• Formative Assessment: Documenting Motor Vehicle Crashes and Local Perceptions with the Hualapai Tribe to Inform Injury Prevention Recommendations

      Mahal, Zeenat (The University of Arizona., 2020)
      Background: This research was designed to understand factors influencing Motor Vehicle Crashes (MVCs) on or near the Hualapai Tribe’s reservation in northwestern Arizona. The goal is to enable the Tribe to develop and implement a locally relevant MVC intervention program. The specific aims were to: i) compile and analyze 2010-2016 MVC data from Hualapai and federal sources to assess distributions of frequency, rates, high risk-locales, causes, days, times, age and sex of the drivers, in addition to assessing related conditions; ii) document local perceptions of environmental, social, and behavioral barriers to safe driving practices, and knowledge of MVC risk factors and existing tribal laws; and iii) provide evidence-based recommendations using the results from quantitative and qualitative data analyses. Approach/Methods: The research process applied a Community-Based Participatory Research approach and mixed methods using: a) secondary data analyses of records from six tribal programs and Indian Health Service (IHS), and b) qualitative analyses of data from two focus groups and field documents. Sensitivity analyses were conducted of IHS and Tribal Driving Under the Influence (DUI) data, using the 2010 U.S. Census as the denominator after adjusting for an undercount of up to 25%. Descriptive statistics, Fisher’s Exact Test, and linear and logistic regressions were used to examine significance. MVCs per 10 miles per year were estimated for State Route 66 and Diamond Bar Road/Grand Canyon West on or near the reservation due to higher numbers of crashes. Statistical process control charts, especially g-charts monitoring time between events, were plotted to examine the stability in the number of MVCs over time for each road. NVivo11Pro© was used to code and analyze the focus group data, guided by both inductive and deductive theories. Results: Driver’s seatbelt use in the Hualapai community increased from 2010 to 2012 (p < .0005), and reported DUIs decreased from 2010 to 2016 (p = .027). Similarly, car/booster seat use improved from 2014 to 2015 (p < .0005). Two hundred and fifty (N = 250) MVC-related injuries were registered at IHS facilities for Hualapai community members between 2006 and 2015. The highest rate, 22.4%, was observed in 15- to 24-year-olds, followed by 21.6% in 55- to 64-year-olds. For several combinations of numerators and denominators, sensitivity analysis of the IHS data shows a clear disparity between the Tribe’s MVC rate compared to the 2008 U.S. rate of 771.4 nonfatal injuries per 100,000 persons and the national goal for Healthy People 2020 (694.3 nonfatal injuries/100,000 persons). The major themes emerged from qualitative analyses of the focus groups were: i) unsafe traffic infrastructures, ii) DUI, iii) repeated DUI offenders driving on the reservation, and iv) a perception of lenient tribal traffic laws and enforcement on the reservation. Using study results, five Public Service Announcements were co-developed to inspire community-members to continue the trends noted from 2010-2016 and be aware of continued risks. Conclusions: MVCs are a multidimensional issue needing communitywide awareness of the range of risk factors. An intervention that addresses human and structural risks requires an alliance of tribal programs and external partners (e.g., IHS, university, federal, and state). Recommendations: Local recommendations include providing school- and institution-based education about alcohol/alcoholism and DUI consequences, and ongoing culturally and locally relevant communitywide education through the local newsletter and radio station.
    • A Highly Modular Router Microarchitecture for Networks-on-Chip

      Wu, Wo-Tak (The University of Arizona., 2019)
      Advances in semiconductor process technology in the past several decades have brought about an abundance of transistors that can be fabricated on a single silicon die. Microprocessor designers have been integrating more and more processing cores on-chip by taking advantage of such abundance. Network-on-Chip (NoC) has become a popular choice for connecting a large number of processing cores in chip multiprocessor designs. NoC provides many advantages over the traditional bus-based approach in terms of bandwidth, scalability, latency, etc. The central part of an NoC is the router. In a conventional NoC design, most of the router area is occupied by the buffers and the crossbar switch. Not surprisingly, these two components also consume the majority of the router’s power. Most of NoC research has been based on the conventional router microarchitecture in the areas of routing algorithm, resource allocation/arbitration, buffer design, etc. There has not been much work done on drastic router microarchitecture redesign. In this dissertation, a novel router microarchitecture design is proposed, which we call Omega, that treats the router itself as a small network of a ring topology. Omega is highly modular and much simpler than the conventional design. It does not use a large crossbar switch as in the conventional design; packet switching is done with simple muxes. Furthermore, the network packet latency is greatly reduced. Simulation and circuit synthesis show that the Omega microarchitecture can reduce latency, area and power by 53%, 34% and 27%, respectively, compared to the conventional design. The Omega microarchitecture design also provides opportunities to implement features that do not exist or are difficult to be realized in the conventional design. To demonstrate this, we implement a new feature on the Omega router to merge packets together in the buffer. The merged packets traverse the network together as long as their routes to destinations do not diverge. This greatly improves the buffer and link utilization. As a result, the effective network capacity can be substantially increased. This dissertation presents one of the first efforts on the new microarchitecture for router considering packet merging. Additional characterizations can be done to better understand its potentials for various applications, and perhaps its shortcomings, in future work to push performance even further.
    • Exploring Non-Psychiatric Nurse Attitudes, Knowledge Base and Comfort Level in Caring for Patients with Mental Illness

