 months after discharge.
27:32It allows us to offer another non
27:35pharmacological option to those
27:38that don't have many options and it
27:41can increase patient satisfaction.
27:43It avoids secondary harm and not
27:46trying to treat a pharmacologically,
27:48and while it is a very specific population.
27:52It's a population where sleep
27:53is most disrupted,
27:55and ideally we would be able to generalize
27:57and apply to a wider population.
28:02The study has some potential strengths.
28:04It's a significant sample size
28:06based on historical data where the
28:09actual study would be taking place.
28:11It's also the first of its kind in that it
28:13offers objective and subjective outcomes,
28:16and we do try to address bias through
28:20blinding the participants to the
28:23non pharmacological intervention.
28:25We do also have limitations.
28:27There is difficulty with binding
28:29given that a weighted blanket is
28:30quite heavy and you can tell it's.
28:32Waited up and there's also a high
28:36variability of sleep at baseline.
28:37I think I mentioned earlier the average
28:39and Niels McHugh is 94 minutes with a
28:41variance of 61 minutes, pretty high.
28:43However, we do try to address that by
28:46carrying out the study in yells McHugh.
28:48Additionally, there's some limitations
28:50with the accuracy of actigraphy,
28:52as it is an accelerometer,
28:54it's worn on your wrist,
28:55and if you're not moving,
28:56it's harder for it to track,
28:58so it's just one thing to keep
29:00in mind when we interpret data.
29:03So I just want to thank you
29:04all for listening.
29:05I want to thank Doctor Nauert.
29:06She was an amazing thesis advisor.
29:08Thank you.
29:09Rosanna and Megan and the
29:11Graduate writing lab and everyone
29:12who helped get us here to this
29:14point and thanks class of 2021.
29:27Blue Jays probably chat.
29:31That you have some funds listening.
29:34Thank you so much.
29:36So it's my pleasure to introduce Carina,
29:39Legio who is going to take us in a
29:41more pharmacological approach to
29:44intervene, so thank you, Karina.
29:55So hi everyone, I'm Karina.
29:57This is my thesis presentation
29:59entitled efficacy of her magic pant
30:01plus calcitonin gene related peptide
30:04monoclonal antibody for migraine and
30:06my advisor was Doctor Schindler.
30:10So just to give some
30:11background, migraine is estimated to
30:13affect about 15% of the global population,
30:16and it's characterized by painful,
30:18unilateral headache attacks often
30:20associated with nausea, vomiting,
30:22photophobia, and phonophobia.
30:24And it's managed with a board of
30:27therapy during a pain attack,
30:29prophylactic therapy to prevent attacks,
30:32and often a combination of both.
30:35There is calcitonin gene related peptide
30:37CGRP and its receptor and they have a
30:41role in the provocation of migraines.
30:43So CGRP is a neuropeptide.
30:45It binds to the CGRP receptor and it
30:48causes potent vasodilation specifically
30:50within the trigeminal gangland and
30:52its proposed that elevated levels
30:55of CGRP may lead to sensitization
30:57of those neuronal circuits so that
31:00the usual sensory inputs like light,
31:03sounds, tastes and odors.
31:05Are then experienced as bothersome.
31:08And so this peptide and its receptor
31:10have been targeted in the development of
31:12both preventive and abortive therapies.
31:17So one of these medications
31:18is called magic pants.
31:20It's brand name is Nartec
31:21oral dissolving tablet,
31:23and it's actually produced here in
31:25New Haven and its uses for the acute
31:28treatment of migraine as an abortive.
31:31And it's part of the small molecule
31:33CGRP receptor antagonist class,
31:35it has a couple of proposed mechanisms,
31:38one of which is that it competes with
31:40the initial CGRP binding event and
31:42blocks the activation of the receptor,
31:44or it potentially displaces the bound CGRP.
31:47And deactivates the receptor and
31:50this medication was just approved
31:52by the FDA in February of 2020.
31:58Then there are the monoclonal antibodies
32:00and these are used as a preventive
32:02migraine therapy and they include
32:03class members such as air knob,
32:05galcanezumab, feminism,
32:07ABBA Neptunism app,
32:09and their mechanisms for gallicanism
32:11gallicanism app from his Mama Neptunism
32:14app is that they neutralize some portion
32:16of the circulating CGRP ligands which
32:19prevent the peptide from signaling.
32:21Erenumab is a little different in that
32:23it blocks the CGRP receptor instead
32:25of the peptide and these are given.
32:28As once monthly injections or via Ivy,
32:32and they're actually giving quarterly
32:34for feminism, AB, and eptinezumab.
32:39So this led to my development of a
32:42problem which is given that Japan's
32:44and Mads both act on the CGRP system.
32:46It begs the questions.
32:48Would patients using both experience of
32:50greater benefit and is this combination safe?
32:52So published reports of the use of both
32:55oral were magicant for acute treatment
32:57and a map for prevention or limited.
32:59There is a small case series that
33:02demonstrated possible efficacy in
33:03treating refractory migraine with Roma,
33:05Japan and Erin AB and then following
33:07this there was an open label.
33:09Substudy of 13 migraine patients
33:11simultaneously using their magic
33:13pants with a map which showed
33:15no serious adverse events.
33:17However, efficacy was not reported.
