BACKGROUND Inappropriate medication use is common and represents a substantial clinical and economic burden in the United States (US). The Center for Medicare and Medicaid Services (CMS) has adopted one of the Pharmacy Quality Alliance (PQA)’s quality measures to assess percentages of older adult beneficiaries receiving high-risk medications (HRM) in Medicare Advantage Prescription Drug plan and stand-alone Prescription Drug plan. Understanding geographic patterns of HRM use may help CMS and their partners develop and tailor prevention strategies (such as prior authorization) to be implemented in the areas of need. Furthermore, The HRM use measure was used to assess Medicare Advantage Prescription drug plan (MA-PD) and stand-alone Prescription Drug plan (PDP) performance and to provide guidance for practitioners to reduce the use of such medications. Limited evidence exists on how HRM use is associated with patient characteristics and whether risk adjustment is necessary to accurately evaluate health plan performance on the HRM measure. OBJECTIVES The overall objectives of this research were to understand regional and patient characteristics associated with HRM use measure to develop a risk adjustment model for the HRM measure to accurately evaluated health plan performance. The first specific aims were to examined HRM use patterns among Medicare beneficiaries enrolled in: (1) Medicare Advantage prescription drug plans (MA-PDs); and (2) stand-alone prescription drug plans (PDPs) across geographic areas over time in the United States. The second specific aims were to: (a) measure HRM use in MA-PD and PDP beneficiaries with disadvantaged characteristics, including low income and disability; and (b) examine the relationship between disadvantaged characteristics and HRM use given constant effect of health plans. The third specific aims were to examine the relations between patient risk factors and the HRM measure and develop risk adjustment tool for the HRM measure in older adults enrolled in MA-PDs and PDPs. METHODS This cross-sectional study used a 5% national Medicare sample (2011–2013 for the first aims and 2013 for the second and third aims). Among beneficiaries aged ³65 years who were continuously enrolled in MA-PDs or PDPs (~1.3 million each year), we identified those with ≥2 prescriptions for the same HRM (e.g., amitriptyline) during the year based on the HRM list provided by CMS and Pharmacy Quality Alliance. For the first specific aims, multivariable logistic regression was used to estimate adjusted annual HRM use rates across 306 Dartmouth Atlas of Health Care hospital referral regions (HRRs), adjusting for sociodemographic, health-status, and access-to-care factors. For the second aims, Multivariable generalized linear mixed models were used to assess the association of HRM use and disadvantage factors such as low-income subsidy (LIS)/dual eligibility status (DE) and disability after adjusting for health plan effect and patient-level confounding characteristics (i.e., sociodemographic, geographic, clinical complexity). For the third aims, multivariable generalized linear mixed models were used to assess the association of HRM use and patient risk factors (e.g., age, gender) and identify risk factors after adjusting for health plan effect. The identified risk factors were used as variables for regression-based risk adjustment for the HRM measure. Unadjusted and adjusted quality rankings among health plans were compared. RESULTS First, a total of 1,161,076, 1,237,653, and 1,402,861 beneficiaries satisfied the study criteria and were included in 2011, 2012, and 2013, respectively. Among our study sample, nearly 40% (39%, 39% and 37% in 2011, 2012 and 2013 respectively) were enrolled in MA-PD plans, whereas remaining 60% (61%, 61%, and 63% in 2011, 2012 and 2013 respectively) were enrolled in PDP plans. HRM use significantly decreased over time among Medicare beneficiaries enrolled in MA-PD (13.1% to 8.4%, p<0.001) and PDP (16.2% to 12.2%, p<0.001) plans. Among MA-PD beneficiaries, HRM users more frequently: female (70.4% vs. 59.9%, p<0.001); White (84.6% vs. 81.4%, p < 0.001); eligible for the Part D Low Income Subsidy or Medicaid benefits (22.3% vs. 16.6%, p<0.001); and disabled (15.6% vs 8.7%, p<0.001) compared to non-HRM users in 2013. Among PDP beneficiaries, HRM users had higher proportions of: females (72.8% vs. 62.5%, p < 0.001); Whites (86.6% vs. 85.3%, p<0.001); LIS/DEs (29.2% vs. 23.3%, p<0.001); and disabled people (15.4% vs 8.5%, p<0.001) compared to non-HRM users. In 2013, the ratios of 75th-to-25th percentile HRM use rates across HRRs were 1.42 (MAPDs) and 1.31 (PDPs). HRRs with the highest HRM use rates were: Casper, WY (20.4%), Waco, TX (16.7%), Lubbock, TX (15.7%), Santa Barbara, CA (15.2%), and Temple, TX (15.1%) (MA-PDs); and Lawton, OK (18.8%), Alexandria, LA (18.8%), Lake Charles, LA (18.6%), Oklahoma City, OK (18.0%), and Slidell, LA (18.0%) (PDPs). Second, there were a total of 520,019 MA-PD and 881,264 PDP beneficiaries who met the study criteria. Of the MA-PD beneficiaries, 88,693 (17.1%) were LIS/DE and 48,997 (9.4%) were disabled. Of PDP beneficiaries, 213,096 (24.2%) were LIS/DE, and 83,593(9.5%) were disabled. LIS/DE beneficiaries had a higher percent of HRM users compared to non-LIS/DE MA-PD (17.0% vs. 9.6%, p < 0.001) and PDP (17.1% vs. 13.2%, p < 0.001) beneficiaries. Disabled beneficiaries had a higher percent of HRM users compared to non-LIS/DE MA-PD (17.0% vs. 9.6%, p < 0.001)) and PDP (17.0% vs. 9.6%, p < 0.001) beneficiaries. Multivariable analyses showed LIS/DE (OR = 1.07; 95% CI: 1.04, 1.10) and disability (OR =1.38; 95% CI: 1.34, 1.42) were associated with HRM among the MA-PD population as well as in the PDP population (LIS/DE OR = 1.14; 95% CI: 1.12, 1.16 and disability OR = 1.37; 955 CI: 1.34, 1.40). Third, the HRM users were more likely to be younger (OR = 0.981, 95% CI, 0.980-0.983 for MA-PD and OR=0.982, 95% CI, 0.981-0.983 for PDP); women (OR = 1.545; 95% CI,1.514-1.576 for MA-PD and OR=1.606, 95% CI, 1.584-1.628); eligible to receive low-income subsidy (OR = 1.086, 95%CI, 1.057-1.115 for MA-PD and 1.170, 95% CI, 1.150–1.190 for PDP); disabled (OR = 1.380, 95%CI, 1.342 –1.420 for MA-PD and 1.378, 95%CI, 1.352–1.405 for PDP); seeing multiple prescibers (OR =1.076, 95%CI, 1.072, 1.081 for MA-PD and 1.072, 95%CI, 1.069-1.075); filling prescriptions at multiple pharmacies (OR = 1.092, 95%CI, 1.083-1.102 for MA-PD and OR = 1.092, 95%CI, 1.086, 1.099 for PDP); and had higher average modified RxRisk-V (OR = 1.176, 95%CI ,1.171 – 1.181 for MA-PD and OR = 1.173, 95%CI, 1.170-1.176 for PDP). Being older and white were protective against receipt of HRMs. These variables were recommended for the risk adjustment model. Unadjusted scores showed low levels of agreement (Cohen’s kappa < 0.7) with risk-adjusted scores in identifying statistical outliers suggesting risk adjustment is necessary. CONCLUSION Geographic variation in HRM use exists among older adults in Medicare, regardless of prescription drug plans. Areas with high HRM rates may benefit from targeted interventions to prevent potential adverse consequences. LIS/DE; disability; demographic such as age, gender, race; and clinical complexity were associated with higher HRM use in both the MA-PD and PDP populations even when controlling for health plan effects. Failure to adjust for beneficiaries case mix might penalize some truly high-quality MA-PD and PDP providers that serve sick beneficiaries or beneficiaries with poor socioeconomic conditions.

