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    • 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.
    • 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.
    • Toddler Mental Health Screening for the Nurse Family Partnership Program

      Diaz de Leon, Cassandra (The University of Arizona., 2018)
      Background: Research has shown that attachment has a powerful impact on the developing brain of a child (Lieberman, 2004). Prevention focusing on the earliest signs of mental illness has the greatest potential for decreasing the risk of mental issues in later life (Ammitzbell et al., 2016). Purpose: The purpose of this project was to train nurses working at the Easter Seals Blake Foundation Nurse Family Partnership Program on the Child Behavior Checklist. The study focused on identification of children who are at risk of mental health problems, largely based on attachment problems, and provide early interventions. Design: The initial step of this study consisted of training home visiting Nurses working at a Nurse Family Partnership Program site in Pima County on the Child Behavior Checklist. The Child Behavior Checklist was meant to be implemented into the program as a secondary mental health screening tool if a child who was 18- or 24-months old was found to be “at-risk” using the Ages and Stages Questionnaire-Social and Emotional Tool. The Child Behavior Checklist, served as a more detailed screening tool if a child was found “at-risk.” Results: During this project, a training on the Child Behavior Checklist was performed. Seven nurses participated in the initial survey, which assessed their thoughts on the current protocols at the Nurse Family Partnership Program. Then their client charts were reviewed to determine if the Child Behavior Checklist was utilized. Lastly, a post survey was sent out to inquire about their thoughts and potential for implementing the Child Behavior Checklist. Implications: From the post survey, it was determined that most nurses thought the Child Behavior Checklist is a great, detailed tool to use if a child is found to be “at-risk.” However, most nurses also stated they did not need to use it due to lack of children having an “at-risk” score using the Ages and Stages Questionnaire-Social and Emotional tool.
    • Improving Stress-Induced Hyperglycemia Management in the Intensive Care Setting

      Elgrably, Alonya (The University of Arizona., 2018)
      Background: Uncontrolled stress-induced hyperglycemia has been shown to increase mortality, prolong ICU length of stay, increase complications, and prolong ICU length of stay. The inadequate management of stress-induced hyperglycemia in the intensive care setting is a persistent gap in quality care. Objective: To implement an evidence-based Stress-induced hyperglycemia protocol in the ICU at NorthBay Medical Center. Design: Descriptive design with pre-and post-intervention measurement. Setting: The Intensive Care Unit at NorthBay Medical Center. Patients: 22 patients with stress-induced hyperglycemia. Eligible patients had a blood glucose level great than or equal to 150 mg/dL. Intervention: Patients with a blood glucose level greater than or equal to 150 mg/dL were started on sliding scale insulin therapy. Patients with a blood glucose level greater than 180 mg/dl the patient were started on an insulin infusion. If the blood glucose levels were <100 mg/dl, insulin therapy was discontinued to prevent hypoglycemia. Blood glucose levels were integrated into ICU multidisciplinary rounds to ensure all patients with stress-induced hyperglycemia were identified. Measurements: ICU length of stay, hospital length of stay, average high blood glucose levels, and number of patients who met criteria but were not started on insulin therapy were measured. Results: The average ICU length of stay pre-protocol implementation (M=4.18, SD=2.48) was greater than the average ICU length of stay post-protocol implementation (M=2.18, SD=1.83). This difference is statistically significant t (20) =2.15, p=0.044; d 0.95. There was no significant 8 difference between pre-protocol implementation hospital length of stay (M=9.27, SD=9.50) and post-protocol implementation hospital length of stay (M=6.27, SD=3.82); t (20) =0.97, p=0.343. There was no significant difference in average blood glucose levels pre-implementation (M=197, SD=69) and post-protocol implementation (M=189, SD=40); t (20) =0.31, p=0.76. Over half (55%) of the patients in the pre-implementation group met criteria for stress-induced hyperglycemia, however, insulin therapy was not initiated by the ICU healthcare provider. Postimplementation, there was 100% compliance with initiating therapy on those patients that met criteria.
    • Assessments of Tumor Metabolism with CEST and DCE MRI

