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  Comparison of Mixed Models and Paired T-Test for Analyzing Crossover Clinical Trials in the Presence of Missing Data

  Bell, Melanie; Vicenti, Anthony; Watkins, Joe; Zhou, Jin (The University of Arizona., 2020)

  AB/BA crossover clinical trials are popular designs that can achieve high power with a lower number of subjects than other randomized control trial designs. They are often analyzed using paired t-test or mixed models, and like many clinical trials, are often impacted by missing data. Mixed models have been shown to produced more powerful and unbiased results in the presence of missing data than t-tests for other designs, but these two approaches have not been compared in crossover trials. We conducted a simulation study to compare the bias and power of paired t-tests and mixed models when analyzing an AB/BA crossover clinical trial in the presence of missing data. Several different missing structures were simulated under two within-subject correlations, ρ =0.3 and ρ =0.7. Both methods performed similarly when analyzing complete data, but the mixed model produced both equal or less bias estimates and higher power than the paired t-test under all simulation scenarios. In the worst-case scenario we considered, the t-tests resulted in percent bias up to -105% and power as low as 5% compared the mixed model’s percent bias of 1% and 57% power. In less severe cases, both methods had 0% bias, but mixed models still achieved an absolute power gain of 2%-6%. In the presence of missing data, the mixed model achieved higher power than the paired t-test under all simulated scenarios. The mixed model also achieved equal or less bias under all simulated scenarios. Therefore, mixed models should be used over paired t-test when analyzing AB/BA crossover clinical trial in the face of missing data.
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  Reclaiming Mining Lands in Southern Arizona: A Scientific and Policy Inquiry towards Resiliency

  Maier, Raina M.; Neilson, Julia W.; Jennings, Lydia Luisa; Gornish, Elise; Rasmussen, Craig; Colombi, Benedict J. (The University of Arizona., 2020)

  Copper is critical to the sustainability of the modern lifestyle; however, mining creates massive land disturbance and generates large quantities of unstable waste materials that need to be managed for the long-term environmental and public health of neighboring communities (Lima et al., 2016). One waste challenge associated with modern mining is managing mine tailings. Mine tailing reclamation is site specific but often has a long-term goal towards ecological restoration and is impacted by stakeholder and rights holder associations (i.e. private, government or tribal) (Keller et al, 2011). Mine waste reclamation aims to stabilize waste to support self-sustaining plant communities. A critical limitation to vegetation success in mining waste is that these “soils” are deficient of the microbial communities and nutrients necessary to support plant establishment. The costs associated with these restoration activities can also be substantial, and vary with mine size, regulatory regimes, technology, presence of legacy reclamation costs, or cultural resources within the area (Mudd, 2009). Long-term ecological management of mine waste is an essential and problematic component of efficient mine site reclamation throughout the Southwest. Soil health properties essential to successful phytostabilization of reclaimed mine sites are poorly understood. This study found that total nitrogen and DNA biomass show promise as potential indicators of soil fertility that correlate with revegetation improvement. Our studies suggest that capping material source significantly influences the rate of plant establishment. Quantitative metrics must be further investigated to improve methods for screening potential capping material sources for mine tailings reclamation. Longer term studies are needed, particularly for mine recovery in the Southwest, where plants grow slower. Future work should consider how below ground fertility metrics reflect ecosystem stability and plant structure, and how the quality and application method of soil capping may impact future plant community structure.
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  Testing the Intrinsic Benefit Model of the Signaling Theory

  Galaskiewicz, Joseph; Okada, Sosuke; Breiger, Ronald; Kugler, Tamar (The University of Arizona., 2021)

  This study proposes the intrinsic benefit model of the signaling theory for sociology. The signaling theory is a subtheory of the game theory. It was developed independently within Evolutionary Biology and Economics, and it is concerned with the communications under the situations with asymmetrical information. Although the signaling theory have been widely adapted across social science, its influence within Sociology has been limited so far. This study proposes the argument that the signaling theory can achieve the increased relevance within Sociology by focusing on the role of (perceived) intrinsic benefit obtained from the signal production. The focus on the intrinsic benefit would allow the signaling theory to be applied on the broader range of phenomena which are of sociological interests, while at the same time analytically integrating additional social and symbolic contexts of the signals. Based on this argument, the propositions were developed about the role of the signal visibility and the intentionality of the signal. The three experiments were conducted to test the propositions. The two vignette experiments were conducted to test the effect of signal visibility on the signaling of environmental commitment through the purchases of electronic vehicles. A laboratory experiments was conducted to test the effect of the intentionality of the signal on the signaling of trustworthiness through donations. The first experiment gave the strong support to the propositions, whereas the second and the third experiment produced the mixed results. The author suggests that the overall findings are consistent with the main argument underlying the intrinsic benefit model.
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  Effects of Buffelgrass Removal and Nitrogen Addition on Soil Microbial Communities During an Extreme Drought in the Sonoran Desert

