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  • A Screening Tool To Identify Patients At High Risk For Perioperative Neuropathy

    Reel, Sally J.; Ibbotson, Carla Minnetta; Elam, Charles R.; Herring, Christopher; Jerman, Jonathan D. (The University of Arizona., 2021)
    Purpose: This project aimed to evaluate anesthesia provider attitudes surrounding the clinical topic of perioperative peripheral nerve injury. Additionally, the project sought to introduce anesthesia providers to a novel risk assessment device that may help identify patients at high risk for perioperative peripheral nerve injury while assessing its potential utility in anesthesia practice.Background: Perioperative peripheral nerve injury is a significant cause of patient morbidity and medical litigation. Anesthesia-related lawsuits involving perioperative nerve injury are the second most common type of intraoperative malpractice lawsuit, consistently representing 15-18% of claims (Grant et al., 2019). Research shows that nerve injury is more common in patients with specific comorbidities, predisposing them to nerve damage (Welch et al., 2009). These patients have physiologic characteristics that may be easily identifiable during a preoperative assessment (ASA, 2018). Methods: The project utilized a descriptive design with quantitative evaluation by an electronic survey created by Qualtrics. The survey was distributed to participants following a medicolegal analysis presentation about perioperative peripheral nerve injury and the introduction of a peripheral nerve injury risk assessment tool created by the author. The study's survey gathered data in two main areas, the providers’ opinions and attitudes towards the problem of a perioperative peripheral nerve injury and their view of the presented screening tool’s usefulness. Results: The strongest metrics resulting from the survey showed that anesthesia providers have an increased interest in improving documentation, improving patient assessment efforts, improving patient communication, and perioperative team communication, with the highest metric showing interest in reducing legal risk. When asked if the anesthesia providers could see themselves using the presented screening tool in their clinical practice, 69% of anesthesia providers responded “yes.” Conclusions: The information gained from the project builds awareness of which areas of clinical interest surrounding the topic of perioperative nerve injury are important to anesthesia providers. Feedback gathered from the survey also revealed a positive interest in the potential utility of a risk assessment device, which may help identify patients at high risk for developing a peripheral nerve injury during general anesthesia.
  • Living without Normativity

    Timmons, Mark; Horgan, Terry; Schwarz, Lucia; Schmidtz, Dave (The University of Arizona., 2021)
    Many philosophers think that morality possesses a particularly robust kind of normativity that other systems of norms, such as etiquette or the rules of chess, lack. My dissertation addresses, first, what exactly this robust normativity is supposed to come down to and, second, the implications for our practical lives if morality ultimately isn’t robustly normative–indeed, if no system of norms is. Regarding the first issue, ethical naturalists believe that the robust normativity ascribed to morality can be captured in fully naturalistic terms; moral facts just are natural facts. On the other hand, metaethical nonnaturalists object that normative properties are just too different from natural ones to be a subset of them. In their view, moral properties are irreducibly normative. I agree with nonnaturalists that robust normativity, if it exists at all, isn’t a naturalistic phenomenon. However, while nonnaturalists provide compelling criticisms of ethical naturalism, they currently lack an informative positive account of the nature of robust normativity that explains how it is different from the purely formal normativity of, say, etiquette. Against this background, my dissertation argues that we can illuminate the elusive concept of robust normativity through metaphors. However, even if we can indeed make sense of robust normativity through metaphors, that leaves open whether robust normativity exists. Some scholars deny the existence of irreducibly normative properties because they consider them to be metaphysically “queer.” Taking such skeptical concerns seriously, I ask: if robust normativity does not exist, what would be the practical implications for our lives? I hold that, in the absence of robust normativity, in an important sense, our practical questions of what to do lack answers. This means that we have to make what some existentialist philosophers call “radical choices,” i.e., spontaneous choices that are not based on pre-existing reasons that could guide our decision-making. However, I suggest that, in the absence of robust normativity, we can rely on our subjective concerns for practical guidance because many of our subjective concerns survive a belief in antirealism about robust normativity and because they enjoy a privileged connection to our motivational system.
  • The World Is Your Oyster: A Multidisciplinary Approach To Evaluate the Spatial Distribution, Occurrence and Risk of V. parahaemolyticus in Oysters and Water

    Verhougstraete, Marc; Cooksey, Emily; Reynolds, Kelly; Burgess, Jeffery; Zimmer-Faust, Amy; Hamilton, Kerry (The University of Arizona., 2021)
    Vibrio parahaemolyticus (V. parahaemolyticus) and Vibrio vulnificus (V. vulnificus) are naturally occurring bacteria and are the leading causes of seafood-borne illness and death in the United States, respectively. While other foodborne illnesses in the United States are decreasing, V. parahaemolyticus and V. vulnificus cases continue to increase. Often illness from V. parahaemolyticus and V. vulnificus are associated with the consumption of raw oysters. The current understanding of V. parahaemolyticus and V. vulnificus are focused primarily on oysters harvested in the Gulf of Mexico and the East Coast, though there is a growing health risk globally and in Southern California. In this dissertation, a multidisciplinary approach was used to show the spatial distribution of V. parahaemolyticus at a global and local level and data were used to inform risk estimates from consuming Southern California oysters contaminated with V. parahaemolyticus. In this dissertation, a scoping literature review provided an up-to-date understanding of V. parahaemolyticus in water and oysters at a global scale. This highlighted the necessity for oyster-related research publication guidelines to compare studies globally. From the details generated in the literature review, a database was developed to aid in a collaborative effort to better understand V. parahaemolyticus. This dissertation was the first to assess V. parahaemolyticus and V. vulnificus in water and Pacific oysters in Southern California. There was a higher concentration of pathogenic V. parahaemolyticus and V. vulnificus in the water column compared to oysters. Additionally, V. parahaemolyticus concentration in water and oysters and V. vulnificus concentration in water were correlated with environmental covariates. Following this field study, a quantitative microbial risk assessment (QMRA) model was utilized to predict illness risk from V. parahaemolyticus in recreationally harvested oysters from Southern California along the “sea-to-fork” pathway. This study utilized regional-specific and national data to estimate V.10 parahaemolyticus illness risk. The mean probability of illness per serving of oysters was 6.20 x 10-5 (95% confidence interval 5.653 x 10-7 – 1.92x 10-4) from consumption of raw oysters harvested in Southern California following the “sea-to-fork” pathway. The mean V. parahaemolyticus illness risk per serving of oysters immediately following harvest was 5.61 x 10-5 (95% confidence interval 4.84 x 10-8 – 1.83 x 10-4). The sensitivity analysis highlighted the relative importance of the initial concentration of V. parahaemolyticus in the oysters, number of oysters consumed, and concentration of pathogenic V. parahaemolyticus following transport in vibriosis risk.
  • Ketamine Infusions for Treatment-Resistant Major Depressive Disorder