      Goldenberg, Joshua (The University of Arizona., 2018)
      This dissertation begins with a comprehensive review of the assessment of tumor metabolism highlighting the various applications of chemical exchange saturation transfer (CEST) MRI. The acidoCEST MRI technique is shown to be the imaging application suffering from the least amount of pitfalls in the quantitative assessment of tumor metabolism. Positron emission tomography (PET) and MR imaging modalities can be simultaneously and successfully synergized to study tumor metabolism during a course of a mitochondrial complex 1 inhibitor drug therapy in the treatment of pancreatic tumors in mouse models. Intramodal imaging with endogenous MRI or acidoCEST MRI and dynamic contrast-enhanced (DCE) MRI can also be sequentially performed to evaluate specific tumor biomarkers and tumor cell perfusion and uptake of gadolinium-based contrast agents or T2ex-based contrast agents in gadobenate dimeglumine (MultiHance®, Bracco Imaging Inc., Milan, Italy) and D-maltose. Machine learning-based classification of tumor models, as well as other pathological conditions, is a valid and helpul approach to CEST and DCE MR analysis. Pancreatic ductal adenocarcinoma tumor models varying in levels of hypoxia such as Hs 766T, MIA PaCa-2 and SU.86.86, have been classified using specific training classifiers on endogenous CEST MRI and DCE MRI datasets. Intramodal MR imaging has also been applied to other pathologies: namely, in imaging of bacterial infections and inflammation. Immunocompetent CBA/J mouse models of infections and MDA-MB-231 mouse models of breast cancer were injected and infused with the T2ex contrast agent D-maltose for DCE MRI. D-maltose infusion has shown to differentiate bacterially infected pathology from inflamed tissue pathology.
    • Putting the Individualized Back into Instruction: Coaching Teachers to Implement Academically Responsive Instruction in Deaf Education Classrooms

      Catalano, Jennifer (The University of Arizona., 2018)
      The goal of this study was to examine the effects of a coaching intervention on teachers’ ability to implement academically responsive instruction through flexible instructional arrangements in self-contained classrooms for students who are Deaf and hard of hearing (DHH). A secondary goal of the study was to determine the impact of the implementation of flexible instructional arrangements on students’ academic engagement within instructional arrangements. Three teachers at a center school for the Deaf received differentiated coaching to learn how to implement the indicators of flexible instructional arrangements. Teachers were coached on 12 operationalized indicators using individual approaches that met the needs, learning styles, and preferences of each teacher. A changing criterion design replicated across teachers was used to examine the impact of the coaching intervention on teachers’ implementation of the indicators, as well as the impact of flexible instructional arrangements on students’ active engagement. Results show that coaching had an impact on all three teachers’ implementation of flexible instructional arrangements. As teachers mastered the indicators of flexible instructional arrangements requiring coaching, change occurred in their implementation of instructional arrangements. Students’ active engagement increased and passive engagement decreased when they participated in less whole class instruction and spent more time in small group and child-managed arrangements. After no longer receiving coaching, teachers maintained the implementation of flexible instructional arrangements and students continued to demonstrate higher levels of active engagement as compared to baseline. Limitations and implications for future practice and research are discussed.
    • Indigenous Health Systems: An Emergent Yaqui-Centered Framework for Public Health Practice

      Oré de Boehm, Christina E. (The University of Arizona., 2018)
      The Yaqui Tribe in Sonora, Mexico is tapping into its collective strength to challenge socio-political and environmental conditions that have exacerbated health inequities. Yaqui traditional systems of governance and healing represent Indigenous knowledge, strength, resilience, and resistance. They continue to serve their communities. Yet, they are omitted from global and national public health initiatives. This is a qualitative study of the health system that serves the Yaqui Tribe in Sonora, Mexico to inform Yaqui-centered public health. From 2014 – 2016, the study accomplished four aims: 1) describe the Yaqui community health and traditional healing systems, including their interface with the Mexican health system; 2) identify Yaqui health and healing concepts; 3) define an emergent Yaqui-centered framework for public health practice; and 4) share findings with tribal leaders in United States and Mexico. Nine traditional healers and two lay health workers shared stories/conversation about their experience as practitioners. A key finding of the study was the centrality of practicing within Yaqui worldview, knowledge, and lived experiences. As a result, the proposed framework is defined by 1) guiding principles of relational accountability; 2) ancestral knowledge of healing and being well in relation the land/Creator; and 3) interactions and context, both historic and contemporary. It is a strength-based, systems thinking approach to practice that can be applied to current tribal health system performance improvement efforts. The framework is a seed intended to inspire further development ‘by and for’ the Yaqui Tribe and Indigenous communities within the Americas and beyond. At the policy level, this study contributes to reframing public health practice as an act of self-determination, an expression of indigeneity, and intrinsically a fight for equity.
    • The Estimation of Selected Physicochemical Properties of Organic Compounds