33:21So therefore further study in the form
33:24of a randomized controlled trial to
33:26investigate the safety and efficacy
33:27of our measure pant in the setting of
33:30common map therapy is necessary and,
33:31if shown to be effective as well as safe,
33:34this therapeutic approach may provide the
33:36best opportunity to expand evidence based
33:38migraine management and to improve the
33:40quality of life and migraine patients.
33:45So I developed the hypothesis
33:46that when using her magic pant
33:48as an abortive intervention,
33:50adult subjects on antique GRP
33:52or anti receptor map preventive
33:54will have a different incidence
33:56proportion of freedom from pain at
33:58two hours compared to those who
34:00have never used a map preventive and
34:02one definition that I want to draw
34:04attention to is the freedom from pain.
34:06So for the purpose of this study it's
34:08defined as on a zero to three pain
34:11numerical rating scale where zero is no pain,
34:13one mild to moderate and three severe.
34:16It's the reduction from moderate two
34:18or three severe at the time of Drug
34:21Administration to no pain for 0.
34:26So for my methods, UM,
34:29we're looking at a population of adults,
34:30so ages 18 to 65 years old,
34:33with at least one year history of migraine.
34:36And this is further divided into our study,
34:38or monoclonal antibody population who
34:40were treated with a map for at least
34:43three months prior to the screening
34:45and then our control population,
34:47or those who have never used an
34:50antique P or anti CGRP receptor map.
34:53Our target sample size would
34:54be 450 subjects and.
34:56The study design would be a biphasic trial.
35:00So the primary phase would be randomized,
35:02double blind,
35:03placebo controlled single attack
35:05study and the secondary phase would
35:07be a two month open label Multi
35:10Attack study and I further delineate
35:12delineated this in the table below.
35:14So you can see the two groups,
35:15there's the control group and
35:17the monoclonal antibody group.
35:18They both undergo a running
35:20period of four weeks.
35:21The primary phase which is the blinded
35:24phase is when the subjects will be asked.
35:27To treat one migraine attack of moderate
35:30to severe intensity and they'll be
35:33allocated and blinded to being given
35:36either were magic pant or placebo
35:38to treat that one migraine attack.
35:41Then,
35:41during the secondary phase,
35:42which is the open label phase,
35:43it'll go on for eight weeks and
35:45patients and all of the groups will
35:47all treat her multiple migraine
35:49attacks with her magic pan.
35:54So we're going to collect data
35:57through an electronic patient.
35:58Reported outcomes diary.
35:59So at the time of a migraine attack,
36:02the subjects will begin to document
36:03in their epro diary by rating their
36:05pain on a scale of zero to three,
36:08and documenting other
36:09symptoms such as photophobia,
36:11phonophobia, or nausha,
36:12and if their pain is rated at two or three,
36:15they'll be asked to self administer
36:17the allocated intervention.
36:18So during phase one it could
36:20be re measure pant or placebo,
36:22and during the second phase it will be.
36:25Where magic pants.
36:26And then they'll re-evaluate their pain
36:28and symptoms at several time points.
36:29Most importantly,
36:302 hours after the intervention,
36:33and they'll also complete a migraine
36:35specific quality of Life Questionnaire,
36:38which will be done during
36:39the running period and at the
36:41ends of weeks four and eight,
36:43and the MSQ is this is a valid
36:46and reliable measure to assess
36:47the effect of migraine on daily
36:50functioning among migraine patients.
36:52Our primary outcome would be freedom
36:54from pain at two hours and will also
36:57look at several secondary outcomes,
36:59including but not limited to,
37:01pain relief at two hours,
37:03freedom from most bothersome
37:04symptom at 2 hours,
37:05and quality of life scores.
37:10So some strengths of this study.
37:13First is that the protocol was written
37:15in accordance with the guidelines of
37:17the International Headache Society for
37:19controlled trials of acute treatment
37:20of migraine attacks and adults.
37:22So some of the elements,
37:23such as the measurement of
37:24freedom from pain at two hours,
37:26is derived from these guidelines.
37:28The guidelines also limits subjects
37:30from having to treat multiple
37:32migraine attacks with placebos.
37:33Therefore,
37:34most migraine studies comparing an
37:36abortive to placebo consists of
37:38subjects only treating one migraine.
37:40Attack with the intervention and
37:43the conclusions are drawn from that,
37:45so I decided to come up with this
37:48unique biphasic design in which I'm
37:50maintaining a phase with blinding
37:52and randomization to investigate
37:54a single migraine attack similar
37:56to the traditional studies.
37:58However,
37:59with the addition of the secondary phase,
38:02it allows for analysis of consistency
38:04of response to measure pant and its
38:07treatment of multiple migraine attacks,
38:09and this is all while still
38:11meeting the ethical.
38:12Guidelines such that no subject
38:14is treating more than one
38:16migraine attack with placebo.
38:18And lastly,
38:19I believe a strength is the inclusion
38:22of the MSQ because it really provides
38:24a more comprehensive measurement of
38:26the medications impact on patients
38:28overall migraine management.
38:32Some limitations of mine is that there is
38:36variability in the types of preventives
38:38the control subjects are taking,
38:40so the control subjects are allowed to
38:42be on preventives that aren't maps.