      Gutierrez, Christina (The University of Arizona., 2019)
      Background: Mental health disorders can be perceived as threatening and uncomfortable to non-psychiatric nurses who may have limited education and/or specialized training on mental health conditions. Due to lack of specialized psychiatric knowledge and training, non-psychiatric nurses develop attitudes that are based on misperceptions such as the fear that mental health patients are aggressive and violent. These perceptions contribute to discriminatory acts by the nurses and heightened stigma. This fear also induces a sense of caution and guard (which in turn interferes with their ability to be effective nurses) due to a perceived threat on their own safety. Objective: Explore nurse attitudes, knowledge base and comfort level of non-psychiatric nurses caring for the patient with mental illness through the use of a pre-existing Likert scale (MICAv4) and a newly developed semi-structured survey (Demographic & Knowledge Base Questionnaire [DKBQ] administered through an online Qualtrics survey. Design: Descriptive quality improvement design. Setting: Medical/Surgical unit in a 212-bed not-for-profit community hospital in the East Valley of the Phoenix Arizona metropolitan area. Participants: Non-psychiatric nurses on the inpatient medical/surgical unit whom care for psychiatric patients and are employed by the community hospital, in Arizona. Results: 60% of the nurses interviewed feel comfortable caring for patients with a psychiatric disorder, 57% feel they have adequate knowledge of psychiatric medications, and 67% feel they have adequate knowledge of psychiatric disorders. In regards to attitudes, 71.4% of the nurses interviewed overall disagree that people with a severe mental illness can never recover enough to have a good quality of life, 62% of participants disagree the public does not need to be protected from people with mental illness, and more than half agree they feel comfortable talking to a person with a mental illness the same as talking to a person with a physical illness. Conclusion: Overall, the nurse participants indicated feeling a baseline comfort in caring for patients with a mental illness. More than half feel they have adequate knowledge of psychiatric disorders and psychiatric medications. The participants, attitudes per the MICAv4 scale indicated the participants have a reduced stigmatic attitude in caring for psychiatric patients.
    • Études for the Orchestral Cymbalist: Developing the Skills for Successful Crash Cymbals Performance

      Timman, Matthew Peter (The University of Arizona., 2019)
      In the study of percussion instruments as a part of a collegiate education, the focus is usually placed upon performance of literature from four major areas: snare drum, mallet percussion, timpani, and multiple percussion. This often leaves an instructional gap in the field of performance on percussion accessory instruments, including performance of orchestral crash cymbals. Though literature exists for the instruction of techniques required for commonly performed orchestral works and collections of basic études for cymbals, currently no pedagogical literature exists that cultivates the techniques required for performance of standard orchestral literature through technical études. By identifying required techniques for the performance of standard orchestral literature, technical études have been composed in order to assist with the development of six essential core techniques required to perform the most widely performed orchestral repertoire and works requested in professional orchestral auditions. In addition to these technical études, accompaniment tracks have been composed, incorporating music from the original orchestral works to help educate performance and cultivate a greater familiarity with the repertoire for which the études are specifically designed.
    • La Verdad Cómica: Rius, La Contracultura Mexicana, y Una Ficción Fundamental No Oficial

      Howard, Sarah E. (The University of Arizona., 2019)
      Eduardo del Río (known as Rius) proved a fierce political activist and prolific comic book creator. He challenged the successes of the Revolution, exposed weaknesses in the government, and provided a voice willing to say something aloud. Unlike most in the comic book industry, del Río held strong leftist political inclinations and campaigned against, among other things, the Institutional Revolutionary Party, U.S. policies in Mexico, and the Catholic Church. Comic books, along with other forms of popular culture, hold an important role in the cultural identity of the nation’s people. Del Río’s work became a part of the continual comic book exchange of its period. His series, Los supermachos (1967-1981) and Los agachados (1968-1977), solidified his role in national identity construction. Comics hold a place in cultural memory and identity construction far more lasting than the inexpensive paper they are printed upon. It is in part because of the persistent nature of comics that an eighty-three-year-old virtual recluse could be considered not only culturally relevant but esteemed. There is no correct way to study popular culture. The closest a scholar can come is to approach the topic openly and from all directions. Popular culture derives power from its fluid, ever-changing, unmeasurable nature. A close study of the work of a man who challenged the status quo provides entry into a field of study that itself questions hundreds of years of history awash in timelines, memorized dates, and military history. Pick up a comic book and dive into the possibilities.
    • Rhetorics of the Fantastic: Re-Examining Fantasy as Action, Object, and Experience

