This open access archive contains publications from University of Arizona faculty, researchers and staff, primarily open-access versions of formally published journal articles. The collection includes published articles and final accepted manuscripts submitted by UA faculty under the UA Open Access Policy. The collection also includes books, book chapters, book reviews, presentations, data, and other scholarly materials submitters have chosen to make available in the repository.


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Recent Submissions

  • Treatment for Early, Uncomplicated Coccidioidomycosis: What Is Success?

    Galgiani, John N; Blair, Janis E; Ampel, Neil M; Thompson, George R; Univ Arizona, Coll Med, Valley Fever Ctr Excellence; Univ Arizona, Coll Med, Dept Med (OXFORD UNIV PRESS INC, 2019-09-23)
    The care of primary pulmonary coccidioidomycosis remains challenging. Such infections produce a variety of signs, symptoms, and serologic responses that cause morbidity in patients and concern in treating clinicians for the possibility of extrapulmonary dissemination. Illness may be due to ongoing fungal growth that produces acute inflammatory responses, resulting in tissue damage and necrosis, and for this, administering an antifungal drug may be of benefit. In contrast, convalescence may be prolonged by other immunologic reactions to infection, even after fungal replication has been arrested, and in those situations, antifungal therapy is unlikely to yield clinical improvement. In this presentation, we discuss what findings are clinical indicators of fungal growth and what other sequelae are not. Understanding these differences provides a rational management strategy for deciding when to continue, discontinue, or reinstitute antifungal treatments.
  • Pain Catastrophizing and Arthritis Self-Efficacy as Mediators of Sleep Disturbance and Osteoarthritis Symptom Severity

    Tighe, Caitlan A; Youk, Ada; Ibrahim, Said A; Weiner, Debra K; Vina, Ernest R; Kwoh, C Kent; Gallagher, Rollin M; Bramoweth, Adam D; Hausmann, Leslie R M; Univ Arizona, Coll Med (OXFORD UNIV PRESS, 2019-08-22)
    Objective. Sleep and pain-related experiences are consistently associated, but the pathways linking these experiences are not well understood. We evaluated whether pain catastrophizing and arthritis self-efficacy mediate the association between sleep disturbance and osteoarthritis (OA) symptom severity in patients with knee OA. Methods. We analyzed cross-sectional baseline data collected from Veterans Affairs (VA) patients enrolled in a clinical trial examining the effectiveness of a positive psychology intervention in managing pain from knee OA. Participants indicated how often in the past two weeks they were bothered by trouble falling asleep, staying asleep, or sleeping too much. We used validated scales to assess the primary outcome (OA symptom severity) and potential mediators (arthritis self-efficacy and pain catastrophizing). To test the proposed mediation model, we used parallel multiple mediation analyses with bootstrapping, controlling for sociodemographic and clinical characteristics with bivariate associations with OA symptom severity. Results. The sample included 517 patients (M-age = 64 years, 72.9% male, 52.2% African American). On average, participants reported experiencing sleep disturbance at least several days in the past two weeks (M = 1.41, SD = 1.18) and reported moderate OA symptom severity (M = 48.22, SD = 16.36). More frequent sleep disturbance was associated with higher OA symptom severity directly (b= 3.08, P <0.001) and indirectly, through higher pain catastrophizing (b = 0.60, 95% confidence interval [CI] = 0.20 to 1.11) and lower arthritis self-efficacy (b = 0.84, 95% CI = 0.42 to 1.42). Conclusions. Pain catastrophizing and arthritis self-efficacy partially mediated the association between sleep disturbance and OA symptom severity. Behavioral interventions that address pain catastrophizing and/or self-efficacy may buffer the association between sleep disturbance and OA symptom severity.
  • Reflections: a Daughter's Experience of Parental Cancer and the Beginnings of Un Abrazo Para La Familia™

    Marshall, Catherine A; Univ Arizona, Dept Disabil & Psychoeduc Studies (SPRINGER, 2020-06-04)
    The author describes her impetus and journey in developing Un Abrazo Para La Familia (TM) [Embracing the Family] (Abrazo), 3 hours of cancer information presented in an educational and modular format and designed for low-income informal caregivers who are co-survivors of cancer. A rehabilitation-informed preventive intervention, Abrazo reflects the importance of family, culture, and socioeconomic background in its approach.
  • Noisy communities and signal detection: why do foragers visit rewardless flowers?