Academic engagement is important for the scholastic outcomes of college students, including degree completion. The current study examined the relations between stress and the intrinsic aspects of academic engagement (e.g. effort, attention, note-taking, attendance, asking for help, etc.), including the four factors of undergraduate engagement as outlined by Handelsman, Briggs, Sullivan, & Towler (2005): Factor 1 – “skills engagement,” Factor 2 – “emotional engagement,” Factor 3 – “participation/interaction engagement,” and Factor 4 – “performance engagement,” in addition to the mediating/moderating properties of the self-care practices of sleep hygiene and physical activity. Intrinsic versus extrinsic engagement was evaluated in this study as it is believed this approach affords more opportunities for subsequent interventions since they can be implemented in an individual or small group setting, and not be constrained by the challenges of making large institutional changes. The sample consisted of 203 undergraduate students from a large southeastern university. Results indicated that stress was negatively correlated with the factor of academic engagement most related to executive functioning (i.e. skills engagement). Of the independent variables evaluated, sleep hygiene showed the strongest correlations with academic engagement, most specifically for the skills engagement and performance engagement factors. Sleep hygiene also functioned as a mediator in the relationship between stress and the skills factor of engagement, resulting in a 47% reduction in the effect of stress. Exercise did not show correlations with any areas of engagement, but did show a small interaction effect on the relationship between stress and the academic engagement factor of participation/interaction. Stress was seen to have a positive impact on participation/interaction engagement. A moderating effect of physical activity was identified, leading to lower participation/interaction engagement when both stress and exercise were high. Exercise, ethnicity, age, class rank, and gender did not add predictive ability to any of the models for academic engagement/factors of engagement. These results highlight the potential benefits of improving sleep habits and promoting programs aimed at minimizing and addressing stress (e.g. meditation, mental health supports) in order to promote success and positive academic outcomes in undergraduate students. Directions for future research were also discussed.

