According to the Revolution: The Cuban Revolution in Cuban History and Cuban History in the Cuban Revolution
Tschudy, James R.
This thesis combines the recent historiography on the Cuban Revolution with a
theoretical approach to put forth a new mode of analysis for the ideological origin and
guide of the Cuban Revolution. The role of Cuban history in the lexicon of the Cuban
Revolution has been prominent, and it has provided the ideological background of the
Revolution. The leadership's focus on Cuban history makes it organic in the Gramscian
sense of organic versus traditional intellectuals.
By analyzing the historical narrative with the assistance of the recent
historiography, this thesis will show that the leadership of the 1959 Revolution had a
blueprint for revolution, as well as a reference to the main obstacles to real change in
Cuba: the power of the United States and the segment of the Cuban elite that willingly
mortgaged sovereignty for economic and social stability in the vain of Cardoso and
Falleto's analysis of dependency theory.
According to the Revolution: The Cuban Revolution in Cuban History and Cuban History in the Cuban Revolution
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Characterizing Therapy Induced Polyploidy (TIP) Populations as a Resistance Mechanism in DH/DE-DLBCL and Identifying Synthetic Lethal Targeted Therapies
Characterizing Therapy Induced Polyploidy (TIP) Populations as a Resistance Mechanism in DH/DE-DLBCL and Identifying Synthetic Lethal Targeted Therapies
Islam, Md Shariful
Lymphoma is a blood cancer that involves the lymphatic system and is the 7th most common cancer in USA. Diffuse large B-cell lymphoma (DLBCL) and Peripheral T-cell lymphoma (PTCL) are the most common types of aggressive B-cell and T-cell non-Hodgkin lymphomas (NHL) respectively. Double-Hit or Double-Expresser DH/DE-DLBCL are high grade B-cell lymphomas characterized by translocation or over expression of MYC and BCL-2 which are mostly incurable with standard chemo-immunotherapy. Therefore, there is an unmet need for novel targeted therapy. Aurora kinase inhibition (alisertib) induces ~30% cell death (in vitro), while a portion of the remaining ~70% cells at day-4 escape apoptosis through polyploid populations which we called therapy induced polyploid cells (TIP). These TIP cells exhibited a high metabolic rate by increased AKT/mTOR and ERK/MAPK activity via BTK signaling through the chronic active B-cell receptor (BCR) pathway. TIP also showed increased levels of phospho-Hck and phospho-Akt indicating increased BCR signaling which is a rationale for combining ibrutinib (BTK inhibitor). Combined inhibition of AK + BTK reduced phosphorylation of AKT/mTOR and ERK-1/2, up-regulated phospho-H2A-X and Chk-2 (DNA damage), reduced Bcl-6 and decreased Bcl-2 and Bcl-xL results in induced apoptosis evident by PARP cleavage. In a DE-DLBCL SCID mouse xenograft model, ibrutinib alone was inactive, while alisertib + ibrutinib was additive with a tumor growth inhibition (TGI) rate of ~25%. However, TGI for ibrutinib + rituximab was ~50-60%. In contrast, triple therapy showed a TGI rate of >90%. Kaplan-Meier survival analysis showed 67% of mice were alive at day-89 with triple therapy versus only 20% with ibrutinib + rituximab. All treatments were well tolerated with no significant changes in body weights. Anti-DLBCL chemotherapy dosing schedules are intermittent, designed to avoid damage to normal tissue such as the mucous membranes, gut and the bone marrow. TIP are common in standard anti-DLBCL therapies (e.g. vincristine, doxorubicin) and thought to be responsible for disease relapse. Some of these TIP cells die but remaining of those are capable of re-entering the cell cycle during off-therapy periods. We discovered how these TIP cells can re-enter cell cycle and molecular mechanism underlying this resistance. We have purified AK inhibitor induced polyploid DH/DE-DLBCL cells by FACS. Time-lapse microscopy of single cells revealed that following drug removal, a subset of TIP cells divide and proliferate by reductive cell division(s). This includes multipolar mitosis, meiosis like nuclear fission or budding off daughter cells. RNA-Seq, Proteomics and Kinomics proling of TIP cells demonstrated that alisertib induced polyploid cells have up-regulated DNA damage response, replication and immune evasion; amplify receptor tyrosine kinase and T-cell receptor signaling; hijacks the spindle assembly checkpoint point control via MYC dysregulation of RanGAP1, TPX2 and KPNA2. We believe these up-regulated proteins are responsible for induction of aneuploid daughter cells and disease resistance and also provide potential opportunities for novel therapy combination that warrant further exploration. Lymphomas are systemic diseases that require a comprehensive knowledge of immune mechanism in cancer as well as targeted therapeutic approach for designing an optimal therapeutic strategy and desired synergy can be achieved by rational combination of small molecule inhibitors with immune modulatory agents that could enhance host immune response. In PTCL we have shown that expression of PD-L1 relative to PD-1 is high in PTCL biopsies ( 9-fold higher) and cell lines. Combination of alisertib with pan-PI3K inhibition or VCR significantly reduced PD-L1, NF-kB expression and inhibited phosphorylation of AKT, ERK1/2 and AK with enhanced apoptosis. In a syngeneic PTCL mouse xenograft model, alisertib demonstrated tumor growth inhibition (TGI) ~30%, whilst anti-PD-L1 therapy alone was ineffective. Alisertib + anti-PD-L1 resulted in TGI >90% indicative of a synthetic lethal interaction. PF-04691502 + alisertib + anti-PD-L1 + VCR resulted in TGI 100%. Overall, mice tolerated the treatments well. Co-targeting AK, PI3K and PD-L1 is a rational and novel therapeutic strategy for PTCL. In conclusion, we have identified therapeutic targets in aggressive B- and T-cell lymphoma which can be combined with immunotherapy that warrant investigation to disrupt rapid tumor evolution of TIP cells to mitigate disease relapse.