    Edmund, Sara J.; Lindly, Lindsey Ann; Elam, Charles R.; Corriveau , Luc (The University of Arizona., 2021)
    Purpose: The purpose of this Doctor of Nursing Practice (DNP) project is to educate mental health professionals at Peak Wellness Center in southeast Wyoming about intravenous ketamine for treatment-resistant major depressive disorder.Background: Intravenous ketamine has been used for several years for analgesia and anesthesia. The use of intravenous ketamine for psychiatric disorders is a new utilization of this anesthetic medication; a knowledge deficit exists among mental health professionals regarding its usage for depression treatment. Methods: A 15-minute, online educational presentation with pre- and post-test surveys was developed detailing strategies for identifying patients that would benefit from intravenous ketamine treatment, safety considerations, contraindications to treatment, cost, insurance considerations, where local ketamine clinics are located, and how to refer clinically qualified patients for treatment. Results: Ten PWC mental health professionals viewed the educational presentation and responded to corresponding surveys. A comparison of the 10 participants responses demonstrated increased intravenous ketamine knowledge, improved comfort level for discussing ketamine treatment with patients, and greater intent to refer qualified patients to certified intravenous ketamine providers Conclusion: The project shows that education can positively impact mental health professionals’ knowledge about new treatment modalities for treatment-resistant major depressive disorder. Keywords: depression, major depressive disorder, intravenous infusion, ketamine, treatment-resistant
  • Robots, Labor Market Frictions, and Corporate Financial Policies

    Klasa, Sandy; Liu, Yanguang; Woutersen, Tiemen; Williams, Ryan; Ion, Mihai (The University of Arizona., 2021)
    Using a novel dataset from the International Federation of Robotics (IFR), I find that robots can transform the labor market landscape and mitigate the impact of labor market frictions on financial policy decisions. Firms with more robots, which reduce labor adjustment costs and operational risk, have higher financial leverage and hold less cash. Such firms rely less on employees and attach less importance to gaining bargaining advantages over unions. The effects of robots on corporate financial policies are stronger for firms with more blue-collar workers. When facing greater foreign competition, firms with more robots are able to adopt less conservative financial policies. The effects of minimum wage increases on corporate financial policies are weaker for firms with more robots.
  • Teaching Up: Developing an Intersectional Andragogy

    Deil-Amen, Regina; Atkins, Celeste; Nicolazzo, Z; Elfring, Lisa K. (The University of Arizona., 2021)
    This qualitative study uses in-depth interviewing to illuminate the experiences of nineteen faculty and build on my own experiences “teaching up” – teaching as faculty from a traditionally marginalized group(s) about privilege – to understand how faculty experience these situations and make meaning of them. Findings revealed racialized gender differences with regard to student resistance. Men of color reported more subtle resistance from students while women, particularly women of color, faced disrespect, harassment, and even death threats. Impression management was particularly salient for faculty of color and most important at the beginning of their career. Racialized gender differences emerged in terms of faculty preferences for how students addressed them and whether feminist pedagogy was appropriate. For Black faculty it was important to bring their culturally authentic selves to the classroom. This was expressed in multiple ways including modeling culturally authentic dress and modes of speaking and sharing reflexively about their own privilege and oppression. The literature on teaching about privilege is written primarily by Whites for Whites. This study addresses that gap by adding marginalized voices as well as moving beyond the one-dimensional current focus of race-based White privilege. Most research emphasizes race, but by utilizing a more multi-dimensional intersectional analysis, this study expands our understanding about teaching about privilege beyond concepts of race to discuss gender, sexual orientation, and ability. It further exposes the inherent racial bias in feminist pedagogy. This study also adds to the research on marginalized faculty by specifically focusing on teaching and classroom experiences from an intersectional perspective. It extends the concepts of controlling images (Collins, 2000) and circumscribed agency (Deil-Amen & Tevis, 2009) by illuminating how they operate in the lived experience and teaching practices of marginalized faculty. Additionally, I add to the funds of knowledge literature by shifting the focus from the students to marginalized faculty and asserting that instead of a deficit-based approach, institutions should focus on the specific funds of knowledge that marginalized faculty have to offer. Finally, I offer a framework for understanding how faculty academic identity is shaped for marginalized faculty who work within hegemonic academia. I show how controlling images are used as a mechanism to reinforce hegemonic ideas, how faculty’s hyperawareness of those controlling images leads to a sense of double-consciousness (DuBois, 1903), and how that awareness is relevant to the ways they attempt to enact agency by shaping their impression management techniques and their faculty academic identity. This study provides concrete suggestions for faculty in terms of classroom management, personal demeanor, teaching about privilege, institutional context, and dealing with student resistance. I propose expanding the funds of knowledge framework to include the unique perspectives and life experiences traditionally marginalized faculty bring to the classroom. I propose that a focus on the funds of knowledge offered by marginalized faculty will allow them to express more freely their culturally authentic selves, model a multiplicity of ways of being a professional academic, and allow them to create holistic faculty academic identities. Finally, I posit a paradigm shift from the innumerable pedagogies being offered in various disciplines to a focus on an intersectional andragogy.
  • Attitudes Towards Collaboration to Create Inclusive Education in Saudi Elementary Schools: General Education Teachers' Perceptions