38:44These can include tapir,
38:46may Botox injections or beta blockers,
38:49and this does present a
38:51potential confounding variable.
38:53However, in order to maintain the
38:54external validity of the study,
38:56it's necessary to include subjects on
38:58preventive for their migraines and better
39:01emulate this study population at large.
39:03And and another limitation is
39:05that there's no active comparator.
39:07So in this study,
39:08were Magic Pant is being compared to placebo,
39:11and it might be argued that the
39:12inclusion of an active comparator
39:14or standard of care treatment
39:16would strengthen the clinical
39:17implications of the study results.
39:19However,
39:19it's really beyond the scope of this trial,
39:22which is primarily focused on comparing
39:24the effects and safety of the drug in
39:27those taking versus not taking a CGRP map.
39:29And depending on the results from this study,
39:31the inclusion of an active comparator.
39:34In similar future studies would
39:35be might be warranted.
39:39And for clinical significance.
39:41So this study really addresses
39:43both preventive and abortive
39:44treatment of migraine,
39:45which are the two pillars of
39:48migraine management long term.
39:50And although the main objective is to
39:52determine the efficacy of her magic,
39:53and in the acute setting,
39:55incorporation of the migraine medication
39:57in combination with the maps in the
39:59long term is what really expands
40:01the impacts of this study because
40:03there's no known cure for migraine,
40:05it's only managed.
40:08And then in terms of quality of life
40:10and disability for migraine patients,
40:12spending less time in pain,
40:14having fewer disability work days
40:16and therefore less time spent in a
40:18health care setting really speaks
40:20to the impacts that this could have.
40:22If this is a more effective
40:25way of managing migraines.
40:27And also it has impacts directly on
40:29the health care system and that it's
40:31cost saving to both the patient and
40:33to the health system when there are
40:35fewer visits to the ER and fewer
40:37hospitalizations related to migraine care.
40:39Treating migraine attacks at home
40:41and being seen as an outpatient
40:43is not only more economical,
40:45but also less distressing for the patient.
40:49So I'd like to acknowledge my thesis advisor,
40:52Dr. Schindler.
40:53She was really great.
40:54She helped tremendously in her
40:56guidance throughout the development
40:58of my protocol and she also helped
41:00give me a lot of great advice about
41:02scientific writing throughout the
41:04project for to Rosanna and Megan.
41:06Thank you for facilitating the thesis
41:08process in a really organized and at
41:11least like a little less overwhelming,
41:13way that was really much appreciated.
41:15And for my mom, dad and my sister Adriana,
41:18who.
41:19Supporting me through PA school and
41:22this project. I appreciate them.
41:25Any references?
41:37So I would like to invite Robert Johnston
41:40to discuss his thesis.
41:42I would like to make one comment
41:45that Robert approached me about
41:47doing a thesis abroad with the
41:51Downs Fellowship. The first day
41:53that I met him.
41:56And it's not the first time that
41:57people do that and follow me around
41:59in between cocktails because we used
42:01to have cocktails at at
42:02one time and the first
42:03week. And so it's not that I
42:07dismissed him, but I thought, OK,
42:09another one who wants to go abroad.
42:11Will he go abroad?
42:13In fact, Robert didn't go abroad,
42:14but did something much better than that.
42:17He continued to do his work and finish his
42:22project in developed capacity in China, too.
42:26Not only complete the
42:28project that he completed,
42:29but also for our colleagues in
42:33China to learn from him so and
42:36the same I have to say Tadao,
42:38who also is our second downs
42:41fellow who went through.
42:44A lot of travel to complete
42:46his project in Uganda,
42:48so I I just wanted to give
42:51a context because this was a
42:53different bit different.
42:54It took one year longer
42:56to do this project,
42:57so thank you Robert and invited
43:00you to walk through.
43:10Good afternoon everybody
43:12again. I'm Robert to our audience
43:14online and I'd like to first thank Dr
43:17Kush nude and Doctor Leon who really
43:19helped make this project possible both
43:22here and planning it and then executing
43:24it while we were in or in China.
43:26The team that was there.
43:28The focus today is on the idea
43:30of healthy aging in early China,
43:32and I'm just going to walk you through
43:34kind of the big picture of what that means,
43:36what we did, and kind of why that matters
43:39and why it would matter to us here.
43:41So by the year 2050,
43:43at least 20% of the world's
43:45going to be over the age of 60.
43:46So everyone in this room will be over 60.
43:49By that point,
43:50it challenges us because there's
43:52logistical questions and social
43:54questions about what are we going
43:56to do when more people need support
43:58in different ways than in the past.
44:00And we talked about this idea of
44:02healthy aging and and what that means.
44:04And when you look at the literature,
44:05it doesn't really tell you a
44:07strict definition.
44:08There's a lot of conflicting views,
44:10whether that's physical.
44:11Social health,
44:13psychological health.
44:14Some combination of that so
44:16we don't have something that
44:18strictly says this is what it is.
44:19And at the same time,
44:21a study that was conducted through
44:23Yale last year looked through the
44:24literature and said there's this
44:26kind of pervasive ageism both in the
44:28literature and across continents that's
44:30affecting the health care of older adults.
44:32And what does that mean as
44:34clinicians if we know that's true,
44:36what can we do about it?
44:37How can we make things better?