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Targeting BCL2 and MYC DNA Secondary Structures by Novel Compounds to Lower Gene Expression in DLBCL
Targeting BCL2 and MYC DNA Secondary Structures by Novel Compounds to Lower Gene Expression in DLBCL
Knight, Eric Victor
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Land Use for Photovoltaic Solar Electric System Siting Rating Metrics
Land Use for Photovoltaic Solar Electric System Siting Rating Metrics
Paul, Patricia
Since solar electric power is becoming increasingly popular throughout the United States, there is some concern that this growth can have negative environmental effects associated with the siting of solar modules and land use. Five different locations for siting photovoltaic (PV) systems were evaluated including open lands, brownfields and mine tailings, rooftops and carports, building-integrated photovoltaics (BIPV), and transportation corridors. A ranking system was created to determine which locations are the best for PV systems. The ranking system examined and compared four important metrics including environmental impacts, technological barriers, cost, and social implications. Based on the results of the rating system, rooftops and carports received the highest ranking with a total score of 11 points, BIPV received the second highest score with a total of 10 points, open lands received 9 points, and brownfields and mine tailings and transportation corridors both received a final score of 8 points each.
Sustainable Built Environments Senior Capstone Project
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The Devil’s Midwives: Titiçih, Gender, Religion, and Medicine in Central Mexico, 1535-1650
The Devil’s Midwives: Titiçih, Gender, Religion, and Medicine in Central Mexico, 1535-1650
Polanco, Edward Anthony
This dissertation evaluates Spanish and Nahuatl (an indigenous language spoken by the Nahuas of Mexico) sources to probe tiçiyotl (Nahua healing knowledge) in sixteenth and seventeenth-century Central Mexico. My study covers a 150-mile area surrounding Mexico City and begins in 1538, when Juan de Zumárraga, the bishop of Mexico, oversaw the first trial against titiçih (healing ritual specialists). The temporal scope of my dissertation ends in 1656, when Jacinto de la Serna (rector of the University of Mexico) wrote a manual for priests who ministered to indigenous people, which was the last source to use the term tiçitl (sing. titiçih). Other notable sources and contributions include the investigation of ecclesiastical trials against titiçih in Central Mexico. These trials include biographical information, and in-depth information on ritual practices that add humanness to the abstract descriptions included in European treatises, manuals, and encyclopedias.
By unpacking the history of Nahua healing knowledge in a colonial context, this study not only explores Nahua people, it also examines how Europeans processed and interpreted indigenous knowledge, materials, and practitioners. Starting in the late sixteenth-century, the Catholic Church systematically attacked Nahua healers in Central Mexico, particularly women, while Spanish physicians absorbed indigenous knowledge and discarded ritual practices and its practitioners. This has made women invisible in academic discussions of tiçiyotl. By employing non-European sources this study includes the perspectives and views of the “colonized,” that is, the indigenous peoples of Central Mexico. Lastly, this dissertation demonstrates that women were integral to the preservation of healing practices and ritual customs among Nahua people in the seventeenth century, and that women led the resistance against Spanish colonialism, and bore the brunt of its wrath.
