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At least 19 recordsLinked to original sources

Graduating to an integrated system: Yale University Medical School and Yale-New Haven Hospital coordinate security.

UNLABELLED: The authors, security directors at Yale University Medical School and Yale-New Haven Hospital respectively, discuss their decision to coordinate their efforts to procure compatible new security systems that would integrate such components as alarms, CCTV, and access control within and between the two campuses. The goal: improve safety and make alarm monitoring easier and more efficient by centralizing operations. THE RESULTS: an increase in security, a decline in security incidents, and a reduction in costs.

Academic Medical Centers↗

New approaches to HIV surveillance: means and ends. Summary report of conference held at Yale University, 21-22 May 1998, by the Law, Policy and Ethics Core, Center for Interdisciplinary Research on AIDS, Yale University.

A system of HIV surveillance based on AIDS case reporting is no longer adequate to monitor the epidemic of HIV/AIDS in the U.S. We are now faced with the challenge of designing an effective system of HIV surveillance. The "New Approaches to HIV Surveillance: Means and Ends" conference emphasized that there are several alternatives, each with strengths and limitations. The CDC has recommended that all states adopt a system of HIV surveillance based on case reporting. Although it has not specified that such systems need be name-based, CDC appears to reward states that adopt name-reporting systems. The rationale for this stance should be reviewed and made explicit. Name reporting may be superior in some respects to a system of case reports based on unique identifiers (UIs), especially in its greater ability to link surveillance activities to follow up at the individual level. Neither a name-reporting nor a UI approach to case reporting would provide HIV incidence data. The only currently envisioned means of providing incidence data is statistical estimation based on "snapshot estimates" of HIV incidence in sample cohorts. Calibration of this new instrument for HIV incidence estimation against existing data or through field trials is of critical importance.

Centers for Disease Control and Prevention, U.S.↗

History of the Department of Pediatrics Yale University School of Medicine.

The history of pediatrics at the Yale University School of Medicine can be divided into eight historical eras. The "Paleohistorical Era" included colonial figures such as Governor John Winthrop and Hezekiah Beardsley who wrote about children's disease in colonial times. Eli Ives, Professor of the Diseases of Children at Yale Medical School gave the first systematic pediatric course in America in the first half of the nineteenth century. During the second era, from 1830-1920, the New Haven Hospital was opened. An affiliation between Yale University and the New Haven Hospital led to the formal establishment of clinical departments including pediatrics in the early 20th century. Six eras coinciding with successive pediatric chairman have led the department to its present respected position in American pediatrics. The department's 75th anniversary in 1996 is an occasion to recognize many of the department's accomplishments and leaders over the years. It is also a time to reaffirm the mission of the department: to the health needs of the children of Connecticut and beyond, to the advancement of scientific knowledge of infants and children and their diseases, and to the training and educational of the pediatric clinicians, educators and investigators of the future.

Connecticut↗

The Sterling Hall of Medicine, Yale University School of Medicine.

A brief history of the Sterling Hall of Medicine at Yale University is presented; this building was erected and dedicated in 1925. This event signified the beginning of a new era for the Yale University School of Medicine, making it possible to attract a caliber of faculty that has enabled the School to attain its present place in medical education.

Connecticut↗

Sabia virus incident at Yale University.

An incident involving a human exposure to a newly isolated arenavirus, Sabia virus, in the Yale Arbovirus Research Unit occurred at Yale University on August 8, 1994. A senior-level visiting research scientist was exposed to Sabia virus while purifying the virus from a large volume of tissue culture fluid. The exposure resulted in development of a Sabia virus infection followed by recovery of the patient. The incident resulted in a comprehensive review by a Yale faculty committee and an external expert committee. As a result, a number of new practices and procedures were added to Yale's biosafety policy for investigating infectious agents in BL-3 facilities.

Air Microbiology↗

The effect of endometriosis on implantation: results from the Yale University in vitro fertilization and embryo transfer program.