      Rick, David Wesley (The University of Arizona., 2019)
      Establishing the literary genre of fantasy, as it is currently known, is largely credited to J. R. R. Tolkien in the mid-twentieth century, though in a broader sense fantastical storytelling has existed for as long as humans have been telling stories. Since its rise to popularity as a contemporary genre, many scholars have studied fantasy in various dimensions, but such study has tended to emphasize genre taxonomy, remaining otherwise generally limited in scope and narrow in focus. This dissertation seeks to complicate an understanding of the term “fantasy,” particularly as it differs from commodified, market-driven genre conventions. It argues that the fantastic represents departure, transformation, and alternative modes of thinking. The project examines major writings on fantasy and the fantastic, including works by writers such as Tzvetan Todorov, Farah Mendlesohn, Ursula K. Le Guin, and Tolkien. It also examines how the fantastic manifests in works not usually thought of as fantasy, as in the writings of Gloria Anzaldúa, and draws upon rhetorical thinkers, such as Wayne Booth and William Covino, while borrowing Kenneth Burke’s dramatistic pentad as a central device to establish a “fantastical pentad.” Part One of this dissertation examines three major capacities of this fantastical pentad: action, object, and experience. As action, the fantastic has the power to complicate, to reimagine—what Tolkien called “sub-creation” and what Paulo Freire called “re-creation.” This produces a fantastical object, or fantasy, that embodies the transformative power of the fantastical act, allowing others to experience it. In turn, experiencing a transformative fantasy offers the opportunity for questioning, evaluating what that fantasy is, how it may or may not be plausible within one’s worldview, and to understand why it is fantastical—that is, what it seeks to transform. Part Two applies these ideas to three sites of inquiry: the composition classroom, games and play, and popular fiction. The project concludes that the fantastic offers, as its primary function, not escapism or mere “flight of fancy,” as has often been claimed in the past, but transformation. This transformation may work in many ways: it may be transformative for the fantasist, who enacts the fantastic; it can be transformative for the audience, who experience the fantasy that the fantasist creates; or, it can be transformative within the object, itself, by reimagining some convention within the writing. This compositional transformation may be a narrative element of fiction such as in the works of Le Guin, where the fantasy is transformative within its genre, or in the writing of Anzaldúa, which blend the fantastic with non-fiction for very material, real-world purposes. This illustrates a cultural significance that reaches far beyond the realm of idle entertainment, providing inspiration and impetus to enact change in the material world.
    • Bifacial Solar Panels System Design, Modeling, and Performance

      Ayala Pelaez, Silvana (The University of Arizona., 2019)
      Bifacial photovoltaic (PV) cell technology is currently poised to change solar modules and systems. They provide higher energy yield from its ability to capture both direct and diffuse illumination on the front- and rear-side of the module. At low-costs for implementation in production lines of traditional monofacial silicon cells, lower maintenance needed in fields compared to a similar power array of conventional modules, improved module characteristics like lower thermal coefficient due to better (in average) processes used in production, the implementation of this technology is projected to have a significant impact in the reduction of the cost of solar power, adoptable in a short period of time. Bifacial technology promises even lower $/W and $/kWh costs, continuing to improve solar photovoltaics’ competitive cost with fossil fuel energy sources and help mitigate climate change. However, bifacial PV performance models are not well established, and field validation data is scarce. Furthermore, existing optical models used to calculate the irradiance input into the modules make certain assumptions that have not been scarcely verified. This dissertation performs a study of these optical models for calculating irradiance available to bifacial panels under different deployment configurations. Sensitivity to mounting parameters and modeling assumptions are explored. The models agree between 2-3% despite differences in assumptions and complexity. The results from a test-bed built to validate the optical models are shown, showing good agreement within 2% error (absolute) in the bifacial gain in irradiance. Furthermore, algorithms for bifacial PV modules with single-axis tracking are implemented and presented. Field-data from two locations with single-axis trackers with monofacial and bifacial PV module technology are used to validate the algorithms. A methodology for calculating bifacial gain due to the fact that they can accept light from both front- and rear-side (a property known as bifaciality), and not due to differences in other cell or module properties, is also presented. This methodology has the possibility of addressing the lack of a framework for reporting bifacial versus monofacial fields gains, which has resulted in a wide range of reported gains. The methodology is used to compare performance data for two 100kW bifacial and monofacial arrays in Klamath Falls, Oregon, finding that 2.4% of the measured performance advantage of the bifacial array is due to improved front-side performance, rather than bifacial response. This dissertation concludes with the design of an optical concentrator to improve the specific uses of bifacial PV modules for vertically-mounted systems. Discussion of areas for improvement and future work are also included.
    • Compassion Fatigue among Pediatric Oncology Nurses