      Al-Antary, Doaa Tawfiq (The University of Arizona., 2018)
      Thermodynamic relationships are used to predict several physicochemical properties of organic compounds. As described in chapter one, the UPPER model (Unified Physicochemical Property Estimation Relationships) has been used to predict nine essential physicochemical properties of pure compounds. It was developed almost 25 years ago and has been validated by the Yalkowsky group for almost 2000 aliphatic, aromatic, and polyhalogenated hydrocarbons. UPPER is based on a group of additive and nonadditive descriptors along with a series of well-accepted thermodynamic relationships. In this model, the two-dimensional chemical structure is the only input needed. Chapter (1) extends the applicability of UPPER to hydrogen bonding and non-hydrogen bonding aromatic compounds with several functional groups such as alcohol, aldehyde, ketone, carboxylic acid, carbonate, carbamate, amine, amide, nitrile as well as aceto, and nitro compounds. The total data set includes almost 3000 compounds. Aside from the enthalpies and entropies of melting and boiling, no training set is used for the calculation of the properties. The results show that UPPER enables a reasonable estimation of all the considered properties. Chapter (2) uses modification of the van't Hoff equation to predict the solubility of organic compounds in dry octanol as explained in chapter two. The equation represents a linear relationship between the logarithm of the solubility of a solute in octanol to its melting temperature. More than 620 experimentally measured octanol solubilities, collected from the literature, are used to validate the equation without using any regression or fitting. The average absolute error of the prediction is 0.66 log units. Chapter (3) compares the use of a statistic based model for the prediction of aqueous solubility to the existing general solubility equation (GSE).
    • Inter-Talker Variability and Perception of Phonetically Similar Tones

      Chen, Yan (The University of Arizona., 2018)
      This dissertation probes the processing of phonetically similar tones under high-variability conditions (i.e., with inter-talker variability), as well as whether orthographic cues for tones affect the perception of non-native tonal contrasts. This current work consists of three studies. Throughout these studies, five Cantonese tone pairs were examined: 1) Mid-Level vs. Low-Level, 2) High-Rising vs. Mid-Rising, 3) Low-Falling vs. Low-Rising, 4) Low-Falling vs. Low-Level, and 5) Low-Rising vs. Low-Level. The phonetic contrast in the first pair is f0 height. The contrast in the second pair is the magnitude of f0 rise. The contrast in the last three pairs is overall f0 contour. Chapter 2 reports on native perception and production of the above-mentioned tones. Through a high-variability mixed-talker AXB task and a mixed-talker delayed shadowing task, I found that the f0-height difference in the two rising tones was easier to perceive than that in the two level tones. In addition, f0-contour differences were easier to perceive than f0-height differences. I also found that participants accommodated the model talkers when shadowing words from them: participants adjusted the average f0 height for the level tones and the magnitude of f0 rise for the rising tones according to the talkers. Chapter 3 reports on non-native perception of lexical tones at first exposure. Three groups of non-Cantonese speakers (English, Mandarin, and Bangkok Thai) completed a mixed-talker AXB task that tested discrimination performance and a mixed-talker delayed shadowing task that tested identification and production. Results showed that, for all non-Cantonese speakers, the perception of the f0-height difference in the two rising tones and that in the two level tones were equally difficult, and that f0-contour differences were easier to perceive than f0-height differences. In addition, L1-dependent patterns were found. In general, tonal-language speakers perceived f0-contour differences better than English speakers. English and Mandarin speakers outperformed Thai speakers in perceiving two rising tones that have similar contour shapes but different f0 heights. Unlike native listeners, non-native listeners were less successful in using syllable-extrinsic information for perceiving f0-height contrasts. Chapter 4 reports on the effect of orthographic cues for tones on non-native perception of tonal contrasts. The non-Cantonese speakers (reported in Chapter 3) who were in an Auditory-Visual training group saw iconic tone letters as immediate feedback in a mixed-talker AX training task, whereas those in the Auditory-Only group did not. Results from the training tasks revealed that the training with tone letters was more beneficial, as there was a facilitation effect on a larger scale, affecting more learners and the learning of more tonal contrasts: the tone letters facilitated the learning of the f0-height contrast between two level tones for all three groups of learners, as well as the learning of f0-contour contrasts for English speakers. In sum, this dissertation provides evidence that 1) the perception of tones contrasting in various phonetic dimensions is affected differently by inter-talker variability; 2) the perception of non-native tones is affected by native language background; and 3) the effect of iconic orthography varies as function of the L1 background of the learners and the specific L2 contrasts tested.
    • Sustainable, Robust, and Resilient Water Resources Planning and Management