44:39But you might ask,
44:40why did we decide to focus in China?
44:42And there were a couple of reasons.
44:44One,
44:44China still has the largest
44:45population in the world,
44:46so this problem is more present to
44:48them and thinking how do we support?
44:50Our population as they grow older and second,
44:53there's been this distinct
44:55environment of younger people moving
44:57from rural areas to urban areas.
44:59That shows us that they don't have
45:01the support or family networks
45:03that they once had,
45:04so they've had to create different
45:06forms of establishing their selves or
45:09sustaining themselves despite those changes.
45:12There have been different
45:13efforts by groups there.
45:14Things like insurance programs,
45:15but there have been mixed results by
45:18that so historically in China there
45:20are these things called kind of red
45:22envelopes or backdoor payments to
45:24physicians to help get better care.
45:26Well,
45:26they subsidized the health care and
45:27said you don't have to do that anymore.
45:29Well,
45:29it actually increased the number
45:31of red envelopes that went out,
45:32and there was a large discussion
45:34about why that would happen if we're
45:35actually helping people by saying
45:37that you no longer have to pay.
45:38So there have been different
45:40challenges to even the things
45:41that we've tried to do to help.
45:42This situation,
45:43in terms of what we might think
45:45of as physical health.
45:46And the last piece I think that's
45:48important to consider here is that
45:49across the board there's this idea of
45:52when you study China that everything
45:54is applicable to everyone in China.
45:56As I said, China has 1.3 billion
45:58people and you would think that there
46:00would be some diversity and experience
46:03there simply because of geography
46:05or your own experience as to what
46:07healthy aging might mean to you.
46:08So we tried to make this study very
46:11broad and what we tried to ask.
46:13So we try to answer two basic
46:15questions here among this population.
46:17That we went and visited,
46:17that I'll introduce you to in just a
46:19second one is what do older men and
46:22women in rural Guangdong province this is?
46:24Southern China.
46:25Think healthy aging means let them
46:27define it for themselves and tell us.
46:29And the second is what are the
46:31obstacles to achieving that and
46:33how does that intersect?
46:34Or how is that different from
46:36what individuals that are involved
46:38with healthcare? Think there so.
46:41How do you investigate these
46:43questions though?
46:43If we just go and say we're just
46:45going to ask these questions,
46:46we probably won't quite get the
46:48results we were hoping for.
46:50So our design was essentially exploratory,
46:53where we let every we allow our
46:55participants to direct us in a sense.
46:57We had an outline where we did interviews,
47:00but we also had our research
47:03team essentially participate.
47:05I had two research assistants who
47:07we trained before they started.
47:09We did about 10 training sessions
47:11where they did interviews where
47:12we sent them out into their
47:14communities before they went there
47:15and they practiced interviewing.
47:17They practiced drawing maps,
47:18they took photographs and did all
47:20these things and then they went
47:21and they lived in this village
47:23for about two months and it was
47:25very challenging for anyone.
47:26I think if I had been there I was.
47:28Anticipating culture shock,
47:29but I think my students who are used
47:31to living in a 15 million person
47:33city moving to a town that has
47:35about 3000 people was a surprise
47:37'cause I saw on social media.
47:39They would say everything is going
47:40great but then we would go on social
47:42media and I would see what was
47:44actually going on and I would say
47:45well what's happening and they would
47:47say there's nothing to do here at night.
47:49There's and then I would say and
47:51there's this other problem that
47:52you have to use a special device
47:54to warm up the water here to take
47:56a bath in the evening and things.
47:58That they weren't anticipating,
47:59but are important to understanding
48:01to experience what people are
48:03going through in their life,
48:04rather than just asking the
48:05question of what the problem is.
48:07And I think that last part of participant
48:09observation is also very important
48:11because what people say and what
48:13people do or sometimes different.
48:14And sometimes it's your ideal.
48:16What you tell someone,
48:17what they actually do could be
48:19different from that and understanding
48:21that and recognizing
48:22that is an important part of what we did.
48:23So you can see the breakdown of
48:25who we interviewed there or who
48:27we met with my students. Again,
48:28were instrumental to making that happen.
48:30The research assistance,
48:31and then as a group, the team.
48:34We analyzed our interviews going
48:35by through them line by line.
48:37We debated we I was told I was incorrect
48:39about something they I told them they
48:41were incorrect and then we finally
48:42would come to some consensus about what
48:44the big picture was in terms of what
48:46we we got out of these interviews.
48:49So where there were three key
48:51themes that we got out of this?
48:53Oh, and one more map for you.
48:54Just so if you aren't oriented to China,
48:56we were in southern China.
48:57This province is called Guandong
48:59and the students were from that red
49:01area in the middle of 15 million
49:03people and we went to that village.
49:05That's kind of circled up there.
49:07That general vicinity was this
49:08small village of about 3000 people
49:10and I say a Hakka village.
49:12This is kind of a sub category
49:14of the main ethnicity that most
49:15people identify with in China,
49:17so we wanted to try to find some
49:19diversity and perspective there.
49:21So with regard to what we learn.
49:22Some of these things will
49:24seem familiar to you.
49:25Chronic disease in discussing healthy aging
49:28came up again and again in some form.
