Undergraduate Research Journal 2019

Office of Undergraduate Research Journal for 2019

College of Architecture & Planning University of Utah UNDERGRADUATE RESEARCH JOURNAL SMART SYSTEMS FOR DIABETES MANAGEMENT Haley Meyer (James Agutter) Department of Architecture Smart home technology like Alexa or Google Home is being readily used in homes today. While these tools are commonly used to ask about the time or the weather, there is a question as to how “smart” we can make this technology. Currently, there are apps that record different aspects of health and fitness, but these can be tedious and require much more motivation to stay on top of. What if we could cue these machines to ask to monitor responses based individualized needs? These machines can become just that, and potentially take the guess work out of tracking these many facets while also being a tool that can give more in-depth feedback based on this response. Furthermore, the end goal is that in the future, these programs can communicate with health care professionals. Within this research, we looked more specifically at diabetes management to track daily aspects that could be monitored more closely, such as blood glucose levels, exercise, and healthy meal choices. By prototyping conversations to ask a consumer before and after meals to check blood glucose levels, one could get a response as to a past overview of their numbers to check whether they have been within a normal range. If the numbers read out of range, a response is made to ask about healthy eating or exercise in order to achieve better numbers for future numbers. By creating a series of graphic responses married with the voice recognition software of these technologies, a conversation was sequenced by first utilizing the machine to prompt to check for a response, which would then listen for this voice input. Once the user gives input, the technology would validate the entry to move forward. Immediate positive feedback would be completed, and a response based on whether the patient is within or outside of bounds would be created. By working towards preventative measures and management, the end goal is that a diabetic can better use these existing tools in order to holistically record aspects of their daily life that they might otherwise ignore or not follow as closely as recommended to by a doctor. By using already readily available technology to track health concerns, members of the community can be better informed about their own well-being, with little to no intrusion on their routines. College of Business University of Utah UNDERGRADUATE RESEARCH JOURNAL A Detailed Analysis of Tax Reclassification on Corporate Investment in Canada Charles Kennedy Poe Fratt (Elena Patel) Department of Finance “In this world, nothing can be said to be certain except death and taxes” Benjamin Franklin This study examines the connection between the 2008 Canadian scientific research and experimental development (SRED) reclassification and the estimated effect on tax deductions for SRED expenditures. Using a difference in the different regression model, I test the hypothesis that favorable tax reclassification is a statistically significant predictor of increases in research and development expenditures within the manufacturing industry. This study attempts to observe a measurable link between tax policy at the federal level and long-term corporate R&D investment. Existing research by Danny Yagan, in ​Capital Tax Reform and The Real Economy, ​identifies no real effect of corporate tax cuts on corporate R&D investment. The principal contribution of this study is the discussion and examination of tax reform on an industry-wide level and the understanding of the effectiveness of reform using reclassification as our vehicle. The standard approach of analyzing industry trends within the United States only allows for a narrow understanding and neglects the global implications of tax policy. I hope to address this narrow approach by analyzing Canadian corporate tax data, adding to a more global understanding. I approached this topic by first trying to understand why firms would invest in scientific research & development. Second, I explored whether SRED expenditures vary significantly across industry sectors. To begin my exploration, I gathered data from the Canada revenue agency, specifically T2 corporate tax summary statistics. After gathering the data, I explored my second inquiry and found that the manufacturing industry had the largest total qualified SRED expenditures, almost double compared to the next highest industry. This finding supported my hypothesis that manufacturing is an SRED-heavy industry, thus a good treatment industry for my difference in difference model. Figure 1 a​ nd ​Figure 2 ​help visualize my findings. ​Figure 1​ shows the lack of change in manufacturing after the SRED reclassification compared to the change seen in the control industries. ​Figure 2 ​shows the lack of change in the tax reduction multiplier, TRM, compared to the change seen in the control industries. The TRM is a ratio of SRED expenditure to total tax deductions applied to income taxes (TRM = SRED Expenditure/Total Deductions). This ratio is helpful in understanding how the reform impacts both the corporate tax liability and the government’s benefit. If we see a reduction in TRM, we can understand that the firm realizes a higher tax benefit as total tax liabilities are decreasing, whereas an increase signifies an increase in total tax liability by the firms. In conclusion, this study was not able to find a statistically significant relationship between favorable tax reclassification and SRED expenditures. These results lead to two conclusions. First, no relationship was observed because no relationship exists. Second, a relationship does exist, but it was not observed due to exogenous market shock/pressures of the 2008 financial recession and the general nominal rigidity of corporate R&D expenditures. Figure 1 Bar Plot of Pre and Post-treatment SRED expenditures CAD Hundreds (Control Industry) CAD Thousands (Manufacturing) S RED = T reatment β 1 + β 2 P ostRef erf erence + β 3 Interaction + β 0 + ε Figure 2 Bar Plot of Pre and Post-treatment TRM levels T RM = T reatment β 1 + β 2 P ostRef erf erence + β 3 Interaction + β 0 + ε University of Utah UNDERGRADUATE RESEARCH JOURNAL FACTORS THAT DRIVE DAILY ATTENDANCE AT MINOR LEAGUE BASEBALL GAMES Dawson Hughes (Scott Schaefer) Department of Finance ABSTRACT This paper examines different factors that are thought to drive attendance at Minor League Baseball games to test what the actual effect of those factors is. It takes into account factors such as day of the week the game is played, month the game is played, whether the game is played on or around a holiday, and team performance to date. I also examined how each of these factors vary across different levels of Minor League Baseball. My initial hypothesis was that each of these would have a relatively strong effect on the game’s attendance. As expected, the results showed that weekend games in summer tended to have much higher average attendance than other games and holiday games had the highest attendance overall. These effects were clear across all levels of Minor League Baseball, though they were more pronounced in the higher levels where attendance is higher with more variability. One unexpected effect that I concluded from the study is that attendance of games just outside of holiday weekends was negatively impacted by the proximity of holiday games. University of Utah UNDERGRADUATE RESEARCH JOURNAL DO FAMILY DEMOGRAPHICS EXPLAIN MIDDLE CLASS STATUS? UTAH VS UNITED STATES Shannon McNatt (Scott Schaefer) Department of Finance Using United States Census data from 1980 to 2010, I analyze the role demographics play in a family attaining middle/upper-class status versus being economically lower-class. My study looks at age, race, education, parental structure, and family size, the influence each has on a family’s status, and how that influence changed over the study period. I find that families in Utah are more likely to attain middle-class status than families living elsewhere in the United States. This has been true for all Census years. However, prior to the 2000 Census, when adjusting for head-of-household (HOH) demographics, family size, and family structure, it appears that Utah’s demographics were the driving force in this differential. Beginning with the 2000 Census there has been a noticeable shift. By 2010, a family was 5.8% more likely to be in the middle or upper class if living in Utah than in the U.S. on average. However, adjusting for demographic factors reduced this difference to .2%, indicating that while families of all demographics were more likely to be in the middle/upper class in Utah than in the U.S. as a whole, demographics remain a factor, but are no longer the defining factor of Utah’s success. Comparing the demographic changes in the U.S. and Utah over the study period, alongside a review of the regression results, points to family type and education not only as key drivers of middle/upper class status, but determining factors in the ability to weather an economic downturn. With education and family structure having a growing importance in a family’s likelihood of being middle/upper class, policies that promote post-high school education (trade and college) and provide support for at risk categories - like single female HOHs with children - will be key to maintaining Utah’s robust middle class and lifting additional families out of poverty. Policymakers should not underestimate the role demographics play in the robust middle/upper class of Utah. As Utah’s demographics continue to change, understanding the linkage between demographics and attaining middle/upper class status will become even more important. An update of this study after the 2020 Census should provide additional insight into the trends in Utah and their impact on class status. University of Utah UNDERGRADUATE RESEARCH JOURNAL THE HISTORY AND FUTURE OF THE UNITED STATES ESTATE TAX Madalin Rooker (Philip Jeffs MBA, CPA Thesis Faculty Supervisor, Shannon Charles, PhD, Honors Faculty Advisor) Department of Accounting THE HISTORY AND FUTURE OF THE UNITED STATES ESTATE TAX by Madalin Rooker A Senior Honors Thesis Submitted to the Faculty of The University of Utah In Partial Fulfillment of the Requirements for the Honors Degree in Bachelor of Science In Accounting Approved: ____________________________ Philip Jeffs MBA, CPA Thesis Faculty Supervisor ____________________________ Rachel Hayes, PhD Chair, Department of Accounting ____________________________ Shannon Charles, PhD Honors Faculty Advisor ____________________________ Sylvia D. Torti, PhD Dean, Honors College May 2019 Copyright © 2019 All Rights Reserved ABSTRACT This is a senior honors thesis submitted for the Honors Degree in Bachelor of Science in Accounting. The subject of the thesis was inspired by the Tax Cuts and Jobs Act of 2017 and focuses specifically on the United States Federal estate tax. The thesis explores the estate tax from inception to the present day and analyzes the changes made to the tax by the Tax Cuts and Jobs Act. Using data from the IRS, observations are made about the effect of the new tax code on the estate tax, on the amount of revenue collected by the levying of the tax, on estate planning, on individuals of differing socioeconomic statuses, on the profession of accounting, and on the economy of the United States. Based on research, this thesis draws conclusions and makes arguments about whether the changes to the estate tax are beneficial or harmful to the aforementioned. Finally, the thesis makes an argument about what the future of the estate tax ought to be and whether it ought to exist into the future. ii TABLE OF CONTENTS ABSTRACT ii INTRODUCTION 1 WHAT IS THE ESTATE TAX? 4 HISTORY OF THE ESTATE TAX 8 MODERN ESTATE TAX DATA 14 THE TAX CUTS & JOBS ACT OF 2017 19 CHANGES TO THE ESTATE TAX 21 THE FUTURE OF THE ESTATE TAX 24 CONCLUSION 26 APPENDICES 28 WORKS CITED 32 1 INTRODUCTION Since the establishment of the United States of America, taxation has been both controversial in conversation and essential to the functioning of society. Taxation is of concern to citizens, businesses, educational institutions, and governmental bodies alike. For centuries, the debate over the taxation of those groups has raged on. Indeed, overly-extensive and unfair taxation was a driving cause of the Revolutionary War. The early colonists of this country took it upon themselves to establish their own government, their own currency, and their own tax laws. Today, the United States tax code remains a hotly contested issue. “Tax reform” is a subject of interest to nearly every presidential candidate, some of whom promise to lower income tax rates for all, to lower rates only for the wealthy and corporations, or to raise taxes on the rich to alleviate the suffering of the poor. Regardless, any change to this country’s tax code has far-reaching effects that impact the lives of all citizens, sometimes in unforeseeable ways. In 2017, Congress passed the Tax Cuts and Jobs Act which took effect on January 1, 2018 and made many changes to the previous tax code. These changes include, but are not limited to, changes to the income tax bracket amounts and income tax percentages. The standard deduction was greatly increased while many itemized deductions and personal exemptions were eliminated. The child tax credit was increased, corporate income will now be taxed at a flat 21% rate, and finally, the tax exemption amount for the Federal estate tax increased dramatically. 1 While some of the most significant changes to the tax code will be discussed in more detail in later pages, this thesis will focus specifically on the United States Federal estate tax. It will provide a history of the tax and explore changes made to the tax by the Tax Cuts and Jobs 1 “Summary of 2017 Tax Cuts & Jobs Act Changes.” Fee-Only Financial Advisors in Dallas | LFC, Lee Financial, 2018, www.leefin.com/2017-tax-cuts-jobs-act-changes/. 2 Act. It will also analyze data provided by the IRS to show how much revenue has historically been collected by levying the estate tax. Finally, this thesis will make predictions about the future of the estate tax and arguments about its effectiveness. While the estate tax may seem trivial in comparison to more well-known, oft-studied taxes, I will show that the changes made to this tax are impactful to the American people. According to David Frisch of Forbes, “while the many changes impact both individual income and corporate income taxes, attention should be paid particularly to how estate taxes have been affected. It remains important to use strategic estate planning with a thorough understanding of both the federal and state exemptions.” 2 As the new tax law did not go into effect until January 1, 2018, and the IRS only publishes data and factual findings every few years, some of the predictions about the effects of the changes to the estate tax will be based on research done on prior changes to the tax. However, the conclusions drawn in this thesis will prove Frisch’s assertion that the changes to the estate tax will indeed have far-reaching effects. Over the course of this thesis, the reader will become acquainted with the estate tax— not only its many iterations, but also its current form, its effects as interpreted through statistics, and its controversy. As mentioned above, not only will predictions about the future of the estate tax be made, but so will recommendations. I will argue that due to the tiny number of estate tax returns now filed as well as the small amount of revenue raised by the tax, one of two things ought to happen to the estate tax. Should it remain at its current exemption amounts with the 2 Frisch, David. “How The Tax Cuts And Jobs Act Of 2017 Affects Estate Taxes.” Forbes, Forbes Magazine, 27 June 2018, www.forbes.com/sites/forbesfinancecouncil/2018/06/27/how-the-tax-cuts-and-jobs-act-of2017-affects-estate-taxes/#3c65ebde6cf9. 3 amount of revenue raised being used for non-specific purposes, it should be abolished. Otherwise, the tax should be altered so that it applies to more estates. The exemption amount should be lowered, and the revenue raised should be used for specific purposes such as to help fund public education or health care. These changes would help redistribute wealth and prevent the estate tax from only applying to the wealthiest members of society. The reasons for these arguments will become clear in the following pages. 4 WHAT IS THE ESTATE TAX? Per the Internal Revenue Service, “The Estate Tax is a tax on your right to transfer property at your death.” The tax is levied on a deceased individual’s estate—the amalgam of the assets owned by the decedent or that the decedent had an interest in at the time of death. When calculating the value of one’s estate, the Internal Revenue Service (IRS) uses the fair value of each item which differs from other accounting measures that use the historical cost (the cost paid to acquire an asset) to value those items. The total of the fair value of each item owned by the decedent is the “Gross Estate” which may “consist of cash and securities, real estate, insurance, trusts, annuities, business interests and other assets.” 3 In short, the government of the United States reserves the right to levy a tax on the estates of its citizens when they die. Over the span of a lifetime, any citizen is likely to accumulate assets or items of value such as cash, property, family heirlooms, or stock certificates. It is likely that upon the acquisition of these items of value, the individual will decide that they would like to bequeath them upon their friends, children, spouse, or others at the end of their life. At the time of death and bequeathal, the government levies a tax. Whether or not any individual estate will be taxed relies primarily on the size of the estate at the time of the owner’s death as well as whether that individual has gifted any assets to others during their lifetime. Throughout history, estates with values below a certain dollar amount (an amount that has fluctuated significantly) can be transferred tax-free. “The Estate Tax: Ninety Years and Counting,” by Darien B. Jacobson, Brian G. Raub, and Barry W. Johnson explains that, “the term ‘death tax’… refers to the ‘power to transmit or 3 “Estate Tax.” Internal Revenue Service, United States Internal Revenue Service, 2018, www.irs.gov/businesses/small-businesses-self-employed/estate-tax 5 the transmission or receipt of property by death’.” Furthermore, “estate taxes are … usually graduated based on the size of the decedent’s entire estate… These taxes are usually graduated based on the amount of property received by each beneficiary and on each beneficiary’s relationship to the decedent.” 4 The Gift Tax Both the Federal estate and gift tax are transfer taxes—taxes on a person’s right to transfer property. While the estate tax is a tax on an individual’s right to transfer property after death (a testamentary transfer), the gift tax is a tax on a person’s right to transfer their property or wealth during their lifetime (inter vivos). Although the focus of this thesis is the estate tax, the estate and gift taxes are inextricably linked as in the simplest terms, any amount of wealth a person transfers during their lifetime reduces the amount of their exemption from the estate tax. For example, now, in 2019, an individual who files as a single tax payer can transfer a total of $11.2 million at death without their estate owing any taxes. However, if that person had gifted a $1 million home to a child and a $200,000 car to a cousin during their lifetime, only $10 million of their estate would be exempt from the estate tax at their death. Any amount an individual gives in gifts will reduce the amount they transfer tax-free at death. Simply put, “The Federal gift tax is imposed on the right of one person (the donor) to transfer property to another (the donee) for less than full and adequate consideration. The tax is payable by the donor… Upon the death of an individual, the Federal estate tax is imposed on the taxable estate. The executor (or administrator) of the estate pays any estate tax that may be due” 4 Jacobsen, Darien B., Raub, Brian G., & Johnson, Barry W. (2007). The estate tax: Ninety years and counting. Statistics of Income. SOI Bulletin, 27(1), 118-128. 6 from the assets of the estate. 5 While the IRS provides a formula one can use to calculate the tax to be paid on a gift, Hoffman et al. say that in general, the gift tax is levied at 40% of the gifts given by an individual each year. Furthermore, “Because Congress did not intend for the gift tax to apply to smaller transfers, it provided for an annual exclusion, which reduces the taxable gift to zero when a small amount is involved… For 2013 through 2017, the exclusion was $14,000; for 2018, it [was] $15,000” (27-4). As it relates to the Federal estate tax, the actual computation of how much tax is paid on the estate of a decedent goes beyond the scope of this thesis. However, again, with regards to the gift tax, “the unified tax credit applies against this tax” (Hoffman et al. 27-4). Again, this means that any amount gifted by an individual inter vivos is subtracted from the amount that individual can transfer tax-free at their death. The remainder of this paper will focus on the Federal estate tax but it is important to keep in mind the effect that gift-giving can have on the amount of tax paid by an estate. Understanding this relationship will help one fully comprehend the IRS data and discussions on the Federal estate tax provided in later pages. Purpose of The Estate Tax The article, “History and Overview of the Federal Estate Tax,” by Prince Law Firm referenced above, explains the purpose of the estate tax. “Prior to 1916, death taxes were enacted temporarily to raise funds for specific purposes. For example, the first version of the estate tax was enacted by Congress in 1797 to fund the formation of the American Navy. The Revenue Act 5 “Chapter 27.” South-Western Federal Taxation, by William H. Hoffman et al., South-Western Cengage Learning, 2018, pp. 27–1 - 27–28. 7 of 1862 enacted an inheritance tax and introduced a gift tax for the first time in order to fund the Civil War effort.” More information on these death taxes will be provided in the next section. Interestingly, Jacobson, Raub and Johnson state that proponents of the estate tax support it based on a belief that the levying of the tax creates a more even distribution of wealth. Because only the wealthiest individuals in the United States are taxed on the passage of their wealth, the levying of the estate tax is a way to spread some of that wealth by giving money to the government which can then fund programs and resources for less well-off portions of society. However, there is some doubt about whether the meager number of estate tax returns filed and the small amount of taxes that are collected by the estate tax truly serve to redistribute wealth. The article references the Statistics of Income Division (SOI)—a subset of the IRS that does research on the amounts and effects of different taxes. In practice, the estate tax affects only the very wealthy. Therefore, as Jacobson, Raub, and Johnson point out, an analysis of the estate tax can reveal much about the behavior of the wealthy. “In this context, estate tax data have frequently been used to evaluate the effects of the tax laws on the economic and social behavior of the very wealthy. For example, the effects of estate taxation on farms, as well as the effects of the tax on a decedent’s propensity to make charitable bequests, have been important considerations to policymakers when debating changes in estate tax laws (118).” The next section will provide a history of the estate tax which will give the reader more information about how the estate tax has historically been enforced, what purposes it has served in the past, and how it became a codified part of the Internal Revenue Code. 8 HISTORY OF THE ESTATE TAX Jacobsen, Raub, and Johnson, the authors of the article, “The Estate Tax: Ninety Years and Counting,” provide an in-depth history of the United States estate tax. Per the authors, “Taxation of property transfers at death can be traced back to ancient Egypt as early as 700 B.C. Nearly 2,000 years ago, Roman Emperor Caesar Augustus imposed the Vicesina Hereditatium, a tax on successions and legacies to all but close relatives” (118). Estate taxes were common in Europe during feudal times and additional taxes were levied in the 18th century on wills, testaments, and other documents that dictated the transfer of property. Many countries, including the United States, enacted similar taxes to raise funds for various efforts. The earliest iteration of the estate tax in the United States was the stamp tax of 1797, the purpose of which was to raise funds for the national Navy. Because stamps were required on all official documents, including wills and “receipts and discharges from legacies and intestate distributions of property” the tax was termed a death tax (Jacobsen, Raub, and Johnson 119). Like the modern estate tax, the stamp tax of 1797 was levied at different amounts depending on the size of the estate bequeathed. Widows, children, and grandchildren were exempt from the tax. Any bequest larger than $50 was taxed and as the size of the bequest grew, so too did the tax amount—amounts between $100 and $500 were taxed 50 cents, with an additional dollar being charged for each additional $500. Five years after its passage, the stamp tax was repealed. The next version of the estate tax was The Revenue Act of 1862 which included a death tax, the purpose of which was to pay for the Civil War because the tariffs and sales of public land in effect at the time were not enough to fund the war. The death tax portion of the Revenue Act of 1862 expanded on the earlier stamp tax by taxing not only the stamps on the wills, but also by including an inheritance tax. At the time, percentage tax amounts were included in the act that 9 varied from 0.75 to five percent. Per the Revenue Act of 1862, estates below $1,000 were exempted from the estate tax, charitable donations at death were taxed at five percent, and the stamp tax, which had been renewed in the Revenue Act, was increased from its original 50 cent value to $20 or more on estates larger than $150,000. The chart in Appendix A provides a look at the death tax rates in 1864, just two years after The Revenue Act of 1862 was passed into legislation. As the Civil War continued and the cost of the war efforts increased, the government sought strategies to increase their revenue stream. So, certain changes were made to the Revenue Act that included increasing legacy tax rates and initiating a tax on the transfer of property at death. Additionally, these amendments established the country’s first gift tax, like the gift tax that was previously explained. When the Civil War ended some years later, the government’s need for the money provided by the Revenue Act disappeared and so, “in 1870, the legacy and succession taxes were repealed… the stamp tax was repealed in 1872. Between 1863 and 1871, these taxes had contributed a total of about $14.8 million to the Federal Budget” (Jacobsen, Raub, and Johnson 119). Toward the end of the 19th century, the United States industrialized quickly. “Industry replaced agriculture as the primary source of wealth and political power in the United States. Tariffs and real estate taxes have traditionally been the primary source of Federal revenue, both of which fell disproportionately on farmers” (Jacobsen, Raub, and Johnson 119-120). As industrialization reigned and agriculture fell by the wayside, “a Federal legacy tax was proposed in 1898 as a means to raise revenue for the Spanish-American War” (Jacobsen, Raub, and Johnson 120). Once again, the government found it necessary to levy an estate tax to fund another war. For the first time, this tax provoked controversy—a hallmark of the estate tax that continues to this day. “Tax rates ranged from 0.75 percent to 15 percent, depending both on the 10 size of the estate and on the relationship of a legatee to a decedent” (Jacobsen, Raub, and Johnson 120). At the time, the exemption amount was $10,000, so only estates worth more than that amount were subject to the death tax. Again, with the end of the war, the War Revenue Act was repealed after raising $14.1 million. After the War Revenue Act was repealed, American society continued to change— corporations became prolific and corporate ownership became common. “This resulted in the concentration of wealth in a relatively small number of powerful companies and in the hands of the businessmen who headed them” (Jacobsen, Raub, and Johnson 120). As the country’s wealth was held by a select few, President Theodore Roosevelt sought ways to spread that wealth. It was that goal that first caused the Federal income tax to be passed into legislation by the 16th Amendment to the United States Constitution. Later, when World War I began, the Federal estate tax was instituted. “The Revenue Act of 1916… created a tax on the transfer of wealth from an estate to its beneficiaries, and thus was levied on the estate, as opposed to an inheritance tax that is levied directly on beneficiaries” (Jacobsen, Raub, and Johnson 120). This is the form of the estate tax we are familiar with today. By examining Appendix B and the article written by Jacobsen, Raub, and Johnson, one can see the progression of the estate tax as well as understand how the tax became what it is today. Controversy Surrounding the United States Estate Tax The estate tax’s controversy has increased as it has evolved. In his article in Society Journal, “Why is the Estate Tax So Controversial?” author Jens Beckert addresses some of this controversy. The following is from the article's abstract: “There are some social issues whose significance for society nobody would seriously question but which nevertheless receive only scarce attention in sociological research. 11 One of these is the bequest of private wealth from one generation to the next. It is currently estimated that about 550 billion dollars are transferred annually in the United States, amounting to more than 4% of the American gross national product (Havens and Schervish 1999) … The bequest of wealth speaks to some of the core questions of sociological scholarship.” 6 At the heart of the controversy is social inequality. Beckert points out that to understand social inequality, one must look further than traditional indicators like the public education system. An individual’s ability to accumulate and transfer wealth is a vital indicator of racial and societal disparity. “The richest 10% of households in the United States owns almost 70% of all private wealth, while the bottom 50% of households must content itself with a meager share of 2.8% (Davies et al. 2006: Table 9; Keister and Moller 2000)” (521). Parents who can pass wealth on to their children may be able to set those children up for success for generations while parents who do not enjoy that ability may leave their children subject to the unreliable nature of the economy and the American stock market. Specifically addressing the controversy of the estate tax, Beckert writes, “from a… historical perspective, estate taxation has been, since the late nineteenth century, one of the most controversial topics concerning the regulation of the transfer of property mortis causa” (522). But why is the estate tax so controversial? Afterall, as Beckert and others write, very little federal income is raised through the estate tax and few estates will pay any estate tax whatsoever, especially with the recent changes made to the tax. 6 Beckert, J. (2008). Why Is the Estate Tax so Controversial? Society, 45 (6), 521-528. 12 Beckert outlines several arguments against the estate tax. First, many argue that private property should be protected from taxation in order to maintain an economic order that encourages investment in private property. Next, the estate tax is levied on only a very few, select individuals. Beckert quotes data from the Internal Revenue Service that says, “[in] 2004… only 19,000 estates had to pay the estate tax. This means that the federal estate tax is assessed on less than 1% of annual deaths… [and] more than half of the estate tax revenue comes from the largest 7% of estates that are subject to taxation” (523). While these two explanations are reasonable sources of controversy, Beckert also addresses the emotional nature of the inheritance of wealth as it comes about only after the death of a loved one and money issues can cause deep rifts and fallings-out in families. In the article, “Grave Robbers: The Moral Case against the Death Tax,” author Edward McCaffrey outlines his arguments against the estate tax, going so far as to argue that, “this study… finds that the tax fails to achieve most – and quite possibly any – of the objectives its supporters promote.” 7 Supporting both his and my arguments, McCaffrey goes on to note that, “the tax raises barely over 1 percent of total federal tax revenues, and when revenue losses from other tax sources are accounted for, its overall impact on the tax receipts is smaller still.” McCaffrey’s data clearly show the wisdom of eliminating the estate tax. Again, to quote the author, “Studies indicate that for every dollar raised from the tax, roughly another dollar is lost because of avoidance, compliance, administrative and enforcement costs.” When we take that assertion into account, not only does the estate tax levy very little revenue, to return to my 7 McCaffery, Edward J. (1999). Grave robbers: The moral case against the death tax (estate and gift tax) (Statistical Data Included). Tax Notes, 85(11), 1429-1443. 13 prior point, the costs of enforcing and collecting the funds from the levying of the tax go a long way in offsetting that revenue. McCaffery goes further by arguing that there is a moral case to be made against the estate tax. Per McCaffery, “The death tax rewards a ‘die-broke’ ethic, whereby the wealthy spend down their wealth on lavish consumption and discourages economically and socially beneficial intergenerational saving. The tax does not promote traditional liberal ideas of redistribution, equality of opportunity, or fundamental fairness.” In short, the estate tax is highly contested. Some argue for it, saying that it helps redistribute wealth. Others argue against it because it is levied on less than 1% of estates. Its roots in long-standing, generational, and social inequality are controversial. The fact that death, taxation, bequeathal, and inheritance are emotionally charged topics makes it contentious. The estate tax is mired in controversy and it seems, even with the changes recently made to the United States tax code, it will remain similarly disputed for years to come. 14 MODERN ESTATE TAX DATA The next step is to analyze statistical data on certain measures regarding the estate tax such as the number of estate tax returns that are filed year-over-year as well as the total net estate tax, which is the total amount the government collects from all taxed estates. Furthermore, estate tax rates and exemption amounts vary from year to year as displayed below. The Internal Revenue Service provides this information for tax years up to 2018 and the data provides information about what estate tax revenue is used for, how much revenue is raised through the estate tax, how many estates are subject to the tax, and more. This data can help one draw a conclusion about the effectiveness of the estate tax. 2007 2008 2009 2010 Tax Rate 45% 45% 35% 35% 2011 35% 2012 2013 2014 2015 2016 35% 40% 40% 40% 40% Year Figure 1: Number of Estate Tax Returns Filed and Revenue Earned from Estate Tax for Years 2007 – 2016, taken from the Internal Revenue Service Exemption Amount $2,000,000 $2,000,000 $3,500,000 $5,000,000 $5,000,000 (temporarily eliminated) $5,120,000 $5,250,000 $2,340,000 $5,430,000 $5,450,000 Figure 2: Estate Tax Rates and Exemption Amounts for the Years 2007 – 2016, taken from The Balance When analyzing the above charts side-by-side, it becomes clear that between 2007 and 2011, the number of estate tax returns filed plummeted from roughly 40,000 to approximately 5,000. In those same years, the exemption amount more than doubled from $2,000,000 to $5,000,000 for single taxpayers. This shows, understandably, that as the exemption amount 15 increases, the number of estate tax returns filed decreases because a larger number of estates are exempt from paying the tax. In 2010 and 2011, it appears that the number of estate tax returns filed fell to less than 5,000. The most likely cause for this important data point is that in 2010, the estate tax was temporarily eliminated, and then later reinstated in 2011. 8 Interestingly, the number of returns filed increased between 2011 and 2016 although, except for in 2014, the exemption amount continued to increase. Perhaps this was because during these years the United States economy began to recover from The Great Recession, so decedents had larger estates to leave to their families. It is impossible to know the exact reason for this increase, but it is interesting. It is also worth noting the increase was minimal—the number of returns filed in 2016 was 12,411 which means the increase from 2011 to 2016 was only a matter of a few thousand, not tens of thousands. 9 Next, one can analyze the net estate tax that was paid during these years—in other words, how much revenue did the government receive through the levying of the estate tax between 2007 and 2016? In the same way the amount of estate tax returns filed plummeted between 2007 and 2011, the amount of revenue raised similarly decreased from roughly $25 Billion in 2007 to around $3 Billion in 2011. Again, this makes sense. As exemption amounts increased and estate tax rates decreased from 45% to 35%, the government brought in less money from taxing the passage of valuable assets from decedents to those still living. The amount of tax paid increased 8 Brunet, Gillian. “New Estate Tax Rules Should Expire After 2012.” Center on Budget and Policy Priorities, 11 Oct. 2017, www.cbpp.org/research/new-estate-tax-rules-shouldexpire-after-2012 9 “SOI Tax Stats - Estate Tax Statistics Filing Year Table 1.” Internal Revenue Service, Internal Revenue Service, 2018, www.irs.gov/statistics/soi-tax-stats-estate-tax-statistics-filing-yeartable-1. 16 more dramatically from 2011 to 2014 when the increase again slowed until 2016. Given the data available about the changes to the exemption amounts and tax rates during these years, this is understandable—in 2014, the exemption amount underwent a dramatic cut from $5,250,000 to $2,340,000 and the tax rate was raised to 40%. It makes sense that the amount of tax paid raised in accordance with the cut to the exemption. Then, as the exemption was again raised after 2014, the amount of tax paid leveled off. The information given by the IRS allows us to make predictions about what will happen to the number of estate taxes filed now that the Tax Cuts and Jobs Act of 2017 has been passed as well as the amount of income the federal government will receive from these estates. I predict that the number of estate tax returns filed will continuously fall from here forward because the exemption amount is now so high, meaning that very few estates will not be exempt from the tax. I further argue that the net tax paid will therefore also fall. While it is impossible to know how drastically the number of estate tax returns filed will decrease until the IRS performs statistical analysis on the returns filed in 2018 and 2019, I predict that the decrease would resemble the chart below. Predicted Number of Estate Tax Returns to be Filed 50,000 40,000 30,000 20,000 10,000 - Figure 3: Prediction about the Future Number of Estate Tax Returns to be Filed, prepared using statistical information from the IRS. See Figure 1. 17 The graph above was created using predicted numbers for 2018 and 2019. I chose the numbers for those years based on predictions from Ashlea Ebeling (cited and discussed later) that under the new tax, fewer than two thousand estates will pay the estate tax. Another source, Brian O’Connor, whose work will be discussed later, predicts that the estate tax will apply to less than one-tenth of one percent of the estates of all decedents under the new tax code. 10 Interestingly, the IRS provides information about the composition of assets in taxed estates. The graph below, prepared by the IRS, summarizes this information for the year 2016. Figure 4: Portfolio Composition of Estates, by Size of Total Assets, Filing Year 2016, taken from the Internal Revenue Service For all estates taxed, stocks make up the most significant portion of the size of the estate while for estates larger than $20 million, pensions and 401(k)s make up less than 5% of estates. Conversely, pensions and 401(k)s make up more than 10% of total estates. 10 O' Connor, Brian J. “Heirs Inherit Uncertainty With New Estate Tax.” The New York Times, The New York Times, 23 Feb. 2018, www.nytimes.com/2018/02/23/business/estate-taxuncertainty.html 18 Finally, based on information provided by the IRS for 2017, shown in Appendix C, I created the following charts. The first shows the number of estate tax returns that were filed in 2017 based on the size of each estate while the second shows the amount of revenue raised by the government on those taxable estates based on the estate size (SOI Tax Stats). 3,000 Number of Taxable Estate Tax Returns for Filing Year 2017 Based on Size of Estate 2,500 2,000 1,500 1,000 500 - < $5,000,000 $5,000,000 < $10,000,000 < $20,000,000 < > $50,000,000 $10,000,000 $20,000,000 $50,000,000 Figure 5: Number of Taxable Estate Tax Returns for Filing Year 2017 Based on Size of Estate, created using statistics provided by the Internal Revenue Service Amount of Tax Raised through the Federal Estate Tax Based on Size of Estate for Filing Year 2017 $10,000,000 $9,000,000 $8,000,000 $7,000,000 $6,000,000 $5,000,000 $4,000,000 $3,000,000 $2,000,000 $1,000,000 $- < $5,000,000 $5,000,000 < $10,000,000 < $20,000,000 < > $50,000,000 $10,000,000 $20,000,000 $50,000,000 Figure 6: Amount of Tax Raised through the Federal Estate Tax Based on Size of Estate, created using statistics provided by the Internal Revenue Service 19 THE TAX CUTS & JOBS ACT OF 2017 H.R.1, the Tax Cuts and Jobs Act, was passed into law on December 22, 2017. Per the United States Congress, “This bill amends the Internal Revenue Code (IRC) to reduce tax rates and modify policies, credits, and deductions for individuals and businesses.” 11 To understand the effect of the Tax Cuts and Jobs Act on the Federal estate tax, I believe it is useful to have a highlevel knowledge of the most impactful changes made to the tax code by the act. First, under Title I, Subtitle A – Individual Tax Reform, Part 1 – Tax Rate Reform, the act temporarily replaces the tax brackets that existed prior to December 22, 2017. Appendix D shows a side-by-side comparison of the tax rates and tax brackets in 2017 prior to the passage of the act and in 2018 after the act was passed. In an article entitled, “A Concise Summary of the New Tax Law,” Adam S. Halpern summarized some of the more significant and important changes made by the Tax Cuts and Jobs Act. He divided his article into sections and spoke in turn about changes to the individual income tax, the estate and gift taxes, the business income tax, employee compensation and international taxes, and more. 12 Overall, many tax rates were reduced, itemized deductions were limited, and dollar limit amounts for items such as charitable deductions were decreased (Appendix D). Per the Internal Revenue Service, “The IRS is working on implementing the Tax Cuts and Jobs Act... This major tax legislation will affect individuals, businesses, tax exemptions and 11 “Text - H.R.218 - 116th Congress (2019-2020): Death Tax Repeal Act.” Congress.gov, 3 Jan. 2019, www.congress.gov/bill/116th-congress/house-bill/218/text. 12 Halpern, Adam S. “A Concise Summary of the New Tax Law.” Fenwick & West LLP - a National Technology and Life Sciences Law Firm, 5 Jan. 2018, www.fenwick.com/publications/Pages/A-Concise-Summary-of-the-New-Tax-Law.aspx. 20 government entities.” Clearly, the effects of the new legislation are far reaching, and the argument made by some that the act only benefits one segment of society (the ultra-rich) is overly simplistic. The IRS’ website divides the changes and their effects into three categories, explaining the effect of the new law on individuals, businesses, and tax-exempt entities. Of the utmost importance to individuals are changes made to the state and local income taxes and changes made to the child tax credit. Businesses are affected by changes made to the income tax rates as well as to deductions for qualified business income and meals and entertainment (which was eliminated). Finally, with regards to tax-exempt entities, “tax reform affects retirement plans, tax-exempt organizations and governments” (IRS.gov). To go in-depth on all the changes made by the Tax Cuts and Jobs Act is beyond the scope of this thesis. Suffice it to say that the changes have far-reaching and significant effects that impact more than just businesses and the ultra-wealthy who will pay less in taxes each year. Of real interest to this thesis are the specific changes made to the estate tax and the effect those changes will have on individuals and the government. This will be discussed in the following pages. 21 CHANGES TO THE ESTATE TAX The Tax Cuts and Jobs Act made significant changes to the estate tax. First, the estate tax exemption was more than doubled which means that a single tax filer’s exemption now sits at $11.2 million and by extension, taxpayers who file married-filing-jointly will be able to bequeath up to $22.4 million in assets before their estates are taxed. These changes are temporary for now as the law has a “sunset clause” that states that unless Congress makes the changes permanent by 2026, the exemption amount will revert to the $5 million amount it sat at prior to 2018. 13 These huge exemption amounts mean that very few estates will be subject to taxation upon the death of the assets’ owners. Per Ashlea Ebeling of Forbes, “the Joint Committee on Taxation estimate[d] the number of taxable estates would drop from 5,000 under [the previous] law to 1,800 under the new law in 2018. By comparison, 52,000 estates paid the tax in 2000 when the exemption was $675,000.” The following chart illustrates the changes to the exemption amount graphically. Exemption Amount $12,000,000 $10,000,000 $8,000,000 $6,000,000 $4,000,000 $2,000,000 $- Figure 7: Estate Tax Exemption Amount changes for the years 2000-2019 – created using information from Forbes Magazine and the Internal Revenue Service 13 “Temporary Increase in Estate Tax Exemption (and Portability).” Gudorf Law Group, LLC, 27 July 2018, www.daytonestateplanninglaw.com/temporary-increase-in-estate-taxexemption/. This article explains when many of the provisions in the Tax Cuts and Jobs Act of 2017 sunset or expire. 22 The provisions in the Tax Cuts and Jobs Act related to the estate tax, as discussed above, have been heralded as a boon to the ultra-wealthy, making them controversial. In her article, “Final Tax Bill Includes Huge Estate Tax Win For The Rich: The $22.4 Million Exemption,” Ebeling writes that the changes made to the estate tax most greatly affect those who are already very wealthy. “President Donald Trump’s vow to kill the federal estate tax failed, but his family, and other high net worth families, could still come out way ahead based on changes to the estate… tax.” Ebeling seems to believe that by making the above-mentioned changes to the estate tax, Trump and GOP lawmakers revealed they have a clear agenda. Looking at the decrease in the number of estate tax returns filed over the last 18 years as exemption amounts have increased, the logical conclusion to draw is that the government is bringing in a lower amount of revenue from estate tax filings than in previous years. As was mentioned earlier, the IRS’ SOI Statistics division does not yet have data related to these changes, so looking at trends from the past that show that revenue has decreased as exemptions have increased allows one to make the logical conclusion that this trend will continue. This begs an interesting question: with regards to the changes made to the estate tax by the Tax Cuts and Jobs Act, who benefits? Why is the federal government agreeable to losing all this income? The History section of this thesis explained what function the federal estate and gift taxes have typically served. It seems that for many decades, the emphasis has been on the tax’s ability to raise funds for war and national security efforts. I would hypothesize that over the years, as this nation’s military has grown, the estate tax was not enough to fulfill this purpose. So, the government turned to other sources to fund these efforts. As the country grew, it seems the small amount of income raised by the estate tax became insignificant and the primary shareholder ceased to be the federal government and became 23 instead members of society who would have to pay taxes on their estates. To the extent that these members of society had connections to the federal government, the tax began to shrink. So, the question I pose here and will argue in the next section of this thesis is, does the United States government need the estate tax anymore or is it time to eliminate the estate tax entirely? 24 THE FUTURE OF THE ESTATE TAX While the changes made to the Federal estate tax in The Tax Cuts and Jobs Act benefit citizens of the United States, according to Brian J. O’Connor with the New York Times, those who inherit under the new law also must deal with a high level of uncertainty. In his article, “Heirs Inherit Uncertainty With New Estate Tax,” O’Connor argues that instead of being coined the “death tax,” the estate tax really ought to be called the “zombie tax.” No matter how many times the exemption is raised and the rates are lowered, no matter how many politicians vie for the tax to be eliminated, it remains a part of the tax code. Not only do those who inherit under the estate tax deal with the possibility that the exemption amounts may change again in the future, they must also account for the fact that unless Congress takes further affirmative action, the changes made to the tax will sunset soon. Should that happen, the exemption amount will revert to the roughly $5.5 million amount it sat at in 2017. Should this happen, I believe the number of estate tax returns filed would increase and the government would raise more revenue from the tax, potentially allowing them to redistribute wealth more effectively. The possibility of this sunset provision going into effect frustrates some wealthy taxpayers according to O’Connor. Yet, although the estate tax has clung to life tenaciously, it is very nearly dead. “The estate tax used to apply to a lot more people even in recent decades, up to 2 percent of all estates. Now we’re down to less than one-tenth of 1 percent… the estate tax is hanging on by a thread” (O’Connor). So, while the sunset of the changes made to the estate tax is a possibility that may very well be faced by taxpayers, tax attorneys, tax preparers, and policy writers, the ultimate elimination of the estate tax is likewise a very real possibility. The data collected by O’Connor suggests that less than a thousand estates will be taxed under the new law and therefore, the 25 government cannot be raising much revenue from these estates. Indeed, some data and researchers suggest that the government spends more to enact and enforce the estate tax than it receives from the tax. Eliminating the estate tax would reduce uncertainty for clients and preparers and simplify the tax code, making life easier for wealthy individuals with large estates who are planning for their future as well as for those who inherit. Furthermore, the money that is currently spent on enforcing the estate tax could be redirected to more profitable audits like income tax returns. Indeed, for these and other reasons I have discussed throughout this thesis, I argue for changes to be made to the estate tax. Either it ought to be abolished to save this country’s government and taxpayers money or it should be changed to apply to more estates and ultimately collect more revenue. That extra revenue could then be fed back to poorer portions of society. The estate tax has served its purpose for hundreds of years but now, embroiled in heated political debate, it seems that its time may have passed. 26 CONCLUSION This thesis has explored the United States Federal estate tax at great length, examining its history and many iterations. Starting as a simple stamp tax that was used to fund some of the first war efforts of this country and progressing to its current form wherein only the very wealthiest of individuals and estates are ever taxed, the estate tax, like the rest of the United States tax code has changed drastically. The estate tax has a long and storied history and has served the country well, producing income that has been used for many purposes. Now, however, to conclude, I argue that the estate tax has become largely useless. With less than one percent of the entire country’s population being taxed under the estate tax, the effort of imposing, enforcing, and collecting the estate tax is greater than the benefits that the country derives from the revenue gained by the estate tax. Therefore, I reiterate the argument made throughout this thesis that one of two things should happen to the estate tax. Either the estate tax should be abolished, or it should be altered so that it applies to more estates and more effectively redistributes wealth. Should it be altered, the exemption amounts should be decreased and the revenue levied from the tax should be used for a specific purpose such as the funding of public education. Earlier in this thesis, I explored the controversy surrounding the estate tax. I cited Edward McCaffrey who wrote that the estate tax is responsible for less than one percent of the amount of revenue raised by all federal taxes. I also provided sources that show that the government spends more money enforcing the estate tax than they receive from it. For all these reasons and more, I agree with McCaffery when he says, “eliminating the death tax… should thus have broad bipartisan appeal.” 