  Barberán, Albert; Williams, Jared Parker; Gornish, Elise; Blankinship, Joseph (The University of Arizona., 2020)

  Understanding the aboveground-belowground links between buffelgrass (Cenchrus ciliaris) invasion and soil microbial communities will be critical for developing a comprehensive understanding of arid ecosystems and for deploying successful control strategies. Buffelgrass, an invasive grass in the arid areas of the US, has drastically modified natural ecosystems. Buffelgrass control efforts have been generally unsuccessful, partly due to the insufficient understanding of how this species might alter belowground conditions in a way that promotes its own spread. In a randomized-block field experiment located at Tumamoc Hill, Arizona, we investigated the effects of buffelgrass removal via hand pulling and nitrogen addition (and their interaction) on soil microbial communities during an extreme drought. We found that these treatments did not significantly impact bacterial and archaeal community diversity and composition, while plant removal weakly affected fungal community diversity and composition. In addition, the removal treatment increased the proportion of putative chitinolytic bacteria (genus Lysobacter) and decreased the proportion of putative fungal endophytes (genus Darksidea). Buffelgrass manual removal may favor fungal endophyte death around and inside of leftover intact roots of buffelgrass, which may result in an increment of chitinolytic bacteria thriving on the degradation of fungal cell walls. Overall, my results suggest that buffelgrass removal can alter soil fungal communities and the proportion of certain microbial functional groups, and low levels of nitrogen addition during an extreme drought may not influence the effects of buffelgrass on soil microbial communities.
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  Beyond Goodbye: Daily Emotion Regulation from Network Members and from Thoughts of Deceased Loved Ones

  O'Connor, Mary-Frances; Stelzer, Eva-Maria; Butler, Emily; Greenberg, Jeff; Mehl, Matthias; Sbarra, David (The University of Arizona., 2021)

  Background: The present daily diary study tested the ERROSS model (Stelzer & O'Connor, under review), examining whether conjugally bereaved individuals benefit from a diverse repertoire of social interaction partners and daily emotion regulation (ER) strategies. Beyond living supportive others, the study investigated associations between daily ER from thoughts of the deceased loved one and mental health, and the potential role of attachment moderators.Method: Participants were 156 community-dwelling adults (86% females) who experienced the death of a spouse or romantic partner up to five years prior. In a structured two-week long daily-diary, participants listed their daily interaction partners and the ER strategies provided by them as well as their daily mental wellbeing and grief. In addition, participants reported on their mental interactions with their deceased spouse and described the felt ER evoked by those interactions. Results: Multilevel modeling analyses found that at the within-person level, daily repertoire was positively related to positive affect, and daily network size was negatively related to life satisfaction. At the between-person level, greater averaged repertoire and network size were positively associated with mental wellbeing (i.e., greater positive affect and life satisfaction, lower negative affect). For ER from the deceased, ER strategies from the deceased were associated with increased negative affect on a daily level, but positively associated with positive affect and life satisfaction on the between-person level. No significant mental health associations emerged for daily grief. Conclusion: These results provide the first evidence of the ERROSS model in a naturalistic setting, and highlight the benefits or a diverse repertoire of ER during the transition to widowhood.
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  Differential Selection and Schizophrenia Orthologues: The Roles of Life History, Neuroanatomy, and Socioecology

  Jacobs, William J.; Penaherrera Aguirre, Mateo; Figueredo, Aurelio J.; Steklis, Netzin G.; Steklis, Horst D. (The University of Arizona., 2020)