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Mexican American Women and Breast Cancer-Comorbidities, Symptom Frequency, Symptom Distress, Symptom Management, and Social Support
Mexican American Women and Breast Cancer-Comorbidities, Symptom Frequency, Symptom Distress, Symptom Management, and Social Support
Burrell, Carlitta Danielle
This descriptive secondary data analysis examined the influence of comorbidity on medication use, symptom frequency, symptom distress, symptom management, social support and social network among Mexican American (MA) women with breast cancer. The total sample included 149 participants. The mean age of the sample was 50.49 years old—young compared to the U.S. national average age at breast cancer diagnosis of 62 years old. Nearly half of the women reported no comorbidities (n = 71), and n = 78 reported one or more comorbidities.
Significant between groups differences showed that the comorbidity group was approximately 10 years older than the no comorbidity group, used more medications, and had twice the social network than the younger no comorbidity group. While the comorbidity group did report more symptom distress than the no comorbidity group, in both groups, the majority of participants reported moderate to high levels of symptom distress. Likewise, there was a small, significant between groups difference for symptom frequency. In both groups, over half of the participants reported having 3-7 symptoms.
Correlations between variables showed a relationship between increased symptom frequency and decreased symptom management, and a relationship between higher symptom distress and lower symptom management. Emotional social support showed a positive influence on symptom frequency and symptom distress, providing evidence that social support is beneficial in improving breast cancer outcomes.
Additional findings include evidence that low socioeconomic status (SES) contributes to cancer health disparities. The overall similarity between the groups suggests that the effects of comorbidity may not have as much influence as would be expected, and SES and other social and contextual factors may have an effect of equalizing the groups for some variables measured in this study.
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A Review of Alternative Building Materials in comparison to CMU: Hempcrete, Woodcrete , Papercrete
A Review of Alternative Building Materials in comparison to CMU: Hempcrete, Woodcrete , Papercrete
Hornby, Rachelle
Buildings consume an extraordinary amout of our finite natural resources during their construction and operation. It is imperative we begin to examine more sustainably-produced materials to construct them, as well as lifecycle costs. Concrete is the most widely-used building material in the world, and aggregate forms the majority of its composition. The goal of this research is to compare building materials incorporating renewable aggregate—hempcrete, woodcrete, and papercrete—as alternatives to traditional concrete utilizing nonrenewable aggregates. Comparing and contrasting commercially-available, similar products helps identify feasible applications for these alternatives to concrete that may prove more responsible, sustainable, and cost-effective throughout a building’s lifecycle.
This paper will analyze three alternative building materials to CMU construction in a comparative analysis. They each contain aggregates that are renewable, unlike CMU. Hempcrete incorporates hemp shives and lime, papercrete incorporates waste paper such as junk mail with Portland cement, and woodcrete incorporates wood chips and saw dust with Portland cement. The question posed is which of these materials is most sustainable, which is most cost effective, which one performs the best, and how do they compare to traditional CMU currently used. This paper will compare hempcrete, papercrete, and woodcrete to one another and to the standard use of CMU.
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What Defines the Effective Hydraulic Conductivity of a Heterogeneous Medium?
What Defines the Effective Hydraulic Conductivity of a Heterogeneous Medium?
Vera, Mauricio Alfredo
Geologic processes produce heterogeneous porous materials that are complex systems to analyze. This research is focused on the bulk behavior of these heterogeneous media, specifically, the effective hydraulic conductivity (Keff). Specifically, I studied media comprised of two block materials with different K values to understand how the percent composition of the materials and their spatial distribution affect Keff. Two approaches are taken. First, I examine an exponential mixing law, that describes Keff as falling between two end members when the materials are distributed parallel to (arithmetic) and perpendicular to (harmonic) the flow direction. The results, based on examining steady state flow through 990,000 grids with MODFLOW linked with MATLAB, indicate a linear increase in the exponent describing K mixing as a function of the fraction of the high K material included, leading to an expression that estimates Keff with an R2 of 0.982. Second, I show that an approach based on energy dissipation weighting, while difficult to infer visually, returns a perfect explanation of K weighting.; Procesos geológicos producen materiales porosos heterogéneos que son complejos sistemas de análisis. Esta investigación se enfoca en el comportamiento aparente de estos medios heterogéneos, específicamente, la conductividad hidráulica efectiva (Keff). Específicamente, estudio un medio compuesto de bloques de materiales con diferentes valores de K (conductividad hidráulica) con el fin de entender como el porcentaje de la composición de los materiales y su distribución afecta a la Keff. Dos aproximaciones son consideradas. En primer lugar, examine una ley de mezcla exponencial, que describa los límites de Keff cuando los materiales son distribuidos paralelamente (aritmética) y perpendiculares (armoníca) a la dirección del flujo. Los resultados examinados, basados en flujos constantes por medio de 990,000 grillas en MODFLOW enlazado con MATLAB, indica un incremento lineal en el exponente que describe K mezclado como función de la fracción de material K alto incluido, liderando una expresión que estima Keff con un R2 de 0.982. Segundo, muestro que una aproximación basada en la ponderación de la disipación de energía, aunque es difícil de inferir visualmente, arroja una explicación perfecta de la ponderación de K.
