Master of Sciences, Case Western Reserve University, 2018, Biology

Plasmodium falciparum histidine-rich protein 2 (PfHRP2) forms the basis of many current malaria rapid diagnostic tests (RDTs). However, parasites lacking the pfhrp2 gene do not express the PfHRP2 protein and are, therefore, not identifiable by PfHRP2-detecting RDTs. In this study, the performance of the SD Bioline Malaria Ag P.f/Pan RDT together with pfhrp2 variation in Madagascar was evaluated. The study also evaluated pfhrp2 gene variation in PNG. Genomic DNA isolated from patient blood samples from Madagascar (n = 260) and PNG (n = 169) were subjected to molecular detection (18S rRNA PCR, followed by post-PCR LDR-FMA) for the identification of Plasmodium spp. infections. PCR amplification of the pfhrp2 gene, sequencing and gene analysis enabled studying of gene variation. PCR diagnosis showed that 28.8% (75/260) in Madagascar and 81.1% (137/169) in PNG had Plasmodium infections. 94.6% (71/75) and 91.2% (125/137), of the infections were P. falciparum in Madagascar and PNG, respectively. Compared to molecular detection, the sensitivity and specificity of the RDT (in Madagascar) for P. falciparum detection were 87% and 89%, respectively. From randomly selected pfhrp2 gene-positive samples, 16 pfhrp2 gene sequences from Madagascar and 18 pfhrp2 gene sequences from PNG were generated. Although extensive variations of the pfhrp2 gene were observed in both countries, this study showed that there was no indication of pfhrp2 deletion. The study also did not observe a clear correlation between pfhrp2 sequence structure and RDT detection rates. Although the absence of pfhrp2 deletion from the samples screened here is encouraging, continued monitoring of the efficacy of RDTs currently used in Madagascar and PNG is warranted.

Committee: Peter Zimmerman A. (Advisor); Daniel Tisch J. (Committee Member); Emmitt Jolly R. (Committee Member); Hillel Chiel (Committee Chair) Subjects: Biology; Epidemiology; Genetics; Molecular Biology; Parasitology

PHD, Kent State University, 2014, College of Public Health

Abstract With just a year remaining to the Millennium Development Goals (MDGs) deadline, there is limited evidence for and adequate level of awareness/use of malaria intervention strategies and by extension, decreases in malaria-related mortality and morbidity. This is a cross-sectional study on awareness and use of malaria control interventions based on data collected from a household survey from two of the 20 local government areas (LGAs) of Lagos State, Nigeria – Alimosho and Kosofe where a malaria control program of Roll Back Malaria (RBM) is being implemented. The sample included pregnant women (n = 250) and mothers of children under five years old (n = 233) that were interviewed using interviewer-administered, semi-structured questionnaires in a household survey. Questionnaires developed by the research staff of the Nigerian Institute for Medical Research probed respondents' demographic characteristics; knowledge and compliance of policy guidelines on the awareness and use of malaria intervention strategies. The study was implemented over a 6-month period from February to August 2014. This study used both linear and logistic regression analysis. Linear regression was used to predict the Compliance Index as a function of the independent variables of Age, Marital Status, Maternal Status, Religion, Education and Local Government Area of residence, while logistic regression was used to predict alignment into high/moderate or low knowledge of malaria categories also as a function of Age, Marital Status, Maternal Status, Religion, Education and Local Government Area of residence. Results of the linear regression showed that the overall model of the six independent variables was able to significantly predict the compliance index, R2 = .163, F(6,409) = 13.28, p <.001. Age, Education and LGA were significant predictors. Results of the logistic regression showed the Exp(B) of two predictors, LGA and Maternal Status, as statistically reliable in distinguishing b (open full item for complete abstract)

Committee: Sonia Alemagno Ph.D (Advisor); Jonathan VanGeest Ph.D (Committee Chair); James Mark Ph.D (Committee Member); Bhatta Madhav Ph.D (Committee Member); John Graham Ph.D (Committee Member) Subjects: Public Health

Master of Arts, The Ohio State University, 2008, Graduate School

Committee: Not Provided (Other) Subjects:

Doctor of Philosophy, Case Western Reserve University, 2023, Genetics

Whole genome sequencing (WGS) is an ever expanding tool in the field of genetics, and is widely used to characterize human genetic variation. There are multiple large-scale sequencing studies being conducted today worldwide, like All of Us, Three Million African Genomes, and GenomeAsia 100k. The addition of these diverse datasets alone can be transformative to our understanding of genetics, but the increase in the diversity of populations sampled also has the potential to reveal additional and novel information relevant to health and disease. Specifically, whole genome sequence (WGS) analyses of DNA from human whole blood may be able to capture genetic variation in other species that can affect both individual and public health. The research detailed in this dissertation aims to illustrate the utility of human WGS data for infectious disease, by showing that the malaria causing parasite Plasmodium can be sensitively detected from unmapped reads (UMRs) from WGS data. Malaria has a significant global health burden, and elimination of the disease has been a goal since the 1950s. Recently, there have been roadblocks in the progress of malaria elimination that can only be resolved through additional research efforts. Development of this detection methodology could be the tool required to better define the parasite population, identify problematic populations, and solve the roadblocks limiting elimination success.

Committee: Thomas LaFramboise Ph.D. (Committee Chair); Scott Williams Ph.D. (Advisor); Peter Zimmerman Ph.D. (Advisor); Dana Crawford Ph.D. (Committee Member); Arlene Dent MD, Ph.D. (Committee Member) Subjects: Biomedical Research; Epidemiology; Genetics; Parasitology

Master of Science, The Ohio State University, 1967, Graduate School

Committee: Not Provided (Other) Subjects:

Master of Science, The Ohio State University, 1965, Graduate School

Committee: Not Provided (Other) Subjects:

Master of Science, The Ohio State University, 1966, Graduate School

Committee: Not Provided (Other) Subjects:

Master of Science, The Ohio State University, 1969, Graduate School

Committee: Not Provided (Other) Subjects:

Doctor of Philosophy, Case Western Reserve University, 2025, Epidemiology and Biostatistics

Malaria remains a global health challenge with over 600,000 deaths annually. Ninety-five percent of the global malaria burden occurs in children living in sub-Saharan Africa. In regions with moderate to high mosquito-borne transmission of Plasmodium falciparum, the most lethal of the 5 Plasmodium species that infect humans, children are repeatedly infected and by age 10 to 12 years develop naturally acquired immunity (NAI). NAI is characterized by protection from symptomatic febrile illness and severe malaria that can lead to death. However, NAI does not protect against chronic asymptomatic blood stage infections that serve as a major reservoir of transmission by local mosquito vectors. Current evidence indicates that host inflammatory responses and the progressive development of NAI in African children is heterogeneous that is, in part, due to genetic polymorphisms, ecologic factors such as residence near mosquito breeding sites, and the use of insecticidal bed nets among other factors. This heterogeneity is relatively unexplored with respect to the innate and adaptive immune mechanisms that underlie NAI. To address this gap in knowledge, we evaluated cellular and molecular responses of African children at healthy baseline, during acute febrile (“uncomplicated”) Plasmodium falciparum malaria, and upon recovery in whole blood of 40 children from Burkina Faso and peripheral blood mononuclear cells of 8 children from Kenya. Cell-type proportion estimates were obtained by deconvolution using RNA sequencing and genome-wide DNA methylation data. Unsupervised learning algorithms identified two distinct immune response groups in children, designated as Type 1 and Type 2, from both Burkina Faso and Kenya. The response designation was based on patterns of cell-type proportions, DNA methylation and gene expression. The two types were predominantly quantitative, with response Type 2 exhibiting larger changes of cell type counts, DNA methylation and gene expression from asymp (open full item for complete abstract)

Committee: Catherine Stein (Committee Chair); Scott Williams (Advisor); James Kazura (Advisor); Arlene Dent (Committee Member); Mark Cameron (Committee Member) Subjects: Immunology; Molecular Biology

Master of Arts (MA), Bowling Green State University, 2024, History

This study explores how Western-based science and technology transformed traditional medical practices in colonial Ghana, especially in the treatment of malaria and trypanosomiasis. Noteworthy is that prior to the arrival of Europeans and the introduction of Western medicine, Africans had developed their own medical system with preventive and curative methods of handling diseases through herbal medicine and spiritual healing. Since African medical methods did not align with Western scientific approach, a clash was predictable. Despite the efforts of the British colonial government to stigmatize and suppress African indigenous methods of treating major diseases, their policies and actions conversely facilitated innovation and advancement in traditional medical practice in Ghana. Yet, the native people were important agencies in this process of scientific advancement in the production, administration, and efficacy of plant pharmacopeia for the treatment of diseases. This study represents a major on how traditional healers and Western-trained indigenous medical practitioners collaborated to validate plant medicine through scientific research. By and large, modern Ghana retained a mix of both Western-based and African indigenous healthcare delivery systems that continue to serve the people till date.

