Medicine and Health Sciences Commons^™

Providing Healthcare Access For The African Population Using An International Care Coordination System: A Case Study Of Nigeria And Ghana, Aminat B. Nwaonumah

College of Graduate Studies: Theses & Dissertations

Introduction: Healthcare access is a major population health challenge among underserved populations in many parts of the world, and the situation in Africa is no exception. Foreign aid, a significant component of healthcare financing in Africa, has played a crucial role in mitigating communicable diseases. However, there is a lacuna in care for non-communicable diseases, such as chronic illnesses, especially among the elderly. This study explored an innovative approach to expanding healthcare access in Nigeria and Ghana through care coordination sponsored by migrant family members residing in the United States. Beyond foreign aid, this research elucidates how the International Care …

Barriers To Seeking Medical Care And Their Effects Among Fat Patients With A Fat Liberation Praxis In The United States, Christina Seiko Cook

College of Graduate Studies: Theses & Dissertations

Weight stigma and weight bias have significant effects on the health of individuals (Alberga et al., 2019; Pearl, 2018; Puhl & Heuer, 2010; Schwartz et al., 2003; Udo et al., 2016). These biases can show up in the form of fatphobia or anti-fat bias. Physicians who hold anti-fat bias can affect their relationship with their patients, leading to poorer health outcomes and worse patient experiences for larger-bodied and fat people (Phelan et al., 2015). The purpose of this study is to contribute to the current literature regarding the positive and negative experiences of fat patients with a fat liberation praxis …

Perceptions And Influences On Physical Activity Engagement During Pregnancy Among Rural Southern Black Women, Sandra Ofosuhemaa

College of Graduate Studies: Theses & Dissertations

Black women living in the rural South experience disproportionately high rates of hypertension, gestational diabetes, excessive gestational weight gain, and adverse birth outcomes. Although physical activity during pregnancy is known to improve maternal and fetal health, Black pregnant women remain less likely to meet recommended activity guidelines. This qualitative study examined the perceptions, beliefs, and multilevel factors influencing physical activity during pregnancy and the postpartum period among Black women in rural Southeast Georgia. Guided by the Health Belief Model (HBM) and Social Ecological Model (SEM), the study explored how individual, interpersonal, community, and structural conditions shaped women’s decisions, motivations, and …

Exploratory Analysis Of Gait Mechanics In Farmers, Mariana V. Jacobs, Kate N. Jochimsen, Jody L. Clasey, Michael A. Samaan

Kinesiology and Health Promotion Faculty Publications

Farmers may be at a higher risk of developing hip osteoarthritis (OA) due to the high demands of their occupation. To the authors’ knowledge, the gait patterns of farmers that may be associated with hip joint degeneration have yet to be analyzed. Therefore, this study compares gait mechanics between farmers and non-farmers (controls). It is hypothesized that farmers would exhibit altered lower extremity joint mechanics during walking when compared to matched controls. This exploratory study included five farmers and five sex-, age-, and body mass index (BMI)-matched controls. A 3D gait analysis was performed while study participants walked at a …

Assessment Of Hip Joint Mechanics During Walking In People With Marfan Syndrome, Mariana V. Jacobs, Justin Melan Pol, Aaron D. Fain, Jody L. Clasey, Brecca M. M. Gaffney, Christopher J. Mclouth, Mary B. Sheppard, Michael A. Samaan

Kinesiology and Health Promotion Faculty Publications

Background: Marfan syndrome (MFS) is an autosomal dominant connective tissue disorder and is associated with muscle dysfunction. Individuals with MFS exhibit quadriceps weakness, hip joint pain, and an increased incidence of hip osteoarthritis (OA) compared to the general population, yet the underlying biomechanical factors associated with these poor hip-related outcomes are not well understood.