      Hwang, Hwee (The University of Arizona., 2018)
      Sustainable, robust, and resilient water resources planning and management (WRPM) has emerged as a major concern, not only for decision makers and water utilities but also for academic researchers. A water resources system is very complex since its enormous number and diverse components are connected and interrelated. To establish effective management and planning for the water resources system, decision makers and planners can disaggregate large water resources systems into multiple scales based on geographical boundaries and the management and planning goals. Arizona’s water resources system can be divided into basin, state, planning area, and local planning area scales. Each scale requires a different approach and models depending on the WRPM goals. This dissertation takes a comprehensive view of sustainable, robust, and resilient WRPM for multi-scale Arizona water resources systems (state, planning area, and local planning area scales). This dissertation is composed of three studies with four journal articles that address sustainable, robust, and resilient WRPM. First, for the state and planning area scale, a large food-energy-water system model is developed for Arizona using a system dynamic modeling approach. Using the model, effectiveness of potential alternatives including graywater reuse, rainwater harvesting, demand reduction, and groundwater importation that promise sustainable water use are evaluated. Second, at the regional planning area scale, impacts of various strategies on the robustness and resilience of regional water supply system (RWSS) during major component failure for a region in southwest Tucson, AZ are assessed. The strategies include (1) restricting water demand, (2) constructing pipelines as alternative water supply pathways, (3) building water tanks as backup water storages, and (4) maintaining the Central wellfield as a backup source. Finally, the impact of network topology within water distribution system (WDS)/water distribution network (WDN) on (1) the accuracy of the first-order second-moment (FOSM) approximation when it is employed as a nodal pressure head uncertainty estimation method and (2) WDN robustness and resiliency. To that end, a quantitative WDS classification scheme that classify a WDS based on its function and network topology are developed. Using the classification scheme, network topology within WDS is identified and used for the analyses.
    • Characterizing Therapy Induced Polyploidy (TIP) Populations as a Resistance Mechanism in DH/DE-DLBCL and Identifying Synthetic Lethal Targeted Therapies

