Promoting population health is an essential task for sustainable development. This study explores the association between socioeconomic status and perceived health in the United States, with special attention on the influence of living arrangements. It also improves the existing explanations of causal mechanisms underlying the impact of SES on health among Americans over 50. Using the first and seventh waves of Health and Retirement Study to run ordered logistic regression, this research addresses the importance of living arrangements and social capital on self-reported health. Income and education are both important predictors of self-reported health. In addition, living arrangements and household social capital also affects self-reported health after controlling individuals’ characteristics and SES indicators. These effects do not appear to mediate the socioeconomic effects on self-reported health. Future research should highlight better measures of living arrangements and social capital, as well as explore longitudinal analyses.

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Background: The management of cleft lip and/or palate (CL/P) includes multidisciplinary care beginning in infancy and continuing through to adulthood. Outcomes of cleft care have been difficult to measure because of the subjective nature of evaluating concepts such as appearance and speech. Including the patient perspective in outcome evaluation through the use of a patient-reported outcome (PRO) measure would provide a more accurate reflection of a patient’s status. The overall objective of this thesis is to show that through adherence to rigorous methods of development, a PRO measure can provide clinically meaningful outcome evaluation in cleft care. Methods: The first paper uses the qualitative method of interpretive description to define a conceptual framework to guide the development of a PRO measure for patients with CL/P, the CLEFT-Q. The second paper describes the protocol for the entire development of the CLEFT-Q. The third paper analyzes the results of the cross-sectional field-test of the CLEFT-Q scales to determine whether or not the CLEFT-Q is able to detect differences between specific cleft types. Results: The qualitative study included 138 patients with CL/P from six countries. The final conceptual framework contained thirteen concepts within the domains of appearance, facial function, and health-related quality of life. The second paper details the process of designing the CLEFT-Q scales. The field-test included 2,434 patients from thirty sites in twelve countries, and CLEFT-Q scores were found to vary with cleft type for all scales. Conclusions: PRO measures need to be rigorously designed in order to provide scientifically sound, clinically meaningful measurement. The CLEFT-Q is able to detect differences between patients with various cleft types, and will be a useful tool to provide the patient perspective in future outcome evaluation in cleft care. / Thesis / Doctor of Philosophy (PhD) / Measuring outcomes of treatment for cleft lip and/or palate (CL/P) should include the patient perspective. The objective of this thesis is to show that through rigorous methods of development, a patient-reported outcome (PRO) measure, the CLEFT-Q, can provide clinically meaningful evaluation of outcomes. First, 136 patients with CL/P from six countries were interviewed to learn what concepts related to having a cleft or its treatment are important to them. A conceptual framework was developed that informed the CLEFT-Q scales. Describing the methodology behind developing the CLEFT-Q then served to inform and engage members of the community. A field-test of the CLEFT-Q scales showed that in a sample of 2,434 patients with CL/P from twelve countries, CLEFT-Q outcomes varied in patients with different types of CL/P. The CLEFT-Q can be used to provide rigorous measurement of PROs in patients with CL/P in the future.

Dysfunction of the visual cortex is implicated in psychosis and recently, the extrastriate visual cortex (V5/MT) has been causally linked to visual hallucinations through lesion network mapping. Transcranial electric stimulation (tES) has been shown to improve psychotic symptoms and cognition in psychosis spectrum disorders. However, few investigations have used novel approaches, such as high definition tES (HD-tES) to target specific brain circuits. Previously, we showed that stimulation delivered to V5/MT using HD-tDCS (direct current) reduced Positive and Negative Syndrome Scale (PANSS) general symptoms in the short-term (5 days), while HD-tACS (alternating current) improved general symptoms and functioning in the long-term (30 days). Here, we aim to determine if HD-tES to V5/MT has altering effects on cognition and self-reported symptoms of psychosis, and to investigate the differences between self-reported and clinician-reported symptoms. A pilot open label study with a within-subjects, single blind, crossover design was conducted in order to characterize the efficacy of cathodal HD-tDCS and 2Hz delta HD-tACS for psychosis treatment. Enrolled patients received 20 mins of HD-tES twice daily for 5 consecutive days applied bilaterally to V5/MT with a washout between conditions. Assessments were performed at baseline, day 5, and day 30. HD-tACS treatment was found to improve cognition on Digit Sequencing, Tower of London, Semantic Fluency, and “S” Letter Fluency tasks as measured by brief assessment of cognition in schizophrenia (BACS) as well as symptoms of paranoid ideation and anger/hostility as measured by the symptom checklist 90 (SC-90) 1 month after treatment. HD-tDCS treatment yielded significant improvement on “F” Letter Fluency as measured by BACS and did not yield any significant improvement on SC-90 symptoms. Lastly, correlations between SC-90 and PANSS described a distinct relationship between the two scales and their measures of psychiatric morbidity. Ultimately, delta wave tACS may be able to improve cognition and certain symptoms of psychosis by altering cortico-cortico communication between relevant brain structures. Future large-scale investigations are needed to further solidify these results. / 2026-03-04T00:00:00Z