Research Question: The purpose of this study was to assess the effects of MFS on gait mechanics and to determine the relationship of gait mechanics with hip-related outcomes within the MFS group. Methods: Eighteen people with MFS and 18 healthy, asymptomatic controls underwent 3D gait analysis. …

The Effect Of The Ketogenic Diet On The Circadian Rhythmicity Of Glymphatic Function In Mice, Tanner Metcalfe

Yale Medicine Thesis Digital Library

The glymphatic system is a network of perivascular spaces that coordinates removal of waste products from brain parenchyma. It is known that the glymphatic system is under control of the circadian rhythm, however little is known about factors that influence this control. Data has shown that the expression of specific circadian rhythm genes is altered when exposed to the ketogenic diet. In this experiment, we show that the day-night rhythmicity of glymphatic function is extinguished in mice exposed to the ketogenic diet through the up-regulation of influx of cerebrospinal fluid to brain parenchyma and the reduction in cervical lymph node …

Clinical Predictors Of Fluid-Responsive Acute Kidney Injury, Cindy Khanh Nguyen

Yale Medicine Thesis Digital Library

CLINICAL PREDICTORS OF FLUID-RESPONSIVE ACUTE KIDNEY INJURY

Cindy Khanh Nguyen, Abinet M. Aklilu, Yu Yamamoto, Bashar A. Kadhim, Claudia Coronel-Moreno, Francis P. Wilson. Section of Nephrology, Department of Internal Medicine, Yale University, School of Medicine, New Haven, CT.

Specific Aims: We aimed to explore and identify common clinical variables that may be helpful in selecting patients who will benefit from volume challenge when the fluid-responsiveness of AKI is unclear.

Methods: Our study is a retrospective secondary analysis of a clinical trial that prospectively enrolled adult patients at Yale-New Haven Hospital with AKI defined by the 2012 Kidney Disease: Improving Global …

Development Of Cerium Oxide Based Polymer Composites With Enhanced Cytocompatability For Biomedical Applications, Roshna Cherugail

Honors Undergraduate Theses

This thesis presents the synthesis and characterization of cerium oxide nanoparticles (CNPs), and silver-doped cerium oxide nanoparticles (AgCNPs) loaded in alginate beads that were designed to be applied in biomedical settings. Cerium oxide was chosen for its antioxidant and anti-inflammatory capabilities, and silver oxide was selected to enhance antimicrobial functionality, both of which are pivotal in expedited wound closure and promoting cellular proliferation. Through the use of an advance electrospray encapsulation apparatus, alginate-based polymer beads were created by incorporating either CNPs or AgCNPs into the matrix. These beads were later characterized using a range of microscopic and FTIR analyses, in …

Implementing A Routine Patient Health Questionnaire-9 (Phq-9) Screening Bundle For Adults (18-65 Years) Scheduled For A Psychiatric Evaluation, Olivier Bertrand Djoumessi

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Depression affects 21 million American adults (8.4%), yet only 28% receive appropriate screening. In Texas, where 20.8% of adults experience depression, systematic screening remains inconsistent. This quality improvement project addressed a critical gap at an outpatient mental health clinic in the Dallas-Fort Worth metroplex, where Patient Health Questionnaire-9 (PHQ-9) screening occurred in only 40% of psychiatric evaluations, resulting in missed diagnoses and inconsistent treatment. Using the Plan-Do-Study-Act framework, the project implemented a comprehensive PHQ-9 screening bundle consisting of staff training, electronic health record integration, and a treatment algorithm based on severity thresholds. The intervention targeted adults, aged 18-65, scheduled for …

A Comprehensive Evaluation Of Thigh Mineral-Free Lean Mass Measures Using Dual Energy X-Ray Absorptiometry (Dxa) In Young Children, Trey R. Naylor, Mariana V. Jacobs, Michael A. Samaan, Laura C. Murphy, Douglas J. Schneider, Margaret O. Murphy, Hong Huang, John A. Bauer, Jody L. Clasey

Kinesiology and Health Promotion Faculty Publications

This study aimed to (1) demonstrate the intra- and interrater reliability of quadriceps (QUADS) and hamstring (HAMS) mineral-free lean (MFL) mass measures using DXA scanning, (2) determine the association of total thigh MFL mass measures with MFL mass measures of the hamstrings and quadriceps combined and (3) analyze the association between total thigh MFL mass and total body MFL mass measures. A total of 80 young children (aged 5 to 11 yrs) participated and unique regions of interest were created using custom analysis software with manual tracing of the QUADS, HAMS, and total thigh MFL mass measures. Repeated-measure analysis of …