27 Ultimately, there are few things that are argued over or hated more than money and taxes, and it is an indisputable fact that the tax code is unendingly controversial. While the Tax Cuts and Jobs Act made certain changes that will likely benefit the country such as changes that allow multinational corporations to repatriate their income without double taxation, other changes were made such as the elimination of certain exemptions and alterations to the tax brackets and rates that seem to benefit only the wealthy. Taxes serve an important purpose and are integral to the functioning of our country and its infrastructure. However, the estate tax no longer serves a purpose and it ought to be eliminated. Regardless of my opinions and arguments on the matter, I strongly believe that in the future the estate tax will be eliminated. Regardless of the moral issues with the tax, ultimately the United States government functions like a business—when it comes to topics like taxes, the goal is to make money. Because the estate tax is expensive to levy and enforce and raises little revenue, it does not make sense for the government to continue to include it as a part of the tax code. So, I believe that the government will abolish the estate tax sooner, rather than later. Despite the controversial nature of the estate tax and the fact that the estate tax is only one small part of a very extensive tax code, historically this tax has been impactful and important. It has had far-reaching effects throughout this country’s history, both positive, and negative, and it is certain to remain a hot topic among politicians and citizens, even if it is abolished. I look forward to closely following the future and fate of the United States estate tax and because of its cost, moral short-fallings, and ultimate obsolescence, I hope to see the day, soon, where the death tax is either no longer a part of our tax code or is being more effectively used to redistribute wealth to underprivileged segments of our society. 28 APPENDICES Appendix A 1864 Death Tax Rates, taken from “The Estate Tax: Ninety Years and Counting” by Darien B. Jacobsen, Brian G. Raub, and Barry W. Johnson 29 Appendix B Significant Estate Tax Law Changes: 1916 to 2001 From “The Estate Tax: Ninety Years and Counting” by Darien B. Jacobsen, Brian G. Raub, and Barry W. Johnson 1916 – Estate Tax Enacted 1918 – Tax base expanded to include: spouse’s dower rights, exercised general powers of appointment, and life insurance over $40,000 payable to estate; charitable deduction added 1924 – Gift Tax Enacted; State death tax credit added; revocable transfers included in tax base 1926 – Gift Tax Repealed 1932 – Gift Tax Reintroduced 1942 – Tax base expanded to include: all insurance paid for by decedent; most power of appointment, and community property (less spouse’s actual contribution to cost) 1948 – Marital deduction replaced 1942 1951 – Powers of appointment rule relaxed community property rules 1935 – Alternate Valuation 1954 – Life insurance rules modified to exclude insurance the decedent never owned 1976 – Unified estate and gift taxes; added generation-skipping transfer tax (GST), orphan deduction, carryover basis rule, special valuation and payment rules for small business and farms: increased marital deduction 1980 – Carryover basis rule repealed retroactively 1981 – Unlimited marital deduction; tax base changed; full value pension benefits, ½ joint property automatically excluded; orphan deduction repealed 1986 – ESOP deduction added and GST modified 1987 – Phaseout of graduated rates and unified credit for estates over $10 million introduced 1988 – QTIP allowed for marital deduction; estate freeze and GST modified 1990 – Estate freeze rules replaced 1997 – Qualified Family-owned Business deduction, conservation easement introduced; 1987 phaseout of unified credit revoked Note: While this timeline extends only to 2001, the estate tax has served the same purpose and been collected in the same manner since that time. 1989 – ESOP 2001 – EGTRRA 30 Appendix C Estate Tax Statistical Data: Estate Tax Returns Filed in 2017 by Tax Status and Size of Gross Estate Focus on Allowable Unified Credit and Net Estate Tax - taken from the Internal Revenue Service 31 Appendix D A Side-by-Side Comparison of the 2017 and 2018 Federal Income Tax Brackets, for Single and Married Filing Jointly Taxpayers – taken from Business Insider Single Taxpayers 2017 Tax Rates (Standard Deduction $6,350; Personal Exemption $4,050) 10% 15% 25% 28% 33% 35% 39.6% $0 - $9,325 $9,326 - $37,950 $37,951 - $91,900 $91,901 - $191,650 $191,651 - $416,700 $416,701 - $418,400 $418,401 or more 2018 Tax Rates (Standard Deduction $12,000; Personal Exemption Eliminated) 10% $0 - $9,525 12% $9,526 - $38,700 22% $38,701 - $82,500 24% $82,501 - $157,500 32% $157,501 - $200,000 35% $200,001 - $500,000 37% $500,001 or more Married Filing Jointly 2017 Tax Rates (Standard Deduction $12,700; Personal Exemption $8,100 10% 15% 25% 28% 33% 35% 39.6% $0 - $18,650 $18,651 - $75,900 $75,901 - $153,100 $153,101 - $233,350 $233,351 - $416,700 $416,701 - $470,700 $470,701 or more 2018 Tax Rates (Standard Deduction $24,000; Personal Exemption Eliminated) 10% $0 - $19,050 12% $19,051 - $77,400 22% $77,401 - $165,000 24% $165,001 - $315,000 32% $315,001 - $40,000 35% $400,001 - $600,000 37% $600,001 or more 32 WORKS CITED Beckert, J. (2008). Why Is the Estate Tax so Controversial? Society, 45(6), 521-528. Brunet, Gillian. “New Estate Tax Rules Should Expire After 2012.” Center on Budget and Policy Priorities, 11 Oct. 2017, www.cbpp.org/research/new-estate-tax-rules-shouldexpire-after-2012. “Chapter 27.” South-Western Federal Taxation, by William H. Hoffman et al., South-Western Cengage Learning, 2018, pp. 27–1-27–28. Cole, Lauren Lyons. “Here's How Your Tax Bracket Will Change in 2018.” Business Insider, Business Insider, 14 Feb. 2018, www.businessinsider.com/tax-brackets-2018-trump-taxplan-chart-2017-12. Ebeling, Ashlea. “Final Tax Bill Includes Huge Estate Tax Win For The Rich: The $22.4 Million Exemption.” Forbes, Forbes Magazine, 26 Feb. 2018, www.forbes.com/sites/ashleaebeling/2017/12/21/final-tax-bill-includes-huge-estate-taxwin-for-the-rich-the-22-4-million-exemption/#3ca087331d54. “Estate Tax.” Internal Revenue Service, United States Internal Revenue Service, 2018, www.irs.gov/businesses/small-businesses-self-employed/estate-tax. Frisch, David. “How The Tax Cuts And Jobs Act Of 2017 Affects Estate Taxes.” Forbes, Forbes Magazine, 27 June 2018, www.forbes.com/sites/forbesfinancecouncil/2018/06/27/how-thetax-cuts-and-jobs-act-of-2017-affects-estate-taxes/#3c65ebde6cf9. 33 Garber, Julie. “See How the Federal Estate Exemptions Have Changed from 1997 to 2018.” The Balance Small Business, The Balance, 11 May 2018, www.thebalance.com/exemptionfrom-federal-estate-taxes-3505630. Halpern, Adam S. “A Concise Summary of the New Tax Law.” Fenwick & West LLP - a National Technology and Life Sciences Law Firm, 5 Jan. 2018, www.fenwick.com/publications/Pages/A-Concise-Summary-of-the-New-Tax-Law.aspx. Jacobsen, Darien B., Raub, Brian G., & Johnson, Barry W. (2007). The estate tax: Ninety years and counting. Statistics of Income. SOI Bulletin, 27(1), 118-128. McCaffery, Edward J. (1999). Grave robbers: The moral case against the death tax (estate and gift tax) (Statistical Data Included). Tax Notes, 85(11), 1429-1443. O' Connor, Brian J. “Heirs Inherit Uncertainty With New Estate Tax.” The New York Times, The New York Times, 23 Feb. 2018, www.nytimes.com/2018/02/23/business/estate-taxuncertainty.html. Prince Law Firm. “History and Overview of the Federal Estate Tax.” Hg.org, Prince Law Firm, www.hg.org/legal-articles/history-and-overview-of-the-federal-estate-tax-6708. “SOI Tax Stats - Estate Tax Statistics Filing Year Table 1.” Internal Revenue Service, Internal Revenue Service, 2018, www.irs.gov/statistics/soi-tax-stats-estate-tax-statistics-filing-yeartable-1. “Summary of 2017 Tax Cuts & Jobs Act Changes.” Fee-Only Financial Advisors in Dallas | LFC, Lee Financial, 2018, www.leefin.com/2017-tax-cuts-jobs-act-changes/. 34 “Tax Reform.” Internal Revenue Service, 2018, www.irs.gov/tax-reform. “Text - H.R.218 - 116th Congress (2019-2020): Death Tax Repeal Act.” Congress.gov, 3 Jan. 2019, www.congress.gov/bill/116th-congress/house-bill/218/text. “Temporary Increase in Estate Tax Exemption (and Portability).” Gudorf Law Group, LLC, 27 July 2018, www.daytonestateplanninglaw.com/temporary-increase-in-estate-taxexemption/. Name of Candidate: Madalin Rooker Birth Date: June 23, 1996 Birth Place: Salt Lake City, Utah Address: 4452 Caddie Lane Highland, Utah, 84003 University of Utah UNDERGRADUATE RESEARCH JOURNAL EXAMINING THE EFFICIENCY OF SECURITIES OWNERSHIP IN THE UNITED STATES Karim Shaaban (Johnathon Brogaard) Department of Finance ABSTRACT The disastrous years following the Stock Market Crash of 1929 led to a series of reforms by President Roosevelt to stabilize the failing economy. The passing of the New Deal laws coupled with more recent laws passed by President Bush and President Obama have led to extensive regulation of the financial industry. Publiclytraded companies must register with the SEC and provide material information to the investing public. To do so, companies collectively spend billions of dollars on lawyers and accountants to adequately provide the information required by the SEC. This requires significant time and effort on behalf of the companies, which takes away from their ability to generate more revenue. Although these regulations are crucially put in place to increase transparency and to prevent foul play, they have become too overreaching with their numerous registrations and accounting requirements. Companies produce annual and quarterly materials for the knowledge of their investors; however, these reports have become painfully long that it is difficult to read the reports of all the companies. The current system governing the securities industry is complex, costly, and inefficient. This raises the question of how it could be improved. To answer this underlying question, one must first understand the historical needs to pass and establish the current securities laws and the issues that arose from their enactments. Next, it is important to compare the system put in place by the United States government to those of other G8 countries in an attempt to find possible solutions that may work for the United States. Finally, one must identify the role technology will play in the future of securities ownership. ii TABLE OF CONTENTS ABSTRACT i INTRODUCTION 1 US SECURITIES LAWS 4 OWNERSHIP IN G8 COUNTRIES 19 BLOCKCHAIN AS A SOLUTION 31 CONCLUSION 34 REFERENCES 36 iii 1 INTRODUCTION Financial Landscape before the New Deal: In the early part of the 20th century, the sales of securities were governed by specialized state statutes often referred to as “Blue Sky Laws” (Macey and Miller, 1991). The term “Blue Sky” comes from the 1917 Supreme Court case: Hall v. GeigerJones Co., which granted individual states the power to regulate the offer, sale, and purchase of securities. Justice Joseph McKenna famously stated in the case: “The name that is given to the law indicates the evil at which it is aimed, that is, to use the language of a cited case, "speculative schemes which have no more basis than so many feet of 'blue sky'"; or, as stated by counsel in another case, "to stop the sale of stock in fly-by-night concerns, visionary oil wells, distant gold mines and other like fraudulent exploitations." Hall v. Geiger Jones Co., 242 U.S. 539 (1917) These laws were viewed as a response by politicians to combat the serious fraud that prevailed in the securities markets in the years leading up to the 1929 stock market crash. Some states passed legislation that required securities sold in their dominion to be submitted to an administrative body for inspection of their merit and worth. Other states produced more passive responses, and they passed laws requiring only the disclosure of material information of the issuer and of the brokers without inspecting the merit or worth of the securities (Macey and Miller, 1991). In the early 1900s, brokers would often sell securities to buyers under false pretenses of grandiose returns without providing material evidence to support their 2 assertions. Imperative details regarding the securities were deliberately hidden to attract more investors to the security. Such promises led investors to purchase more shares, which artificially overvalued publicly traded companies and inflated the market (Segal, 2019). The Blue Sky Laws of the early 20th century were well-intentioned, but were ultimately flawed (Macey and Miller, 1991). The government did not require or enforce the disclosure of material company information to investors on a federal basis, and it allowed for states to pass their own legislation on the matter, which often did not coincide with other states’ regulatory laws. This lack of disclosure in addition to the inconsistency of the regulatory laws of the states ultimately led to the four-day collapse of the stock market in late October, 1929 4. The Wall Street Crash of 1929 propelled one of the longest and most devastating depressions in the history of the industrialized western world, which led to the loss of billions of dollars (Pells and Romer, 2019). During the depression, industrial production in the United States fell 47%, real GDP fell 30%, and, at its peak, unemployment surpassed 20 percent (Pells and Romer, 2019). Following the tragic events of the Great Depression, President Franklin D. Roosevelt signed into law the Securities Act of 1933 as part of his New Deal initiative to bring about economic relief, recovery, and reform. The Securities Act of 1933 is known as the “truth in securities” law because its primary objectives are to provide investors with material information and prohibit any form of deceit or fraud (“The Laws that Govern the Securities Industry,” 2013). In the following year, President Roosevelt signed the Securities Exchange Act of 1934 (SEA) as a continuation of the 3 New Deal. The SEA allowed for the creation of the Securities Exchange Commission (SEC), and gave the agency the authority to govern and monitor securities transactions in an attempt to establish financial transparency across the transactions. The laws and government agencies that arose out of President Roosevelt’s New Deal set the foundation of the security laws used today. 4 US SECURITIES LAWS The Securities Act of 1933: Congress passed The Securities Act of 1933 as a response to the financial ruin caused by Great Depression. As a part of Roosevelt’s New Deal, the law seeks to amend and reverse the economy, and it aims to prevent another Great Depression in the future. In signing this law, President Roosevelt created the first piece of major legislation concerning the sale of securities (Kenton, 2019). The main objectives of The Securities Act of 1933 are to provide the public with material information regarding securities being offered for public sale through increased transparency in financial statements and to create laws that prohibit deceitful practices and misrepresentations of the financial health of publically traded companies. In order to achieve these goals, the law requires companies to disclose important financial information to investors through the registration of their securities with the SEC. The Securities Act is meant to protect the interests of the investing public. The SEC requires transparency from the registered companies to provide investors with current and accurate information; however, it remains the responsibility of the investor to make cautious decisions when investing because although the SEC requires financial statements to be accurate, it does not guarantee it (“The Laws that Govern the Securities Industry,” 2013). Registration Process Companies planning on raising capital from public investors through the sale of securities must register with the SEC through a registration statement. The 5 company must include a prospectus in the registration statement, and then the SEC relays the information to the public. The prospectus is a legal document that contains important details of the business such as the company’s history, management profiles, financial statements, and other material information. When a company first sells stocks to the public in an SEC-registered offering, it is referred to as an initial public offering (IPO) (Stowell, 2013). There are exemptions for the SEC’s registration requirements with Rule 144 of the Securities Act being the most commonly cited. Rule 144 regulates the resale of restricted securities among qualified institutional investors (Stowell, 2013). The SEC defines restricted securities as “securities acquired in unregistered, private sales from the issuing company or from an affiliate of the issuer” (“Rule 144: Selling Restricted and Control Securities,” 2013). These securities include most bonds and convertible transactions, which are exercised without registering with the SEC (Stowell, 2013). There are five conditions that must be met to qualify for a Rule 144 exemption: 1. 2. 3. 4. 5. Holding Period Current Public Information Trading Volume Formula Ordinary Brokerage Transactions Filing a Notice of Proposed Sale With the SEC (1) For companies registered with the SEC, they are required to hold their securities for at least six months before selling their restricted securities in the marketplace. For firms not registered with the SEC, they are required to hold their restricted securities for at least a year. In both cases, the relevant holding period begins on the date when 6 the securities are bought and fully paid for. This holding period only applies to restricted securities. (2) There must be adequate and current public information concerning the financial health of the company in order for investors to be fully aware of the potential risks they are taking. This information is often presented through historical financial statements, business descriptions, and management biographies. (3) If the selling party is an affiliate of the company, the number of securities the affiliate may sell during any three-month period cannot surpass 1% of the total outstanding shares in its share class. (4) As an affiliate, sales must meet normal trading conditions and be considered normal transactions, and brokers cannot be overcompensated for the sales. Neither the broker nor the seller can solicit orders to buy securities. (5) The SEC requires an affiliate to file a notice in the event where a sale is valued over $50,000 or involves over 5,000 shares over a three-month period. The Securities Exchange Act of 1934: The passing of the Securities Exchange Act of 1934 granted Congress the ability to create the SEC, and it gave the commission the authority to oversee securities, markets, and financial professionals. This includes the power to “register, regulate, and oversee brokerage firms, transfer agents, and clearing agencies as well as the nation’s self-regulatory organizations” (“The Laws that Govern the Securities Industry,” 2013). The purpose of this regulatory agency is to ensure financial transparency in securities transactions in secondary markets to reduce potential 7 fraud. The SEC enforces the laws that govern the securities industry such as the Securities Act of 1933, the Trust Indenture Act of 1939, the Investment Company Act of 1940, the Investment Advisors Act of 1940, the Sarbanes-Oxley Act of 2002, and the Dodd-Frank Act of 2010. The Securities Exchange Act requires corporate reporting. Companies controlling more than $10 million in assets whose securities are held by 500 or more investors and/or institutions must file annual and other periodic reports to the SEC. This allows for increased transparency among large publicly traded firms. The Act also dictates proxy solicitations, in which it compels companies to disclose material information to shareholders for annual votes or for voting in the elections of board directors. The information present in proxy materials must be filed with the SEC prior to any solicitation to guarantee conformity with the SEC’s disclosure rules (“The Laws that Govern the Securities Industry,” 2013). The solicitations must acknowledge all important matters and decisive facts to give shareholders a better sense of the issues they are voting on. In addition, the Act has strict guidelines for tender offers to further ensure the safety of investors. A tender offer occurs when an investor or institution offers to purchase shareholders’ shares in a company at a premium. The SEC requires the buyer of these shares to disclose their position once the buyer accumulates 5% or more of the company’s shares (“The Laws that Govern the Securities Industry,” 2013). Again, this information is crucial to keeping investors informed about the events that occur in the companies they are investing in to ultimately protect their financial 8 interests. In this case, the disclosure of an investor’s position once they acquire 5% or more shares will alert other investors of a possible takeover. This law forbids individuals from engaging in insider trading. Insider trading occurs when an investor uses material non-public information to purchase or sell securities, thus giving the investor an upper-hand on the public. Insider trading is illegal and a direct violation of the Securities Exchange Act. The SEC has prosecuted officers, directors, employees, lawyers, and accountants on the grounds of insider trading (“The Laws that Govern the Securities Industry,” 2013). The maximum prison sentence for violating this law is 20 years, and the maximum fine is $5 million. The SEC acts to enforce the laws proposed in the Securities Act of 1933 to protect the interests of investors and reduce fraudulent activities in the financial industry. These laws seek to create a level playing field for all investors because the government believes that transparency is necessary to prevent another financial collapse following the Great Depression. Section 16: Beneficial Ownership Section 16 of the Securities Exchange Act lays out the regulatory filing requirements for officers, directors, and principal stock holders, who own more than 10% of the company. These three classes of people are referred to as insiders (Feldman and Teberg, 1966). The SEC requires registration of ownership within 10 days of becoming a beneficial owner, officer, or director under an initial statement in Form 3. The purpose of this filing is to disclose “the amount of all equity securities of such issuer of which he is the beneficial owner” (Feldman and Teberg, 1966, p.1057). From then on, in the event of changing ownership, the SEC requires the changes to be 9 filed within the first 10 days of a calendar month in which a transfer of ownership has occurred. This sets a precedent that the beneficial ownership of insiders must be frequently updated and disclosed (Feldman and Teberg, 1966). A beneficial owner is defined as “one who benefits from a security or property because the use and title belongs to him/her, although the legal title may belong to another person” (US Legal, Inc., n.d.). The legislative history of the term indicates that it was meant to “exclude a person having bare legal title only” (Feldman and Teberg, 1966, p.1058). The word “beneficial,” in this case, refers to the benefits that come with equitable ownership, so a “beneficial owner” is not only an equitable owner, but one who enjoys the benefits associated with security ownership. Beneficial refers to the advantageous gain received from owning securities. There are two categories of benefit that arise with the ownership of securities: (1) Intrinsic benefits such as voting rights, dividends, and interest payments, and (2) Extrinsic benefits that are associated with the buying and selling of securities. These benefits can be magnified by acquiring a large number of shares in a company, which in turn can grant the owner of the shares more control. The volume of buying and selling many shares can give the owner the ability to drive the market price of a security up or down. By manipulating the market in such a way, the owner may create and take advantage of a potentially profitable opportunity (Feldman and Teberg, 1060). In addition, owning a considerable number of shares grants the insider control of the company through voting rights. This control gives the insider the ability to affect the timing and proceedings of corporate events, which ultimately affects the market price of the security, as well as the news release of these events. 10 Individuals within a company with this level of influence can obtain market advantages for themselves that are not accessible to the remainder of the investing public through their knowledge of material non-public information and their ability to regulate the timing of corporate announcements. Congress concluded that this level of control led to malicious practices in the years prior to the Great Depression that conflicted with its desire to maintain a fair marketplace for securities. Evidence collected prior to the enactment of the Exchange Act adjudged that said malicious practices directly contributed to the uncontrolled speculation, which played a role in the credit inflation causing the Crash of 1929 leading to the Great Depression (Feldman and Teberg, 1966). Congress viewed Section 16 as a crucial piece of their plan to control speculation and market manipulation by establishing the paradigm that company managers and insiders have fiduciary responsibilities to their stakeholders. The House Report described the deterrents put in place as "the most potent weapon[s] against the abuse of inside information" (Feldman and Teberg, 1966, p.1062). Congress believed that the continuous reporting requirements set by Section 16, in concordance with the other statutes of the Exchange Act, would essentially eradicate insider misconduct. 11 The Trust Indenture Act of 1939: The Trust Indenture Act of 1939 (TIA) acts as an amendment to the Securities Act of 1933, and it governs the offerings of debt securities, such as bonds, to the public (US Legal, Inc., n.d.). The act is intended to protect the rights of bondholders by requiring the bond issuer to retain the services of a trustee, whose duty is to uphold these rights. The act calls for a qualified trustee to best serve the interests of the bondholders. Debt securities may be registered under the Securities Act of 1933, but may not be offered for public sale without a formal contract between the bond issuer and the bond holder. This contract is referred to as the trust indenture, which states the individual items and terms of the bond issuance, and requires the presence of a trustee. In the period before the Great Depression, indentures were not required to contain material information regarding the performance of a company, and, therefore, investors could not properly assess the risk of a company defaulting on its debt obligations. Before the law passed, trustees were passive in their roles, but with the passing of the law, they were given more responsibilities and liabilities. This passiveness prevented collective bondholder action, in which bondholders trying to force action did not have access to the information of other bondholders, who would, in theory, act with them. The enactment of TIA required trustees to provide a list of their bondholders to improve the communication (Kenton, 2019). In addition, TIA stripped trustees of their immunity clauses making them liable for their negligence. Section 315d of TIA states that an indenture cannot include any provision "relieving the indenture trustee from liability for its own negligent action, its own negligent 12 failure to act, or its own willful misconduct” (Katz, 1940, p. 290). Former Dean of the University of Chicago Law School, Wilber G. Katz, believed that “standing alone, this probably would effect a very radical change in the responsibility of the trustee” (Katz, 1940, p. 290). In summary, TIA furthered Congress’ vision of creating a fair securities market by imposing stricter regulations on bond issuers and increasing the liability for trustees. 13 The Investment Company Act of 1940: The Investment Company Act of 1940 furthered President Roosevelt’s vision of creating a stable regulatory framework following the Crash of 1929. This act defines an investment company (i.e. mutual fund), and it separates the responsibilities of investment companies from those of investment banks to cut any potential conflicts of interest that may occur. It also requires investment companies to register with the SEC in order to sell their securities to the public. After registration, investment companies must adhere to certain limitations including leverage, shortselling, and performance fees (Stowell, 2013). Investment Advisors Act of 1940: The Investment Advisors Act of 1940 became law simultaneously with the Investment Company Act of 1940, following a survey carried out by the SEC, which concluded that “the activities of investment advisors and advisory services patently present various problems which usually accompany the handling of large liquid funds of the public” (Lovitch, 1975, p. 67). The goal of this act is to protect the investing public from any malpractices by individuals who are paid to provide advising services regarding securities. To do so, the government required investment advisors to register with the SEC, and the act made it unlawful for such advisors to engage in any level of fraud or deceit. The statutes of the act apply to any persons who fall under the definition of an “investment advisor.” This includes anyone who receives compensation for advice regarding the value of securities or about the buying and selling of securities. 14 Sarbanes-Oxley Act of 2002: The Sarbanes-Oxley Act of 2002 responded to numerous corporate scandals and bankruptcies that occurred earlier in the decade by companies such as Enron, WorldCom, Xerox, HealthSouth, Sunbeam, Waste Management, Global Crossing, Tyco, and others. This legislation was enacted to repair the broken auditing system, which became prevalent in many of these large companies. Investors lost trust and confidence when these massive corporations exaggerated their financial statements. Sarbanes-Oxley is meant to protect shareholders from fraudulent misrepresentations found in financial statements. The Sarbanes-Oxley Act led to higher accountability for those intentionally falsifying financial statements, and included a prison sentence for those caught. The passing of the law allowed for the creation of the Public Company Accounting Oversight Board (PCAOB), a quasi-public institution with the power to oversee auditors. The primary goal of the PCAOB is “to enlist auditors to enforce existing laws against theft and fraud by corporate officers” (Coates, 2007, p. 91). Section 302 of the Sarbanes-Oxley Act requires a company’s management to sign off on its financial statements before they are released to the public to ensure that the reviewed financial statements present a truthful and accurate view of the firm’s financial health. Management officers who sign off on inaccurate representations of their financial statements may face various criminal penalties, including prison time. Section 401 of the act compels companies to disclose any relevant material information that may exist, but is not recorded on the financial statements. This is to 15 provide transparency to the investing public regarding the overall condition of the companies in which they invest. The Dodd-Frank Act of 2010: The Dodd-Frank Wall Street Reform and Consumer Protection Act was signed into law by President Obama as a response to the catastrophic effects of the 2008 financial crisis. The Dodd-Frank Act is “the most far-reaching regulatory change to the financial services industry since 1934. 21” This act, like the laws passed by the New Deal, intended to pull the United States out of another financial crash by addressing the systemic flaws leading to the crash, and offering regulatory responses to counter their effects. Prior to the 2008 financial crash, several government agencies were put in place to regulate financial institutions; however, this often led to regulatory gaps between the agencies. To fill these gaps, the act created the Financial Stability Oversight Council. The Council is responsible for providing an early warning system for finding and preventing rising systemic risks (Stowell, 2013). The reform increased the responsibilities of banks and other financial institutions engaging in securitization and the sale of securitized products by requiring them to retain at least 5% of each debt tranche they create (Stowell, 2013). In addition, the government required stricter regulations on over the counter (OTC) derivatives, which were not regulated before the crash. This granted the SEC and the Commodities and Futures Trading Commission the authority to regulate OTC derivatives. 16 The Dodd-Frank Act ended the “too big to fail” policy to prevent government bailouts in the future. It also included the Volcker Rule, which prohibited banks from engaging in proprietary trading. The Volcker rule also reduces bank investments in private equity funds and hedge funds to 3% of any fund, and overall investments in these funds was reduced to 3% of Tier 1 Capital (Stowell, 2013). Impact of these Laws Today: The securities laws passed by the US government in the 20th and 21st centuries act to reverse and prevent market crashes. The purpose of the New Deal was to alleviate the damages caused by the Great Depression and to prevent another crisis from happening in the future. The same can be said of the Sarbanes-Oxley Act passed by President Bush and the Dodd-Frank Act passed by President Obama. The passing of these laws and government initiatives have reduced the damages caused by the market crashes, but, in passing more laws, lawmakers have increased regulations on companies. This increased regulation puts an economic burden on the companies to comply with the laws. Companies must hire expensive lawyers and accountants to compile reports regarding their company’s financial health on a quarterly basis. Not only are these regulations expensive to comply with, but the laws themselves are outdated. Over the past century, technological advancements in finance have changed the landscape of the sector making it easier to trade securities almost instantaneously and in large volumes. New types of securities introduced into the marketplace, such as the credit-default swaps (CDOs) that played a part in the 2008 financial crisis, often have low, if not no, regulation by the government. 17 From this, one can conclude that the rate at which laws are created is significantly slower than the rate of the sector’s growth. Laws must move faster to keep up with the ever-changing financial landscape to preserve the health of the economy. Lawmakers must be capable, and they must be up to date on the technological advancements and the impacts of new securities. The securities laws need to be revised regularly to solve this inefficiency. 18 OWNERSHIP IN G8 COUNTRIES Securities Ownership in the US: A stock is a type of equity security that represents an investor’s partownership in a corporation. Historically, equity ownership in the United States was as simple as owning a colorful and engraved piece of paper called a stock certificate (Aronstein, 1978). The certificates included important information regarding the number of shares owned, the date of ownership, an identification number, and other rights that a shareholder might have, such as voting. The invention of the stock certificate revolutionized trading in a way that made the transferring process easy for investors. Shareholders could transfer their rights easily and directly by handing the piece of paper to their desired transferee (Aronstein, 1978). The stock certificate gave buyers confidence in the legitimacy of their purchase, and the exchange between the buyer of the stock certificate and the seller became a simple transfer of paper. This basic system of exchange made it easier for creditors to access the shares owned by their debtors simply through seizing the debtors’ certificates, and the physical location of the certificates determined the jurisdiction in certain legal proceedings (Aronstein, 1978). Before computers and the internet, transferring ownership required face-toface interactions or the use of mail to complete the exchanges. However, by the mid1960s, the New York Stock Exchange incorporated a fully automated computerized system, which allowed investors to begin trading nationwide, and later globally. This caused the market environment to dramatically change, and many believed that there 19 was no longer a need for stock certificates. The introduction of technology and the rapid integration of global markets transformed the simple system of exchanging stock certificates into a complex web of brokers, correspondents, exchanges, and other intermediaries (Aronstein, 1978). Technology and globalization come with many obvious benefits such as the ability to trade overseas, trading at higher volumes, fasters trades, more accurate records, and instantaneous communication with corporate issuers; however, the introduction of this new system made the transfer of ownership much more expensive and time-consuming compared to the previous system of basically exchanging pieces of paper (Aronstein, 1978). Modern US Ownership In the event of a merger or an acquisition, the management of the target company attempt to strike a deal with the acquirer, and then the target calls a meeting so shareholders can vote on the merits of the deal. Typically, it is inconvenient for shareholders to travel to attend these meetings, so many them are absent. In response to this, companies mail proxy cards to the missing voters, which they can fill out and mail back to the company with directions regarding how the shareholder wishes to vote. The proxy card appoints an individual, who will be at the meeting, to vote on behalf on the absent shareholder (Levine, 2016). This may seem simple enough, but in many cases, individual shareholders are not the actual owners of the stock. In other words, the shareholders are not “shareholders of record,” whose shares appear on the company’s stock registry (Levine, 2016). Rather, the shareholders hold their shares in “street name,” which means that their broker owns the shares on their behalf. This makes the broker the 20 legal owner of the shares and the investor the beneficial owner. There are several advantages that come with street name registration such as the ability to place limit orders to sell a security at a specified price and being able to set up margin accounts. The broker also becomes responsible for safeguarding the shareholders’ stock certificates, so the investor does not need to worry about them getting lost or stolen (“Holding Your Securities- Get the Facts,” 2003). The disadvantages that arise include delays in dividend payments because it must first go through the broker. Another disadvantage is that since the shareholder is not registered with the company, he or she will not receive important corporate information directly, but through the broker (“Holding Your Securities- Get the Facts,” 2003). Since the broker is the legal owner of the shares, it receives the voting rights associated with ownership. The broker will still ask the shareholder how to vote, and then it will send representatives go to the meeting and vote on the investors’ behalf. If a shareholder with a street name registry desires to attend the meeting and vote for themselves, they must ask the broker for a proxy to attend the meeting. However, the system of ownership is still more complex. Brokers typically do not even own the shares they hold for investors in street name, but, instead, the brokerages agreed to place all their shares in a single place called the Depository Trust Co. (DTC), which owns the brokerages’ shares. This facilitates transfers of shares because brokers no longer need to go from brokerage to brokerage exchanging physical stock certificates; instead, they can accomplish everything on the DTC’s central computer (Levine, 2016). This level of convenience increases the complexities associated with voting. The DTC becomes the record owner under state laws, whereas 21 brokers are the record owners under federal law. This results in the DTC needing to give proxies to brokers so that they can vote on behalf of their investors. The institutions that manage these shares must keep track of thousands of stocks, and it is difficult, if not impossible, to keep track of meetings for each company that is invested in. These institutions hire outside firms to aid them in organizing company meetings, voting, and submitting proxies. This current method of owning stocks is extremely confusing and profound. The system is governed by laws written nearly 100 years ago, which do not all translate into the modern day. 22 Securities Laws in Japan: Following Japan’s defeat in World War II, the United States government began rebuilding Japan, which included the restructuring of their financial system. In 1948, the Japanese Diet enacted the Securities and Exchange Law, which used the codes from the Securities Act of 1933, the Securities Exchange Act of 1934, and the GlassSteagall Act of 1933 almost verbatim. However, since the birth of Japan’s modern regulatory system, the system has transformed into a somewhat different scheme. In 1947, the Japanese government established the Ministry of Finance (MOF) to oversee the regulation of Japan’s financial system. Up until 1971, foreign securities firms could not operate in Japan. This changed with the passing of the Law Concerning Foreign Securities Firms, which allowed foreign firms to enter provide investment banking services in Japan (Stowell, 2013). In 1992, Japan passed the Financial Institution Reform Act, which reversed the separation of investment banking and commercial banking. The act also created the Securities Exchange and Surveillance Commission (SESC), which shared some of the regulatory responsibilities of the MOF. Starting in 1998, Japan began to deregulate its financial industry, which is referred to as the “Big Bang.” The Big Bang separated the SESC and the MOF, and established the Financial Supervisory Agency, which became Japan’s main regulatory body. The Financial System Reform Law in 1999 granted commercial banks the ability to own brokerage firms that underwrite equity and debt securities (Stowell, 2013). Japan passed the Financial Instruments and Exchange Law in 2006 that acted like the Sarbanes-Oxley Act in the United States. The law called for increased regulation on broker-dealers, added disclosure requirements for registered public companies and 23 large shareholders, and tender offer rules 26. During the 2008 Crash, Japanese banks had much lower exposure to subprime mortgage securities than the US and the UK. While American and British lawmakers took large measures to regulate their financial markets, Japan stayed passive because its lawmakers believed that increasing regulation would make Japanese banks less competitive in the international arena (Stowell, 2013). Modern Japanese Ownership In recent years, the Bank of Japan (BOJ) has accumulated ownership in 40% of the companies listed on the Tokyo Stock Exchange. The BOJ is a top 10 shareholder in each one of those companies. The BOJ buying shares of Japanese companies is a part of its monetary easing initiative to “lift the country out of deflation, and hit a 2% price stability target” (Shirai, 2018). 24 Securities Laws in the UK: Prior to 1986, firms in Britain’s financial system regulated themselves. In 1986, Britain experienced its own Big Bang that reformed the self-regulated into a statutory framework. The Financial Services Act 1986 created Britain’s regulatory arm called the Securities and Investment Board (SIB) (Stowell, 2013). Firms must register with the SIB because conducting any investment business without authorization from the British regulator is a criminal offense (Stowell, 2013). Britain’s financial system once again changed in 1997, when the government renamed the SIB to the Financial Services Authority (FSA). The newly formed regulatory arm consolidated the power of nine other regulatory agencies into one massive agency. This gave the FSA more power and control over regulating banks. Like the SEC in the United States, the FSA has the authority to pass its own rules without the need to go through Parliament. In 2001, Parliament enacted a law called the Financial Services and Markets Act 2000 to replace the Financial Services Act 1986. Following the 2008 Crash, the British government sought to once again reform their financial system because of the regulatory failure that occurred during the global stock market crash. Parliament signed into law the Financial Services Act in 2013, which ultimately dissolved the FSA. The responsibilities of the FSA were divided between the newly created Financial Conduct Authority, responsible for policing financial activity, and the Prudential Regulation Authority of the Bank of England, responsible for regulating financial firms. 25 Securities Laws in China: In the mid-1800s, the Treaty of Nanking ended the first of two Opium Wars between China and Britain. One of the terms of the treaty gave Britain control over the Hong Kong island for a period of 99 years. Because of this, Hong Kong’s financial system was under British control instead of Chinese control, which caused a rift between the two systems. Before 1992, the Chinese economy was essentially closed off to investment banking and other foreign investments. However, under Deng Xiaoping’s administration, China began opening doors to attract foreign trade and investments. In 1992, the Chinese government established the State Council Securities Commission (SCSC) and the China Securities Regulatory Commission (CSRC) to regulate their new and growing financial sector. The SCSC focuses primarily on regulating the centralized market, whereas the CSRC acts as the enforcement arm for the SCSC, and it also regulates China’s securities market (Stowell, 2013). In 1998, the Chinese government enacted the Securities Law of the People’s Republic of China, which merged the SCSC and the CSRC into one government entity under the State Council. This law also separated banks engaging in deposit-taking from those engaging in securities activities. In 2005, the Chinese government revised the Securities Law of the People’s Republic of China and the Company Law of the People’s Republic of China to keep up with the rest of the world. The revisions amended 40% of the existing articles, which included 53 additions and 27 deletions (Stowell, 2013). The reformed law lowered restrictions on banks that engage in securities activities, created a Chinese derivatives 26 market, increased security and protection for Chinese investors, and gave the Chinese regulators the power to audit and investigate firms under their jurisdiction, with the ability to control a securities firm’s assets (Stowell, 2013). Modern Chinese Ownership China’s communist regime limits the foreign direct investment within its borders. The Chinese government looks to exercise a certain amount of control over its domestic companies, and, therefore, restricts the amount of foreign investment. The restrictions ensure that foreign entities do not accumulate ownership and control over Chinese companies and resources. Over time, these ownership restrictions have been relaxed in some sectors, but key sectors, such as oil and gas, are still under the full control of the Chinese government. Companies in China can issue three primary classes of shares. “A” shares can only be owned by Chinese citizens, and they are traded on the Shanghai and Shenzhen stock exchanges. These shares apply to Chinese companies, and must be purchased using China’s local currency, the renminbi. This share class is off-limits for nonChinese investors, but, in 2002, China began allowing Qualified Foreign Institutional Investors (QFII) to purchase a limited amount of “A” shares of any listed Chinese company. By 2006, 40 financial institutions qualified for QFII status, including Goldman Sachs, HSBC, and Deutsche Bank. China’s “B” shares are also traded on the Shanghai and Shenzhen exchanges, but the can be purchased using US dollars and be owned by foreigners. The Chinese government intended to use this share class to help domestic companies raise capital from overseas. In 2001, the CSRC began permitting Chinese citizens to buy “B” shares. 27 The third primary class of shares in China are “H” shares. “H” shares of mainland Chinese companies that are traded on the Hong Kong stock exchange. This class of shares can only be bought using Hong Kong dollars. Foreigners are permitted to buy “H” shares, and, as a result, the shares are more liquid that “A” shares. Because of this, “A” shares trade at a premium compared to “H” shares of the same company. Hong Kong, for many years, existed as an English colony, and was subject to Britain’s common law basis. Hong Kong operated independently from mainland China during this period; however, since 1999, China has begun to exert its influence and control on Hong Kong. 28 Comparing G8 Ownership Systems: Due to the increased globalization that occurred in the last 100 years, the basis of the laws of the countries examined are similar. However, since the 1930s, countries have reacted to certain economic and political events differently. The way governments respond to such events is determined by their financial policies and culture. Following the 2008 financial crisis, the United States and the United Kingdom believed that increasing regulations in their financial markets would help stabilize their falling economies. Japan took a different approach altogether, and it did not seek economic reform in order to keep its banks competitive in the international arena. Culture plays a significant role in the ownership systems of these countries. The Chinese government and its people put the wellbeing of the state above all else. China prohibits foreigners from investing in its domestic companies to maintain control under its Communist regime. To uphold this policy, China implemented several classes of shares that base ownership on citizenship. Only approved foreign institutional investors can purchase shares originally meant for Chinese nationals, but all other foreign investors can purchase shares through the Hong Kong exchange. This system of ownership could not be applied to the United States because many of its citizens would be against the idea of “big government.” This belief goes hand in hand with the culture present in the US. Japan’s central bank, the BOJ, accumulating significant ownership in 40% of its publically traded companies would also fail in the US for similar reasons. The American public would not want its government and central bank to gain that much power. 29 Though not all of these systems would be able to work well in the US, American lawmakers can still learn from these other countries. Japan, the UK, and China all regularly update and reform their laws relative to the current financial landscape. In the last 30 years, the United States only passed two new securities laws, which is not nearly enough to reduce the inefficiencies found in the system. China amended nearly half of its existing articles in 2005, and both the UK and Japan underwent a “Big Bang” to reform their financial systems. It is time for the United States to experience its own “Big Bang” in order to stay competitive in the future. 30 BLOCKCHAIN AS A SOLUTION Every day, trillions of dollars are exchanged between billions of people in the global financial system through orders, trades, payments, etc. (Tapscott & Tapscott, 2017). The participants of these transactions record the exchange in their own ledgers, which is one version of the truth that may differ between the participants. Because each ledger could possess different information, transaction participants must depend on a trusted third party, such as a bank, to maintain the integrity of the transaction. This can make a simple, ordinary transaction complex. For example, if Person A in the US wishes to send money to Person B in Brazil, he or she must first tell the trusted third party to transfer the desired sum of money to Person B. The trusted third party, because it is centralized, can then identify Person B in Brazil through their bank account, and then it can deposit the money to Person B. Several problems arise through this method of exchange. First, the use of a third-party intermediary results in many fees that are required to complete the transaction. Second, the use of intermediaries causes a three-day delay in the transaction, so Person B does not receive the transfer immediately. Third, the use of an intermediary limits the interaction between the participants of the transaction. This current method presents several inefficiencies, and it is therefore costly. The use of multiple ledgers has the potential to lead to errors, fraud, and more inefficiencies. This financial system often creates redundant and tedious paperwork that is evaluated over and over again by expensive lawyers and accountants. 31 Santander Bank estimates that the inefficiencies of the system ultimately cost consumers up to $20 billion a year in banking and insurance fees. In recent years, a possible solution has emerged to solve the inefficiencies of our current global financial system: Blockchain (Tapscott & Tapscott, 2017). Blockchain is a globally distributed digital ledger that records transactions publically and chronologically (“Blockchain: Explained in Plain English,” 2018). Each transaction is a piece of data that is recorded in a “block.” Blocks can contain data for asset transfers, money, medical records, voting rights, etc. Once the block is updated with the desired data, it is added to the chain of already existing blocks, hence the name “Blockchain.” Data in the Blockchain cannot be edited or removed from the chain once it is uploaded. Since the ledger is widely distributed across millions of computers around the world, the trust and integrity of the system lies in network consensus and the cryptography (Tapscott & Tapscott, 2017). The implementation of Blockchain would allow for businesses and individuals from across the world to interact with one another in ways never seen in the history finance. Two or more parties would be able to “forge agreements, make transactions, and build value without relying on intermediaries to verify their identities, establish trust, or perform the critical business logic” (Tapscott & Tapscott, 2017). Large financial institutions such as JP Morgan Chase, Credit Suisse, and Citigroup have collectively spent millions investing in Blockchain technology because they believe they will be able to do more with less. Best-selling author, Don Tapscott, believes that “by reducing transaction costs among all participants in the economy, Blockchain supports models of peer-to-peer mass collaboration could make many of 32 our existing organizational forms redundant” (Tapscott & Tapscott, 2017). This would ultimately help strengthen and transform our outdated system and money for the consumers. save 33 CONCLUSION The United States maintains many of the laws it enacted during the time of the New Deal. These laws are outdated, and they have made the system of owning securities increasingly complex as new regulations arise. The accrual of regulations over time has made reporting standards time consuming and expensive for companies around the world. Companies are mandated by the government to file extensive reports with the SEC, which require hiring pricey lawyers and accountants. The current system of ownership adds several intermediaries to a simple transaction, and that burden ultimately falls onto the investing public through billions of dollars’ worth of fees to the intermediaries. By examining the securities laws of the United States, one can understand the fundamental parts of the ownership system. The history behind the laws and the problems they attempt to solve are crucial in identifying our current problem. The financial marketplace leading up to the Great Depression became unfair and fraudulent. Brokers failed to disclose material information to their clients, and, as a result, investors were led to purchase more shares of companies. This systemic overinvesting by the public caused publically traded companies to be artificially overvalued and inflated the market. These events coupled with other factors ultimately provoked the Crash of 1929. In response to the failing economy, President Roosevelt enacted the New Deal to mitigate the damages caused by the depression. Roosevelt passed a series of securities laws to increase transparency for investors, so they could make informed investing decisions based on accurate information. 