49:31It was about mobility,
49:32psychological health in some form,
49:34and high blood pressure,
49:35but it was also about participating,
49:36which I'll explain to you
49:38in just a moment here.
49:39But you can see pictures from our
49:41site where on special activities
49:43the social workers tried to address
49:45this by saying we can do screenings.
49:47They had a canteen where we called it.
49:50The elder rank canteen,
49:51where older adults often met.
49:53And they had activities that went together,
49:55so being able to participate
49:57despite your chronic disease was
49:59very important to people.
50:01The second is relationships and
50:02I think this was unexpected,
50:05but in some ways for others,
50:06not as not too surprising where
50:08people didn't want to burden others,
50:10no matter how bad their situation was.
50:12People often would not ask for help
50:15or they didn't want to even have a
50:17family member because they felt that
50:18it was wrong to put this pressure on
50:20family members or community members.
50:22So again,
50:22there were these social avenues that
50:24they tried to address this through.
50:26The government had subsidized housing
50:27that they tried to say this is
50:29available to you without burdening.
50:31Another person,
50:32social workers who are delivering meals
50:34that was built into the community efforts.
50:39And the final piece here.
50:41The third kind of result we had was
50:43or theme we found with this complex
50:45site set of ideas about where to seek
50:47your health care and what it means.
50:49I put this garden here of someone's home
50:53because a lot of participants use folk
50:55medicine in order to manage their health
50:57beyond the things that we had available.
50:59Like blood pressure medications,
51:01diabetes medications, and so forth,
51:03this was important to them,
51:05but no one was really discussing
51:06it outside of the participants.
51:08The healthcare workers, for instance.
51:10And the other was this was the local clinic.
51:12There were two clinicians total in the town.
51:16And essentially what their role was in
51:18that conversation that we were having.
51:21So before I transitioned to kind
51:23of why any why this matters?
51:26I'd just like to point out with all of
51:28that what I think of the strengths and
51:30limitations here are really connected
51:32to this online collaboration we had.
51:33I couldn't have done this without those
51:35students who were there on the ground,
51:37and the commitment to everyone on the team,
51:39and it was really unexplored
51:40territory in a sense,
51:42because we weren't planning for this.
51:44Everything we got to do the same thing,
51:46but we needed to build the team very strongly
51:48before we could go out into the field.
51:50So how do you foster relationships?
51:52You need more time than you perhaps
51:54would if you were there with the team.
51:56The second part is we made sure that we
51:58had a shared understanding of how we
52:00do this and what the literature says.
52:02So we at least came in with the same
52:05framework in terms of what this means.
52:07When we move forward into the field.
52:10And I think the last piece here
52:12is the geographical boundaries.
52:13So we're saying we were in a
52:15village of 3000 people,
52:16which is helpful in the
52:18sense of it closes us off.
52:19It says these results are probably true
52:22for this village for what we had in terms
52:25of reaching saturation for interviews.
52:27However,
52:27can that apply to another part of China
52:30or even another part of the world?
52:32And we'll kind of answer that in terms of
52:36clinical significance or our conclusions.
52:38Here one is,
52:40there's a dynamic relationship between
52:42the biomedical model of medicine
52:45that we understand and those social
52:47expectations that were defined by
52:49people in the community there.
52:51And those three results are built
52:53into what I've said here.
52:54Community engagement was directly
52:56tide to chronic disease.
52:59You don't necessarily have to
53:01fix every chronic disease.
53:02But being able to participate in
53:04the community was very important to
53:06someone saying this is healthy aging.
53:08So how do you reach that point?
53:10And I think that really relates
53:12to problem number 2.
53:14The medicine was available,
53:15not everyone used it,
53:17and expectations of it were very different.
53:20There were many participants who
53:21talked about having had a stroke,
53:23having diabetes, high blood pressure,
53:26and not using the medications
53:27because they said they weren't
53:29cured by the medicine setting.
53:30Those expectations perhaps wasn't
53:32there and what's going to happen
53:34later on five years after a stroke,
53:36they haven't had another stroke,
53:37so they said I don't need to take
53:39any of these medicines anymore.
53:41And the third part is there were
53:43a lot of people trying to help
53:44this community in different ways.
53:45The social workers,
53:47government officials,
53:48the health care workers.
53:49But they were kind of working in parallel.
53:51There weren't.
53:52There wasn't a lot of communication
53:54between them and I think that there
53:56is an opportunity for a little
53:57more interaction to say who can
53:59deliver this kind of information.
54:01You're you're getting these resources.
54:03You have what you need,
54:04but making sure that we're meeting
54:06what participants want in that
54:08community as well as we're doing
54:10the best in terms of delivery
54:11in the news that we need to.
54:13And I think that question of is this
54:16relevant to anyone else besides
54:18this small community in China?
54:20Our argument is that.
54:22The individual results of.
54:25Not wanting to burden the community
54:27may not be relevant to someone here.
54:30However,
54:30if you are a clinician in any form of
54:32clinic where you work with the Community,
54:34you can repeat this study very
54:36easily with just a few people
54:38to see what people want.
54:39And while you do that,
54:40perhaps in your individual meetings,
54:43when you meet with your patient,
54:44it's the idea that we can take one
54:46step further and say what do we
54:48think the broader community here is.
