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  Managing Flash Floods: Risk Perception from a Cultural Perspective

  Coles, Ashley R. (The University of Arizona., 2008)

  Flood risk managers educate the public on the dangers of driving through flooded roadways, yet losses to life and property continue to occur. This study integrates cultural psychology and risk perception theory to explore how culture, psychological processes, and behavior influence one another. Flood risk managers in Tucson, Arizona collaborated in the development of a questionnaire mailed to local residents. Questions regarding levels of trust, self-efficacy, social autonomy, social incorporation, time perspective, and situational factors were analyzed with respect to whether respondents stated that they have or have not driven through a flooded roadway. Respondents’ decisions are influenced by the presence of signs and barricades, passengers, risk of personal injury or damage to the vehicle, and the availability of flood-related information. The most influential factor is the prior successful crossing of other vehicles. The results illuminate complex interrelations among the cultural factors and provide considerations for future risk perception research.
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  Management Of Food Allergies In School Settings

  Masciola, Anna Marie (The University of Arizona., 2019)

  This thesis will highlight the most current research regarding the management of food allergies and anaphylaxis in the school setting. Food allergies have become extremely common among the modern population, and school officials may not have the proper tools in place to properly care for a food allergic child or an anaphylactic emergency (Food Allergy Research and Education, 2018). This literature review summarizes barriers to managing food allergies well in the school setting, as well as knowledge and perceptions of school staff members before they are educated on food allergies. It also describes several policy changes and educational interventions that promote a safer school environment, which can be implemented to create a safe school environment for the food allergic student. The role of the school nurse in implementing these changes is also discussed. In addition to current research, this thesis will also list best practice recommendations, a theoretical implementation plan, and a theoretical evaluation process.
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  Mind Body Therapies For Pain Management A Best Practice Approach

  Frisch, Courtney Lanier (The University of Arizona., 2019)

  This thesis examines the most current research on mind body therapies in pain management. The purpose of exploring mind body therapies in pain management is to move away from the use of opioids to manage pain and towards an integrative nursing approach. The opioid epidemic is growing, and the statistics are tragic. In 2016, an estimated 2.4 million Americans had an opioid use disorder (Ryan, 2018). Pain is a challenge that affects Americans in all populations. The American Nurses Association states that 11-40% of the U.S. population reports some level of chronic pain for a time period over three months (American Nurses Association, 2018). The literature review that has been conducted in this thesis analyzes the best practices of mind body therapies to manage pain. The mind body therapies recognized in this thesis include mindfulness meditation, guided imagery, breathing exercises and relaxation techniques. The goal of this research is to improve the opioid epidemic statistics by removing opioids or decreasing the dose and frequency of opioids in pain management plans through education. In addition to the literature review, this thesis will outline best practice recommendations, a projected implementation plan and a proposed evaluation of the implementation method.
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  Best Practices In Tobacco Cessation In Rural Populations

  Gawin, Leah Grace (The University of Arizona., 2019)

  The purpose of this thesis is to develop best practice recommendations to provide tobacco cessation to rural populations. Recommendations for best practice will be developed from evidence-based research within the last ten years. Tobacco addiction is still a problem in America and tobacco cessation interventions are needed to fight this epidemic. Tobacco use accounts for six million deaths per year and is the leading cause of preventable death (Petersen et al., 2017). Rural communities are behind the national average in tobacco cessation. In 2009, the prevalence of smoking was 26% in rural areas which was similar to the national average in 1990 (Mussulman et al., 2014). Rural communities lack adequate medical access, insurance coverage, cell phone access for quitlines and tobacco cessation education. In addition, rural areas have a higher prevalence of low socioeconomic status and tobacco is socially more accepted in these areas (Weg et al., 2016). Education is a powerful tool in the implementation of tobacco cessation interventions, and if used in the clinical setting can improve patient outcomes. If nursing programs were to include tobacco cessation in the curriculum, nurses would have a greater impact on the fight against tobacco use especially in rural communities.
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  Best Practices In Equine Assisted Therapies For At-Risk Youth

  Meaux, Allison Elizabeth (The University of Arizona., 2019)