Sex-Specific Roles Of The Adipocyte Mineralocorticoid Receptor In Obesity And Early Life Stress, Meghan B. Turner

Theses and Dissertations--Pharmacology and Nutritional Sciences

Obesity is a burgeoning health epidemic caused by chronic overnutrition and exacerbated by genetic, environmental and developmental factors. The adipocyte mineralocorticoid receptor (MR), a transcriptionally active nuclear receptor, is speculated to contribute to metabolic dysfunction in the obese state. MR expression is increased in obese adipose tissue, and MR modulates the expression of fat-derived hormones such as leptin and adiponectin. In women, obesity can be exacerbated by early life stress, such as adverse childhood experiences (ACEs). Studies show that women display a positive association between cumulative ACE exposures and increased body mass index. Previously, we demonstrated that maternal separation and …

2025 North Dakota American Indian & Alaska Native Maternal Child Health Profile, Kilyn R. Parisien

Public Health Student Publications

This report was created to identify and address the health needs and inequities of American Indian and Alaska Native (AI/AN) women and their children who reside in North Dakota

Data in this report has been collected from a variety of federal and state agencies, such as the North Dakota Department of Health and Human Services, U.S. Census Bureau (American Community Survey), and Centers for Disease Control and Prevention. The NDDoH’s approach for this report was to focus on having high-level discussions for each of the sections of AI/AN maternal and child health. This report is one of four components in …

Mechanistic Insights Into The Antimicrobial Action Of Fungus-Derived Xanthoquinodins Against Clostridioides Difficile, Erika A. Serravalle

Graduate Thesis and Dissertation post-2024

The bacterial pathogen Clostridioides difficile is the leading cause of antibiotic- and healthcare-associated diarrhea, imposing significant clinical and economic impacts. The emergence of hypervirulent strains, such as PCR ribotype 027 (RT027), has exacerbated disease severity, recurrence rates, antibiotic resistance, and epidemiological spread. Expanding resistance profiles among C. difficile strains continue to limit the effectiveness of current IDSA-SHEA recommended therapies, which are already compromised by high recurrence rates due to antibiotic-induced disruption of the gut microbiota. These challenges highlight the urgent clinical need to identify and characterize antimicrobial compounds targeting alternative pathways in C. difficile physiology. We report the discovery and …

Synthesis And Evaluation Of Chalcones As Treatment For Negative Sense Single Stranded Rna Viruses And Applications As Broad-Spectrum Antivirals, Lorael Kirton

Graduate Thesis and Dissertation post-2024

Chalcones are a class of compounds naturally found in plants and are predicated upon a 1,3-diphenylprop-2-en-1-one scaffold. Chalcones possess many biological activities ranging from anticancer to antiviral activities. This thesis investigates the broad-spectrum antiviral properties of chalcones. Some chalcones have been reported to affect host cell mechanisms such as mammalian target of rapamycin (mTOR) signaling cascade or the cell cycle to reduce viral replication. Previously, a series of chalcones 8 were synthesized and investigated in human cytomegalovirus virus (HCMV) and human immunodeficiency virus (HIV). In this study, ten new chalcones predicated upon the design of 8 were synthesized and a …

Fgf19 Facilitates Metastatic Phenotypes In Colorectal Cancer, Joseph W. Nolff

Graduate Thesis and Dissertation post-2024

Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the United States. With 154,000 new cases estimated in 2025, there is an increased need for early screening to detect CRC prior to metastasis. Our laboratory has focused on enteroendocrine hormone Fibroblast Growth Factor-19 (FGF19) as it is overexpressed in a subset of CRC tumors. FGF19 is an intestinal-derived hormone involved with lipid homeostasis when bound to its receptor, Fibroblast Growth Factor Receptor-4 (FGFR4). Our objective focuses on FGF19 contribution towards an epithelial-to-mesenchymal transition (EMT) and overall metastatic properties including rapid proliferation and/or increased cell motility. Immunofluorescence was …