54:50What do we think we want to achieve
54:52and how can we kind of direct
54:54our resources in that sense?
54:56I think we do a lot of that here,
54:57but I think in terms of some of
54:59those highlights that we have there,
55:01it's surprising if we never asked
55:02the question of our Community,
55:04what do they want?
55:06We'll never get the answer.
55:08Alright,
55:08thank you everyone,
55:09I appreciate it and it was a great
55:11joy taking part in this project
55:12in getting to share a little
55:14bit of it with you today.
55:26Questions now to the percentage
55:28question anyone have?
55:34Any questions for our
55:36presenters before we move
55:37into our panel?
55:40Sandy
55:49Gary. Thank you, thank
55:52you on behalf of
55:53these very hardworking students.
55:55I think one of the things that I would
55:58like to comment is that through these
56:00examples just four before we see the
56:02other nine that are in the website,
56:05our students explore a number of topics,
56:09explore different types of study designs,
56:12from observational studies,
56:14randomized control trials,
56:16qualitative research.
56:17They had topics that involve global health.
56:21Uh, ethics.
56:23When you are talking about considering
56:26the community and how that is going to.
56:29Affect our thinking clinically we
56:31had people talking about biologics,
56:34people talking about non
56:35pharmacological interventions.
56:36And
56:38of course one of my.
56:40You know, very interesting the idea that
56:43you went into exploring healthy parities.
56:47So thank you all for pursuing your
56:51own passion and open doors to others
56:54to learn more about this
56:57question. I think there was a fan. Before.
57:02I was actually curious.
57:06I. I'm sure she just missed it.
57:10It was really cool. She
57:11did design and
57:12having like one place that I was checking
57:15was a control group where they still
57:17taking her translator or they not.
57:21I was just wondering if there if I like.
57:25Yeah, so the control group and the
57:28monoclonal antibody group during
57:30that first phase there pulled
57:31randomized Hyderabad and during
57:34that security everybody everybody
57:36even in the control room.
57:37This control is the fact
57:39that they're not on the body,
57:42not that they're not taking the
57:43approach, which I know is a little
57:45bit confusing, and so
57:46they're all taking Medicaid.
57:48Second phase, which variable Windley.
57:51So they all know that they're all taking.
57:54More so comparing if you're on a map
57:56and you're already like benefiting
57:58from that now. Would you experience
58:01any greater benefit by having a board
58:04that way and then those who aren't
58:06on map are they experiencing?
58:12Thanks for clarifying.
58:25Yeah, thank you so much. So
58:27I think we would like to continue just
58:30to talk about the the pieces 2021 in
58:34numbers you used 3123 references.
58:38We had 51 readers and 44
58:43advisors more advisors than.
58:45One to one, because many of
58:47these alternative thesis invited
58:49collaboration across multiple advisors
58:51with different types of expertise.
58:57This is a big step for our thesis advisors.
59:01Really big, big thanks to all of them.
59:04Some of them are in our audience today,
59:07so we appreciate so much so much.
59:10All the dedication and the support
59:12for the research program and
59:14the P education in general.
59:16And I would like to invite Kyle to give up.
59:21Some thanks to someone who has helped
59:25us for 14 consecutive years and
59:29has left yell and sent us lots of
59:32emails saying how sorry he was that
59:35he was leaving because he cannot
59:37longer work with be a student.
59:39So I would like you to acknowledge
59:42that person.
59:47Yeah, so I'm Kyle. I had the privilege
59:50of working with Doctor Cohn. Fortunate
59:53to be the last person here at Yale
59:55who will be working with him after
59:5714 years of distinguished service.
59:59We actually reached out to all of
01:00:01his advisors from the past 14 years,
01:00:03and the plan was to take all of
01:00:05their words and put them on a slide.
01:00:07And we actually got words and
01:00:09video recordings and they were
01:00:11just too much and too big.
01:00:13So now you're stuck with me trying to do
01:00:15my best to fill in for all the 14 years.
01:00:17The people who he's kind of
01:00:20touched and I gotta say,
01:00:22you know Dave has this extensive
01:00:24knowledge and this way of being that
01:00:27makes you as a learner feel like you're.
01:00:31Doing everything and that you're
01:00:32amazing and Dave is just in the
01:00:35background like a puppet master,
01:00:36just kind of pulling a string every
01:00:38once in a while when you need one
01:00:40cold and you don't even know it.
01:00:42And I don't.
01:00:43I don't think I can say enough thanks to him,
01:00:46not only for my project but for the
01:00:49past 14 years and for all the lives
01:00:50and their careers that he's advanced.
01:00:52So thank you, Doctor Cohn,
01:00:54I hope you're here and listening to this,
01:00:55and if not,
01:00:56I'm going to send you a recording.
01:00:58And I expect to get pictures of
01:01:00a beach in Hawaii in return.
01:01:01So thank you.
01:01:07When I David Cone announced that he
01:01:10is retiring, he said that he was semi
01:01:12retiring and now living in Hawaii
01:01:14and working part time and going to
01:01:16the beach every day with his wife.
01:01:18So David well done.
01:01:21So next we are going to have the
01:01:25opportunity to listen a bit about
01:01:28the thesis of other students that
01:01:31have recorded their projects and they
01:01:34are going to be coming here to talk
01:01:36a little bit in a minute about what
01:01:39inspired them and what they learned about it.