      Cooper, Jessica (The University of Arizona., 2019)
      Purpose: To conduct an educational intervention to improve knowledge about compassion fatigue among pediatric oncology nurses at Phoenix Children’s Hospital (PCH). Background: Burnout, secondary traumatic stress, and decreased compassion satisfaction contribute to compassion fatigue. Pediatric oncology nurses face stressful situations based on the unique care demands of children battling cancer such as complex treatment regimens, managing professional boundaries, providing emotional support. grief, and bereavement. Compassion fatigue is a progressive process that can impact a nurse’s quality of life and contributes to decreased job satisfaction, performance, patient satisfaction, and turnover. Methods: A 20-minute educational PowerPoint presentation was presented on compassion fatigue to highlight what compassion fatigue is, signs and symptoms, and common triggers. There was also a handout provided with available resources at PCH that could be utilized to help with compassion fatigue. The Professional Quality of Life (ProQOL) scale was used to measure compassion fatigue and compassion satisfaction levels and a pre- and post-test was completed to measure if an educational intervention improves nurse’s knowledge about compassion fatigue. Findings: The results showed that participants (n=30) knowledge significantly improved after the 20-minute educational intervention (p=0.001) with a mean score of 76.2% on the pre-test and a mean score of 95.4% on the post-test. In addition, nurses had a significant increase (p=0.0001) in the utilization of resources; prior to the intervention only seven participants (23.3%) utilized some of the available resources offered by PCH compared to 24 participants (80%) one-month post-intervention. However, there were no statistically significant changes in raw scores for the pre- and one-month post ProQOL survey (p > 0.05). Overall the participants viewed the class worthwhile and had positive things to say about the class. Implications: The results of this study showed that an educational intervention on compassion fatigue improved nurses knowledge about compassion fatigue, symptoms, common triggers, and available resources with improved utilization of available resources. Even with improved knowledge and utilization of resources, there was not a statistically significant difference in pre- and one-month post survey scores on compassion satisfaction, burnout, and secondary traumatic stress. Future research could benefit from analyzing the long-term effects improved knowledge of compassion fatigue and the utilization of resources has on compassion satisfaction and fatigue.
    • Evaluating Healthcare Providers’ Utilization of Social Support for COPD Patients

      Nguyen, Thiennga (The University of Arizona., 2019)
      Background: Currently, most primary healthcare providers manage chronic obstructive pulmonary disease (COPD) through pharmacological treatments, often lacking assessment of the patient’s social support. A lack of social support negatively impacts the quality of life (QOL) of individuals with COPD resulting in increased morbidity, hospital readmissions and excessive costs (Metting, van der Molen, & Kocks, 2016). A comprehensive approach extends beyond pharmacological management to include ways that improve patients’ disease knowledge and self-efficacy, resulting in better disease management and improved QOL. Aim: The purpose of this quality improvement (QI) project is to increase healthcare providers’ understanding of the importance of adding a social support referral as part of a comprehensive treatment for patients with COPD. Methods: The QI project was conducted at Banner Desert Medical Center in Mesa, Arizona. The targeted participants were registered nurses, case managers, social workers, and any other care providers in telemetry units, where most COPD patients are treated. The project included a pre- and post-test survey questionnaire and a brief PowerPoint educational presentation. The presentation showed the positive role of social support groups for COPD patients based on multiple evidence-based studies and introduced several options of social support groups to the participants. Results: Total number of participants who completed the project were 42 (n=42), and included registered nurses, one case manager, and one social worker. Most of the participants were not aware of the existence of any social support group before the educational presentation. After the presentation, the collected data demonstrated increased participants’ knowledge and attitudes about the social support groups and the participants’ willingness to utilize the social support referral as part of a comprehensive education and treatment for COPD patients. Conclusion: The referral of social support program is a cost-effective intervention. As shown in several evidence-based studies, the benefits are endless when integrating the referral of a social support group, such as the Better Breathers Club, into COPD patients’ education and discharge planning, so that the patients themselves can connect, share their experiences, learn to better cope with the disease, improve their knowledge and self-care and reduce their depression, exacerbation, and hospital readmissions.
    • Improving Use of Opioid Safety in Primary Care

      Fisher, Kristen (The University of Arizona., 2019)
      With an increase in opioid prescription rates, opioid misuse, abuse and overdose deaths have increased in parallel. Primary care providers are responsible for the majority of the system’s pain management but may lack proper training. The purpose of this project was to implement an educational module designed to improve primary care providers’ knowledge about unnecessary opioid prescriptions, safe pain management and opioid related disorders. This project implemented an educational module to familiarize primary care providers with evidence based guidelines for prescribing opioids for chronic pain management. This project used a pretest-posttest design to evaluate if the educational module was effective in increasing provider knowledge. Provider knowledge was assessed using the KnowPain-12 tool and an eight-item survey based on the Center for Disease Control (CDC) guidelines for opioid prescribing. Six providers participated in the educational intervention and responded to the pre and post-survey. For the KnowPain-12 survey, three providers had a higher score following the intervention, one provider’s score stayed the same and two had lower scores. The KnowPain-12 survey score ranges from 0-60, average score of the pre-intervention survey was 39.33 and the average score of the post-intervention survey was 39.50. For the knowledge assessment of the CDC guidelines, one point was awarded to each correct response for a total of eight points possible. Overall scores were high, with an average score of 6.83 before the intervention and 7.5 after the intervention. Findings suggest that there may be an educational gap in chronic pain management for primary care providers. There needs to be further research to evaluate opioid prescribing practices in the primary care setting and to identify educational gaps. Educational interventions should be implemented to improve provider knowledge of chronic pain management.
    • Mind the Gap: Gender Differences in Alcohol Consumption and Protective Behavioral Strategies at a Large Public University, 2002 - 2016