This study identified first-generation college student’s parents’ needs and support systems during their child’s college admissions process. Literature supports the benefits of improving college knowledge among high school parents of first-generation college students. Parent college knowledge includes information about the college admissions requirements, college admissions processes, parental involvement, and access to social support. Research on these populations is more commonly done through quantitative studies that do not always include parents’ voice or qualitative research that tends to highlight students’ experiences. Regardless of the type of research, parents’ ability to provide guidance has a significant impact on first-generation college students’ enrollment and retention rates (Auerbach, 2007; Duggan, 2001). Social capital informed the design of this study to examine the access of college knowledge resources used by first-generation college students’ parents. The qualitative study was supported in a constructivist epistemology. Data were collected through semi-structured focus groups and individual interviews, which included 28 high school parents and/or guardians. Results categorized into three factors: college admissions requirements, the navigation of the college admissions process, and access to social support for guidance. The study concludes with findings that allow educators to better understand the needs of first-generation college students’ parents as well as steps that can be taken to provide parents with the tools needed to better guide their children through the college admissions process. Keywords: parent college knowledge, educational equity, college admission, high school

In the first portion of this dissertation I examine the effect of gravitational acceleration on the angle of repose of granular features. To do this I have used HiRISE DTMs to compare the slipface angles of Martian sand dunes with those measured on Earth. In doing this I have found that the slopes of active dunes on Mars do not differ from their terrestrial counterparts, and as such I have concluded that gravitational acceleration does not effect the angle of repose. In the second, larger portion of this dissertation I examine the morphology and formation of Crater Concentric Ridges (CCRs). These features, formerly known as 'Lunar Concentric Dunes', are ridges oriented concentrically to fresh craters a few kilometers in diameter. Using LROC NAC data I have created a catalog of 77 craters that have these features in their ejecta blankets. Further, I have used this data to map and measure the CCRs around eight craters of varying diameters in order to analyze their distributions. I have also been able to characterize the morphology of these ridges and how that morphology changes with distance from the host crater. Using DTMs made from NAC images I have studied the three-dimensional topography of CCRs in order to fully describe the morphology of these features. This morphological analysis has allowed me to refute several hypotheses for the formation of these features, including the previously accepted ballistic impact sedimentation and erosion hypothesis. In order to formulate a new theory for the formation of these features I have created simulations of crater ejecta flowing over regolith using discrete element modeling. In these simulations I found that Kelvin-Helmholtz instabilities form at the interface between the ejecta and regolith. I posit that these instabilities are responsible for the formation of Crater Concentric Ridges. This hypothesis is supported by the observation that the topography produced in my simulations strongly resembles that which I have measured and described around real lunar craters.

Statistical genetics is a scientific field concerned with the development of statistical methods for drawing inferences from genetic data. Research in statistical genetics generally involves developing theory or methodology to support research in one of three related areas: population genetics, genetic epidemiology and quantitative genetics. This dissertation is an ensemble of my research work in statistical genetics, including three projects with varying focuses. The first project applies a rare variant region-based test to identify sets of common or rare variants aggregated in and around genes associated with Dravet Syndrome. The second project proposes a score-based test to investigate the association for a set of rare variants and ordinal traits. The third project describes an implement of dimensionality reduction method in genotype data for population inference.