34 In theory, providing investors with important information is beneficial, but there is too much information available for one investor to digest. Gathering and presenting this information is costly, and it often leads to redundant paperwork. These costs eventually end up being a burden on consumers. The current system boasts billions of dollars’ worth of inefficiencies each year, and a change is necessary for the US to remain a financial power in the world today. As Blockchain technology matures, financial institutions can utilize its services to reduce intermediaries, costs, and time of transactions. Blockchain could potentially be the next financial revolution, and if it is to succeed, lawmakers must take initiative early on, and they must regulate the new technology accordingly and regularly. The existing laws may not apply to the new technology, so it is crucial to update, or even change, them to accommodate its possible implications. 35 REFERENCES Aronstein, M. J. (1978). The Decline and Fall of the Stock Certificate in America. Penn Law Journals,1, 273-283. Blockchain: Explained in Plain English. (2018, July 27). Retrieved from https://coinmetro.com/blog/blockchain-explained-in-plain-english/ Coates, John, C IV. (2007). "The Goals and Promise of the Sarbanes-Oxley Act." Journal of Economic Perspectives, 21 (1): 91. Feldman, J.; Teberg, R. L. (1966). Beneficial Ownership Under Section 16 of the Securities Exchange Act of 1934. Western Reserve Law Review 17(4), 10541062. Holding Your Securities- Get the Facts. (2003, March 04). Retrieved from https://www.sec.gov/reportspubs/investorpublications/investorpubsholds echtm.html Katz, W. G. (1940). Responsibility of Trustees Under the Federal Trust Indenture Act of 1939. American Bar Association Journal 26(4), 290-292. Kenton, W. (2019, March 29). Securities Act of 1933. Retrieved from https://www.investopedia.com/terms/s/securitiesact1933.asp Kenton, W. (2019, March 12). Trust Indenture Act of 1939. Retrieved from https://www.investopedia.com/terms/t/trustindentureactof1933.asp Levine, M. (2016, May 13). T. Rowe Price Voted for the Dell Buyout by Accident. Retrieved from https://www.bloomberg.com/opinion/articles/2016-0513/t-rowe-price-voted-for-the-dell-buyout-by-accident Lovitch, F. B. (1975). The investment advisers act of 1940 who is an investment adviser. University of Kansas Law Review24(1), 67-104. Macey, J. R.; Miller, G. P. (1991). Origin of the Blue Sky laws. Texas Law Review70(2), 348-349. Pells, R. H., & Romer, C. D. (2019, March 07). Great Depression. Retrieved from https://www.britannica.com/event/Great-Depression Rule 144: Selling Restricted and Control Securities. (2013, January 16). Retrieved From https://www.sec.gov/reportspubs/investorpublications/investorpubsrule 1 44htm.html Segal, T. (2019, April 01). Blue Sky Laws. Retrieved from https://www.investopedia.com/terms/b/blueskylaws.asp Shirai, S. (2018, October 16). The Effectiveness of the Bank of Japan's Largescale Stock-buying. Retrieved from https://voxeu.org/article/effectiveness-bank- japan-s-large-scale-stockbuying-programme Social Welfare History Project. (2011). Stock Market Crash of October 1929. Social Welfare History Project. Retrieved from http://socialwelfare.library.vcu.edu/eras/great-depression/beginning-ofgreat-depression-stock-market-crash-of-october-1929/ Stowell, D. P. (2013). Investment Banks, Hedge Funds, and Private Equity (3rd ed.). Waltham, MA: Academic Press., 36-38, 41-45, 48-49, 316. Tapscott, A., & Tapscott, D. (2017, March 01). How Blockchain Is Changing Finance. Retrieved from https://hbr.org/2017/03/how-blockchain-is-changingfinance The Laws That Govern the Securities Industry. (2013, October 01). Retrieved from https://www.sec.gov/answers/about-lawsshtml.html#jobs2012 US Legal, Inc. (n.d.). Beneficial Owner Law and Legal Definition. Retrieved from https://definitions.uslegal.com/b/beneficial-owner/ US Legal, Inc. (n.d.). United States Trust Indenture Act of 1939 Law and Legal Definition. Retrieved from https://definitions.uslegal.com/u/unitedstates- trust-indenture-act-of-1939/ University of Utah UNDERGRADUATE RESEARCH JOURNAL THE ROLE OF TEAM SELECTION IN COMPETITION PREFERENCES GENDER GAP Fergus Stevens (Elena Asparouhova) Department of Finance Introduction Women are statistically underrepresented in high-profile leadership positions. Female under representation in teams and leadership roles has been attested to an observed reluctance to compete when compared to men (Niederle & Vesterlund, 2011). Reduced female competition has been attributed to male overconfidence and risk tolerance. An idea raised by Niederle & Verstulund (2007), is that girls are ‘nurtured’ differently than boys such that in professional life women shy away from competition. Niederle & Vesterlund observed child games and parental teachings as a source of competitive differences. This theory provides a social explanation in a historical context, but it doesn’t explain a persistent difference that is consistently observed in competition. The purpose of this study is to inquire into the potential existence of a gender bias in team selection which would, overtime, compound to discourage women from participating in competition with a selective outcome. Research exists that shows women opt to participate in co-operative team environments (Kuhn & Villeval, 2011, Healey & Pate, 2011). However, while women prefer to participate in cooperative environments their competitive aversion leads to under representation in leadership team compositions. Checchi, Cicognani & Kulic (2015) found that gender quotas work as an affirmative solution to alleviate male dominated selection committees. And while direct quotas will help composition, it is important to identify the root cause that deters females from entering competitive environments. The goal of this study is to examine if a negative gender bias exists that deters women from competition due to a historically learned disadvantage, even if their performance is equal to or superior to their male counterparts. Method Study Design The study was composed of a participant based study that was performed at the David Eccles School of Business at the University of Utah. The sample was composed primarily of undergraduate and graduate business students. The study was completed with 12 participants. Every participant completed an online game consisting of two sections of timed two digit summation questions and a nametag selection step. After participants completed the math sections they were allowed to choose an alias between four names such as Matt, Mark, Megan, and Mia, where half are generally interpreted as male names and the other as female names. After participants select an alias their scores are sent to four randomly chosen ‘selectors’ from the room of 12 participants. The selectors are instructed to choose a team member between two participant aliases and their score from the first math task. After the selectors have made a series of decisions between all participants a random round is selected and used to calculate the payoff for the subjects participation in the experiment. The final payoff is a function of the participants score from the second math task and their status on a team. Data Collection and Analysis Once participants have completed the game a matrix is produced that links participants to their alias, scores, and round playoffs. Analysis is completed by observing the selection frequency of gender defined aliases and their respective scores. Results One pilot study was successfully completed with the outlined method. Without meaningful data no conclusions can be drawn about the hypothesis. However, the success of the pilot study demonstrates the feasibility of the study and proves that data can be collected in future studies. References Checchi, Daniele, et al. “Selection into Research: Do Gender and Connections Matter?” 30 Apr. 2015, www.siecon.org/online/wp-content/uploads/2015/10/Cicognani.pdf. Healy, Andrew, and Jennifer Pate. “Can Teams Help to Close the Gender Competition Gap?” The Economic Journal, vol. 121, no. 555, Sept. 2011, pp. 1192–1204., doi:10.1111/j.1468-0297.2010.02409.x. Niederle, Muriel, and Lise Vesterlund. “Do Women Shy Away From Competition? Do Men Compete Too Much?” The Quarterly Journal of Economics, Aug. 2007, pp. 1067–1100., doi:10.3386/w11474. Niederle, Muriel, and Lise Vesterlund. “Gender and Competition.” Annual Review of Economics, vol. 3, no. 1, 25 May 2011, pp. 601–630., doi:10.1146/annurev-economics-111809125122. Kuhn, Peter J., and Marie-Claire Villeval. “Do Women Prefer a Co-Operative Work Environment?” SSRN Electronic Journal, 19 Nov. 2011, doi:10.2139/ssrn.1946160. School for Cultural & Social Transformation University of Utah UNDERGRADUATE RESEARCH JOURNAL AQUÍ Y ALLÁ: AN ORAL HISTORY PROJECT Ivonne Paredes Romero (Dr. Annie Fukushima) Division of Ethnic Studies There are approximately 11.3 million undocumented immigrants in the United States, and it is estimated that 6 million of those are Mexican citizens. As of the 2018 fiscal year, Immigration and Custom Enforcement has deported a total of 141,045 Mexican individuals in comparison to the 128,765 deported in 2017. For many, repatriating as many Mexicans is in the individuals’ best interest since they can now better their country of origin. Yet, for the undocumented Mexican that has lived in the United States for a significant number of years ‘repatriation’ is not the accurate term to use to describe their experiences. Returning, or facing the possibility of returning, to a land that is supposed to recognize them as fully contributing members of society is overshadowed by the realization that it does a superficial job at facilitating their reintegration. By not accepting their foreign education and social capital these individuals are left feeling just as limited and invisible as they did when residing in the United States. Yet, society is barely aware of this continued struggle for recognition because they do not think about the deported or returned individual after the fact. This oral history project has set out to correct that and ensure that as many voices within this community were heard, for it is just as important to know about those that are no longer present as it is to know the stories of those that still reside within the United States. Therefore, the purpose of this project was to create a bilingual audiovisual installation that would honor the stories and resilience of our Mexican undocumented, DACAmented, and returned/deported communities as they fight for recognition as transnational citizens on both sides of the U.SMexico border. The installation materialized into an unapologetically bilingual website that reflects the bicultural identity of the community. The site houses the Aquí y Allá Project a place where the interviews conducted can be heard and read in their original format. Spanish-English translations are also made available for the community to choose the language they wish to interact with the interviews in. However, it is important to note that translations can never be perfect. My hope is that I did them justice and replicated the raw emotions as powerfully in the target language as in the original language. The individuals interviewed were recruited from both Mexico City and Utah and they all fall on different parts of the immigration spectrum. Yet, their stories are equally powerful as they reflect on the way their immigration statuses as an undocumented young man with a work permit, a DACAmented student, and deported mother shape their sense of visibility in society. All three share the same dream of one day being able to have the mobility and freedom of reuniting with their families and being able to call both the United States and Mexico their homes. They are the reason this project is possible and I very much hope their stories touch the hearts of many. They are the beginning of what I hope becomes an ongoing project to give voice to those that are not fully heard either because they are living in the shadows or no longer present on this side of the border. School of Dentistry University of Utah UNDERGRADUATE RESEARCH JOURNAL BOND STRENGTH OF CARIES-AFFECTED TEETH TREATED WITH SILVER COMPOUNDS Hanthao Phan (Lilliam Marie Pinzon) School of Dentistry Background Dental caries is currently a prevalent public health problem across the world. Silver diamine fluoride (SDF) is an anti-caries agent that is used in dentistry to arrest or slow down the rate of dental caries progression. Similar to SDF, application of silver nitrate followed by fluoride varnish has been used in American dentistry to arrest dental carries since 1800s. SDF or silver nitrate treatment of sound dentin helps preventing bacterial growth under resin restoration, thus preventing recurrent caries. However, any agent applied on dentin or enamel prior to restoration could potentially compromise the mechanical properties of adhesives and resins. The purpose of this study is to evaluate the effects of 38% SDF, 48% silver nitrate, and the combination of each agent with 5%fluoride varnish on bond strength of resin composite to the dentin on permanent molars. Methods Twenty human caries-affected permanent molars were randomly selected and sectioned into halves. The tooth specimens were randomly distributed into 5 groups: (1) no treatment – control group, (2) 38% silver diamine fluoride – SDF, (3) 48% silver nitrate – SDN, (4) 38% SDF followed by 5% fluoride varnish, (5) 48% silver nitrate followed by 5% fluoride varnish. After applying universal adhesive Parkell, composite stubs were built up on the surface (n=40). They were then de-bonded in tension to measure bond strength. Bond strength values were calculated. Failure modes were determined at 100X magnification. Means and standard deviations were calculated. Means were compared using analysis of variance. Fisher's PLSD intervals were calculated at the 0.05 level of significance. Results: Means and standard deviations are listed in table 1. Fisher’s PLSD interval for comparisons of means among groups was 4.1 MPa, respectively. Means with the same superscripted letters are not statistically different at the 0.05 level of significance. Table 1: Bond Strengths CG SDF 38.4(3.5) 23.5(3.4)a SDN 22.6(4.1)a SDF+F 23.6(4.3)a SDN+F 22.9(4.8)a Conclusions: The SDF, SDN, SDF+F, and SDN+F treatments resulted in bond strengths above 20 MPa. These results show that pretreating caries-affected dentin with 38% SDF and 48% SDN with or without fluoride does not affect the bond strength of composite resin to caries-affected dentin. Paste text here… College of Education University of Utah UNDERGRADUATE RESEARCH JOURNAL WHY EVALUATE NARRATIVE DEVELOPMENT IN HEADSTART STUDENTS? Maria Carrillo Castillo (Seung-Hee Claire Son) Department of Educational Psychology Reading comprehension has been reported as one of the challenging skills in which many children need support (National Institute of Child Health and Human Development, 2000). In the past, decoding-- the process of translating a printed word into a sound--was thought to be the primary lesson taught to children and reading comprehension came alongside with it. Therefore, most research on reading has targeted decoding, not comprehension (Priya & Wagner, 2009). However, thanks to an accumulation of evidence, it has been shown that comprehension in many cases comes before decoding skills and they are not taught or learned for that matter, side by side (Dooley & Matthews, 2009). Early reading development at this age comes with story aspect information processing, before decoding-related processing (Juel & Holmes, 1981). During preschool years, story comprehension develops as an initial step to reading comprehension. Diving deeper into the matter, young children who initially struggle with story comprehension and the breakdown of the structured narrative have challenges later, which further affects their understanding and comprehension of reading (Bianco et al., 2010; Nation & Snowling, 2004). This shows how important it is to examine characteristics of early story comprehension among English language learning preschoolers. Researchers should provide valuable information about the foundational process related to early comprehension development, including children’s understanding of story structure characteristics and their development over time. To overcome challenges that may come in future reading skill development. Reference 1. Bianco, M., Bressoux, P., Doyen, A.-L., Lambert, E., Lima, L., Pellenq, C., & Zorman, M. (2010). Early training in oral comprehension and phonological skills: Results of a three-year longitudinal study. Scientific Studies of Reading, 14(3), 211-246. doi: 10.1080/10888430903117518 2. Dooley, C. M., & Matthews, M. W. (2009). Emergent comprehension: Understadning comprehension development among young literacy learners. Journal of Early Childhood Literacy, 9, 269-294. doi: 10.1177/1468798409345110 3. Gámez, P. B., González, D., & Urbin, L. M. (2017). Shared Book Reading and English Learners’ Narrative Production and Comprehension. Reading Research Quarterly, 52(3), 275-290. 4. Juel, Connie, & Holmes, B. (1981). Oral and silent reading of sentences. Reading Research Quarterly, 4, 545-568 5. Nation, Kate , & Snowling, Margaret J. (2004). Beyond phonological skills: Broader language skills contribute to the development of reading. Journal of Research in Reading, 27(4), 342-356. 6. National Institute of Child Health and Human Development. (2000). Report of the National Reading Panel (NIH Publication No 00-4754). Washington, DC: U.S. Government Printing Office 7. Paris, A. H., & Paris, S. G. (2003). Assessing narrative comprehension in young children. Reading Research Quarterly, 38(1), 36-76. 8. Priya, K., & Wagner, R. K. (2009). The roles of fluent decoding and vocabulary in the development of reading comprehension. In R. K. Wagner, C. Schatschneider & C. Phythain-Sence (Eds.), Beyond decoding: The behavioral and biological foundations of reading comprehension (pp. 124-139). New York: Guilford Press University of Utah UNDERGRADUATE RESEARCH JOURNAL BRYANT AND BEYOND: PROMOTING ACADEMIC SUCCESS IN STUDENTS OF LOW-INCOME COMMUNITIES Andre Cruz Delgadillo (Carolyn Bliss, PH.D., Michelle Ngo) Department of Undergraduate Studies Introduction The Emeritus Alumni Board, in conjunction with Bryant Middle School, began the Bryant and Beyond program in 2010. The Bryant and Beyond program initiative was available to 8th graders at Bryant Middle School who participated in the English Language Development Program. The scholars identified as having college potential were tracked as they continued their education at Innovations, West or East High School. The students would receive “Prospective College Scholarships” guaranteed to them upon the completion of high school, take a college preparatory curriculum, and maintain a certain GPA. Students awarded the prospective scholarships are offered mentoring and tutoring, provided by LEAP students, to help complete high school and attend college. The purpose of the research is to examine the social and environmental determinants associated with the academic success of Bryant and Beyond students to assess further the barriers they face towards the pursuit of higher education. Methodology The approach of the Bryant and Beyond program focused on financially supporting and promoting the academic success of low-income students. At the start of the academic year, each University of Utah Health Sciences LEAP fourth-year student is paired with a Bryant and Beyond student. During the partnership, the LEAP student mentors and advises the mentees in preparation for college coursework. The Bryant and Beyond program financially supports the students by awarding them a Prospective College Scholarship, guaranteed to them upon the completion of high school and meeting minimum GPA of 3.0 or higher. Furthermore, the LEAP mentors were provided with funding to be utilized towards activities or supplies that would further promote the academic success of the students. This academic year, the LEAP cohort employed their funding to organize a celebratory dinner for the final Bryant and Beyond graduating class in which their accomplishments, as well as their families, were acknowledged. The advancing of the academic success of the students was promoted through the mentorship from the LEAP students. The mentorship encompassed the guidance on general academic review of content, scholarship application assistance, and miscellaneous help that was guided toward the academic success of the students. To address the complications of scheduling tutoring sessions, a digital communication platform was utilized to improve efficiency and communication. The Discord application was utilized as a central platform for all students involved. Discord enabled students to post homework questions, ask for career/college advice, etc. Information regarding scholarships/job opportunities/financial support was posted on the platform for the students’ accessibility. Outcome The Discord application served as an efficient communication platform that allowed fluid conversations between mentors and mentees. Although there is no substitute for physical presence, the utilization of digital communication allowed the students to have a more accessible form to relay information. The celebratory dinner for the final Bryant and Beyond graduating class served as an acknowledgment and encouragement to students and their family. The LEAP students had the opportunity to share their collegiate experience, as well as the continuous advising upon their completion of the program to the Bryant and Beyond students. Three of seven graduating seniors attended the dinner with the companion of their families. The dinner allowed the LEAP mentors to engage the family of the students and express the importance of their support in the success of their student reaching higher education. Limitations discouraged the Bryant and Beyond students from academically excelling. A primary barrier included students having to work to provide for their families, consequently, leaving little time for them to apply for scholarships, study for classes, and respond consistently to LEAP mentors. Other obstacles were limited parental support, the perception of college unaffordability, and family obligations. Conclusion The purpose of the program was to increase college access to low-income and first-generation students. The Bryant and Beyond program strived to bridge the gap between social determinants and academic success through active mentoring and financial support. The perception of college is unfavorable in underserved and underrepresented communities due to the perceived poor short-term benefits it offers and students not having the safety net of parents who have navigated college to rely on. A majority of the students in the Bryant and Beyond cohort are eligible for scholarships and financial aid that would finance tuition and expenses, but most often, students are unaware of these available resources. Programs like Bryant and Beyond are able to monitor the progress of students and offer mentorship from undergraduates that have similar experiences that can ultimately motivate and inspire them to advance in their higher education. Although the Bryant and Beyond program is ending, it can be concluded that scholarship programs are beneficial to underserved communities. The scholarship program recognizes the gap between first-generation students and higher education; in addition, it addresses the developing trend of increasing tuition cost. Institutions like the University of Utah have a primary role in the affordability of education, and the new administration has been a national leader in value by providing high-quality education at an affordable cost. An innovative income share agreement program has been created to aim at filling funding gaps to allow students to complete their degrees in a timely manner. Acknowledgments Thanks to all members of Bryant and Beyond for their insight and assistance in the initiation of this project, as well as the University of Utah School of Medicine, Health Science LEAP and the Salt Lake City School District. This research was supported by the Emeritus Alumni Board. College of Engineering University of Utah UNDERGRADUATE RESEARCH JOURNAL Correlating Collagen Orientation and Density with Age and Region in Human Eyes Yousef Alsanea (Brittany Coats, Christopher Creveling) Department of Mechanical Engineering Retinal detachment, separation of the light sensitive layers of the eye, occurs in one out of 10,000 people in the United States and can lead to permanent blindness. While detachment may occur due to trauma, it can also be caused by age-related vitreous degradation or other age-related ocular disorders exacerbated by adhesion between the vitreous and retina. Collagen fibers are believed to be the primary contributor to vitreoretinal adhesion, but little empirical data exist to show how collagen varies with age and region in the eye. In this study, we characterize collagen at the vitreoretinal interface, and identify changes with age and region. Data from this research will be useful in understanding mechanisms of adhesion, and assist in creating mechanically accurate computational models for the human eye. Transmission electron microscopy images (TEM) were taken at the vitreoretinal interface from the equator and posterior pole of human donor eyes (n=13, Fig. 1). TEM images were filtered with a non-local means denoising filter with smoothing parameter of 10. A technique called ridge detection was used to detect and segment collagen fibers, then a MATLAB code was used to combine segmented fibers based on slope, intercept and least-squares regression fit. Output parameters were collagen density, collagen fiber angle, and inner limiting membrane (ILM) thickness. ANOVA statistical analyses were used to compare results by region (equator vs. posterior) and age (greater than 60 years of age vs. less than 60 years of age). Fiber angles in the equator from donor eyes less than 60 years of age (19.8°±1.1°) were significantly lower than posterior fiber angles (p<0.03, 26.0°±8.6°). After 60 years of age fiber angles in the equator increased to 36.1°±6.8° but this increase was not statistically significant (Fig. 2). There were no region or age effects in collagen density. ILM thickness was significantly thicker in the posterior pole (1811.4μm ±104.5μm) compared to the equator (p<0.03, 322.3μm ±73.9μm), regardless of age (Fig. 3). The data in this study show age and region dependent trends in collagen structure and ILM thickness at the vitreoretinal interface. Further statistical significance could be achieved by gathering more data at the posterior pole, but findings to date suggest that the vitreous contracts with age and increases traction forces applied to the retina. This may provide insight into why diseases are exacerbated by lingering adhesions. The next step in this study would be correlating our parameters to vitreoretinal adhesion forces, and using the data to develop computational models capable of predicting retinal detachment or posterior vitreous detachment in the elderly. Figure 1. Transmission electron microscopy image of the vitreoretinal interface in the equator of 63-year-old human eye. Figure 2. Average collagen fiber angle in human eye by age and region. Error bars are pooled error variances. *p<0.03 Figure 3. Average ILM thickness in human eye by age and region. Error bars are pooled error variances. *p<0.03; **p<0.005 University of Utah UNDERGRADUATE RESEARCH JOURNAL UNMASKING THE PLAYER: EXTENDED FICTION IN GAME DESIGN Austin Anderson (Michael Young) Department of Computer Science INTRODUCTION In any story, an element being diegetic means that it is an element of the story that the characters of the fiction can sense. The simplest example is that of music in a movie; if there is a radio playing music in the scene, that music is diegetic. If a musical soundtrack plays over the scene but is something the characters cannot hear, it is non-diegetic(DIEGETIC). The border between the diegetic and non-diegetic is most commonly referred to as “the fourth wall” (Webster), in reference to the imaginary fourth wall of a play set, where the sides and back of the room that events are taking place in are fully represented on the theater stage, but the opening through which the audience observes the events of the play is an imaginary barrier. This barrier isn’t just literally a completion of the four walls in a traditional room of a building, but also metaphorically separates the reality from the fiction, quarantining both from each other as to not interfere. The problem with this boundary is that it can’t fully encompass the medium of video games. Video games, at their very essence, are an interactive medium. They require some breach of the fourth wall for them to function, as the game could not proceed to tell its story without a player’s input, which is an addressing of the audience due to the necessity of their action. Indeed, in the article “A Circular Wall? Reformulating the Fourth Wall for Video Games”, Steven Conway offers this criticism of the term: … whilst the notion of the fourth wall finds itself within a welcoming habitat amongst media such as books, television and cinema, the physical interaction demanded by computer games creates a completely different relationship between product and audience. (Conway) Press the ‘Action' Button, Snake! The Art of Self-Reference in Video Games speaks to this further, where the author makes a similar argument against the use of the term “breaking the fourth wall” in discussing video games; The self-referential aspects of games like Zork, Sonic the Hedgehog, Eternal Darkness, and Metal Gear Solid are examples of what Rune Klevjer refers to as "extended fiction," the act of pushing out boundaries of make-believe to include certain aspects of the user's reality. Because games are complex artifacts that function on different levels of reality simultaneously, they are not "breaking" anything by sliding between the different levels of reality already at play. They are simply making use of the unique affordances of the video game medium and trusting the player to be able to parse the different levels of reality into a coherent whole. (Weise) Even as such, video games still have traditional lines in the sand of what is considered diegetic and non-diegetic. Those items that are diegetic are traditionally inside the bounds of the magic circle1, which is “…generally limited to the fictional world generated between the game console/PC program and the player” (Conway). However, there exist a set of games that break beyond these bounds, what Conway refers to as “an extension of the magic circle”(Conway); games that take those items that were traditionally non-diegetic and thrust them into the realm of the diegetic, or other games that obscure or imply the diegetic nature of some elements of the 1 A term coined by Dutch writer Johan Huizinga, referring to the artificial circle that is drawn around an arena of play(Huizinga) game, such as whether or not the player is diegetic. These games use extended fiction game design elements. Elements of a game that use extended fiction re-contextualize a players relationship to the game, bringing their interactions into a new perspective and prompting new self-reflections in the player. They can provide not only enthralling gameplay experiences, but also metanarrative2 self-critique of the medium of video games that is hard to imagine possible without these methods. This thesis will offer up examples and analysis of some of games that use extended fiction, provide a guide to the mechanical design and narrative patterns used to perform these techniques, and an explanation of why the medium of video games is uniquely suited to execute these critical narrative techniques. A guide on how to execute any sort of metanarrative critique would be pointless, as any worthwhile execution of extended fiction will require a somewhat unique approach; instead this thesis will recognize patterns and techniques used to create extended fictions, what effects those techniques have, and what critiques have been previously offered using those techniques. TO YOU WHO I’VE NEVER MET The Mother series is an example of a collection of games that are not afraid of acknowledging the virtual nature of their existence. In Earthbound (the second game in the mother series, released as Mother 2 in Japan) for the Super Nintendo Entertainment System, the player character (a child) is confronted by two adult policeman who comment “At times like this, kids like you should be playing Nintendo games” (Earthbound). Quirky, self-aware jokes like this abound in the Mother games, but Earthbound executes a much more profound extended fiction as well. Metanarrative is a “fiction that comments upon its own artificiality” (Metanarrative). Used in video games, metanarrative is often used for self-critique of the interactions between game and player. 2 The player has a significant amount of control in Earthbound. Earthbound is a game in the traditional JRPG3 style, which is a style of design that usually allows the player to control a party of characters and commands where they go, what they do, who and how they fight, and so on. Not only does the player have a controlling role in accomplishing set gameplay goals, but they control multiple characters from a top-down perspective—a perspective that could be very easily described as the perspective of a god viewing and controlling mortals from above. Godlike control of a world is a regular occurrence in video games, especially JRPG games like the mother series; in fact, a “God Game” is a separate, well-defined subgenre in which the player controls an entire virtual world and its inhabitants from above. Earthbound is not a God Game, but the player’s perspective on the world certainly draws parallels to that of a god over a digital realm. Further in line with the perspective of a benevolent deity, Earthbound is a game that pushes the player to care for its denizens. The game clocks in at an average playtime of 28-36 hours (HLTB), so the player is spending almost a full work week interacting with the world from above and speaking to its quirky inhabitants. Through interacting with the denizens of Earthbound, the player is brought into a caring relationship with them that builds throughout the game. In particular, the player comes to care for the player-controlled characters: Ness, Paula, Jeff, and Poo, those characters whose interactions they specifically control. In any game, the characters that a player controls are distinctly embodied and empathized with, as Peter Bayliss states in Beings in the Game World; Over time the player will become better aware of what the capabilities and limitations of their avatar are, and thus have a better understanding of the possibilities offered by their avatar to act within the game-world… the player 3 JRPG is an acronym for Japanese Role-Playing Game (JRPG), a stylistic sub-genre of role-playing video games that follows a school of game design originating and traditionally followed in Japan. comes to “think like a computer” by internalizing the logic and rules of the game through the experience of embodying their avatar, which is then reflected in their conduct during the course of play.(Bayliss) This process of thinking like a computer could be more aptly stated as thinking in the game world’s terms. The more time a player spends with a game, the more they come to internalize the games ruleset, making it more natural for them to understand the world of the game, and thus allowing them to better empathize with the characters and how those characters interact with the world. Games quite often encourage the player to empathize with and care for the characters within the game, giving the player tasks to help others and showing meaningful influence on those characters’ lives through the actions directed by the player. In describing Little King’s Story, Murphy and Zagal state: Little King’s Story encourages the player to recognize, relate to, and ultimately care about the citizens of his kingdom… If the player takes the time to interact with the citizens, he will discover that each of these non-player characters has his own personality and story… Over the course of the game, the player becomes familiar with the citizens that he spends more time with, observing them interact with each other and with the player’s avatar. All of these things serve to encourage the player to care about the well-being of the citizenry of his kingdom…(Zagal) All of this storytelling effort is dedicated to bringing the player to feel a responsibility for the denizens of the digital realm. As a game about saving the world from invasion, it’s critically important to Earthbound that the player cares about saving the world of the game, or else they will be narratively disinterested and ultimately likely have an inferior experience with the game. When the player is successfully influenced to feel a sense of duty to the characters of the world, they’re more likely to truly engage with the game and its themes and be motivated towards the goals of the characters. However, this sense of responsibility is traditionally detached from the actual game in diegetic terms. The player, their responsibility, and their control are traditionally nondiegetic parts of the game narrative. A player, while they may come to care about and feel responsible for the game world, isn’t explicitly acknowledged as actually responsible for the games world, nor is their sentiment for the characters of the game addressed. Earthbound challenged those traditions at its iconic climax. At the end of Earthbound, there is a fight to save the characters world from destruction. Four children are pitted against Giygas, the “Embodiment of evil, Universal Cosmic Destroyer” (Giygas). Right before the fight begins, one of the main characters, Paula, turns towards the screen, and addresses the player by name. The player had initially entered their name at the very start of the game for no discernable reason, but at this point, one of the game’s characters directly addresses the player, pleading with them for help (Figure 1). This is a surprise to the player because Paula has previously used her prayers to call out to other characters in the game for help, but this time, calls out to the player. "I'm calling out to you who I've never met... I'm calling our friend who we've Figure 1, Screenshot from Earthbound never met... (player name)! (player name)! We need your help! I am Paula and I am with another friend, Ness... We are trying to contact you..." (Earthbound) The player is suddenly pulled, not from the immersion of the game world, but into a diegetic role in the game world. The responsibility and level of control in guiding these children and keeping them safe is suddenly diegetically acknowledged, a move that drastically heightens the sense of duty the player feels to help these characters because they now express awareness of the players ability to help them. In a game where the player assumed, they were non-diegetic, an invisible god controlling the actions of smaller beings, their anonymity and stakes-free position outside of the game world is challenged; if they fail, the game will explicitly acknowledge that they, the player, failed, instead of attributing the failures to the game’s protagonists. Paula, who has prayed to contact all 4 main characters in the game at some point, prays to contact the character, treating them exactly like any of the other diegetic main characters of the game. In a dire moment, the game is breaking down all the barriers it can in a desperate plea for a savior. The game has challenged the player’s detached involvement and has pulled them in and given them a hefty emotional stake in the affairs of the game, its people, and its world. This moment provides an incredible breakdown of barriers between game and player. Jeremy Parish described it in Metatext: Separating the Player from the Character: If you're not expecting it, this turn of events is quite stunning. Taken in the context of the final showdown with the mighty Giygas, set in an unsettling, surreal dreamscape, it feels almost like the game itself is breaking down. It's perhaps the most clever and powerful moment in a clever and powerful game. (Parish) This is the penultimate example of explicitly acknowledging the player’s role in a game where they exhibit so much control. The game’s characters acknowledge the player as a diegetic presence with control over them, and that they, as fictional, virtual beings, rely on the player to survive and save their virtual world. The surrealistic imagery of the game itself breaking down conveys that the player is not saving a fictional world, it’s saving the entire game as a virtual entity, from an attack on the inside. It places an incredible amount of responsibility on the player’s shoulders; whether or not these characters or their world exist, the burden of protecting them has suddenly been very directly, diegetically placed on the shoulders of the player. This is a pronounced example of a dynamically diegetic element in a game. The execution of this design principle is simple; the player is led to assume that the game’s components fulfill traditionally diegetic roles: the music and menus in the game are non-diegetic, the characters and world are diegetic, the player is non-diegetic as well as the reality of the game being a piece of software, etc. But at a climactic moment, a non-diegetic element is folded into the game to become diegetic, as the games fiction is extended. Then, that element, be it the controls, the game console, or the player, becomes a key part of the story, and the mechanics of the game. The story is no longer just about the written plotline; the story is about the gameplay, about interactivity, about the very nature of interacting with a digital realm. The story truly embraces the unique interactive aspect of video games and suits its narrative to that aspect, critiquing this aspect in any way the author intends. The developer creates a scenario for the story to unfold in, but the actions the player takes write the story one button press at a time, a story that the player is involved in. What this subversion of diegetic tradition does in Earthbound is nothing short of extraordinary. In a time of desperate need, the game’s characters call on every last hope, reaching beyond the boundaries of what the player believed possible, both acknowledging their empowerment and sobering them at the same time. It heightens the drama of the situation so well and in such a surprising way, and truly, diegetically invests the player in the fate of a world not their own, making the success of victory that comes at the end all the more personal. THE OTHER SIDE OF THE SCREEN Video games, as an art form, are always a collaborative effort between at least 2 parties: the developer4, and the player. Without the developer, be it a single person or a 300-employee studio, the game wouldn’t exist. Without the player, the game couldn’t perform as a piece of art. This is an endlessly fascinating relationship caused by the interactive nature of the medium. Within this collaboration, there are many non-diegetic positions the developer can traditionally fulfill: the storyteller, the toymaker, the referee, the dungeon master, etc. But on occasion, developers choose to engage in a diegetic relationship with the player, morphing the friendly 4 A game “developer” is a common term for anyone who works on the creation of a video game. relationship from one of artist to audience to one of rivalry and contention. This is another example of extended fiction folding traditionally non-diegetic elements. In the following cases, the game extends its fiction by bringing the developer into the diegetic realm of the game. The idea of the developer being the rival to the player, of being in an antagonistic relationship with the player, is a fascinating but common one. John “TotalBiscuit” Bain’s view of single player games is exactly this, stating that “I view single player games as competitive… I view it as the notion of competing with the developer’s challenges, the things that the developer has prepared for me.” (Bain) At its most basic, the purpose of a game is to create a set of challenges for the players entertainment, and then give them a toolkit of actions that, if performed in some correct sequence, will result in overcoming the challenge. There is sometimes only one way to complete a challenge; other games offer multiple different strategies a player can execute to complete a given challenge. This notion hearkens back to the traditional table top role-playing game model, with a “Game Master” who is “the person who organizes or directs the play in a role-playing game.” (Game Master), and players who compete against the challenges the game master has set up for them. Most players opt to tackle the challenges head on through traditional in game mechanics, but some players find much more enjoyment in subverting the creators plans by pushing the limits of the presented ruleset for a given game. In Creative Player Actions in FPS Online Video Games, the author discusses these kinds of behaviors as “creative player actions” and “creative innovations”; Play is not just "playing the game," but "playing with the rules of the game" and is best shown in the diversity of talk, the creative uses of such talk and player behavior within the game, plus the modifications of game technical features… as in any human performance, creativity of execution is the norm… This creative subversion of game rules occurs consistently in the many debates over "cheating" within the game…. what is consistent is the bending of conventional game rules, as we have seen in this example, which can easily be viewed as a creative innovation within the game. (Wright) Players can, through experimentation with the toolbox they are given, find a unique combination of in-game actions to perform that went totally unpredicted by the game’s designer. These creative player actions often totally undercut the intended skill check5 and associated challenge the game was meant to provide. Players who are likely to engage in creative player actions often enjoy this breaking of rules. These players are referred to as “Transgressive Players” (Aarseth), and the psychological motivations of transgressive players are explained by a portion of Progress in Reversal Theory; For example, conforming to the rules and rituals of some club that one is honored to be a member of can be a pleasure in itself, as can defying the rules of some petty authority or bureaucracy which appears to be restricting one’s activities unnecessarily. Conversely, failure to conform in the conformist state or failure to defy in the negative state will both contribute some degree of displeasure to the overall hedonic tone at the time in question. (Cowles) 5 A skill check is a term derived from tabletop RPG’s that refers to testing the abilities of a player. One of the most famous (and comedic) examples of creative player actions can be found in The Elder Scrolls V: Skyrim. The player can, at any point in the game, pick up and move around items within the game world and drop them wherever they want. The player can also, at any time, attempt to steal items from NPCs in the game. If they are caught doing so by an NPC, they are then confronted and punished for their attempted theft. But, if the player places a pot or Figure 2, Screenshot from The Elder Scrolls V: Skyrim basket over the head of all the present NPCs, their line of sight is totally cut off and they cannot detect the player stealing items from them. This leads to humorous instances where the transgressive player is casually robbing a merchant, while the merchant stands obliviously, acting normally with a kettle covering his head (Figure 2). This also removes all risk and challenge from the situation, undermining the developers intended challenge and risk/reward system involved with stealing. When a transgressive player can execute on creative player actions, the result often breaks the immersion of the player, reminding them of the artificiality of the digital realm they’re interacting with. These situations draw the player out of the experience, pulling them from full immersion in a well simulated world to a non-immersed state with an obviously digital simulation. Traditionally these exploits are seen as disruptions to the game’s intended narrative, as they subvert the presentation of conflict intended to give plot and tone to the world the player interacts with. Indeed, the interactive nature of video games themselves provides difficulty in explicitly conveying narratives, as is stated in A Case Study in the Design of Interactive Narrative: The Subversion of Narrative; “The difficulty is that the exercise of interactive choice and a conscious volition can disrupt the immersion into narrative and story. In comparison to reading a book or watching a movie, some disruption of the narrative experience is inevitable. (Bizzocchi) However, in some games, especially those in which the developer assumes a diegetic competitive role towards the player, these opportunities for creative player actions are often a bait and switch and create more immersion for already defiant players who attempt them. Player’s think they’ve found a loophole, a way to exploit the game that the developer didn’t consider, but it’s a trap laid by the developer to then return fire on the player for trying to circumvent the game’s logic. The developer has thought through the exploits the player might try and placed faux opportunities at likely points to mess with them. They really aren’t catching the transgressive players acting unpredictably; they’re forming outcomes around things they anticipate the transgressive player to do, things the player might think are unpredictable. They’re folding what would usually be considered as non-diegetic exploits of the ruleset of the game into a diegetic position in the narrative. These exploits become diegetic maneuvers of the player against a diegetic game master, expanding the game narrative beyond the traditional on-screen plot elements into a player/dungeon-master competitive narrative around game rule experimentation. One of the best games that successfully exemplifies this relationship is ICEY. ICEY is a side scrolling brawler that relies on a very simple directional arrow system and a guiding narrator to direct the player where to go. The entire game can be played following the arrow, fighting enemies and experiencing the story of the titular main character in the “correct” way. The player can also choose to deviate from the arrows and explore at any time, and the game will acknowledge the transgressive player’s “disobedience”. The game’s narrator will make sarcastic, disparaging comments about the player, and the game will lead the player to weird secrets and present a wholly different experience. These “unintended paths” lead the player to unfinished levels, rooms with videos of prototype versions of the game, and continuous dialogue from the narrator about how much harder video game players make his life because of their insistence on testing the boundaries of the game instead of just playing it like it was meant to be played. The developer of ICEY designed the game specifically to tempt players into veering off the intended path so he could express his frustration with this habit players have in regular games, creating a metanarrative around this concept about the rigors of game development with an uncooperative audience. The game’s description on Steam states: ICEY is a Meta game in disguise. The narrator will constantly urge you in one direction, but you must ask, "Why? Why am I following his directions? Why can't I learn the truth about this world and ICEY's purpose here?" Fight against his tyranny and uncover what's really going on for yourself! (Buy ICEY) This purposefully challenges players to rebel against the game, it’s narrator, and ultimately, it’s developer, pushing the normal player to become transgressive. Narrators in games and other mediums are often perceived as the author themselves, being that “The narrator is always either a character who narrates or the author.” (Alber) ICEY’s narrator is the game’s lead developer. “Fight against his tyranny” is not a call to fight against the tyranny of the voice the player is hearing, but the tyranny of the game, the tyranny of the rules the developer has set in place. It is a call to fight the rules and systems the developer prepared, the purposeful design and well-planned challenges they laid out, the carefully prepared story they penned for the player’s enjoyment. The object of the player’s crusade becomes the intent to try overturning the original design and taking control of the game’s world. This very explicitly brings the game’s player and developer into a diegetic struggle for control. The narrative stops being about the adventures of the protagonist characters and changes the narrative into a faux competition between developer