      Salafsky, David B. (The University of Arizona., 2019)
      Alcohol use among college students is a persistent and far-reaching public health issue. While some measures of alcohol use within the college population appear to have improved, questions remain as to whether the alcohol use gender gap has been stable or is in a period of change. Protective behavioral strategies (PBS), harm reduction approaches commonly used to address high-risk alcohol use among college students, were also assessed, to determine their relationship with several key alcohol consumption measures for both males and females. Methods: This research summarizes alcohol-related consumption measures based on annual, cross-sectional survey data collected between 2002 - 2016 at a large, public university. Linear regression models as well as descriptive statistics were used to explain overall trends and gender-specific patterns of use over time. In addition, an analysis based on pooled data between 2013 – 2016 was conducted to determine the association between protective behavioral strategies and key alcohol consumption measures, to inform programming that uses these strategies to reduce high risk alcohol use among students, and determine which strategies may be more likely to benefit either males and females for the following alcohol measures: binge drinking in the past two weeks, average drinks when partying and the number of drinks last time consumed alcohol. Both logistic and linear regression models were used to describe these relationships. Results: The results of the 15-year trend analysis revealed significant and meaningful declines among all students in past 30-day alcohol use, average number of drink consumed in the past week, average number of nights students “party” each week, and reductions in the frequency of binge drinking. Looking at the gender gap specifically, these results showed a declining gender gap (i.e. where the difference between male and female use decreased) most notably in average number of drinks consumed in the past week, estimated BAC last time students drank, and past 30 day alcohol use. Based on recent survey results, women showed slightly higher past 30-day alcohol use and reported a higher estimated BAC last time they drank, compared to men. For the second aim of the study, which was based on pooled data collected between 2013 - 2016, most PBS that were expected to moderate alcohol use showed clear and strong protective effects, with a few exceptions. Top strategies for females that were associated with lower alcohol consumption included stopping alcohol use 1-2 hours before going home, avoiding pre-partying and avoiding hard liquor. For men, these included setting a limit on drinks, avoiding pre-parting, and avoiding hard liquor. Conclusion: A number of alcohol measures improved during the study period, and for these, male university students showed greater declines, on average, than females – resulting in a shrinking gender gap. Decreases in the frequency of drinking occasions likely influenced overall declines in average drinks per week and the frequency of binge drinking. Male and female students showed considerable overlap with respect to protective behavioral strategies that were negatively associated with alcohol use and identified a few strategies that may have limited effectiveness. These results highlight evolving trends in alcohol use among college students and point to specific strategies which can help address this longstanding public health issue. Policy and program recommendations, informed by these findings, are detailed in its conclusion.
    • Providers’ Knowledge, Attitudes and Willingness to Use an End-of-Life Protocol on an Inpatient Oncology Unit

      Sakalauski, Renee (The University of Arizona., 2018)
      Objective: The purpose of this Doctor of Nursing (DNP) project was to examine providers’ knowledge, attitude, and willingness to use an end-of-life care protocol on an inpatient unit. Background: Cancer is second leading cause of mortality in the United States and despite increases in hospice and palliative care services, many cancer patients at end-of-life are dying in the hospital setting. Research shows the use of an end-of-life care protocol set increases patient care outcomes and increases provider satisfaction with end-of-life care, however; they are not being utilized in many hospitals. The National Consensus Project (NCP) for quality palliative care published evidence based clinical practice guidelines as a set of standards for improving the quality of patient care specifically at end-of-life. There is very little research that examines determinants related to providers’ knowledge, attitudes, and willingness to use an end-of-life care protocol based on the clinical practice guidelines established by the NCP. Methods: Qualitative descriptive research study consisting of a electronic survey questionnaire. Setting: Large cancer facility in Goodyear, Arizona. Participants: Sample of 21 out of 35 providers that included hospitalists, physicians, oncologists, nurse practitioners, and physician assistants. Conclusions: Providers were not knowledgeable regarding the NCP’s clinical practice guidelines for end-of-life care, but their attitudes strongly favor the six suggested practice guidelines for actively dying patients, and they were somewhat willing to adopt these practices. There was also a moderate correlation between the number of years worked with end-of-life patients and the providers’ willingness to learn more about and to use end-of-life care protocols in their practice.
    • Transition of Care: The Evaluation of Hand-off Communication Between Emergency Department and Medical/Surgical Nursing Units