OBJECTIVE: To investigate the effect of endometriosis on implantation. DESIGN: Case-control study from Yale University IVF-ET program. PATIENTS: Two hundred eighty-four consecutive IVF cycles were analyzed retrospectively. Patients with endometriosis only (n = 35; 89 cycles) were compared with an age-matched control group with tubal infertility (n = 70; 147 cycles) and also to a group with unexplained infertility (n = 15; 48 cycles). Data from the endometriosis group was analyzed further in subgroups of minimal-mild (43 cycles) and moderate-severe (46 cycles). RESULTS: No difference was found in the number and the quality of oocytes retrieved and fertilization rates between the endometriosis, the tubal infertility, and the unexplained infertility groups. The quality and the number of embryos transferred in each group were comparable. A trend toward reduced pregnancy rate per transfer (14.8%) in the endometriosis versus tubal or unexplained infertility groups (25.7% and 23.3%, respectively) was observed. Implantation rate (gestational sac per transferred embryo) was significantly lower in the endometriosis versus the tubal infertility group (3.9% versus 8.1%; unexplained infertility group, 7.2%). Analysis of first cycles only across all groups revealed that the implantation rate also was significantly lower in the endometriosis versus the tubal infertility group (3.1% versus 9%; unexplained infertility group, 6.7%). Within the endometriosis group, although the pregnancy rate per cycle and per transfer were similar in subgroups, patients with minimal-mild endometriosis had the lowest implantation rate. CONCLUSION: We conclude that, in patients with endometriosis, implantation rate is low. Abnormal implantation, which may be secondary to endometrial dysfunction or embryotoxic environment, is a factor in endometriosis-associated subfertility.

Adult↗

The early years of coeducation at the Yale University School of Medicine.

The Yale School of Medicine began accepting women as candidates for the degree of medicine in the fall of 1916. This decision was consistent with the trend in medical education at the time. While Yale was not the first prestigious Eastern medical school to admit women, joining Johns Hopkins (1893) and the University of Pennsylvania (1914), it was not one of the last. Columbia University College of Physicians and Surgeons admitted women a year later, but Harvard Medical School held out until 1945. The years 1916--1920 saw the number of women enrolled in medical school almost double. Yale's decision to admit women seems to have been made with little resistance from the faculty. The final decision was made through the encouragement and financial help of Henry Farnam, a professor of economics at Yale, who agreed to pay for the women's bathrooms. His daughter, Louise, was in the first class of women. At graduation she was awarded the highest scholastic honors, the Campbell Gold Prize. From Yale she travelled to the Yale-sponsored medical school in Changsha, China, where she became the first female faculty member, a position she held for twelve years. The impressions of Ella Clay Wakeman Calhoun, the only woman to graduate in the second class of women, are presented here. Since 1916 the Yale School of Medicine has undergone extensive physical and philosophical changes, developments in which women have participated.

Connecticut↗

Immunization against swine influenza in the Yale University Community.

Nineteen percent of the approximately 30,000 members of the Yale community aged 18 through 59 received swine influenza monovalent vaccine (A/New Jersey/1976) during the three days of a mass immunization program in Nov. 1976. Based on 1508 card questionnaires received, 71.2 percent of the vaccine recipients experienced a sore arm, 23.4 percent headache, 13.4 percent chilliness, and 9.7 percent feverishness or fever. The sore arm was judged as severe in 5.9 percent as was the headache in 4.2 percent. Other reactions were regarded as severe in less than 2 percent. All reactions were reported more commonly by women than mean and all decreased with age.Serologic tests carried out at the start of the immunization period revealed that influenza A/New Jersey/1976 antibody was absent from 78.6 percent of the recipients; almost all persons under 25 lacked this antibody. A significant antibody rise occurred in 78.3 percent of those receiving a single dose of monovalent vaccine. Somewhat better antibody responses occurred in 36-59 year olds than in those age 17-25 (84.9 vs 75.5 percent); the geometric mean antibody titer was also much higher (1:136.8 vs 1:31.2). However, the presence of pre-existing homologous antibody did not significantly improve the antibody response to the vaccine. Cross-reacting antibody rises to A/Victoria/1975 were found in 16.2 percent of the recipients of monovalent vaccine.

Adolescent↗

The International Health Program: the fifteen-year experience with Yale University's Internal Medicine Residency Program.

The purpose of this study was to assess the impact of international health electives on physicians-in-training. A retrospective study was conducted using an anonymous, self-administered mailed survey to internal medicine residents who trained at Yale from 1982 to 1996 based on their experience with our International Health Program (IHP). The response rate was 61%, with 96 completed surveys in the participant group and 96 completed surveys in the nonparticipant group. Participants were more likely than nonparticipants to care for patients on public assistance (77 versus 49; P < 0.001) and immigrant patients (41 versus 23; P = 0.006). Among residents who changed their career plans, participants (22) were more likely than nonparticipants (14) to switch from subspecialty medicine to general medicine (P = 0.02). Participants were significantly more likely to have a positive view of health care delivery in developing countries. Compared with nonparticipants (64), IHP participants (74) believed that the physical examination is under-used by physicians from the United States as a diagnostic skill (P = 0.03). International health experiences appeared to have an important impact on the decisions and attitudes of residents.