    Liaupsin, Carl J.; ALMedlij, Modhawi Abdulrazaq; Gonzalez, Taucia; White, Jennifer M. (The University of Arizona., 2021)
    This survey study investigated general education teachers’ attitudes towards inclusion and collaboration to create inclusive classrooms for students with learning disabilities in Saudi elementary public schools. General education teachers in Saudi Arabia are central to the success of the inclusion of students with learning disabilities, and understanding their attitudes is fundamental to the success of inclusion and collaboration. A sample of 188 Saudi general education teachers responded to an online Likert scale survey supplemented with open-ended questions. Descriptive statistics and One-way ANOVA were used in the analysis of the data, which revealed that the sample of general education teachers have neutral attitudes towards inclusion. However, these teachers have positive attitudes towards collaboration, including the two domains of knowledge of and feelings towards collaboration. There was a significant (p < 0.05) difference in the teachers’ attitudes towards inclusion and their feelings towards collaboration when resource rooms exist in schools. However, there was no significant difference in teachers’ attitudes regarding the knowledge of collaboration when resource rooms exist in schools. The open-ended questions revealed that teachers were aware of the importance of their role in the success of inclusion. In addition, the teachers stated that the availability of resources, including special education (SE) teachers is key to creating successful collaboration. A number of barriers to achieving inclusion and collaboration were raised by the teachers, including lack of SE teachers, and the number of students in the classrooms. Concerns were also raised regarding students with learning disabilities, and their abilities to access the general curriculum. Issues external to teacher-to-teacher and teacher-to-students’ relationships, such as administrative support and lack of knowledge regarding inclusion and collaboration practices were also identified. This study lays the foundations for further research regarding in-service training programs, ways to develop and enhance collaboration between teachers and to investigate the perceptions of students with learning difficulties regarding having a collaborative team of teachers who can motivate and guide them in the general education classroom.
  • Native American College Student Dynamics at a University Native American Student Center

    Lopez, Jameson D.; Haudley, Charlinda; Jo Tippeconnic Fox, Mary; Cabrera, Nolan L.; Tachine, Amanda R. (The University of Arizona., 2021)
    The purpose of this study is to explore Native American identity through student interactions at a university Native American student center. Two theories guide this research: the peoplehood sense of belonging and Indigenous identity. This study explores how Native American students engage with their peers who are from similar and different tribes. The three research questions this study aims to answer are: 1) How do Native American students describe their experiences with Native students from different tribes? 2) How do Native American students perceive tribal dynamics at a university Native student center? 3) How do Native American student dynamics affect a Native specific sense of belonging at a university Native American student center? This research shifts the narrative of how organizational structures directly impact Native students, resulting in the institution being held accountable for the inadequate institutional support for the Native American student center and other Native student support services that directly influence the Native student experience. Using stories as a knowledge-gathering method (Kovach, 2009), nine Native American students, referred to as storytellers, share their interactions with students from various tribal backgrounds and lived experiences. This dissertation uses the language of storytelling to demonstrate how students share their experiences in the interviews. The researcher refers to Indigenous Storywork (Archibald, 2008) as a methodological framework to develop a culturally responsive environment that allows for storytelling. As knowledge holders and tribal citizens of sovereign nations, the storytellers provide recommendations for the university leadership, Native American student center, Native American student support services, and campus stakeholders to enhance intertribal student engagement opportunities for Native American students. As well as demonstrating to key decision makers the value of a Native American student center and its impact on peoplehood sense of belonging.
  • Education and Implementation of the Fascia Iliaca Block for Acute Hip Fracture Patients

    Torabi, Sarah; Roberts, Chrisanna Marie; Hoch, Kristie; Daly, Patricia (The University of Arizona., 2021)
    Purpose: This quality improvement (QI) project aimed to increase anesthesia providers knowledge on the use of the fascia iliaca compartment block (FICB) for patients with acute hip fractures through an educational presentation, hands on training, and clinical practice guideline (CPG). The goal was to increase confidence in administering this block so providers feel more comfortable implementing this in their clinical practice.Background: Adequate pain management can decrease morbidity and mortality by decreasing overall opiate consumption, improving mobility, decreasing hospital length of stay, and avoiding adverse side effects of untreated pain. This Doctor of Nursing Practice (DNP) project was implemented at a Level I trauma center in Texas which did not have a FICB CPG in place for patients with acute hip fractures. Pain control for hip fractures were often managed with systemic opioids with minimal regional analgesia implementation at this facility. Literature review supports the use of a FICB as a first line analgesia in patients with acute hip fractures. Lack of knowledge leads to lack of implementation resulting in suboptimal pain management. Methods: The Model for Improvement methodology identified the lack of implementation of this regional block and the Plan-Do-Study-Act (PDSA) cycle guided this project. An educational presentation was delivered to anesthesia providers (n=17) that outlined FICB administration, a CPG for acute hip fracture patients, and hands-on training with the ultrasound. Results: Pre-survey results revealed that 64% (n=11) of CRNAs had not performed any FICBs within the last six months. Likelihood of FICB administration in patients with an acute hip fracture increased from 29% (n=5) to 58% (n=10) following the educational presentation. The post-quiz at the hands-on workshop identified 97.4% of participants were able to identify contraindications, anatomy, and treatment for complications. Recognition of lidocaine toxicity and appropriate dosage for this block resulted in a 76.47% rate. The 30-day survey resulted in 80% of CRNAs (n=4) implementing at least 1 FICB and all (100%) of CRNAs (n=5) reported this training was beneficial for their anesthesia department. Conclusions: In conclusion, CRNAs increased their knowledge with the educational training and there has been increased implementation after the hands-on workshop.
  • Implementation of the Generalized Anxiety Disorder 7-Item (Gad-7) in an Integrated Primary Care Setting