  Purpose: To develop evidence-based best practice recommendations for nursing professionals, community and health professionals, and parents to reference when considering equine assisted therapy (EAT) for at-risk youth. Background: Developmentally, adolescents are at risk for developing unhealthy lifestyle choices and coping mechanisms. EAT programming is an intervention that is gaining evidence-based support and is an experiential therapy that provides youth with a greater range of emotional wellness and relational skills than traditional classroom counseling. Approach to practice: The best practice recommendations are based on a literature review conducted through a search on PubMed with the following keywords: at-risk youth, adolescents, equine, and psychotherapy. The articles included in this search were published from 2007 to 2017. Ten articles were included in the literature review portion of this thesis. Outcomes: The proposed best practice recommendations are for professionals to reference when identifying potential candidates that would benefit from EAT and when determining if a program is credible for referral. Conclusions: As more research on EAT is conducted and published, the guidelines can be more intricately defined and professionals working to address the mental health wellness needs of at-risk youth can feel more confident in referring clients to EAT.
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  Best Practice Recommendations For Prescription Opioid Education

  Mills, Olivia Anne (The University of Arizona., 2019)

  What seemed like a perfect solution in the 1990’s for the treatment of pain— which was once labeled by the Joint Commission as “the fifth vital sign”—has inadvertently led to a national crisis with tragic consequences (Baker, 2017). The Joint Commission, in 1997 stated that a patient had a right to be “free of pain”. This treatment mandate found a solution in opioids. Twenty years later, the “solution” has turned into a crisis of national urgency. Part of the reason for the rise in the use of opioids was the lack of education and understanding by health care professionals, including nurses, of the implications of the broad use of opioids in non-cancer settings. In response to the crisis, much thought and research has focused on changes to treatment options for pain, including better practices for opioid prescription and even alternatives. The goal of this thesis is to highlight new policies and perspectives that have evolved and will discuss the role that healthcare providers—with an emphasis on nurses—have to help solve the opioid crisis regarding the best practices for prescribing opioids for pain management and the best recommendations for health care professionals to educate patients about prescription opioids.
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  Best Practice Recommendations For Asthma Management In School-Age Children To Prevent School Absenteeism

  Vu, Tran Minh Anh (The University of Arizona., 2019)

  This paper explores the most current research on asthma management in school-age children. The purpose is to create evidence-based recommendations suitable to implement at schools to promote health and prevent school absenteeism. Asthma is one of the most common chronic diseases that affects about 10% of the pediatric population, especially those who are from low socioeconomic back grounds, and racial/ethnic minorities (Gleason, Cicutto, Haas-Howard, Raleigh, & Szefler, 2016; Rodriguez et al., 2013). This population often lacks asthma self-management skills to prevent or decrease asthma attacks, and maintain adequate health and well-being. As a result, children with asthma present with more sick days due to illness, increased emergency visits due to uncontrolled asthma, and could present with socioeconomic burden to caregivers (Gleason et al., 2016; Rodriguez et al., 2013). To prevent asthma exacerbation, school nurses or asthma counselors have an important role in the coordination of care, communication, and education to children, families, school staff, and clinicians (Gleason et al., 2016; Liptzin et al., 2016). This paper not only identifies best practice recommendations, but also proposes a plan for implementation and evaluation of the effectiveness of the proposed implementation plan.
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  Best Nursing Practices In Treating Neonatal Abstinence Syndrome

  Comrie, Hayley Rebecca (The University of Arizona., 2019)

  This paper reviews the current research on best nursing practices for infants with neonatal abstinence syndrome (NAS). Women who use substances while pregnant put their babies at an increased risk for getting NAS. At delivery, the maternal drug supply is cut, which can cause a range of withdrawal symptoms. Evidence-based articles published within five years were found on Pubmed, Google Scholar, and CINHAL. The articles focus on nonpharmacologic interventions that can be used to reduce the need for pharmacologic treatment. Nonpharmacologic interventions include swaddling, vibrotactile stimulation, laser acupuncture, rooming-in, breastfeeding, kangaroo care, reiki therapy, and a quiet, dark environment. If these methods do not relieve symptoms, pharmacologic treatment may be necessary. Traditional pharmacologic therapy is oral morphine; however, methadone is an alternative. Buprenorphine is a promising new option due to a shorter length of stay in the hospital. Other articles discuss the implementation of a clinical practice guideline, the safety of breastfeeding while the mother is on a drug maintenance plan, and the characteristics of maternal-infant dyad interactions. Based on the review of current literature, this paper will identify the best nursing practice recommendations for nurses, a proposed implementation plan for the recommendations, and an evaluation of the implementation process.
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  Using Flow Cytometry To Identify Key Cell Populations Implicated In Opioid-Induced Osteopenia In A Cancer Induced Bone Pain Model

  Mohty, Dieter Mohammad (The University of Arizona., 2019)

