INTRODUCTION Lack of follow-up to recommended appointments can decrease vision outcomes. Research is needed to determine the best approach to scheduling follow-up appointments in the primary eye care setting to help overcome barriers and decrease disparities in vision health. The specific aim of this work is to evaluate the effectiveness of automated and personal telephone interventions to improve follow-up adherence in the primary eye care setting. METHODS In a prospective, single-blind, randomized, controlled trial, 1,095 patients seen in the Cataract and Primary Care service (CPEC) at Wills Eye Hospital who were due for follow-up appointments were randomly assigned to usual care, automated telephone intervention or personal telephone intervention group. Patients in the usual care group (n=364) received a form letter reminding them to make an appointment and an automated reminder phone call one day prior to their scheduled visit. Automated intervention participants (n=365) received the usual care form letter and an automated call 1-month prior to their recommended follow-up date, a mailed appointment reminder if an appointment was scheduled, and an automated telephone reminder the day before the scheduled appointment. If a patient in the automated intervention group did not attend the scheduled appointment, a reminder postcard was sent. Personal intervention participants (n=365) received the traditional form letter and a personal telephone call 1-month prior to the recommended follow-up date, a mailed appointment reminder if an appointment was scheduled, and a personal telephone reminder prior to the scheduled appointment. If a patient in the personal intervention group did not attend the scheduled appointment, they received a personal call. Scheduling and attendance data were extracted from the electronic medical record system. RESULTS Patients in the personal intervention group had greater adherence to follow-up recommendations than patients in the usual care group (37.70% vs. 27.47%; RR: 1.37; CI 1.24-1.52; p<0.001) and automated intervention group (29.59%; RR: 1.27; CI 1.15-1.41; p=0.02). Patients in the usual care group were not significantly different than patients in the automated intervention group in regards to adherence to follow-up recommendations (27.47% vs. 29.59%; RR: 1.08; CI 0.98-1.18; p=0.53). Personal intervention improved adherence for patients who have been previously recognized as at risk including men (37.04% vs. 22.39%; RR: 1.65; CI: 1.41-1.94; p=0.01), African Americans (39.58% vs. 29.52%; RR: 1.34; CI 1.16-1.55; p=0.03), patients under 65 (28.93%-18.67%; RR: 1.55; CI 1.40-1.71; p=0.01), and patients who live greater than 20 miles from Wills Eye Hospital (44.74% vs. 12.50%; RR: 3.58; CI 2.59-4.95; p=0.01). Additionally, personal intervention improved adherence in patients with Medicare (58.42% vs. 43.56%; RR: 1.34; CI 1.01-1.79; p=0.03) and urban patients who live within 2 miles of Wills Eye Hospital (41.18% vs. 17.54%; RR: 2.35; CI 1.81-3.04; p=0.01). As a secondary endpoint, personal intervention significantly improved appointment scheduling over usual care (51.09% vs. 32.14%; RR 1.59; 95% CI 1.33-1.90; p<0.001) and automated intervention (51% vs. 36%; RR: 1.40; CI 1.18-1.66; p<0.001). Automated intervention did not significantly improve appointment scheduling over usual care (36% vs. 32%; RR: 1.13; CI 0.93-1.39; p=0.22). CONCLUSION Personal intervention improved adherence to recommended follow-up for primary eye care appointments overall and in at-risk populations. Automated intervention had no significant improvement over usual care. The cost effectiveness of personal intervention to improve outcomes in a primary ophthalmology setting should be evaluated to determine whether the intervention should be implemented as a process change at Wills Eye Hospital and at other primary ophthalmology care centers.

Doctor of Philosophy / Department of Mathematics / Andrew Bennett / Many students have difficulty performing well in Calculus 1. Since Calculus 1 is often the first math course that people take in college, these difficulties can set a precedent of failure for these students. Using tools from data mining and interviews with Precalculus and Calculus 1 students, this work seeks to identify the different types of students in Calculus 1, determine which students are at risk for failure, and to study how intervention can help them succeed both in mathematics and in their college careers.

Rates of obesity and lifestyle related diseases have increased in the last decade, adding strain to the health care system. While research mounts for the protective benefit of a diet rich in fruits and vegetables, the majority of Americans do not consume the recommended amounts. Successful strategies to improve healthy eating have utilized planning and goal setting to increase awareness of opportunities to eat healthy foods. Implementation intentions utilize if-then statements which describe potential situations to perform one's goal behaviors. In order to extend the research on implementation intentions and health behaviors, the role of romantic relationships will be investigated. Eating behavior is often part of a social environment allowing influence from close others to affect our eating choices. Romantic partners play an important role in eating behaviors due to the frequency of eating together and meal planning. Incorporating a partner's presence into implementation intentions to eat healthier was expected to improve the effect of implementation intention interventions. The first study investigated these hypotheses on individuals in relationships in an experimental laboratory-based design. The second experimental study aimed to determine if the benefit of the partner implementation intention intervention on couples requires both partners. Conclusions in each study were limited by methodological and sampling issues that occurred. Study 1 was unable to support the hypotheses due to the sample collected having low intentions to increase their fruit and vegetable eating. Study 2 suffered from unequal means in fruit and vegetable eating at the first session indicating issues with the measure or random assignment. These methodological concerns are discussed and areas for future research are explored.