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THE RELATIONSHIP BETWEEN WAR AND MEDICAL PROGRESS AS SEEN IN THE SPECIFIC CASE OF TYPHUS IN EUROPE DURING WWII
THE RELATIONSHIP BETWEEN WAR AND MEDICAL PROGRESS AS SEEN IN THE SPECIFIC CASE OF TYPHUS IN EUROPE DURING WWII
Livingston, Annalise
There is a well established connection between war and medical advancement in history.
The necessities and stress of conflict push scientific ingenuity and the funding provided by the
military enhancing scientists’ ability to innovate. However, this process is hardly a simple
cause-effect relationship but often the outcome of complex interactions between governments,
the military, and scientists. In this paper I argue that there are certain requirements that need to be met to achieve
medical and scientific advancement during war. By examining a single case: typhus prevention
in Europe during World War II, I explore the effect of certain complications and ineptitudes that
prevent the furthering of medical knowledge, juxtaposing it against successful scientific and
medical innovation. I contrast the successful improvement of public health medicine by the
western Allies, especially the United States, to the unsuccessful attempt at medical advancement
made by Nazi Germany. The evidence I provide to support my argument is drawn from
contemporary medical reports and scientific papers as well as previous research on typhus and
military public health medicine.
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Aquatic and Riparian Connectivity in Arid Landscapes
Aquatic and Riparian Connectivity in Arid Landscapes
Sharma, Akanksha
Aquatic and riparian ecosystems are of critical importance in arid environments, supporting a diverse suite of resident and migratory species over different life stages. Ecological connectivity is an important property in the functioning of these ecosystems, and a significant subject of interest for researchers,scientists,resource managers, practitioners and other stakeholders. Furthermore, a variety of perceptions exists on aquatic and riparian connectivity among stakeholders, and connectivity of these ecosystems in arid landscapes is a relatively unexplored subject. I focused on these issues in the US portion of the Madrean Archipelago by combining qualitative methods to capture the diversity of perspectives among experts and quantitative spatial analysis to capture the variety of factors that influence aquatic and riparian connectivity. I synthesized the resultant expert perspectives into a Connectivity Component-Dimension Framework that deconstructs aquatic and riparian connectivity into connectivity components and their dimensions. Using GIS and regression analysis, I applied this framework to a case study of the threatened Chiricahua leopard frog (Rana chiricahuensis) in the Cienega Creek basin in Arizona and created connectivity indices for this focal species. Some factors that emerged significant in this case study included elevation, fire hazard potential, and density of leopard frog sightings. This connectivity framework and the related indices provide customizable options for stakeholders to assess aquatic and riparian connectivity multidimensionally using readily available data. These tools can be used by stakeholders for exploratory analysis, assessment and visualization of aquatic and riparian connectivity, in arid landscapes, and beyond.
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Effects of Stress, Sleep Hygiene, and Exercise on Academic Engagement in Undergraduate Students
Effects of Stress, Sleep Hygiene, and Exercise on Academic Engagement in Undergraduate Students
Nelson, Audrey
Academic engagement is important for the scholastic outcomes of college students, including degree completion. The current study examined the relations between stress and the intrinsic aspects of academic engagement (e.g. effort, attention, note-taking, attendance, asking for help, etc.), including the four factors of undergraduate engagement as outlined by Handelsman, Briggs, Sullivan, & Towler (2005): Factor 1 – “skills engagement,” Factor 2 – “emotional engagement,” Factor 3 – “participation/interaction engagement,” and Factor 4 – “performance engagement,” in addition to the mediating/moderating properties of the self-care practices of sleep hygiene and physical activity. Intrinsic versus extrinsic engagement was evaluated in this study as it is believed this approach affords more opportunities for subsequent interventions since they can be implemented in an individual or small group setting, and not be constrained by the challenges of making large institutional changes. The sample consisted of 203 undergraduate students from a large southeastern university. Results indicated that stress was negatively correlated with the factor of academic engagement most related to executive functioning (i.e. skills engagement). Of the independent variables evaluated, sleep hygiene showed the strongest correlations with academic engagement, most specifically for the skills engagement and performance engagement factors. Sleep hygiene also functioned as a mediator in the relationship between stress and the skills factor of engagement, resulting in a 47% reduction in the effect of stress. Exercise did not show correlations with any areas of engagement, but did show a small interaction effect on the relationship between stress and the academic engagement factor of participation/interaction. Stress was seen to have a positive impact on participation/interaction engagement. A moderating effect of physical activity was identified, leading to lower participation/interaction engagement when both stress and exercise were high. Exercise, ethnicity, age, class rank, and gender did not add predictive ability to any of the models for academic engagement/factors of engagement. These results highlight the potential benefits of improving sleep habits and promoting programs aimed at minimizing and addressing stress (e.g. meditation, mental health supports) in order to promote success and positive academic outcomes in undergraduate students. Directions for future research were also discussed.