  Strong opioid analgesics such as morphine are the first line of analgesic treatment for alleviating a variety of acute and chronic ailments. However, prolonged opioid administration causes detrimental side effects. This study investigates one such side effect: chronic peripheral inflammation. To determine whether morphine can exert an inflammatory effect on peripheral tissues such as bone, we created a cancer induced bone pain (CIBP) model. We then constructed an immunophenotyping panel that could identify standard inflammatory and bone degradative populations to see whether morphine can induce the infiltration and proliferation of these cell populations. We also wanted to know if using flow cytometry on treated full femur samples is viable in tracking such populations. Results showed that full femur processing does not impact cell viability and is thus a practical alternative to collect cells for analysis. In addition, we observed some preliminary trends indicating morphine can induce the infiltration of immune and bone degradative cells to the bone marrow. These findings are consistent with previous studies examining orthopedic outcomes of morphine treated patients. This study serves as the foundation for our TLR-4 mediated inflammation hypothesis and will be supplemented with knock-out and biochemical studies in the future.
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  Sleep Disruption Does Not Modify Sodium Intake Among Rats Fed A Cafeteria Style Diet

  Snapp, Victoria Rhae (The University of Arizona., 2019)

  Introduction: Sleep disruption (SD) and high sodium diets increase hypertension. We determined if SD increased sodium intake, preference for high sodium foods and if sex modified this effect when rats were fed a cafeteria-style diet (CAF-D). We hypothesized that SD would increase sodium intake and preference for savory foods independent of sex. Methods: Sprague-Dawley rats (n=8 male, n=20 female) were fed a CAF-D (rotating selection of 24 sweet and savory human foods + rodent chow ad libitum) and randomized to sleep undisturbed or SD due to environmental noise (8h/d, 16d). Calorie intake, weight gain and estrous cycle phase were determined daily. Results: In contrast to before treatment, undisturbed females gained significantly more weight than undisturbed males. Sleep disrupted males and females had similar weight gain. SD significantly increased calorie intake in males only. Independent of treatment or sex, rats preferred sweet relative to savory foods. Treatment didn’t affect sodium intake but sleep disrupted males consumed significantly more sodium than females and ate more calories from savory foods than undisturbed males. Conclusions: Females are more sensitive to CAF-D than males. Despite that SD increased savory food intake in males, SD did not increase sodium consumption because these rats preferred sweet foods.
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  The Mu-Delta Opioid Receptor Heterodimer May Evoke Similar Signaling Within The Striatum, Periadqueductal Gray, And Brainstem

  Nguyen, Paul Nhan (The University of Arizona., 2019)

  Opioid drugs like morphine are the gold standard for treating acute and chronic pain, but they induce detrimental side effects such as tolerance and dependence. It has been suggested that the mu-delta opioid receptor heterodimer (MDOR) enhances some of these side effects and that heterodimer targeted drugs could be a solution to weaken these side effects. We have thus created an MDOR selective antagonist called D24M with a ~100-fold in vitro selectivity for the MDOR over the monomers. We then used D24M to examine MDOR physiology in mice. We found that intracerebroventricular (icv) injection of 1 nmol D24M strongly increased oxymorphone anti-nociception in models of tail flick, paw incision, and chemotherapy-induced neuropathic pain, but had no effects on morphine or buprenorphine anti-nociception. D24M also strongly decreased morphine withdrawal in acute and chronic dependence models. We then tested ERK activation via western blot analysis with the injection of D24M or vehicle and various opioid drugs. We found that D24M has similar effects on ERK pathway activation for each part of the three tested brain regions (striatum, periaqueductal grey [PAG], and brainstem); further confirming that ERK is a possible pathway for the MDOR to promote kinase activation. This discovery could be a stepping stone for determining the signaling mechanisms of the MDOR.
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  The Magnitude Of NK Cell Mobilization Is Associated With Plasma Epinephrine In Response To Steady-State Aerobic Exercise

  Lynn, Cassandra Amalia (The University of Arizona., 2019)

  The objective of our research was to identify any demographical or physiological differences between participants split into high and low groups based on median NK cell deployment that might leave them less likely to receive exercise-induced cancer benefits. We hypothesized that ß-adrenergic receptor sensitivity would be positively correlated with the amount of epinephrine secreted during exercise, resulting in greater lymphocyte mobilization with greater catecholamine secretion. 18 participants performed steady-state exercise on a stationary leg cycling ergometer at workloads determined to be 10% above their individually determined lactate threshold (LT). Baseline demographic characteristics and physiological values collected during the experiment were compared across high and low NK cell mobilizers. The results show that out of all characteristics accounted for in this study, epinephrine release post-exercise was the only statistically significant variable (p<0.05). Low NK cell deployers released less amounts of epinephrine (mean=0.101 ng/mL) during exercise than high NK cell deployers (mean=0.188 ng/mL). This difference in epinephrine release post-exercise may be explained by factors related to obesity, errors in calculating lactic threshold (LT), or perhaps even psychological perception of stress, but the reasons still remain unclear.
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  Adult Acquired Flatfoot Deformity: A Review And Gait Analysis Of Posterior Tibial Tendon Dysfunction