    Lichtenberg, Elinor M; Heiling, Jacob M; Bronstein, Judith L; Barker, Jessica L; Univ Arizona, Dept Ecol & Evolutionary Biol (ROYAL SOC, 2020-05-18)
    Floral communities present complex and shifting resource landscapes for flower-foraging animals. Strong similarities among the floral displays of different plant species, paired with high variability in reward distributions across time and space, can weaken correlations between floral signals and reward status. As a result, it should be difficult for foragers to discriminate between rewarding and rewardless flowers. Building on signal detection theory in behavioural ecology, we use hypothetical probability density functions to examine graphically how plant signals pose challenges to forager decision-making. We argue that foraging costs associated with incorrect acceptance of rewardless flowers and incorrect rejection of rewarding ones interact with community-level reward availability to determine the extent to which rewardless and rewarding species should overlap in flowering time. We discuss the evolutionary consequences of these phenomena from both the forager and the plant perspectives. This article is part of the theme issue 'Signal detection theory in recognition systems: from evolving models to experimental tests'.
  • The Relationship Between Health-Related Quality of Life and Saliva C-Reactive Protein and Diurnal Cortisol Rhythm in Latina Breast Cancer Survivors and Their Informal Caregivers: A Pilot Study

    Pace, Thaddeus W W; Badger, Terry A; Segrin, Chris; Sikorskii, Alla; Crane, Tracy E; Univ Arizona, Coll Nursing, Div Community & Syst Hlth Sci (SAGE PUBLICATIONS INC, 2020-05-29)
    Introduction: To date, no study has explored associations between objective stress-related biomarkers (i.e., inflammatory markers, diurnal rhythm of cortisol) and health-related quality of life (HRQOL) in Latina breast cancer survivors and their informal caregivers (i.e., family, friends). Method: This cross-sectional feasibility study assessed saliva C-reactive protein, saliva diurnal cortisol rhythm (cortisol slope), and self-reported HRQOL (psychological, physical, and social domains) in 22 Latina survivor-caregiver dyads. Feasibility was defined as >= 85% samples collected over 2 days (on waking, in afternoon, and in evening). Associations between biomarkers and HRQOL were examined with correlational analyses. Results: Collection of saliva was feasible. Strongest associations were observed between survivor evening cortisol (as well as cortisol slope) and fatigue, a component of physical HRQOL. Discussion: Associations presented may help promote investigations of mechanisms linking stress-related biomarkers and HRQOL in Latina breast cancer survivor-caregiver dyads, which will facilitate development of culturally congruent interventions for this underserved group.
  • Effects of higher-order multipoles of the lunar disturbing potential on elongated orbits in cislunar space

    Rosengren, Aaron J.; Namazyfard, Hossein; Giacaglia, Giorgio E. O.; Univ Arizona, Aerosp & Mech Engn Dept (SPRINGER HEIDELBERG, 2020-05-29)
    For an Earth satellite in cislunar space, the effects of the third or higher-order harmonics in the solar disturbing function are negligible. For lunar perturbations, however, these terms become increasingly important as the semimajor axis increases. We investigate the effects of these higher-order multipole moments on circular, moderate, and highly elliptical orbits, where the semimajor axis is a relatively large fraction (similar to 20%) of the Moon's one. We specifically characterize the regions of cislunar space where the octupole-order approximation, often used in celestial and astrophysical dynamics for studying the stability and fates of hierarchical planetary systems, is actually a valid truncation of the gravitational interactions.
  • Social Insurance and Public Assistance in the Twentieth-Century United States

    Fishback, Price V.; Univ Arizona, Econ (CAMBRIDGE UNIV PRESS, 2020-04-06)
    The growth of American governments in the twentieth century included large increases in funds for social insurance and public assistance. Social insurance has increased far more than public assistance, so "rise in the social insurance state" is a far better description of the century than "rise in the welfare state." The United States has increased total spending in these areas as much or more as have European countries, but the U.S. spending has relied less heavily on government programs. In the U.S. states largely determine the benefits for many of the public assistance and social insurance programs, leading to large variation in the benefits across the country. I develop estimates of these benefits across time and place and compare them to the poverty line, manufacturing earnings and benefits, state per capita incomes in the US, as well as GDP per capita in countries throughout the world.
  • Monumental architecture at Aguada Fénix and the rise of Maya civilization