    Bouchard, Lindsay; Curran, Brett N.; Gallagher, Shawn; Edmund, Sara (The University of Arizona., 2021)
    Purpose: The GAD-7 is an effective, validated tool that screens adults for generalized anxiety disorder, allowing for timely diagnosis, treatment initiation, and behavioral health referral. A quality improvement project was designed to educate primary care providers at an integrated, community health clinic on the indication, use, and interpretation of the GAD-7.Background: Generalized anxiety disorder is a common condition that can have widely detrimental effects. Consistent use of the GAD-7 in primary care settings can mitigate anxiety-related dysfunction, reducing tertiary care interventions, lowering spending, and improving patient outcomes. The GAD-7 facilitates measurement-based care, which optimizes diagnostic speed and accuracy, and facilitates high-quality care. The clinic implemented the GAD-7 as a standard of primary care to address gaps in anxiety assessment and integrative care practices. Methods: Twenty primary care providers were recruited through convenience sampling and educated during an in-service, evidence-based presentation. The participants completed pre- and post-intervention surveys that assessed existing and subsequent GAD-7 knowledge and use. Descriptive statistics were used to analyze and interpret the survey data. Results: Post-intervention, most participants reported that the GAD-7 would improve their ability to assess patients for anxiety and identify those who require further treatment. All participants reported that the GAD-7 would improve their ability to identify patients for behavioral health referral. Conclusions: The education presentation effectively improved GAD-7 knowledge and perception among the primary care providers. Increased provider knowledge enables successful GAD-7 implementation as part of routine, measurement-based care at the clinic. Continued GAD-7 use will improve outcomes for patients and the clinic, reducing a significant gap in integrative care delivery. Keywords: measurement-based care, generalized anxiety disorder, GAD-7
  • 5-HT1F Receptor Agonism for the Treatment of Spinal Cord Injury

    Schnellmann, Rick G.; Simmons, Epiphani Ciara; Bhattacharya, Martha; Largent Milnes, Tally; Doyle, Kristian; Madhavan, Lilitha (The University of Arizona., 2021)
    Spinal cord injury (SCI) is characterized by vascular disruption leading to ischemia, decreased oxygen delivery and loss of mitochondrial homeostasis. The dysregulation observed with SCI leads to defective respiratory chain function and reduced ATP production, exacerbating neuronal death and loss of locomotor capability. A growing body of research supports pharmacological induction of mitochondrial biogenesis (MB) as an effective approach to treat SCI. MB is a multifaceted process involving the integration of highly regulated transcriptional events, lipid membrane and protein synthesis/assembly and replication of mitochondrial DNA (mtDNA). We previously identified 5-hydroxytryptamine receptor 1F (5-HT1F) agonism as a potent inducer of MB in multiple organ systems. The series of studies presented herein explores the therapeutic potential of 5-HT1F receptor agonism on MB induction and recovery following SCI using a moderate force-controlled impactor-induced contusion mouse model. Post-SCI, mitochondrial dysfunction presents in the spinal cord, as indicated by decreased mtDNA and mitochondrial protein expression. Daily treatment with LY344864 and lasmiditan, two highly specific 5-HT1F receptor agonists, beginning after injury, not only attenuates these decreases, indicating MB, but also accelerates recovery, as denoted by decreased lesion volume and enhanced locomotor function. 5-HT1F receptor agonism increased locomotor capability, with both LY344864- and lasmiditan-treated mice reaching a Basso-Mouse Scale (BMS) score of ~3.4 by 21d, while vehicle-treated mice exhibited a score of 1.9. Importantly, knockout of the 5-HT1F receptor blocked these effects. Remarkably, a similar degree of locomotor restoration was observed when treatment was initiated 1 or 8h after injury, emphasizing the potential clinical applicability of this therapeutic approach. Furthermore, lasmiditan is FDA-approved for the treatment of migraines and could be repurposed for the treatment of SCI. In addition, injured mice treated with 5-HT1F receptor agonists display decreased Evan’s Blue dye accumulation and increased protein expression of tight junctions in the spinal cord compared to vehicle-treated mice, suggesting enhanced restoration of vascular integrity. These findings led us to investigate if lasmiditan induces MB and function specifically in endothelial cells. In vitro studies determine lasmiditan induces MB and enhances early-phase angiogenic pathways via Akt-eNOS activation in primary cultures of mouse cerebral endothelial cells. These data provide evidence that induction of MB via 5-HT1F receptor agonism may be a promising strategy for the treatment of SCI and related CNS injuries characterized by mitochondrial and vascular dysfunction.
  • Fascia Iliaca Compartment Blocks for Patients with Acute Hip Fracture