and player. The player is now defiantly competing against the developer they believe is antagonizing them, and the developer playing the part of the authoritative opposing force to actively encourage the player to explore and discover. This clever design philosophy rewards players not with just the traditional rewards inherent to overcoming a challenge in a game through intended actions, but a more intense reward that comes with the need for creative innovations through gameplay. As stated by Bain, “One of the things I really enjoy about this game is trying to outsmart the developer… and the discovery that …the developer has outsmarted me, not the other way around. That is a very joyful feeling indeed” (Bain). The experience of being rewarded for cleverness and exploration is one that doesn’t rely on fast reflexes or clever strategy, but on ingenuity. The enjoyment comes not from quick combos or good aim, but in being acknowledged as thoughtful enough to find hidden rewards and think independently of developer hand holding. In ICEY, the sarcastic insults prompted by disobedience are a thinly veiled reward to the player, an acknowledgement of respect from the developer to the player for uncovering the secrets of the game. Furthermore, the creator of ICEY offers a critique to players who do dig far enough into his game; knowing that players who persist in creative gameplay actions are most likely ones who have done so before and will do so again, he offers up a frustrated dialogue on how he knows the audience will disparage a game that they can find a way to exploit. In reality, it’s very difficult to make a game, and it’s very easy for problems like this to appear… Unknowingly, 10 years flew by in the blink of an eye. With all the effort I spent, I think a few scattered bugs or missing features are entirely acceptable… Games are about entertainment. Don’t place too much value on a few mishaps here and there. (“Icey”) What the developer does here is masterful; he presents situations in which he pretends as if the player has found a bug or exploit in the game, but really, it’s an intended experience in the game to push players who do find one of these situations into a more clearly understanding the frustrations experienced by game developers. It takes what is usually a peak behind a curtain in a disenchanting, immersion ruining sense, and turns it into an immersive, personal moment between developer and player. The execution of this design technique is dissectible into three parts. First, the game must present a “correct” or “intended” way of playing the game. Second, the game must have opportunity, whether explicitly encouraged or implicit, to stray from the “intended” route through the game. It is important to note that this encouragement can also take form in reverse psychology, and more often than not does for purposes of comedic entertainment. Finally, the game must provide a feedback system of some kind, whether explicitly positive rewards (such as points or achievements) or sardonic rewards, such as annoyed responses from characters or the narrator, to encourage the player to keep playing and pushing boundaries. Successful execution of this technique often involves layered subversions of video game tropes, in order to lead players into situations they expect to be able to exploit. The final step also requires acknowledgement of the player and/or developer as diegetic forces in the narrative. This provides motivation and immersion to the player in the experience, bringing their creative player actions into the realm of diegetic and intended solutions in a game of wits against the developer, instead of breaking their immersion through unintended creative player actions. While diegetic adjustment is not explicitly required to execute this kind of intended creative player action focused game design, the purpose it serves in maintaining immersion is key to keeping players invested in a game with any sort of intentional narrative. My experiences with this technique revolve around my game A Very Bad Clock Game, a game that I developed in my alternative game development class. The game revolves around dropping a ball onto the hands of a real time clock in order to shepherd it into the goal. The game is intensely not fun; the way I provided motivation to the player was through directly antagonizing them. I informed them that the game wasn’t fun or impressive in any way, that it’s a waste of their time, etc. This provided an actually interesting conflict in the game; not between the player and the rather tedious puzzles, but between the player and the developer (me) in who had the most patience. I found it best to approach the player early with the antagonistic relationship, since, as the game is intentionally boring, its possible players give up before they even find the extended fiction elements of the game. Very few video games, or pieces of art in general, diegetically acknowledge the people who created them, or their audiences. And even fewer of those games acknowledge in any way those who push at the limits of the software, finding their own intensely creative ways of overcoming challenges. Games that not only acknowledge these methods of gameplay but are designed specifically to reward this type of play, provide unique narratives in the realm of games. Rather than just preventing transgressive player actions from breaking game systems, a task that consumes millions of assurance and bug fixing hours a year, the developers instead anticipate these actions and, in surprisingly good spirits, playfully put the players in their place. These games that account for a mass amount of gameplay variance with sarcastic commentary are perhaps the most honest expressions of the frustrations of the game development process that we have, but also a playful acknowledgement of the creativity of players. JOLLY COOPERATION The Souls series of games, consisting of Demon’s Souls and the Dark Souls trilogy, have become synonymous with grim worlds and grueling difficulty. The series takes place in harsh medieval worlds, once grand kingdoms of men now fallen, becoming a land of decrepit castles and grisly monsters. The tone of the Souls games also evokes feelings of intense loneliness, best described by author Matt Sam; The emphasis on loneliness is important to create an atmosphere of dread and despair in Lordran. The world is meant to encompass a truly dark and ugly air, as detailed by nearly every location and every character in the game. In fact, it’s not even just the player that’s alone: it’s everyone. In the Tomb of the Giants, Nito is alone, in the Painted World of Ariamis, Priscilla is alone, at the Kiln of the First Flame, Gwyn is alone. Everyone in Dark Souls is alone. (Sam) Even the player-controlled heroes at the start of the game are warped undead, hideous bony figures with wrinkled yellow skin. The entire tone of the world is one of brutality and sorrow, with the gameplay being no exception. The gameplay is tonally consistent with these themes in that it’s second to second action is especially ruthless; one mistake can lead to quick death, so much so that the “You Died” screen from Dark Souls has become infamous in gaming culture (Dark Souls / Memes). But the games are even more difficult due to the lack of available information. After the game’s tutorial, where to go, what to do, and how-to progress are all unexplained and intentionally obfuscated. The player doesn’t have so much as a map to show them around the world; the entirety of this world and its terrifying daemons must be conquered with almost no presented information on how to do so. For most any other game, these would be unforgivable flaws. Conveying information to players so that they can feel competent and progress is key to retaining players and providing a good gameplay experience. Games cater to the player, making it convenient for them to enjoy the core gameplay loop of the game, where the challenge traditionally resides. The obtuseness of the Dark Souls games makes them incredibly difficult to jump into and play. Through combining themes of loneliness with the merciless nature of the player’s interaction with the world, the creators of the game create great need within the player for direction, direction they can only find through cooperation with other players. And through the other themes of the game, they encourage that cooperation, in a fascinating way that maintains their fiction while implying the creator’s intent. Dark Souls lore specifies that time in these games does not necessarily pass in a linear fashion. Best described by the character Solaire in the game: “We are amidst strange beings, in a strange land. The flow of time itself is convoluted, with heroes’ centuries old phasing in and out. The very fabric wavers, and relations shift and obscure. There's no telling how much longer your world and mine will remain in contact. But, use this, to summon one another as spirits, cross the gaps between the worlds, and engage in jolly co-operation! – Solaire of Astora (Dark Souls) This dialogue reveals that, in the realm of the game, there are other diegetic heroes who have already completed the quest you are embarking on, that there are heroes in other variants of this world pursuing the same goals as you, and that there will be heroes after you, hoping to triumph over the same evil. In fact, players can leave messages in their world that will appear in another player’s world, and even summon spiritual remnants of other players, whether to learn of their activity or summon them for aid. The game very explicitly pushes the player towards collaboration, whether through observation or active cooperation, with other human player characters. This is described in No Mastery Without Mystery; While playing Dark Souls, the player frequently encounters fleeting spectral presences (Fig 3). Ghostly fellow travelers keeping her company as she rests at a bonfire, adventurers engaging in combat against unseen enemies, warriors dying in battle: all appear momentarily before fading away from view. A diegetic justification is offered for this — early in the game, a non-playercharacter tells the player that, in Lordran, “the flow of time itself is convoluted, with heroes’ centuries old phasing in and out. The very fabric wavers, and relations shift and obscure… However, the full aesthetic effect of these presences is achieved once the player realizes the identity of these spectral presences: that is, that they are in fact other players, captured and re-presented in real-time as they engage in their own simultaneous playing of Dark Souls wherever (and whoever) they might be in the world. The ghostly figures travel paths different to the ones the player takes; they wear armor and wield weapons the player might not yet have discovered; they deploy techniques the player might not yet have learnt, or even known were possible. In short, they shadow the player’s own playing of Dark Souls with an intimation of all the “paths not taken,” revealing the vast space of possibility that is both hinted at and, simultaneously, closed off by the player’s activation of a single playing-out of the game. (Vella) Figure 3, Screenshot from Dark Souls III (Dhimitri) The game diegetically pushes heroes towards learning, taking advice and assistance from other heroes who have gone before and giving the same to heroes who will come after. This parallels reality in that there are players that have played the game before and gained knowledge of its systems and world, and that more players will begin the game every day who will need assistance to succeed. The game is so difficult and vague that it is incredibly hard to complete without guidance from outside sources. What this implies is quite engrossing; the game is implicitly encouraging non-diegetic cooperation outside of the game through its diegetic themes. Indeed, this encouragement is not an explicit one, but the results speak to the intended effect, as the Souls games have one of the most well-regarded internet communities surrounding a game. Jordan Palithorpe of Emerson College states; (Dark Souls) effectively creates a discourse community and brings others together to figure out how to parse its systems. I think the majority who appreciate these games do so because it forces people to talk to each other. The game intentionally creates a viral moment of interest where everyone is trying to parse the game together, to uncover mechanical secrets and share strategies for progressing that would be incredibly difficult to do alone. (Hamilton) Non-diegetic communities around games are certainly nothing new or revolutionary, but that the Souls series diegetically but not explicitly encourages non-diegetic activity is a fascinating and wonderful technique with wonderful results. In terms of a cooperative metanarrative, Dark Souls is the outstanding example. Not only does it succeed in conveying feelings of loneliness in this large, desolate world, but conveys the necessity for cooperation throughout the game through hints and aid. The game’s community has grown to reflect this and is largely considered one of the friendliest gaming communities on the internet. The design principles that accomplished this monumental achievement are not difficult to dissect and codify, but the principles themselves are incredibly risky undertakings. Recommending the game design philosophy of purposefully obscuring information is entirely antithetical to traditional game design tenants of empowering players with the necessary information to overcome game challenges. Furthermore, the reliance this game has on the community around it actually forming and becoming useful is massive; that the community enthusiastically gathered around the game is not something that’s a reasonable expectation for just any game. The steps the game takes are fairly simple: obscure information, require extensive amounts of effort to be put into the experimentation and understanding of the game’s world and systems, and hope that the necessary player enthusiasm towards your game follows. The design of the Souls games is an incredibly confident one, and was only made possible by the strong theme, tonal consistency, and well realized aesthetic. Creating a game in the style of Dark Souls is not a task to be undertaken lightly. The game’s cooperative metanarrative, and its requirement for collaboration and focus on the importance of such, have had one of the most resounding effects on the gaming ecosystem in the medium’s history. The diegetic themes of these games have non-diegetically bonded the game’s player base together, teaching the player to understand these themes by experiencing them, pushing players into “jolly cooperation” in their struggle against the harrowing world of the Souls games. LET ME READ YOUR MIND “Entertainment takes it as a given that I cannot affect it other than in brutish, exterior ways: turning it off, leaving the theater, pausing the disc, stuffing in a bookmark, underlining a phrase. But for those television programs, films, and novels febrile with self-consciousness, entertainment pretends it is unaware of me, and I allow it to. Playing video games is not quite like this. The surrender is always partial. You get control and are controlled. Games are patently aware of you and have a physical dimension unlike any other form of popular entertainment. Even though you may be granted lunar influence over a game’s narrative tides, the fact that there is any narrative at all reminds you that a presiding intelligence exists within the game along with you, and it is this sensation that invites the otherwise unworkable comparisons between games and other forms of narrative art.” -Tom Bissel, Extra Lives (Bissell) The player of any single-player video game is always playing against a game that is handicapped. Computers are faster at the computations that video games require than any human mind could ever hope to be. The game could, at any point, defeat the player completely through perfect responses to their input. The game, after all, is processing and representing the player’s input on screen; it has knowledge of what the player’s avatar will do before they even do it. The game, as a system, knows at all times the position, the resources, and the possible actions a player could take. Games are programmed in such a way that they don’t utilize perfect information. The game’s antagonizing forces process limited data and make committed decisions to create realistic and conquerable challenges for the player. Games have set behaviors that the player can understand and then take advantage of, creating situations that give the player a sense of achievement. A simple example of this is the Goombas from Super Mario Bros(Super Mario Bros.). Goombas are programmed to move on a set path and have set behavior. The player very quickly learns this set behavior, and how to exploit their preprogrammed routines to defeat or avoid them and progress. In diegetic terms, player input and processing are usually non-diegetic; in the realm of the game, actions taken by the player are diegetically represented, but the actual outside input, processing, and surroundings of the game that causes these actions are not traditionally diegetic. In Metal Gear Solid, the game on multiple occasions breaks this tradition, representing elements peripheral to the software as diegetic. In what has become one of the most legendary moments in video games, Solid Snake approaches the telepathic Pyscho Mantis, both player and protagonist ready to fight him. But no matter what Snake or the player does, they can’t land a hit on Psycho Mantis. The telepathic antagonist taunts Snake (and the player directly), stating “I can read your every thought!” (Kojima). The game, represented by Psycho Mantis, is detecting the players every action, and “reacting” to those actions perfectly. The player is unable to defeat Psycho Mantis at this point because he possesses ultimate control over the situation, able to detect and react to the player’s every move. Psycho Mantis even asserts his control over the game’s systems by “telepathically” activating the rumble function on the player’s controller, Figure 4, Screenshot from Metal Gear Solid(Metal Gear Solid Wiki) making it shake and move around as if he is manipulating the real world from within the game. He’ll also turn the screen black, pretending that he’s switched the player’s television input. Psycho Mantis also reads the player’s memory card, quoting things like "You like Castlevania, don't you?"(Kojima) if the player has save files from Castlevania, Symphony of the Night on their memory card, and other game specific dialogue for different game save files (Figure 4). Pyscho mantis appears to the player to be entirely aware of the surroundings of his digital realm, and to be entirely in control of it. Furthermore, the player experiences the same feelings of helplessness that Solid Snake does; while the fiction may be stating the Psycho Mantis is reading Snake’s mind, the gameplay is forcing the player to experience the closest thing they can to having Psycho Mantis read their mind. Solid Snake receives one saving grace after struggling against Psycho Mantis for a while, in the form of a message from his commanding officer: “I’ve got it! Use the controller port! Plug your controller into controller port 2. If you do that, he won’t be able to read your mind!” (Kojima). To beat Psycho Mantis, the player must unplug the controller from the default player 1 controller port, and plug it into the player 2 port6, usually only reserved for multiplayer games. Once this is done, Psycho Mantis exclaims “What? I cannot read you!” (Kojima), and the player can, from that point, damage and defeat Psycho Mantis. This set of mechanics implies that the player has confused Psycho Mantis, and thus, confused the game. The player didn’t defeat the game through in-game actions; they defeated the game by circumnavigating the game’s “logic”, where the game, represented by Psycho Mantis, was reading the inputs of the player through the initial player controller port and utilizing that to defeat the player. The player had to undermine the game’s absolute control in the digital realm by taking an action in the physical reality that the game can have no control over. Every button press, joystick push, or decision sent into a game’s systems can be overridden, undermined, or changed by the game’s logic; but the game cannot control the player’s manipulation of the Playstation that the game is dependent on. This is a strange and fascinating commentary on control; the game controls all its logic, and every in-game action that the player takes is at the 6 This action differs slightly depending on the different console ports of the games, but this description is regarding the original Playstation port from 1998. Other ports of the game execute similar actions or simulate those actions. mercy of the game’s programming. But the game ultimately exists only in a virtual plane and can only exert so much control over our reality, one in which the player is in ultimate control. The commentary on the relationship the player has with the virtual world and the virtual world has with the real world, and the control dynamic involved, is an engrossing way to both somber and empower the player. Similar instances occur throughout the Metal Gear series, and through other games. In XMen for the Sega Genesis/Mega Drive, the final level of the game asks the player to “reset the computer” in the game, but then provides no in game action for the player to take to do so. The game has converged the in-game computer with the player’s game console, “and what the game actually required was for the player to perform a soft reset7 on his or her own Mega Drive by lightly pressing the reset button” (Conway). This is another example of extending the fiction to include traditionally non-diegetic systems related to the game. Playing with the ability of a player to control the game through extending the fiction to involve the controls is a somewhat common technique in extended fiction game design; another example of this occurs in Emily Is Away. Emily is Away is a game that takes place in a simulated instant messaging window, recollect of late 90’s AIM, with themes about the awkwardness of youthful relationships. It consists of a very simple control scheme and story, with simple dialogue choices to respond. However, near the climax of the game, the game’s controls are drastically altered. Throughout the game, the player input to the game consists of two actions; the first is a numbered dialogue choice selection, where the player selects one of three options for the instant message they want to send. The second part requires the player to tap on the keyboard to 7 A “Soft reset” is a computer controlled reset of a machine, as opposed to a “Hard Reset” which is equivalent to unplugging and plugging a computer back in. Soft resets often retain some data hard resets do not as they control the shutdown process. simulate typing out the message itself; each keyboard press will print a character to the text box window, though the actual content is limited to the chosen prewritten dialogue choice. At the climax of the game, this input flow is interrupted; the player is presented with choices for dialogue, but when they attempt to type them out using the second half of the input process, their dialogue choice is typed out, deleted, and replaced with something else. The player is rendered helpless as their avatar can’t bring themselves to make the dialogue choices that might salvage their relationship with the titular character of the game. The execution of this is masterful; the reality of the helplessness that the player experiences in this moment parallels the helplessness that their avatar is being portrayed as feeling; through forcefully restricting the player’s ability to affect the game and its characters, the player is pushed into experiencing the same emotions of helplessness that are preventing the avatar from acting. This provides a very different experience to that of the Psycho Mantis boss fight; while Pyscho Mantis prompted loss of control and frustration against an enemy, the frustration caused by Emily Is Away is one caused by emotional helplessness. Both are communicated through experienced gameplay, instead of conveyed via narrative. My experience with this technique took place in the design of Justice.exe, a short mobile game developed for my When Machines Decide praxis lab. In the game, the player is given a binary choice of swiping left and right to sentence criminals to minimum or maximum sentences. The game is centered around the concept of machine learning in criminal justice sentencing, and so, in the end of the game, the machine learning algorithm that was being trained by the player through their choices is given control of decision making; the player is left with no control as the machine applies what it thinks the player was making their decisions based off of. This results in the machine sometimes sentencing more or less harshly based on race, gender, zip code, or other factors that most players would not account for in their sentencing of criminals. The game diegetically removes control from the player in order to reflect the dangers of machine learning being put into control in our society. The game was simple, and perhaps not long enough to be successful in emotionally affecting the player a great deal, but it was a valuable experience in designing extended fiction and was reasonably successful in emotionally conveying the dangers of machine learning in criminal sentencing through gameplay. This design technique is easily broken down; first, the player thinks that they’re in a position of control, which is almost a given for any player familiar with video games. Then, at some point, their position of control over the software must be brought into question, through taking that control away or manipulating it in some way. After that, if the goal is to re-empower the player, providing some unique, outside-the-box solution to manipulate the game’s digital world is effective in establishing the player’s position of outside control while still effectively imparting on them the message the game wishes to send. If the goal isn’t to re-empower, but to somber the player, then it’s unnecessary to give them a special action peripheral to the game to assert their control. The hard part is to frame this design style in a unique way, since it’s execution in Metal Gear Solid is so infamous, replicating it for the same purposes wouldn’t have the same shocking effect. In conclusion, extended fiction regarding a player’s level of control over the game system is an intriguing way to cause emotional resonance in the player through gameplay. It heightens the immersion of the player, highlighting and critiquing their actual relationship with the game software in order to bring about much more existential narrative, both within the game and within the player. FLOWERS FOR M[A]CHINES High scores. S ranks. Victory screens. Upgrades. Saving the princess. All are traditional goal states for the players of video games, and for good reason. Whether in games with or without narrative, competitive games or single-player experiences, quantitative representations of success and progressing mastery are deeply satisfying and motivating for players. Jane McGonigal states in Reality is Broken “Fun from games arises out of mastery. It arises out of comprehension.... With games, learning is the drug.” (McGonigal) This is what Milan Jaćević reflects on as the “implied player”, and goes further to separate from the player as a person, the “implied being”; Much like the implied reader, the implied player is a construct whose elements can be traced to the structure of the game… the player is presumed to be willing and able to take part in, and complete, goal-oriented ludic schemas such as quests… on the macrostructural level, the player is presumed to be willing and able to follow the game’s macrostructure to the end… While the notion of the implied player comprises a set of expectations for behavior, the notion of the implied being includes a set of engagement criteria expected of the moral, cultural, embodied being interacting with the game and the values on offer therein. These values can be interpellated and negotiated not necessarily in gameplay, but rather from gameplay, during moments of reflection inspired by gameplay experiences and subsequent interaction with the wider player community. (Jaćević) It stands to reason, then, that clever designers in games would seek to undermine the relationship between the implied player and implied being for critical purposes. This is done in many examples by introducing narrative reasons to perform poorly, lose, or otherwise forfeit gameplay success for a greater ethical narrative purpose. Extending the fiction to include the implied player’s goals is a great way to create conflict within the implied being. Part of them wishes to perform well, as many have been conditioned to do by years of traditional games (not just video games, but other forms of competition and achievement as well). But this part of their psyche is challenged by the ethical or narrative structures the game presents, and so their own value structure in relationship to the game is challenged. Jaćević calls this “ludeoethical tension”, describing it as “evoking a feeling of tension in the player between ludic ability (and the need to exercise it to progress in the game) on the one hand, an ethical inability on the other” (Jaćević). A great example of ludoethical tension takes place in the game Life Is Strange, a narrative adventure game developed by Dontnod Entertainment and released in 2015. The game’s protagonist, Max, finds herself with powers to control time, and so the game takes place around decision making and puzzle solving elements with the ability for her, and ultimately the player, to reverse time at any point and try to mold events to their desired outcomes. Narrative adventure games8 such as Life is Strange or Telltale’s The Walking Dead are based heavily on a structure that changes events drastically based on player choice, with events in game that take place 20 hours after a player choice sometimes being influenced by that player choice. Often, the culmination of these decisions is the reward for the player; a grand climax that takes into account a large number of player decisions and combines them to drastically influence the ending. Life is Strange handles this in a peculiar but intensely interesting way; at the end of the game, a choice is presented. Throughout the game, Max’s main goal is to try and help her troubled friend Chloe, who’s prone to finding herself in life threatening situations that require Max to rewind time to save her. But Max’s usage of her time travel powers has had a massive effect on the world around her, causing a massive tornado to form and threaten her home town of Arcadia Bay. It’s made clear at the end of the game that there is a binary choice: take shelter with Chloe and allow the tornado to destroy Arcadia Bay and everyone in it, or rewind time all the 8 Games that revolve around very little second to second reflex based gameplay, instead implementing more choice and puzzle based adventures. way back to the first instance of Max saving Chloe, and allow Chloe to die so that Max never causes the tornado to form in the first place. What’s presented here is much more than just a terrible choice for a person to make, it’s also a choice for the player. Do they literally throw away all the effort they made in the game to save Chloe in order to make the ethical choice? The game presents the ethical choice as one contrary to the goals of the player throughout the entire game. All the player’s successes and carefully made choices will be diegetically lost, and more importantly, the goal of the game as was understood up to this point, which was to help the troubled Chloe, will be an abject failure. It’s a moment that causes great frustration and emotional turmoil in the player, not only because of the inherent tragedy of the on-screen events, but because of the inherent ludic sacrifice the player will have to make, whether of their ethical grounds or of their personal attachments to game-oriented success. In a more direct example, Manhunt presents a similar conflict between implied player and implied being, described in Manhunt – The Dilemma of Play; In a macabre twist, the player is awarded extra points for completing more gruesome executions. Within the context of the game, points serve no function or purpose. In the game, nobody knows or cares that you, the player, got more points. Their only purpose seems to be to tempt the player. To force the player to question how much he really values what is essentially a meaningless measure of achievement. How far would you go for a few points more? As a game player, how do you value your competitiveness and achievements as a player (get the most points) versus doing the right thing in the context of the narrative? What does it mean to be a good player?(Zagal) Herein lies a direct and clear example of ludoethical tension; while traditional goals of video games revolve around high scores, and gaining points being an ultimate good, Manhunt and games like it create great discomfort in the tension they create between the classical conditioning players have to score more points, and the great moral stress inflicted on them through performing the actions required to get more points. Another, albeit brief example of this narrative device is present in Hellblade: Senua’s Sacrifice. Hellblade is a game with surreal themes, a game where the titular character is experiencing extreme psychosis and is accompanied at almost all times by voices in her head, manifesting to the player as binaural audio. These voices are sometimes helpful, like when they warn the player of incoming attacks, and sometimes malicious, like when they taunt Senua throughout the game. The game takes place from a third person standpoint, with sword-based combat regularly occurring throughout the game, that requires the player to perform well to defeat enemies and move on. In the climactic battle of the game, the player is presented with a horde of enemies that respawn infinitely. The only way to complete the battle is to allow the enemies to kill Senua. This is prompted by the voices Senua hear encouraging her to “let go, let go of your battle” (Hellblade). This presents a somewhat different ludeoethical tension within the player; they must abandon learned practices of fighting and struggling against monsters for Senua to finally find peace and let go of her inner demons, those demons being her struggle to come to terms with the death of a love one. While not as sacrificial as the player choosing to nullify the struggle they had against the game for the ethical choice in games like Life is Strange or Nier: Automata, it does bring about a similar emotional effect as was achieved with Emily is Away; the player must choose to stop struggling against the enemies that face them, give up any hope of ludic victory, and let go, in the same way that Senua must give up her struggle and come to terms with her loss. “As she learns to accept death Senua also learns to accept her own darkness — and the fact that it'll always be with her.” (Williams) This game design relies heavily on player attachment to the game’s narrative. For example, if Arcadia Bay of Life is Strange felt like a wooden town with uninteresting or even despicable characters, very few players would feel ethically motivated to save it from destruction instead of losing the well written and complex character of Chloe, who represents in many ways repeated success states of the player. If the player had no attachment to the survival of Senua from Hellblade, the final surrender would be a pointless and uninteresting twist. First and foremost, games that wish to create ludoethical tension between implied player and implied being must have compelling stories and characters, and gameplay that provides value to the implied player. Games that don’t offer significant motivation for the implied player cannot create ludoethical tension if the player is easily motivated to abandon the gameplay achievement in favor of ethical choices. Following those two daunting requirements, it’s a simple matter of providing a situation which pits the player’s sense of morality or attachment to narrative against the game’s traditional gameplay success states. The intrinsic conflict this design philosophy causes within the player creates markedly impactful gameplay moments, immersing not only the player, but their motivations as a part of the game and it’s narrative. OUR CHOICES MAKE US The penultimate non-diegetic element in relation to any game is the player. Already discussed in earlier sections are games that explicitly acknowledge the player as part of the extended fiction, and while these games provide great exploration of interesting narrative and metanarrative concepts, they aren’t exactly searing in their critiques: Earthbound provides an emotionally resonant but not critical view of the player as a savior, Icey provides a playful, thoughtful rivalry between player and developer, and Life is Strange takes into account the anticipated goals of the implied player in order to pit them against emotional attachments of the implied being. This chapter will discuss the player in a diegetically ambiguous position, and specifically how ambiguous player-avatar relationships provide deep immersion and critique of the player-avatar relationship. Matthew Weise describes this concept as it appears in metal gear solid as such; Metal Gear Solid stretches the membrane between the fictional world and the real world as a way of bringing player and fiction together -- not driving them apart. It does this by reveling in the ambiguous nature of the player-avatar relationship. The player is Snake, but not Snake. Snake is the player, but not the player. When characters look at Snake they often see Snake, but they just as often see the player, staring right through Snake's eyes. (Weise) In other words, an ambiguous player-avatar relationship is a situation in which the player is not explicitly acknowledged as diegetic, but the themes, dialogue, and overall presentation of the game imply heavily a knowledge of the player’s presence. More importantly, the responsibility for the events that take place in the game are often ambiguously attributed to the player, implying that the only reason the (often horrific) results of the player actions are the fault of the player for interacting in the first place. This is a form of player culpability, or implication of the player as accountable for the actions their avatar takes in the game9. These situations are often presented in surrealistic ways, as was the case with Earthbound’s acknowledgement of the player in its surreal climax. To describe a technique based in surrealism, there’s no better place to start than Hotline Miami. Hotline Miami is a game about violence, described most commonly as “ultraviolent” (Onyett). The game revolves around the protagonist receiving over-the-phone instructions to 9 This is not meant to imply that Metal Gear Solid does not have a culpable player, as the actions of the player character are usually no more horrific than that of any spy movie action hero. clear buildings full of Russian mobsters, and following out those orders with a variety of weapons in the most brutal and stylized ways possible. Baseball bats, golf clubs, machetes, knives, guns, and bare hands are all used to create bright red splatter marks that track the player’s bloody trail through the level. The game induces such a heart-pumping adrenaline rush in its fine-tuned gameplay that any trepidation the player might have about the sickening violence is lost in the thrill of the interaction. The game makes its ultraviolent content fun and satisfying, drawing the player in, making them want more, but then questions why they so thoroughly enjoy the violent acts their avatar commits in the game. Hotline Miami has an ambiguous player-avatar relationship that makes the player culpable. The player avatar is no hero rescuing a victim in distress, or a vigilante stopping bad guys from doing bad things. Their violent rampages are just that, a bad person killing other bad people, likely given directions by even worse people. The game contains no morality, no redemption; its addicting gameplay is its own reward, and yet the enjoyment of that reward is questioned by the game itself. “Do you enjoy hurting other people?” the game asks (Hotline Miami). “You’re not a very good person, are you?” it states (Hotline Miami). These state that the player is not progressing through the game with a greater purpose or performing horrific acts for a greater good; they are doing what they’re told to do by the game, the only thing they’re allowed to do in the game: “The only way to truly interact with the world is to kill. Such is the case with many games, yet few call out the inanity of it so bluntly” (Onyett). Like Manhunt, Hotline Miami forces the player to be culpable, though in a different sense. While the culpability of the player in Manhunt relies on their choices, that being whether they execute more or less gruesome executions for points, Hotline Miami has no such choice. When the game asks, “Do you like hurting other people?” (Hotline Miami), there is no diegetic answer “no” for the player to respond. The only way for the player to respond to the ethical side of the ludoethical tension the game causes is for them to stop playing. Continuing the game implies that the player is culpable in the actions their avatar takes, no matter how horrific. Continuation of the game, especially beyond the point where the game declares you “not a very good person” (Hotline Miami), is an admission of complete surrender of the implied being to the implied player. Another game in this style is Spec Ops: The Line. A game adaption of Heart of Darkness, stylistically in the vein of Apocalypse Now, Spec Ops tasks the player avatar, a generic but likable army captain with venturing into the ruins of modern-day Dubai in an attempt to find the missing John Konrad. This presents a perfect example of the unremarkable character that’s often present in games with ambiguous player-avatar relationships. This type is usually devoid of distinguishing features, sometimes being entirely silent and often never being seen from a thirdperson perspective by the player in first person games. Captain Walker is a character with voice acting and some personality, but he is a character that provides an easy avatar for a player to identify with, and thus it is more difficult for the player to distinguish between their actions and the actions of their avatar. As the game progresses, Walker and his team are forced into increasingly grisly situations, all seemingly caused by the cruelty of Konrad. At one point, Walker and his team are pinned down by enemy gunfire, and so, launch White Phosphorus into the enemy combatants, only to realize when the combat has ceased that they murdered a large group of civilians in doing so. As the game progresses, it’s surrealistic and ghastly imagery seep into even the loading screen messages of the game, with quotes like “Do you feel like a hero yet?” (Yager) taking the place of what started as helpful gameplay tips. The insanity and eerie tone of the game permeates through every aspect of it, with player characters becoming more battered and bloody as the game progresses. In the end of the game, as Walker alone approaches Konrad’s penthouse in the Burj Khalifa, he finds Konrad dead, having committed suicide before the story of the game had even began. Konrad’s voice over the radio was entirely imagined by Walker, him being pushed into disassociating the atrocities he committed and blaming them on the imagined Konrad. The hundreds of NPCs murdered over the course of the game were entirely murdered by Walker. As another one of the game’s loading screens states, “The US military does not condone the killing of unarmed combatants. But this isn’t real, so why should you care?”. The game uses the nondiegetic loading screens to explicitly address a non-diegetic player, but the diegetic narrative of the game implies and indicts the player in a much more serious capacity. The confusion of the player, their complicitous in the atrocities committed, all are implicitly attributed to the player. One of the writers of Spec Ops, Richard Pearsy, described the conclusion as such; “When the Delta Squad arrives, Konrad faces exposure and humiliation and takes what he sees as the only honorable way out – suicide. In the end he literally paints a picture of the player's sins, presenting the player with the dilemma Konrad, himself, faced. What have I done? How do you feel about what you have done?” (Pearsy) The player moving through the game even after explicitly being told through the loading screens that “If you were a better person, you wouldn’t be here” (Yager), is intensely challenged. The player’s continued interactions with the game implicate them in the results of those actions; the massacre committed by Walker is only enabled by the player’s continued insistence on playing the game, despite the intense narrative ludoethical tension it provides. The game that goes the furthest with its examination of player motivation and provides the most pointed ludoethical tension is Bioshock. Bioshock does this through enthusiastically embracing of the concept of extended cognition, a “theory states that our cognition (or mind) includes not just the brain, but also the body and the surrounding environment” (Cuddy). This feeds into the notion that the character in the game is not a separate entity, controlled by the player, but an extension of the player themselves. Bioshock encourages its player-avatar ambiguity by making the protagonist virtually indistinguishable from the player; the player never sees the avatar’s face, never hears them speak, and the only distinguishing feature the player can find on the character’s model is the chain tattoos on the avatar’s wrists. First-person perspective games will usually involve a combination of voice acting, and cutscenes featuring the protagonist, distinguishing them as a defined character, but Bioshock doesn’t. This is purposeful; the player avatar is meant to be as transparent as possible, removing the buffer between the player and the game world. Bioshock removes almost all separation of player from the avatar, directing the game’s themes and commentary right at the player with all but explicit acknowledgement; Bioshock, in some ways, is the antithesis of an RPG, because there is no buffer between the players’ choices and their avatars’ choices. The actions are not Nathan Drake’s or Jane Shepard’s, they are the player’s actions, and the player’s consequences as well. Bioshock’s formula for guiding the player through the game is a common one; the player is given direction over a short-wave radio by a friendly Irish voice named Atlas. This voice, a man claiming to be just as trapped in the city of Rapture as the players’ avatar is, guides the player, giving them direction, helping them through obstacles and leading them towards their eventual salvation, always with a polite “Would you kindly…” (Bioshock) before instruction. The game even offers convenient notifications of the next step in the players quest to clearly convey all the necessary information. Like the concepts found in Icey, the narrator could be seen as a representation of the game itself, but in this case the narrator is clearly not the game’s designer, and the multiple narrating contacts the player has throughout the game muddle this comparison. Bioshock’s twists and turns lead it to a climax in which the Rapture’s founder, Andrew Ryan, looks up from his office putting green and asks “Stop, would you kindly?” as the player avatar is walking towards him. Control is wrested from the player and the avatar stops. “Sit, would you kindly?” Ryan asks, and the avatar sits. “Stand, would you kindly?”, and the avatar stands. Ryan proceeds to walk up the player and state his designated mantra: “A man chooses, a slave obeys”. And then, Ryan hands the player avatar his golf club, utters the single word “Kill”, and, looking into the camera all the time, repeats “A man chooses, a slave obeys” as he is beaten to death by the player’s avatar (Bioshock). The player is helpless to intervene. They have lost all control over their avatar’s actions. The instructions they thought they had been willingly following throughout the course of the game had turned out to be controlling them. Through the extended cognition that the game works so hard to imply, they’ve lost control over themselves. Shortly after, the player regains control just as quickly as it was taken away. Again, as if no revelation had taken place, Atlas asks the player “Would you kindly” hand control of the city’s security systems over to him, and the game’s quest marker dings with the next notification as though everything is normal. The player has been broken; they have been betrayed and shown their own weakness, their total lack of control in this world. The effect this has on the player is well described in Bioshock and Philosophy: Gadamer said that there are always risks in any case of a fusion of horizons. One of these risks is having a completely unforeseen experience, or the risk of being changed yourself by the horizon of the “other”—whether the other is a person, a book, a work of art, or a video game. Is this not precisely what happens at the twist of Bioshock? The player plods through the game with a certain hermeneutic horizon that the game maintains up until the twist. Then, it pulls the rug out from under that horizon. The game invalidates it. When successful, Bioshock’s twist sends players reeling. They are left holding fragments of their naive horizon, and broken concepts of what kind of game Bioshock was expected to be. (Cuddy) The player is once again left holding the pieces and asking themselves “why?”. Why proceed with the horrific actions necessary to complete Bioshock? Why persist through this horrible world and unquestioningly kill and plunder for a faceless voice? Why continue after the moment when it has been so obvious that you are the “slave”, and not the “man”? This is the strongest example of ludoethical tension found in games, and the moment the requires the most ethical surrender of the player to continue playing. So how do they do it? Ambiguous player-avatar relationships, player culpability, and ludoethical tension are perhaps the most complex of the extended fiction techniques discussed in this paper. The game’s first and foremost rely heavily on their tone; tonal consistency with the critique that the game wants to make of the player is an absolute necessity. This includes not just the narrative and atmosphere of the game, but the gameplay as well; games that wish to make the player culpable in horrific acts must force them to participate in truly despicable actions and participate in them in a core sense. The player must be characterized by the gameplay actions they take. Richard Pearsy writes of this regarding Spec Ops; “Lastly, we decided to tie characterization directly to core game mechanics. Character is action, and this is doubly true in The Line, where for the most part, players use a single set of mechanics during both combat and narrative events. This features most prominently in the game's "decision scenes”. (Pearsy) Finally, the games must confront the player, implicitly forcing them to reconcile with the actions they took. But importantly, the game shouldn’t confront the player in a necessarily judgmental way; much more effective is the presentation of the events in their true context, leaving the player to judge themselves. Ludoethical tension and player culpability cannot be forced onto a player, the must be implied and experienced naturally. These games that ask questions of the player, that confront them and demand them to look inwards and discover their own intentions to address their resolution to ludoethical tension, achieve perhaps the most successful form of metanarrative, because it is an entirely unique metanarrative. Why the player chooses to play, why they choose to continue, these are all questions each player can only answer for themselves. The player’s interpretation of what the game is asking them and what their own answers are can and do vary wildly. The game has taken a personal interest in them; it has asked what they think. It has prompted them not to look deeper into it, the game, but into themselves. CONCLUSION Video games contain one vital element that separates them from all other forms of art; they are directly interactive. Interactivity is defined as “… (of two people or things) influencing each other” (Oxford). Players are required to influence the game and successful video games influence the player in return, but it is typically influencing them to an entertained state. Games try to evoke different emotional responses in the player through gameplay or narrative events that happen on the screen. Metanarrative video games pursue a different kind of emotional invocation—they pursue the idea of making the player feel things about themselves, making the player understand a more philosophical level of the medium of video games. They push to make the player as much a part of the interactive experience as they can, extending the fiction of the game to include more than just the events that take place on the screen. They bring the player in, disregarding the barriers between the physical and digital worlds. They seek to humble, to encourage, to promote feelings of importance and feelings of control, or to destroy any sense of these that the player might have. Video games that contain and utilize extended fiction build an uncommon and deep relationship with the player and the world around them to make the interaction between player and game mean more than a simple position of outside control. These kinds of games are not satisfied with being interacted with and displaying the results of those interactions on a screen; they demand to affect the player, just as much as the player affects them. References Aarseth, Espen. (2007). I Fought the Law: Transgressive Play and The Implied Player. Alber, Jan, and Per Krogh Hansen. Beyond Classical Narration: Transmedial and Unnatural Challenges. De Gruyter, 2014. Anderson, Austin. “A Very Bad Clock Game.” Google Play, 1.0, 5 Dec. 2018, play.google.com/store/apps/details?id=com.BoredMortician.ArduosClockGame. Bain, John "Totalbiscuit", director. YouTube. YouTube, YouTube, 9 Dec. 2016, www.youtube.com/watch?v=BWtX1FQ_U64&t=1293s. Bayliss, Peter. “Beings in the Game-World: Characters, Avatars, and Players.” She Ji: The Journal of Design, Economics, and Innovation, 2007, researchbank.swinburne.edu.au/items/383db9c5-49ff-40a6-bb7d-d46888330ed1/1/. “BioShock.” 