This dissertation addresses the question of whether non-adjacent morphological dependencies are as difficult to learn as non-adjacent phonological dependencies. Non-adjacent dependencies have been investigated in the past, and have proven to be at best difficult to learn (Bonatti, Peña, Nespor, & Mehler, 2005; Gómez, 2002; LaCross, 2011, 2015; Newport & Aslin, 2004), and at worst, completely unlearnable (Newport & Aslin, 2004: experiment 1). LaCross (2011, 2015) showed that speakers of a language employing non-adjacent dependencies were able to learn an artificial grammar employing analogous non-adjacent dependencies easily, suggesting there may be a linguistic bias that makes speakers more aware or capable of unconsciously parsing non-adjacent dependencies so long as they speak a language that employs vowel harmony. The research in this dissertation studies three subject populations with two tasks and two grammars to discover whether speakers of a language utilizing root-and-pattern morphology also have the ability to unconsciously parse non-adjacent dependencies pred- icated on morphological structure. Chapter 2 uses a segmentation or statistical learning task similar to the experiments mentioned above, while Chapter 3 uses a word elicitation task to establish a more fine-grained representation of what experiment participants learn after a very short exposure. The experiments show that there may be a cognitive bias toward concatenative morphology even among Arabic and Maltese speakers, but also that Arabic and Maltese speakers are willing to adjust CV skeleta and syllabic structure when deriving plural forms from singular forms. The methods that they use when producing novel plural forms are similar to those found in their L1, showing that this type of bias is predicated on morphophonological structure in the participants’ L1. The results together support a root-based lexicon for Arabic and Maltese and aggressive morphological decomposition (Boudelaa & Marslen-Wilson, 2001, 2004a, 2004b, 2015; Deutsch, Frost, & Forster, 1998; Frost, Deutsch, & Forster, 2000; Frost, Forster, & Deutsch, 1997; Ussishkin, Dawson, Wedel, & Schluter, 2015) even in novel words. Additionally, this work supports the notion of morphological abstraction, abstract grammatical features (such as past or plural) may be expressed by multiple allomorphs, particularly in the context of learning a new language. I extend this work to suggest that a processing model of Distributed Morphology (Halle & Marantz, 1993; Harley & Noyer, 1999; inter alia) would be appropriate both to model the results here and to better explain morphological processing disorders. Although Distributed Morphology has not been extensively tested as a processing model, recent research shows compatibility with existing psycholinguistic models (Gwilliams & Marantz, 2015; Stockall & Marantz, 2006) and has better explanatory power for deficits in morphological processing (Tat, 2013).

Transmission spectroscopy provides a powerful probe of exoplanet atmospheres, enabling constraints on their compositions and structures. Recent advances in instrumentation and observational techniques have enabled detections of molecules in the atmospheres of exoplanets as small as Neptune as well as provided constraints on cloud properties for Earth-sized and super-Earth exoplanets. However, these precise observations have also revealed that the heterogeneous nature of stellar photospheres presents a significant challenge to high-precision transit depth determinations. This owes to a fundamental limitation of the transmission spectroscopy technique, which is that transiting exoplanet atmospheres are illuminated by a spatially resolved region of the stellar photosphere, the spectrum of which we cannot directly measure. Any difference between the out-of-transit disk-averaged emergent spectrum of the star—our necessary reference by which we measure transit depths—and the average emergent spectrum of the transit chord—the true light source for the transmission measurement—will imprint on the observed transmission spectrum. This phenomenon is what I term the transit light source effect. In this thesis, I present my work to understand the transit light source effect in F to M dwarf systems and constrain stellar contamination signals in transmission spectra from two M dwarf systems. I first describe a modeling effort to constrain spot and faculae covering fractions and the concomitant stellar contamination spectra on M dwarfs. I find that large covering fractions of active regions are possible for typically active M dwarfs, and therefore stellar contamination signals can be likewise large and even overwhelm planetary atmospheric features produced by small transiting planets. This is indeed what I find in two observational studies of transiting M dwarf systems: the M4.5V GJ 1214 system and the M8V TRAPPIST-1 system. I then expand the analysis to F5V to K9V spectral types, investigating stellar contamination signals with a model similar to that presented for M dwarfs. I find that stellar contamination signals are much weaker for typical F to K dwarfs than for M dwarfs, though signals are detectable in high-precision transmission spectra, and active G and K dwarfs, in particular, can impart relatively large transit depth changes. Finally, I summarize the findings of this thesis and conclude with a look toward future prospects for disentangling stellar and planetary signals in exoplanet transmission spectra.

