A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Background: Dengue fever is the most common mosquito borne viral disease in the world. Its symptoms can be fairly nonspecific and most commonly include fever, rash, headache, and eye pain. Passive surveillance is currently the most prevalent method used to detect dengue cases in the United States. Identification of positive cases can be limited by the public’s awareness of the disease’s symptoms, barriers to healthcare seeking behavior, and by physician approval of laboratory testing. Objective: This study sought to evaluate barriers to dengue reporting, as well as the patient‐ level factors that may limit the efficacy of passive surveillance of dengue in Key West, Florida. Methods: Cross‐sectional surveys were administered across Key West, FL. Subjects were asked if they had a recent fever, additional dengue symptoms, and whether they sought medical care for these symptoms. Also the hypothetical question was posed: would you seek medical care for a fever greater than 102 F? Responses were stratified according to patient characteristics and demographics. Results: In Key West, patient‐level factors that influenced the decision to seek medical care for a high fever were: having a specific doctor call when sick (p<0.006), health insurance status (p<0.037), and ethnicity (p<0.005). Additionally, barriers to dengue reporting were identified. The most impactful were the decision to seek medical care for symptoms consistent with dengue fever, and the doctor’s decision to administer confirmatory dengue laboratory tests. Only one person with a recent fever plus one additional classic dengue symptom received laboratory testing, and this was done outside of the United States. There were four individuals who met the current WHO clinical case definition for dengue, yet none were offered laboratory testing or were diagnosed with the disease. Conclusion: This study shows that both patients and doctors in Key West, Florida underestimate the potential for dengue when there are symptoms consistent with the disease. As such, it is certainly possible that there have been unreported cases in the country.

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Sea level rise (SLR) varies depending on location. It is therefore important to local residents, businesses and government to analyze SLR locally. Further, because of increasing ice melt and other effects of climate change, rates of SLR may change. It is therefore also important to evaluate rates of change of SLR, which we call sea level acceleration (SLA) or deceleration. The present thesis will review the annual average sea level data compiled at the Key West tidal gauge in Key West, Florida. We use a multi-model approach that compares the results of various models on that data set. The goal is to determine if there is a consistent result that can be ascertained from the various models. Generally, all the models reveal a clear upward trend of SLR. Further, the models provide evidence that the trend has increased over the last 8-10 years, i.e., that there is SLA.

The time-honored profession of commercial fishing in the Florida Keys is in danger of extinction as each year passes and fewer commercial fishermen remain in an industry that is sinking in the wake of politicians, land developers, and financial woes. At the heart of the problem is the threat of overfishing, a subject that is increasingly at the forefront of media attention and environmental campaigns. The villain in this story of death and destruction more often than not are commercial fishermen. But the blame is misguided. Our fishermen work according to the letter of the law and strive to maintain healthy sustainable fish stocks and sound marine ecosystems. It is unlikely that the American hunger for seafood will diminish so in the absence of locally caught fish the public has no choice but to support the efforts of unchecked foreign fisheries—Fisheries that are not managed as well as ours and in some instances fish until there is nothing left to take. / text

Lately, we have been noticing an unusual rise in the sea level near many Floridian cities. By 2060, scientists believe that the sea level in the city of Key West will reach between 22.86 to 60.96 centimeters (Strauss et al. 2012). The consequences of sea level rise are unpleasant by gradually tearing away our beaches and natural resources, destroying our homes and businesses, etc. Definitively, a continual increase of the sea level will affect everyone either directly or indirectly. In this study, the sea level measurements of four Floridian coastal cities (including Key West) are collected in order to describe their trend toward sea level rise over the past 100 years. After the comparisons, some models describing the sea level rise in the city of Key West, Florida, are developed. Any inferences for these above cities may well be extended to similar ones.

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