Committee: Apollos Nwauwa Ph.D (Committee Chair); Eugene Grunden Ph.D (Committee Member) Subjects: African History; History

Master of Sciences, Case Western Reserve University, 2024, Pathology

Malaria caused by the Plasmodium vivax parasite is a leading cause of disease burden in many tropical and subtropical parts of the world. Infection leads to the generation of antibodies specific to parasite proteins, such as apical membrane antigen 1 (AMA1). This ligand plays a role in invasion of reticulocytes by binding of the rhoptry neck (RON) complex, which is composed of RON proteins. This complex is inserted by the parasite into the cell surface. In malaria infections, IgG1 and IgG3 isotype frequencies are increased. These isotypes can activate complement or bind Fc receptors to initiate effector functions. As part of a project that isolates cDNA from individual PvAMA1- specific IgG expressing B cells, we aim to develop a rapid method to identify the IgG subclass from these B cells to provide a more comprehensive view of immunoglobulin generation in these individuals.

Committee: Neena Singh (Committee Chair); Jürgen Bosch (Committee Member); Christopher King (Committee Member) Subjects: Immunology; Molecular Biology; Parasitology; Pathology

Master of Science, Miami University, 2022, Kinesiology, Nutrition, and Health

Access to quality, affordable, and reliable healthcare has been a long-standing challenge in rural areas of developing countries. Rural households often incur high out-of-pocket expenditure for healthcare, resulting in a significant cost burden when seeking treatment for an illness. This study aimed to examine the cost structure of healthcare in a rural, underserved community in the Kaloleni Subcounty of Kilifi, Kenya. We measured the impact of direct healthcare costs on a sample of 37 households, along with the coping strategies and treatment-seeking behavior arising from these costs. Direct healthcare costs were grouped into 3 categories: consultation, diagnostic, and medicine fees. Results show that medicine was the highest direct healthcare cost, accounting for 64% of all expenses paid during an episode of illness. Direct healthcare costs also comprised over 12% of the monthly household expenditure in these households, with the lowest-earning homes being disproportionately affected. Malaria was the most common illness reported in the study area, accounting for 37% of all illness cases. Several strategies are proposed to ease the burden of direct healthcare costs. These include government subsidies for community-level healthcare facilities, increasing the availability of medicines, and improving the distribution/use of treated mosquito bed nets to prevent malaria transmission.

Committee: Philip Smith (Advisor); Paul Branscum (Committee Member); Helaine Alessio (Committee Member) Subjects: Health Care; Health Sciences; Public Health

Doctor of Philosophy, The Ohio State University, 2021, Chemistry

Mass spectrometry (MS) is a powerful analytical tool that plays crucial roles in many fields, including disease diagnosis, environmental monitoring, drug discovery, and chemical reaction screening and their mechanistic studies. The plethora of applications using MS continue to expand; this, in turn, has enabled continuous explorations that have resulted in the development of innovative ion sources and analyzers. Ambient ionization is a recent innovation that enables direct in-situ complex mixture analysis without having lengthy pretreatment of the sample (e.g., extraction, precipitation, lyophilization). Therefore, direct analysis using ambient ionization reduces analysis time and allows high throughput chemical detection. With such developments in ionization techniques, chemical instrumentation is getting advanced into new applications which were not previously possible. A future outlook on instrumentation is manufacturing portable mass spectrometers. In addition to basic figures of merits of the mass spectrometer, portable mass spectrometer broadens the scope of modern MS due to less power consumption, relatively low cost, and fieldable application. This dissertation describes the development of MS-based applications for clinical diagnosis utilizing ambient ionization and portable mass spectrometer (Chapters 2-4) and reaction screening (Chapter 5). Chapters 2-4 describe the innovations of coupling microfluidic paper-based analytical device (µPAD) to the portable mass spectrometer for ultrasensitive malaria diagnostic. Diagnosis of malaria, which is one of the deadliest infectious diseases, is the primary focus of this dissertation. This disease is encountered in developing countries and other resource-limited settings. Thus, the objective is positioned toward developing an ultrasensitive point-of-care tool so that all people can have equal opportunity to get diagnosed early and accurately. In chapter 2, the use of a portable mass spectrometer became the focus of t (open full item for complete abstract)