      Naour, Michelle G. (The University of Arizona., 2018)
      Hand-off communication from the emergency department (ED) to inpatient nurses is an important process for transfer of safe and quality patient care from one department to another. Annually, there are130.4 million ED visits with 12.2 million of those visits resulting in hospital admission, providing ample opportunities for poor communication (Rui, Kang, & Albert, 2013). Miscommunications during patient hand-off are estimated to contribute to 80% of adverse events (The Joint Commission, 2012). This theory-driven, quality improvement project sought to evaluate the hand-off communication process between nurses from the ED and nurses in the inpatient Medical/Surgical units using human factors System Engineering Initiative for Patient Safety (SEIPS) approach, originally created by Pasqual Carayon in 2006. An online survey was created using an adapted SEIPS Model evaluating the interactive concepts of person, tools and technologies, tasks, organization, and environment and their impact on staff and patient outcomes. The survey was distributed to both the ED and Medical/Surgical nurses to gain their perspective on the interdepartmental hand-off communication process and how it impacts the staff and patient outcomes. There as an included option for the bedside nurses to provide recommendations on how to improve the hand-off communication process. Data was collected, anonymously, through an online database and descriptive statistics were used to analyze the results. The quality improvement project found that majority of nurses prefer verbal hand-off communication with a structured standard format of delivery in conjunction with the electronic health record. The project found that nurses perceive that the nurse-to-patient ratio and surrounding tasks impact the effectiveness and quality of hand-off communication. The most common suggested hand-off communication improvements were to not allow hand-off communication or transfer of the patient from the ED to the Medical/Surgical unit during peak times, such as shift change, and to follow up on tools and technology compliance. Overall, the person, the tools and technologies, the tasks, and the environment are contributing to ineffective hand-off, while the organization has adequately provided the resources the staff needs to perform an effective hand-off communication. All of which were concluded to have an impact on the staff and patient outcomes.
    • Interactions Between Atmospheric Aerosols and Marine Boundary Layer Clouds on Regional and Global Scales

      Wang, Zhen (The University of Arizona., 2018)
      Airborne aerosols are crucial atmospheric constituents that are involved in global climate change and human life qualities. Understanding the nature and magnitude of aerosol-cloud-precipitation interactions is critical in model predictions for atmospheric radiation budget and the water cycle. The interactions depend on a variety of factors including aerosol physicochemical complexity, cloud types, meteorological and thermodynamic regimes and data processing techniques. This PhD work is an effort to quantify the relationships among aerosol, clouds, and precipitation on both global and regional scales by using satellite retrievals and aircraft measurements. The first study examines spatial distributions of conversion rate of cloud water to rainwater in warm maritime clouds over the globe by using NASA A-Train satellite data. This study compares the time scale of the onset of precipitation with different aerosol categories defined by values of aerosol optical depth, fine mode fraction, and Ångstrom Exponent. The results indicate that conversion time scales are actually quite sensitive to lower tropospheric static stability (LTSS) and cloud liquid water path (LWP), in addition to aerosol type. Analysis shows that tropical Pacific Ocean is dominated by the highest average conversion rate while subtropical warm cloud regions (far northeastern Pacific Ocean, far southeastern Pacific Ocean, Western Africa coastal area) exhibit the opposite result. Conversion times are mostly shorter for lower LTSS regimes. When LTSS condition is fixed, higher conversion rates coincide with higher LWP and lower aerosol index categories. After a general global view of physical property quantifications, the rest of the presented PhD studies is focused on regional airborne observations, especially bulk cloud water chemistry and aerosol aqueous-phase reactions during the summertime off the California coast. Local air mass origins are categorized into three distinct types (ocean, ships, and land) with their influences on cloud water composition examined and implications of wet deposition discussed. Chemical analysis of cloud water samples indicates a wide pH range between 2.92 and 7.58, with an average as 4.46. The highest pH values were observed north of San Francisco, coincident with the strongest land mass influence (e.g. Si, B, and Cs). Conversely, the lowest pH values were observed south of San Francisco where there is heavy ship traffic, resulting in the highest concentrations of sulfate, nitrate, V, Fe, Al, P, Cd, Ti, Sb, P, and Mn. The acidic cloud environment with influences from various air mass types can affect the California coastal aquatic ecosystem since it can promote the conversion of micronutrients to more soluble forms. Beyond characterization of how regional air mass sources affect cloud water composition, aircraft cloud water collection provides precious information on tracking cloud processing with specific species such as oxalic acid, which is the most abundant dicarboxylic acid in tropospheric aerosols. Particular attention is given to explore relationship between detected metals with oxalate aqueous-phase production mechanisms. A number of case flights show that oxalate concentrations drop by nearly an order of magnitude relative to samples in the same vicinity with similar environmental and cloud physical conditions. Such a unique feature was consistent with an inverse relationship between oxalate and Fe. In order to examine the hypothesis that oxalate decreasing is potentially related to existing of Fe, chemistry box model simulations were conducted. The prediction results show that the loss of oxalate due to the photolysis of iron oxalato complexes is likely a significant oxalate sink in the study region due to the ubiquity of oxalate precursors, clouds, and metal emissions from ships, the ocean, and continental sources.
    • Describing the Needs of Advanced Practice Registered Nurses (APRNs) Who Plan to Specialize in Cardiology