01:01:42We were going to go into a room
01:01:44and do it by zoom,
01:01:46but we think that we need to
01:01:48hold this in person situation.
01:01:50So I'm going to start calling people.
01:01:52To join us and possibly come come
01:01:58here in pairs and talk a little
01:02:00bit about your thesis. So Alicia.
01:02:06It's Alicia here.
01:02:07No listen.
01:02:08It's not here,
01:02:09so I'm going to call Maria and Kyle
01:02:11to talk a little bit and then we
01:02:14will go through some other people.
01:02:17Thank you.
01:02:27Hello.
01:02:31I was just up here.
01:02:33Would inspire oh
01:02:35what inspired me.
01:02:36Oh man, so I mean I'm going to give
01:02:39Doctor Cohen more props on this one.
01:02:41So I actually went to him
01:02:43with my thesis idea.
01:02:44Basically just looking at P as in
01:02:46the pre hospital space 'cause I
01:02:48haven't heard of anybody doing that
01:02:50and he said you're exactly on time.
01:02:52This is fantastic.
01:02:53There's plenty of conversations
01:02:55happening about this,
01:02:56so we just kind of ran with it.
01:02:59Yep. What inspired me,
01:03:01I think the most inspirational
01:03:03thing that I can share with anybody
01:03:05who's looking at doing their thesis
01:03:07and struggling with that decision
01:03:09about what to do and and struggling
01:03:12through getting it done and the
01:03:14massive amount of work that it takes.
01:03:16There's something really magical about this
01:03:20cluttered clump of numbers on a spreadsheet.
01:03:23Entering your email and you look at it,
01:03:25you go.
01:03:26What the heck is this?
01:03:28And then three months later,
01:03:29you're looking at.
01:03:30Words on a piece of paper and
01:03:31you've explained everything that's
01:03:33going on in that spreadsheet and
01:03:35watching meaning come out of these
01:03:36meaningless numbers on a page.
01:03:38Really, really cool.
01:03:39And I,
01:03:40I hope everybody gets to experience that.
01:03:42So there's some more words for you.
01:03:50For the inspiration behind
01:03:52my project, as many people in this country,
01:03:56I've had very expensive medical bills and
01:03:58a lot of times I don't find out what the
01:04:01cost of my medical care is until I get
01:04:03that Bill and I was actually having Tex
01:04:06Mex for dinner with my husband once and
01:04:08we were talking about cost of medicine in
01:04:11this country and how ridiculous it can be.
01:04:14So that's that. Started this conversation.
01:04:15It was right about the time that we
01:04:18were starting to choose our thesis
01:04:19topic and I I knew that number.
01:04:21Like Kyle said,
01:04:23numbers mean a lot in medicine.
01:04:25Evidence based research is
01:04:26what we do here at Yale.
01:04:28And so I wanted to put numbers
01:04:31to the cost of treatment.
01:04:33And so I love primary care.
01:04:35I love preventative care and I
01:04:37wanted to do it in a setting where
01:04:38we treat a very expensive illnesses,
01:04:40just diabetes.
01:04:41So yeah, if you have the time to watch,
01:04:44great, if not essentially.
01:04:45We don't talk about cost of treatment enough,
01:04:48and it's something that we should.
01:04:50We can all incorporate into our care things.
01:04:58So now I will invite Brittany and Linda.
01:05:17I want to. So what I learned
01:05:21during my thesis project was how much
01:05:24time and effort goes into developing
01:05:27all this evidence based medicine
01:05:30that you know all of the current
01:05:32treatments and everything are based on.
01:05:34So I think I just have such a great
01:05:37appreciation for everything that
01:05:38researchers and people in in the field are
01:05:42doing to to develop such such innovative
01:05:45interventions in medicine and what?
01:05:49Uh, what motivated me was that you
01:05:52know we were home during the pandemic
01:05:54when we were picking our topics and
01:05:56I was living at home with my mom who
01:05:58was a teacher and she was doing remote
01:06:00learning and telling me all about the
01:06:01difficulties that her students were having.
01:06:03So that was really the main thing
01:06:06that inspired me to pick my topic.
01:06:10And for me personally,
01:06:11I've always been interested in research.
01:06:13I did research in undergrad and coming here.
01:06:15I know it's something I want to continue
01:06:17with, and it's also something that
01:06:18I'm looking forward to implement,
01:06:20implement into my professional career.
01:06:23I've always had some kind of
01:06:25interest in Women's Health,
01:06:25and I knew of my advisor
01:06:28before even the thesis project,
01:06:29so I figure maybe I can formulate it to
01:06:32something that's in his expertise and
01:06:34he just so happened to have some data
01:06:37lying around, so I was very thankful.
01:06:39For him for sharing his data that way,
01:06:40I was able to participate in
01:06:43the alternative thesis project.
01:06:45Uhm, yeah.
01:06:48So young.
01:06:55For those who find inspiration,
01:06:56know that it could be at home,
01:06:58so next one is Ashley and Alison.
01:07:03If they are here, yeah.