  The evolution of major psychopathologies remains a point of intense debate within the scientific community. Counter to classical Darwinian perspectives, these disorders persist in human populations despite their high fitness costs (shorter lifespan and fewer surviving offspring reaching sexual maturity). Schizophrenia, an umbrella term referring to a cluster of positive (delusions, hallucinations, disorganized behaviors) and negative signs (flattened affect, limited motility, anhedonia, asociality, among others), is no exception. Over the past three decades, researchers have developed various theories to address this evolutionary conundrum. Comparative researchers have addressed this subject by investigating numerous empirically based animal models. These investigations have detected potential mechanisms involved in the development of schizophrenia and explored the effectiveness of various interventions aimed towards reducing the pathology’s severity. Even though this approach offers a unique approach to this subject, the current literature could benefit from a comparative phylogenetic perspective. For example, the molecular genetic literature has identified a positive association between life history indicators, such as maximum longevity, with the persistence of ancestral variants of genes (orthologues) across non-human species. Given that slow-life history species are generally subject to weaker selective pressures, this pattern is expected. Hence, deleterious or near deleterious mutations are harder to eliminate. The present dissertation aims to complement the molecular genetic literature by considering the roles of life history, neuroanatomy, and socioecology in this pathology's evolution. The current manuscript describes three comparative phylogenetic studies that outline the evolution of schizophrenia. Study 1 explored the connection between life history and the (dN) ̅⁄(dS) ̅ values (a metric of orthologue persistence) of this pathology. Building on the previous result, Study 2 proposed a comparative phylogenetic examination of schizophrenia, autism, and bipolar disorder orthologues, as a potential complementary avenue for understanding the evolutionary dynamics of comorbidity among these disorders. As predicted, the analyses detected an underlying common genetic factor loading into the orthologue estimates for each disorder. Moreover, a Higher-Order Life History factor exhibited significant positive associations with the (dN) ̅⁄(dS) ̅ values of autism and bipolar disorder. Similarly, this latent variable positively and significantly predicted the Genetic Psychopathology factor. Study 3 explored the connections among substrate use, diet, sociality, life history, neuroanatomy, and their respective relations with the persistence of schizophrenia orthologues in eutherian mammals. The model hypothesized that a Higher-Order Life History factor should positively associate with neuroanatomical indicators such as the species’ total number of neurons. Lastly, the number of neurons predicted the persistence of schizophrenia orthologues. Life history mediated the association between sociality and neuroanatomy. Moreover, the total number of neurons mediated the connection between life history and the estimates for schizophrenia orthologues. The phylogenetic model demonstrated that sociality, a Higher-Order Life History, and the total number of neurons had significant positive associations with schizophrenia ancestral alleles' persistence.
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  Factors Shaping Endophyte Communities Associated with Selected Cultivated Plants in Arizona

  Arnold, Anne E.; Hamzazai, Aasiya; Schuch, Ursula; Ray, Dennis T.; Pessarakli, Mohammad; Orbach, Marc J. (The University of Arizona., 2020)

  Symbiotic microbial communities can be found in all plant species in all major terrestrial ecosystems including wild, horticultural, agricultural and residential garden settings. Microorganisms such as some bacteria and fungi that colonize the interior of a plant tissue without causing apparent disease – endophytes -- can be acquired through horizontal transmission or via vertical inheritance. Studies have shown that endophytes inhabit all tissue types of host plants and play vital roles in plant health and productivity, providing tolerance against biotic and abiotic stresses. However, the diversity of endophytes occurring in different plant tissues such as leaves, stems and seeds, and the factors that influence the endophytic diversity in those tissues is not well known. The knowledge gap is especially large for semi-arid areas such as Arizona, where endophytes may be especially important for plant survival under environmental stress.In the first part of this study, I evaluated colonization of three different types of crop seeds by soilborne fungi under different agricultural, residential and wild grassland settings in central and southern Arizona, USA. I found that fungal colonization differed among plant varieties, even when placed into the same soil. Seeds recruited distinct fungal communities in different locations, and fungal communities differed among agricultural, residential, and grassland settings. Variation in fungal communities was consistent with variation in soil chemistry. This work provides a case study regarding the diversity of fungal endophytes that can infect seeds in Arizona soils and highlights the prevalence of certain taxa, such as Fusarium and Alternaria, that are especially common and may be beneficial for plants, despite their reputations more broadly as undesirable pathogens or producers of mycotoxins. In the second part of this study, I provide a first perspective on endophytic biodiversity associated with common plants in a residential garden setting (i.e., the garden endobiome). I surveyed leaf and stem tissue of 17 different plant varieties late in the growing season in a garden environment in Tucson, Arizona. I found that the isolation frequency of bacterial and fungal endophytes from leaves, and bacterial endophytes from stems, varied among plant families. Different plant species in a given family showed similar isolation frequencies of endophytes. In general, bacteria were more common in leaves, and fungi were more common in stems. Edible and inedible leaves harbored fungi with similar frequency overall, but I did not observe bacteria in edible leaves. Because this study used inexpensive methods, I develop it further as the basis for an educational module to be used for students at the high school or college level, with limited resources, to study endomicrobiomes of cultivated plants in developing countries. Ultimately, my dissertation provides an overview of the endophytic communities that colonize various tissues and plant species in a variety of settings in Arizona. Such studies can help in mapping the distributions of endophytic microbes important for plants and provide a road-map for identifying the drivers of their community composition. These studies also can provide a basis for selecting potentially beneficial fungi and bacteria to aid in plant resilience in a changing world. Finally, this body of work provides a basis for teaching students in the developing world about biodiversity, ecology, mycology, and plant biology through endophytes, Earth’s most widespread symbionts of plants.
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  Calculation of the Resummed Radiation Reaction to Order 1/M Using Heavy Fermion Effective Theory

  Fleming, Sean P.; Hill, Andrew; Rutherfoord, John; Su, Shufang; Gralla, Samuel E.; Meinel, Stefan (The University of Arizona., 2020)