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Examining Three Levels of Social Integration and Health in Minorities: A Bioecological Perspective
Examining Three Levels of Social Integration and Health in Minorities: A Bioecological Perspective
Flores, Melissa Ann
Background. Understanding and dismantling health disparities remain one of the most essential imperatives for our nation. The complexity of interacting sociodemographic and structural factors affecting health is difficult to quantify. Thus, sophisticated approaches which take into account not only an individual but their dynamic, social environments are necessary for understanding resiliency and strengths in these populations (Thornton et al., 2016). In this dissertation, I adopted a developmental perspective (e.g. Bioecological Theory) that may guide scientists when considering several interacting, sociocultural environmental factors at once. Social integration is a powerful force in an individual's life. Although 'social integration' may have many names (perceived social support, closeness of social ties, diverse social networks, etc.), broadly, it is accepted that one's social life has a profound impact on their corresponding health and mortality through various behavioral and physiological pathways (Holt-Lunstad, Smith, & Layton, 2010; Robles & Kiecolt-Glaser, 2003; Symister & Friend, 2003). Thus, any comprehensive study on health should include a broader investigation of socio-environmental variables including measures of social integration and broader community culture and resources. Historically, however, investigations focused on social integration, physical health, and the association between the two have traditionally underrepresented minority individuals (Heiat, Gross, & Krumholz, 2002; Hussain-Gambles, Atkin, & Leese, 2004; Murthy, Krumholz, & Gross, 2004).
Research Aim and Questions. Adopting a social-ecological systems approach, the focus of my dissertation is to examine social integration at three levels (the spousal/partner relationship, immediate family-level dynamics, and neighborhood and community level factors) and the association of these levels of social integration with the health of minority individuals (Bronfenbrenner & Evans, 2000; Bronfenbrenner & Morris, 1998, 2007). I addressed this aim through three, separate research questions (RQ)/Chapters: RQ1/Chapter II) The individual and spousal/partner relationship, What are the associations between marital status and social support with health quality of life (HQoL), and mortality in post-menopausal, Hispanic women? RQ2/ Chapter III) Immediate family-level dynamics, Does synchrony of emotional arousal in diverse families facing breast cancer predict depressive mood and coping style in breast cancer patients? RQ3/ Chapter IV) Neighborhood and community level factors, Do social ties or social support mediate the ethnic density effect for Hispanics and other racial-ethnic groups?
Methods and Data Sources. Three distinct data sources were examined within this body of work. In Chapter II, I utilized data from the Women's Health Initiative, Observational Study (Anderson, et al., 1998). In this analysis, I examined the relation between marital status and two outcomes: mortality and health quality of life. I also assessed whether the relations between marital status and these outcomes were attenuated or moderated by social support and language acculturation. In Chapter III, I utilized data collected for The Family Coping and Breast Cancer Project which recruited patients during the years of 1991 – 1993 (Weihs et al., 2005). In this analysis, I examined emotion arousal synchrony among family members (patient and spouse, and patient and child) using cross recurrence quantification analysis. I then examined whether the relations between emotion arousal synchrony and two breast cancer patient outcomes (coping style and depressive mood) are moderated by patient perceived family environment ratings or race. Lastly, in Chapter IV, I analyzed data from Wave 2 of the National Social Life, Health, and Aging Project (O’Muircheartaigh, English, Pedlow, & Kwok, 2014). In this analysis, I examined whether the Hispanic ethnic density effect was mediated by either social network variables (size, closeness of ties, and diversity) or social support and whether these associations were moderated by Hispanic ethnicity.