Elderly Black and Hispanic adults have poorer overall health, higher disability rates, and lower life expectancies than elderly Whites and other racial and ethnic minority group members. There are also sex differences in health, with women more likely to suffer from non-life threatening chronic conditions and men more likely to suffer from acute conditions. Health pathways, or the processes to good or poor health, are shaped by race, SES, and sex. This study focuses on the race and SES literature, framing race and SES inequalities within a cumulative advantage lens. Using Hierarchical Linear Modeling techniques to examine data from the Health and Retirement Survey, this study finds that there are racial differences in health through health problems, health insurance, and health care treatment, and that Black, Hispanic, and other racial and ethnic minority group members have worse self-reported health than Whites in old age. This study also finds evidence of cumulative advantage through friends in the neighborhood, and finds evidence of cumulative disadvantage through health problems and hospital and nursing home treatment. There are also cumulative disadvantages for women, who have more functional limitations in old age than their male counterparts, and these disadvantages grow over time. This study adds support to the race literature, by furthering understandings of race and SES as interconnected but not interchangeable systems of inequality. In lieu of the findings, this study provides implications for future research and ways to reduce racial health disparities in old age. / Ph. D.

This study examines the languages attitudes surrounding the standard (Academic Guaraní) and vernacular (Jopará) varieties of Guaraní, as well as the reported language use for Spanish and the two varieties of Guaraní. The study addresses language attitudes as manifestations of pride, loyalty, and prestige and reported language usage characteristic of a dichotomy between high and low varieties (e.g. Loureiro-Rodríguez, 2008) in order to determine if similar language attitudes and linguistic norms are evident in this community. A survey was used to gather data from 10 students and 10 teachers who live and work in Altos de La Cordillera (a small town with rural and urban features). Contrary to the findings of previous research studies on the language attitudes associated with high and low varieties (e.g. Garrett, 2001), the participants of this study appear to show an all-round favorability for the standard variety of Guaraní (Academic Guaraní). Furthermore, the reported language use of Spanish, Jopará, and Academic Guaraní does not seem to provide evidence for a Spanish/Guaraní diglossia in this community nor does there appear to be a dichotomy between the high and low varieties of Guaraní such as what has historically existed between Spanish and Guaraní. The participants' language attitudes and patterns of reported language use are interpreted in relation to notions of solidarity, superiority, accommodation, and the relationship between adolescence and identity formation. / Master of Arts / This study examines the languages attitudes surrounding the variety of Guaraní taught in school (Academic Guaraní) and the primarily oral variety of Guaraní (Jopará) historically spoken at home or in private contexts. It also examines the reported language use for Spanish and the two varieties of Guaraní. The study addresses language attitudes as manifestations of pride, loyalty, and prestige and reported language usage characteristic of multilingual communities in order to determine if similar language attitudes and linguistic norms are evident in this community. A survey was used to gather data from 10 students and 10 teachers who live and work in Altos de La Cordillera (a small town with rural and urban characteristics). The participants of this study appear to show an all-round favorability for the standard variety of Guaraní (Academic Guaraní). Furthermore, the reported language use of Spanish, Jopará, and Academic Guaraní does not seem to be connected to the formality or informality of the given situation or context. The participants’ language attitudes and patterns of reported language use are interpreted in reference to inter and intra-group relations and the notion of superiority.