  Oliver, Tyler Edward (The University of Arizona., 2019)

  The posterior tibial tendon plays a key role in positioning the foot for effective propulsion during gait. Posterior Tibial Tendon Dysfunction (PTTD) is a common tendinopathy that leads to flatfoot deformity with a profound decrease in gait function. Single leg heel rise (SLHR) is a key functional test for assessing PTTD as its successful completion requires dynamic stabilization of the hindfoot by the PTT. Numerous studies have investigated differences in gait kinematics and kinetics between patients with PTTD and healthy controls, but there is limited data comparing the stability during SLHR between these groups. The purpose of this study was to: (1) summarize the previous findings of gait alterations with PTTD in order to obtain a comprehensive understanding of the differences between PTTD patients and healthy control, and (2) to extend these findings by comparing differences in frontal plane foot kinematics and kinetics during gait and SLHR. The results from this study showed conclusive changes in foot kinematics and kinetics of PTTD patients during both gait and SLHR. These changes may be associated with the pathological process of PTTD and provide a more comprehensive understanding in optimizing treatment and standardization of care of PTTD.
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  Relationship Of Physical Activity With Bone Parameters In Hispanic Girls

  Blew, Diego Weibrecht (The University of Arizona., 2019)

  Increased levels of moderate-to-vigorous physical activity (MVPA) are associated with enhanced bone mass/density development in non-Hispanic children, which may prevent osteoporosis later in life. This relationship has not been established in Hispanic females; as osteoporosis rates increase, an understanding of this relationship across populations is vital.
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  The Effect Of Long Term Housing On The High Rates Of Morbidity And Mortality In Women Experiencing Homelessness

  Jordan, Gianna Marche (The University of Arizona., 2019)

  The issue of homelessness is an increasing problem in the United States, with the number of people experiencing homelessness increasing in the past two years. Historically, deinstitutionalization in the 1970s along with welfare reform in the 1990s had a drastic impact on the number of people experiencing homelessness. With the belief that the individual was responsible for their condition, homeless outreach focused on addressing individual behaviors such as substance abuse and mental illness as the reason a person was experiencing homelessness. This belief ignored any structural factors such as politics, the economy, gendered issues, and race as aspects that could contribute to someone experiencing homelessness. With a shift from a behavioralist view to a structuralist view, a Housing First program emerged as an alternative to the treatment first method. The Housing First Programs provide someone experiencing homelessness with housing immediately and does not require them to abstain from substances or access mental health treatment. By giving someone housing, the ability to make choices in their life, and reducing the harm they may encounter a Housing First program would reduce the high rates of morbidity and mortality in women experiencing homelessness.
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  Gender Gap In Migraine: A Feminist Understanding Of A Complicated Health Disparity

  Vargas, Laura Gabriela (The University of Arizona., 2019)

  Migraine is a complex disorder with mechanisms that are largely unknown, as well as a wide gender disparity. American women are affected by migraine at a rate of 20.7 percent, while men are affected at a rate of 9.7 percent. Feminist intersectional theories of health disparities can help explain these patterns by taking into account intersections of race, gender, sex, age, socioeconomic status and environment to create a more detailed explanation of how bodies are evidence of social inequality. Physiological research utilizes the biomedical model of health, which states that all disease has a biological or behavioral root cause. In the case of migraine, presence of estrogen is often cited as a compounding factor and the reason for higher migraine rates in women. This reasoning does not fully explain why both men and women get migraines that are not at all related to menstruation. Biomedical and feminist intersectional modes of thinking are parallel and not often used together to understand disease. Ultimately, integrating these two viewpoints could further treatment of migraine by allowing healthcare professionals to be more understanding of the impact of a socially determined environment on an individual’s health and migraine status.
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  Ca2+/Calmodulin-Dependent Protein Kinases: Role In Excessive Cell Growth And Hypertension

  Carr, Shane Geary (The University of Arizona., 2019)