Results. In the first study (Chapter II) I found that marital status was a significant predictor of mortality for older Hispanic women. Specifically, widowed women had significantly higher mortality risk when compared to their married counterparts. This relation, however, was not present after controlling for social support and language acculturation. In regard to health quality of life, marital status was associated with physical functioning, with widowed women reporting significantly worse physical functioning three years after baseline when compared with their married counterparts. This study suggests that widowed, Hispanic women may be at risk for poor health and this may be facilitated through social support and language acculturation. In the second study (Chapter III) I found that the relation between emotional arousal synchrony and patients' depressive mood in families facing breast cancer was moderated by family environment, specifically conflictual environments. I also found that the relation between emotional arousal synchrony and coping style was moderated by family environment, specifically for cohesiveness ratings. Moderation by race was not found. These results suggest that emotion arousal synchrony are family dynamics that may have differing implications depending on the family environment. In the third study (Chapter IV) I found two Hispanic ethnic density effects, but they were not mediated by social network variables. However, they were mediated by social support, but not in the direction I hypothesized. Social support was an inconsistent mediator of the relation between ethnic density and depressive symptoms and a suppressor of the relation between ethnic density and morbidity. These results suggest that for all racial/ethnic groups, ethnically dense neighborhoods do not beget higher social ties and social support.
Conclusions. Overall, findings in this dissertation suggest that varying levels of the social-ecological environment are associated with health in minorities in various ways. A common phenomenon that arose in all three analyses were questions about how covariates or mediators influenced the association of the main variable of interest and its relation to different health outcomes. Broadly, this may be a common issue for social scientists interested in utilizing social variables from different social-ecological levels (micro-system, exosystem, etc.), which corroborates my previous statement regarding the complexity of social environments.
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Development of Bioanalytical Assays Using Scintillant Polymer-Core Silica-Shell Nanoparticles
Development of Bioanalytical Assays Using Scintillant Polymer-Core Silica-Shell Nanoparticles
Mokhtari, Zeinab
Ideal nanosensors of biomolecules are sensitive, selective, stable, minimally
invasive, amenable to mass production with low-cost, and applicable for reproducible in
vitro and in vivo analyses. The nano scintillation proximity assay (nanoSPA) presented
here is based on a composite architecture of polystyrene-core and silica-shell
nanoparticles, with a high surface area to volume ratio (ca. 2×107 m-1) and density of
approximately 1.6 g/cm3. nanoSPA obviates the need for separation of bound from free
radiolabeled molecules prior to measurements, with minimized complexity and
maximized versatility. Selected β-emitter radioisotopes were utilized for the development
of radioassays for analysis of biological processes using nanoSPA.
35S was employed for thiol/disulfide ratio analysis for the first time. Thiolresponsive
nanoSPA was used for quantification of 33S-cysteine and 33S-cystine as
models of 35S-thiol and 35S-disulfide. Synthetic samples of 33S-cysteine and 33S-cystine
and human embryonic kidney (HEK293) cell lysates were analyzed using thiolresponsive
nanoSPA for evaluation of thiol/disulfide ratio as a measure of redox status of
the sample. Limit of detection for 35S-thiol analysis was
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Impact of Geographic Variation, Disability, Socioeconomic Status and Risk Adjustment on High-Risk Medication Use among Elderly Medicare Beneficiaries
Impact of Geographic Variation, Disability, Socioeconomic Status and Risk Adjustment on High-Risk Medication Use among Elderly Medicare Beneficiaries
Chinthammit, Chanadda
BACKGROUND
Inappropriate medication use is common and represents a substantial clinical and
economic burden in the United States (US). The Center for Medicare and Medicaid
Services (CMS) has adopted one of the Pharmacy Quality Alliance (PQA)’s quality
measures to assess percentages of older adult beneficiaries receiving high-risk
medications (HRM) in Medicare Advantage Prescription Drug plan and stand-alone
Prescription Drug plan. Understanding geographic patterns of HRM use may help CMS
and their partners develop and tailor prevention strategies (such as prior authorization) to
be implemented in the areas of need. Furthermore, The HRM use measure was used to
assess Medicare Advantage Prescription drug plan (MA-PD) and stand-alone Prescription
Drug plan (PDP) performance and to provide guidance for practitioners to reduce the use
of such medications. Limited evidence exists on how HRM use is associated with patient
characteristics and whether risk adjustment is necessary to accurately evaluate health
plan performance on the HRM measure.
OBJECTIVES
The overall objectives of this research were to understand regional and patient
characteristics associated with HRM use measure to develop a risk adjustment model for
the HRM measure to accurately evaluated health plan performance. The first specific
aims were to examined HRM use patterns among Medicare beneficiaries enrolled in: (1)
Medicare Advantage prescription drug plans (MA-PDs); and (2) stand-alone prescription
drug plans (PDPs) across geographic areas over time in the United States. The second
specific aims were to: (a) measure HRM use in MA-PD and PDP beneficiaries with
disadvantaged characteristics, including low income and disability; and (b) examine the
relationship between disadvantaged characteristics and HRM use given constant effect of
health plans. The third specific aims were to examine the relations between patient risk
factors and the HRM measure and develop risk adjustment tool for the HRM measure in
older adults enrolled in MA-PDs and PDPs.