Fructose Induces Metabolic Changes Distinctly Different From Glucose In A N2a Cell Line., Catherine A. Ghigleri

All Master's Theses

Over the last 50 years, there has been a rise in diagnoses of Alzheimer’s Disease and other dementias associated with metabolic stress. This parallels an increase in fructose consumption and has led to research on the effects of fructose on the hippocampus, a brain structure responsible for learning and long-term memory formation. The hippocampus is also a region of the brain that metabolizes fructose. Experiments using animals fed diets containing fructose have shown a correlation between fructose consumption, learning impairment, and structural changes to the hippocampus in animals’ brains. However, the effects of fructose on hippocampal neurons have not been …

Facilitating Engagement In Meaningful Occupations Through Nature-Based Experiences, Sydney Johnson

Occupational Therapy Capstones

Background: Many children, especially those living in urban areas, are spending less time in nature than ever before which is decreasing their engagement in meaningful occupations such as sleep, play, education, social participation, and activities of daily living. Interacting with nature can improve children’s emotional regulation, development, attention span, mental health, and overall well-being. It is important that children have access to nature and its benefits to ensure they are reaching their full potential in life. One method to improve children’s access to nature is providing them with nature-based activities that can be modified or adapted for those living in …

Symbol-Temporal Consistency Self-Supervised Learning For Robust Time Series Classification, Kevin Garcia, Cassandra Garza, Brooklyn Berry, Yifeng Gao

Computer Science Faculty Publications

The surge in the significance of time series in digital health domains necessitates advanced methodologies for extracting meaningful patterns and representations. Self-supervised contrastive learning has emerged as a promising approach for learning directly from raw data. However, time series data in digital health is known to be highly noisy, inherently involves concept drifting, and poses a challenge for training a generalizable deep learning model. In this paper, we specifically focus on data distribution shift caused by different human behaviors and propose a self-supervised learning framework that is aware of the bag-of-symbol representation. The bag-of-symbol representation is known for its insensitivity …

Tissue Kallikrein 1 Cleaves Complement Factor C3 And Activates The Alternative Complement Pathway, Sarah E. Sartain, Andrew Yee, Paula Jacobi

Research Data

Hematopoietic stem cell transplant-associated thrombotic microangiopathy (HSCT-TMA), characterized by microvascular endothelial damage and severe renal injury, negatively affects HSCT survivorship with high mortality and long-term renal morbidity. After HSCT, innate immunity and inflammation are often dysregulated. The alternative complement pathway (AP) of the innate immune system is overactivated in HSCT-TMA, but the mechanisms of its initiation are poorly described. Complement component C3 of the AP can be cleaved by proteases outside of the AP. Because mRNA expression of tissue kallikrein 1 (KLK1), an inflammatory serine protease that produces kinins, has been found to be markedly elevated in the renal endothelium …

Oil And Wine: A Christian Reflection On The Sacred Oath, Faith Abraham

be Still

This essay explores the intersection of medicine, faith, and the deeper calling to heal. Reflecting on experiences at the Christian Community Health Fellowship (CCHF) Conference, it examines the weight of the physician’s oath—not just as a professional obligation, but as a sacred commitment to justice, dignity, and human connection.

Can Eastern Wisdom Solve Western Problems? A Book Review On Sun Tzu’S “The Art Of War”, Tian Qin

Health Care Administration Faculty Research

This paper explores how Eastern philosophical wisdom, specifically Sun Tzu’s The Art of War, can be applied to address modern Western organizational challenges. By drawing parallels between Sun Tzu’s military strategies and Bolman and Deal’s (2008) organizational theory—particularly the structural, political, and human resource frames—the review highlights how strategic evaluation, environmental awareness, and adaptive leadership can drive success in contemporary institutions. It critically examines Sun Tzu’s authoritative leadership style and its limitations, while emphasizing the continued relevance of strategic thinking, stakeholder analysis, and resource management in complex organizations such as higher education. The analysis suggests that while some of Sun …

