Theses and Dissertations

On average, children from low socioeconomic backgrounds tend to eat around half of their fruit and vegetable intake from the National School Lunch Program (NSLP). If it weren’t for this national program, the majority of these children would not come close to achieving the recommended intake for fruits and vegetables (FV), which can be defined as one to two cups of fruits daily and one to three cups of vegetables daily. The reasons for such a statement are puzzling; the prices for FV have stayed relatively the same over time. In addition, the increase in frozen and canned FV are not only relatively inexpensive, but their packaging helps increase the lifespan of the product. Why then are children, especially in families from low socioeconomic settings, not meeting these daily requirements? After reading many articles, I have concluded that one of the main factors is finance. It can be costly, in terms of time as well as financially, to buy fresh products and take time out of the day to prepare a meal, especially when fast-food restaurants can provide a cheap and satisfying meal in a fraction of the time. Another factor influencing the lack of FV consumption in children is time; many parents have long work hours and perhaps do not have enough time in their day to prepare complex and nutritious meals. Lastly, another factor that must be considered is the possibility of living in a food desert: an area in which there is limited access to nutritious foods within half a mile walking distance. It is because of these reasons that I would like to discuss different ways to help children reach the recommended daily value for FV intake in more detail.

Research Objective Social determinants of health (SDOH) are the conditions in one’s living environment that affect health, functioning, and quality of life. Total joint arthroplasty (TJA) is a surgical procedure to replace a damaged joint with an artificial joint. TJA complications include acute myocardial infarction, pneumonia, sepsis, surgical site bleeding, pulmonary embolism, or periprosthetic joint infection. Previous research demonstrates that Black race, Hispanic ethnicity and poverty were negatively associated with TJA outcomes in veterans. The goal of this mixed methods quality improvement study is to determine if SDOHs affect TJA complications at a health system in the Phoenix metropolitan area. Methodology For this study, records from patients who underwent hip or knee TJAs at any of the four system facilities between 2/2019-2/2020 were included. Demographics and clinical data were extracted from the electronic health record (EHR) via Midas+ Care Management with SDOH variables from case manager notes corresponding to food, utilities, housing and transportation insecurities, and interpersonal safety. Complications were identified using ICD-10 codes. SDOH for individuals with and without complications were compared. A multinomial logistic regression was performed in SPSS to identify significant variables. Semi-structured interviews with case managers (n=2), orthopedic surgeons(n=5), and primary care physicians (n=4) were performed to explore care team interactions with SDOH. Interview notes were coded and analyzed based on response frequency and themes. Results Of 2,520 patients who underwent TJA, 50 (1.98%) experienced a TJA complication. Of those, 38% screened positive for an SDOH. For those without a TJA complication, 27% screened positive for an SDOH (p=0.093). Most interview participants identified a correlation between socioeconomic status and surgical outcomes. They also recognized that language barriers for Spanish-speaking individuals and family involvement post-discharge are significant factors in TJA outcomes. Conclusions This single system mixed methods retrospective quality improvement study demonstrates that patients who screen positive for an SDOH are more likely to experience a TJA complication. We recommend that SDOH assessments be obtained for all patients undergoing TJA, be available to care teams, and be incorporated into care plans to improve outcomes.

Physical therapy modalities are passive tools that are used in physical therapy clinics, beside the exercise program and manual therapy, that promote blood flow, decrease inflammation, and improve range of motion and function. Electrical stimulation, ultrasound, ice, and heat were analyzed in this review. The purpose of this quantitative review is to use the research that has been conducted over the past 30 years to determine if physical therapy modalities are effective at decreasing inflammation, increasing range of motion and function, decreasing pain, and to draw a conclusion about whether or not they should still be used on patients today. Systematic reviews and meta analysis were analyzed and compared to qualitative surveys and patient/therapist surveys conducted in this study to determine if ultrasound, electrical stimulation, ice, and heat were effective. The results showed that both electrical stimulation and ultrasound were effective for decreasing pain, increasing functionality, and decreasing inflammation (Ashrafi, 2017; Bistolfi, 2018; Ferronato, 2017; Fuentes, 2010; Haile, 2021; Yu, 2015). However, the types of injuries, frequency, and duration of the modalities used still need to be further researched to understand how to maximize the effectiveness of these modalities. Ice therapy was significantly effective at decreasing inflammation, while heat therapy was significantly effective at decreasing pain, both in the short term (Wang et al., 2021).

For most women, pregnancy is the period in which they will have more interaction with the healthcare field than any other period in their lives. The quality and accessibility of obstetric care varies greatly throughout the United States, and health disparities in this field have the largest impact on African American women. Black mothers in the U.S. are three to four times more likely than white mothers to die as a result of pregnancy related complications. The increased risk of maternal morbidity and mortality seen in the African American population is largely due to preventable causes. This thesis project includes three case studies which analyze the most prevalent and preventable sources of health disparity affecting Black mothers: preeclampsia, hemorrhage, and cesarean section. Possible solutions to each of these disparities are explored on an individual, institutional, and societal scale.

This paper will analyze the two films Mississippi Burning and BlacKkKlansman, as well as some of the historical contexts surrounding them, in order to unpack the various aspects of police brutality, protest culture, and ideals of reform shown within. Furthermore, it will investigate the impact of diverging from history on the perception of policing units, and the importance of more accurate narratives like BlacKkKlansman in popular culture. <br/> To find evidence that BlacKkKlansman is a much more accurate narrative regarding law enforcement and the effects that sentiments seen in Mississippi Burning have on modern day events, a comprehensive research analysis was conducted. Both films were watched multiple times and analyzed thoroughly, and further research was done to understand not only the narrative elements of the plot, but how the visual aspects strengthen the arguments both films try to make. Scholarly articles on contexts surrounding the subjects of the film were also analyzed, including topics on the FBI, Martin Luther King Jr, and police brutality. Through this, it became evident that Mississippi Burning overlooked most of the reality of the events the film is loosely based upon in order to present a white savior story, whereas BlacKkKlansman addresses the existing prejudices head on while also showing the relation the events have to a more modern context, specifically surrounding the Trump administration.