METHODS
This cross-sectional study used a 5% national Medicare sample (2011–2013 for
the first aims and 2013 for the second and third aims). Among beneficiaries aged ³65
years who were continuously enrolled in MA-PDs or PDPs (~1.3 million each year), we
identified those with ≥2 prescriptions for the same HRM (e.g., amitriptyline) during the
year based on the HRM list provided by CMS and Pharmacy Quality Alliance. For the
first specific aims, multivariable logistic regression was used to estimate adjusted annual
HRM use rates across 306 Dartmouth Atlas of Health Care hospital referral regions
(HRRs), adjusting for sociodemographic, health-status, and access-to-care factors.
For the second aims, Multivariable generalized linear mixed models were used to assess
the association of HRM use and disadvantage factors such as low-income subsidy
(LIS)/dual eligibility status (DE) and disability after adjusting for health plan effect and
patient-level confounding characteristics (i.e., sociodemographic, geographic, clinical
complexity). For the third aims, multivariable generalized linear mixed models were
used to assess the association of HRM use and patient risk factors (e.g., age, gender) and
identify risk factors after adjusting for health plan effect. The identified risk factors were
used as variables for regression-based risk adjustment for the HRM measure. Unadjusted
and adjusted quality rankings among health plans were compared.
RESULTS
First, a total of 1,161,076, 1,237,653, and 1,402,861 beneficiaries satisfied the
study criteria and were included in 2011, 2012, and 2013, respectively. Among our study
sample, nearly 40% (39%, 39% and 37% in 2011, 2012 and 2013 respectively) were
enrolled in MA-PD plans, whereas remaining 60% (61%, 61%, and 63% in 2011, 2012
and 2013 respectively) were enrolled in PDP plans. HRM use significantly decreased
over time among Medicare beneficiaries enrolled in MA-PD (13.1% to 8.4%, p
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Blue Design: Fighting Food Deserts With Rainwater Harvesting
Blue Design: Fighting Food Deserts With Rainwater Harvesting
Graff, Jackson
Food deserts are an increasing issue in the United States. Low-income areas within cities have little economic incentives for grocery stores, leaving the residence with little to no access to healthy foods. Schools within these food deserts have the ability to provide members of the low-income communities with these healthy foods. These foods can be sustainably grown with rainwater harvesting design and implementation. Tucson Arizona and its food desert locations were the focus area of this study. After generating the data on how much rainwater each school was able to collect in a given year, the amount of potential food produced was calculated for each school. The data and report provide the foundation for schools to build their rainwater harvesting and community farming programs upon. The results suggest that every school has the potential to at least supplement their daily diets with healthy foods grown on campus and watered with a sustainable source.
Sustainable Built Environments Senior Capstone Project
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Adaptive Reuse as a Sustainable Solution
Adaptive Reuse as a Sustainable Solution
Breckenridge, Lauren
The scope of the research if focusing on how adaptive reuse of historic buildings satisfies the three pillars of sustainability. The implementation of adaptive reuse will reduce environmental impact, provide a place for communities to learn and interact with, and bring money into the local economy. The methodology for the study included an online survey, case studies, and literature reviews. This allowed the research to be unbiased and to obtain current research on the topic to figure out if there is a lack of knowledge on the topic. Case studies offer real-world examples of adaptive reuse in and their payoffs. The literature reviews provide information on the concepts and strategies that are involved with adaptive reuse. An online survey was conducted to grasp the general public’s knowledge of the topic. The purpose of researching adaptive reuse in historic buildings is to persuade people to restore a property for a new use rather than constructing a new building. This practice will be able to fulfill social, environmental, and economic sustainability in communities. The findings towards the research topic implied that more research and implementation of adaptive reuse in historic buildings need to be utilized to show the benefits as a sustainable solution.
Sustainable Built Environments Senior Capstone Project
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ROUTE REPAIR: DESIGN CHANGES TO IMPROVE SAFETY AT MOUNTAIN AVENUE AND HELEN STREET
ROUTE REPAIR: DESIGN CHANGES TO IMPROVE SAFETY AT MOUNTAIN AVENUE AND HELEN STREET
Fitzpatrick, Quinton
The intersection of Mountain Avenue and Helen Street in the city of Tucson, Arizona,
lies at the end of a high use pedestrian and cyclist corridor. The intersection is located near the
University of Arizona and is vital in facilitating walking and cycling connections to the
university as well as the greater surrounding areas, including downtown Tucson. The intersection
is currently unsafe and inefficient as a result of both design and location. This Thesis attempts to
analyze and provide recommendations for potential design changes that would increase both
vehicle levels of service and safety for all road users.