2K Games, 2007. Bissell, Tom. Extra Lives: Why Video Games Matter. Vintage Books, 2011. Bizzocchi, Jim, and Robert F. Woodbury. “A Case Study in the Design of Interactive Narrative: The Subversion of the Interface.” Simulation & Gaming, vol. 34, no. 4, Dec. 2003, pp. 550–568, doi:10.1177/1046878103258204. “Buy ICEY.” ICEY on Steam, store.steampowered.com/app/553640/ICEY/ Conway, Steven. “A Circular Wall? Reformulating the Fourth Wall for Video Games.” Gamasutra Article, 22 July 2009, www.gamasutra.com/view/feature/132475/a_circular_wall_reformulating_the_.php Cowles, Michael P., et al. Progress in Reversal Theory. North-Holland, 1988. Cuddy, Luke, and Collin Pointon. “Bioshock's Metanarrative.” BioShock and Philosophy: Irrational Game, Rational Book, John Wiley and Sons, Inc., 2015, pp. 3–14. “Dark Souls.” Namco Bandai Games America, 2011. Dhimitri, Ray, director. Dark Souls III - Vordt Of The Boreal Valley W/ Phantom Sword Master (NPC Summon) - NO DAMAGE (NG+). YouTube, YouTube, 18 Apr. 2016, www.youtube.com/watch?v=NlTQYFnY8r0. “DIEGETIC | Definition in the Cambridge English Dictionary.” DIEGETIC | Definition in the Cambridge English Dictionary, dictionary.cambridge.org/us/dictionary/english/diegetic. “Earthbound.” Nintendo of America, 1995. “Fourth Wall.” Merriam-Webster, Merriam-Webster, www.merriamwebster.com/dictionary/fourth%20wall. “Game Master.” Dictionary.com, Dictionary.com, www.dictionary.com/browse/game-master. Hamilton, Kirk. “What Game Designers Love (And Don't Love) About Souls Games.” Kotaku, Kotaku.com, 28 June 2018, kotaku.com/what-game-designers-love-and-don-t-love-aboutsouls-g-1699490162. “Hellblade: Senua's Sacrifice” Ninja Theory, 2017. “HLTB”. How Long to Beat?, howlongtobeat.com/game.php?id=3034. “ Hotline Miami.” Devolver Digital, 2012. Huizinga, Johan. Homo Ludens a Study of the Play-Element in Culture. Angelico Press, “Icey”, FantaBlade Network, 2016 “Interactivity | Definition of Interactivity in English by Oxford Dictionaries.” Oxford Dictionaries | English, Oxford Dictionaries, en.oxforddictionaries.com/definition/interactivity. “JRPG”. Urban Dictionary, www.urbandictionary.com/define.php?term=JRPG. 2016. Kojima, Hideo. “Metal Gear Solid.” Konami Digital Entertainment, Inc., 1998. McGonigal, Jane. Reality Is Broken: Why Games Make Us Better and How They Can Change the World. Vintage, 2012. “Metal Gear Solid Wiki.” Metal Gear Solid Wiki, metalgear.fandom.com/wiki/Fourth_wall. “Metanarrative | Definition of Metanarrative in English by Oxford Dictionaries.” Oxford Dictionaries | English, Oxford Dictionaries, en.oxforddictionaries.com/definition/metanarrative. Onyett, Charles. “Hotline Miami Review.” IGN Boards, IGN, 27 Oct. 2012, www.ign.com/articles/2012/10/27/hotline-miami-review. Parish, Jeremy. “Metatext: Separating the Player from the Character.” USgamer.net, USGamer.net, 20 July 2016, www.usgamer.net/articles/metatext-separating-the-playerfrom-the-character. Pearsy, Richard. “No Good Deed - Narrative Design in Spec Ops: The Line.” Gamasutra Article, 2012, www.gamasutra.com/view/feature/176598/no_good_deed__narrative_design_in_.php?pag e=1. Sam, Matt. “Dark Souls and Loneliness.” UNIV 200, 2 Mar. 2015, rampages.us/sammv/2015/03/02/dark-souls-and-loneliness/. “Super Mario Bros.” Nintendo, 1985. Vella, Daniel. “No Mastery Without Mystery: Dark Souls and the Ludic Sublime.” The International Journal of Computer Game Research, vol. 15, no. 1, July 2015. Weise, Matthew. “Press the Action' Button, Snake! The Art of Self-Reference in Video Games.” Game Career Guide Article, 25 Nov. 2008, www.gamecareerguide.com/features/652/press_the_action_button_snake_.php. Williams, Hayley. “The Ending Of Hellblade: Senua's Sacrifice Explained.” Kotaku Australia, Kotaku Australia, 30 Aug. 2017, www.kotaku.com.au/2017/08/the-ending-of-hellbladesenuas-sacrifice-explained/. Wright, Talmadge & Boria, Eric & Breidenbach, Paul. (2002). Creative Player Actions in FPS Online Video Games - Playing Counter-Strike.. Game Studies. 2. Yager. “Spec Ops: the Line.” 2K Games, 2012. Zagal, Jose P. “Manhunt - The Dilemma of Play.” Well-Played 2.0, edited by Drew Davidson, ETC Press, 2010, pp. 241–243. Zagal, Jose, and John Murphy. “Videogames and the Ethics of Care.” Design, Utilization, and Analysis of Simulations and Game-Based Educational Worlds, 2011, pp. 193–205., doi:10.4018/978-1-4666-4018-4.ch012. Acknowledgements I’d like to express my gratitude to those who helped me to complete this thesis: Michael Young for being my thesis advisor, Dr. Erin Parker being the Honors Faculty advisor, Roger Altizer and Jose Zagal for their helpful discussions, Alexander Johnstone for taking the time to review and critique my paper, Matt Anderson for sharing his expertise and his encouragement, Zoe Smith for thorough revisions and writing critique, Skyler Hektner for his many hours of content discussion and critique, and Karen Lowe for igniting my enthusiasm for deep analytical reading of media. University of Utah UNDERGRADUATE RESEARCH JOURNAL ENHANCED GEOTHERMAL ENERGY RESERVOIR SIMULATIONS FOR OPTIMIZING WELL CONNECTIONS Marcus D’Ambrosio1 (Dr. John McLennan1,) 1-Department of Chemical Engineering Geothermal energy has been harnessed for over a hundred years and is becoming increasingly prevalent as alternative energy is popularized. Conventional geothermal power plants rely on large reservoirs of high temperature rock and a conductive natural fracture system; this natural fracture system can be very hard to come by. A recent research concept in geothermal energy, known as EGS (Enhanced Geothermal System), is a synthesized fracture system created by hydraulic fracturing. This expands the number of potential geothermal sites tremendously since any high temperature rock reservoir can be utilized for geothermal power without the presence of a natural fracture system. The principle for exploiting EGS involves drilling two parallel horizontal wells in an adequately hot geothermal reservoir (temperatures of approximately 200°C). Multiple conductive connections are established between these two wellbores by hydraulic fracturing. Cold fluid is circulated down one of the wells and flows through the fractured thermal reservoir. As it flows towards the second well, this fluid picks up heat from the reservoir. The heated fluid is circulated to the surface where, when pressure is reduced, it flashes to steam and drives turbines and generators to produce electricity. This is a carbon-free energy source. Application of EGS will enable geothermal energy development in many parts of the country where the natural fracturing required for conventional geothermal energy development are not inherently present in the subsurface. This research focuses on the numerical simulation of this hydraulic fracture process in order to fully utilize the natural high-temperature rock reservoir at the FORGE site in Milford, Utah. The main variables studied were pump rate, pump volume, fluid viscosity, and proppant. Using StimplanTM, numerous simulations were performed; this allowed the creation of response surfaces shown below – as well as many others – that can be used to accurately predict and optimize the system with respect to different variables. Fig 1. Efficiency response surface for pump rate vs. total pump volume Fig 2. Fracture height response surface for pump rate vs. total pump volume Fig 3. Table of studied variables After sufficient testing and data analysis, the following results were obtained: • • • • • Studied Variable Values Studied Pump Rate 1 – 20 BPM Increasing injection pump rate increased the overall efficiency, size, and pressure of Total Volume 25 – 125 M-Gal the fractures. Fluid Viscosity 1 – 100 cp Increasing total pump volume decreased the overall efficiency but significantly Proppant Mesh (20-40) – (70-140) increased the size of the fractures; volume Proppant Conc. 0.0 – 4.0 PPG had minimal effects on pressure. Increasing fluid viscosity created a more cylindrical cross section and significantly increased efficiency without driving pressures beyond manageable levels. The implementation of proppant increased efficiency only at higher concentrations and slightly shrunk the fractures’ dimensions. Larger mesh proppants increased efficiency more than smaller mesh but caused a significant increase in pressure at higher concentrations. From these results I concluded that low volume, high pump rate is the optimal pump schedule to create a high efficiency fracture system fitting the desired specifications for FORGE development. Additionally, using more viscous fluid and introducing a large mesh proppant at relatively high concentrations benefitted the system further by increasing efficiency and ensuring that the fractures will properly connect the injection and production wells. This optimized fracture system can be created by a process with the following specifications: • 25 M-Gal pump distributed in 3 stages at 5, 10, and 10 M-Gal, respectively • Injection pump rate of 20 barrels per minute (BPM) for all 3 stages • Use of a Newtonian fluid with viscosity of 100 centipoise (cp) • Injection of a 30 – 50 mesh temperature resistant proppant at 3 pounds per gallon (PPG) This will result in a 24% efficiency increase relative to baseline while keeping pressures below 400 psi throughout the process. The fractures will easily bridge the 600-foot gap between wells to minimize fluid loss and maximize heat transfer with a productive surface area of 425,700 ft2. The continuation of this research will consist of further investigation into heat transfer and energy generation for the FORGE site. I plan to produce more long-term, quantitative results for the financial feasibility of the studied hydraulic fracturing process. University of Utah UNDERGRADUATE RESEARCH JOURNAL VERIFYING ULTRASOUND BEAM PREDICTION MODELING FOR BREAST TUMOR TREATMENT Megan Dearden1, 2 (Allison Payne, PhD2) 1Department of Biomedical Engineering, 2Department of Radiology and Imaging Sciences OBJECTIVES This study aims to experimentally verify the efficacy of a rapid ultrasound beam modeling algorithm in heterogeneous tissue-mimicking phantoms. METHODS Three heterogenous phantoms (102x30 mm, 250 bloom, 70% milk) were constructed with a ballistics gelatin recipe containing inclusions of canola oil. Acoustic properties were measured using through-transmission and radiation force balance techniques. With the phantom placed in the near-field of the ultrasound beam, a scanning hydrophone (Onda, HNR-0500) was used to measure the 2D pressure patterns created at the geometric focus of the focused ultrasound beam (f=940 kHz, 256 elements). Numerical models were created of the phantom using MRI scans, and the experimental data was compared to pressure patterns simulated with the Hybrid Angular Spectrum (HAS) acoustic simulation algorithm [1]. RESULTS The experimental and simulated peak pressures differed by 9 ± 6 %. The average difference for full width half maximum of the beam over all three directions was 14 ± 7 %. The root mean square difference normalized was 7 ± 1 %. CONCLUSIONS HAS is a full-wave acoustic simulation algorithm shown to accurately predict pressure of a focused ultrasound transducer in heterogeneous environments. Because HAS is significantly faster than other acoustic modeling techniques (runs in seconds rather than hours), it is a potentially valuable clinical tool [1]. Experimental validation using magnetic resonance temperature imaging techniques in both phantoms and in vivo environments is ongoing. ACKNOWLEDGEMENTS This work was funded by NIH 5R37 CA224141. REFERENCES [1] Vyas et al., IEEE Trans Ultra Ferro Freq, 59(6), 2012. FIGURE 1: Comparison of hydrophone measurement and HAS simulation in (a) transverse plane and (b) transverse peak pressure trace after propagating through a heterogeneous phantom. University of Utah UNDERGRADUATE RESEARCH JOURNAL EFFECT OF INDOXYL SULFATE ON ATORVASTATIN MEDIATED PRODUCTION OF ENDOTHELIAL NITRIC OXIDE SYNTHASE Isabelle Falzon (Dr. Yan-Ting Shiu) Department of Biomedical Engineering Globally, it is estimated that about 5 million people have end stage renal disease (ESRD) [1]. Patients with ESRD require either a kidney transplant or dialysis. The median wait time for a kidney transplant is 4 years in the US [2]. Therefore, many patients need dialysis for renal replacement therapy. Hemodialysis requires functional vascular access to send blood to the dialysis machine from the patient and return blood to the patient from the dialysis machine [2]. It has been proposed that increasing vasodilation will help keep vessels open and usable for hemodialysis. The endothelial nitric oxide synthase (eNOS) produces nitric oxide, a vasodilator [3]. However, a uremic toxin called indoxyl sulfate (IS), which accumulates in ESRD patients, has been shown to decrease eNOS expression [4]. Atorvastatin (ATV), a common cardiovascular disease medication, has been shown to increase eNOS expression [5], but it is unknown how IS affects this vascular beneficial effect of ATV. An in vitro cell culture model with human umbilical vein endothelial cells (HUVECs) was used to investigate the combined effect ATV and IS on eNOS. Both Western blotting and immunofluorescence were used to quantify eNOS expression. This study found that IS inhibited the ability of ATV to increase eNOS expression. Thus, because of IS, ATV may not be able to increase nitric oxide mediated vessel dilation in ESRD patients as effectively as in patients with normal kidney function. Future research could consider if higher doses of ATV in the presence of IS could lead to the same effect on eNOS as lower doses without IS. Overall, this study demonstrates the importance of considering the effect of the accumulation of uremic toxins in ESRD patients on potential treatments. References: 1. T. Liyanage, T. Ninomiya, V. Jah, B. Neal, H. M. Patrice, I. Okpechi, M. H. Zhao, J. Lv, A. X. Garg, J. Knight, A. Rodgers, M. Gallagher, S. Kotwal, A. Cass, V. Perkovic. “Worldwide access to treatment for end-stage kidney disease: a systematic review.” Lancet. vol. 385, pp. 1975-1982, 2015. 2. United States Renal Data System. 2018 USRDS annual data report: Epidemiology of kidney disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2018. 3. A. M. Andrews, D. Jaron, D. G. Buerk, and K. A. Barbee. “Shear stress-induced NO production is dependent on ATP autocrine signaling and capacitative calcium entry.” Cell Mol Bioeng. vol. 7, no. 4, pp. 510-520, 2014. 4. F. Shang, S. Wang, C. Hsu, Y. Miao, M, Martin, Y. Yin, C. Wu, Y. Wang, G. Wu, S. Chien, H. Huang, D. Tarng, Y. Shiu, A. K. Cheung, P. Huang, Z. Chen, J. Y. J. Shyy. “MicroRNA92a mediates endothelial dysfunction in CKD.” J Am Soc Nephrol. vol. 28, pp.1-11, 2017. 5. Y. Miao, N. E. Ajami, T. Huang, F. Lin, C. Lou, Y. Wang, S. Li, J. Kang, H. Munkacsi, M. R. Maurya, S. Gupta, S. Chien, S. Subramaniam, Z. Chen. “Enhancer-associated long non- coding RNA LEENE regulates endothelial nitric oxide synthase and endothelial function.” Nat Commun. vol. 9, no. 292, pp. 1-13, 2018. University of Utah UNDERGRADUATE RESEARCH JOURNAL MAGNETIC RESONANCE GUIDED FOCUSED ULTRASOUND TO OPEN THE BLOOD-SPINAL CORD BARRIER AND GLIAL SCAR Riley Haag-Roeger, Allison Payne PhD. Department of Biomedical Engineering Abstract: Few methods currently prove effective in repairing a spinal cord injury (SCI) due to the inability to deliver therapeutics past the blood spinal cord barrier (BSCB) and glial scar. MRI guided focused ultrasound (MRgFUS) has been proven to effectively open the blood brain barrier (BBB) for chemical delivery, but few studies have been conducted quantifying the effect of MRgFUS on the opening of the BSCB and the glial scar that forms after injury. We sought to quantify the opening of the BSCB and glial scar in a rat injury model. To quantify opening, we compared contrast uptake at the site of injury/sonication, to a site 2 cm below that did not receive treatment. We found a significant increase in contrast uptake at the site of injury, which suggests that MRgFUS can open the BSCB and glial scar. However, there was not a significant increase in contrast uptake in rats with no SCI. This is most likely a result of the bone of the lamina and spinous process altering the ultrasound during the procedure. Our findings indicate the potential to use MRgFUS to increase access to the SCI, which may increase the effectiveness of drug and gene therapies. Fig. 1 Fig. 2 Fig. 1. MRI image of rat spinal cord overlaid with segmentation. The sonication and control regions are detailed by red and blue, respectively. Fig. 2. Contrast enhancement of the spinal cord for rats with SCI for both the HIFU and sham HIFU procedures. The rats receiving HIFU experienced an increase in contrast enhancement by 14.13% at the site of sonication in comparison to just 2.59% at the control site. ). For the sham HIFU procedure, an average contrast enhancement of 5.04% and 2.31% was measured at the sonication and control site respectively. All t-tests were performed with a significance level of α = 0.01. University of Utah UNDERGRADUATE RESEARCH JOURNAL LOW-COST SURFACE ELECTROMYOGRAPHY SLEEVE FOR QUICK AND REPEATABLE DECODING OF MOTOR INTENT Anna N. Harding1, Jacob A. George1, Tyler S. Davis, MD, PhD2, Michael D. Paskett1, Mark R. Brinton, PhD1, Spencer C. Iverson3, and Gregory A. Clark, PhD1 1 Department of Biomedical Engineering, 2Department of Neurosurgery, 3Department of Mechanical Engineering Abstract - Surface electromyography (sEMG) is a noninvasive way to decode motor intent for applications such as prosthetic control, virtual reality, and stroke / spinal cord rehabilitation. State-of-the-art methods of decoding motor intent used in myoelectric prostheses have limited capabilities, partially due to limited sEMG data. Furthermore, frequent changes in electrode alignment restrict the ability to reliably decode motor intent over an extended period of time. To address these challenges, we developed an easy-to-don, low-cost sleeve that can acquire robust and repeatable sEMG signals from 32 integrated electrodes. Coated brass snaps and grommets were embedded into a neoprene sleeve to serve as dry electrodes and placement markers, respectively. The sleeve is quick and easy to don: for five subjects, donning the sleeve was faster than a previous prototype (13.86 ± 9.67 s vs. 35.64 ± 19.0 s; p < 0.01; paired t-test) and orders of magnitude faster than current clinical approaches (~10–15 minutes). The sleeve was also rated as more comfortable to don (4.25 ± 1.05 vs 3.33 ± 0.65; p < 0.01; paired t-test). The high electrode density and consistent donning allow for high degree-of-freedom motor decodes that are stable over time. Signal-to-noise ratio and error in intended movement were comparable to a previous prototype, and cross-talk error was lower (RMSE 0.007 vs 0.014, p < 0.01; paired t-test), potentially due to reduced wire movement. Future work includes optimizing electrode positioning to maximize useful information or reduce electrode count and modifying the design to integrate with a prosthetic socket. University of Utah UNDERGRADUATE RESEARCH JOURNAL CHARACTERIZATION OF AN OPEN-SOURCE 3D-PRINTED ROBOTIC HAND Moriah Henning (Melynda Schreiber, M.S., Andrew Merryweather, PhD.) Department of Mechanical Engineering The goal of this study was to analyze the compatibility of a 3D-printed open-source robotic hand – specifically, the InMoov robot – with a brain computer interface (BCI) during activities of daily living (ADLs). In order to better understand the InMoov hand’s limitations and abilities, this study characterized the grasping movement of the InMoov hand with respect to its maximum fingertip and grasping force. A model of the index finger was created in MATLAB, and the maximum force provided by servos was calculated. Denavit-Hartenberg (DH) parameters were used to find the connection between links of a given finger joint length and range of joint angles found in SOLIDWORKS models. The InMoov arm was then 3D-printed and built to test actual fingertip and grip forces using force sensitive resistors (FSR) and to compare to the calculated force values. The results found an average 1N orthogonal force in the fingers, which differs from the 37N of orthogonal force calculated for the index finger. The average measured grip force of the InMoov hand was found to be insufficient for ADLs. The study concluded the InMoov hand is limited by a lack of tendons and abduction/adduction movement that is available in a human finger, but the addition of friction pads and adduction/abduction in all fingers may increase the InMoov hand’s ability to grip and perform ADLs. University of Utah UNDERGRADUATE RESEARCH JOURNAL DESIGN AND CONSTRUCTION OF A VASCULAR FLOW CIRCUIT FOR MAGNETIC RESONANCE IMAGING STUDIES David Jiang (Lucas H. Timmins) Department of Biomedical Engineering Cardiovascular disease (CVD) is the leading cause of death in the United States - approximately 840,000 deaths per year. Recent advancements in phase-contrast magnetic resonance (PCMR) imaging, which is a non-invasive, non-ionizing radiation-based imaging modality, now provide the ability to visualize and quantify the hemodynamics (i.e. blood flow patterns) in the human body. Given the known association between CVD and disturbed blood flow patterns, PCMR holds tremendous clinical value as a diagnostic and prognostic tool for functionally and structurally assessing the heart and great vessels. However, the continued use of PCMR imaging to evaluate hemodynamic-induced CVD requires rigorous, well-controlled experimental testing, and validation prior to clinical implementation. These improvements to PCMR are best performed in an experimental setting, without the need for human subjects, in order to refine the validity of PCMR-acquired hemodynamics for human use. The aim of our study was to design and construct an MRI-compatible flow circuit that subjects patient-specific arterial models to physiological fluid dynamic conditions in order to advance PCMR imaging. The flow circuit consisted of a positivedisplacement pump, controlled via a servomotor, to produce (output) a user-defined flow waveform. The pump was connected to the arterial models with PVC fiber-reinforced tubing filled with water. Real-time fluid dynamic measurements were acquired with an in-line ultrasonic flow meter and pressure transducer. All components were controlled via a data acquisition card connected to a laptop computer to simultaneously control the pump head rotation velocity, and acquired flow rate and pressure readings. Our research efforts have successfully manufactured a custom computer-controlled flow circuit, capable of accurately simulating a range of physiologically relevant waveforms with minimum cycle-to-cycle variation (Fig. 1). Our data showed that under steady flow conditions, the difference between the desired and measured flow waveform was 0.002 ± 0.013 L/min (p = 0.16), with maximum differences of 0.03 L/min. Furthermore, the difference in sinusoidal waveforms was 0.064 ± 0.082 L/min (p = 0.21), and the maximum difference was 0.25 L/min. A latency of 20 ms was observed between desired and measured sinusoidal flow waveforms. Finally, the difference in aortic flow waveforms was 0.018 ± 0.13 L/min (p < 0.05), with a maximum difference 0.61 L/min, and latency of 30 ms. The developed testing apparatus will allow for the robust analysis, validation, and subsequent improvement of current PCMRI imaging techniques Figure 1. Representative desired and measured A) steady, B) sinusoidal, and C) and processing for patient-level CVD risk-assessment aortic flow waveforms in an ideal flow circuit in the clinical setting. configuration. University of Utah UNDERGRADUATE RESEARCH JOURNAL DESIGNING FOR INTERACTIVITY: THE CAMERA IN 3D VIDEOGAMES Jackson Keller (Gabriel Olson) Department of Entertainment Arts and Engineering ABSTRACT This paper analyzes the effect that camera control has on art, design, and player experience in 3D video games. It will specifically explore the implications of various methods of camera control that have emerged during the brief history of 3D games: the first and third-person perspectives, fixed and filmic perspectives, abstract non-linear perspectives, and unique perspectives enabled by recent technological innovation, including Virtual and Augmented reality. TABLE OF CONTENTS ABSTRACT I INTRODUCTION 3 THE EMERGENCE OF 3D VIDEO GAMES 4 THE THIRD-PERSON PERSPECTIVE 9 ALTERNATE APPROACHES TO THE CAMERA: IMITATING FILM 14 THE NON-LINEAR PERSPECTIVE: EXPERIMENTAL ART AND SIMULATED CAMERAS 20 THE IMPLICATIONS OF INNOVATION: MODIFICATION OF EXISTING PERSPECTIVES 22 CONCLUSION 24 SPECIAL THANKS 25 WORKS CITED 26 ii INTRODUCTION Both games and film are audiovisual media. One understanding of the medium of games is as a form of interactive movie, descending from the legacy of film. While games are certainly their own art form (The 2011 Brown v. Entertainment Merchants Association Supreme Court decision gave video games first amendment protection as an art form), many games do contain filmic elements. However, interactivity i is central to the medium and generally takes precedence over aesthetic control. Most 3D games allow the player to control the camera, and the gameplay experience lacks the cinematographic precision of film. Designers craft levels to lead players towards game objectives, as well as composed aesthetic experiences when possible. Certain games take alternative approaches to the relationship between cameras and 3D art. Some games use the techniques of film entirely, while others explore non-linear perspectives of space that optical cameras cannot. Recent technological advances in Augmented and Virtual reality complicate the relationship between game cameras and player interaction with games. This paper aims to highlight the emergence of camera practices in games to understand the implications of each unique approach. It will explore the relationship between the camera, interactivity, and 3D art in video games through the examination of various genres, beginning with early first-person-shooter games in the 1990s. It will trace the progression of 3D games from this point onward, exploring genres that add a new understanding to the relationship between the camera and game art including the third-person perspective and the fixed cameras of traditional Survival Horror. Some other less prominent camera perspectives have also emerged. Abstract art games explore the use of non-linear perspective but find little footing due to the prominence of Physics-Based Rendering and linear perspective. Recent technologies including Augmented and Virtual reality, and procedural generation workflows may not create entirely new camera perspectives, but alter the effect of existing perspectives, marking them as another important area of analysis. Ideally, this work will create a formalized, foundational understanding of the effects of various camera types across 3D video games, which other researchers can then use to further explore the use and significance of cameras in specific games. Essentially, this work analyzes the tools available to developers to craft visual rhetoric: the emotions and information that each image in the game imparts. 3 THE EMERGENCE OF 3D VIDEO GAMES The 1993 release of id Software’s DOOM dramatically altered the field of video games. The game was both immensely popular and controversial. DOOM quickly became one of the most influential games of all time: it pioneered the First-Person Shooter (FPS) genre, established the grounds for the future successes of 3D games, popularized online multiplayer gaming, and marked PC gaming as an important platform for future development after the Golden Era of the Arcade in the 1980s (Anderson). DOOM also proved controversial, inciting debate about violence in videogames and its effect on players. In these respects, DOOM is a seminal text in the history of game development and game criticism. Quake, which id published in 1996, built upon DOOM’s foray into 3D space. In terms of 3D art in games, these early FPS games were revolutionary, allowing players to explore stylistically rich environments with both the freedom of interactivity and crafted artistic design, establishing the basis for the future of 3D video game art. DOOM was not the first 3D, first-person game. Steve Colley released Maze War in 1973, and id Software published Wolfenstein 3D in 1992. However, DOOM embraced 3D more fully, setting it apart from these other titles. It features textured environments rather than the vector graphics ii of Maze Wars. As in Wolfenstein, enemies and objects are represented with 2D image sprites rather than 3D polygonal meshes iii. Sprites rotate based on player and camera position, making them visible from any perspective. Unlike Wolfenstein, the environments of DOOM are dynamic and rich (Figure 1). The Moon base levels features sci-fi paneling, flashing lights, and the corpses of space marines. Hellscape levels feature pentagrams, upside down crosses, red mountains, and living, fleshy environments (Figure 2). This use of gritty, violent, and satanic imagery contributes to the game’s dark mood. This tone complements the game’s violent content, enabling art to reflect gameplay. Wolfenstein includes the same level of violence, but its drab, grey environments fail to create the same sense of atmosphere and cohesiveness. Additionally, DOOM’s environments are fully explorable and set a standard for 3D environments. The player has full control over the camera, so the environments must be appealing from multiple angles. Designers place objects throughout levels, so that no area appears dull or empty. Figure 1 - Evolution of Aesthetics from the vector graphics of Maze War, to the simple environments of Wolfenstein 3D, and finally the atmospheric setting of DOOM (Maze War and Wolfenstein images courtesy of Wikipedia). 4 Allowing player control of the camera also adds design challenges. Because developers cannot control the camera how a cinematographer would in film, they must use other methods to create aesthetically appealing shots. Consider the final boss battle of chapter 1 – “Knee Deep in the Dead.” As the player walks up the stairs to the final pentagram altar, two demons emerge from pillars framing either side of the shot. Here, the developers force the player into a crafted shot with a balanced composition (Figure 3). Windows in the game world allow developers to constrict player view, focusing player gaze on some element of the scenery. In the moon base, windows frame grey mountains, contributing to player understanding of the level’s setting (Figure 4). The extent to which designers and artists can control compositions is limited by the player’s control of the camera to some extent. It is hard to force players to follow the rule of Figure 2 - Moon Base and Hell environments in DOOM (Chapters 1 & 3 respectively). thirds iv, although placement of game objects may make it more likely that players do. In any case, levels are designed so that the potential for exquisite compositions exists. Some players even play photographer within games, seeking out balanced compositions and taking screenshots of them (Gilmour). The interactivity of video games has implications to art design beyond crafting aesthetic experiences. Designers must also make sure that the environment is readable and navigable by players. Sprites of dead bodies not only add to the tone of despair, but let the player know which areas they have already been through. Powerups, which provide the player with special abilities, mark progress in the level and orient players, leading them towards designed experiences. Figure 3 - Inevitable encounter with a level of compositional balance. While games, as a medium, allow for interactivity, the 3D exploration of DOOM elevated this interactivity by adding another dimension. DOOM involves more than beating the game—it 5 is also about exploring an environment in 3D space, finding secrets and designed aesthetic and mechanical experiences (Figure 5). In a market dominated by two-dimensional games, the added exploration of monumental 3D games like DOOM changed the nature of games. Indeed, 3D games with interactive environments are now standard. Not only was the market of games impacted, but also the process of development. 3D artistic assets must be viewable from any angle, and the process of making a 3D mesh differs greatly from making sprites. While DOOM’s answer to this challenge was rotating 2D sprites, its environment design set the foundation for future 3D games. Figure 4 - Window view. Figure 5 - A crafted aesthetic and gameplay experience at the beginning of “Knee Deep in the Dead.” The player emerges from a doorway to this visually composed scene. This design also provides gameplay satisfaction—shooting one barrel sets off a chain reaction, eliminating the demons. While DOOM only features horizontal camera movement, Quake introduces full vertical and horizontal camera rotation. This added verticality creates new gameplay experiences (like aiming up to shoot an enemy on a ledge) as well as new aesthetic opportunities. Assets can be seen from above and below. The ceiling, or sky, of the game takes on more importance, and design must shift accordingly to ensure that these assets also create fleshed-out environments. This change in design is immediately apparent upon beginning Quake. A dynamic, purple sky filled with clouds moves above. The ceiling features textured wooden planks (Figure 6). In this introductory sequence, the sky is one of the game’s most visually striking elements. Its appearance stands out, naturally drawing player vision, forcing use of the new camera mechanic. Quake’s verticality also introduces the ability to jump. Players may climb up ledges and through the environment, increasing avenues for exploration. 6 Figure 6 - Opening Tour de Force in Quake, demonstrating the game’s verticality. As in DOOM, Quake also features a rich 3D environment with a distinct style. Satanic imagery and demons permeate the game once more. Levels are littered with images of pentagrams and skulls. However, Quake’s aesthetic is gothic rather than sci-fi (Figure 7). Stone and wood replace flickering computer panels. Medieval knights, bloodhounds, and enemies wearing steel breastplates attack the player rather than the demons of Hell. Environments take the form of castles with drawbridges and towers, not the bloody, organic hellscapes and artificial labs of DOOM. Again, immersive levels with a clear tone are created through art style. Figure 7 - shots demonstrating elements of Quake’s medieval, gothic aesthetic. Quake’s use of true 3D objects instead of rotating sprites further demonstrates the evolution of 3D games since DOOM. Enemies and props are 3D meshes rather than rotating 2D sprites with multi-directional animation sets (Figure 8). Meshes behave as objects do in the real world, and the player’s perspective of an item or enemy depends on their view of the mesh rather than the rotation of a flat image plane. This true three-dimensionality is the basis for modern games, and a sharp departure from earlier 2D games. The use of 3D objects also allows for a greater level of realism. Player perspective of an object depends on position relative to that object. In DOOM, any in-game object appears the same from basically any angle. Enemies have 4 distinct animations depending on the cardinal direction they face, but the effect pales in comparison to actual 3D meshes seen from any angle. 7 Figure 8 - 2D sprites representing objects in DOOM compared to the 3D polygonal objects of Quake. The artistic evolution present in id Software’s early FPS games impacts these games on all levels. Mechanically, the exploration and open-endedness of these games takes on a new level of importance; challenges can be solved in three dimensions. Both DOOM and Quake established the foundation for interactive 3D videogames, in which the player controls the camera. These games demonstrated, early on, ways in which developers can create experiences of immersion, while maintaining the game’s elements of interactivity and exploration in a 3D space. Level design presents crafted shots to players. Doors that players must pass through open to designed shots with compositional balance. Quake’s 3D objects allow realistic viewing from any angle. In a market at the end of a Golden Era dominated by 2D games, 3D FPS games reinvigorated the medium and expanded possibilities for player interaction. Although these titles were not the first 3D games, they popularized 3D gaming at large, making 3D a lucrative avenue for future games in the 1990s. 8 THE THIRD-PERSON PERSPECTIVE id Software’s early FPS games paved the way for 3D, and other camera perspectives quickly emerged in 3D games. Many of these perspectives simply mirrored existing 2D perspectives such as top-down, side scrolling, or isometric v views. These games are essentially 2D games, and assets and levels are designed according to the already existing design patterns. Of course, the aesthetic effect of using 2D assets in a 3D space (sometimes called 2.5D) is distinct. Lighting can cast more realistic and dynamic shadows, and environments can create a greater perception of depth than in traditional 2D games. However, the design of the game and its art is essentially the same as that of a 2D game and is not contingent upon player control of the camera (Figure 9). Figure 9 – Never Alone (2014). A 2.5D game with 3D art that behaves as a 2D side scroller. While 2D cameras are outside of the scope of this paper, this image also highlights a common feature of most 2D side-scrollers. The player can see areas of the environment that the protagonist cannot, granting a greater situational awareness. Other games innovated upon the top-down approach common to 2D games, placing the camera outside of the player character in a similar perspective, while allowing players to rotate the camera around the player to see different parts of the environment. The third-person perspective was extremely popular in 3D platformers of the 1990’s. Games like Crash Bandicoot (1996), Spyro (1998), and Banjo Kazooie (1998) all used this perspective to their advantage. Because the third-person camera revolves around the player character, this character’s visual personality has a newfound importance. Most 3D platformers of this era capitalized on character personality, creating vibrantly-colored cartoon personas that players would enjoy looking at (Figure 10). These characters also have distinct and interesting silhouettes which read well from behind—the main angle the player will see their character from at any given moment. 9 Figure 10 – 3D third-person platformer box art, highlighting the cartoony, stylized main characters. Image courtesy of https://aminoapps.com/c/video-games/page/blog/25-game-grey-discuss-a-platform-genre-rarevival/lJSQ_uD6bRJ0mBV1VLDBeoBQPwV3rq. Aside from a focus on the player character, the implications to art and design presented by the third-person perspective are generally the same as those presented by the first-person perspective. In both viewpoints, designers must lead the player’s movement (and gaze) around a 3D environment that the players are largely free to explore. However, there are some minor differences between these camera styles. First-person games limit player views more than the third-person games. In a third-person game, players typically see at least some of the area around their character on all sides, including their rear. First-person games allow developers to surprise characters from behind to a greater extent than third-person games which provide greater situational awareness (Figure 11). This situational awareness is like what a player might experience in a 2D sidescroller. Generally, this affects level design more than art. Art for environmental assets in third-person games is fundamentally the same as third-person art, although generally the player sees it from further away allowing the level of detail to be potentially lower. The main differences between third-person games and first-person games emerge in the ways developers limit camera movement. In first-person games, movement of the camera generally does not provide problems. First-person games often allow the player to rotate in 360 degrees in all directions. If the camera is limited in any way, it is to prevent the player from looking all the way up or all the way down to avoid realizing that their character often has no rendered feet. In third-person games, giving players full freedom over the camera causes problems. Figure 11 – The same shot in The Elder Scrolls IV: Oblivion (2006) from the third and first-person perspectives. Notice how the third-person perspective allows the player to see the guard (glowing) behind them. Game designer John Nesky describes the importance of camera control when designing Journey (2012) in a Game Developer’s Conference (GDC) talk on camera design. Cameras in games “divert” player attention. Cameras, and the player’s interaction with those cameras, must lead players towards designed experiences. Nesky catalogues 50 mistakes made by camera 10 designers in third-person games. Among the mistakes to avoid: giving players complete control of the camera and breaking line of sight to the player avatar at a time that obstructs gameplay. Cameras must pivot around the player character and be controlled by the player, but they should also be intelligent. They should be able to move around the environment without requiring constant input from the player. Constantly controlling movement and the camera can be overwhelming for inexperienced and veteran players alike. Cameras also should never obstruct the player’s ability to navigate an environment. Furthermore, cameras need to pivot at times to lead the player. If a player has wandered for too long without making progress, a good game will pivot the camera towards an objective, guiding players. This gentle hinting allows for both player control and interaction with the game, and designer control of player’s movement. Again, these techniques allow designers to create designed and guided camera shots. At the same time, interactivity takes precedence over camera control in most third-person games. Nesky’s lecture highlights the importance of the balance between interactivity and guiding the player camera. Taking away control entirely should also be avoided. Instead, developers should hint and nudge the camera, but not prohibit the player from moving the camera back to any other perspective. Hints are useful, both to lost players and to designers creating crafted shots, but players should be able to ignore hints for the sake of interactivity and exploration (Nesky). Aside from these considerations, first-person games and third-person games are largely similar in how they lead the player towards designed experiences. Because both camera perspectives grant the player a large amount of control, designers and artists must ensure that player’s see designed experiences. This concept has been briefly explained in this paper’s section on id Software’s early FPS games which pioneered these techniques of player manipulation. However, the problem of controlling people’s eyes to present designed experiences is not limited to, nor originally from games. Consider the experience of visiting a theme park like Disneyland. These parks mimic the structure of movies, drawing directly on cinematic principles (Freitag 704). Disneyland heavily employs “visual framing” in rides to draw the eye in a way that simulates the effects of cameras in film (Freitag 708-709). Rides shift and spin, pointing spectator gaze at specific areas of attractions. Some games (like the traditional Survival Horror games explored later in this paper) control player vision in the same way, but the more interesting comparison between games and theme parks emerges in the area of the park in which a park-goer has freedom to explore. Even Disneyland’s “spatial organization” draws upon film (Freitag 714-715). The park is designed to present images to spectators. Visitors first walk down main street, captivated by the complex scenery and storefronts around them. The Disney castle acts as a focal point, and visitors are “drawn towards it” (Freitag 715). From the central plaza, each separate area of the park is presented as a “closed composition,” featuring a “tall central structure” that serves as an additional focal point and is surrounded by “smaller structures.” (Freitag 716). Here, the architectural and visual design of the park draws visitors towards sights with crafted compositions. Thus, the park draws people towards its most visually striking and memorable elements, while obscuring all that goes on behind-the-scenes (Figure 12). 11 Figure 12 – Disneyland map. Note how each section of the park has at least one central “tower” structure surrounded by smaller structures. Games use this same technique of designed layouts and focal points particularly well. Early third-person games struggled with the freedom of camera control and even popular titles like Banjo Kazooie have instances in which the camera clips through scenery in the game (Anderson). But now, game design generally draws player vision effectively. Many games even use the same technique directly employed by theme parks to indicate player destination. The Elder Scrolls IV: Oblivion (which can be played in either third or first-person, highlighting the similarity between the perspectives) places towers in the barren planes of oblivion to indicate player objectives (Figure 13). Games also use sound to effectively draw players. The distinct clicking noise produced by zombie-like “clicker” enemies in The Last of Us (2013) can push players towards designed aesthetic and gameplay experiences by making them avoid confrontation. Figure 13 – Towers in the Planes of Oblivion that serve as player objectives. Note how the towers are framed by smaller structures and rock outcroppings. Film, which acts as inspiration for both games and theme parks, has begun to incorporate some of these design tricks from games. Virtual Reality (VR) vi allows for true audience 12 interaction with the medium, to a formerly impossible extent. In VR movies, or “experiences,” viewers can control the camera, acting as a cinematographer. The viewer is both a creator of the experience and its spectator. Of course, the amount of control is again limited here. In a VR filmmaking guide, VR filmmaker Logan Dwight explains how “guiding action” can draw a viewer’s focus and attention to specific parts of the scene. Because the viewer has freedom to look where they want, “secondary” and “tertiary” action fills the rest of the scene to create a sense of immersion in the experience (Dwight). Dwight notes how these techniques are mastered in videogames using level design. VR filmmaking, and even theme parks, highlight the increasingly blurred boundaries between media. So, first-person and third-person camera perspectives are strikingly similar in terms of player experience in a game, and generally have the same implications to art and design. In both instances, developers must guide players through environments which are open to exploration. Generally, this is achieved through points of interest (POI) that draw player attention for a variety of reasons. POIs can be related to the mechanics and goals of the game (i.e. powerups that help the player), to aesthetics (such as the visual framing in Oblivion) or through sound cues and hints. In any case, this guidance can either be used as a tool to progress the game, or to showcase the game visually with a crafted shot. Minor differences emerge between these perspectives because of their focus. Especially in early third-person games, character art and design take on increased importance. Third-person views create greater situational awareness, but also give the player less camera control at certain times. As these camera perspectives and game genres developed, another meaningful camera perspective emerged in response to the clumsiness of many early third-person platformers. 13 ALTERNATE APPROACHES TO THE CAMERA: IMITATING FILM Video games invite players to create their own experience as they play. Both games and film are audiovisual art forms, but games introduce an element of interactivity that film lacks. Games require input and control—players alter the game’s outcome, and their experience of it, through participation. In film, cinematographers compose crafted shots to provoke emotion or convey information. Alternatively, many 3D games allow players to control the camera, making the creation of composed shots more difficult. Designers can make levels that lead players through the game, exposing them to crafted aesthetic experiences when possible, but some games draw directly from the techniques of cinema. Early Survival Horror games like Alone in the Dark (1992), Resident Evil (1996), and Silent Hill (1999) use fixed camera angles with cinematic compositions. Here, the term fixed refers to cameras that will behave in a fixed way, determined by the game designers. These cameras are not necessarily static and can move along a path. Because controlling a character from a limited vantage point proves difficult, this cinematic style, and traditional Survival Horror, has become largely obsolete. Regardless, Survival Horror is demonstrative of the appropriation of the techniques of cinematography in games. Many modern games like the Uncharted and Metal Gear Solid series utilize filmic techniques to a lesser extent, intermingling cinematic control with the interactivity that defines games. The Survival Horror genre flourished in an era in which games struggled to create fluid, intuitive controls. According to games journalist Jim Sterling, “fixed camera angles, dodgy controls and clunky combat were seen as problematic in most games, [but] the traditional Survival Horror took them as a positive boon.” (Sterling qtd. in Perron 110). The clumsiness of the games contributed to the fear and distress of the experience. Monsters encroached upon panicked players who couldn’t aim well enough to protect themselves (Figure 14). The ability to defend oneself easily would decrease the game’s tension. In this era, the medium of games struggled with another issue: the “representation gap” between games and film (Weise). Developers wished to make games with environments that were as aesthetically rich as film, and by mimicking filmic techniques, this goal became more attainable. The limitations of games in the 1990s and the goals of developers propelled the genre to success. 