  The Abraham-Lorentz-Dirac equation, which is the widely-accepted expression for the recoil force experienced by a radiating charge (known as the \textit{radiation reaction}), displays strange, unphysical behavior. As such, it has been rife with controversy and confusion for over a century. For most of that time, these issues were treated mostly as curiosities and left to the musings of theoreticians. But the advent of high-intensity pulsed tabletop lasers in recent decades has made the radiation reaction relevant to modern experimental physics, which has led to a resurgence of research into the topic. In this dissertation, we calculate the radiation reaction to order $m^{-1}$ experienced by a charge of mass $m$ in an external electromagnetic field resulting from emission of a single photon. To accomplish this, we use heavy fermion effective theory (HFET), which is an effective field theory of QED, and model the total electromagnetic field as the superposition of a quantized self-field associated with the charge and a classical external field. HFET is a novel approach that greatly simplifies the calculation compared to full QED. The simplified calculations allow us to resum our force expression to all orders in $e A_{\text{cl}}$, where $A_{\text{cl}}$ is the background field; this is a novel result. Wilson lines arise in our expressions as a result of resummation.
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  A 5-Axis Calibration System for Calibrating DOI-Correcting Gamma-Ray Detectors

  Furenlid, Lars R.; Anderson, Owen Adams; Kupinski, Matthew A.; Sabet, Hamid (The University of Arizona., 2020)

  Improving the resolution of pinhole single photon emission computed tomography (SPECT) depends on correcting parallax error at the edges of gamma-ray detectors. A novel way to achieve this is to use laser-induced optical barriers (LIOB) to restrict the spread of scintillation photons to a segment of the crystal that corresponds to a ray angle through the pinhole. The gains in resolution at the edge of the detector would be lost, however, without a way to use maximum likelihood (ML) position estimation to correlate detector response to the segment of the scintillation crystal where the gamma ray scintillated into visible photons. To find the response from a given segment of the crystal, a mean detector response function must be acquired from recording the mean detector responses when a known ray angle of gamma ray enters the detector. This motivates designing an building a novel calibration stage that has the ability to aim a pencil-beam of gamma rays into a detector at any position and angle that is possible with a photon traveling through the pinhole from the field of view.
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  Beyond the Standard Model Higgses at Future Colliders

  Su, Shufang; Li, Shuailong; Meinel, Stefan; Varnes, Erich; Johns, Kenneth; Zhang, Shufeng (The University of Arizona., 2020)

  Motivated by several long-standing puzzles confronting the Standard Model (SM) in particle physics, many Beyond Standard Models (BSM) with extended Higgs sectors were proposed. The Two-Higgs-Doublet Model (2HDM) is a prototype model with two doublets in the Higgs sector. Other than the SM-like Higgs h, the low energy spectrum of 2HDM contains four BSM Higgs states, the neutral CP-even Higgs H, the neutral CP-odd Higgs A and a pair of charged Higgs H±. Along with the four incarnations, namely type-I, type-II, type-L and type-F, it provides rich phenomenologies for exploration. In this thesis, we explore four types of 2HDMs at several future colliders as well as the opportunities to distinguish them. Two general methods are employed: the direct search at a future 100 TeV pp collider and a multi-TeV muon collider and the indirect search at several proposed Higgs factories and Z-factories. With direct search, we study the exotic charged Higgs decay H± -> HW± in a hierarchical Type-II 2HDM at a 100 TeV pp collider and find that almost the entire space can be probed after combining with other exotic Higgs decay modes. In addition, due to the clean environment at a muon collider, it allows the probe of heavy BSM Higgses at an unprecedentedly high scale and offers remarkable chances for discrimination among the four types. With an indirect search, BSM Higgses are explored by accurately studying their corrections to the SM Higgs and Z-pole precision observables. For illustration, we study the impact on Type-I 2HDM and find the parameter space can be tightly constrained. The discovery potential and the extent to which the four types of 2HDMs could be distinguishable are also examined. We find that most of the currently allowed parameter regions permit a 5σ discovery at future Higgs factories and the four types of 2HDMs can be largely distinguishable once a 5σ discovery is made.
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  Implementation of a Migrant Well-Child Health Toolkit for CAWC Healthcare Providers

  Peek, Gloanna J.; Warne, Adriana; Russell-Kibble, Audrey (The University of Arizona., 2020)