      Islam, Md Shariful (The University of Arizona., 2018)
      Lymphoma is a blood cancer that involves the lymphatic system and is the 7th most common cancer in USA. Diffuse large B-cell lymphoma (DLBCL) and Peripheral T-cell lymphoma (PTCL) are the most common types of aggressive B-cell and T-cell non-Hodgkin lymphomas (NHL) respectively. Double-Hit or Double-Expresser DH/DE-DLBCL are high grade B-cell lymphomas characterized by translocation or over expression of MYC and BCL-2 which are mostly incurable with standard chemo-immunotherapy. Therefore, there is an unmet need for novel targeted therapy. Aurora kinase inhibition (alisertib) induces ~30% cell death (in vitro), while a portion of the remaining ~70% cells at day-4 escape apoptosis through polyploid populations which we called therapy induced polyploid cells (TIP). These TIP cells exhibited a high metabolic rate by increased AKT/mTOR and ERK/MAPK activity via BTK signaling through the chronic active B-cell receptor (BCR) pathway. TIP also showed increased levels of phospho-Hck and phospho-Akt indicating increased BCR signaling which is a rationale for combining ibrutinib (BTK inhibitor). Combined inhibition of AK + BTK reduced phosphorylation of AKT/mTOR and ERK-1/2, up-regulated phospho-H2A-X and Chk-2 (DNA damage), reduced Bcl-6 and decreased Bcl-2 and Bcl-xL results in induced apoptosis evident by PARP cleavage. In a DE-DLBCL SCID mouse xenograft model, ibrutinib alone was inactive, while alisertib + ibrutinib was additive with a tumor growth inhibition (TGI) rate of ~25%. However, TGI for ibrutinib + rituximab was ~50-60%. In contrast, triple therapy showed a TGI rate of >90%. Kaplan-Meier survival analysis showed 67% of mice were alive at day-89 with triple therapy versus only 20% with ibrutinib + rituximab. All treatments were well tolerated with no significant changes in body weights. Anti-DLBCL chemotherapy dosing schedules are intermittent, designed to avoid damage to normal tissue such as the mucous membranes, gut and the bone marrow. TIP are common in standard anti-DLBCL therapies (e.g. vincristine, doxorubicin) and thought to be responsible for disease relapse. Some of these TIP cells die but remaining of those are capable of re-entering the cell cycle during off-therapy periods. We discovered how these TIP cells can re-enter cell cycle and molecular mechanism underlying this resistance. We have purified AK inhibitor induced polyploid DH/DE-DLBCL cells by FACS. Time-lapse microscopy of single cells revealed that following drug removal, a subset of TIP cells divide and proliferate by reductive cell division(s). This includes multipolar mitosis, meiosis like nuclear fission or budding off daughter cells. RNA-Seq, Proteomics and Kinomics proling of TIP cells demonstrated that alisertib induced polyploid cells have up-regulated DNA damage response, replication and immune evasion; amplify receptor tyrosine kinase and T-cell receptor signaling; hijacks the spindle assembly checkpoint point control via MYC dysregulation of RanGAP1, TPX2 and KPNA2. We believe these up-regulated proteins are responsible for induction of aneuploid daughter cells and disease resistance and also provide potential opportunities for novel therapy combination that warrant further exploration. Lymphomas are systemic diseases that require a comprehensive knowledge of immune mechanism in cancer as well as targeted therapeutic approach for designing an optimal therapeutic strategy and desired synergy can be achieved by rational combination of small molecule inhibitors with immune modulatory agents that could enhance host immune response. In PTCL we have shown that expression of PD-L1 relative to PD-1 is high in PTCL biopsies ( 9-fold higher) and cell lines. Combination of alisertib with pan-PI3K inhibition or VCR significantly reduced PD-L1, NF-kB expression and inhibited phosphorylation of AKT, ERK1/2 and AK with enhanced apoptosis. In a syngeneic PTCL mouse xenograft model, alisertib demonstrated tumor growth inhibition (TGI) ~30%, whilst anti-PD-L1 therapy alone was ineffective. Alisertib + anti-PD-L1 resulted in TGI >90% indicative of a synthetic lethal interaction. PF-04691502 + alisertib + anti-PD-L1 + VCR resulted in TGI 100%. Overall, mice tolerated the treatments well. Co-targeting AK, PI3K and PD-L1 is a rational and novel therapeutic strategy for PTCL. In conclusion, we have identified therapeutic targets in aggressive B- and T-cell lymphoma which can be combined with immunotherapy that warrant investigation to disrupt rapid tumor evolution of TIP cells to mitigate disease relapse.
    • Looking at Frankenstein: Ten Film Visions of Mary Shelley's Novel, 1990-2015

      Osborne, James Elliott (The University of Arizona., 2018)
      This dissertation considers ten film adaptations of Mary Shelley's Frankenstein; or, the Modern Prometheus produced between 1990 and 2015. The dissertation examines the ten films through critical and historical lenses that permit analysis of them as reflective of certain anxieties and cultural obsessions of the times in which they were produced, and as mirroring issues from Shelley's era that continue to resonate today. The films analyzed are discussed within the context of adaptation theory - principally, but not exclusively, through the analytical framework proposed by Kamilla Elliott in Rethinking the Novel/Film Debate (2003). They are also considered in light of contemporary historical phenomena, such as the end of the Cold War (Corman), and in light of recent advances in genetic research (Wickes, Nispel, Mercurio, Senese, and Rose); the films are also interrogated as to their "faithfulness" to the Shelley text (Branagh and Connor), the hybridization of artistic forms (Boyle/Dear), and the reimagining of Shelley's novel in the tradition of Hollywood and British Frankenstein cinema (McGuigan). The dissertation utilizes filmmaker interviews, contemporary reviews of the films, academic texts, and Shelley's own words as interpretive vehicles to analyze how each film addresses her text and the issues contained therein. The epilogue presents a brief overview of significant breakthroughs in genetic research reported in the summer of 2017, considering these advances as paradigms against which the fictional, semi-fantastic scientific discoveries detailed in the films of Wickes, Nispel, Mercurio, Senese, and Rose can be measured. The epilogue and the dissertation conclude with a brief discussion of Denis Villeneuve's Blade Runner 2049 (2017), considered as an exploration of certain issues manifested in Shelley's Frankenstein - among others, the creation of a race of motherless "others" and the question of identity - and of issues related to the unfettered use of genetic engineering in pursuit of a capitalist, consumerist ideal.