A Path Analysis Of Predictive Factors Affecting Kangaroo Mother Care Practice Among Mothers In Communities In Upper East Region, Ghana, Francis Anaba Agana

Chulalongkorn University Theses and Dissertations (Chula ETD)

This cross-sectional descriptive correlational study aimed to explore the level of KMC practice among the mothers in communities in Upper East Region, Ghana, and to explore the direct and indirect effects of socioeconomic status, social support, maternal autonomy, self -efficacy and sociocultural norms on the practice of KMC in communities in Upper East Region, Ghana. The sample were 300 mothers of preterm and/low birth weight babies recruited by using stratified random sampling technique. This study applied the Socio-Ecological Model as a theoretical framework. Data were collected using questionnaires including socioeconomic status, social support, maternal autonomy, self-efficacy, sociocultural norms and KMC …

The Effects Of An Integrated Application Supported Mindfulness-Based Cognitive Therapy Program On Depression Among Adolescents With Non Suicidal Self-Injury, Russunan Jantarapakdee

Chulalongkorn University Theses and Dissertations (Chula ETD)

This randomized controlled trial with repeated measures aimed to evaluate the effectiveness of an integrated application supported MBCT program in reducing depression among adolescents with NSSI. The sample consisted of 96 participants who met the inclusion criteria and were randomly assigned to either the experimental group or control group, with 48 participants in each group. The experimental group received the program, was developed based on the MBCT framework proposed by Segal et al. (2013) once a week for 60 minutes over eight weeks. Sessions were delivered through both on-site activities at schools and online meetings via the LINE application, supplemented …

Molecular Investigation Of Clade Classification, Knockdown Resistance And Pathogen Detection Of The Head Louse (Pediculus Humanus Capitis) Collected From Children In Ang Thong, Thailand, Urooj Gul

Chulalongkorn University Theses and Dissertations (Chula ETD)

Human head lice (Pediculus humanus capitis) are medically significant ectoparasites due to their capacity to harbor pathogenic bacteria and the increasing prevalence of insecticide resistance. A total of 112 head lice specimens were collected from children in Ang Thong, central Thailand. Phylogenetic analysis of the mitochondrial cytb gene identified two well-supported clades, with clade A (69.2%) predominating over clade C (30.8%) in the studied population. Molecular screening revealed a high incidence of bacterial associations, with Staphylococcus aureus detected in 96.4% of specimens and Acinetobacter spp. in 2.7%. Furthermore, genotypic analysis of the voltage-sensitive sodium channel (VSSC) gene demonstrated a strikingly …

Recommendations For The Novel Assessment System In The Doctor Of Medicine Program From The Medical Students’ And The Educators’ Perspectives, Tanat Tabtieang

Chulalongkorn University Theses and Dissertations (Chula ETD)

The 2024 Doctor of Medicine curriculum at Chulalongkorn University introduced a new assessment system comprising outcome-based assessment system with milestones, a non-tiered grading model with recognition of excellence, a professional development dashboard (PDD), remediation with re-examination, and a faculty-level student profile (FLSP). This study employed a quantitative cross-sectional survey design, complemented by a sequential exploratory element, to compare student and faculty perspectives using a questionnaire across five themes, analyzed with descriptive statistics, Mann-Whitney U tests, and effect sizes (ES). A total of 490 students and 285 faculty responded. When analyzed by theme, students showed greater confidence than faculty in the …

Antimicrobial Activity Of Silver Nanoparticles Synthesized Using Thai Herbal Extracts, Charuwan Pradabsang

Chulalongkorn University Theses and Dissertations (Chula ETD)