Adult↗

Psychiatric disorders in the relatives of probands with affective disorders. The Yale University--National Institute of Mental Health Collaborative Study.

A family study of psychiatric disorders in 2,003 first-degree relatives of 335 probands found increased rates of bipolar I disorder and major depression (MD) in the relatives of probands with bipolar disorder and increased rates of MD in the relatives of probands with MD. There was a similarity in rates of affective disorders in the relatives of ambulatory and of hospitalized depressed probands (suggesting that ambulatory depressed patients may be as suitable as hospitalized ones for biological studies) and a comparability of rates of illness in relatives between centers for most disorders when comparable diagnostic criteria and procedures were used.

Adult↗

Testicular seminoma. Results of the Yale University experience, 1964-1984.

Eighty-three testicular seminoma patients were treated with radiation therapy from 1964 through 1984. Seventy-nine (95%) of the 83 patients had early disease that included 61 Stage I, 15 Stage IIA (pelvic or paraaortic lymph node involvement less than or equal to 5 cm), and 3 Stage IIB (pelvic or paraaortic lymph node involvement greater than 5 cm) patients. The 15-year actuarial survival for this group of Stage I and II patients was 95% (+/- 5%). Stage I patients were treated with a mean paraaortic/pelvic dose of 2924 cGy and only one patient developed recurrent disease. This recurrence was at the margin of the radiation field and probably represents a marginal miss. The Stage IIA patients were treated with slightly higher doses (mean, 3335 cGY) to the paraaortic/pelvic region and there were no recurrences. The three Stage IIB patients received tumor doses of 3245 cGy, 4090 cGy, and 4500 cGy, respectively, and there were no recurrences. Low dose prophylactic mediastinal and supraclavicular irradiation (mean, 2320 cGy) was used in 17 (94%) of the 18 Stage II patients and there were no mediastinal or supraclavicular recurrences. Four patients presented with advanced disease (one Stage III, three Stage IV) and the only disease-free survivor was treated with cisplatinum-based combination chemotherapy and radiation therapy. Three patients developed minor complications from the radiation therapy: one patient had persistent scrotal and leg edema and two patients treated with prophylactic mediastinal irradiation had chronic low leukocyte counts. Two of the 79 Stage I and II patients developed a second malignancy: one had bronchogenic carcinoma at the margin of a mediastinal field, and one had diffuse histiocytic lymphoma both in and out of the radiation therapy fields. The 15-year actuarial probability of developing a second malignancy was 3.3%. Radiation therapy after operation is a successful treatment option for most patients with Stage I and II seminoma.

Cisplatin↗

Chemotherapy of recurrent/advanced cervical cancer: results of the Yale University PBM-PFU protocol.

Chemotherapy for cervical cancer patients with recurrent and/or advanced disease has been complicated by excessive toxicity and short duration of responses, leading to little or no improvement in survival. Modification of drug scheduling and delivery of platinum, bleomycin, methotrexate, and 5-FU has resulted in a new combination regimen with little toxicity and a survival advantage for responders. PBM (platinum 80 mg/m2 D1, bleomycin 10 mu/m2/day D3-6, methotrexate 150 mg/m2 D15, 22 with leucovorin) is alternated with PFU (platinum 100 mg/m2 D1, 5-FU 1000 mg/m2/day D2-5) q 4 weeks for 3-6 months. The platinum, bleomycin, and 5-FU were delivered by continuous infusion. Twenty-three patients with recurrent and 17 with advanced cervical cancer are evaluable; 91% of patients with recurrent disease had received prior radiation therapy. The response rate was 30.4% in those with recurrent disease, and 41.2% in those with advanced disease, with 86 and 42.9% of responders respectively achieving a CR. Survival data were analyzed for each group separately, as well as for the combined recurrent/advanced disease group (N = 40). The results and significance were not changed by the groupings. In the combined recurrent/advanced group, median duration of response was 10.5 months, mean 20.1, and the median overall survival was 11 months, mean 20.5 +/- 3.5. There was a survival advantage accrued to the responders (median, 28 months) vs the nonresponders (10 months) (P = 0.0005 by log rank test). Moreover, there was a significant difference in progression-free interval between responders vs nonresponders (P = 0.0001), as well as between responders and those with stable disease (P = 0.001). This regimen was very well tolerated and there was no significant pulmonary toxicity. Furthermore, in the subset of 23 patients who had recurrent disease, 67% achieved palliation of pain. Experience with this protocol supports the continuing use of chemotherapy in the management of cervical cancer patients.

Adult↗