    Torabi, Sarah; Tilton, Kaitlin Nicole; Hoch, Kristie; Daly, Patricia (The University of Arizona., 2021)
    Purpose. The purpose of this quality improvement (QI) project was to increase anesthesia provider utilization of the fascia iliaca compartment block (FICB) for perioperative pain management in patients with acute hip fractures through an educational workshop and development of a clinical practice guideline (CPG).Background. At a Level I trauma center in south Texas, opioids continue to be the primary source of perioperative pain management among geriatric patients with acute hip fracture. Currently, no standard pain management protocol exists for this special population. Optimizing quality pain control while limiting opioid-related adverse effects presents a unique challenge for the anesthesia provider, as both adverse effects and uncontrolled pain produce unfavorable problems in this population, resulting in prolonged hospital stay and increased costs (Bordi 2018; Castillon et al., 2017). Methods. This doctor of nursing practice (DNP) project was completed by three DNP-Nurse Anesthesia (NA) students whom each had a role in organizing this educational workshop. A CPG was developed by the students and evaluated by a group of certified registered nurse anesthetists (CRNAs) in Arizona. The educational workshop included a PowerPoint (PPT) presentation and hands-on FICB regional training. A pre- and post-education survey, proficiency quiz, and 30-day follow up survey were used to measure knowledge and whether this project resulted in a practice improvement. A convenience sample of 30 CRNAs employed at this facility were invited to participate in this one-day educational workshop. Results. A total of 17 (57%) CRNAs participated on the day of the educational workshop. Data from pre- and post-education surveys demonstrated a significant increase in knowledge (24%) and intent to utilize (24%) FICB in the perioperative setting. The 30-day follow-up survey had a limited response (n=5) compared to initial participants (n=17), but the results showed anesthesia providers (80%) utilized the CPG, thirty days following education. All 30-day follow-up survey participants (100%) acknowledged that the educational workshop was beneficial. Conclusion. The educational workshop was useful in increasing implementation of the FICB for pain management among patients with hip fractures. Future projects should focus on sustainability of evidence-based practices and barriers to implementation.
  • Implementation and Analysis of 3-D Tomographic Reconstructions from Space-Based Imaging Platforms

    Kupinski, Matthew; Hinton, Garrett Wesley; Clarkson, Eric; Hart, Michael; Hancock, Jed (The University of Arizona., 2021)
    Imaging satellites that look nadir face a variety of obstacles. In addition to designing the system for the intense environment that the satellite will be experiencing, there are other factors to consider: reflections and emissions from the ground, from clouds, and from the OH-airglow layer. Depending on the desired object, these nuisance signals can significantly reduce image quality. The ground will have city lights, clouds will reflect light, and every material will have a different reflectance, some up to 60%. Performing a tomographic reconstruction can effectively separate a signal from other emissions and reflections. The Atmospheric Waves Experiment (AWE) is a prime example for use of tomographic reconstruction techniques from an imaging space platform. AWE is designed for studying the OH-airglow layer and atmospheric waves (also called gravity waves) which cause emission changes in the OH-airglow layer. A reconstruction for AWE would separate signals from the OH-airglow layer from reflected light from clouds and the ground. Performing tomographic reconstructions for the Atmospheric Waves Experiment (AWE) and analyzing them is the primary focus of this dissertation. This work covers an implementation of MLEM for use in satellite images pointing nadir. The algorithm is fast enough to be performed in real-time for many applications. This work covers the details of the reconstruction implementation and the challenges it poses and then a detailed study of the image quality of the tomographic reconstructions is presented. Some of the useful tools developed during this study include the construction of a short-wave infrared (SWIR) model of the atmosphere, methods for projecting simulated models through the imaging system, performing tomographic reconstructions of the simulations, and using a Hotelling observer to determine the overall image quality. Tomographic reconstructions are found to be effective in many applications for space imaging. However, the severely limited projection angles do provide constraints on the overall reconstructed resolution.
  • Diabetic Living: Senegalese Women's Experiences with Metabolic Illness

    Pike, Ivy L.; Bunkley, Emma Nelson; Nichter, Mark; Lamoreaux, Janelle; Shaw, Susan J. (The University of Arizona., 2021)
    This dissertation draws on the lived experiences of metabolic illness among women in Senegal in order to illuminate the global rise of noncommunicable diseases. Existing literature on noncommunicable diseases in low-and-middle-income countries (LMIC) is scarce while at the same time these countries are poised to experience the highest disease burden. This project seeks to address this lacuna by examining the everyday lived experience of noncommunicable diseases at the individual and community levels. Introducing the concept of interembodiment and looking at production of health within households, rumors, and stigma, this work reframes our understanding of embodiment of illness by situating it in its social context. Medical anthropological research on diabetes and hypertension in LMICs has thus far focused on Guatemala, India, Kenya, and Ethiopia. This dissertation adds to the conversation by introducing a critical West African perspective which is sorely missing. Focusing on women’s experiences of hypertension, diabetes, and kidney disease/failure in Senegal, this project illustrates the nuanced ways noncommunicable diseases are shifting individual notions of self, kin structures, and social communities. It also addresses the ways in which current health infrastructures are and are not prepared to deal with this rise in noncommunicable disease. Through 15 months of mixed-methods research, including participant observation, over 60 interviews, and 100 surveys, this project centers on Saint-Louis, Senegal, located on the Senegal River in the north of the country. Saint-Louis is a small but global city, and its relatively remote location closely links it to rural villages in the region. This setting provided insight into how women with differential access to wealth, nutritional resources, and health care manage their chronic illnesses. Quantitative data was gathered from 107 women, who completed surveys to assess quality of life, psychosocial stress, and emotional well-being. Of these women, 36 were included in ethnographic focal-follows, which involved multiple interviews and participant observation with these individuals as they went about their everyday experiences within their homes, clinical settings, and communities. Doctors, nurses, pharmacists, traditional healers, Ministry of Health officials, and demographers were also interviewed to understand clinical, national, and epidemiological approaches to these disease burdens. The dissertation concludes by asking readers to focus not to the obvious – broken infrastructure, lack of “reliable” data, overwhelmed systems – but rather on how, out of these colonial hauntings, there is potential for this diabetic narrative to be part of a reimagined global health informed by sub-Saharan African perspectives. What does the West have to learn from Senegal? As an interlocuter said: “…the mere fact of thinking about (the) future is a good starting point because when we think about something and we say that that thing is probable, we’re making it possible. We have to think in
  • Software-Defined Networking Control for X-haul Optical Networks in Testbed Experiments and Emulation