      Stokes, Allison (The University of Arizona., 2018)
      Background: Cardiology is but one of the many clinical foci available to certified Advanced Practice Registered Nurses (APRNs). In fact, more acute care APRNs choose cardiology as their focus than any other. With such strong interest in cardiac advanced practice nursing, it is imperative to assess the adequacy of preparation for those who wish to follow this career path. Known barriers exist in the educational and clinical preparation of this APRN population, however, there is little research detailing the specifics of those barriers. Purpose: This study describes the needs of APRNs who plan to specialize in cardiology. Method and Sampling: A qualitative design was used to describe the motivation of APRNs specializing in cardiology, tools they currently utilize to achieve their specialization, and their needs based on the current approach. I recruited participants, APRNs specializing in cardiology, through meetings at a local cardiology practice. Seven APRNs specializing in cardiology with experience ranging from 10 months to 15 years, and currently working in a cardiac setting, participated in the study. Structured interviews were conducted to describe the needs of APRNs who plan to specialize in cardiology. The interviews were audiotaped and analyzed to reveal commonalities. Findings: After analyzing the audio recordings three major commonalities emerged: APRNs specializing in cardiology must overcome limited educational opportunities, APRNs specializing in cardiology require a higher level of skill than their formal training and licensing requirements provide, and the need to validate APRNs specializing in cardiology knowledge. Additional commonalities included availability and the type of degree programs, and a lack of cardiac focus in educational preparation. Conclusion: The findings showed the needs of APRNs who plan to specialize in cardiology are rooted in their educational preparation. There is a vast amount of variability among degree programs and a severe lack of cardiac focus in their educational preparation. In order to achieve competency, 100% of study participants secured a mentorship with an expert cardiac clinician for a minimum of one year post-graduation and without assistance from their educational programs. Additionally, APRNs specializing in cardiology believe a national certification or examination requirement would be beneficial to their practice.
    • Barriers to Practice: Understanding Phsyician and Hospital Administrator Knowledge, Beliefs, and Attitudes of the Role and Scope of Practice of Acute Care Nurse Practitioners in the Acute Care Setting in Rural Montana

      Krogue, Paul Anthony (The University of Arizona., 2018)
      Purpose: to describe the knowledge, beliefs, and attitudes of physicians and hospital administrators regarding the role and scope of practice of acute care nurse practitioners in rural Montana. Background: Nurse practitioners have been increasingly called upon to provide high quality and cost-effective healthcare in variety of settings and have consistently shown to provide a high-level of patient care in both the primary and acute care settings. The acute care nurse practitioner specialty is relatively new, and with very few licensed acute care nurse practitioners in the state of Montana, the role and scope of practice is not well understood by physicians and hospital administrators who are often tasked with hiring and recruiting providers in the hospital setting. The Consensus Model, which served as the conceptual framework for this project, advocates that nurses provide care for the population that is specific to their licensure, accreditation, certification, and education. Method: Some 28 physicians and hospital administrators completed a survey that included 21 Likert scale statements that were divided into the subscales of Knowledge, Belief, and Attitude. Results included: 1) An existing gap in knowledge regarding the role and scope of practice of acute care nurse practitioners, 2) acute care nurse practitioners should always have some form of physician oversite, and 3) there is disparity in patient outcomes when patient care is provided by nurse practitioners. Conclusion: Attitudes of survey respondents were overwhelmingly positive for the future of acute care nurse practitioners filling various provider roles in the hospital setting. These results can provide a foundation for future inquiry and can assist in the development of education and collaborative efforts to further advance the utilization of acute care nurse practitioners in Montana.
    • Bodies in (E)motion: Decoding Chinese Writing in the Interplay between Embodied Experience and Technics

      Hou, Dongchen (The University of Arizona., 2018)
      This dissertation examines the significance of human bodies in the interaction with technologies in writing. Instead of treating writing as linguistic signifiers, this work conceptualizes writing as visual traces imbued with rich information on writers’ embodied experience and bodily dynamic with the external environment. A dialectical relationship in writing—writing as embodied experience and writing as technics—undergirds the overall discussion. On the one hand, writing delivers writers’ embodied experience including bodily locomotion, sensuous feeling, and embodied creativity; on the other hand, writing’s embodiment is influenced and formulated by technics, the external prostheses that mediate embodied sensuousness. Grounded in this dialectical relationship in writing, this dissertation examines four cases—stenography, typewriter, calligraphy robots, and artificial writing—to demonstrate the interactive trajectory between external prostheses and embodied writing subjects, as well as its enmeshment with specific socio-political and historical desires, power relations, and discourses. Chinese writing, due to its traditional emphasis on embodied traces in writing, exemplifies the tensions between the two. Under the overarching dialectical relationship between embodiment and technics, this work specifically looks at labor and authorship production in each modality of writing. The development of writing technologies triggers the changes of writers’ embodied experience due to the interrelatedness of the interior and prosthetic. The expressive hand, traditionally seen as the origin of creativity and subjectivity, has been deskilled. Authorship derived from the hand has shifted thereafter. Writing technologies’ encroaching into writing subjects’ embodied domain simultaneously evidences the transition from the “human” to the “posthuman,” the latter of which illustrates the equation of human with “information-processing machines” (Hayles 2008). After looking at human-technology encounters happening in writing, I find that the deskilling of the hand interestingly anticipates the reskilling of writing subjects. When the expressive hand is deskilled, writing subjects engage with the labor in embodied experience—the holistic collectiveness and dissolution of the intellectual/artistic labor and reproductive labor—and contribute to authorship production in different modalities of writing. This research engages intellectual conversations with works that challenge the deep-seated hierarchy between speech and writing, and a series of derivative distinctions between mind and body, and Episteme (knowledge) and Techne (craft, art, technology) by focusing on the embodied experience in writing. It articulates how the body becomes a site to perceive the dynamics between human subjects and machines, relinking the chain of authorship production from tangibility to abstraction.
    • Design and Synthesis of Modular Reagents for Chemical Biology