Maintaining current and future infrastructure will require smart practices to help better meet user needs with fewer financial resources. The recent adoption of information communication technologies, such as, 311-call centers enables city agencies to detect and more quickly respond to real-time infrastructure system service disruptions and maintenance requests. Of the 200 or more cities that use 311, New York City's system is the largest, receiving more than 19.5 million citizen requests since 2010. Current citizen service requests made through 311 range from issues about street and sidewalk conditions to problems with their water, sanitation, snow removal, and traffic congestion. In the first manuscript, service requests were compared to socio-economics within zip codes. Zip codes were clustered by four socio-economic variables including median house value, percent of the population with a bachelor's degree, unemployment rate, and percent non-white to represent socio-economic differences between zones in the city. Results show that citizens from low socio-economic areas, meaning those with low median house values, low population with a bachelor's degree, high unemployment, and high percent non-white are burdened with significantly more infrastructure maintenance requests. When controlling for physical differences such as miles of road, total frequency of calls, and the number of people per zip code, people from low socio-economic zones are more likely to call about issues related to street conditions, sanitation, and their water system. In the second manuscript, service request response time by agency were compared based on location and socio-economic variables. The location of the call based on borough and the socio-economic characteristics of the zip code do significantly influence agency response time. Citizens reporting issues in Queens can expect to wait significantly longer, about 3 days more, to receive a response for a similar request in other boroughs of New York City. This is for issues about water, sewer, traffic lights, and street condition. The Department of Transportation, Department of Sanitation, and the New York Police Department respond significantly faster to service requests in zones classified with high and middle socio-economic groups compared to zip codes with low socio-economic groups of people. These differences in geography and socio-economic characteristics suggest unequal treatment of maintenance issues. These differences in response may expose an implicit bias in maintenance response. By recognizing these differences, city engineers can begin to prioritize maintenance issues based on how communities perceive infrastructure in need of repair, and thus better meet the needs of individual citizens in the future. / Master of Science / Infrastructure includes systems including buildings, roads, water/wastewater, trash, and various other networks that facilitate citizens everyday lives. These infrastructure systems will always require maintenance in order to keep it running effectively and efficiently. Using smart and sustainable practices in this process can help better meet user needs, while saving more money. Using more technology such as 311-call centers can allow cities to detect and more quickly respond to real-time infrastructure disruptions and maintenance issues. 311 call centers receive calls about anything from street condition problems such as potholes to problems with their drinking water. Of the 200 or more cities that use 311, New York City’s system is the largest, receiving more than 20 million citizen requests since 2010. The first manuscript looks into what certain types of people call about. Using zip codes, areas of the city were grouped together based on four socio-economic variables; median house value, percent of the population with a bachelor’s degree, unemployment rate, and percent non-white. People from low socio-economic areas, meaning those with low median house values, low population with a bachelor’s degree, high unemployment, and high percent non-white call more about infrastructure maintenance requests. When controlling for physical aspects of these areas such as miles of road, total amount of calls, and the number of people per zip code, people from low socio-economic areas are more likely to call about issues related to street conditions, sanitation, and their water system. The second manuscript looks into how long it takes government agencies to respond and resolve these calls. The location of the call based on location in the city and the socio-economic characteristics of the zip codes have an effect on agency response time. People reporting issues in Queens can expect to wait much longer, about 3 days more, to receive a response for a similar issue called from another borough of New York City. The Department of Transportation, Department of Sanitation, and the New York Police Department respond significantly faster to service requests in areas with high and middle socio-economic status groups compared to zip codes with low socio-economic groups of people. By knowing that location and socio-economic status matter when citizens call 311, city engineers can begin to use this data to help prioritize maintenance issues based on specific areas and needs of individual people in the future. These differences in location and socio-economic characteristics could possibly suggest unequal treatment of maintenance issues. However, since the differences seen in this research are with only certain variables accounted for, further research will be needed to help show possible causation for these differences.