  Hypertension is a widespread disease with over one-third of all US citizens being afflicted. Hypertension significantly increases the likelihood of heart disease, which is the currently leading cause of death in the US. This paper reviews the factors that cause hypertension, such as increased cardiac output, increased stroke volume, increased vessel length, and decreased vessel radius. The second section delves into our research on how excessive pulmonary arterial smooth muscle cell (PASMC) proliferation contributes to hypertension. We observed that patients with idiopathic pulmonary arterial hypertension (IPAH) have increased cytosolic calcium concentration in their PASMCs. However, it is unknown how calcium plays a role in this increased proliferation. This study explores our hypothesis that the family of proteins Ca2+/Calmodulin-Dependent Protein Kinases (CaMK) may be the link between calcium and excessive cell proliferation. Our results found that two CaMK proteins, CaMKIV and CaMKII δ, cause increased proliferation and are found at higher concentrations in patients with IPAH. We found that these two CamK proteins are necessary for the increased activity of AKT and PDGFR, two proteins involved in the proliferation pathway. While more research is needed, these results suggest that CaMKIV and CaMKII δ could be targets for the treatment of hypertension.
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  Integrating The Sociology Of Standards With Community Paramedicine

  Rabinowitz, Aaron Samuel (The University of Arizona., 2019)

  As of 2019, over 130 community paramedicine (CP) programs exist internationally. These are the goals that community paramedicine seeks to achieve: prevent hospital readmissions, reduce frequent EMS (emergency medical service) and ED (emergency department) user’s reliance on emergency services, provide alternative and more appropriate destinations for patient care, and chronic disease management by increasing patient access to primary care services. There is no way of assessing if these common goals are being met because programs today use a diversity of different strategies, techniques, and measurements when providing care. This reflects different electronic interfaces, different patient referral forms, different program evolution patterns, and different program strategies. For example, the use of an urban or rural community paramedicine model, or the use of one software in favor of another. The consequences of these different strategies include: failure to legitimize CP as an emerging type of healthcare, failure to optimally control program costs, failure to develop a language for communication that is understood by all community paramedics, failure to make data comparable between different programs, and failure to advance the outlined goals of CP. Drawing on the sociology of standards, this thesis proves that terminological and procedural standards can address these problems by creating a common language for communication and clinical practice guidelines for all community paramedics. Without the creation of such standards, the above consequences will not be remedied. Community paramedicine programs will have the ability to overcome the consequences I have listed through the creation and implementation of these standards.
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  The Benefit Of Intergenerational Interactions On Geriatric Patient Satisfaction And Well-Being

  Rowlison, Gabrielle Marie (The University of Arizona., 2019)

  This project aimed to address social isolation, decreased morale, and negative perceptions of healthcare in older adult communities such as assisted and independent living facilities by introducing intergenerational interactions as an intervention. This intervention, which took place in Spring 2019, was a component of a course taught by Elizabeth Glisky, PhD of the Department of Psychology. The students of the class visited an assigned elder at three different sites in Tucson, and spent some time interacting with their elders and learning about their lives. The college students then created “Life Story” booklets for the adults with whom they interacted. Questionnaires addressing the older adults’ psychological well-being, level of depressive symptoms, and perception of care they receive from their primary care provider were administered before and after the intervention. There were marginally significant improvements in overall psychological well-being and in the subcategory of autonomy. There were no changes in depression or perceptions of care. Although the main goal of this study was to improve older adults’ perceptions of their relationship with their primary care provider by increasing comfort in interacting with younger adults, we were unable to observe such changes. Possible reasons for this null finding are suggested in the discussion.
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  Interactions Between Ecosystem Dynamics On Belowground Microbial Community Capacity Under Semiarid And Arid Conditions

  Theilmann, Mira Lizabeth (The University of Arizona., 2019)

  Ecosystem sustainability in semi-arid to arid landscapes depends on plant-microbe soil interactions. The belowground microbial communities of semi-arid and arid ecosystems are less robust than those of temperate climates and therefore more vulnerable to environmental stress and anthropogenic disturbance. Study of the ecosystem dynamics that accompany ecosystem degradation during the transition from semiarid to arid landscapes may provide critical insights applicable to the reclamation of semi-arid marginal lands, such as those compromised by mining activities. The specific goal of this project is to define the characteristics of semiarid and arid ecosystems and their relationship to the sustainability of associated vegetation and microbial communities. To supplement ecosystem characterization, the microbial biomass of soils from undisturbed Sonoran Desert areas will be compared to degraded substrate compromised by mining activities at Resolution Copper Mine. This comparison of semi-arid and arid microbial communities between undisturbed sustainable soil and disturbed substrate from variable levels of reclamation may determine the importance of microbial community composition on reclamation success. The research questions to be addressed by this thesis are what are the defining physical characteristics of sustainable semi-arid and arid zones and what are the crucial interactions between aridity driven water deficit and vegetation and microbial communities?

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