    Inomata, Takeshi; Triadan, Daniela; Vázquez López, Verónica A; Fernandez-Diaz, Juan Carlos; Omori, Takayuki; Méndez Bauer, María Belén; García Hernández, Melina; Beach, Timothy; Cagnato, Clarissa; Aoyama, Kazuo; et al. (NATURE PUBLISHING GROUP, 2020-06-03)
    Archaeologists have traditionally thought that the development of Maya civilization was gradual, assuming that small villages began to emerge during the Middle Preclassic period (1000-350 bc; dates are calibrated throughout) along with the use of ceramics and the adoption of sedentism(1). Recent finds of early ceremonial complexes are beginning to challenge this model. Here we describe an airborne lidar survey and excavations of the previously unknown site of Aguada Fenix (Tabasco, Mexico) with an artificial plateau, which measures 1,400 m in length and 10 to 15 m in height and has 9 causeways radiating out from it. We dated this construction to between 1000 and 800 bc using a Bayesian analysis of radiocarbon dates. To our knowledge, this is the oldest monumental construction ever found in the Maya area and the largest in the entire pre-Hispanic history of the region. Although the site exhibits some similarities to the earlier Olmec centre of San Lorenzo, the community of Aguada Fenix probably did not have marked social inequality comparable to that of San Lorenzo. Aguada Fenix and other ceremonial complexes of the same period suggest the importance of communal work in the initial development of Maya civilization. Lidar survey of the Maya lowlands uncovers the monumental site of Aguada Fenix, which dates to around 1000-800 bc and points to the role of communal construction in the development of Maya civilization.
  • SMARCB1 Gene Mutation Predisposes to Earlier Development of Glioblastoma: A Case Report of Familial GBM

    Mukherjee, Sanjib; Stroberg, Edana; Wang, Fengfei; Morales, Linden; Shan, Yuan; Rao, Arundhati; Huang, Jason H; Wu, Erxi; Fonkem, Ekokobe; Univ Arizona, Sch Med (OXFORD UNIV PRESS INC, 2020-03-13)
    Glioblastoma (GBM) is the most aggressive adult brain tumor. While GBM typically occurs sporadically, familial GBM can be associated with certain hereditary disorders and isolated familial GBMs in the absence of syndrome are rare. Relevant hereditary factors have remained elusive in these cases. Understanding specific genetic abnormality may potentially lead to better treatment strategies in these patients. Here, we analyzed GBM tissue from our patient and 2 afflicted family members, with next generation sequencing to better understand the genetic alterations associated with this disease development. DNA was extracted and sequenced and the data were then analyzed. Results revealed 2 common mutations in afflicted family members; PDGFRA and HRAS. In addition, both siblings showed a mutation of the SMARCB1 gene. The sister of our patient exhibited a homozygous mutation, while our patient had heterozygous mutation of this gene in the tumor tissue. This result suggests that mutation of SMARCB1, either alone or in the presence of PDGFRA and HRAS mutations, is associated with earlier onset GBM.
  • Unresolved Politics: Implicit Ambivalence and Political Cognition

    Gonzalez, Frank J.; Univ Arizona (SAGE PUBLICATIONS INC, 2020-05-01)
    This paper introduces a novel framework for understanding the relationship between implicit and explicit preferences and political cognition. Existing work in political psychology focuses primarily on comparing the main effects of implicit versus explicit attitude measures. This paper rethinks the role of implicit cognition by acknowledging the correspondence between implicit and explicit preferences (i.e., the distance between implicitly and explicitly measured attitudes). Data from the 2008 American National Election Study are used to examine implicit racial ambivalence, or the gap between one's implicit and explicit racial preferences, as it exists in the United States. Results indicate implicit racial ambivalence, which has been shown to yield effortful thinking related to race, is negatively related to education and Need for Cognition, and predicts race-related policy attitudes as well as vote choice in the 2008 election. Furthermore, implicit ambivalence moderates the influence of ideology on political attitudes, including attitudes toward outcomes that are only covertly related to race and cannot be predicted directly by implicit or explicit racial attitudes alone.
  • Social Determinants of Health and Health Care Delivery: African American Women's T2DM Self-Management