  Purpose. The purpose of this QI project was to implement a Migrant Well-Child Health Toolkit at Casa Alitas Welcome Center (CAWC) that serves as a guideline for volunteer medical professionals in conducting comprehensive well-child examinations on migrant children upon arrival to the migrant shelter in Tucson, Arizona.Background. Arizona is one of ten U.S. states that houses nearly three-quarters of children in immigrant families (Linton et al., 2016). The migrant population arrives with unique healthcare needs and is more likely to immigrate with pre-existing health conditions and exposure to traumatic events because of their turbulent migration histories (Seery et al., 2015). Conducting comprehensive well-child assessments on newly migrated children will prepare them for school entry, identify immediate health needs, assess developmental milestones, and ensure vaccinations are up to date (AAP, 2020a). Methods. This QI project used a pre and post-survey design. The Migrant Well-Child Health Toolkit is comprised of current recommendations for migrant well-child visits according to the AAP, CDC, WHO, Bright Futures Guidelines, SAMHSA, and Arizona’s EPSDT program. A pre-recorded PowerPoint presentation delivered provider training to the participants on the toolkit. A pre-survey assessed their prior knowledge of conducting well-child examinations on migrant children. The post-survey evaluated their learning and readiness to implement the intervention and included questions to determine the toolkit's initial validation. Results. A convenience sample of 10 participants (n=10) completed the project’s components with a response rate of 10.8%. All of the project’s outcomes were met; increased provider knowledge in migrant child health, confidence in performing well-child health screenings, and intent to conduct well-child health assessments at CAWC. Additionally, 90% (n=9) of CAWC providers indicated that the toolkit contains the resources necessary to conduct well-child screenings on migrant children. Conclusion. The findings suggest that the toolkit was developed with high-quality evidence, clear presentation, and offers the resources necessary to conduct well-child screenings at CAWC. This data serves as an initial step to inform future efforts that promote health equity and guides an implementation strategy to integrate the Migrant Well-Child Health Toolkit into clinical practice when caring for migrant children.
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  Improving the Clinical Management of Pediatric Concussions in Rural Primary Care

  Prettyman, Allen; Samsam, Leila; Gregg, Renee; Raubacher, Saundra (The University of Arizona., 2020)

  Purpose: This project aims to determine if a targeted educational module about return-to-learn coupled with instruction about using a concussion symptom evaluation tool improves provider knowledge about guideline recommendations and the intent to translate knowledge into practice at North Country Health Care. Background: Concussions are a common cause of morbidity in youth, with the incidence rising. Since primary care providers (PCPs) are predominantly responsible for managing concussions, their knowledge about evidence-based care is crucial to patient outcomes. Significant gaps exist in provider knowledge of return-to-learn guideline recommendations, potentially resulting in suboptimal care. Numerous pediatric concussion clinical practice guidelines and validated concussion evaluation tools are available to guide practice. The literature suggests that provider education is a critical component of disseminating guideline recommendations. Methods: The quality improvement project consisted of a targeted educational presentation delivered to health care providers at North Country Health Care. The education highlighted key return-to-learn guideline recommendations and introduced a concussion symptom evaluation tool that the participants applied to a clinical case study. Pre and post-test surveys assessed knowledge and intent to apply knowledge to practice. Results: Using descriptive statistics, a comparative analysis of pre- and post-test surveys were completed to determine if the education intervention improved provider knowledge about return-to-learn recommendations. The findings showed a 47% improvement in overall knowledge about return-to-learn guideline recommendations following the education, and 60% of participants reported they intended to translate knowledge into practice. Conclusions: The project findings support the literature regarding existing knowledge gaps in primary care about return-to-learn guideline recommendations. Several guidelines exist, but effective dissemination is a barrier. The outcomes demonstrated substantial improvement in provider knowledge of key return-to-learn guideline recommendations using a targeted education designed for adult learners, reinforcing existing literature that education is a crucial component of evidence-based practice. Future quality improvement (QI) efforts should focus on disseminating return-to-learn guidelines to a larger number of providers. Research should focus on determining the most effective dissemination strategies for translating knowledge into practice.
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  mHealth Feasibility: Assessing Oregon’s SBIRT App for Primary Care Self-Screening

  Daly, Patricia; James, Stacy; Pacheco, Christy; Shea, Kimberly (The University of Arizona., 2020)

  Purpose: The purpose of this quality improvement project was to assess the feasibility and usability of self-screening for risky substance use using the Oregon SBIRT app in a primary care setting. This project was conducted in the University of Arizona Telehealth Learning Center (TLC), a virtual clinic with professional participants.Background: Mobile health applications (mHealth apps) are gaining popularity in health management. Substance use interventions via mHealth improve access, especially for rural and underserved patients. Engagement with technology may reduce the stigma often reported with in-person exchanges. The Oregon SBIRT app is currently the only patient-facing app using the SBIRT method. Methods: TLC participants received an emailed disclosure form and link to a scheduled, recorded group Zoom session. After reviewing the project’s purpose, the SBIRT method, and the Oregon mHealth app, participants completed online surveys. Participants accessed the online Oregon SBIRT app using personal Internet-connected devices. Pseudonyms and fictional scenarios of substance use habits were used to protect privacy. Themes from subjective reports and validated measurements determined the feasibility and usability of the Oregon SBIRT app for self-screening in a primary care setting. Results: To be clinically feasible and useful, the Oregon SBIRT app requires a secure and easily accessible method to communicate app results. Participant feedback focused mainly on the challenges of managing multiple technologies in an online group setting. Conclusion: Quality improvement project design should not add unnecessary complexity or detract from the project's purpose. Remote videoconferencing may be inappropriate for trialing mHealth apps in a group but may be ideal for conducting focus groups.
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  Transitions from Jail in the Rural Community for Adults with Mental Illness