14 Figure 14 - A zombie, seen in the mirror, approaches the player early in the game. Here the clever placement of a mirror allows the player to understand the danger they face without being able to see it clearly-the environment is designed with the camera angle in mind. Survival Horror games most directly resemble film from use of fixed cameras; cinematic angles constrict and obscure the player’s view, allowing developers to hide scares (Figure 15). While cutscenes certainly contain cinematic elements, this influence appears in gameplay as well (Perron 79). In fact, the cameras of Survival Horror define gameplay. The sound of an offscreen danger, and the inability to see that danger, leaves players uncertain and afraid. In the Film Quarterly journal, UC Berkley Ph.D. candidate Irene Chien notes that as players progress, “the game viewpoint switches without warning from one fixed and limited vantage point to another [in a] cinema-style montage that can be awkward and jarring” (64-65). This awkwardness distresses the player further, while allowing designers to play the role of cinematographer, “confin[ing] players in dark, claustrophobic interiors” with the “restricted […] framing” of “horror cinema” (Chien 64). Shots have both the crafted composition of film and functionally convert “off-screen space [to an] out-of-reach source of dread and danger” (Chien 64). The framing of the games surrounds the player as much as its pressing environments. Both narrow hallways and narrow camera angles trap players in dangerous situations they cannot look away from. Yet this cinematographic control also allows for shots that shock the player with their aesthetic quality, creating a sense of discord between unexpected beauty and fear. 15 Figure 15 - A typical Survival Horror shot. This controlled upset and awe is rare in games. Restricted cameras contrast starkly with the “360- degree views of vast, exquisitely textured landscapes that are open for free-roaming exploration” of recent open-world 3D games (Chien 64). Survival Horror’s setting and framing encroach upon the player, evoking fear. The lack of grace the player experiences from being unable to control their view of the environment increases unease. Survival Horror elicits “intense automatic emotional responses from players” (Perron 114). A shot that obscures part of a room would usually annoy players, but in Survival Horror this shot, borrowed from film, suggests hidden danger to the player (Figure 16). Ultimately, the constrained, claustrophobic style of Survival Horror is almost antithetical to most 3D, exploration-focused games. Figure 16 - A wall obscures player vision, foreshadowing possible danger. The cinematic elements of these games extend beyond the use of camera angles and the compositions of shots and scenes. Visual noise in Silent Hill mimics the grain of film stock. In16 game lights produce lens flares (Perron 79-80). The author Bernard Perron even compares the game’s aesthetic to that of German Expressionism, in which the protagonist’s interior and mental state is mirrored by the environment and the presentation of it (85). The Survival Horror genre appropriates the conventions of film both through the composition of its shots, but also through the depiction of its environments and visual camera effects. While the inability to control a camera reduces interactivity, this design decision initially benefitted Survival Horror games. The filmic nature of Survival Horror earned the genre its positive reception (Perron 93). Its reliance on the authority of film established it as art in the eyes of critics. Even though early Survival Horror games relied heavily upon the language of cinema, they are still distinct as an art form. In 2002, the influential film magazine Cahiers du Cinéma, affirmed that videogames allow the “actor and the spectator” to be one and the same, something film cannot achieve. (Higuinen and Tesson qtd. in Perron 96). While film may involve a spectator intellectually, they can’t control its outcome or the framing of the film itself (except in the case of modern VR experiences). Additionally, games engage senses that film cannot. Controller vibrations allow for tactile stimulation, indicating damage to the player or a simulated “acceleration of the heartbeat” (Perron 108). The added sense of touch creates a greater level of immersion within a game. While games and film are both audiovisual media, the stereoscopic nature of sounds in games also increases immersion. As the player moves, sounds increase or decrease in volume depending upon their spatial relationship to the player (Perron 116). Survival horror depends upon film, but also engages with that legacy by exploring it through the interactivity of games. The initial success of the genre eventually dwindled. In the 90s, Survival Horror “was a formula for success … Restricted cameras caused players to fear every step they took, while characters that couldn’t hold a gun steady encouraged players to flee rather than fight.” (Sterling qtd. in Perron 110). The clumsiness of these games’ controls and restricted framing led to “chilling—or, for some gamers, frustrating—moments.” (Perron 84). Eventually this frustration won out over fear, leading to the genre’s demise. Intuitive control in other game genres (like third-person platformers) improved, and the market shifted towards games that harnessed this newfound ease of use. In the early 2000s, Survival Horror tried to follow suit, offering thirdperson over-the-shoulder camera views (Figure 17). “Yet this more responsive and intuitive” gameplay sacrificed the genre’s hallmark “disorientation and terror.” (Chien 65). These games no longer elicited the fear of earlier titles, playing like action games instead. The genre of Horror still plays an important role in the sphere of games, but the dependence of Survival Horror on fixed, cinematic cameras is gone. Figure 17 - Over-the-Shoulder view in Resident Evil 4 (2005). Image from Sterling: https://www.destructoid.com/howsurvival-horror-evolved-itself-intoextinction-114022.phtml. Most modern 3D games either take on a first-person perspective or a third-person over the shoulder perspective during gameplay. Game developers still employ the language of cinema 17 during cutscenes and even during specific portions of gameplay, but ease of control generally takes precedence over controlling player emotion and experience. Players, not designers, control the camera. Still, The Walking Dead (2012) and Heavy Rain (2010), both narrative driven games, employ a variety of camera angles and techniques from film. Because gameplay is not the central element of these games, the decreased precision of control generally does not impede player experience. Additionally, some action games, like Uncharted 3 (2011), remove player control of the camera at certain points in favor of the aesthetics of cinematic composition. As the player wanders through the desert, cuts demonstrate the passing of time, and one shot with a tracking camera reveals the vastness of the desert (Figure 18). These cinematic moments within the larger game “recreate what it feels like to be inside [the] cinematic world” without the downfalls of purely cinematic camera angles (Weise). The use of filmic techniques is widespread, from AAA to indie vii. Indie developer Blendo Game’s critically acclaimed Quadrilateral Cowboy uses several techniques from film including jump cuts and elliptical structures (Keller). Most modern games draw upon the legacy of film more subtly than traditional Survival Horror. “The dream of the interactive movie is still [alive], but [developers are] smarter about using … these conventions” (Weise). Games use the language of film, but do so sparingly, at specific times to evoke reactions. Rockstar Games’ more recent titles like Red Dead Redemption 2 (2018) even allow players to use first-person, third-person, and cinematic camera perspectives at any point (Figure 19) Figure 18 - Tracking shot in Chapter 18 of Uncharted 3 (2011). The camera zooms away from the protagonist, Nathan Drake, highlighting the danger he faces in the desert. Screenshot from https://www.youtube.com/watch?v=UNlpbfWeeE0. Ultimately, film provides games with a useful legacy and the opportunity to build upon an established art form. Survival Horror’s use of this legacy conferred respect upon the medium early on. Eventually, the medium grew out of the limitations and clumsiness of the genre. Horror games today are less filmic than their predecessors, but perhaps they still draw on the legacy of film tactfully and subtly. Rather than mimicking a horror film, games place the player in that film, and allow them to experience it from a new perspective. As an artistic style, and genre, Survival Horror forms an important section of the aesthetic history of videogames. Few genres demonstrate the same interconnection between film and games. The aesthetics of Survival 18 Horror depends upon the calculated control of cinematography, not harnessing the chaos of interactivity that is the hallmark of the medium, and the specialty of other third-person and firstperson titles. Figure 19 – Three shots from Red Dead Redemption 2 (2018) demonstrating the variety of camera perspectives available to players: First-person (top left), third-person (top right), and cinematic (bottom left). Before exploring some of the more novel camera perspectives in games, I would like to briefly mention visual rhetoric viiiin relation to the common camera perspectives already explored in this paper. According to game designer and academic Ian Bogost, “visual rhetoric is often at work in video games” (124). Games are a visual media, and therefore use the techniques of visual rhetoric to convey ideas. This paper aims to explore how cameras, and the tools available to game designers, can contribute to the visual rhetoric of a game rather than to explore the foundations of visual rhetoric itself. For instance, I have explored how a designer might create compositions in a game through level design and world-building, or through cinematic cameras. I have not, however, mentioned the emotional or intellectual impact of such a composition because this is out of the scope of this work (visual rhetoric encompasses a whole field of research). Instead, this paper explains the tools game designers can employ using various camera types to take advantage of visual rhetoric in their work. I have mentioned visual rhetoric because it is a necessary consideration when analyzing game cameras, and because it contributes to another key feature of games: procedural rhetoric. As visual rhetoric refers to persuasive (or communicative) use of imagery, procedural rhetoric refers to “the practice of using processes persuasively” (Bogost 125). Essentially, the use of gameplay for the sake of an argument. Bogost argues that the gameplay of a game like America’s Army: Operations (2002), which closely simulates real-life military experience, communicates the importance of the “chain of command” in the military, as well as the importance of values like honor and discipline. The gameplay offers an “an incomplete, yet embodied experience” of life in the US military. I would also argue that the first-person camera perspective of the game further places players in the shoes of a soldier. Essentially, the game’s visual rhetoric reinforces, and contributes to, its procedural rhetoric. Again, any deep exploration of procedural or visual rhetoric is not within the realm of this paper, but I thought it necessary to mention these core elements of games briefly due to their intimate relationship with game cameras and camera perspectives. 19 THE NON-LINEAR PERSPECTIVE: EXPERIMENTAL ART AND SIMULATED CAMERAS Returning from that detour to the core investigation of this paper: game designers generally use cameras in conjunction with games’ interactivity to create a medium which draws from film but is simultaneously unique. Alternatively, some games use the camera to draw upon other art forms. Game developers see the relationship between cinema and games as “fruitful” and able to push the medium to explore “new directions” (Weise). This relationship allows developers to use the language of games, interactivity, “to recreate what it feels like to be inside [the] cinematic world [of a movie]” (Weise). However, this relationship is not required, nor inherent to games. The camera in videogames is simulated, and therefore need not restrict itself to the constraints of physical reality faced by an optical camera (Thomas and Haussmann). Games can explore non-linear perspectives ix that cinema cannot, just as movements like cubism explored facets of artistic expression that realism (or photography) could not (Thomas and Haussmann 3). Essentially, game cameras can explore our perceptions of space, drawing upon inspiration from media like painting. Game developers David Thomas and Gary Haussmann outline the potential games have for exploring nonlinear space. Traditionally 2D games like Asteroids (1979) present perspectives that would be impossible in any medium using real cameras. Because the screen wraps from top to bottom and left to right allowing player to move out of the screen on one side and back onto it in another, the space explored in Asteroids must be a torus x (Thomas and Haussmann 5). But this space is presented as a flat rectangle, meaning the camera can view all sides of a torus in a way which no real camera could. 3D games have the same potential. The Bug Eye Project, made by the paper’s authors, was meant to explore these possibilities. Unfortunately, the experiment was short-lived and is no longer around due to the difficulty of working in 3D game engines xi and systems designed around linear perspective (Thomas and Haussmann 7). Games have long strived towards realism in terms of graphical fidelity and realistic perspective. Certainly, games have explored stylized graphics with exaggerated forms, lighting, and materials, but these games still rely upon linear perspective (Figure 20). Increasingly, game technology supports this perspective. Innovations like Physics-Based-Rendering (PBR) xii and real-time raytracing xiii depend upon the assumption of linear perspective. Figure 20 – Realism in Call of Duty: Black Ops 4 (2018) contrasted with the stylization of Overwatch (2016). Both games are first-person shooters, but their art styles are entirely distinct. Nonetheless, both games use linear perspective. Black ops 4 image courtesy of Forbes. While non-linear camera perspectives highlight an interesting opportunity for the future of games, only a few games, to my knowledge, explore the use of such a perspective. Perhaps the reluctance to create experimental games with non-linear perspective stems from the relationship between cameras and interactivity in the medium at large. Games are built for player interaction, and humans understand and interact with the world using the linear perspective that our eyes 20 present to us. Therefore, creating interactive games requires a system that allows for human engagement. While the level of control over the camera varies from game to game and genre to genre, all games must present the world so that the player may navigate it. The aesthetic elements of games, whether stylized are not, are designed with the assumption of linear perspective, allowing for easy interaction. However, some recent puzzle games explore unique uses of the camera. For instance, the winner of the 2019 Intel University Games Showcase award for innovation, Moncage (2019), revolves entirely around camera perspectives. The game (self-reflexively) begins with a camera inside a cube-shaped cage. As the player progresses, each face of the cube becomes a window (or a camera) into a new environment. Moving the game’s camera around each face of the cube will change the angle from which the player can see into each scene. To solve puzzles, the player must match up objects from various scenes, connecting the spaces between them (Figure 21). Here, the game employs multiple cameras that go beyond a linear understanding of space. Each camera provides a linear perspective into a scene, but also connects the scenes to one another. Monument Valley (2014) employs a stationary, isometric camera, but the physical space of the game takes advantage of Escher-esque optical illusions that could not exist in a linear space. It is no coincidence that both these titles are puzzle games. They challenge our understanding of space in a way that would hamper gameplay in most other genres. While the medium of games has not yet progressed towards abstract camera perspectives at large, other recent technological innovations present noteworthy implications to camera design. Figure 21 – Moncage - left: Here the player must connect images from 3 separate cameras to allow the machinery to function. Monument Valley - right: An optical illusion in the vein of M.C. Escher. (screenshot from Polygon.com) 21 THE IMPLICATIONS OF INNOVATION: MODIFICATION OF EXISTING PERSPECTIVES New technology and design workflows introduce new considerations into the interaction between art and control in games. New camera perspectives like Augmented Reality (AR) xiv require designers to create games and art considering their interaction with the real world. Even VR, which many consider an extreme version of the first-person perspective, has important implications to game art and design. Some research suggests that the intense immersion of VR creates greater player impact, requiring the intense experience of some games to be toned-down to prevent player harm (Madary and Metzinger). Procedural Generation xv requires careful monitoring over player control of the camera to create detailed environments when the player is not looking. In the context of AR, the most important consideration is the presence of real-world objects. In terms of art and design, the implications of real objects depend on the goals of the project. If the goal is to create realistic gameplay experiences, then objects and textures should follow the styles of realism. Alternatively, stylized assets can create novel experiences that make the world more exciting. In Apple’s guidelines for AR developers, they acknowledge that not all AR experiences “require realistic virtual objects,” but those that try to create “convincing illusions” should contain “detailed 3D assets with lifelike textures.” Additionally, these assets should reflect environmental lighting and cast virtual shadows on real world objects (Apple). Stylized games like Pokémon Go (2016) have been wildly successful without this realism because they place beloved characters and creatures within the real world, while encouraging explorative and social gameplay. Essentially the novelty of seeing Pokémon in the real world contributes to a compelling experience made possible through AR. Apple also outlines several other design guidelines for developers that further reveal some of this “perspective’s” implications. AR requires an open space to play in, sufficient lighting, and flat surfaces to place game objects on. Players will often play in suboptimal environments, requiring developers to come up with solutions to these anticipated problems. For instance, if a user tries to play in an area without enough lighting, developers should give the users a simple message that they need to turn on more lights (Apple). Apple’s guidelines offer various other suggestions about creating intuitive and immersive experiences, but perhaps the most salient implication of AR as a camera perspective comes from the way users control the camera. Users directly manipulate their viewing device (be it a HMDv like the Microsoft HoloLens, or mobile phone), moving the camera around the environment physically. Ultimately, the intuitiveness of AR experiences stems from ease of controlling the camera. To see an object more closely, the player need only move closer to the object. To see something from a new angle, the player simply moves around. VR is like AR in terms of ease of camera control. To change the camera perspective, players need only look around as they do in the real world. However, the extreme levels of immersion created by VR may have serious implications. Jeremy Bailenson, the director of the Stanford Virtual Human Interaction Lab has researched the uses and effects of VR since it has been available commercially (Nintendo released the Virtual Boy in 1995). His suggestions for using VR: “VR can be stored in the brain's memory center in ways that are strikingly similar to real-world physical experiences … If it's an activity that you're ethically not comfortable with in real life, don't do it. If you think of it that way, the guidelines on what you want to do in VR become very clear” (Bailenson qtd. in LaMotte). Of course, one might argue that on the higher level of reason and logical thinking, users in a VR experience know what they are experiencing is not real. Scott Stephan, a VR designer, provides an interesting understanding of VR horror games that may serve as a counterargument to this point: “The way I process these scares is not through the eyes of a person using their critical media-viewing faculty but through the eyes of I, 22 the self, with all of the very human, systems-level, subconscious voodoo that comes along with that” (qtd. in Parkin). So perhaps VR affects us on a deeper level than that of conscious reasoning. In fact, research done at various other labs may indicate that VR experiences even blur our understanding of the boundaries between the self and the other, and muddle our understanding of our own agency (Twilley). The ethical and psychological implications of VR have even led a team of German researchers to compile a near comprehensive set of guidelines to using VR that addresses developers, researchers, and consumers (Madary and Metzinger). The product warning for Google’s Daydream view headset warns users that “If the [VR] content is frightening, violent, or anxiety provoking, it can cause your body to react physically, including increasing your heart rate and blood pressure. It can also, in some individuals, cause psychological reactions, including anxiety, fear, or even Post Traumatic Stress Disorder” (qtd. in LaMotte). Many VR headsets also include suggestions to not allow children under a certain age to explore VR. Alternatively, VR has been used for many positive applications in the field of psychology since its inception. Researchers have used VR for Exposure Therapy xvi treating PTSD and phobias (“Bravemind”, “Virtual Reality Therapy for Phobias”). It has been used to increase empathy and self-esteem (Twilley). VR may be particularly beneficial for anxiety treatment and pain management (Jerdan et al.). Ultimately, addressing all the psychological effects of VR is not within the scope of this work. But considering that VR may have different effects for players than traditional video games will be important for both designers and consumers of VR technology in the future. Procedural generation is not a modification of any existing camera perspective, but as a technology and workflow, it requires designers to consider new elements. Looking at Minecraft (2009), worlds are procedurally generated before the player steps foot in them. However, enemies spawn in areas of low light. The spawning of enemies must occur outside of the player line of sight to maintain a sense of immersion. This requires that the game track the player camera and respond accordingly. Looking further into procedural generation, the Endurance downloadable content xvii (DLC) for Rise of the Tomb Raider (2015) also tracks the player camera to generate a world as the player plays, creating a unique gameplay experience every playthrough. However, procedurally generated games often lack the same handcrafted element that comes from other games. To combat this randomness, developers using procedural generation insert specific handcrafted elements into the environment, allowing for a greater degree of environmental storytelling and emergent narrative. In Endurance, the game uses a “vignette system” to track player stats. Based on whether a player needs help or is doing quite well and needs some sort of roadblock, the game spawns “vignette” assets that affect player experience by providing supplies or acting as a source of danger. As in Minecraft, spawning of these assets must occur outside of player vision, but also cannot occur where the player has already been to maintain a sense of immersion. Based on user research conducted by the Endurance team, players would typically explore their environments in a spiral. This allowed designers to place these “vignettes” out of the player’s vision, in an area where the player had not been, that they would likely find (Thayer). These design considerations, and their implications to the game camera, will likely become more prominent as game developers continue to refine procedural generation. 23 CONCLUSION Game cameras, and player control of them, deeply affects the way players experience a game and the way designers create the game and assets within it. Although many 3D games grant players freedom of control over the camera, developers design worlds and spaces to lead players. Developers often draw upon other forms like film, creating crafted compositions despite the freedom of interactivity granted to the player. The exploration of the purpose and use of 3D cameras began, at a large scale, in the 1990s with the emergence of first-person shooters, thirdperson platformers, and games which used fixed cameras like Survival Horror. Even now, developers continue to explore new ways to use the camera to create unique aesthetic and mechanical experiences. The idea of abstract, non-linear games is alluring, albeit complex and difficult. New technologies and workflows mirror earlier camera perspectives and techniques with greatly different effects. AR blurs boundaries between reality and games by using real cameras to place games in our world. VR creates previously impossible levels of immersion, presenting positive benefits and potential dangers. Procedural generation workflows require additional monitoring of player use of the camera to create immersive environments. Aside from exploring new camera perspectives, developers also continue to refine the techniques for camera control, aiming to preserve player interaction as well as a level of control over design. First-person and third-person games are still predominant perspectives in the market of 3D games. Although developers have improved camera techniques over decades and continue to do so, these principles are only now being formally investigated and described. Indeed, many of the observations and analyses of camera perspectives within this work are not groundbreaking. This paper simply aims to explicitly articulate the implications of camera perspectives within games. The scholarly exploration of “gamatography” is still in its early stages in terms of an explicit and formalized understanding of the purpose of game cameras (Nesky). This paper highlights the difference in gamatography among various camera perspectives from gaming’s relatively brief history. Hopefully, this work can serve as a foundation for other game developers and academics to further explore gamatography in specific games, or to explore uses of visual rhetoric that are unique to the medium of games. This paper should also grant developers a greater awareness of how they use cameras in their own games. This increased awareness of camera function will enable designers to take advantage of opportunities to create crafted aesthetic compositions, if they are not already doing so. Any time a player emerges from a choke point, like a doorway they must pass through, designers can reasonably predict the player will be moving and facing forward. Designers who read this work should recognize this opportunity to craft a shot, and hopefully consider what the visual rhetoric of that shot conveys, as well as the interaction between visual rhetoric and procedural rhetoric. For instance, a designer for a new Doom title might use this opportunity to create a jarring composition that complements the fast-paced action and destruction of the series by challenging typical notions of aesthetic value. Furthermore, considering the implications of camera design in emerging platforms like AR will be extremely important, because standards for AR design are not fully-formed. 24 SPECIAL THANKS Alisha Thayer, for allowing me to reference your lecture on the vignette system in Rise of the Tomb Raider: Endurance. Andrew Phelps Ph.D., for the research suggestions of other interactive forms which also guide a viewer’s eye. Connie Wilkerson, for the assistance in finding a mentor and figuring out the Thesis process. Dong Zhou and Yijia Chen, for letting me write about Moncage while it is still in development. Gabe Olson, for mentorship. Matthew Anderson, for teaching me about the history of video games and their development. Michael Gills Ph.D., for making me a better writer. Roger Altizer Ph.D., for the guidance in finding a meaningful topic. 25 WORKS CITED Alone in the Dark. Infogrames Entertainment SA. 1992. America’s Army: Operations. United States Army. 2002. Anderson, Matthew. "Video Games History." Intro to Video Games Course, Nov. 2017, University of Utah, Salt Lake City. Lecture. Asteroids. Atari. 1979. "Augmented Reality." Human Interface Guidelines, Apple, developer.apple.com/design/humaninterface-guidelines/ios/system-capabilities/augmented-reality/. Accessed 6 Feb. 2019. Banjo Kazooie. Rare. 1998. Bogost, Ian. “The Rhetoric of Video Games." The Ecology of Games: Connecting Youth, Games, and Learning. Edited by Katie Salen. The John D. and Catherine T. MacArthur Foundation Series on Digital Media and Learning. Cambridge, MA: The MIT Press, 2008. 117–140. doi: 10.1162/dmal.9780262693646.117 "Bravemind." Medical Virtual Reality, USC Institute for Creative Technologies, medvr.ict.usc.edu/projects/bravemind/. Accessed 6 Feb. 2019. Call of Duty Black Ops 4. Treyarch. 2018. Chien, Irene. “Playing Undead.” Film Quarterly, vol. 61, no. 2, 2007, pp. 64–65. JSTOR, JSTOR, www.jstor.org/stable/10.1525/fq.2007.61.2.64. Crash Bandicoot. Naughty Dog. 1996. DOOM. id Software. Ultimate Doom Version. 1993. Dwight, Logan. "These VR Film Tips Show How To Direct Audience Attention." UploadVR, July 2016, uploadvr.com/vr-film-tips-guiding-attention/. Accessed 2 Dec. 2018. Freitag, Florian. "“Like Walking into a Movie”: Intermedial Relations between Theme Parks and Movies." The Journal of Popular Culture 50.4 (2017): 704-22. Print. Gilmour, David. "The Art of Video Game Photography." Motherboard, 18 July 2015. Vice, motherboard.vice.com/en_us/article/8qxpp4/the-art-of-video-game-photography. Accessed 6 Feb. 2019. Heavy Rain. Quantic Dream. 2010 Jerdan, Shaun W et al. “Head-Mounted Virtual Reality and Mental Health: Critical Review of Current Research” JMIR serious games vol. 6,3 e14. 6 Jul. 2018, doi:10.2196/games.9226 Keller, Jackson. "Hacking, Heists, and Humanity." 2 May 2017. Exposure, jacksonkeller.exposure.co/hacking-heists-and-humanity. Accessed 2 Dec. 2018. Manuscript. LaMotte, Sandee. "The Very Real Health Dangers of Virtual Reality." CNN, 13 Dec. 2017, www.cnn.com/2017/12/13/health/virtual-reality-vr-dangers-safety/index.html. Accessed 6 Feb. 2019. Madary, Michael, and Thomas K. Metzinger. "Real Virtuality: A Code of Ethical Conduct. Recommendations for Good Scientific Practice and the Consumers of VrTechnology." Frontiers in Robotics and AI 3.3 (2016). Print. Maze War. Steve Colley, Greg Thompson, and Howard Palmer. 1973. Minecraft. Mojang. 2009. Moncage. Dong Zhou and Yijia Chen. 2019. Monument Valley. Ustwo Games. 2014. Nesky, John. "50 Game Camera Mistakes." 2014. GDC Vault, UBM Tech, gdcvaultcom.ezproxy.lib.utah.edu/play/1020460/50-Camera. Accessed 24 Nov. 2018. Lecture. Never Alone. Upper One Games. 2014. Overwatch. Blizzard Entertainment. 2016. 26 Parkin, Simon. "The Coming Horror of Virtual Reality." The New Yorker, 15 May 2016, www.newyorker.com/tech/annals-of-technology/the-coming-horror-of-virtual-reality. Accessed 6 Feb. 2019. Perron, Bernard. Silent Hill: The Terror Engine, University of Michigan Press, Ann Arbor, 2012, pp. 65–125. JSTOR, www.jstor.org/stable/j.ctv65swb6.8. Pokémon Go. Niantic Inc, The Pokémon Company. 2016. Quake. id Software. 1996. Red Dead Redemption 2. Rockstar Games. 2018. Resident Evil. Capcom. 2015 Remastered version. 1996. Rise of the Tomb Raider: Endurance Mode. Crystal Dynamics. 2015. Silent Hill. Konami. 1999. Spyro. Insomniac Games. 1998. Thayer, Alisha. "Leave (Some Of) It to Chance: Insights on Replay in Tomb Raider." Entertainment Arts and Engineering Lecture Series, 27 Sept. 2018, University of Utah, Salt Lake City. Lecture. The Elder Scrolls IV: Oblivion. Bethesda. 2006. The Last of Us. Naughty Dog. 2013. The Walking Dead. Telltale Games. 2012 Thomas, David, and Gary Haussmann. "Cinematic Camera as Videogame Cliché." DiGRA 2005 Conference: Changing Views – Worlds in Play, PDF ed., 2005. Twilley, Nicola. "This Is Your Avatar Speaking." The New Yorker, 20 Feb. 2015, www.newyorker.com/tech/annals-of-technology/virtual-reality-avatar-speaking. Accessed 6 Feb. 2019. Uncharted 3. Naughty Dog. 2011 United States, Supreme Court. Brown v. ENTERTAINMENT MERCHANTS ASSN. United States Reports, vol. 564, 26 June 2011, p. 786. Justia, supreme.justia.com/cases/federal/us/564/786/. Accessed 6 Feb. 2019. "Virtual Reality Therapy for Phobias." Duke Psychiatry and Behavioral Sciences, Duke University School of Medicine, psychiatry.duke.edu/virtual-reality-therapy-phobias. Accessed 6 Feb. 2019. Weise, Matthew. "Cinematic Games Are Dead! Long Live Cinematic Games!" Mar. 2015. GDC Vault, UBM Tech, 2015, gdcvault-com.ezproxy.lib.utah.edu/play/1021857/CinematicGames-Are-Dead-Long. Accessed 27 Oct. 2018. Lecture. Wolfenstein 3D. id Software. 1992. 27 i Interactivity - When referring to interactivity in this paper, I refer to direct involvement of the spectator in the creation of the game. Player interaction with the game largely determines their experience of it. Other media arguably feature interaction as well, and artists have long investigated the question of spectator involvement in the creation of an artistic experience. Readers create an understanding of a text based on experience and knowledge. Someone watching a film performs the same construction of a narrative. In games, this interaction is more explicit because players influence the form itself. What is played depends on the player, as well as the player’s interpretation of the played content. Games have an added level of interactivity that other media generally lack, and I refer to this specifically with the term interactivity. ii Vector Graphics – 2D graphics defined by the connection of vertices in 2D space. iii Sprites and Meshes – Sprites are computer graphics that may be manipulated as a single entity (Google). 3D Meshes are composed of a network of interconnected vertices in 3D space creating a mesh. This is how 3D models exist in videogames. iv Rule of thirds – One of the basic guidelines for composition. Typically, a frame is divided horizontally and vertically into thirds. Subjects should be placed at the intersection between these dividing lines, or along the lines themselves. v 2D game views – Top-down is as it sounds. Side scrolling cameras follow the player character from a side view, and do not rotate. The Isometric perspective preserves equal proportions between the X,Y, and Z axes of 3D space, creating the illusion of 3D, however this does not allow for linear perspective and is an impossible perspective in the real world. vi Virtual Reality - Total immersion of a user in virtual space. Usually through a Head-MountedDisplay (HMD) consisting of goggles and headphones. vii AAA and Indie – AAA (pronounced “triple-A”) is a designation within the industry indicating games with the highest budgets and marketing. These are made by large, studio teams. Alternatively, Indie games are made by (usually) small, lower-budget teams, and are published by the developer, rather than a games publisher. viii Visual Rhetoric – The “figures and forms” of expression in visual media (Bogost 124). Just as the art of rhetoric serves as a means of understanding written and verbal communication (that uses words), visual rhetoric is the understanding of visual media (that uses images and scenes). For instance, certain compositions or camera shots have emotional significance. A shot below a subject might make the subject appear more powerful, whereas a shot from above might make the subject appear weaker. In games, a gigantic boss (a common trope) forces the player to look up, therefore the composition imparts the power and strength of a formidable enemy. This communication of emotions and ideas through camera angles and composition is a basic example of visual rhetoric at work. ix Linear Perspective - a type of perspective used by artists in which the relative size, shape, and position of objects are determined by drawn or imagined lines converging at a point on the horizon (Google). This perspective mimics our perception of the real world. x Torus – a 3D primitive shape resembling a ring. Refer to the figures from Thomas and Haussmann to understand their explanation of Asteroids game space: 28 xi Game Engines – Software tools that facilitate the creation of video games. Physics-Based Rendering - Rendering computer graphics using simulations of real-world physical properties. xiii Real-Time Raytracing - A recent innovation in computer graphics that allows for detailed light simulation in real-time. Ray-tracing simulates the emission of light particles from a light source as well as how they bounce around the environment. This technique creates realistic light and shadow but is quite computationally intensive. The ability to use raytracing in real-time as opposed to only in pre-rendered scenes will allow for extremely realistic lighting in videogames. xiv Augmented Reality - Games which superimpose game content on the real world. xv Procedural Generation – the creation of games and content through automated, programmed systems. xvi Exposure Therapy – A technique for reducing negative responses to stimuli. Typically, a patient is gradually exposed to the anxiety-producing stimuli in a safe environment. This technique aims to decouple the negative response from the stimuli. xvii Downloadable Content – Additional content that is added to a released game. These can often be purchased for an additional cost and can range from cosmetic items to new gameplay experiences. xii 29 University of Utah UNDERGRADUATE RESEARCH JOURNAL AUTOMATED WATER DRONE DEVELOPMENT FOR HEAVY METAL CONTAMINATES DETECTION Alexandros Koloveas, Hannah Jelinne Gay (Swomitra Kumar Mohanty) Department of Chemical Engineering Water is a crucial resource, not only is it used for drinking but also for recreation, power generation, and it is an environmental necessity. Water contamination can arise as a side effect from industrial processes or an extreme natural phenomenon. Contaminations must be treated quickly or risk permanent environmental damage. However not only is the process for sending out surveyors to canvas the contaminated region time consuming, the waiting period for the many water sample results can also be extremely long. The objective of this project is to develop a low-cost autonomous water drone with integrated sensors to sample bodies of water for potential contaminants such as those produced in an algae bloom. Once they have been detected proper clean up can commence before a situation occurs. It will eliminate wait time, be able to perform multiple tests in a short amount of time, create high resolution data, give rapid responses to environmental changes, and find contamination source allowing for easier and faster clean ups. Chemically treated paper sensors known as colorimetric sensors will be attached onto the surface water drone where a color changing chemical reaction will trigger on contact with the specified contaminate. For better detection underwater samples have higher concentrations of contaminates which lead to the development of a submarine drone. The submarine has a Raspberry Pi to control the drone, a battery source to power the drone’s attachments, and sending data back from the drone. It takes advantage of CO2 cartridges to change its buoyancy to submerge and resurface. It has more room for sample collection and different types of sensors can be used with it. Characterization of the Hematopoietic Stem Cell Microenvironment 1 University of Utah UNDERGRADUATE RESEARCH JOURNAL CHARACTERIZATION OF THE HEMATOPOIETIC STEM CELL MICROENVIRONMENT: UNDERSTANDING THE ROLE OF THE EXTRACELLULAR MATRIX Jenna Langford, Tara Deans, PhD Department of Biomedical Engineering Hematopoietic stem cells (HSCs) are the stem cells of the bone marrow that proliferate to make the majority of blood cell types, including leukemic blood cells. HSCs are difficult to grow in vitro, but better HSC cultures could lead to therapies for abnormal HSC proliferation diseases such as leukemia. Hematopoiesis is the process whereby HSCs proliferate and differentiate to maintain appropriate levels of blood and immune cells. Understanding what influences hematopoiesis would allow for advancements in growing HSCs in vitro. However, it is not currently well understood what factors directly impact hematopoiesis [3]. We are interested in identifying the roles of the extracellular matrix (ECM) and its associated proteins in the bone marrow microenvironment. The HSC microenvironment is most directly influenced by the interplay of localized niches, which are heterogenous populations of cells that organize into functionally distinct regions in the bone marrow [2]. These regions signal to HSCs and guide progenitors for renewal, proliferation, and localization [1]. ECM molecules play an integral role in composing niches. Studies have shown that ECM within the niche can mediate functions of hematopoiesis [4]. Determining which components of the ECM are essential to the microenvironment is fundamental to understanding hematopoiesis and creating an effective HSC culture in vitro. Characterization of the Hematopoietic Stem Cell Microenvironment The Hematopoietic Stem Cell Niche, in Watercolor. 2 Characterization of the Hematopoietic Stem Cell Microenvironment 3 REFERENCES [1] Calvi LM, Link DC. (2015, Jul.). The hematopoietic stem cell niche in homeostasis and disease. Blood. [Online]. 126(22), pp. 2443-2451. Available: http://www.bloodjournal.org/content/126/22/2443 [2] Lo Celso C, Fleming H, Wu J. (2009, Jan). Live-animal tracking of individual haematopoietic stem/progenitor cells in their niche. Nature [Online]. 457 (7225), pp. 9296. Available: https://www.nature.com/articles/nature07434 [3] Sarkaria S, Decker M, Ding L. (2018, Mar.). Bone Marrow Micro-Environment in Normal and Deranged Hematopoiesis: Opportunities for Regenerative Medicine and Therapies. BioEssays [Online]. 40(3). Available: https://onlinelibrary.wiley.com/doi/abs/10.1002/bies.201700190 [4] Muth C, Steinl C, Klein G, Lee-Thedieck C. (2013, Feb.). Regulation of Hematopoietic Stem Cell Behavior by the Nanostructured Presentation of Extracellular Matrix Components. PLOS ONE [Online]. 8(2),e54778. Available: https://doi.org/10.1371/journal.pone.0054778 University of Utah UNDERGRADUATE RESEARCH JOURNAL EXTENDING SUPPORT FOR FLOATING-POINTS IN THE BOOGIE AND SMACK SOFTWARE VERIFIERS Liam Machado (Advised by Zvonimir Rakamarić) School of Computing ABSTRACT Software verification, which aims to prove critical properties about programs using rigorous formal methods based on logic, is an active area of research in the field of computer science. In particular, the verification of floating-points is a topic of paramount importance, given their ubiquity across a wide range of software, including video games, OS kernels, medical devices, and rockets. Several years ago, floating-point support was added to the Boogie verifier, a tool that is widely used by researchers in both industry and academia. In this thesis, I present the expansion of Boogie’s original implementation to support rounding modes, an updated syntax for floating-point constants, and the fixing of various bugs, among other changes. I also present the addition of support for the math.h functions in the SMACK toolchain, which utilized Boogie’s updated implementation in order to do so. Finally, I compare the performance of the updated implementation against other competitive verification tools on a comprehensive set of floating-point benchmarks. ii CONTENTS ABSTRACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ii LIST OF FIGURES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iv LIST OF TABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v ACKNOWLEDGEMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vi 1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2 BACKGROUND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.1 Boogie . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.2 SMACK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.3 Existing Floating-Point Support in Boogie . . . . . . . . . . . . . . . . . . . 3 3 3 3 3 ENHANCING SUPPORT FOR FLOATING-POINTS . . . . . . . . . . . . . . . 3.1 Correct Types Returned for Floating-Point Expressions . . . . . . . . . . . . 3.2 Valid Programs Passed to Corral . . . . . . . . . . . . . . . . . . . . . . . . 3.3 Redesign of Floating-Point Constants . . . . . . . . . . . . . . . . . . . . . . 3.3.1 No Synonyms for Special Values . . . . . . . . . . . . . . . . . . . . . 3.3.2 Readable Mantissa and Exponent . . . . . . . . . . . . . . . . . . . . 3.3.3 Unnormalized Significand . . . . . . . . . . . . . . . . . . . . . . . . 3.4 Updated Constant Syntax . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.5 Rounding Mode Support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.5.1 Using a Rounding Mode with ”builtin” Functions . . . . . . . . . . . 3.6 Code Reorganization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 9 9 10 10 10 11 12 12 13 14 4 APPLICATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.1 SMACK Support for math.h Functions . . . . . . . . . . . . . . . . . . . . . 4.1.1 Regressions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.2 SMACK Support for Rounding Modes . . . . . . . . . . . . . . . . . . . . . 4.3 O2Controller . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 15 16 18 18 5 EXPERIMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 6 RELATED WORK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 7 CONCLUSIONS AND FUTURE WORK . . . . . . . . . . . . . . . . . . . . . . . 21 iii LIST OF FIGURES 2.1 The SMACK Toolchain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iv 3 LIST OF TABLES 2.1 2.2 2.3 2.4 2.5 Special Values . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Built-in Operators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Operators Accessible with the ”builtin” Attribute . . . . . . . . . . . . . . . Rounding Modes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Type Conversion Functions . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 5 5 6 7 4.1 math.h Functions Supported by SMACK . . . . . . . . . . . . . . . . . . . . 17 5.1 SV-COMP Benchmark Results . . . . . . . . . . . . . . . . . . . . . . . . . . 19 v ACKNOWLEDGEMENTS I would like to thank Dietrich Geisler for implementing the original floating-point support in Boogie. I would also like to thank Rustan Leino for designing the updated Boogie syntax for floating-point constants. This work was supported by funding from the Undergraduate Research Opportunities Program at the University of Utah and the National Science Foundation award CCF-1704715. vi 1 1 INTRODUCTION Software verification, which aims to prove properties about programs using rigorous formal methods based on logic, is an active and critical area of research in the field of computer science. Because of the magnitude and importance of verifying that a program works as intended, a myriad of software tools have been developed for this task (see the results of the annual software verification competition SVCOMP for a list of such tools [35]). In the past several decades, researchers have invented a number of software verification techniques. More recently, techniques based on automated theorem provers have been shown to be particularly promising. There are several steps involved in performing verification using such techniques. The actual verification is typically performed by a Satisfiability Modulo Theories (SMT) solver, which takes as input the program expressed as a series of mathematical logic statements, and utilizes a variety of algorithms in order to solve for them. However, the issue remains of translating an input source file into a set of logic statements. One tool that can be leveraged to bridge this gap is the Boogie intermediate verification language (IVL), an intermediate representation that lies between high-level programming languages and first-order logic format [3]. Verification tools including Corral [22] and Boogie [3] have been developed that can convert Boogie IVL programs into first-order logic statements, pass these statements to a built-in SMT solver such as Z3 [27], and output the verification result. Another tool that aids in this process is the SMACK verification toolchain [31], which is capable of converting LLVM Intermediate Representation (IR) into Boogie IVL. LLVM [24] is a compiler infrastructure that includes a tool called Clang [8]. Clang translates source files written in high-level programming languages into a single universal intermediate representation and that has support for many popular languages including C, C++, C#, Java, and Python. By using the intermediary languages of Boogie and LLVM IR, a tool such as SMACK to translate between them, and a back-end verifier such as Corral to verify the resulting logic statements, users are able to verify the assertions in input programs. Floating-point verification is a sub-field of software verification that has gained significant importance. Floating-point arithmetic appears in a wide variety of software applications, ranging from video games and device drivers to flight navigation systems and radiation therapy machines. However, there are relatively few verification tools that provide support for floating-point types. In 2016, Dietrich Geisler, a University of Utah alumni, added floating-point support to the Boogie verifier, basing the implementation on the SMT-LIB FloatingPoint theory [33]. This theory is supported by a variety of SMT solvers and is itself based off of the 2008 revision to the IEEE 754 standard [20]. The floating-point support was designed to provide a human-readable Boogie syntax while being easily translatable to SMTLIB format. However, the initial implementation was incomplete and possessed a variety of bugs. Several parts of the SMT-LIB standard were missing in the implementation, including support for rounding modes. The implementation was incompatible with the Corral verifier, a tool which is dependent on Boogie, failing on simple floating-point regressions. Additionally, the syntax for floating-point constants was relatively complex and difficult to convert to and from standard decimal notation. Dietrich also began adding support to SMACK for modeling the math.h functions from the C Standard Library, utilizing Boogie’s floating-point implementation in order to do so. 2 However, this project was left mostly unfinished, and many of the implemented function models were incorrect. My main contributions are: • I added support for rounding modes to Boogie’s existing floating-point implementation • With the help of Rustan Leino, I devised and implemented a novel syntax for floatingpoint literals in Boogie • Building on the initial work done by Dietrich, I added support in SMACK for verifying the math.h functions from the C Standard Library • All of the source code that I wrote was peer-reviewed, tested, and merged by the Boogie and SMACK developers into their respective main trunks. In this thesis, I begin by describing several tools referenced throughout subsequent chapters. Next, I present the original implementation of floating-points in Boogie. I follow this by describing the issues present in the original implementation, as well as how the updated implementation resolved each of these issues. I then detail how I utilized Boogie’s updated implementation in order to finish adding support for the math.h functions in SMACK. Next, I present the experimental results of making these fixes. I did this by leveraging SMACK and running it against a comprehensive set of floating-point benchmarks obtained from the Software Verification Competition (SV-COMP) 2017 [35]. I then give an overview of the related work that has been done on floating-point verification, followed by my conclusions. 3 2 BACKGROUND 2.1 Boogie Boogie refers to a procedural language designed as an intermediary form between high-level programming languages and first-order logic format. It is a platform that may be used to build verifiers for programs written in other languages [3]. Boogie also refers to a verification tool that accepts Boogie IVL code as input. The tool generates a set of weakest preconditions for the program [1] and passes the result to an SMT solver. Currently, Boogie has support for the Z3 and CVC4 [11] solver tools. 2.2 SMACK The SMACK verification toolchain is capable of transforming LLVM Intermediate Representation (IR) [24] into Boogie code. LLVM IR is a low-level, platform independent instruction set, serving as a universal intermediate representation of programs written in higher-level languages. SMACK is also an end-to-end toolchain for software verification, providing a complete environment for users to analyze the assertions in input programs. Figure 2.1 depicts a visualization of this process. First, SMACK includes Clang [8], a sub-project of LLVM that translates input source files into LLVM IR. After the LLVM IR is run through several optimization passes, SMACK translates it into Boogie code. The Boogie code is then passed to a back-end verifier included with SMACK, which is responsible for computing the final verification result. SMACK comes packaged with four back-end verifiers: Corral, Boogie, Duality [13], and Symbooglix [23]. 2.3 Existing Floating-Point Support in Boogie In this section, I describe the features included in the original floating-point support added to Boogie in 2016, which was primarily developed by Dietrich Geisler. For more details regarding the development of this implementation, refer to previous work [29]. Figure 2.1: The SMACK Toolchain 4 Table 2.1: Special Values Value Declaration +infinity 0+oo[sigSize]e[expSize] -infinity 0-oo[sigSize]e[expSize] 0NaN[sigSize]e[expSize] NaN Type declarations A floating-point type with sigSize significand bits and expSize exponent bits is defined using the syntax float[sigSize+1]e[expSize] (the +1 signifies an implicit bit in front of the decimal place). Both sigSize and expSize must be greater than 1. For example, a floating-point variable with 52 significand bits and 11 exponent bits may be defined like so: var t : float53e11; Constant declarations A floating-point constant is defined using the syntax (-)[sig]e[exp]f[sigSize]e[expSize]. In the above syntax, sig is the significand value, exp is the exponent value, sigSize is the number of significand bits, and expSize is the number of exponent bits. Finally, the presence of a - sign signifies a negative value. For example, the constant -17.75 is defined using the following syntax: var t : float11e5; t := -112e19f11e5; NaN and ±infinity may be defined using the above syntax. For example, +infinity may be defined in the following way: var t : float11e5; t := 0e31f11e5; Alternatively, these special values may be defined using the syntax shown in Table 2.1. Built-in operators There are several floating-point operators that are built into Boogie’s syntax. These operators, as well as their corresponding syntax, are shown in Table 2.2. All arguments must share the same significand size and exponent size. If the return value is a float type, it is guaranteed to have the same significand size and exponent size as the arguments. Accessing operators with the ”builtin” attribute The ”builtin” attribute enables access to operators that are not built into Boogie. These operators are listed in Table 2.3. As was the case with the built-in operators, all arguments must share the same significand size and exponent size. If the return value is a float type, it is guaranteed to have the same significand size and exponent size as the arguments. These functions are accessed by creating a new function with ’function name’ that takes in type arguments ’arg types’ and returns a value of type ’return type’, with the syntax below: 5 Table 2.2: Built-in Operators Operator Built-in syntax Return type fp.neg(x) -x float fp.add(x, y) x+y float fp.sub(x, y) x-y float fp.mul(x, y) x*y float fp.div(x, y) x/y float fp.leq(x, y) x <= y boolean fp.lt(x, y) x <y boolean fp.geq(x, y) x >= y boolean fp.gt(x, y) x >y boolean Table 2.3: Operators Accessible with the ”builtin” Attribute Operator Return type fp.abs(x) float fp.fma(x, y, z) float fp.sqrt(x) float fp.rem(x, y) float fp.roundToIntegral(x) float fp.min(x, y) float fp.max(x, y) float fp.isNormal(x) boolean fp.isSubnormal(x) boolean fp.isZero(x) boolean fp.isInfinite(x) boolean fp.isNaN(x) boolean fp.isNegative(x) boolean fp.isPositive(x) boolean function {:builtin "fp.op"} ’function_name’(args) returns (return_type); Here is an example showing how to use the fp.abs function: type float32 = float24e8; function {:builtin "fp.abs"} abs(float32) returns (float32); procedure foo() { var x : float32; var y : float32; x := -0e127f24e8; //x = -1 y := abs(x); assert(y == 1); } 6 Table 2.4: Rounding Modes Rounding Mode Acronym roundNearestTiesToEven RNE roundNearestTiesToAway RNA roundTowardPositive RTP roundTowardNegative RTN roundTowardZero RTZ This same syntax may also be used for the built-in operators. For example, the following code accesses the ”fp.lt” operator via the ”builtin” attribute: type float32 = float24e8; function {:builtin "fp.lt"} less_than(float32, float32) returns (bool); procedure foo() { var x : float32; var y : float32; x := -0e127f24e8; //x = -1 y := 0e127f24e8; //y = 1 assert(less_than(x, y)); } Operators that Accept a Rounding Mode Some of the functions shown in Tables 2.2 and 2.3 require a rounding mode to be passed to it. This is done by passing it as an argument to the ”builtin” attribute when using the syntax described in the previous section. The rounding modes supported by Boogie are shown in Table 2.4. For example, the following code shows how to declare the ”fp.add” operator using the RTP rounding mode: function {:builtin "fp.add RNE"} add_rne(float24e8, float24e8) returns (float24e8); function {:builtin "fp.add RTP"} add_rtp(float24e8, float24e8) returns (float24e8); procedure foo() { var x : float24e8; var y : float24e8; var z1 : float24e8; var z2 : float24e8; z1 := add_rne(x, y); z2 := add_rtp(x, y); assert(z1 <= z2); assert(z1 == x + y); 7 Table 2.5: Type Conversion Functions Operator Return Type to fp(float) float to fp(real) float to fp(bit vec) float to fp unsigned(bit vec) float fp.to ubv(float) bit vec fp.to sbv(float) bit vec fp.to real(float) real } Note that using operators with the built-in syntax defaults to the RNE rounding mode, as demonstrated by the second assertion. Type Conversions The ”builtin” attribute is also used to access several type conversion functions, which are listed in Table 2.5. The syntax for accessing these operators is slightly different than for operators described in previous sections. Specifically, to_fp is accessed by passing the string (_ to_fp expSize sigSize) to the ”builtin” attribute. For example, the following code converts a 16-bit floating-point value to a 32-bit one: type float16 = float11e5; type float32 = float24e8; function {:builtin "(_ to_fp 8 24) RTP"} float16_to_float32(float16) returns (float32); procedure foo() { var f : float16; var g : float32; f := 0e15f11e5; g := float16_to_float32(f); assert(g == 0e127f24e8); } Additionally, fp.to_ubv and fp.to_sbv are accessed by passing the string (_ op_name bvSize) to the ”builtin” attribute. Here is an example that converts a 32-bit floating-point value to a bit vector of size 32: type float32 = float24e8; function {:builtin "(_ fp.to_ubv 32) RTZ"} float32_to_bv32(float32) returns (bv32); procedure foo() { var f : float32; 8 var g : bv32; f := 2097152e127f24e8; // f = 1.25 g := float32_to_bv32(f); assert(g == 1bv32); } fp.to_real is accessed in the same way as operators in the previous sections. 