    Ochieng, Judith M; Crist, Janice D; Univ Arizona, Coll Nursing (SAGE PUBLICATIONS INC, 2020-04-22)
    African American (AA) women have high prevalence of Type 2 diabetes mellitus (T2DM) and complications. No studies have been conducted about how social determinants of health and health care delivery affect their T2DM self-management. The purpose was to describe how social determinants of health and healthcare delivery may influence AA women's T2DM self-management using qualitative descriptive methodology (N = 10). Ten participants were interviewed. Participants' geographical location, education, level of income, health literacy, and systemic racism, that is, healthcare delivery services, for example, inadequate healthcare services, providers' assumptions about the patient's knowledge of diabetes, providers' attitudes toward patients, and stigma related to diabetes as a disease were identified. Understanding the role of social determinants of health and the health care delivery system in influencing T2DM self-management is a powerful tool for providers and practitioners for improving practice and health care policies to decrease health disparities and improve health outcomes among AA women with T2DM.
  • A multi-century Sierra Nevada snowpack reconstruction modeled using upper-elevation coniferous tree rings (California, USA)

    Lepley, Kai; Touchan, Ramzi; Meko, David; Shamir, Eylon; Graham, Rochelle; Falk, Donald; Univ Arizona, Lab Tree Ring Res; Univ Arizona, Sch Nat Resources & Environm (SAGE PUBLICATIONS LTD, 2020-05-12)
    Snowpack in the Sierra Nevada Mountains accounts for around one-third of California's water supply. Melting snow provides water into dry summer months characteristic of the region's Mediterranean climate. As climate changes, understanding patterns of snowpack, snowmelt, and biological response is critical in this region of agricultural, recreational, and ecological value. Here we investigated the relationships between tree rings of montane conifer trees (Tsuga mertensiana, Abies magnifica, Abies concolor, Calocedrus decurrens, Juniperus occidentalis, and Pinus ponderosa) and regional climate indices with the goal of reconstructing April 1 snow-water equivalent (SWE) in the North Fork American River watershed of the Sierra Nevada. Chronologies were positively correlated with April 1 SWE of the year prior to ring formation. Temporal trends in correlation between tree-ring chronologies and climate indices indicate strengthening tree growth response to climate over time. We developed a skillful, nested reconstruction for April 1 SWE, 1661-2013. Variability of the reconstruction is within the envelope of 20th and 21st-century variability; however, the 2015 record low snowpack is unprecedented in the tree-ring record, as in results from previous studies. Future research should focus on integrating modern snow sensor data into paleoclimate research and understanding mechanistic linkages between snow and tree growth response.
  • Middle age, a key time point for changes in birdsong and human voice

    Badwal, Areen; Borgstrom, Mark; Samlan, Robin A; Miller, Julie E; Univ Arizona, Dept Neurosci; Univ Arizona, Univ Informat Technol Serv; Univ Arizona, Dept Speech Language & Heating Sci; Univ Arizona, Dept Speech Language; Univ Arizona, Dept Hearing Sci (AMER PSYCHOLOGICAL ASSOC, 2020-03-12)
    Voice changes caused by natural aging and neurodegenerative diseases are prevalent in the aging population and diminish quality of life. Most treatments involve behavioral interventions that target the larynx because of a limited understanding of central brain mechanisms. The songbird offers a unique entry point into studying age-related changes in vocalizations because of a well-characterized neural circuitry for song that shares homology to human vocal control areas. Previously we established a translational dictionary for evaluating acoustic features of birdsong in the context of human voice measurements. In the present study. we conduct extensive analyses of birdsongs from young, middle-aged, and old male zebra finches. Our findings show that birdsongs become louder with age, and changes in periodic energy occur at middle age but are transient; songs appear to stabilize in old birds. Furthermore, faster songs are detected in finches at middle age compared with young and old finches. Vocal disorders in humans emerge at middle age, but the underlying brain pathologies are not well identified. The current findings will motivate future investigations using the songbird model to identify possible brain mechanisms involved in human vocal disorders of aging.
  • Healthcare Ethics During a Pandemic