  McEwen, Marylyn; Langley, Carrie Ann; Kahn-John, Michelle; Rainbow, Jessica (The University of Arizona., 2021)

  The purpose of this study was three-fold: 1.) to address the gap in our understanding of the factors that facilitate the use of community-based transitional support services post-release from jail when transitioning into the rural community for adults with mental illness and 2.) to address the gap in our understanding of the factors that inhibit the use of community-based transitional support services post-release from jail when transitioning into the rural community for adults with mental illness and 3.) to determine the acceptability of a biological sample to measure interlukin-6 (IL-6) for future research. Annually, nearly one million people are incarcerated in jails throughout the United States, with over 80% of them experiencing a mental illness. Rural communities have greater rates of disease burden and fewer community-based resources. These factors combined with the lack of mandated jail-to-community transition programs complicate the transitional experience for individuals living with mental illness. The transitional period, from jail to the community is filled with competing demands and can cause stress and anxiety. Acute stress has been associated with inflammation. This population often expresses resistance in providing biological samples, so aim three will allow for planning for future research involving biological specimen collection. This qualitative descriptive study provided a rich account of the inhibitors and facilitators experienced among individuals transitioning from the rural jail to the rural community while experiencing mental illness. Meleis’ Transitions Theory provided the conceptual underpinnings for this study. Data sources included interviews, a demographic data questionnaire and field notes. Data analysis was developed through qualitative content analysis through open coding, which allowed the researcher to build concepts and categories, forming themes. This iterative approach allowed for the grouping of similar codes and clusters. The results of this study illuminated several points. “Out of Jail but No Freedom” established the overarching theme for this study in which the facilitators and inhibitors of situational and health-illness transitions for adults with mental illness transitioning to the rural community is described. This research is significant for nursing practice and policy reform. Systematic reform is needed within jail medical operations, clinical models of community provided care, within policy that guides healthcare funding and delivery models, as well as court services. Mandated policies, unfunded and directed to be financially supported by communities further perpetuate disparities and social determinates of health, significantly impacting our most rural and socioeconomically depressed locations. This study illuminates the need for systematic reform within our medical divisions of rurally located jails as well as within public policy that guides healthcare funding and clinical models of care. It has become evident from this research the transition from jail is largely shaped by the experience while incarcerated. Individuals who experience jail incarceration have a right to evidenced-based standards of care, and transition programs to assist them back into the community.
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  Restoration and Recovery of Soil Microbial Activities Following Disturbances in Drylands: Mining, Warming and Wildfire

  Gallery, Rachel E.; Espinosa, Noelle Justine; Moore, Dave JP; Breshears, Dave D.; Saleska, Scott R. (The University of Arizona., 2020)

  Drylands cover a large portion (approximately 40%) of the Earth’s land area and are under expanding pressures to provide ecosystem services for a growing population, which results in significant disturbance to soils and soil degradation. Disturbance to dryland soils may come from land use changes such as mining, environmental changes such as climate warming and ecosystem regime changes such as increased wildfire frequency and severity. These disturbances negatively impact numerous critical soil functions, including site productivity, soil carbon storage and cycling, and ecohydrological dynamics, the restoration of which requires an understanding of microbial processes that may regulate these functions. This dissertation examines the response of microbial activities to these differing examples of dryland disturbances and their role in the restoration or natural recovery of the critical soil functions described above. I first evaluated the effects of three candidate restoration amendments (woodchips applied at the surface, woodchips incorporated into the soil and biochar incorporated into the soil) on soil carbon dynamics and microbial activities as well as plant cover in disturbed soils. I found the most beneficial effects on extracellular enzyme activities and soil carbon resulted from surface-applied woodchips, while woodchips incorporated into the soil may increase heterotrophic soil efflux of CO2 and soil carbon loss, adversely affecting the restoration of critical soil functions. Following this study, I evaluated the potential influence of prolonged warming on the microbial responses to these restoration amendments. I found that responses to warming in drylands may be limited, and therefore the beneficial outcomes of surface-applied woodchip restoration amendments may remain useful under warmer conditions. Finally, using a 30-year chronosequence of fire in the Rocky Mountains of Colorado, I evaluated the degree and persistence of the effects of high severity fire disturbance on extracellular enzymes and the relationship between extracellular enzyme activities and critical soil functions. We found a persistent long-term negative effect of high severity fire on soil extracellular enzyme activities and that recovery of vegetation and subsequent carbon inputs to soil are a key component of extracellular enzyme recovery. Taken together, this research provides evidence that evaluating microbial responses to restoration or recovery of soils can contribute to our understanding of the success of restoration activities and natural recovery of dryland soil.
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  Opioid Consenting: A Novel Program to Address Opioid Safety