Since the end of the Cold War, much has been written on the various overseas military adventures of Western powers, with significant focus being placed on the legality and legitimacy of these interventions. Despite the volume of work produced on the topic, this thesis argues that much of it has been framed incorrectly, allowing for a conflation of the concepts of legality and legitimacy to distract from the true source of international legitimacy and the true role of international law. Over this period of time, through a combination of selective application and lack of genuine understanding of its role, statutory international law has steadily lost traction and credibility. Through an analysis of a range of case studies from the post-Cold War era, this thesis argues that international legitimacy emanates not from the international legal order (as represented and overseen by the UN) but from consensus amongst kin countries. There are various potential avenues available to achieve consensus, but which is chosen depends on the circumstances of each individual case. National interest underpins state decision-making and, if significant enough, can, on its own, provide a route to consensus. Additionally, a shared national security concern - the pre-eminent catalyst for consensus during the Cold War - remains a powerful option. Furthermore, in the post-Cold War world, a new, norms-based justification, often classified as “humanitarian intervention” has also developed. Demonstrating compliance with international law can, depending on circumstances, be potentially available to strengthen the case for consensus but is not necessarily always an appropriate or productive choice and plays a secondary role to other, more powerful considerations. By focusing on key case studies it is possible to identify trends in approach to the use of international law and identify the nature of the role it plays in international power politics. Through close analysis of a wide variety of primary and secondary sources, it is possible to identify key drivers for decision-makers and detect the impact of past experience on the use of international law in the quest for legitimacy ahead of launching military action. The trends in approach and in relations between close Western allies (in particular the UK and US) have been identified from the Gulf War in 1990 through to the ongoing crisis engulfing Syria, and potentially hold valuable lessons for future strategic decision-making.

This thesis examines the way the state intervenes in the labour market for youth through an analysis of the implementation of the Youth Training Scheme. It adopts a dynamic model of policy formulation and delivery to explore the extent to which the state is able to compensate for the crises of contemporary capitalism. The first part of this thesis looks at the way in which theories of the state translate into theories of state intervention and the assumptions these make of the ability of the state to intervene. It argues that current theories do not adequately consider the way in which policy is continually renegotiated throughout its delivery. The failure to consider the institutional form of the state has lead to both normative and conspiratorial theories of state intervention. These have commonly considered the outputs of policy rather than its delivery. It is also maintained that policy analysis has not systematically related the evaluation of policy to a theory of the state. The second part analyses the implementation of the Youth Training Scheme as an example of an intervention by the state into the labour market. It shows, through an empirical analysis that policy objectives are renegotiated throughout the delivery of the programme. In particular the research looks at the way in which the Youth Training Scheme emerged in three constrasting labour markets. The research focusses on the recruitment to, and training within, schemes to illustrate the effects of labour market structure on the outcome of the programme. This analysis takes into account the structure into which policy is delivered as well as the institutional constraints on policy implementation. By using the dual focus of the state and the capital/labour relationship a framework for the analysis of policy in the sphere of production is developed.

The context for this work is set by the proliferation of intrastate conflicts and the international legal debate of humanitarian intervention. The thesis specifically addresses the concept of the “Responsibility to Protect” (R2P) as formulated by the International Commission on Intervention and State Sovereignty (ICISS). The objective is to assess the present quality of R2P as a concept of international law. Five components of the R2P framework are discussed: the primary responsibility of every state to protect its population from large-scale killings and large-scale ethnic cleansing; the right of other states to collective humanitarian intervention through the United Nations; a right of unilateral humanitarian intervention without prior Security Council authorization; the responsibility of the international community to take military action; and the criteria for external military involvement. Methodologically, the analysis is grounded in the dominant theory of legal positivism and its doctrine of sources, which requires notably an analysis of treaties and customary international law. An ethical theory is devised and applied, however, to remedy inadequacies of a strictly positivist method that sets out to determine international law solely on the basis of hard facts. These ethical considerations serve as a background theory to provide guidance in difficult cases of treaty or customary law analysis, and they fill gaps in positive international law as legally binding “principles of ethical law”. In conclusion, the individual components of R2P differ in terms of their legal status and the degree to which it can be explained by the traditional posivist approach to international law. The primary responsibility of every state has become accepted as a hard norm of international customary law; the right of collective humanitarian intervention is provided for in Chapter VII of the UN Charter; a right of unilateral humanitarian intervention has become part of the international legal system as a “principle of ethical law”; the residual responsibility of the international community is a principle of “legal soft law”; finally, positive international law defines no criteria delineating the permissible and required use of force for the protection of foreign populations. / Law, Faculty of / Graduate