    Iserson, Kenneth; Univ Arizona, Dept Emergency Med (WESTJEM, 2020-04-13)
    As clinicians and support personnel struggle with their responsibilities to treat during the current COVID-19 pandemic, several ethical issues have emerged. Will healthcare workers and support staff fulfill their duty to treat in the face of high risks? Will institutional and government leaders at all levels do the right things to help alleviate healthcare workers risks and fears? Will physicians be willing to make hard, resource-allocation decisions if they cannot first husband or improvise alternatives? With our healthcare facilities and governments unprepared for this inevitable disaster, front-line doctors, advanced providers, nurses, EMS, and support personnel struggle with acute shortages of equipment—both to treat patients and protect themselves. With their personal and possibly their family’s lives and health at risk, they must weigh the option of continuing to work or retreat to safety. This decision, made daily, is based on professional and personal values, how they perceive existing risks—including available protective measures, and their perception of the level and transparency of information they receive. Often, while clinicians get this information, support personnel do not, leading to absenteeism and deteriorating healthcare services. Leadership can use good risk communication (complete, widely transmitted, and transparent) to align healthcare workers’ risk perceptions with reality. They also can address the common problems healthcare workers must overcome to continue working (ie, risk mitigation techniques). Physicians, if they cannot sufficiently husband or improvise lifesaving resources, will have to face difficult triage decisions. Ideally, they will use a predetermined plan, probably based on the principles of Utilitarianism (maximizing the greatest good) and derived from professional and community input. Unfortunately, none of these plans is optimal.
  • Augmenting the Disaster Healthcare Workforce

    Iserson, Kenneth; Univ Arizona, Dept Emergency Med (WESTJEM, 2020-04-13)
    In disasters such as the COVID-19 pandemic, we need to use all available resources to bolster our healthcare workforce. Many factors go into this process, including selecting the groups of professionals we will need, streamlining their licensing and credentialing processes, identifying appropriate roles for them, and supporting their health and well-being. The questions we must answer are these: How many staff will we need? How do we provide them with emergency licenses and credentials to practice? What interstate licensing compacts and registration systems exist to facilitate the process? What caveats are there to using retired healthcare professionals and healthcare students? How can we best avoid attrition among and increase the numbers of international medical graduates? Which non-clinical volunteers can we use and in what capacities? The answers to these questions will change as the crisis develops, although the earlier we address them, the smoother will be the process of using augmentees for the healthcare system.
  • Alternative Care Sites: An Option in Disasters

    Iserson, Kenneth; Univ Arizona, Dept Emergency Med (WESTJEM, 2020-04-13)
    During the current COVID-19 pandemic, the limited surge capacity of the healthcare system is being quickly overwhelmed. Similar scenarios play out when an institution’s systems fail, or when local or regional disasters occur. In these situations, it becomes necessary to use one or more alternative care sites (ACS). Situated in a variety of non-healthcare structures, ACS may be used for ambulatory, acute, subacute, or chronic care. Developing alternative care facilities is the disaster-planning step that moves communities from talking to doing. This commitment pays real dividends if a disaster of any magnitude strikes. This paper discusses the basic criteria for selecting, establishing and ultimately closing an ACS, difficulties of administration, staffing, security, and providing basic supplies and equipment.
  • SARS-CoV-2 (COVID-19) Vaccine Development and Production: An Ethical Way Forward

    Iserson, Kenneth V.; Univ Arizona, Dept Emergency Med (Cambridge University Press (CUP), 2020-06-05)
    The world awaits a SARS-CoV-2 virus (i.e., COVID-19 disease) vaccine to keep the populace healthy, fully reopen their economies, and return their social and healthcare systems to “normal.” Vaccine safety and efficacy requires meticulous testing and oversight; this paper describes how despite grandiose public statements, the current vaccine development, testing, and production methods may prove to be ethically dubious, medically dangerous, and socially volatile. The basic moral concern is the potential danger to the health of human test subjects and, eventually, many vaccine recipients. This is further complicated by economic and political pressures to reduce government oversight on rushed vaccine testing and production, nationalistic distribution goals, and failure to plan for the widespread immunization needed to produce global herd immunity. As this paper asserts, the public must be better informed to assess promises about the novel vaccines being produced and to tolerate delays and uncertainty.
  • Empowering Clinician Education with Patient‐Outcome Feedback