9 3 ENHANCING SUPPORT FOR FLOATING-POINTS I will now describe the changes made in the updated floating-point implementation in Boogie. These changes include the fixing of several significant bugs, revision of the syntax for floating-point constants, addition of rounding mode support, major code reorganization, and renaming of regressions. 3.1 Correct Types Returned for Floating-Point Expressions In the original implementation, floating-point expressions were sometimes computed to have an incorrect return type. For example, Boogie threw an exception when provided the following program: 1 2 3 4 type Ref; var Heap: HeapType; type Field A B; type HeapType = <A, B> [Ref, Field A B]B; 5 6 7 8 procedure mfl(one: float23e11, two: float23e11) returns () { assert two == one; } The expression at line 8, two == one, will return a result of type float23e11, even though the assert expression expects a Bool value as an argument. I resolved this issue in a pull request, which can be viewed at [17]. 3.2 Valid Programs Passed to Corral Additionally, the original implementation resulted in errors within the Corral verifier. Corral is a verification tool that utilizes goal-directed symbolic search strategies in order to verify Boogie programs [10]. Additionally, Corral’s implementation depends on Boogie’s. Corral obtains intermediate versions of programs processed by Boogie, which it then further processes. However, the original floating-point implementation was resulting in Boogie generating syntactically incorrect intermediate programs. For example, consider the following Boogie program: procedure foo(a: float24e8, b: float24e8) { a := 0e127f24e8; //a = 1 b := 0e128f24e8; //b = 2 assert (a + a == b); } Given the above program as input, Boogie will generate the following intermediate program: procedure foo(a: float24e8, b: float24e8) { a := 0x2\^127; //a = 1 b := 0x2\^128; //b = 2 10 assert (a + a == b); } I resolved this issue in a pull request, which can be viewed at [9]. 3.3 Redesign of Floating-Point Constants The primary issue with the original floating-point syntax was that it was relatively difficult for a human to convert to and from standard decimal notation. It also possessed several features that were confusing to both new users and those unfamiliar with how floatingpoints are represented in memory, as specified by the IEEE 754-2008 revision. The redesign of floating-point constant syntax followed several guiding principles explicated by Rustan Leino at [32]. These guidelines are described below. 3.3.1 No Synonyms for Special Values Under the original syntax, floating-point special values could be represented in multiple ways. For example, the floating-point constant +infinity (for a 23-bit significand and 8-bit exponent) may be represented as either 0+oo24e8 or 0e255f24e8. This becomes potentially confusing for users who may not be able to tell whether they are writing a special value or a value that falls within the bounds of the valid floating-point range. Under the new syntax, synonyms for special values are disallowed. ±infinity and NaN may only be written using the syntax listed in Table 2.1. 3.3.2 Readable Mantissa and Exponent Consider representing the number 10 in Boogie, using a 23-bit significand and an 8-bit exponent. A human must use roughly the following process to perform the conversion: 8−1 −1)−127 1010 = 10102 = 1.01 ∗ 23 = 1.01 ∗ 2(2 = 1.01 ∗ 2130−127 The final expression implies that the exponent value is 130 and the significand value is 101. Because the hidden-bit convention is used, the first 1 is implicit. Additionally, the significand must be 23 bits long. Therefore, the significand is actually 010 0000 0000 0000 0000 00002 = 209715210 . This corresponds to a Boogie constant string of 2097152e130f24e8. As illustrated above, converting from decimal to Boogie constant syntax is a relatively long and error-prone process. Converting the opposite direction is similar in difficulty. Ideally, the conversion process should be shorter, and the representation should be easier to read. The new design makes several changes to the syntax to accomplish this. Firstly, it makes the exponent unbiased. The IEEE 754 standard specifies that a bias value is added to the exponent of the desired number to obtain the corresponding bit pattern. Specifically, for a floating-point value with a w-bit exponent, a bias of 2w−1 − 1 is added to the exponent. This is done in order to provide a clean method of representing both positive and negative exponents. For example, to represent the value 0.25 = 1.0∗2−2 using 8 bits for the exponent, a bias of 28−1 − 1 = 127 is added. Thus, 0.25 is represented within Boogie as 0e-2f24e8. 11 Note that the value of the exponent is 125 instead of −2, since the bias of 127 is added to obtain the proper value. However, while adding a bias is required to represent floating-points internally abiding by the IEEE-754 standard, it is completely unnecessary to do so at the user level. Users who are unfamiliar with this convention may mistakenly think that the value 0e125f24e8 is equivalent to 1.0 ∗ 2125 instead of 1.0 ∗ 2125−127 . The new syntax thus changes the exponent to be unbiased, simplifying the syntax and making it easier to understand. With this change, the Boogie string to represent 10 changes from 2097152e130f24e8 to 2097152e3f24e8. The second change in the new syntax is the removal of the hidden bit convention. The IEEE 754 standard specifies that the first set bit in the significand is not explicitly included in its internal representation. In the original Boogie syntax, this convention was replicated. However, many users who are unfamiliar with this convention can mistakenly include it as part of the significand. The hidden-bit convention is unnecessary in user-level syntax, confuses users, and complicates the representation. In the new syntax, the first bit is included by prepending the significand with the string ”1.”. Additionally, the significand is now written in hexadecimal notation instead of decimal. This accomplishes several things. Firstly, it simplifies conversion from binary; it is much easier to convert between binary and hexadecimal than it is to convert between binary and decimal. Secondly, it shortens the resulting constant string; using a higher base reduces the number of characters needed to write the significand. With the removal of the hidden-bit convention and a hexadecimal significand, the Boogie string to represent 10 changes from 2097152e3f24e8 to 1.200000e3f24e8. Finally, and most importantly, the significand is now written in a left-to-right manner instead of right-to-left. For example, consider the significand in the above example, which was originally treated as 010 0000 0000 0000 0000 0000. Left as is, this would be written in hexadecimal as 200000. However, to a human, it is counterintuitive to write this number starting from the right. When we write decimal numbers on paper, we start from the left and progress to the right. Thus, the significand should instead be treated as 0100 0000 0000 0000 0000 000. Therefore, the Boogie string to represent 10 changes from 1.200000e3f24e8 to 1.400000e3f24e8. Another important change it to allow the user to exclude unnecessary trailing zeroes if they choose. This further simplifies the Boogie string to 1.4e3f24e8. For consistency with the hexadecimal significand, the exponent is now in base 16 instead of base 2. To accommodate this change, the digit before the decimal point is also allowed to be any hexadecimal digit, not just a 1. This now results in a Boogie constant string of A.0e0f24e8 to represent 10. 3.3.3 Unnormalized Significand Finally, the new syntax allows the significand to be unnormalized. In other words, there can be arbitrarily many digits before and after the decimal point, provided that the floatingpoint value that the written constant is equivalent to can fit within the specified number of significand and exponent bits. Thus, 10 can be written in Boogie as 0xA0.0e-1f24e8, 0xA.0e0f24e8, 0x0.Ae1f24e8, 0x0.0Ae2f24e8, etc. 12 3.4 Updated Constant Syntax In this section, I describe my implementation of Boogie’s updated floating-point constant syntax, following the guidelines stated in previous sections. A floating-point constant can be declared with the following syntax: (-)0x[sig]e[exp]f[sigSize]e[expSize] In the above line: sig = hexdigit {hexdigit} ’.’ hexdigit {hexdigit} exp = digit {digit} sigSize = digit {digit} expSize = digit {digit} A floating-point number written using the above syntax is equivalent to the value (−)(sig∗ 16 ). As long as the equivalent value fits in a floating-point variable with ’sigSize’ significand bits and ’expSize’ exponent bits, there are no restrictions on the values of ’sig’ and ’exp’. The significand must have trailing zeros such that the last nibble is fully included. For example, in order to represent a floating-point value that has a 24-bit significand with the bit pattern 1 0000 0000 0000 0000 0000 001 (including the hidden bit at the beginning) and an exponent of 0, it may be written as 0x1.000002e0f24e8, but not 0x1.000001e0f24e8. As another example, we can assign the constant -2.25 to var ’name’ by writing: exp var name : float24e8; name := -0x2.4e0f24e8; It is disallowed to use synonyms of the special values listed in Table 2.1 (for example, 0x1.0e32f24e8 is equivalent to 0+oo24e8 but is a syntax error). 3.5 Rounding Mode Support In the original implementation, Boogie had no support for reasoning about rounding modes. Tools that convert programs written in a high-level programming language to Boogie would be unable to do so if the program involved rounding modes. For example, consider the following snippet of C code: if (x == 1) { fesetround(FE_UPWARD); } else { fesetround(FE_DOWNWARD); } 13 float y = floor(3.5); fesetround is a Standard Library function that allows the user to set the rounding mode used by the program. Without a way of explicitly representing and reasoning about rounding modes in Boogie, verification tools have no way of modeling the above code. To resolve this issue, I added a rounding mode type to Boogie, accessible through the rmode keyword. It is capable of modeling the five rounding modes defined in the SMT-LIB FloatingPoint theory, listed in Table 2.4. For example, the RoundTowardNegative rounding mode may be assigned to var ’mode’ by writing: var mode: rmode; mode := RTN; Or, alternatively, the full name may be used: var mode: rmode; mode := roundTowardNegative; 3.5.1 Using a Rounding Mode with ”builtin” Functions In the original implementation, SMT-LIB functions that used rounding modes needed to have them hard-coded in the function definition, as described in Section 4.3. If a user wanted to use a specific function with different rounding modes, they would have to include separate declarations for each rounding mode. However, with the addition of a rounding mode type, operators that accept rounding modes may now do so as an argument to the function itself, rather than as an argument to the ”builtin” attribute. This is done by creating a new function with function_name that takes in arguments of types arg_types, along with an rmode variable, and returns a value of type return_type, using the syntax below: function {:builtin "fp.op"} ’function_name’(rmode, args) returns(return_type); For example, the following code demonstrates how to declare the ”fp.sub” operation and use it with both the RNA and RTZ rounding modes: function {:builtin "fp.sub"} sub(rmode, float24e8, float24e8) returns (float24e8); . . . . var x : float24e8; var y : float24e8; var z : float24e8; z := sub(RNA, x, y); z := sub(RTZ, x, y); 14 Or, alternatively: function {:builtin "fsub"} sub(rmode, float24e8, float24e8) returns (float24e8); . . . . var mode : rmode; var x : float24e8; var y : float24e8; var z : float24e8; mode := RNA; z := sub(mode, x, y); mode := RTZ; z := sub(mode, x, y); Additionally, as explained in Section 4.3, operators that accept rounding modes may be declared to conform to a specific rounding mode that is specified as part of the ”builtin” attribute. 3.6 Code Reorganization The min, max, and rem floating-point functions originally could be accessed without the ”builtin” attribute, which was inconsistent with the other SMT-LIB functions. I revised the implementation such that the ”builtin” attribute is now required to access these functions. Additionally, I made changes to the regressions included in the Boogie project that test the floating-point implementation. These regressions were originally named ”float1.bpl”, ”float2.bpl”, etc. Having uninformative names made it difficult to determine what feature each one was testing. Thus, I renamed these regressions to reflect their individual intended purpose. I made both of the above changes in a pull request that can be viewed at [26]. 15 4 APPLICATIONS 4.1 SMACK Support for math.h Functions I used Boogie’s floating-point implementation to add support in SMACK for verifying the C standard library math.h functions. This project was begun in 2017 by adding support for some of the math.h functions. However, most of the functions were either unimplemented or modeled incorrectly. To resolve these issues, I added models to SMACK for most of the remaining functions and rewrote many of the existing models. Each model includes explicit Boogie code that makes calls to relevant ”builtin” functions. For example, SMACK implements the fabs function like so: double fabs(double x) { double ret = __VERIFIER_nondet_double(); __SMACK_code("@ := $abs.bvdouble(@);", ret, x); return ret; } Note how short the implementation is, due to there being an equivalent ”builtin” absolute value function. Also note how the __SMACK_code function must be called in order to inject inline Boogie code into C programs. When SMACK verifies an input C program that includes a call to fabs, it will generate the following Boogie code to model the fabs function: type bvfloat = float24e8; function {:builtin "fp.abs"} $abs.bvfloat(i: bvfloat) returns (bvfloat); var i: bvfloat; //the argument passed to fabs var j: bvfloat; //the return value of fabs . . . . . j:= $abs.bvfloat(i); Some functions require more involved implementations, due to not having an equivalent ”builtin” function. For example, below is the code for modeling the modf function: double modf(double x, double *iPart) { double fPart = __VERIFIER_nondet_double(); if (__isinf(x)) { *iPart = x; fPart = 0.0; } else { *iPart = trunc(x); __SMACK_code("@ := $fsub.bvdouble($rmode, @, @);", fPart, x, *iPart); } if (__iszero(fPart)) { fPart = (__signbit(x)) ? -0.0 : 0.0; 16 } return fPart; } Table 4.1 displays a list of the math.h functions currently supported by SMACK. The models may be viewed at [25]. 4.1.1 Regressions The vast majority of the math.h functions result in special behavior when passed ±0, ±infinity, or NaN. In order to help ensure that the models matched expected behavior for all cases, I wrote regressions in the SMACK project for each supported function. The regressions collectively total approximately 4000 lines of C code. For example, below is the regression that tests SMACK’s model of the fmod function: #include "smack.h" #include <math.h> // @expect verified // @flag --bit-precise int main(void) { double NaN = 0.0 / 0.0; double Inf = 1.0 / 0.0; double negInf = -1.0 / 0.0; double val = __VERIFIER_nondet_double(); if (!__isnan(val) && !__isinf(val) && !__iszero(val)) { if (val > 0) { assert(fabs(val) == val); } else { assert(fabs(val) == -val); } } assert(fabs(0.0) == 0.0); assert(fabs(-0.0) == 0.0); int isNeg = __signbit(fabs(-0.0)); assert(!isNeg); assert(fabs(Inf) == Inf); assert(fabs(negInf) == Inf); assert(__isnan(fabs(NaN))); return 0; } 17 Table 4.1: math.h Functions Supported by SMACK float fabsf(float) double fmod(double, double) float fdimf(float, float) double modf(double, double*) float roundf(float) double copysign(double, double) long lroundf(float) double nan(const char*) float rintf(float) int isnormal(double) float nearbyintf(float) int issubnormal(double) long lrintf(float) int iszero(double) float floorf(float) int isinf(double) float ceilf(float) int isnan(double) float truncf(float) int isnegative(double) float sqrtf(float) int signbit(double) float remainderf(float, float) int fpclassify(double) float fminf(float, float) int finite(double) float fmaxf(float, float) long double fabsl(long double) float fmodf(float, float) long double fdiml(long double, long double) float modff(float, float*) long double roundl(long double) float copysignf(float, float) long lroundl(long double) float nanf(const char*) long double rintl(long double) int isnormalf(float) long double nearbyintl(long double) int issubnormalf(float) long lrintl(long double) int iszerof(float) long double floorl(long double) int isinff(float) long double ceill(long double) int isnanf(float) long double truncl(long double) int isnegativef(float) long double sqrtl(long double) int signbitf(float) long double remainderl(long double, long double) int fpclassifyf(float) long double fminl(long double, long double) int finitef(float) long double fmaxl(long double, long double) double fabs(double) long double fmodl(long double, long double) double fdim(double, double) long double modfl(long double, long double*) double round(double) long double copysignl(long double, long double) long lround(double) long double nanl(const char*) double rint(double) int isnormall(long double) double nearbyint(double) int issubnormall(long double) long lrint(double) int iszerol(long double) double floor(double) int isinfl(long double) double ceil(double) int isnanl(long double) double trunc(double) int isnegativel(long double) double sqrt(double) int signbitl(long double) double remainder(double, double) int fpclassifyl(long double) double fmin(double, double) int finitel(long double) double fmax(double, double) 18 4.2 SMACK Support for Rounding Modes I added rounding mode support to SMACK by writing models for the fegetround and fesetround functions, which are C Standard Library functions that are part of the fenv.h header file. These functions allow for the reading and writing, respectively, of the rounding mode used by the program. The models for these functions may be found at [16]. 4.3 O2Controller I am currenctly using the updated floating-point support in Boogie and SMACK to verify O2Controller, a medical device that monitors oxygen flow used by patients, being developed by Dynasthetics [15], a Utah based company. O2Controller is implemented in C and contains over a thousand lines of heavy floating-point computations. I, along with Prof. Zvonimir Rakamarić, have collaborated with the developers of O2Controller in order to determine the most salient portions of the code to verify, add assertions accordingly, and verify the code using Boogie. Although this project is still a work in progress, Boogie has already shown promising results. It has caught several bugs in the program that Corral failed to catch within a reasonable time limit. For example, Boogie verified four key properties of this application in eleven minutes, while Corral spent more than three hours to verify just one of these properties. 19 5 EXPERIMENTS In 2017, SMACK participated in the Software Verification Competition (SV-COMP), competing against a myriad of other verification tools. SV-COMP was designed as a way to spread awareness of the state of the art in verification technology, as well as establish an accepted set of benchmarks that researchers can use to compare the performance of tools. SV-COMP’s benchmarks are divided into distinct categories that each test different aspects of programs, including loops, memory safety, and concurrency. ReachSafety-Floats is a category consisting of benchmarks that make heavy usage of floating-point operations. SMACK was using Corral as its back-end verifier during this time. Table 5.1 shows the results of running a performance comparison between SMACK with Boogie, SMACK with Corral, Ceagle [37], and ESBMC [30] on the SV-COMP 2017 ReachSafety-Floats category benchmarks. The entry for the verifier, ”SMACK w/ Boogie” corresponds to SMACK using Boogie’s updated floating-point implementation. As the results illustrate, although SMACK obtained better results with Boogie’s updated implementation, it was still outpaced by Ceagle and ESBMC, the winner and runner-up, respectively, of the ReachSafety-Floats category in SV-COMP 2017. These tools are likely much more optimized for float-point operations than SMACK is. Additionally, Boogie uses Z3 as its back-end SMT solver by default. These tools may be using SMT solvers that perform better than Z3 on floating-point expresions. Table 5.1: SV-COMP Benchmark Results Verifier # Solved # Timeout # Error SMACK w/ Boogie 92 70 10 SMACK w/ Corral 85 78 9 Ceagle 164 0 8 ESBMC 169 0 3 20 6 RELATED WORK There currently exist a variety of verification tools that are capable of analyzing floating-point expressions. FPTaylor [34] is a tool designed to estimate the round-off error of floating-point calculations. A related tool, FPTuner [6], may be used to tune the precision of multiple floating-point expressions in order to achieve an error bound that is below some threshold. KLEE [4] is a symbolic execution engine that operates on LLVM IR and is able to execute statements involving floating-point variables. ESBMC is a context-bounded model checker that placed first in the ReachSafety-Floats category of benchmarks. It has support for a variety of SMT solvers, including Z3 and MathSAT [7]. [18] shows that, when using MathSAT, ESBMC outperforms Z3 and approaches used by other tools in SV-COMP. Ceagle is another tool that obtained strong results in SV-COMP, placing second in the ReachSafety-Floats category. CBMC [21], like ESBMC, is a bounded model checker for C/C++ programs. It comes packaged with a MiniSat-based solver that supports the SMT-LIB FloatingPoint theory. However, it also support external verifiers, including Z3, MathSAT, Yices 2 [14], and Boolector [28]. In SV-COMP 2019 [36], VeriAbs [12] placed first in the ReachSafety-Floats category. VeriAbs is a bounded model checker, but utilizes techniques including abstract acceleration and k-induction in order to scale for large loop iterations. Pinaka [5], which placed second in 2019, is a tool built on the CProver framework. It it capable of reasoning about rounding modes for floating-point operations. Other verification tools that support floating-point functionality include Ultimate Automizer [19] and BLAST [2]. Many of the tools described in this chapter have competed in SV-COMP, and the results of this competition serve as a useful performance comparison. 21 7 CONCLUSIONS AND FUTURE WORK I extended the existing floating-point support in the Boogie verification tool by making the syntax more readable, adding rounding mode support, changing the implementation to be consistent with the SMT-LIB floating-point standard, and fixing several bugs, including incompatibility with Corral. I used the updated implementation to finish adding support in SMACK for verifying the math.h functions from the C Standard Library. In addition, I used Boogie and SMACK’s implementation to find and resolve bugs in O2Controller, a real-world application. The performance of SMACK on floating-points still does not reach the level of the topperforming verification tools in SV-COMP, such as ESBMC and Ceagle. These tools are almost certainly taking advantage of algorithms and optimizations that SMACK is not. As future work, it would be useful to investigate what these approaches are and implement them into SMACK in order to improving its own performance. Additionally, the work with O2Controller remains incomplete. So far, key portions of the code have been analyzed disjointly, but the entire codebase has not been analyzed in its entirety. I would like to fully verify O2Controller and see it be approved by the FDA for official usage. Finally, although the regressions for evaluating the correctness of the math.h models in SMACK are comprehensive, they do not prove that the models match the specified behavior for these functions. As future work, I would like to utilize more advanced techniques, such as differential testing, to validate the accuracy of these models by comparing them with official implementations of the math.h functions. 22 BIBLIOGRAPHY [1] Mike Barnett and K. Rustan M. Leino. Weakest-precondition of unstructured programs. In Proceedings of the 6th ACM SIGPLAN-SIGSOFT workshop on Program analysis for software tools and engineering (PASTE), pages 173–193, 2005. [2] D. Beyer, T. A. Henzinger, R. Jhala, and R. Majumdar. The software model checker blast. In International Journal on Software Tools for Technology Transfer, vol. 9, no. 5-6, pages 505–525, 2007. [3] Boogie: An Intermediate Verification Language. https://www.microsoft.com/en-us/ research/project/boogie-an-Intermediate-Verification-language/. [4] C. Cadar, D. Dunbar, and D. Engler. KLEE: Unassisted and Automatic Generation of High-Coverage Tests for Complex Systems Programs. In 5th USENIX Symposium on Operating Systems Design and Implementation (OSDI), pages 209–224, 2008. [5] Eti Chaudhary and Saurabh Joshi. Pinaka: Symbolic Execution meets Incremental Solving (Competition Contribution). In Dirk Beyer, Marieke Huisman, Fabrice Kordon, and Bernhard Steffen, editors, Proceedings of TACAS, LNCS. Springer and Cham, 2019. [6] W.F. Chiang, M. Baranowski, I. Briggs, A. Solovyev, G. Gopalakrishnan, and Z. Rakamarić. Rigorous floating-point mixed-precision tuning. In ACM SIGPLAN Notices, vol. 52, pages 300–315, 2017. [7] Alessandro Cimatti, Alberto Griggio, Bastiaan Schaafsma, and Roberto Sebastiani. The MathSAT5 SMT Solver. In Nir Piterman and Scott Smolka, editors, Proceedings of TACAS, volume 7795 of LNCS. Springer, 2013. [8] Clang: a C language family frontend for LLVM. https://clang.llvm.org/. [9] Fixed floating-point issues with corral. https://github.com/boogie-org/boogie/ pull/84. [10] Corral Program Verifier. q-program-verifier/. https://www.microsoft.com/en-us/research/project/ [11] Cvc4, the smt solver. http://cvc4.cs.stanford.edu/web/. [12] Priyanka Darke, Sumanth Prabhu, Bharti Chimdyalwar, Avriti Chauhan, Shrawan Kumar, Animesh Basakchowdhury, R. Venkatesh, Advaita Datar, and Raveendra Kumar Medicherla. VeriAbs: Verification by Abstraction and Test Generation. In Dirk Beyer and Marieke Huisman, editors, Tools and Algorithms for the Construction and Analysis of Systems, LNCS. Springer, 2018. [13] Duality. https://www.microsoft.com/en-us/research/project/duality/. [14] Bruno Dutertre. Yices 2.2. In Armin Biere and Roderick Bloem, editors, Computer Aided Verification, LNCS, pages 737–744. Springer and Cham, 2014. 23 [15] Dynasthetics. http://www.dynasthetics.com/. [16] fenv.c. fenv.c. https://github.com/smackers/smack/blob/master/share/smack/lib/ [17] Fix #80: Return correct return type for floating-point expressions. https://github. com/boogie-org/boogie/pull/82. [18] Mikhail Y. R. Gadelha, Lucas C. Cordeiro, and Denis A. Nicole. Encoding FloatingPoint Numbers Using the SMT Theory in ESBMC: An Empirical Evaluation over the SV-COMP Benchmarks. In Simone Cavalheiro and José Fiadeiro, editors, Formal Methods: Foundations and Applications, LNCS. Springer, 2017. [19] M. Heizmann, J. Christ, D. Dietsch, E. Ermis, J. Hoenicke, M. Lindenmann, A. Nutz, C. Schilling, and A. Podelski. Ultimate automizer with smtinterpol. In Tools and Algorithms for the Construction and Analysis of Systems (TACAS), pages 641–643, 2013. [20] 754-2008 - IEEE Standard for Floating-Point Arithmetic. https://ieeexplore.ieee. org/document/4610935. [21] Daniel Kroening and Michael Tautschnig. CBMC: C bounded model checker (Competition contribution). In Erika Ábrahám and Klaus Havelund, editors, Proceedings of TACAS, LNCS, pages 389–391. Springer, 2014. [22] A. Lal, S Qadeer, and S. K. Lahiri. A solver for reachability modulo theories. In International Conference on Computer Aided Verification (CAV), pages 427–443, 2012. [23] D. Liew, C. Cadar, and A. F. Donaldson. Symbooglix: A symbolic execution engine for boogie programs. In IEEE International Conference on Software Testing, Verification and Validation (ICST), pages 45–56, 2016. [24] The LLVM compiler infrastructure project. http://llvm.org/. [25] math.c. math.c. https://github.com/smackers/smack/blob/master/share/smack/lib/ [26] Modifications to floating-point support. https://github.com/boogie-org/boogie/ pull/85. [27] L. D. Moura and N. Bjørner. Z3: An Efficient SMT Solver. In Tools and Algorithms for the Construction and Analysis of Systems (TACAS), pages 337–340, 2008. [28] Aina Niemetz, Mathias Preiner, and Armin Biere. Boolector 2.0 system description. Journal on Satisfiability, Boolean Modeling and Computation, 9:53–58, 2014 (published 2015). [29] Floating point support. https://github.com/boogie-org/boogie/pull/35. 24 [30] Felipe R. Monteiro, Mikhail Ramalho, Lucas Cordeiro, Bernd Fischer, Jeremy Morse, and Denis A. Nicole. ESBMC 5.0: an industrial-strength C model checker. In Proceedings of the 33rd ACM/IEEE International Conference on Automated Software Engineering (ASE), pages 888–891, 2018. [31] Zvonimir Rakamarić and Michael Emmi. SMACK: Decoupling source language details from verifier implementations. In International Conference on Computer Aided Verification (CAV), pages 106–113, 2014. [32] Support for ”+zero” and ”-zero” special values. https://github.com/boogie-org/ boogie/pull/91. [33] SMT-LIB The Satisfiability Modulo Theories Library. theories-FloatingPoint.shtml. smtlib.cs.uiowa.edu/ [34] A. Solovyev, C. Jacobsen, Z. Rakamarić, and G. Gopalakrishnan. Rigorous estimation of floating-point round-off errors with symbolic taylor expansions. In FM 2015: Formal Methods, pages 532–550, 2015. [35] Competition on Software Verification (SV-COMP). https://sv-comp.sosy-lab.org/ 2017/. [36] Competition on Software Verification (SV-COMP). https://sv-comp.sosy-lab.org/ 2019/. [37] Dexi Wang, Chao Zhang, Guang Chen, Ming Gu, and Jiaguang Sun. C code verification based on the extended labeled transition system model. In ACM/IEEE 19th International Conference on Model Driven Engineering Languages and Systems (MoDELS 2016), pages 48–55, 2016. University of Utah UNDERGRADUATE RESEARCH JOURNAL NON-INVASIVE MRI-GUIDED HYPERTHERMIA OF DEEP TISSUE Dylan Palomino1 (Dennis Parker, PhD1,2) 1 Department of Biomedical Engineering and 2Department of Radiology and Imaging Science A new system of radiofrequency (RF) applicators operating at 13.56 MHz is being developed to apply hyperthermia (HT) for adjuvant therapy in the treatment of pancreatic cancer. Because administering thermal therapies to deep tissues is currently limited by a lack of temperature monitoring that is both non-invasive and accurate, the system is being designed to operate in an MRI scanner operating at 123 MHz. The most common form of magnetic resonance thermometry (MRT) employs the proton resonant frequency shift. Unfortunately, extended MRT is subject to severe magnetic field drift, a systemic error of the MRI scanner itself, resulting in temperature errors on the order of several degrees. In addition, the HT system will pose an electromagnetic compatibility concern with the MRI system. In this study, we investigated methods to improve the accuracy of MRT as well as to help decouple the RF heating coils of the HT system from the RF imaging coils of the MRI system. To improve accuracy, we employed polydimethylsiloxane as a reference for the magnetic field drift. The reference was subtracted from the uncorrected temperatures, reducing the root-mean square error from approximately 14 °C to less than 0.6 °C. To improve electromagnetic compatibility, a selective RF shield was employed to mitigate interactions between the two systems. The operating frequency of the HT system is attenuated by 16.79 dB while the operating (imaging) frequency of the MRI system is allowed to pass relatively unhindered (-0.37 dB). Future work will include a method for mitigating the effects of motion due to respiration and/or peristalsis. Overall, this research serves as a milestone towards the wide use of thermal therapies in the clinic. This is of particular importance for cancer research as HT in conjunction with radiation therapy and/or chemotherapy has been shown to increase their efficacy. University of Utah UNDERGRADUATE RESEARCH JOURNAL POLYMERIC ELECTRODE DESIGN FOR IMPROVED BIOCATALYTIC CURRENT IN MICROBIAL FUEL CELL SYSTEMS Sarai Patterson (Shelley Minteer, PhD) Department of Materials Science and Engineering As global energy consumption increases and contributes heavily to climate change, it is necessary to develop new sources of clean energy. The treatment of wastewater accounts for 3% of total energy usage in the United States, equivalent to the annual energy requirement of 9.6 million homes; however, the water itself can contain up to ten times the energy required to treat it. Microbial fuel cells (MFCs) take advantage of the ability of microorganisms to capture energy from their environments. These devices can harvest the chemical energy in wastewater to simultaneously produce clean electricity and remove contaminants, turning a waste product into an energy resource. MFCs take advantage of the oxidative capabilities of various enzymes and bacteria in order to oxidize organic matter in wastewater, drive electrons through an electrical circuit, and generate useable power (Figure 1). One of the greatest challenges involves establishing efficient electronic communication between the microbial cells and the electrodes. Figure 1: A microbial fuel cell incorporates a microbial species which oxidizes organic compounds and produces an electrical current. This project focused on the design of a redox polymer to facilitate the transfer of electrons from the bacterial species, R. capsulatus, to the electrode. Several polymeric materials were synthesized, mixed with microbial cells, and deposited on carbon paper electrodes. The electrodes were electrochemically characterized, and the system was optimized to achieve the highest possible current density. This research represents a step toward an efficient, self-sustained MFC for concurrent renewable power generation and wastewater treatment. University of Utah UNDERGRADUATE RESEARCH JOURNAL DEVELOPMENT AND CHARACTERIZATION OF INTERCONNECTED POROSITY AEROGELS By Alexander Reifsnyder, Mentored by Krista Carlson Department of Metallurgical Engineering ABSTRACT Although silica aerogels have long been tempting materials for filtration media, the closed-cell structure of silica aerogels has prevented this occurrence. By creating a macroscopically open-cell structured silica aerogel, this project seeks to make aerogels viable filtration media. Two different methods were developed to generate silica aerogel membranes using nitrocellulose scaffolds. The first method involved incorporating fibers of nitrocellulose into the sol gel prior to gelation. Nitrocellulose fibers were either removed via calcining after supercritical drying or via a solvent during aging to produce reticulated micron-sized channels in the aerogels. The second method refined the dissolution approach by using a nitrocellulose lacquer mixed with the sol. This mixture separated into two phases, one which was nitrocellulose-rich and the other which was solrich. The nitrocellulose-rich phase was subsequently removed from the aerogel using a solvent, creating aerogels with interconnected porosity. ii TABLE OF CONTENTS ABSTRACT ii ACKNOWLEDGEMENTS 1 INTRODUCTION 2 METHODS 5 Sol Formation 5 Solvent Exchanges 6 Supercritical Drying 7 Formation of Nitrocellulose 9 Interconnected Porosity Adjustments 10 Silver Nanoparticle Doping 11 Rapid Solvent Exchanges 12 RESULTS 14 SEM Morphology 14 Structural Damage 16 FTIR of Nitrocellulose 17 TEM Analysis 18 Porosity Analysis 20 DISCUSSION 21 CONCLUSION 23 REFERENCES 24 iii ACKNOWLEDGEMENTS I gratefully acknowledge the financial support provided by the Crus Center for Renewable Energy for undergraduate student support, the Office for Undergraduate Research, and the U.S. Department of Energy Waste Treatment and Immobilization Plant Project, grant contact number DE-EM0004744. I also want to thank my parents for fostering my love of research and experimentation. My interest in science was also supported by several of my teachers. I want to specifically thank Mr. Josephson, Ms. Davis, Ms. Leahy, Dr. Zung, and Mr. Krajca. INTRODUCTION Aerogels are a class of ultra-high porosity materials which are composed of a continuous three-dimensional network of meso- and micro-porous structures [1]. Silica aerogels have been thoroughly characterized and considered for innumerable applications that require high chemical durability and extraordinary temperature resilience [2,3]. A typical silica aerogel is hydrophilic but can be modified to become hydrophobic by hybridizing the inorganic framework with various organic cross linkers or polymers. These chemistry adjustments can also increase the mechanical robustness [4–8]. The extremely high surface area of silica aerogel materials make them appear ideal for the filtration of unwanted species from gases, but some issues prevent this process. One of the challenges hindering silica aerogel use in gas filtration applications is the isolated micro-scale porosity of the structural framework, making them nearly impermeable to gases. Even though some solutions have been proposed to circumvent the low permeability issues [9,10], the extremely low density makes implementation of aerogels into real-world applications challenging. Issues such as channeling and other forms of non-uniform flow, as well as difficulties with maintenance [11,12] still plague packed-bed type systems. Adjusting the permeability of silica-based aerogels could enable their use as membranes, eliminating some of the issues faced by these packed-bed systems. Prior studies have focused on altering the sol-gel chemistry to produce aerogel structures with increased permeability to gases [13]. One method to increase the permeability of a monolithic aerogel while maintaining the structural integrity is by introducing meso- or macro-scale interconnected porosity within the microporous matrix [14,16,17]. In some cases, 2 alteration of the gel chemistry and aging can be performed to decrease in the micropores and increase the mesopores. The resulting aerogels, however, tend to be extremely fragile and more susceptible to fracture during exposure to the higher flow rates observed in many commercial applications [14,15]. Certain organic aerogels have relied on the polarity of two phases in order to produce separate phases during gelation. The polarity difference also allows for easy removal of the unwanted scaffold phase to create voids in the final material [18]. Indeed, numerous reports on this technique have been presented, however none discuss a way to apply this method with inorganic aerogels, such as silica aerogels [7,19,20]. This study describes a new method to produce silica-based aerogel membranes with increased gas permeability by using removable nitrocellulose scaffolds. Nitrocellulose was chosen as the scaffold material due to the ability to disperse nitrocellulose in sols and its ease of removal from the silica matrix by either calcination or dissolution. In addition, nitrocellulose was previously used with excellent results as a template, in combination with surfactants, for the preparation of nanoporous thin films and ceramics [21,22]. In this work, to form membranes with interconnected channels, nitrocellulose fibers were placed directly into the sols during gelation. If the solvent exchange before supercritical drying was performed in ethanol, then the scaffold was removed via calcining the aerogel at 225 °C. However, if acetone was used during the solvent exchange, the nitrocellulose fibers would dissolve, leaving an open channel structure that remained after supercritical drying. Additionally, a highly permeable membrane with interconnected porosity was made using a nitrocellulose lacquer which was mixed with the sol before gelation. Similar to the fiber method, an acetone solvent 3 exchange could be used to dissolve away the lacquer phase, leading to a highly permeable membrane with interconnected porosity. After creating a highly permeable aerogel, the structure must be functionalized in order to act as an efficient filter. This study functionalized the aerogels with silver nanoparticles, which can be used to capture iodine very effectively. These nanoparticles were produced in-situ by converting silver ions to silver nanoparticles via exposure to ultraviolet light. This thesis elaborates on a previously published work co-authored with Bonan Wang [23]. 4 METHODS Sol Formation Figure 1. Aerogel formation reactions. Sol-gels were made using the alkoxysilane precursor tetraethyl orthosilicate. A total of 7 mL of the desired precursor solution was mixed with 11 mL of anhydrous ethanol. A second solution was prepared by mixing 11 mL of anhydrous ethanol, 3 mL of deionized water, 0.0102 mL of ammonium hydroxide, and 0.0246 g of ammonium fluoride. This solution was mixed using a vortex mixer for 30 seconds before adding them to the mold. If the time for gelation was longer than 5 minutes, the molds were gently sealed with parafilm. Optionally, the tetraethyl orthosilicate can be substituted with a mixture of methyltriethoxysilane and tetraethyl orthosilicate. The addition of this component can significantly alter the final aerogel’s mechanical properties and has the added benefit of 5 making the aerogels hydrophobic. An aerogel with 25 vol% methyltriethoxysilane can be placed directly in a beaker of water and remain intact. Solvent Exchanges The solvent exchanges are a straightforward procedure. After the alcogels have solidified, they are immersed in ethanol or a similar solvent to remove impurities. This process is diffusion-limited. Every one milliliter of alcogel requires 25 milliliters of ethanol to exchange. The ethanol is replaced entirely every 18 hours for a total of between 72 and 144 hours. 6 Supercritical Drying Figure 2. Schematic of the supercritical drying chamber After solvent exchanging for the prescribed amount of time, the supercritical drying process must begin. Due to the restrictively high price of commercial supercritical dryers, an inexpensive laboratory scale version was constructed out of Class 3000 steel pipe fittings. A three-dimensional rendering of the chamber is displayed in Figure (2). The sample chamber is opened and sealed with the solid plug at the rear of the chamber. On 7 the opposing face, a viewport allows the chamber to be observed to ensure it is operating correctly. To load the supercritical dryer, approximately 150mL of solvent is added to the dryer. Alcogels are then added to the dryer and the dryer is sealed using a pipe plug and Teflon sealant tape. The supercritical dryer is then charged with liquid carbon dioxide through the fill valve. The pressurization rate for the charging process must not exceed 100 PSI/min. This reduces the risk of cracking the alcogels with a severe pressure shock. After pressurizing, the solvent is drained through the drain valve while the fill valve remains open to replace the drained solvent with liquid carbon dioxide. After the supercritical dryer is loaded, the solvent in the gels is slowly exchanged with liquid carbon dioxide. The process to exchange the supercritical dryers is to first open the fill valve, then the vent valve is gently cracked open. The drain valve is opened until approximately one pound of carbon dioxide has been exchanged. This can be measured via weighing the dry ice as it exits the supercritical dryer or by measuring the weight lost from the syphon tank. The solvent exchange process is repeated three times, with 24 hours between each exchange. Supercritical drying is achieved by heating the supercritical drying chamber through its critical point. Due to the closed nature of the chamber, the heating process causes the pressure to increase. The vent valve is opened to relieve excess pressure. Due to the design limitations, the pressure in the supercritical drying chamber must not exceed 2,000 PSI but during supercritical drying the pressure must not be lower than 1,100 PSI. There is a safety valve which is calibrated to release pressure when the supercritical drying 8 chamber reaches 2,000 PSI. The chamber is heated until the internal temperature reaches 45 degrees Celsius, as verified by an infrared thermometer pointed at the sight glass on the chamber. Once the internal temperature has reached this threshold, the chamber is isothermally depressurized by opening the vent valve while heating the chamber. The rate of depressurization must not exceed 100 PSI/min. This reduces the risk of cracking the aerogels with a severe pressure shock. Formation of Nitrocellulose Figure 3. Esterification of cellulose Nitrocellulose was formed by nitrating cellulose in the form of cotton balls in a 40 °C mixture of 75 mL sulfuric acid and 25 mL nitric acid. Approximately 400mg of cellulose was placed in the nitration solution and allowed to react for various time periods between 10 and 60 minutes. During this reaction, sulfuric acid acts as both a desiccant and a catalyst by removing water from the reaction and providing H+ to the HNO3 to generate the active nitrating agent, NO2+. 10 minutes was the shortest nitration time period used for this project. Cotton which was nitrated for less than 10 minutes burned similarly to the original cotton and had very limited solubility in acetone. After nitration, the nitrocellulose was washed in a bath of chilled deionized water. The nitrocellulose was 9 washed for a total of 15 minutes, replacing the entirety of the water every five minutes. Sodium bicarbonate was added to the final bath to ensure neutralization of excess acid. The washed nitrocellulose was dried at for 12 hours at 60 °C in a drying oven located in a fume hood. Due to the risk of spontaneous combustion which is associated with nitrocellulose, the samples were used immediately after the completion of the drying process to eliminate the need for storage. Interconnected Porosity Adjustments To create the interconnected porosity, two methods were explored. First, 7-25 milligrams of nitrocellulose fibers (a ‘scaffold’) were evenly dispersed throughout the mold. The sol was then allowed to set while the fibers remained in place. The scaffold could then be removed during solvent exchanging by replacing the solvent with acetone. Lengthening the solvent exchange time to 144 hours is necessary in order to fully remove the fibers. The sol gel is then supercritically dried according to standard procedure. Alternatively, the fibers could be removed after supercritical drying. In this procedure, the sol is solvent exchanged for the standard 72 hour period, then supercritically dried. After the aerogels were removed from the supercritical drying chamber, they were calcined in pure oxygen at 220 degrees Celsius to remove the scaffold. The second procedure uses a mixture of nitrocellulose and acetone. For every 25 milligrams of nitrocellulose, 1 milliliter of acetone is used. This ‘lacquer’ is then dispersed in the sol by vortex mixing for one minute. The resulting mixture separates into 10 microdroplets of lacquer and, after the sol gel sets, the lacquer can be removed by solvent exchanging in acetone for 144 hours. This lacquer cannot be removed with calcining. Silver Nanoparticle Doping Silver nanoparticles can be introduced into the aerogel by adding 2.2 grams of silver nitrate to the sol. This is best accomplished by first dissolving the silver nitrate in the water used for making the sol, then adding the water to the rest of the mixture. This ensures that all the silver nitrate dissolves and is evenly distributed throughout the sol. During curing, the sol is exposed to ultraviolet lights to convert the silver nitrate into silver nanoparticles. UV-C lamps were used to expose the gel over an eight-hour period. Following this, the gels were processed according to standard procedures. 11 Rapid Solvent Exchanges Figure 4. A Soxhlet extraction apparatus [24] 12 With the adjustments to the formation procedure introduced by the interconnected porosity process, the lengthy solvent exchanges were causing a bottleneck in testing. Therefore, a faster method of solvent exchanging was sought. A Soxhlet extractor is a special piece of glassware which continuously exposes a sample to a hot solvent, periodically replacing and draining the used solvent. This procedure not only decreases the time needed to exchange the alcogels, it also reduces the amount of solvent used for the process. The Soxhlet extractor we used has a 150mL capacity in the extraction chamber, and has a solvent period of approximately 10 minutes. By using the Soxhlet extractor to perform the solvent exchanges, the exchange time for all alcogels has been reduced to 24 hours. 13 RESULTS SEM Morphology The microstructure aerogels were characterized using a Hitachi S-4800 scanning electron microscope. Tetratethyl orthosilicate-based aerogels (TEOS) and Methyltriethoxysilane (MTES) hybridized aerogels were tested with varied levels of loading, both for the fiber process and for the nitrocellulose lacquer. Figure 5. Tetraethyl orthosilicate aerogel membranes formed using the calcining method. Nitrocellulose scaffold was still present after calcining in oxygen at 225 °C (A). Fibers which remained present in the membrane after calcining in air (B) were removed after recalcining in oxygen at 500 °C (C, D). The channel linings show the same structure as the surrounding aerogel (E). Photographs of different aerogels and the result of nitrocellulose removal via calcination in air versus oxygen (F). 14 Figure 6. TEOS based membranes with 25, 33, and 50 percent lacquer (A,B,C). MTES based membranes with 25, 33, and 50 percent lacquer (D,E,F). Figure 7. MTES aerogels fabricated with nitrocellulose fibers solvent exchanged in acetone before supercritical drying. The acetone exchange dissolved most of the 30 minute fibers (A) and all 60 minute nitrocellulose fibers (B) The dissolution of the nitrocellulose scaffold leaves interconnected channels on the order of tens of microns (C,D). 15 Structural Damage Figure 8. Aerogels produced with the calcination method can become damaged from heat (A). (B) shows the microstructure from the top portion of the aerogel. 16 FTIR of Nitrocellulose Figure 9. FTIR of nitrocellulose and cotton (Top). NIR of nitrocellulose and cotton (Bottom). 17 TEM Analysis Transmission electron microscopy was performed to ensure that the sample contained silver nanoparticles which were free of oxides. This TEM was performed with a Joel JEM 2800 S/TEM. Figure 10. TEM micrograph of a silica aerogel chunk with nanometer-sized silver particles (Left) and a diffraction pattern showing a crystalline structure of the nanoparticles (right) 18 Figure 11. The line EDX analysis of a silver nanoparticle where silver is yellow (A). A full EDX analysis of silver (B), silicon (C), oxygen (D) and the relative abundance of each (E) 19 Porosity Analysis Table 1. Helium pycnometry data for a variety of TEOS AND MTES samples. T-xx is coded for a TEOS aerogel with xx% lacquer. M-xx is coded for a MTES aerogel with xx% lacquer. 20 DISSCUSSION Initial results showed that the nitrocellulose fibers of the aerogel remained intact after calcination at low temperature, but could be effectively removed from TEOS-based aerogels by calcining in oxygen at a high temperature, shown in Figure (5C) and (5D). Though the structure on the inside of the channels appear consistent in some experiments, such as Figure (5E), the results were sometimes less successful. The white boundaries towards the top of the aerogel shown in Figure (8A) indicate that the high localized heat from the combustion of the nitrocellulose has caused the microstructure to condense. This can be confirmed with Figure (8B) where the structure of the aerogel has clearly been damaged. When the nitrocellulose was removed with an acetone solvent exchange, the channel lining appeared more compact than the bulk aerogel as can be seen in Figure (7B). While simple, the use of fibers had issues with damage and consistency whether dissolution or calcination was used. The development of the nitrocellulose lacquer method showed great improvement in consistency and possible loading levels. Figure (6) shows a series of aerogel samples produced with the lacquer method. In the TEOS aerogels, shown in Figures (6A), (6B), and (6C), increased mesopores and pitting of the aerogels with increasing lacquer content occurs. A similar phenomenon can be observed with MTES aerogels shown in Figures (6D), (6E), and (6F). These MTES samples appear to have more cohesive and homogenous microstructures than the equivalent TEOS samples, creating fine web-like structures rather than large isolated pitting. This phenomenon is especially apparent in the comparison between Figure (6C) and (6F). 