Committee: Abraham Badu-Tawiah (Advisor); Robert Baker (Committee Member); Vicki Wysocki (Committee Member) Subjects: Analytical Chemistry

Doctor of Philosophy (Ph.D.), University of Dayton, 2021, Electrical Engineering

Purpose: To present and demonstrate a computationally efficient deep learning approach for computer-aided detection systems for medical imaging applications that include malaria, diabetic retinopathy, and tuberculosis. Approach: We propose a novel and a computationally efficient deep learning approach for medical image analysisusing convolutional neural networks (CNNs). We demonstrate the efficacy of our proposed method in the detection of malaria, diabetic retinopathy, and tuberculosis. We refer to our approach as Incremental Modular Network Synthesis (IMNS), and the resulting CNNs as Incremental Modular Networks (IMNets). Our IMNS approach is to use small network modules that we call SubNets that are capable of generating salient features for a particular problem. Then, we build up ever larger and more powerful networks by combining these SubNets in different configurations. At each stage, only one new SubNet module undergoes learning updates. This reduces the computational resource requirements for training and aids in network optimization. Results: We compare IMNets against classic and state-of-the-art deep learning architectures such as AlexNet, ResNet-50, Inception v3, DenseNet-201, and NasNet for the various experiments conducted in this study. Our proposed IMNS design leads to high average classification accuracies of 97.0%, 97.9%, and 88.6% for malaria, diabetic retinopathy, and tuberculosis, respectively. Conclusions: Our modular design for deep learning achieves the state-of-the-art performance in the scenarios tested. The IMNets produced here have a relatively low computational complexity compared to traditional deep learning architectures. The simpler IMNets train faster, have lower memory requirements, and process images faster than the benchmark methods tested

Committee: Russell Hardie Dr. (Committee Chair); Vijayan Asari Dr. (Committee Member); Youssef Raffoul Dr. (Committee Member); Temesguen Kebede Dr. (Committee Member); John Loomis Dr. (Committee Member) Subjects: Biomedical Engineering; Computer Engineering; Electrical Engineering

MS, University of Cincinnati, 2020, Education, Criminal Justice, and Human Services: Information Technology

Malaria is a female Anopheles mosquito-borne disease that transmits a motile infective form to the host body such as humans, which reproduce asexually in the blood cells of the host. The typical symptoms of malaria are fever, headache, tiredness, and vomiting. In severe cases may lead to coma and death. In this research, we used deep neural networks to detect the malaria virus in human blood cells. Traditional malaria detection techniques require experts to test blood cells under a microscope. The shortage of skilled technicians and the unavailability of required equipment and infrastructure result in false diagnoses leading to an increase in mortality rate. Early researches have shown detection using Machine Learning techniques like Support Vector Machine (SVM), which is tedious and requires hand-engineered feature extraction to train data, and the results were not up to the mark. The proposed method in this research shows a system with end-to-end automated models using a deep neural network that performs both feature extraction and classification using blood smear cell images. The dataset used in this research was taken from the National Institute of Health (NIH) Malaria Dataset. Models are evaluated based on accuracy, precision, recall, and F1-score. Data Preprocessing techniques like data segmentation and normalization are applied to maximize the model performance. In this research, two deep Convolutional Neural Networks, VGG-19, and ResNet-50, are experimented on to analyze and compare the best performing model on the malaria dataset. Our results showed that the ResNet-50 outperforms the VGG-19 by achieving an accuracy of 97 percent.