  Carlisle, Heather; Adams, Kalekia; Grimm, Doneen; Shea, Kimberly (The University of Arizona., 2020)

  Purpose. The purpose of this program evaluation was to determine the impact of St. Joseph’s opioid consent initiative on naloxone (Narcan) use and opioid prescribing patterns at discharge in accordance with recommendations and strategies set forth by the CDC and ADHS to increase opioid patient safety.Background. Opioids are commonly used in managing moderate to severe pain in the hospital setting (Costello, 2015). In the United States (US), opioids are the most common drug class of prescriptive medication (Stepan et al., 2019). Coincidentally, opioids are classified as a leading cause of death in individuals under 50 years of age in the US with overdose fatalities from opioid use steadily increasing over the last 20 years across the country (National Institute on Drug Abuse [NIDA], 2015; Stepan et al., 2019). In Arizona, more than two people die each day because of opioid overdose (ADHS, 2020). Since 2017, and for each year thereafter, Maricopa County has consistently reported the highest number of verified overdose cases for commonly prescribed opiates (ADHS, 2020). St. Joseph’s hospital developed an opioid consenting program to attempt to address prescription opiate safety in the community by targeting patient’s disembarking the acute setting by offering opioid educational awareness for informed decision making regarding the inclusion of opioids in their care regimen at discharge. Methods. A formative program evaluation using pre and post outcome measurement comparisons to examine the effect of opioid consenting on documented Narcan administrations and discharge opioid prescriptions six months before and after program implementation. Results. Opioid prescriptions from the pre-implementation period (Mean = 1039.18, SD = 1445.09) decreased significantly, Z = 2.7136, p = .00666 compared to the post-implementation period (Mean = 674.73, SD = 1045.09). The difference in Narcan use from the pre-implementation period (Mean = 85, SD = 90.51) and post-implementation period (Mean = 96.5, SD = 105.36) was not significant, Z = 1.41421, p = .1573, alpha = 0.05. Conclusions. The significantly decreased number of opiate prescriptions cannot solely be attributed to initiation of the opioid consent program due to indeterminable effects of multiple unmeasured confounding factors. Further evaluation is warranted.
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  Toward a History of the Institutionalization of the Classical Guitar: Vahdah Olcott Bickford (1885–1980) and the Shaping of Classical Guitar Culture in Twentieth-Century America

  Mugmon, Matthew S.; Acosta Zavala, Kathy; Post, Jennifer C.; Rosenblatt, Jay M. (The University of Arizona., 2020)

  This dissertation has two primary aims: to demonstrate how women guitarists have been the primary advocates for the construction of a guitar-specific institutional landscape, and — with a specific focus on American guitarist Vahdah Olcott Bickford (1885–19890) — to narrate the history of the establishment of local guitar societies across the United States. Although guitar societies have become ubiquitous in the early twenty-first century, the formation of the first American guitar society in 1923 was a byproduct of women guitarists’ entrance into the workforce and of the longstanding tradition of women’s philanthropy and voluntarism in the arts. Furthermore, the guitar society model derived from national and international institutional precursors. The most important of these precursors were the American Guild of Banjoists, Mandolinsists and Guitarists (BMG Guild) and the German guitar societies that emerged between 1899 and 1910. I argue that guitar societies allowed amateur and professional classical guitarists to break from the multi-instrument values fostered by the BMG movement in order to organize and focus their efforts on solely promoting the classical guitar. As one of the founding members of the American Guitar Society (AGS) and Guitar Foundation of America (GFA), Vahdah Olcott Bickford was one of the main forces behind the establishment of classical guitar organizations in America. Her efforts to establish an American guitar society were not isolated, but rather were inspired by the activities of other women guitarists emerging at the turn of the twentieth century, such as Gertrude Miller, and of women philanthropists in her network in Los Angeles. Through the lens of philanthropy and voluntarism, I show that Olcott Bickford was as an institutional pioneer and the first American philanthropist who devoted her life to preserving classical guitar culture in America.
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  A Rhetorical Analysis of Selected Motets of Johann Christoph Bach (1642-1703)

  Chamberlain, Bruce; Brobeck, John T.; Vanderlee, Jeffrey Keith; Schauer, Elizabeth (The University of Arizona., 2020)