Class of 2014 Abstract / Specific Aims: The primary objective was to determine the effectiveness of a criteria-based antibiotic order form (CBAOF) at increasing appropriate meropenem use at University of Arizona Medical Center –South Campus (UAMCSC). The secondary objective was to assess any cost savings associated with increased appropriate meropenem use. Methods: A retrospective chart review of patients (n = 133) meeting inclusion criteria at UAMCSC during the pre and post-intervention periods was conducted. Outcomes included appropriate empiric use of meropenem, appropriate treatment of a known pathogen use of meropenem, appropriate dose and frequency of meropenem, appropriate antibiotic streamlining after culture and susceptibility report, and meropenem acquisition costs. Main Results: Appropriate empiric use of meropenem was significantly higher after the implementation of the CBAOF (100% vs. 65.8%, p = 0.002). Although not statistically significant, the post-intervention group had more patients meeting the criteria for appropriate use of meropenem for a known pathogen than the pre-intervention group (50% vs. 40%, p = 0.809). There were no differences between the pre and post-intervention groups with respect to appropriate dose of meropenem or appropriate frequency. After the implementation of the CBAOF there were significantly more patients who received antibiotic streamlining within 24 hours of culture and susceptibility reports (12.5% vs. 48.7%, p = 0.002). Drug acquisition costs for meropenem were reduced by approximately $30,000 after CBAOF implementation. Conclusion: The CBAOF was effective at increasing appropriate empiric meropenem use and decreasing meropenem acquisition costs at UAMCSC.

Class of 2014 Abstract / Specific Aims: The purpose of this study is to assess whether baseline rates of metabolic monitoring of scheduled atypical antipsychotics are sustained as a result of a pharmacist intervention. Methods: This study was a retrospective chart review assessing rates of metabolic monitoring two months after a pharmacist intervention that utilized a pharmacist-physician metabolic monitoring recommendation form was discontinued. Patients ages 18 years or older with orders for a scheduled atypical antipsychotic were included. Patients with orders for first-generation antipsychotics or who have orders for as needed atypical antipsychotics were excluded. Main Results: Data from the two month post intervention period was compared to those obtained during the pharmacist intervention. For the monitoring of hemoglobin A1c and fasting lipid panels, which improved during the pharmacist intervention, there was a non-statistically significant trend towards decreased monitoring. For hemoglobin A1c, the rates of monitoring decreased from 21.59% to 12.32% (p = 0.09). For fasting lipid panels, monitoring decreased from 39.77% to 28.99% (p = 0.125). Conclusion: A pharmacist intervention utilizing a recommendation form was effective in sustaining the improvement of baseline metabolic monitoring of personal history of diabetes and cardiovascular disease and monitoring of hemoglobin A1c and lipid panels. However, a trend towards decreased monitoring was observed in both the percentage of hemoglobin A1c and lipid panels ordered. Thus, continuing pharmacist intervention may be necessary in order to ensure that baseline metabolic monitoring for atypical antipsychotics occurs.

Class of 2013 Abstract / Specific Aims: To further explore the relationship between patient’s diabetes knowledge and pharmacist intervention in patient care related to diabetes management. Study participants included diabetic patients being seen at the El Rio Health Clinic East campus. Subjects were patients being seen only by their primary care providers for diabetes management as well as patients being managed by a clinical pharmacist in addition to their primary care provider. Methods: Questionnaires were administered to eligible patients at the time of their clinic visit. Knowledge was assessed in various areas of diabetes management including diet, exercise, blood glucose management, overall diabetes control, and insulin therapy where applicable. HbA1C was self-reported as a secondary measure. Main Results: Questionnaires were completed by a total of 78 subjects. The pharmacist group included 48 subjects (mean age = 54; SD = 11.9; 60% Caucasian; 65% female) and the non-pharmacist group included 30 subjects (mean age = 52; SD = 9.5; 66% Caucasian; 57% female). Overall, there was no statistically significant difference in diabetes knowledge (p = 0.17) between the two groups. Conclusion: Survey data from this study, although limited and not adequately powered, showed no statistically significant difference in diabetes knowledge between the pharmacist group and non-pharmacist group.

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