Committee: Bilal Gonen Ph.D. (Committee Chair); Nelly Elsayed Ph.D. (Committee Member) Subjects: Information Technology

Doctor of Philosophy (PhD), Ohio University, 2020, Biological Sciences (Arts and Sciences)

Malaria and Chagas disease are two of the most important vector-borne parasitic infections in Ecuador. A better understanding on the transmission scenarios is needed to propose effective strategies for disease control. In Chagas disease, human-vector dynamics is not well understood; however, the presence of active transmission in endemic areas has been demonstrated. The pattern of blood meals of insects that are vector of diseases is fundamental to unveil transmission dynamics. In this study DNA from intestinal contents of triatomines were used to amplify fragments of cytb mitochondrial genes. The results showed that humans are a main source of food for triatomines, indicating that the vector-human contact is more frequent than previously thought. Although other groups of mammals such as rodents are also an available source of blood, birds (particularly chickens) might have a predominant role in the maintenance of triatomines in these areas. The presence of human blood meal in 42% of the samples, even in peridomiciliar and sylvatic environments, together with high infection rates with Trypanosoma cruzi (the causal agent of Chagas disease) indicate that humans are not accidental host, but an important source of blood for triatomines in all environments, and with high risk of T. cruzi transmission. Consequently, domestic-centered strategies might not prevent vectorial transmission and data of Chagas disease cases might be underestimated. Strategies for Chagas disease control in Ecuador require to evaluate capacity dispersal of triatomines and outdoor activities as risk factors for parasite transmission in Ecuador. In the case of malaria, the lack of a complete inventory of vector species is a barrier for an understanding of malaria transmission. Even more, implication on transmission of reported species is still poorly understood. Identification of species is mainly carried out by morphological characteristics; however, it fails in discriminating species closely relat (open full item for complete abstract)

Committee: Mario Grijalva Ph.D. (Advisor); Sarah Wyatt Ph.D. (Committee Member); Calvin James Ph.D. (Committee Member); Janet Duerr Ph.D. (Committee Member); Daewoo Lee Ph.D. (Committee Chair) Subjects: Biology; Biomedical Research; Entomology

Doctor of Philosophy, The Ohio State University, 2019, History

During the nineteenth and early twentieth centuries, the Ottoman state sought to exploit Iraq's natural resources and address its ecological vulnerabilities as part of a broader effort at modernization. In doing so, it was informed by an “environmental imaginary” of Iraq's supposed environmental decline when compared to its perceived past prosperity. That fact, along with Iraq's frontier dynamics, incentivized an already expanding and growing Ottoman government to further solidify its rule in the region through a set of imperial policies aimed at effective environmental management. This dissertation examines this development as it unfolded between the years 1831 and 1909, a period in Ottoman history characterized by rapid government expansion and the state's use of modern forms of governmentality. It draws on an array of Ottoman, British, and French archival sources to demonstrate how irrigation, flood control projects, epidemics, provisioning operations, cash crop cultivation, and climate irregularities all shaped Ottoman imperial policy in Iraq in previously unappreciated ways. Ultimately, this dissertation suggests that, in the Iraqi frontier, late Ottoman state building was a symbiotic process informed by central government priorities and on-the-ground environmental realities.

Committee: Carter Findley (Advisor); Jane Hathaway (Committee Member); Scott Levi (Committee Member); Sam White (Committee Member) Subjects: Environmental Studies; History

Doctor of Philosophy, Case Western Reserve University, 2019, Biology

Malaria continues to be a persistent threat to the health of Madagascar's people. Effective control necessitates efficient vector surveillance. Laxity has lethal consequences. Mosquito control across the island has historically focused on reduction of, and protection from, malaria vectors that feed and rest indoors. In spite of evidence suggesting that outdoor resting and feeding mosquitoes could be involved in malaria transmission in this county, surveillance protocols continue to emphasize endophilic vectors, leaving gaps in our understanding of the role of exophilic mosquitoes. We deployed a modified barrier screen trap, the QUEST (QUadrant Enabled Screen Trap), in conjunction with a novel assay we call BLOODART (BLOOdmeal Detection Assay for Regional Transmission) to sample exophilic vectors in the Madagascar Highland Fringe. We captured a total of 1252 female Anopheles mosquitoes (10 species), all of which were subjected to BLOODART analysis. QUEST collection produced a heterogenous distribution of mosquito density, diversity, host choice, and Plasmodium infection. The mosquitoes in this collection frequently exhibited multiple blood feeding behavior (MBF) (46.4%), and a shift in the overall percentage of human positive bloodmeals from December 2017 to April 2018 (27% to 44%). Plasmodium positivity (prevalence = 6%) was found primarily in vectors considered to be of secondary importance, indicating a need to account for these species in routine surveillance efforts. We modeled the potential impact of multiple blood feeding behavior on common transmission metrics, including the entomological inoculation rate, the vectorial capacity, and the proportion of living infectious vectors in a mosquito population. These models suggest that multiple host contact could act as a force multiplier for malaria transmission.