    Kilper, Daniel; Yu, Jiakai; Djordjevic, Ivan; Tandon, Ravi (The University of Arizona., 2021)
    Today’s telecommunication networks encounter challenges with rapidly growing traffic demands in various internet applications and services, such as video streaming, augmented/virtual reality, connected vehicles, dense wireless radio nodes, and edge cloud computing. Cloud radio access networks (C-RANs) have been proposed to enable resource sharing, modular radio functions, network scalability, and efficient energy management for future mobile wireless networks. In C-RANs, traditional co-located baseband units (BBUs) and radio units (RUs) are split into central units (CU) hosting BBU pools and massive numbers of RUs connected through fronthaul (FH) optical transport links. However, the communication between CUs and RUs using either digital transmission with the common public radio interface (CPRI) or analog transmission with radio-over-fiber requires high bandwidth and strict synchronization delay limits. Thus, the evolution of next-generation optical transport systems is required to build efficient, dynamic, and scalable communication networks that support data transmission with high capacity and ultra-low latency to realize high performing C-RAN architectures. Conventional commercial optical transport systems in metropolitan areas are based on wavelength-division multiplexing (WDM) networks where static wavelength channels are provisioned along fiber links between network nodes (containing optical switches or amplifiers) to ensure the data transmission of the peak traffic for backhaul (BH). This results in inefficient utilization of optical network resources in C-RANs where high-capacity and low-latency x-haul (FH, midhaul, and BH) optical transport is required. In addition, conventional optical network elements (NEs) with vendor-specific operating systems (OS) increases the cost of upgrading the system for higher performance, and the complexity of designing novel control planes for scalable networks. To address these problems, there is growing interest in optical transport networks built with open and fully-programmable optical systems using software defined networking (SDN) controlled white-boxes such as reconfigurable add/drop multiplexers (ROADMs), optical circuit switches (OCSs), and erbium dopped fiber amplifiers (EDFAs). This thesis examines SDN control strategies for x-haul optical systems in 5G and beyond wireless radio access networks. First, the Cloud Enhanced Open Software Defined Mobile Wireless Testbed for City-Scale Deployment (COSMOS) advanced wireless testbed is reviewed. A dedicated multi-functional Ryu SDN controller is implemented in the testbed’s optical network with wavelength channel assignment and topology reconfiguration for intra-/inter- domain control, network element (NE) monitoring, and a wireless handover experiment. Secondly, a BBU pool allocation optimization algorithm and a physical impairment-aware routing and wavelength assignment (PIA-RWA) considering midhaul BBU-RU functional split are explored to maximize traffic capacity and minimize resource occupation in an optical network of a New York metropolitan area C-RANs use case. In addition, several artificial neural network (ANN) models are also investigated to contribute accurate quality of transmission (QoT) prediction tools of the physical optical layer. Lastly, Mininet-Optical is developed as an extension to Mininet to achieve a novel multi-layer network emulation tool for SDN controller development. A dynamic optical SDN controller with least-congested PIA-RWA and BBU resource load balancing strategies is evaluated to enhance the network capacity in a virtual COSMOS environment emulated by Mininet-Optical considering various diurnal wireless traffic patterns.
  • Direct Care Workers’ Perceptions of Care Towards Sexual and Gender Minority (SGM) Older Adults

    Crist, Janice D.; May, Jennifer T.; Rainbow, Jessica G.; Stone, Jeff (The University of Arizona., 2021)
    PURPOSE: The purpose of this study was to describe direct care workers’ (DCW) perceptions of the care provided to sexual and gender minority (SGM) older adults in the long-term care (LTC), assisted living, and home health settings.BACKGROUND: The intentional and unintentional behavior of those who provide healthcare to patients can impact positively or negatively the decisions made, treatment plan, health outcomes and overall well-being of patients. These intentional and unintentional behaviors by healthcare workers (e.g., any member of the healthcare team who cares for patients) can impact the care of marginalized populations. Marginalized populations, such as sexual and gender minority (SGM) older adults, suffer the greatest repercussions from negative behaviors by healthcare workers because these marginalized populations also often experience other obstacles to optimal care, such as environmental injustices, violence, prejudice, and being stereotyped, in addition to population-specific health concerns. DCW provide the closest interaction with SGM older adults in these settings. The perceptions of care DCWs provide to SGM older adults is important because the quality of care can be influenced by negative attitudes. METHODS: Qualitative description was used to synthesize what is known about DCWs’ perceptions of care toward SGM older adults. RESULTS: The overarching category, “Care is Different, but Not my Care,” was supported by the categories Cues of Stereotyping, Cues of Prejudice, and DCWs’ Care and Social System. DISCUSSION: Scant research on DCW perceptions of care toward SGM older adults living in LTC, assisted living, and home health settings exist. Cues of stereotyping and prejudice show indications of implicit bias in DCW statements toward SGM older adults. DCWs are a marginalized population which will need to be considered when developing future training in caring for SGM older adults in LTC, assisted living, and home health settings. IMPLICATIONS: Specific implications for practice, policy and future research are explicated to guide future interventions to ensure equitable, quality care in the healthcare setting.
  • An Assessment of Political Shocks: Considering the Domestic and International Consequences