Synthesis of silver nanoparticles (SNP) using Thai herbal plants, namely Garcinia cowa Roxb. ex Choisy (S1), Boesenbergia rotunda (L.) Mansf. (S2), Curcuma mangga Valeton & Zijp (S3), Momordica charantia L. forma abbreviata (Ser.) W. J. de Wilde & Duyfjes (S4), Persicaria odorata (Lour.) Soják (S5), Litsea elliptica Blume (S6), Gnetum gnemon Linn. var. tenerum Markgr (S7), Phaleria macrocarpa (Scheff.) Boerl. (S8), Salacia chinensis Linn. (S9) and Brachypterum scandens (Roxb.) Miq. (S10), is considerably economical and safe. Plants and preparation methods can affect properties and bioactivity such as controlled temperature of SNP. This study aimed to assess the ability of aqueous …

The Development Of Surveillance And Monitoring Tools For Pharmaceutical Supply Chain Management System For Public Health Emergencies, Kakanang Tosanguan

Chulalongkorn University Theses and Dissertations (Chula ETD)

Background: Thailand frequently experiences public health emergencies (PHEs) that severely disrupt pharmaceutical supply chain (PSC) management. This study addresses the urgent need for a specialized assessment tool to identify system weaknesses, support timely risk management, and enhance national preparedness planning.Methods: Utilizing a sequential exploratory mixed-methods design (July 2022–July 2024), the study began with a scoping review to identify existing frameworks. Following this, in-depth interviews with 36 key stakeholders synthesized conceptual domains. The draft tool underwent rigorous content validity assessment by 63 experts and was then pilot tested with 62 participants to confirm reliability (Cronbach’s alpha).Results: The evidence synthesis resulted in …

Optimization And Efficacy Of Car T Cells Derived From Newly Generated Anti-Cd22 Monoclonal Antibody For Blood Cancer Treatment, Wipawadee Ruengdej

Chulalongkorn University Theses and Dissertations (Chula ETD)

Chimeric antigen receptor (CAR) T-cell therapy has revolutionized the treatment of B-cell malignancies. Nevertheless, relapse due to loss of CD19 expression remains a major clinical challenge. CD22 serves as an alternative target because of its consistent expression on malignant B cells, even in CD19-negative disease. Optimization of CD22-directed CAR design is therefore critical to enhance antitumor potency and persistence. Two novel anti-CD22 CAR constructs were generated from monoclonal antibody clones 24A7G6 and 29H9C8, each incorporating either a 4-1BB or CD28 costimulatory domain. The resulting CAR T cells were evaluated for proliferation, phenotype, and cytotoxicity against CD22-positive (Raji, Nalm-6) and CD22-negative …

Bridging University And Hospital Libraries: Evidence-Based Strategies For Developing A New Medical School Library, Dana Thimons, Nancy Hampton, Kelly Fogarty

Faculty and Staff Publications

This poster, presented at the Medical Library Association (MLA) Annual Meeting, describes how Xavier University of Louisiana and Ochsner Health partnered to establish a new medical school, requiring library leaders to address LCME Standard 5.8 (Library Resources/Staff) within the data collection instrument and self-study for preliminary accreditation. A cross-institutional workgroup undertook a multi-method approach to building an evidence-based case for library planning, including a literature review, comparator institution database analysis, mapping of needs to LCME Standards, informal stakeholder interviews, consultation of AAHSL statistics and Doody's resources, evaluation of current holdings, and price estimation for needed resources. Key challenges included communicating …

Effect Of Walking With An Active Ankle Exoskeleton On The Biomechanical Responses Of The Lumbar Spine, Jose E. Rubio, Junfei Tong, Aravind Sundaramurthy, Anup Pant, Sridevi Nagaraja, Meredith K. Owen, Michael A. Samaan, Brian W. Noehren, Jaques Reifman

Physical Therapy Faculty Publications

Objective: Musculoskeletal injuries pose a health threat to U.S. Service members. In particular, the physical demands of walking and running with load carriage contribute to a high incidence of musculoskeletal injuries of the lower back. Active ankle exoskeleton devices are promising technologies that may help mitigate the impact of load carriage on the incidence of these injuries. However, the safe extended use of these devices requires an understanding of their beneficial or detrimental effects on the lumbar spine. In this pilot study, we investigated the impact of walking with an ankle exoskeleton device on lumbar biomechanical responses.

Methods: We collected …