Skin infections by the ectoparasitic mite Sarcoptes scabiei are a preventable source of morbidity worldwide. While scabies affects all socioeconomic sectors, it is especially prominent in the developing world where crowding, poor hygiene, and limited access to basic health care are commonplace. Mass eradication efforts of this parasite have historically been hampered by delivery and compliance issues surrounding topical standards of care. There have been advances in eradication over the last decade due to the expanded use of oral Ivermectin for the treatment and prevention of ectoparasites such as scabies. Previous research focused on various treatment aspects of the disease, yet most identified the need for basic scabies health education to accompany future studies to improve program sustainability and the overall health literacy of target populations. The Virginia College of Osteopathic Medicine sponsors a public health clinic in Veron, Dominican Republic that reports a high prevalence of scabies infections among its general patient population. The lack of any means of direct measurement, proper intervention, or control raises concerns that long-term infection may lead to multiple other secondary disease sequelae. The Veron Scabies Eradication and Education Program was designed to address this deficiency and build on previous studies related to this problem by using a novel treatment and education protocol. The purpose of this research was to identify, treat, and prevent primary and secondary health problems due to long-term scabies infection in the community of Barrio Nuevo, Veron, Dominican Republic in order to provide long-term sustainable eradication through a researcher-designed health education program and medical service protocol. Participants continued typical daily life while interventions and education were monitored to detect change over a 9-month timeline using selected measurement intervals to test multiple scabies disease and knowledge objectives and related hypotheses. Following this basic protocol, the following scabies markers were evaluated at baseline: subject demographics, scabies diagnosis and treatment history, baseline treatments and reported side effects, and scabies education pre-test results. The following scabies markers were also assessed at baseline and reassessed at 2 weeks, 1 month, 2 months, 8 months, and 9 months: risk and prevention behaviors, symptomatology, skin exam findings, and scabies education post-test results. There was a statistically significant post-intervention improvement in scabies markers when compared to pre-intervention values (p<0.05). This study demonstrated that a community scabies program involving large-scale treatment and education can provide rapid and long lasting improvements to the health of a highly endemic population. Community-wide scabies eradication is possible with the appropriate level of structure and support using low cost medication available to the health care system that serves Veron, Dominican Republic. Given the efficacy and safety profile of Ivermectin demonstrated in this study and substantiated by others, it is recommended that the Dominican Republic Ministry of Health consider adopting Ivermectin as the standard of care for scabies treatments and enforce an existing formal ban on Lindane products. The protocol from this research should be considered for adoption to provide a sustainable, practical, self-sufficient model for improved health outcomes, health behaviors, and health literacy. Future studies should replicate this research to determine validation in other settings, cultures and situations, build on the findings by exploring additional variables related to environmental risk factors, and continue to develop interventions that promote health education and enhance clinical practices. / Ph. D.

Coastal lakes, lagoons, and wetlands often provide excellent records of environmental change related to both marine and terrestrial processes. Although coastal paleoenvironments in the Caribbean have been a subject of increasing interest, long-term environmental reconstructions from lakes on the Atlantic side of the Caribbean islands are lacking. Laguna Limon is a freshwater lake in the El Seibo province of northeastern Dominican Republic. We collected a 315-cm sediment core from the center of the lake to examine lake evolution using loss-on-ignition and foraminiferal analysis. Loss-on-ignition results indicated the presence of a low-energy lagoon in the lake's present location between about 4700 and 1400 cal yr BP. During this period a foraminiferal assemblage dominated by the brackish-water Ammonia parkinsoniana but also containing relatively-abundant normal-marine salinity taxa (e.g., Quinqueloculina spp., Archaias angulatus, and Trochulina rosea) gradually was replaced by a low-diversity assemblage dominated by Ammonia tepida and Ammonia parkinsoniana, indicating a gradual decline in salinity due to the lagoon's growing isolation from the Atlantic Ocean. By 1400 cal. Yr. BP, the lake had become a shallow wetland, indicated by sediments with a high organic content. At 1200 cal. Yr. BP the lake flooded with freshwater, as it remains today. This study provides context for ongoing research into the environmental and human history of the Laguna Limon area. / Master of Science

The study of lake sediments can provide valuable insights into lake history and climate variation throughout time. In-depth studies have been carried out at Lake Miragoane, Haiti and in high- and mid-elevation sites in the Dominican Republic, and a few other inland and coastal locations throughout the Caribbean; however, to date little has been published on prehistoric conditions in other coastal areas of Hispaniola. Laguna Alejandro (informally named by researchers) (~18.31°N, 71.03°W), on the southwest coast of the Dominican Republic, was examined to expand our knowledge of long-term environmental history in this region. This ~25 hectare lake is separated from the Caribbean Sea by a 100 m wide limestone ridge about 3–5 m tall. We recovered two consecutive cores (0–100 cm, 100–185.5 cm) close to the limestone barrier to investigate the potential for paleotempestology and other paleoenvironmental reconstructions. Three AMS 14C dates indicate that the lake is ~1100 years in age. Sediment analyses revealed three major events that correlate with bands of uncharacteristic sediment composition and particle size at 74–77.5 cm, 150.5–153 cm, and 183.5–185.5 cm. Four distinct strata containing serpulids and several pockets of Ammonia beccarii provided insights on changes in salinity and the connections between the lagoon and the ocean. The upper deposit (74–77.5 cm, 620 ±60 YBP) contains gypsum and represents a period of increased salinity within the lake brought on by drought. The two lower bands are composed of sand consistent with nearby beach sands. The 150.5–153 cm band provides evidence of a hurricane landfall at 1022 ± 60 YBP. The combination of biological data from 165–183.5 cm and sediments within the 183.5–185.5 cm band provide evidence for salinity fluctuations that indicate the closure of the lake. Sediments contained a variety of invertebrates that helped to document changes in lake chemistry through time. This study of Laguna Alejandro sediments documented lake history and provided information on recent climatic shifts in the region. / Master of Science

Throughout the history of the Dominican Republic, theater has played an instrumental role in the cultural life its people, one which transcends purely artistic and cultural dimensions extending its influence into the political and social fabric of the nation. In spite of Spanish colonization and later Haitian occupation, a nascent national identity began forming early on. The staging of certain plays exposed latent conflicts and revealed sectorial, class interests. Theater provided a means of expression for popular sentiments, thus revealing an urge by the people to manifest their concerns, usually under the heavy weight of censorship. This thesis focuses on key moments of the first 140 years of Dominican Republic theater. It is organized into three chapters: "Historical Antecedents", "Theater of the Dictatorship" and "Theater of the Post-Dictatorship." The first chapter deals with the struggle for independence through 1844; the next focuses on the theatrical plays and political climate of bloody Rafael Leonidas Trujillo dictatorship which spanned from 1930 to his assassination in 1961, and the third presents the theater that appeared in the subsequent years of the equally repressive Joaquin Balaguer presidency (1966-1978). The analysis of these key historical moments, in conjunction with the dramaturgy of playwrights such as Franklin Domínguez, Marcio Veloz Maggiolo and Héctor Incháustegui Cabral, maps the function of theater as a tool of raising awareness, transmitting ideologies, and unifying a nation, in spite of despotism and oppression often disguised as democracy. As such, it documents the role that theatre played during a nation-building process that stages the history of political repression, lack of freedom of expression as well as social and political injustice.