  The motets of Johann Christoph Bach (1642-1703) represent a small, but richly expressive body of work that has fallen out of regular performance in the modern day. In the generation just following his life, however, Bach was lavished with praise for his colorful text setting in historical family documents compiled by his younger cousin Johann Sebastian Bach (1685-1750) and his son Carl Philipp Emanuel Bach (1714-1788). Composers of Lutheran sacred vocal music studied rhetoric as part of the Lateinschulen curriculum, and developed a method of applying the rhetorical process of spoken oratory to the process of musical composition. This included the equation of specific musical gestures to ornamental figures of speech, known as musical-rhetorical devices, which composers utilized to bring text to emotionally stirring, persuasive delivery.The motets of Bach were composed in the midst of a large-scale reconceptualization of harmony spurred by the codification of the harmonic triad as the basic unit of harmony, rather than the melodically based modal system of the Renaissance. This is the transitional period between modality and modern tonality. Bach actively composed near the end of this century-long transition, and his harmonic language contains elements of both harmonic systems. I provide an exploration of the expressive techniques of Johann Christoph Bach as seen in a sample selection of three motets that were composed amidst the transitional harmonic atmosphere of seventeenth-century Germany, and focus on Bach’s varied application of musical-rhetorical devices to render each clause of text persuasive and memorable.
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  A Comparative Study of Vladimir Leyetchkiss's 1985 Piano Transcription of Igor Stravinsky’s Le Sacre du printemps

  Woods, Rex; Linder, Daniel; Dong, Minjun; Knosp, Suzanne; Cockrell, Thomas (The University of Arizona., 2020)

  Vladimir Leyetchkiss was a pianist, composer, and teacher born in Russia on August 8, 1934. It was Leyetchkiss’s love for transcriptions that led him to study with Heinrich Neuhaus. His passion for writing and playing piano transcriptions was fueled by his strong interest in orchestral music and conducting. His transcription work was facilitated by his impressive technique as well as his ability to produce an orchestral sound at the piano. He transcribed numerous orchestral works for the piano including Trois nocturnes by Debussy, L’Apprenti sorcier by Dukas, Tasso: Lamento et Trionfo by Liszt, symphonies of Taneyey and Prokofiev, and most notably, Igor Stravinsky’s Le Sacre du printemps. This study shows that Leyetchkiss’s piano transcription of Le Sacre du printemps is superior to three existing transcriptions of the same work by other composers, because of its fidelity to the original orchestral score. The three existing transcriptions are: Le Sacre du printemps for Piano Four Hands by Igor Stravinsky; The Rite of Spring: Complete Ballet for Piano Solo by Sam Raphling; “The Rite of Spring: An Original Solo Piano Transcription of Stravinsky's 1913 Ballet with Annotations and Historical Notes” by William Norman Fried. Leyetchkiss’s piano transcription not only includes as many elements and voices as possible from the orchestral score but is also practical and accessible for the performer. Studying and performing this repertoire is a rewarding process for pianistic and musical growth. A comparative analysis of these four transcriptions will follow a brief history of the development of the piano transcription (Chapter 2), and an introduction to Stravinsky’s Le Sacre du printemps (Chapter 3). Chapter 3 includes comparison of selected passages from five representative sections of Le Sacre du printemps: “The Augurs of Spring,” “The Ritual of Abduction,” and “Dance of the Earth” from Part I and “Naming and Honoring of the Chosen One” and “Sacrificial Dance (The Chosen One)” from Part II.
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  Development of Wireless Implantable Micro Flow Sensor for Conditional Monitoring of VP Shunts

  Enikov, Eniko T.; Edes, Gergo; Anton, Rein; Nikravesh, Parviz E.; Tharp, Hal S. (The University of Arizona., 2020)

  This dissertation describes the development of a self-contained high-frequency high sensitivity implantable microfluidics flow sensor using MTJ magnetic sensors to detect motion of slow-moving fluids. A motivating application for the proposed device is the development of an implantable flow sensor, capable of monitoring the amount of cerebral spinal fluid drained from the ventricles of the brain. Micro-fabricated ferromagnetic flaps are used to detect motion of the surrounding fluid. The deflection of the flaps is detected by an ultra-sensitive MTJ magnetic field sensor placed outside of the lumen of the catheter. Numerical and experimental results are provided demonstrating a resolution of 0.4 ml/h, a working range of 0-40 ml/h, and a maximum uncertainty of 4% RMS. The present study identifies thermal noise as the main source of low-frequency drift. Using thermal compensation, it was found that the drift can be reduced below 2 ml per 24-hr. Combining an array of four transducers operating in series, it has been demonstrated that a sensitivity can be increased 10.9-fold. Furthermore, the report examines the long-term structural stability of the sensors and produces a corrosion report suggesting a lifespan of 15 to 55 years. MRI compatibility analysis showed a sensitivity reduction of 64% in the device. Several in vivo recalibration methods were introduced to eliminate the calibration error. A protein deposition study showed stable sensor performance under 1.5 mg/ml protein concentration.

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