    Iserson, Kenneth V.; Univ Arizona, Dept Emergency Med (Wiley, 2020-06-07)
    Emergency physicians (EPs) often lack the information they need about their patients’ outcomes so that they can both optimally adjust and refine their diagnostic and treatment processes and recognize their clinical errors. Patient‐outcome feedback (POF) provides that information by informing clinicians about a patient’s clinical course after that clinician’s evaluation and treatment. This feedback may encompass the period after the EP has transferred a patient’s care to another EP or after the patient has left the ED or hospital. EPs obtain POF through various active and passive methods, depending on their institutional and medical record systems. Active methods require that clinicians or others spend time and effort acquiring the information; passive methods deliver it automatically. POF is an excellent performance‐based measurement that helps clinicians to stimulate their learning and to build their own validated mental library of outcomes with which to make clinical decisions, i.e., heuristics, System 1 thinking. POF offers especially useful feedback about patients who have been admitted, were referred to specialists, had major interventions, had potentially significant tests pending on discharge, or were handed off to another EP. The current healthcare system makes it difficult for EPs to discover their patients’ outcomes, squandering significant educational opportunities. Three stimuli to improve this situation would be to require EPs to receive passive POF as part of hospital accreditation, for reviewing POF to be classified as a Category 1 Continuing Medical Education activity, and to reimburse clinicians for learning activities related to POF. Research indicates that our healthcare institutions and systems would be well served to provide clinicians with ongoing automatic information about their patients’ outcomes.
  • A knowledge map analysis of brain biomechanics: Current evidence and future directions

    Eskandari, Faezeh; Shafieian, Mehdi; Aghdam, Mohammad M.; Laksari, Kaveh; Univ Arizona, Dept Biomed Engn (ELSEVIER SCI LTD, 2020-05)
    Although brain, one of the most complex organs in the mammalian body, has been subjected to many studies from physiological and pathological points of view, there remain significant gaps in the available knowledge regarding its biomechanics. This article reviews the research trends in brain biomechanics with a focus on injury. We used published scientific articles indexed by Web of Science database over the past 40 years and tried to address the gaps that still exist in this field. We analyzed the data using VOSviewer, which is a software tool designed for scientometric studies. The results of this study showed that the response of brain tissue to external forces has been one of the significant research topics among biomechanicians. These studies have addressed the effects of mechanical forces on the brain and mechanisms of traumatic brain injury, as well as characterized changes in tissue behavior under trauma and other neurological diseases to provide new diagnostic and monitoring methods. In this study, some challenges in the field of brain injury biomechanics have been identified and new directions toward understanding the gaps in this field are suggested.
  • Cluster robust covariance matrix estimation in panel quantile regression with individual fixed effects

    Yoon, Jungmo; Galvao, Antonio F.; Univ Arizona, Dept Econ (WILEY, 2019-11-05)
    This study develops cluster robust inference methods for panel quantile regression (QR) models with individual fixed effects, allowing for temporal correlation within each individual. The conventional QR standard errors can seriously underestimate the uncertainty of estimators and, therefore, overestimate the significance of effects, when outcomes are serially correlated. Thus, we propose a clustered covariance matrix (CCM) estimator to solve this problem. The CCM estimator is an extension of the heteroskedasticity and autocorrelation consistent covariance matrix estimator for QR models with fixed effects. The autocovariance element in the CCM estimator can be substantially biased, due to the incidental parameter problem. Thus, we develop a bias-correction method for the CCM estimator. We derive an optimal bandwidth formula that minimizes the asymptotic mean squared errors, and propose a data-driven bandwidth selection rule. We also propose two cluster robust tests, and establish their asymptotic properties. We then illustrate the practical usefulness of the proposed methods using an empirical application.

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