The focus of the current study is the use of form in the collection of Vespers music by Chiara Margarita Cozzolani (1602-c.1678), an Italian Benedictine nun living in Milan who spent her entire life cloistered within the walls of the Santa Radegonda convent. Although her life was typical of upper-class Milanese women, her compositions demonstrate that her approach to music is anything but typical. She composed in every genre of her day and published a large amount of music during her lifetime. Cozzolani’s collection of Vespers music comes from her final publication of 1650. With the exception of a few historians who have focused specifically on convent music, such as Robert L. Kendrick and Craig Monson, this music has largely been overlooked. The reasons for this are unclear given the wealth of material and the quality of musical aesthetic of this music. It is, however, heartening to see the body of research into Cozzolani’s music grow due to the renewed interest in music by female composers both past and present.

Molecular Dynamics (MD) is a numerical simulation technique which is used to obtain the time evolution trajectory of a system of interacting particles. Consideration of the molecular movement in the space of generalized internal coordinate rather than in Cartesian coordinate is an efficient way to deal with the constraints such as fixed angles and lengths. This type of molecular dynamics is called Internal Coordinate Molecular Dynamics (ICMD). To integrate the equation we need to invert the dense mass matrix. Since the direct calculation of mass matrix inversion is cubically scaled with the number of atoms in a molecule, a more efficient method is required for macro-molecules simulation. Fixman's work in 1974 and the follow-up studies have developed a method that can factorize the inverse of mass matrix into an arithmetic combination of three sparse matrices—one of them is positive definite and need to be further factorized by using the Cholesky decomposition or similar methods. When the molecule subjected to study is of serial chain structure, this method can achieve $\mathcal{O}(n)$ computational scaling, where $n$ is the number of atoms within a specific molecule. However, for molecules with long branches and loops, the nonzero structure of this positive definite matrix makes its decomposition in scaling of $\mathcal{O}(n^3)$. We have presented a new method which can guarantee for no fill-in in doing the Cholesky decomposition. As a result, the inverting of mass matrix will remain the $\mathcal{O}(n)$ scaling, no matter the molecule structure has long branches or not. Based on the above $\mathcal{O}(n)$ method in inverting mass matrix, an $\mathcal{O}(n)$ framework for internal coordinated molecular dynamics has been built. It has the following properties: has $\mathcal{O}(n)$ time complexity; constraints such as constant bond lengths and angles can be arbitrarily applied\added{ on tree structures}; suitable to complex geometries such as branches, \added{flexible }loops, dummy atoms/sites; and is singularity free in inverting mass matrix. When compared to traditional MD methods, the new method is especially powerful in macromolecule simulations. The ICMD utilizes the bond angle $\theta_i$, torsional angle $\phi_i$, and bond length $b_i$ as the basic types of internal coordinate parameters. However, there is a serious problem of using $\theta_i$ and $\phi_i$ as the internal coordinates. When $\theta_i$ is very close to $0$ or $\pi$, the mass matrix becomes singular and its inverse does not exist, so that the numerical integration of the equations of motion is unstable in this situation. In this work, we will introduce a convention switch method which can prevent the singularity by adopting two alternative rotation conventions. According to our test, this method is suitable to any size of molecule. In addition, it only requires a very small amount of additional computational cost. The conservation of total energy in microcanonical (NVE) ensemble simulation is extremely important because the NVE ensemble simulation is a statistical sampling over the constant energy surface in the hyperdimensional phase space. A symplectic numerical scheme can make the error of the total energy be bounded even for exponentially large simulation time. On the other hand, non-symplect time integrators such as 4th order Runge-Kutta (RK4) would give monotonic increasing or decreasing total energy. In internal coordinate molecular dynamics, the Hamiltonian is a strongly coupled equation which depends both on the momentum and position vectors, and very few explicit symplectic numerical methods existing for inseparable Hamiltonian. In this work, the influence of symplectic and non-symplectic time integrators on the energy conservation of ICMD have been studied.

Gioachino Rossini was perhaps more prolific than any known composer in his operatic writing for the mezzo-soprano and contralto voices. While modern practice casts many of these roles as somewhat interchangeable among mezzo-sopranos, recent writings have lamented the decline in the number of contraltos. This asks the question of whether or not the composer's own distinctions indicate that contraltos should be uniquely represented in these roles. This paper is an examination of Rossini's writing for some of his favorite singers, including Marietta Marcolini, Adelaide Malanotte, and Isabella Colbran, as well as later interpretations by Giuditta Pasta, in order to discover the unique imprint that they left on these roles. In addition, this paper will outline the history of the contralto as it pertains to the development of Rossini as a composer and the facets of character, tessitura, range and ensemble writing to explore how Rossini may have heard and appreciated the central part of the female voice, and what makes his writing for these voice types historically distinct and significant.