    Volgy, Thomas J.; Gordell, Kelly Marie; Ghosn, Faten; Willerton, John P. (The University of Arizona., 2021)
    The aim of this dissertation is to produce a systematic assessment of political shocks and their potential consequences. Political shocks are important and significant phenomena within international politics. However, no overarching study of shocks currently exists and consequently the topic has remained underdeveloped relative to other important concepts within international relations. Despite their importance, what qualifies as a political shock and whether the dynamics associated with the concept are generalizable remains unclear. As such, I ask how can political shocks be observed taking place and what are the potential domestic and international consequences? To address these questions, I develop a framework of political shocks which centers on acute periods of state instability to reflect when states have experienced political shocks. When such destabilization is present, path dependencies are disrupted creating new environments in which states and their communities operate within. As such, political shocks serve as challenges to the existing status quo while states must continue to manage as effectively as possible in the face of such challenges. I also incorporate elements of opportunity and willingness to understand the different dynamics within these complex environments in terms of domestic and international security dimensions and outcomes. I pursue a dual empirical assessment of both outcomes by evaluating whether international conflict in the form of militarized interstate disputes (MIDs) as well as the level of human rights abuses, specifically physical integrity violations, are affected via a series of negative binomial and ordered logistic regressions. Overall, I find that both domestic and international outcomes are impacted by political shocks. When states experience shocks, both the extent of international conflict experienced, and level human rights abuses that take place increase. I also observe similar effects when taking into consideration additional interactive factors of domestic and neighboring unrest. The outcomes of this project suggest that political shocks pose a significant threat across security domains and to various outcomes of interest. The work produced is also relevant for our present-day dynamics. Critical events that have the capacity to destabilize domestic conditions and politics and which potentially have regional and global reach continue to take place. As such, it is not only pertinent but also necessary to establish a way in which to study these events and their dynamics in a systematic manner. By doing so, we not only can better understand the potential effects of such critical events but also work toward identifying strategies and forming politics to be address them in the future.
  • Paper-Based Microfluidic Platform for Biomedical Applications

    Yoon, Jeong-Yeol; Kaarj, Kattika; Slack, Donald C.; An, Lingling; Kim, Minkyu (The University of Arizona., 2021)
    The development of rapid medical diagnostic and biosensor devices is increasing due to the emergence of new diseases in the present and upcoming future. In this dissertation, the development of simple and cost-effective paper-based microfluidic devices are discussed. First, the paper-based microfluidic chip equipped with colorimetric reverse-transcriptase loop-mediated isothermal amplification (RT-LAMP) and smartphone optical sensing was developed for Zika virus detection. The assay time of our developed device was 15 minutes with a limit of detection of 1 virus copy/µL. Second, the paper-based liver cell model with physiologically relevant flow device was developed. The toxicity of three commercially available drugs, Phenacetin, Bupropion, and Dextromethorphan, and its combination with Fluconazole (an antifungal drug) were investigated. Drug toxicity effects could be observed as early as 40 minutes on our developed device. Third, we developed a paper-based in vitro tissue model comprising a standalone device capable of delivering two types of mechanical stimuli (i.e., shear flow and local compression). The device was fabricated cost effectively through 3D-printing, with an overall device cost of ~$50. This developed device was utilized to investigate the effects of various mechanical stimuli on vascular endothelial cell migration. Cell migration on our paper-based chip was observed as early as 5 hours. Lastly, the traditional methods of providing mechanical simulation to OOC systems and future directions of their development were discussed and suggested. These developed devices show a promising capability of transferring laboratory diagnostic assays to field-based assays that are easy-to-use, rapid, cost-effective, and accessible and affordable to the general public. Such developments aim to improve the quality of healthcare systems and public health.
  • The Role of the P2X7 Receptor in Radiation-Induced Salivary Gland Inflammation and Dysfunction