      Mehari, Bereketab Tesfayesus (The University of Arizona., 2018)
      Bioconjugation strategies for chemical modification of biomolecules play an important role in gaining greater understanding of biological processes. A number of chemical reactions have been developed for labeling biomolecules in biologically relevant conditions. In an effort to expand the chemical tools available for biological studies, the Jewett group is working towards developing new and improving current bioconjugation strategies to address questions in chemical biology. The traceless Bertozzi-Staudinger reaction is one of the most selective bioconjugation reactions. However, its utility is limited due to poor solubility in aqueous conditions and challenges in the synthesis of functionalized variations of the reagent. A modular one-pot synthetic strategy has been developed. It was also demonstrated that this method can be used to introduce aldehyde and azide functionalities as chemical handles for modification of these reagents. In addition, the design and synthesis of a traceless Bertozzi-Staudinger reagent that has been functionalized with a triazabutadiene probe is described. The orthogonal nature of the traceless Bertozzi-Staudinger and triazabutadiene moieties was established. The utility of the bifunctionalized reagent as a tool for attaching a cargo onto the traceless Bertozzi-Staudinger reagent by utilizing the reactivity of the triazabutadiene moiety and vice versa was demonstrated using a model compound. It was also shown that the reagents that have been modified using this strategy retained their chemical reactivity. In conclusion, this work describes the design and synthesis of bioconjugation reagents that can expand the toolbox of reagents available for the study of biological process.
    • Peridynamics for Solving Linear/Nonlinear Ordinary and Partial Differential Equations

      Dorduncu, Mehmet (The University of Arizona., 2018)
      This study concerns the construction of numerical solutions to linear/nonlinear ordinary and partial differential equations with certain challenges by using the Peridynamic Differential Operator (PDDO). These challenges may be due to the presence of discontinuities arising from a crack, dissimilar material interface or a moving interface due to phase changes or due to the presence of a strong degree of coupling among the coupled field equations. The peridynamic (PD) discretization can be both in time and space. Therefore, their numerical solutions can be achieved by employing either implicit or explicit methods. The PDDO enables differentiation through integration over a domain of interaction. The association among the points within the range of this domain defines the degree of nonlocality. Since the PDDO permits differentiation through integration, it is very robust for determining higher order derivatives of spatial and temporal functions that present singular and discontinuous behavior. The solution process involves neither a derivative reduction process nor a special treatment to remove a jump discontinuity or a singularity. Comparison of the solutions from the PDDO with those of the existing analytical or numerical methods proves that the PD modeling provides accurate solutions to rather complex linear and nonlinear partial differential equations of parabolic, hyperbolic and elliptic type. In order to demonstrate the crack growth analysis capability, the PDDO is applied to model a diagonal plate with a pre-existing crack under tension. In the case of coupled field equations, the PDDO is applied to model thermoelasticity, thermoelectricity, thermo-oxidation, and lithium diffusion and stress evolution.
    • Beyond the Tangled Bank: Posthuman Ecosystems in Nineteenth-Century British Literature

      Lyons, Emily Renee (The University of Arizona., 2018)
      The first generation of humans to live in a world indelibly marked by industrialism came of age in the nineteenth century. Industrialism set a pace of rapid social, economic, and environmental change that would come to define the Victorian era, and that would reverberate from England throughout the entire world. The advances of the period that afforded insights into the connections between the macro and the micro in physics, biology, geology, and other branches of the natural sciences, as well as the networks of trade and communication being laid down across the globe as part of the project of imperialist expansion and exploitation, all called new attention to the entangled relations of humans, human-created institutions and technologies, and nonhuman nature. The nineteenth-century British texts that are the subject of this study engage with these entangled relations in ways that call into question what it means to be human. Since the poststructuralist turn, scholarly work on the Victorian era touching questions of human subjectivity has often emphasized how the dominant power structures of the nineteenth century—white heteropatriarchy, industrial capitalism, and imperialism—upheld a model of human subjective measured against the standard of the white able-bodied man of property, and heavily invested in enforcing rigid hierarchies of race, class, and gender. I argue that the works of literature in this study demonstrate that the category of the human has not been so narrowly defined and fixed in the Victorian imagination as has previously been supposed, but is instead profoundly unstable and porous. Human subjectivity in these texts emerges from non-linear, non-hierarchical networked relations among human and nonhuman agents, forming what I term “posthuman ecosystems.” These Victorian examples prefigure posthumanist and ecocritical discourse of the anthropocene.