Committee: Peter Zimmerman PhD (Advisor); Gavin Svenson PhD (Committee Member); Mark Willis PhD (Committee Member); Christopher Cullis PhD (Committee Member); Nicole Crown PhD (Committee Chair) Subjects: Biology; Entomology; Epidemiology; Molecular Biology

Doctor of Philosophy, Case Western Reserve University, 2018, Molecular Medicine

It is estimated that 400,000 children die of malaria annually, with 90% of these deaths occurring in sub-Saharan Africa. Researchers do not fully understand the development of immunity to malaria caused by Plasmodium falciparum (Pf), the most deadly of the malaria species in humans. Although people living in malaria-endemic regions are subject to repeated malaria infections over their lifetime, clinical immunity takes years to develop because antibodies and memory B cells (MBC) specific to malaria antigens are acquired gradually with exposure. Only 30-60% of those living in malaria-endemic regions acquire MBC to any given Pf antigen over their lifetimes, suggesting the parasites evade and possibly suppress the immune system in a way that prevents adequate memory formation. B cell subsets shift in proportion during active malaria infections to a phenotype that over-represents atypical MBC, which are not thought to secrete functional antibodies. Evidence from T cell experiments supports the idea that cellular immunity is dysfunctional during acute malaria. Our research sought to characterize how antibodies, B cells, and T cells shift in response to repeated exposure and clinical infections with Pf in children and adults. We found that children and adults living in regions with decreasing malaria transmission have a delay in acquiring antibodies specific to malaria antigens. Anti-malarial antibody levels and distributions of B cell subsets were different between children and adults, likely because of their different cumulative exposure to Pf. Children with acute, uncomplicated malaria had dysfunctional memory B cell activation in response to polyclonal stimulation, high levels of atypical memory B cells, and a lack of activated T follicular helper cells compared to matched healthy samples. We observed these trends in B and T cells from Kenyan and Papua New Guinean children, who have very different human genetic backgrounds and parasite diversity; therefore, we hyp (open full item for complete abstract)

Committee: James Kazura MD (Advisor); Arlene Dent MD, PhD (Advisor); Christopher King MD, PhD (Committee Member); Alan Levine PhD (Committee Chair) Subjects: Biology; Biomedical Research; Immunology

PhD, University of Cincinnati, 2017, Education, Criminal Justice, and Human Services: Health Education

Introduction: Malaria is a major public health problem and life-threatening disease. In the Democratic Republic of the Congo (DRC), roughly 400 children die every day and almost half of these deaths are attributable to malaria. Malaria is the leading cause of morbidity and mortality in children under age 5 in the DRC, accounting for an estimated 40% of outpatient visits and 40% of childhood mortality. The purpose of this study was to examine whether malaria control methods (i.e., insecticide bed net use and taking sp/fansidar or chloroquine for malaria) differed based on perceived problems preventing pregnant women from seeking medical advice or treatment (big problem, not a big problem), receipt of prenatal care (no, yes) and source of prenatal care (e.g., doctor), and sociodemographic characteristics. Methods: A secondary data analysis of pregnant women (n = 2,404) who completed the Demographic and Health Survey in the DRC (DHS-DRC7) was conducted. Results: Results indicated that use of a mosquito bed net, taking sp/fansidar, and taking chloroquine for malaria significantly differed among pregnant women based on educational attainment, ethnicity, and wealth index. Pregnant women who did not sleep under a bed net were more likely to not receive ANC (p = .002), including 1.95 times more likely (p = .002) to not receive care from a doctor than pregnant women who did not sleep under a mosquito net. Pregnant women who did not take sp/fansidar for malaria during pregnancy were more likely to perceive that distance to a health facility (p < .001) and not wanting to go alone (p = .009) were big problems for getting medical help for themselves. Pregnant women who did not take sp/fansidar during pregnancy were more likely to not receive care from a doctor (p = .01), nurse (p = .002) or birth attendant (p < .001). Pregnant women who did not take chloroquine for malaria while pregnant were 3.6 times more likely (p = .04) to not receive care from a doctor. Discussion: Awarenes (open full item for complete abstract)

Committee: Ashley Merianos Ph.D. (Committee Chair); Rebecca Vidourek Ph.D. (Committee Chair); Keith King Ph.D. (Committee Member) Subjects: Health Education