    Limesand, Kirsten H.; Gilman, Kristy Ellen; Simpson, Richard; Zhao, Ningning; Skulas-Ray, Ann (The University of Arizona., 2021)
    Annually, >600,000 cases of head and neck cancer are diagnosed worldwide, with treatment commonly entailing surgical removal of the tumor followed by ionizing radiation (IR) therapy. Salivary glands, located proximal to tumors, are incidentally damaged during radiotherapy, leading to loss of glandular function. Reduced saliva output leads to many health complications such as increased risk of mucositis, dental caries, and malnutrition, and makes talking, chewing, and swallowing difficult, greatly reducing the quality of life of patients. A limited number of therapeutic options for salivary hypofunction are currently available, however, they are palliative and require life-long use by patients. Therefore, uncovering the signaling mechanisms behind radiation-induced damage to salivary glands is critical to develop novel drug targets to reverse salivary gland dysfunction and, thus, improve the quality of life for head and neck cancer survivors. The P2X7 receptor (P2X7R) is a purinergic receptor activated by extracellular adenosine triphosphate (eATP, >100 μM), a damage-associated molecular pattern (DAMP) typically released from cells to alarm neighbors of a nearby insult. Brief P2X7R activation by eATP leads to formation of a homotrimeric, nonselective cation channel, whereas repetitive or prolonged stimulation causes formation of a large pore and activation of the NLRP3 inflammasome. P2X7R activation often leads to reactive oxygen species (ROS) generation, membrane depolarization, membrane blebbing, cytokine production, or cell death. To evaluate the possible role of the P2X7R in radiation-induced damage to salivary glands, mice that are globally deficient in the P2X7R (P2X7R-/-) were used for experiments and outputs were compared to wildtype (C57BL/6J) mice. Immediately following radiation exposure, there is increased ATP secreted from wildtype primary parotid glands cells that is not observed in P2X7R-/- cells. Surprisingly, this did not lead to alterations in cell death at 24-72 hours post-IR between genotypes. Irradiated wildtype primary parotid cells secrete high levels of the biologically active lipid, prostaglandin E2 (PGE2) that is not detected in P2X7R-/- cells and does not clearly align with mRNA levels and activity of PGE2 synthesizing enzymes. Remarkably, P2X7R-/- mice have improved salivary gland function at days 3 and 30 post-IR and treatment with a P2X7R-selective antagonist, A438079, was able to preserve salivary gland function in wildtype mice. This study suggests P2X7R antagonism may be a promising approach for preventing radiation-induced salivary gland dysfunction and further understanding of PGE2-mediated signaling in irradiated salivary glands is warranted. PGE2 is a bioactive lipid derived from arachidonic acid that signals via four E-prostanoid receptors (EP1-4R) to induce various physiological outputs. EP2 and EP4 canonically activate adenylate cyclase, increasing intracellular cyclic adenosine monophosphate (cAMP) levels, leading to cAMP response element binding protein (CREB) phosphorylation. EP2 and EP4 also activate a non-canonical pathway of EGFR transactivation via β-arrestin that leads to protein kinase B/Akt phosphorylation. EP3 inhibits adenylate cyclase, decreasing cAMP-mediated signaling and CREB phosphorylation. EP1 activates phospholipase C, leading to increased inositol 1,4,5-triphosphate and calcium within the cell. EPRs have also been shown to activate other signaling pathways, including p38 mitogen-activated protein kinase (MAPK), extracellular regulated kinases 1/2 (ERK1/2) and c-Jun N-terminal kinase (JNK) pathways, although the corresponding EPR is not clearly defined for these pathways. As described above, there is increased PGE2 in supernatants from irradiated wildtype primary parotid gland cells, with a significant reduction of PGE2 secreted from P2X7R-/- cells that correlates with improved salivary gland function in mice post-IR. Differences in PGE2-mediated pathways between wildtype and P2X7R-/- mice have not been previously described in irradiated parotid glands and is the major goal of this study. EPR distribution at the mRNA and protein level is differentially modulated in P2X7R deficient mice days 2-30 post-IR. Unexpectedly, the most well characterized EP-mediated signaling pathways, measured by phosphorylation of CREB and Akt are minimally different between genotypes days 2-30 post-IR and CREB-activated gene targets are inconsistently modulated across timepoints. Likewise, phosphorylation of p38 MAPK and ERK1/2 are modestly different across timepoints. Interestingly, phosphorylation of JNKs and their downstream target, c-Jun are different between genotypes days 7-30 post-IR and may explain the differences in salivary gland function seen between strains. Shockingly, evaluation of these pathways in primary cell cultures generated different results, indicating other cell types, such as immune cells, are likely influencing radiation-activated signaling pathways in vivo and should be further evaluated. JNK/c-Jun pathway activation is known to occur following radiation and influences the compensatory proliferation response. Targeting PGE2 production to modulate JNK pathway activation may provide novel therapeutic options to improve salivary gland function post-IR. Indomethacin is a nonsteroidal anti-inflammatory drug (NSAID) that functions by inhibiting cyclooxygenase (COX) enzymes to block eicosanoid production. Data within this dissertation implicated PGE2 as a critical signaling mediator leading to radiation-induced salivary gland dysfunction, with activation of the JNK/c-Jun pathway correlating with the observed loss of function seen in wildtype mice. To further evaluate the role of PGE2-JNK-c-Jun signaling in radiation damaged salivary glands, mice were exposed to radiation and received injections of indomethacin with different dosing regimens. Remarkably, mice receiving three injections of indomethacin after radiation exposure (days 3, 5, and 7) have improved salivary gland function at day 30 post-IR. Indomethacin treatment to primary parotid cells reduced COX-1 activity and decreased PGE2 secretion. PGE2 treatment to primary parotid gland cells led to phosphorylation of JNK and c-Jun. PGE2 also induced cell proliferation, decreased amylase levels and reduced store operated calcium entry in cells following carbachol stimulation. Importantly, indomethacin treatment to mice decreased JNK pathway activation and rescued amylase levels in whole parotid tissues following radiation. Combined, these data support the notion that PGE2 production days 3-7 post-IR is detrimental to salivary glands due to JNK-c-Jun pathway activation and modulating this pathway via indomethacin treatment may be a promising therapeutic for restoring salivary gland function following radiotherapy.
  • Preparing Preservice Teachers for a Diverse Society: A Cosmopolitan Approach to Literacy Education through Children's Literature

    Short, Kathy G.; Ryman, Cynthia Kay; Combs, Mary Carol; Nicholas, Sheilah E.; Gilmore, Perry (The University of Arizona., 2021)
    The purpose of this dissertation is to examine a theoretical framework and praxis for a cosmopolitan approach to literacy in a university children’s literature course for undergraduate preservice teachers. This approach to literacy entails a reflexive consideration of personal convictions and an openness to learning from the perspectives of others. This research is framed as a teacher research study. This study's research questions focus on how preservice teachers respond to cosmopolitan literacy practices and a critical inquiry into teaching engagements. Data for this study were collected across two semesters, with a total of fifty-eight students providing informed consent to participate. Of these students, eight were selected for a focused case study. This research provides insights into the dispositions that orient preservice teachers toward cosmopolitanism. It also provides insights into the types of literacy engagements that are most productive in encouraging cosmopolitan perspectives. These engagements invite a consistent and explicit recognition of personal biases, openness to learning from others, and consciousness of ethical action. This research emphasizes the need to consider cosmopolitan literacy practices as imperative to preparing teachers for a diverse society. It is crucial in our ever-expanding global society that literacy practices promote reflexive consciousness and reflective openness to listening and learning from others.

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