A case study of successful cities and nationally recommended best practice design
strategies was conducted to determine what features and infrastructure could be implemented to
improve the intersection.
It was found that safety infrastructure at intersections and connectivity between safe
intersections were among the best practices for improved bicyclist and pedestrian safety. An
application of these designs to the study intersection was explored with several alternatives
offered. The application of left turn and straight through restrictions for automobiles proved the
most promising design change. A significant increase in the level of service of the intersection
was observed along with a 66% decrease in the number of conflict points at the intersection, a
proxy for intersection safety.
In conclusion, it is recommended that turning restrictions be implemented at this
intersection to improve walking and cycling safety and connectivity in the greater university
region of the city of Tucson.
Sustainable Built Environments Senior Capstone Project
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Sustainable Climate Design
Sustainable Climate Design
Lenon, Traci
Sustainable climate design is one that is sensitive to the environment, energy consumption, human thermal comfort, and health & wellbeing. Several tools are used including a psychometric chart, sun dial diagrams, and 3D modeling to make design decisions. A design in Green Bay, WI a cold & humid climate, is analyzed to find sustainable design strategies that achieve this goal.
Sustainable Built Environments Senior Capstone Project
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Networks and Discourses Around Third Grade Reading Policy: Neoliberalism and New Governance in the Classroom
Networks and Discourses Around Third Grade Reading Policy: Neoliberalism and New Governance in the Classroom
Reff, Audrey
While top down federal policy processes continue to deliver policy as grand solutions to real and imagined problems within the nation’s public schools, states continue to churn out their own layers of educational accountability policy. But it is no secret that state and federal policies and programs like No Child Left Behind and Reading First have failed to achieve their objectives and, with each failure, new iterations of these reforms become more punitive to schools, teachers, and students.
This dissertation critically engages one such policy, Arizona’s Move On When Reading third grade reading law. The study contextualizes the policy process at the intersection of neoliberalism, new governance, and the legacy of NCLB’s scientifically based reading instruction to understand the contributions of a state level ad hoc policy committee charged with reviewing and recommending revisions to the state law. Drawing conceptually on comparative case study (Vavrus & Bartlett, 2006), critical discourse analysis (Fairclough, 2012; Koyama, 2017), and network ethnography (Ball, 2012), I applied Ball’s (1993) theory of the policy cycle to understand the policy’s network and discourse as it was discursively shaped within the contexts of influence, text production, and practice effects.
Consistent with vertical case study design (Vavrus & Bartlett, 2006), data were collected and analyzed at the text, practice, and broader socio-cultural level to provide macro, micro, and local level views of policy contexts, processes, and effects. Answering Gillborn’s (2005) critical policy study questions about policy drivers, policy rhetoric and reality, and policy winners and losers, the study illustrates how the state’s policy has been produced and continues to be perpetuated by networks of influence and neoliberal and managerial discourses despite status quo effects for children.
Study findings reveal that Arizona’s Move On When Reading statutes, as amended, reflect the dominant narratives of testing and accountability, science, and learn-to-read then read-to learn that grew within conservative and neoliberal ideologies made popular by the No Child Left Behind Act and the National Reading Panel and which continue through the Every Student Succeeds Act. These narratives combine and travel through networks and discourses and sanction, via state statute, the punitive, harmful, raced, and classed practice of retention that decades of research has warned against, leaving the opportunity gap unchanged and critical implications for local educational leaders.
Keywords: third grade reading policy, new governance, neoliberalism, discourse, networks, critical theory, policy cycle, vertical case study
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Politicking While Black: News and Social Media Representations of Three Black Female Political Candidates Running for the House of Representatives in the 2018 Midterm Election
Politicking While Black: News and Social Media Representations of Three Black Female Political Candidates Running for the House of Representatives in the 2018 Midterm Election
Cabrera-Peterson, Zeina Atalig
African American women have been the leading force in political campaigns long before they had the right to vote and hold office. Today, roughly 5% of African American woman hold political positions (CAWP, 2018). However, despite their political participation, there are few studies that examine representation of Black female political candidates in news media. This study employed a content analysis of news reports and three Black female candidates' Twitter campaign accounts to examine how news media represented these three, first-time candidates and to analyze how these candidates represented themselves on Twitter. Based on the overall analysis of a census of newspaper articles and Twitter candidate accounts, the study found that race and gender was not a leading area of news coverage or self-representation in tweets. The research found that these candidates were mostly identified by their former occupations and were not questioned because of who they are, but because of what they do. These findings are significant because it challenges and reshapes gender and race identities.
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