Ce travail se propose d’étudier, sous un angle grammatical, le phénomène romanesque connu sous le nom de "monologue intérieur", qu’il convient d’emblée de distinguer du "stream of consciousness", auquel il est souvent ramené. Afin de mieux cerner et de définir ce qu’est le monologue intérieur, nous confrontons les définitions qui en sont généralement données à des textes de fiction anglophones, et nous analysons les techniques linguistiques utilisées pour représenter ce discours particulier. Il apparaît donc que le monologue intérieur n’est pas une technique linguistique mais doit plutôt se concevoir comme une catégorie narratologique. Ce discours s’incarne grâce à diverses techniques linguistiques : le discours immédiat mais aussi certaines des techniques du discours rapporté, avec en son centre le discours direct (libre) et à sa périphérie le discours indirect classique. Le discours indirect libre, quant à lui, navigue entre les deux. Ces différentes techniques reposent donc sur une conception particulière du discours intérieur qu’elles véhiculent, et leur étude permet d’étudier la possibilité offerte à l’auteur ou au narrateur de détourner leur forme afin de servir une stratégie narrative, avec parfois pour but de faire passer pour verbal ce qui ne peut l’être. / This thesis investigates the literary phenomenon known as “interior monologue” from a grammatical point of view, and is based on a clear distinction between “interior monologue” and what is called “stream of consciousness”, both phenomena usually being seen as the same. The main objectives are therefore to define what we call “interior monologue” in order to confront this definition with English language literary texts, and to analyse the various linguistic techniques used to represent this special discourse. Interior monologue is therefore seen not as a linguistic technique but as a narratological category. This particular discourse is represented using different linguistic techniques: “immediate discourse” but also some of the reported speech techniques, with (free) direct speech as the core of the category, and indirect speech at its periphery, free indirect speech navigating between those two poles. These techniques differ both in their form and in the conception of the interior discourse they convey, but they always create the illusion of giving access to the (fictional) original discourse. It is for this reason that we want to show the possibility for the author or the narrator to use a syntactic form suggesting a reported discourse seemingly closely linked to the original discourse, to represent something that sometimes cannot be considered as verbal.

Doctor of Philosophy / Department of Hospitality Management / Kevin R. Roberts / Ethnic foods have gained in popularity and have become mainstream in the diet of most Americans. However, researchers have noted that ethnic food, specifically food served in ethnic restaurants, has been associated with foodborne outbreaks. Little has been done using the Social Cognitive Theory to predict food safety behaviors, especially in independent ethnic restaurants. The purpose of this study was to determine whether self-efficacy, self-regulation, outcome expectations, and environmental determinants are predictive of self-reported food safety behaviors in independent ethnic restaurants. Utilizing a thorough literature review and results of five focus group and group interviews, a questionnaire was developed. The questionnaire was translated to Chinese and Spanish and back-translated to English to ensure consistency. After pilot-testing, a multistage random sampling technique was utilized to collect data, targeting a total of 150 food handlers from independent Mexican and Chinese restaurants. A total of 204 food handlers responded, but due to incomplete data or responses from non-food handlers, 201 responses were usable for a response rate of 80.4%. A multiple regression analysis investigated the prediction of food safety behavioral intentions based on the respondents’ self-efficacy, self-regulation, outcome expectations, and environmental determinants and found the model was significant (F = 75.246, p = 0.002). The significant independent variables in the model were self-regulation (β = 0.467, p = 0.001), environmental determinants (β = 0.181, p = 0.011), and outcome expectations (β = 0.152, p = 0.018), which explained about 60.6 % of the variance in food safety behavioral intentions. Self-efficacy was not significant (β = 0.078, p = 0.219). A mediation analysis showed that behavioral intentions are a significant mediator of the relationships between self-efficacy and self-reported food safety behaviors (b = 0.24, CI [0.161, 0.336], self-regulation and self-reported food safety behaviors (b = 0.252, CI [0.155, 0.366]), outcome expectations and self-reported food safety behaviors (b = 0.355, CI [0.247, 0.469]), and environmental determinants and self-reported food safety behaviors (b = 0.269, CI [0.172, 0.393]). Implications, limitations, and direction for future research were discussed.