01:07:18Alright, so my inspiration
01:07:20for my thesis was that
01:07:24I've always had an interest in developmental
01:07:27disorders and neurologic disorders,
01:07:29'cause my younger brother has autism,
01:07:32so this is kind of always been the
01:07:35patient population I've been interested
01:07:37in serving in my career as a PA,
01:07:40and so I thought I would take
01:07:42that into this project and use
01:07:44this opportunity for research.
01:07:46In epilepsy in children?
01:07:48UM, so that was kind of what
01:07:50sparked my interest for this study,
01:07:52and it was such a joy and to be able to
01:07:56learn about nonpharmacologic treatments
01:07:58like exercise for these children,
01:08:01who often have a really heavy burden
01:08:03of disease and take a lot of different
01:08:06pharmacologic measures to treat seizures.
01:08:09So this was kind of my interest
01:08:11in why this study
01:08:13was so important to me.
01:08:17Hi everyone, so this project
01:08:19kind of found me along the way.
01:08:22I was inspired by my wonderful mother
01:08:25who underwent back surgery and I just
01:08:28really wanted to learn more about
01:08:30it so I didn't know where to start.
01:08:34I had no treatment or anything in mind
01:08:36and I just started reading everything I
01:08:38could get my hands on and along the way
01:08:41I just kind of found this in a paper
01:08:43I was reading where I noticed this.
01:08:45Pattern of this surgery being performed
01:08:48very widely with an off label,
01:08:51this protein that they use
01:08:53is used extremely commonly,
01:08:55even though it's off label and there
01:08:57were some concerns that were popping up,
01:08:59and so I thought I would explore
01:09:01that a little bit more.
01:09:03So I would say to just the other classes,
01:09:07find a topic you want to learn more about,
01:09:09and sometimes if you read enough about it,
01:09:12can just find you along the way.
01:09:15Thank you.
01:09:20Monica and Stephanie to join.
01:09:33OK so I'm Monica and I would
01:09:35say the inspiration for my
01:09:37thesis topic came from when I was
01:09:39working as a medical assistant in
01:09:41outpatient gastro enterology before
01:09:43PA School and I just found that a lot
01:09:45of my patients and inflammatory bowel
01:09:47disease were young and in experiencing
01:09:50more depression anxiety than others
01:09:53and it just inspired me to look more
01:09:55into treatment. Or mental health
01:09:57and inflammatory bowel disease.
01:09:59And especially with colvet.
01:10:01I think it's extremely important to
01:10:03find treatment for mental health
01:10:04with those and chronic diseases.
01:10:08And then for the other classes,
01:10:09something that
01:10:10Doctor Proctor taught me was that
01:10:12you should not be too hard on
01:10:14yourself and just to take things
01:10:15one day at a time. And that helped me
01:10:17so much throughout the thesis project.
01:10:19And I couldn't have done it without her.
01:10:23Hi, I'm Stephanie.
01:10:25So I actually changed my thesis topic after
01:10:27submitting my first one over the summer.
01:10:30I wasn't very inspired over the summer,
01:10:31just kind of picked something 'cause the
01:10:34time you know time was then to submit
01:10:36it and then on my second rotation I
01:10:38was in Guy knock and I went to surgery.
01:10:41Patient was really frail.
01:10:43You know the the surgeon kept
01:10:45commenting on her BMI?
01:10:46You know the complications that she was
01:10:49worried about and I kind of just dove
01:10:51into that, researched it a lot more.
01:10:53Kind of.
01:10:53Found the concept of free abilitation
01:10:55along the way and came up with
01:10:58my new thesis topic and submitted
01:11:01it just before Thanksgiving.
01:11:03And yeah, I learned, you know,
01:11:05just kind of overall about how
01:11:09your baseline status going into
01:11:11surgery can affect outcomes,
01:11:12even if it's not in guy knock.
01:11:14You know, I think it's it can be
01:11:15applied to like surgery overall.
01:11:17So it was a fun, fun project.
01:11:20Great, that's great.
01:11:27Are there any questions for I?
01:11:30I don't see any questions in the chat,
01:11:33so we may be celebrating with
01:11:35cookies sooner than we think.
01:11:38I just wanted to say
01:11:39congratulations to everyone I I
01:11:42really appreciate so much that
01:11:44you found inspiration near and far from you.
01:11:48I think it's great too if you if
01:11:50you take something with you is that.
01:11:53When things don't work,
01:11:54we are here to change them and when things
01:11:56work we are here to make them better.
01:11:59Just put forward,
01:12:00push forward and be prepared that
01:12:03in 30 years from now you will still
01:12:06be in practice we will hope.
01:12:09Some of us would be home.
01:12:10Hopefully we will be going to you,
01:12:13for you know for care and we
01:12:16would like that you will stay,
01:12:17stay fresh and interested in the things
01:12:20that are happening, not only to your
01:12:23patients near you but also to others. And
01:12:26there are a lot of people that are
01:12:28not included in research and I'm
01:12:30delighted that you have chosen to
01:12:32include the those who are not seen.
01:12:35Sometimes that's a great way to look.
01:12:38Or start a career.
01:12:40So thank you so much and I know
01:12:42that I made you work a little
01:12:44bit too hard and that's what
01:12:47it makes you extraordinary.
01:12:49Piats, because we ask you to go
01:12:52extra and what you had to do Sunday.
01:12:55Do you have to say?
01:12:59Comma. Of course.
01:13:08Hard working.