21 The nitrocellulose used to produce these aerogels has been optimized to provide optimal solubility in acetone yet remain insoluble in ethanol. The FTIR and NIR data displayed in Figure (9) shows that esterification of cotton readily takes place. The nitrogen content of the nitrocellulose used in this study is expected to be greater than 11.3%. It has been reported that when the nitrogen content is between 10.7%–11.3%, nitrocellulose is reportedly soluble in alcohols, ketones, esters, and glycol ethers, but at nitrogen contents greater than 11.3% the nitrocellulose is no longer soluble in ethanol [25]. Silver nanoparticles were produced and confirmed to be in the matrix of the aerogel with TEM analysis. Figure (10) shows a small silica monolith with nanoscale silver embedded in it and a diffraction pattern suggesting that the nanoparticles are crystalline in nature. The lack of oxides on these nanoparticles was confirmed with the EDX data presented in Figure (11). The helium pycnometry data presented in Table (1) shows that with increasing percentages of lacquer, the porosity increases. The MTES aerogels were generally more permeable, which is consistent with the observations from Figure (6). 22 CONCLUSION This thesis examined the process of creating interconnected porosity aerogels via two unique methods. Both methods improved gas permeability through the monolithic aerogel. While incorporating nitrocellulose fibers directly into the aerogels did produce interconnected porosity, the removal of the fibers was inconsistent and often led to damage to the microstructure of the aerogel. Making aerogels with the lacquer scaffold was by far the more effective approach. The MTES-based aerogel with 50% nitrocellulose lacquer was the most permeable aerogel produced in this study, and it was also the most consistent in microstructure and repeatability. One of the many benefits to this process is the potential to be applied to a wide range of aerogel chemistries. With the new ability to use monolithic forms as a filtration media, aerogels may soon find new uses in society. 23 REFERENCES [1] M. Anderson, R. Stroud, C. Morris, C. Merzbacher, D. Rolison, Tailoring advanced nanoscale materials through synthesis of composite aerogel architectures, Adv. Eng. Mater. 2 (2000) 481–488. [2] K. Sinkó, Influence of chemical conditions on the nanoporous structure of silicate aerogels, Materials 3 (2010) 704. [3] Z. Ülker, D. Sanli, C. Erkey, Chapter 8 - applications of aerogels and their composites in energy-related technologies, in: V. Anikeev, M. Fan (Eds.), Supercritical Fluid Technology for Energy and Environmental Applications, Elsevier, Boston, 2014, pp. 157–180. [4] K. Kanamori, Y. Kodera, G. Hayase, K. Nakanishi, T. Hanada, Transition from transparent aerogels to hierarchically porous monoliths in polymethylsilsesquioxane solgel system, J. Colloid Interface Sci. 357 (2011) 336–344. [5] S. Li, H. Ren, J. Zhu, Y. Bi, Y. Xu, L. Zhang, Facile fabrication of superhydrophobic, mechanically strong multifunctional silica-based aerogels at benign temperature, J. Non-Cryst. Solids 473 (2017) 59–63. [6] A. Mahani, S. Motahari, A. Mohebbi, Sol-gel derived flexible silica aerogel as selective adsorbent for water decontamination from crude oil, Mar. Pollut. Bull 129 (2018) 438–447. [7] H. Maleki, L. Duraes, A. Portugal, A new trend for development of mechanically robust hybrid silica aerogels, Mater. Lett. 179 (2016) 206–209. [8] S. Standeker, Z. Novak, Z. Knez, Adsorption of toxic organic compounds from water with hydrophobic silica aerogels, J. Colloid Interface Sci. 310 (2007) 362–368. [9] M. Guise, B. Hosticka, B. Earp, P. Norris, An experimental investigation of aerosol collection utilizing packed beds of silica aerogel microspheres, J. Non-Cryst. Solids 285 (2001) 317–322. [10] N. Soelberg, T. Watson, Deep bed adsorption testing using silver-functionalized aerogel, in: D.o.E.N. Laboratory (Ed.), Idaho National Laboratory, 2012. [11] A. Kohl, Absorption and stripping, in: R. Rousseau (Ed.), Handbook of Separation Process Technology, Wiley & Sons, 1987. [12] R. Perry, D. Green, Perry's Chemical Engineers' Handbook, 7 ed., McGraw Hill, 1997. [13] S. Cao, K. Yeung, J. Kwan, P. To, S. Yu, An investigation of the performance of catalytic aerogel filters, Appl. Catal. B Environ. 86 (2009) 127–136. [14] M. Aegerter, N. Leventis, Aerogels Handbook, Springer, 2011. [15] R. American Society of Heating, A.-C. Engineers, 2005 ASHRAE Handbook: Fundamentals, ASHRAE, 2005. [16] S. Gu, S. Jana, Open cell aerogel foams with hierarchical pore structures, Polymer 125 (2017) 1–9. [17] J. Korhonen, P. Hiekkataipale, J. Malm, M. Karppinen, O. Ikkala, R. Ras, Inorganic hollow nanotube aerogels by atomic layer deposition onto native nanocellulose templates, ACS Nano 5 (2011) 1967–1974. 24 [18] X. Wang, S.C. Jana, Tailoring of morphology and surface properties of syndiotactic polystyrene aerogels, Langmuir 29 (2013) 5589–5598. [19] S.J. Kim, P. Raut, S.C. Jana, G. Chase, Electrostatically active polymer hybrid aerogels for airborne nanoparticle filtration, ACS Appl. Mater. Interfaces 9 (2017) 6401–6410. [20] N. Teo, S.C. Jana, Open cell aerogel foams via emulsion templating, Langmuir 33 (2017) 12729–12738. [21] X. Li, G. Fryxell, C. Wang, J. Young, Nitrocellulose templated hierarchical pore structure in mesoporous thin films, Inorg. Chem. Commun. 9 (2006) 7–9. [22] X. Li, G. Fryxell, C. Wang, J. Young, Templating mesoporous hierarchies in silica thin films using the thermal degradation of cellulose nitrate, Microporous Mesoporous Mater. 99 (2007) 308–318. [23] Wang, B., Reifsnyder, A., Zharov, I., & Carlson, K. (2019). Silica aerogel membranes fabricated using removable nitrocellulose scaffolds. Microporous and Mesoporous Materials,278, 435-442. doi:10.1016/j.micromeso.2018.12.045 [24] “Soxhlet Extraction.” Indiamart www.indiamart.com/proddetail/soxhlet-extraction19701915748.html. [25] Nitrocellulose Walsroder Nitrocellulose: Essential for an Extra-special Finish, DOW Chemical Company 25 Name of Candidate: Alexander Reifsnyder Birth date: March 17, 1997 Birth place: Port Chester, New York Address: 747 Boston Post Road Rye, NY 10580 26 University of Utah UNDERGRADUATE RESEARCH JOURNAL QUANTIFYING BONE DENSITY USING CONVENTIONAL RADIOGRAPHY Kristin Rominger (Edward Hsu, PhD) Department of Biomedical Engineering Introduction Osteoporosis is a major cause of morbidity and mortality worldwide. It is responsible for more than 8.9 million fractures annually [1], affecting 1 in 3 women and 1 in 5 men over the age of 50 [2], [3]. Since osteoporosis cannot be reversed, early diagnosis is critical in preventing and reducing the debilitating effects of a loss of bone density [4]. The gold standard for diagnosing osteoporosis is dual-energy x-ray absorptiometry (DXA) [4]. This technique uses two x-ray beams of different energies to differentiate soft tissue densities from bone mineral density (BMD). DXA-obtained BMD measurements of the femur, hip, and lumbar vertebrae are most commonly used to estimate bone fracture risk and diagnose osteoporosis [4], [5]. However, whole-body DXA scanners are expensive and only available in large cities and healthcare centers [6], [7]. Although portable BMD devices are available, they remain costly and are confined to use for peripheral measurements. Since these devices do not measure BMD of the femur, hip, or lumbar vertebrae, they are unsuitable for diagnostic use. Quantitative ultrasound is one portable BMD technique that attempts to lower costs, but is still under development and currently used as a pre-screening tool to identify candidates for DXA scanning [8]. An imaging modality that is relatively low-cost and widespread throughout both developed and developing countries is conventional radiography [5]. When radiographic scanners were equipped with an intensity calibration device during imaging, the intensities in the radiograph were successfully related to standardized mass quantities, a necessity for quantifying BMD [6]. Due to these reasons, conventional radiography offers an alternative to costly and inaccessible DXA scanners. Although there exists a motivation to quantify bone density from radiographic images, methods to do so are currently undeveloped. To make radiographs suitable for quantitative BMD measurements, the soft tissues of the anatomy need to be separated from the bone, and the thickness of the bone needs to be accounted for. In this study, we developed a preliminary method to quantify bone density using radiographs. We employed geometrical modeling of both the cortical bone and the soft tissues of a radiograph dataset to account for bone thickness and estimate bone density without interference from soft tissues. For validation, we compared bone densities obtained using our method to CT density measurements of the same subjects. We also compared the CT density measurements to baseline radiograph densities that were obtained without modeling. To quantify our results and determine correlation between CT density measurements and the baseline and modeled densities obtained from the radiographs, we performed linear regression analysis. This work constitutes progress towards a low-cost, widely accessible method for diagnosing osteoporosis that is especially needed in developing countries. Methods Radiograph Dataset Selection and Backgrounding To quantify bone mineral density from radiographs, we applied a second-order soft tissue model to estimate tibial and metacarpal bone mineral densities from the radiographs of 15 parrots (8 Sun Conures, 7 Quakers). The parrots were imaged with an intensity calibration device consisting of six plastic washers whose masses varied linearly. We first subtracted the background intensity of each image from the full image, setting the background intensities to zero, before constructing a calibration curve that related intensities of the standardized intensity calibration device to their mass quantities. Backgrounding, construction of the calibration curve, and all further manipulation and modeling of the radiographs were performed in MATLAB R2016b (MathWorks, Natick MA). Region of Interest Selection with Noise Reduction The midline of the bottom tibia in each image was fit to a linear equation to align the image coordinates with the axis of the tibia (Fig. 1A) and calculate the indices ranging between 20% and 50% of tibial length (measured with respect to the distal end). This region of the tibia closely approximated a cylindrical shape and was used for modeling. With the axis of the tibia aligned with image coordinates, the intensity values were recorded by horizontal position. We averaged the intensity of each horizontal position in sets of ten vertically adjacent pixels. This averaging was performed to reduce the effects of noise in order to generate more representative intensity profiles and facilitate modeling. Soft Tissue Modeling From the plotted intensity profiles of each set of measurements (Fig. 1B), the intensities of the soft tissues were modeled as quadratic functions and digitally subtracted from the original scan of the tibia to create a ‘bone only’ scan (Fig. 1C). The intensities located in the coordinates containing the tibia bone itself were neglected during the modeling of the quadratic function, but the subtraction was applied to all intensities. Bone Density Quantification The bone density of each parrot was quantified from its bone only scan by modeling each tibia as a concentric cylinder with a hollow interior. The two peak intensities observed in each bone only intensity profile (Fig. 1D) correspond to the projection of the intensities of the cortical bone. These values were averaged and divided by the number of pixels that the intensity sum was calculated over, generating a relative density value for each parrot. Eq. 1, derived directly from the Pythagorean Theorem, shows the calculation for the total number of pixels that each intensity was calculated over (n), where rout is the outer diameter of the cortical bone and rin is the inner diameter of the cortical bone. $ 𝑛 = 2$𝑟!"# $ − 𝑟%& (Eq. 1) Each relative density value was converted to a standardized density value using the constructed calibration curve. A C B D Fig. 1: Intensity profiles of original and bone-only radiograph images of the tibia. The original image (A) is shown directly above its intensity profile along the length of the tibia (B), with soft tissues modeled in red. Note that each intensity profile curve corresponds to the averaged intensities of 10 vertically adjacent pixels for a given horizontal pixel location. The bone-only image (C) is the original image with the modeled soft tissue intensities removed. Its intensity profile is shown directly below (D). Validation and Statistical Analysis To serve as a baseline for comparison, ‘uncorrected’ density calculations from the same radiograph scans were obtained without performing any geometrical modeling or soft tissue removal. These calculations were performed on the same tibias, in the same locations (between 20% and 50% of tibia length measured with respect to the distal end). They followed the same procedures as the corrected radiograph intensities for density quantification, with the exception that the intensities used for density quantification were taken from the original image with soft tissue intensities included, and without accounting for the number of pixels that the intensities were taken over. Both the uncorrected and corrected radiograph densities were compared to CT measurements, which represent the accepted densities. CT scans of the same 15 parrot dataset were obtained. Since the CT scans featured the birds in different positions than the radiograph scans (and thus could not be correlated to the correct tibia used for the radiograph analysis), CT density measurements of both tibias were taken and averaged. These CT measurements were taken using Amira (Thermo Scientific, Waltham MS), 3D software used for CT visualization and analysis. These measurements were in Hounsfield units (HU), which are linear in scale, and were taken and averaged over the same locations as in the radiographs (between 20% and 50% of tibia length measured with respect to the distal end) by selecting this region. Both the uncorrected and corrected radiograph measurements were independently compared to the CT measurements. We performed linear regression analysis of uncorrected radiograph measurements vs. CT measurements and corrected radiograph measurements vs. CT measurements to determine R2 values for each relation, and whether a significant correlation could be established for each relation. R2 values vary from 0 to 1 and represent the percent of variation in the radiograph model that is predicted by the CT measurements, with values closest to 1 representing the best fit between the radiograph predictions and the CT measurements. In addition, hypothesis testing of the slope of each regression line was performed using a t-test (with associated p-values) to test the null hypothesis that the slope is not statistically different than zero, using a minimum confidence level of 95%. A slope of zero implies that there is no significant linear relationship between the radiograph and CT densities, as a change in CT density would not be reflected by a change in radiograph density. A low p-value (p < 0.05) suggests that the slope is not zero, and that changes in CT density are associated with changes in radiograph density. This is necessary for radiograph densities to be representative of CT densities. Finally, the entire process of bone density quantification, validation, and statistical analysis was repeated for the leftmost metacarpal in each parrot radiograph of the dataset. Results The uncorrected and corrected tibial densities, plotted against the corresponding CT densities for each parrot, are shown in Figures 2 and 3, respectively. For the uncorrected radiograph densities, a positive slope was found at the 95% confidence level (p = 0.04) from the regression analysis, with an R2 of 0.29 for the regression equation. From this equation, uncorrected tibial radiograph density is predicted to equal 2.00 + 0.0032∙(CT density), when CT density is reported in HU and radiograph density is reported in standardized intensity calibration device units. When modeling was applied to the radiographs, a positive slope was found at a higher confidence level of 99.995% (p = 0.0001) from the regression analysis, and R2 improved to 0.70 for the regression equation. From this equation, tibial radiograph density is predicted to equal 2.32 + 0.0069∙(CT density), when CT density is reported in HU and radiograph density is reported in terms of standardized intensity calibration device units. Radiograph Density [Relative Unit] 5.8 5.6 Data Trendline 5.4 5.2 5 4.8 4.6 4.4 4.2 750 800 850 900 950 CT Density [HU] 1000 1050 Fig. 2: Uncorrected radiograph densities compared to CT densities in the tibias of 15 parrots. Linear trendline: y = 0.0032x + 2.00 (p < 0.05, R2 = 0.29). Note that radiograph density units are reported in terms of the standardized intensity calibration device, which is linear in scale. Radiograph Density [Relative Unit] 10 Data Trendline 9.5 9 8.5 8 7.5 750 800 850 900 950 1000 1050 CT Density [HU] Fig. 3: Corrected radiograph densities compared to CT densities in the tibias of the 15 parrots. Linear trendline: y = 0.0069x + 2.32 (p < 0.0005, R2 = 0.70). Figures 4 and 5 show the uncorrected and corrected metacarpal densities, respectively, plotted against the corresponding CT densities for each parrot. Results from simple linear regression indicate that a non-zero slope could not be found at a 95% confidence level for either the uncorrected or corrected radiograph densities. For the uncorrected radiograph densities, simple regression analysis resulted in a p-value of 0.3, with an R2 of 0.080. From this analysis, uncorrected metacarpal radiograph density is predicted to equal 0.21 + 0.00023∙(CT density), when CT density is reported in HU and radiograph density is reported in standardized intensity calibration device units. When modeling was applied to the radiographs, simple regression analysis resulted in a p-value of 0.2, and R2 improved slightly to 0.14. Based on this analysis, metacarpal radiograph density is predicted to equal 7.79 + 0.0054∙(CT density), when CT density is reported in HU and radiograph density is reported in terms of standardized intensity calibration device units. Radiograph Density [Relative Unit] 0.5 0.48 0.46 0.44 0.42 0.4 0.38 0.36 Data Trendline 0.34 0.32 850 900 950 CT Density [HU] 1000 Fig. 4: Uncorrected radiograph densities compared to CT densities in the metacarpals of 15 parrots. Linear trendline: y = 0.00023x + 0.21 (NS, R2 = 0.080). Radiograph Density [Relative Unit] 14 13.5 13 12.5 12 11.5 11 10.5 Data Trendline 850 900 950 1000 CT Density [HU] Fig. 5: Corrected radiograph densities compared to CT densities in the metacarpals of the 15 parrots. Linear trendline: y = 0.0054x + 7.79 (NS, R2 = 0.14). Discussion This study is a first attempt to quantify bone density using soft-tissue modeling of radiographs. We used intensity calibration and second-order modeling of soft tissues to determine the bone densities of radiographs at the tibial and metacarpal sites. Based on the comparison of these results to CT-obtained bone densities of each site, a significant correlation between the densities from the radiographs and those from CT was found for the tibial site, but not the metacarpal site. A significant correlation between the bone density derived from the modeled radiographs and the CT measurements (accepted densities) was found at the tibial site (R2 = 0.70, p < 0.0005) (Fig. 3). Based on this relatively high R2 value, the tibial densities obtained from the modeled radiographs are generally representative of the accepted density values. This result also marked a significant improvement from the baseline (unmodeled) radiograph densities, which featured a weaker correlation (R2 = 0.29, p < 0.05) (Fig. 2). The difference in the two results is due solely to soft-tissue modeling, demonstrating its significance in determining the bone density of radiographs at the tibia. However, a significant correlation between the modeled radiograph and CT densities was not found for the metacarpal site (R2 = 0.14, NS) (Fig. 5). Although there was a slight increase in R2 when comparing this result to the baseline correlation (R2 = 0.080, NS) (Fig. 4), the correlation remained non-significant and the modeled radiograph densities were not representative of the CT densities at the metacarpal site. The difference in the significance in correlation between the tibial and metacarpal sites is likely due to the differences in geometry and surrounding skeletal structure of the two sites. The tibial site is relatively isolated from surrounding bones and is also geometrically simple in shape, closely approximating a concentric cylinder. In contrast, the metacarpal site features overlapping bones and feathers and has irregular geometry that our model may have had trouble accounting for. When comparing the tibial site results from our radiograph-based method to results obtained from other portable or peripheral BMD quantification devices, the tibial site featured strong correlation to accepted BMD [10]-[13]. These other quantification devices are most likely to be used in areas without access to standard equipment, such as DXA scanners, and serve as a standard-for-comparison for our radiograph-based technique. In one study, Kim et al. tested the association of speed of sound measured by ultrasound densitometry with bone mineral density measured by DXA in seven sites throughout the spine, femur, and forearm. They found r values ranging from 0.63 to 0.78 (all p < 0.0001), corresponding to R2 values ranging from 0.40 to 0.61 [10]. Similarly, Kayalar et al. tested the association of BMD measurements of the calcaneus (heel bone) obtained from the DXA Laser Calscan device with T-scores obtained from traditional DXA. T-scores are calculated from the measured BMD value, representing the number of standard deviations that the BMD value varies from the average BMD of a 25-yearold of the same sex. The Calscan device is more mobile and less costly when compared to traditional DXA, but features relatively low correlation when compared to results from traditional DXA scanners, with r = 0.340 (p = 0.001), corresponding to R2 = 0.12 [11]. Finally, portable DXA scanners that measure the bone density of peripheral sites including the forearm and fingers have been compared to traditional DXA measurements of the hip and spine. Comparison of the BMD measurements from AccuDXA 2 portable scanner with those from traditional DXA resulted in r = 0.61 (p < 0.001) for women, corresponding to R2 = 0.37, and r = 0.53 (p < 0.001) for men, corresponding to R2 = 0.28 [12]. When compared with Tscores of the hip using traditional DXA, T-scores of the forearm from the Osteometer-DTX200 peripheral DXA scanner resulted in r = 0.34 (p < 0.05), corresponding to R2 = 0.12 [13]. Although all of the correlations presented from these portable or peripheral BMD quantification devices were statistically significant, the correlations were often relatively weak. The R2 value obtained using BMD measurements of the tibial site after soft-tissue modeling was performed surpassed that of the other techniques presented, indicating its potential utility. However, there are limitations with this study that may affect the comparison of its results with the other methods. Most significantly, we applied our analysis to a parrot dataset rather than a human dataset and used CT, rather than DXA, to validate. Differences in the trabecular and cortical bone content between humans and parrots may yield different success in quantifying BMD in humans with the radiograph-based method. In addition, the BMD measured in the parrots consisted almost entirely of cortical bone, while osteoporosis in humans primarily causes a decrease in the BMD of trabecular bone. Using CT to validate our method also limits the utility of our results, as the radiograph-derived BMD results would ideally be put into the context of DXA-obtained measurements since current diagnostic criteria for osteoporosis have been developed from DXA. Finally, by quantifying BMD from a single tibia from each radiograph, this study assumed that both the left and right tibia had approximately the same bone density, which may introduce small inaccuracies into our results. Despite these limitations, this study was able to demonstrate that intensity calibration and soft-tissue modeling of radiographs can yield representative bone density measurements for an isolated, geometrically simple site (tibia) in a research context. This study also demonstrates the significance of soft-tissue modeling in accurately determining the relative intensity of embedded structures. This may have applications in areas such as oncology, as it could potentially be used to enhance bone tumor visualization using conventional radiography. In addition, by demonstrating that a technique based on conventional radiography can be used to quantify bone density, this study offers a potential method to diagnose osteoporosis in developing countries where DXA and CT are largely inaccessible. An “add-on” system consisting of the intensity calibration device and the software capable of quantifying bone density using soft-tissue modeling could be eventually be supplied to facilities that own a conventional x-ray scanner, which are much more widespread than either CT or DXA scanners. Before this radiograph-based system can be adapted clinically, there are several key developments that first need to occur. Future work includes applying the system to a human dataset and validating its results with DXA-obtained bone densities. In addition, the technique needs to be automated (e.g., user-selection of soft tissue boundaries needs to be removed) and converted into a programming language that is compatible with conventional x-ray scanners. Finally, algorithms need to be developed to better detect and account for overlap when quantifying bone. Successfully introducing these developments would result in a low-cost, widely accessible method to diagnose osteoporosis in developing countries where osteoporosis often goes undiagnosed, resulting in debilitating bone fractures that may be preventable with earlier diagnosis and preventative measures. Conclusion In this study, we developed a preliminary method to quantify bone density using radiographs, employing geometrical modeling of both cortical bone and soft tissues of a radiograph dataset to estimate bone density without interference from soft tissues. We were able to successfully quantify bone densities in the tibia, as validated by CT measurements. Greater correlation to absolute density was observed for our method as compared to other peripheral or low-cost methods that aim to be used in developing countries or other areas where DXA scanners are not available. However, future work needs to be done to address sites with greater overlap or more irregular geometry before this method can be employed clinically. Ultimately, this work constitutes progress towards a low-cost, widely accessible method for osteoporosis diagnosis in developing countries. References [1] O. Johnell and J. A. Kanis, “An estimate of the worldwide prevalence and disability associated with osteoporotic fractures,” Osteoporos. Int., vol. 17, no. 12, pp. 1726– 1773, 2006. [2] L. J. Melton, E. A. Chrischilles, C. Cooper, A. W. Lane, and B. L. Riggs, “Perspective. How many women have osteoporosis?” J. Bone Miner. Res., vol. 20, no. 5, pp. 826– 892, 1992. [3] L. J. Melton, E. J Atkinson, M. K. O’Connor, W. M. O’Fallon, and B. L. Riggs, “Bone density and fracture risk in men,” J. Bone Miner. Res., vol. 13, no. 12, pp. 1915– 1923, 1998. [4] J. M. Kling, B. L. Clarke, and N. P. Sandhu, “Osteoporosis prevention, screening, and treatment: a review,” J. Womens Health, vol. 23, no. 7, pp. 563– 572, 2014. [5] M. K. Garg and S. Kharb, “Dual energy x-ray absorptiometry: pitfalls in measurement and interpretation of bone mineral density,” Indian J. Endocrinol. Metab., vol. 17, no. 2, pp. 203 – 210, 2013. [6] International Osteoporosis Foundation, “The Asian Audit: Epidemiology, costs and burden of osteoporosis in Asia 2009,” International Osteoporosis Foundation, 2009. Available: https://www.iofbonehealth.org/sites/default/files/PDFs/Audit%20Asia/Asian_regional_audit_ 2009.pdf. [Accessed Nov. 2, 2017]. [7] R. Handa, A. Ali Kalla, and G. Maalouf, “Osteoporosis in developing countries,” Best Prac. Res. Clin. Rheumat., vol. 22, no. 4, pp. 693– 708, 2008. [8] K. Thomsen, D. Jepsen, L. Matzen, A. Hermann, T. Masud, and J. Ryg, “Is calcaneal quantitative ultrasound useful as a prescreen stratification tool for osteoporosis?” Osteoporos. Int., vol. 26, no. 5, pp. 1459– 1475, 2015. [9] M. S. Echols and E. W. Hsu, “Validation of a novel radiograph density determination process: a multicenter study,” in 37th Ann. Conf. and Expo. of Assoc. Avian Vet. (AAV), Portland, USA, Aug. 27-Sept. 1, 2016, pp. 39. [10] K. I. Kim, I. K. Han, H. Kim, and N. H. Cho, “How reliable is the ultrasound densitometer for community screening to diagnose osteoporosis in the spine, femur, and forearm?” J. Clin. Densitom, vol. 4 no. 2, pp. 159– 165, 2001. [11] G. Kayalar, A. Cevikol, G. Yavuzer, Y. Sanisoglu, A. Cakci, and T. Arasil, “The value of calcaneal bone mass measurement using a dual x-ray laser calcscan device in risk screening for osteoporosis,” Clinics (Sao Paolo), vol. 64, no. 8, pp. 757– 762, 2009. [12] D. von Muhlen, D. Claflin, and E. Barrett-Connor, “A cross-sectional association of phalangeal bone mineral density versus hip bone mineral density with osteoporosis and nonvertebral fracture,” J. Clin. Densitom, vol. 12, no. 3, pp. 392– 392, 2009. [13] V. K. Wadhwa and N. J. Parr, “Peripheral or axial bone density measurements to identify osteoporosis in prostate cancer patients undergoing androgen deprivation therapy,” Urology, vol. 73, no. 6, pp. 1347– 1351, 2009. University of Utah UNDERGRADUATE RESEARCH JOURNAL A NOVEL APPROACH TO ESTIMATE ENERGY EXPENDITURE USING UPPER BODY JOINT TRACKING Ann E. Rowley (Kai Kück, PhD) Department of Biomedical Engineering Physical fitness is known to be directly correlated with postoperative outcome, where better physical fitness leads to a better postoperative outcome. Patients that improved their physical fitness before surgery exhibited reduced postoperative mortality. The earlier that a patient’s physical fitness can be evaluated, the more time the patient can engage in prehabilitation prior to surgery to potentially improve their postoperative outcome. Current methods to evaluate physical fitness, especially for patients undergoing hip or knee surgery, are costly and time consuming. We aim to assess in a small pilot study whether our simple joint tracking method and arm exercise routine is sufficient for a subject to reach a metabolic threshold of four times their resting oxygen consumption. A C# software program was written in coordination with a Microsoft Kinect™ camera system to track the motion of a subject’s joints in an arm exercise routine. The subject was tracked in parallel with a metabolic monitor and the Kinect™ while performing the arm exercise. This joint positional data was converted into kinetic energy and then converted into a measure of oxygen consumption. While the Kinect™ was able to approximate the oxygen consumed by the subject, the arm exercise was unable to achieve the targeted patient oxygen consumption of four times the resting oxygen consumption. This lowered metabolic response may be due to the reduced muscle mass undergoing metabolic demand in the upper extremities during the activity. A new, more metabolically demanding, arm exercise or a submaximal metabolic threshold will need to be developed. University of Utah UNDERGRADUATE RESEARCH JOURNAL VENTRICULAR PACING DEPTH LOCALIZATION BASED ON EPICARDIAL ACTIVATION MAPS Lindsay C. Rupp (Rob S. MacLeod, PhD) Department of Biomedical Engineering Premature ventricular contractions (PVCs) are a heart rhythm abnormality that leads to poorly synchronized contraction and impaired blood flow. PVCs are commonly treated with radiofrequency ablation (RF) to heat and destroy the small regions of tissue causing the irregularity. There are two distinct approaches to access the heart for RF ablation. Approach one is used if the PVC is located towards the epicardium, or outer heart surface; a small incision is made in the chest wall, and a steerable catheter is inserted to direct an ablation catheter to the believed site of origination of the PVC. Approach two is used if the PVC is located towards the endocardium, or the inner wall of the heart; catheter access is simpler via the femoral vein to the heart chambers and the PVC site. The choice of approach can be ambiguous due to the limited accuracy of current clinical PVC localization techniques, particularly the depth within the ventricular wall. This ambiguity increases procedure time and patient risk, and limits the success of the treatment. The long term goal for this project is to improve non-invasive PVC localization by creating a metric based on body-surface ECGs that will determine the depth of a PVC, specifically epicardial versus endocardial. As a first step, in this study we created an algorithm and a candidate metric from measured epicardial potentials validated from known PVC sites. Our novel localization metric is based on epicardial activation time maps, which measure the amount of time taken at each location to detect a propagating electrical wave. Depending on the location of a PVC’s origination site, activation time maps have distinct, oriented patterns. The oriented patterns develop on a region of the epicardial surface immediately radial from the activation site. The localization algorithm estimates the depth of a PVC by calculating the orientation of the developed pattern. The first step is to determine which electrodes have been activated during the first 15% of the activation duration and project the selected electrodes onto a plane. Next, we fit a line to the activated electrodes and determine its angle relative to a local horizontal axis on the heart; we found that this angle predicts the depth of the PVC. To test the novel PVC localization technique, we stimulated PVCs in the left ventricular free wall of an open chest animal experiment. The sites of origin of the PVCs lay at nine known, regular intervals along an electrode array that is introduced in the heart. From each experimental recording, five representative beats were extracted and epicardial activation time maps were computed from epicardial potentials measured simultaneously using a 247-lead epicardial sock. Our algorithm was able to calculate the angle of the orientated pattern for each stimulation site. Overall, the general trend was as follows; as the depth of a PVC becomes more superficial, the angle of the developed pattern rotates in a clockwise direction, mimicking the known rotation of underlying myocardial muscle fibers. By calibrating the depth of stimulation with activation orientation, we will be able to predict the unknown depth of a PVC from the epicardial surface. Future work will test the hypothesis that a similar pattern is detectable from the torso surface, thus resulting in a noninvasive approach to determine the location and depth of a PVC. University of Utah UNDERGRADUATE RESEARCH JOURNAL Finding and Recording Radio-Frequency Heating in the Eyes Katelynn Stroth (Dennis Parker, PhD) Department of Biomedical Engineering Magnetic Resonance Imaging (MRI) machines have been around for quite some time, helping take images of vital organs in the body with the use of radio frequency (RF) magnetic fields. MRI’s use high powered magnets that align the protons in the body with the magnetic field. An RF magnetic field is then applied through to the patient, stimulating the protons in the body to rotate out of equilibrium. Once the RF field is turned off, the sensors in the MRI will detect the energy released as the protons attempt to realign with the magnetic field. As the amounts of energy released change, physicians are able to tell the difference in tissue types from these magnetic properties. When a patient is placed in an MRI, the patient’s body is subjected to the RF magnetic field, which is then used to rotate the magnetic moments from alignment within the main field and deposits energy in the body (similar to a microwave oven). One of organs that might experience heating from the RF magnetic field is the eye. This could pose a potential problem because the eye can’t regulate heat like other body parts. Some organs rely on perfusion to lower their temperature; however, the eye experiences very minimal to no perfusion. The amounts of RF heating are not enough to be potentially life-threatening, however, there is evidence that too much RF heating may cause cataracts, or clouding of the natural lens. We aim to validate how a cow eye model can mimic the properties of soft tissues during induced heating. To test this aim, we placed six non-fixed cow eyes in a fixture that mimics soft facial tissues in the face. Four temperature probes were placed in the fixture, then placed in an MRI scanner (3T TIM TRIO) capable of RF heating. The data acquired was analyzed in MATLAB and converted into temperature graphs. The importance of this study was to determine if the eye could be heated and if the tissues in the eye mimicked facial tissue properties. We were able to find temperature changes within the eye and able to understand a little bit more about eye tissue properties. This study could be the stepping stone to future research in determining how the eye can be damaged by MRI RF heating. University of Utah UNDERGRADUATE RESEARCH JOURNAL CHARACTERIZATION OF APOPTOSIS AND INHIBITORY NEURONS IN CORTICAL ORGANOIDS GENERATED FROM HUMAN INDUCED PLURIPOTENT STEM CELLS Paisley Tarboton1 (Alex Shcheglovitov2, Faculty Mentor) 1 Department of Bioengineering, 2Department of Neurobiology and Anatomy ABSTRACT Modeling human brain diseases in a laboratory setting is critical to understanding the underlying pathology and developing new treatments for patients. Organoids are 3D tissue cultures that provide a promising way to model human brain development in vitro and have been used previously to gain novel insights into diseases unique to humans. We are examining a method for generating cortical organoids with a single internal lumen from induced pluripotent stem cells. It is still unclear how well these organoids represent the many cell types present in the brain. To establish cortical organoids as a model for the developing human cortex, my study focused on the characterization of inhibitory neuron subtypes in cortical organoids and the origins of the ventricle-like lumen. The primary aims were to determine the role cell death and apoptosis played in creating the organoid structure, and to determine the nature of inhibitory neurons present within that structure. I analyzed confocal microscopy images of immunostainings to determine cell identities and distributions. First, in examination of apoptotic cells, we showed cell death was occurring in a low proportion of cells (1.10±0.54%) and that apoptotic cells were distributed away from the center of the organoid. Second, by examining stains unique to specific subtypes of inhibitory neurons, we showed the presence of parvalbumin (PV) (4.41±2.65% of inhibitory neurons), somatostatin (SST) (6.15±2.81%), calretinin (CR) (3.85±0.19%), and calbindin (CB) (4.65±2.91%) expressing subtypes. Together, these results indicate that the organoids’ internal lumen is not an area of excessive cell death and that the organoids contain of a diverse population of inhibitory neurons. This broadens current understanding of the connections between in vivo and in vitro growth and the capabilities organoids can provide for understanding neurodevelopmental disorders. TABLE OF CONTENTS ABSTRACT INTRODUCTION BACKGROUND METHODS RESULTS DISCUSSION CONCLUSION ACKNOWLEDGEMENTS REFERENCES 1 2 3 7 10 18 20 20 21 2 INTRODUCTION One of the challenges in understanding and developing treatments for human diseases is reproducing the disease in a laboratory setting accurately enough that tests can produce relevant information. In vivo animal studies and in vitro cell culture both provide advantages and limitations. The advantage of animal modeling is that neural cells develop in a natural environment, complete with support tissue such as blood vessels. However, animal models of the brain can be hindered by differences in cell types [1]–[5], and development [6], [7] between the mouse, non-human primate, and human brain. One way to gain the human-specific information missing from animal studies is by using cortical organoids. Cortical organoids are threedimensional (3D), self-organized, tissues grown from human pluripotent stem cells [8]–[11]. These organoids recapitulate features of cerebral cortex structure and function with multiple cell and tissue types [10]. Although organoids provide the advantage of using human cells, studying the brain in vitro raises a different set of issues that must be addressed to validate them as a model for brain development. One concern is that organoids contain only brain tissue, and therefore lack blood vessels and other structures that support the brain in vivo [8], [12]. Although culture media attempts to provide the nutrients required for cell growth, the current diversity of culture media used in the literature and the lack of a completely standardized culture protocol means investigating cell death in the organoids is necessary to confirm the health of the tissue [10], [12]–[14]. Another factor to consider is that organoids are most often used to model only one region of the brain at a time [9], [10], [12]–[15]. For example, several studies have been conducted using organoids that model the dorsal telencephalon [11], [13]–[15]. One effect of focusing on an organoid representing the dorsal telencephalon may be the exclusion of cells that are not generated in the dorsal region itself but migrate from ventral areas [9], [14], [16]. This includes at least a portion of inhibitory neurons, which often migrate from the ganglionic eminences (GEs) to the dorsal telencephalon during development [17]. However, whether all inhibitory neurons come from outside the dorsal telencephalon [18] or whether a majority are generated in the dorsal telencephalon itself [6] remains undetermined. Studying what types of inhibitory neurons are present in dorsal organoids could help answer this question [9], [14]. In this study, we aimed to improve the understanding of dorsal cortical organoids as a model for the brain by examining two features: cell death and the subtypes of inhibitory neurons present in the organoid. This was done by analyzing microscope images of immunostained organoid sections. Our results show that the organoids seemed to be healthy, with only small amounts of cell death. We also showed that a variety of inhibitory neurons types were present, supporting the idea that the development of inhibitory neurons can occur from progenitors within the dorsal telencephalon. This adds an additional data point to the body of research connecting how organoid systems develop in comparison to in vivo growth and encourages further investigation into the use of organoids to understand disorders that may be related to inhibitory neurons. 3 BACKGROUND There are a variety of disorders affecting human brain development that have yet to be fully understood because of their intricacy and the complexity of the brain itself. These disorders can have a damaging effect on mental health [19], as well as general quality of life [20] [21] across patients’ lifespans. Caring for children with neurodevelopmental disorders also takes a physical and psychological toll on caregivers [22]. Given that these disorders have been shown to affect about 15% of children in the US, improving our knowledge of how the brain develops is an important goal [23]. In order to develop treatments for neurological disorders, we need to first advance our understanding of their physiological characteristics. Only limited information can be gained from clinical studies using techniques such as medical imaging [24]–[29]. To glean a deeper understanding, it is essential to model both healthy and diseased states in a laboratory setting. A large amount of what we know about brain development has come from experiments on animal models. In particular, mice and rats are commonly used because of many practical advantages [7] despite the fact that their brains are not as similar to human brains as brains from primates [30]. Mouse and rat brains can be used because many pivotal events in development are conserved across mammals, albeit on varying time and spatial scales [7]. Modeling the brain in vitro can provide some advantages over animal models, along with a different set of drawbacks. A. Cell Differentiation and in vitro modeling An important tool for the production of relevant human tissue in the lab is the use of stem cells to produce a variety of other cell types. Embryonic stem cells have the ability to become any type of cell in the body under the right conditions [31], [32]. As the body develops, embryonic stems cells become more specific stem cells that can only produce, for example, brain cells. Once a cell has become fully differentiated it only fulfills a certain purpose, such as in the role of a neuron. This process of more and more precise specialization occurs as cells respond to signals that they receive from nearby or sometimes distant cells [11], [33], [34]. A single cell may respond to a complex combination of signal molecules, usually proteins, secreted by many cells around it. One response a cell may have to the signals it receives is the production of certain proteins that perform a role in that cell’s structure, movement, chemical processes, or subsequent signaling [35]. If expression of a particular protein is somewhat unique, it can be used to define cell types and characteristics that are relevant to research [36]. Fully differentiated cells do not under normal circumstances go back to producing other cell types as a stem cell could [35], [37]. However, Takahashi et al. showed that previously differentiated cells, such as fibroblasts, could in fact be made into stem cells with the application of four transcription factors [35]. The resulting cells, called induced Pluripotent Stem Cells (iPS cells) are functionally equivalent to embryonic stem cells [35]. Furthermore, by additionally controlling the signals these cells receive, researchers are able to control their differentiation towards desired cell types, such as neural progenitors able to produce cells of the cerebral cortex [16]. This opens up exciting possibilities for taking a small sample of patient cells, creating iPS cells, and then developing tissue in the lab that replicates that same patient’s disorder, allowing researchers to better understand it and develop treatments [10], [24], [38], [39]. This is the goal that organoids aim to fulfill. Organoids are 3D tissues that model either a full or partial organ [8], [9], [40]. Organoids have been used to model a variety of tissues in the body, including muscle [41], the kidney [42], and the stomach [43]. A variety of approaches have been developed to model the cerebral cortex with cortical organoids. One of the first was by Lancaster et al. [10], who were able to show different regions of the brain with cell types organized in layers as in vivo. They also were able to derive iPS cells and then organoids from 4 the skin cells of a patient with genetically-based microcephaly, a disease that has been difficult to reproduce in animals [44]. In doing so, they were able to replicate characteristics of the patient’s disorder such as reduced volume of neuroepithelium and poor orientation of radial glial cells [10]. Microcephaly caused by ZIKA virus infection was additionally recapitulated in cortical organoids by Qian et al. [14], showing the ability to model diseases from a variety of causes. Qian et al. also developed organoids specific to different regions of the brain [14]. B. Overview of brain development In order to make these organoids useful models of the brain, it is necessary to replicate some of the steps of normal brain development in the lab. The brain forms from neuroectodermal cells that develop during gastrulation [45]. These cells create a hollow structure called the neural tube early in development. The cells on the outside of this tube give rise to the entire brain and spinal cord, while the hollow cavity becomes the equivalently hollow ventricles in the mature brain [45]. After the neural tube is formed, three initial brain regions develop by the eighth week of human development: precursors to the forebrain, midbrain, and hindbrain. The forebrain region splits into the telencephalon and diencephalon. We will concentrate on the telencephalon here, because it is the precursor to the focus of this work, the cerebral cortex. Dorsal and ventral regions of the telencephalon develop respectively into dorsal and ventral regions of the mature cortex [45]. In forming all of these regions, the original neuroectodermal cells that outlined the neural tube divide to produce more specific progenitors which in turn produce the many different cell types of the brain. In general, the dividing progenitor cells remain nearest the hollow of the ventricle, while mature neurons move outward, forming the bulk of the cerebral cortex in layers [45]. C. Inhibitory neurons in humans and animal models Within the cerebral cortex, there are several broad cell types, the distribution of which is mostly shared across mammalian species [7]. These include glial cells, which perform a variety of support functions for the brain, and two main types of neurons: excitatory and inhibitory. The balance of excitatory and inhibitory neurons is important to proper functioning of neural circuits [46]. Inhibitory neurons, also called GABAergic because of their production of the neurotransmitter γ-aminobutric acid (GABA), only comprise about a fifth of neurons in the cortex [18]. However, they have important roles in regulating excitatory neurons [46] and have been implicated in multiple disorders including epilepsy [47] and autism [48]. Inhibitory neurons also present an area where we see marked differences between humans and other mammals, with the human brain having more GABAergic neurons than even other primates [4], [49]. Across many species, inhibitory neurons can be classified into three major groups, designated by the expression of somatostatin (SST), parvalbumin (PV) or 5-hydroxytryptamine 3A (5-HT3A) [50]. In mice, the origins of each group of inhibitory neurons have been thoroughly characterized [50]–[54] and can be used as the basis of what we understand to occur in humans [7], [18]. The earlier developing groups, PV and SST, migrate from the medial ganglionic eminence (MGE) to the dorsal cortex [51]. The later developing group, expressing 5HT3A, migrates from the caudal ganglionic eminence (CGE) [50]. These three groups originating in the ganglionic eminences produce all inhibitory neurons in mice [51]. Within the three groups, there are additional divisions, just a few of which will be considered here. Vasointestinal peptide (VIP) is expressed in a subset of cells that are part of the 5-HT3A group 5 [50] while calbindin (CB) expression occurs in a subset of the SST group [17]. Calretinin expression seems to overlap with both SST and 5-HT3A groups [17]. Unlike mice, humans [55] and other primates [30] generate some inhibitory neurons in the dorsal telencephalon itself. Multiple studies show that inhibitory neurons from the late developing group (marked by 5-HT3A and originating in the CGE in mice), including those expressing CR, can come directly from the dorsal telencephalon in humans [17], [30], [55]. Letenic found that as many as 65% of inhibitory neurons came from the VZ and SVZ of the dorsal telencephalon, leaving only 35% to originate in the ganglionic eminences [6]. Others have argued that all inhibitory neurons come from outside the dorsal cortex, with some migrating from the GEs early in development and others coming later [18]. Because of the differences between rodents and humans, this is one area where animal models can only go so far in improving our understanding of the human brain, and techniques developed to study human tissue in vitro may provide better insight. One goal of this study is to contribute to the understanding of inhibitory neuron development in the dorsal cortex using organoids that model this brain region. D. Cortical Organoids The dorsal prefrontal cortex region of the brain has been shown to have a role in a broad array of functions such as working memory [56], pain perception [57], and sense of self [58]. Changes in this region have been found in psychiatric disorders such as autism [59], bipolar [60], schizophrenia [61], and depression [62]. Because of these important roles several studies have attempted to model the dorsal prefrontal cortex or, more specifically, its embryonic precursor, the dorsal telencephalon, using cortical organoids [9]–[13], [15]. These studies have been successful in showing layered organization of neuronal cell types [10], along with some glial cells [13], and have modeled cellular changes associated with disorders such as autism [15]. However, there are many neuronal and glial cell types that have yet to be characterized thoroughly in cortical organoids and which need to be understood in order to study complex diseases. E. Inhibitory neurons in cultured cortical tissue Inhibitory neurons were lacking in some initial studies of dorsal cortical organoids [16]. This seemed to support the hypothesis that most inhibitory neurons originate in the subcortex and migrate to the dorsal cortex later in development [18]. Migration of interneurons was additionally shown in vitro by Birey et al., using separate ventral and dorsal organoids that were grown, respectively, from ventral and dorsal neural progenitors. When they later fused these separate organoids, Birey et al. observed migration of GABAergic neurons from the ventral subcortex to the dorsal cortex, as in vivo [9]. However, in work by Lee et al. both inhibitory and excitatory neurons were found in dorsal cortical organoids [12]. Inhibitory neurons subtypes are one feature that was considered in this study. Analyzing the subtypes of inhibitory neurons present could help determine how dorsal cortical organoids are capable of producing the variety of interneurons present in the developing brain or, alternatively, whether some neurons must migrate from the subcortex as proposed by others [9]. F. Apoptosis and cell death in cultured cortical tissue Another feature we examined was cell death and the arrangement of cells around an inner lumen. Zhang et al. showed differentiation of pluripotent stem cells into neural precursor cells results in the formation of neural-tube-like structures called neural rosettes. Cells in each rosette are oriented around a central lumen [63]. Many previous studies have used cortical organoids that develop from clusters of these rosettes [10], [14]. In the neural tube and, correspondingly, 6 the neural rosette, molecular signaling between cells is an important way that unique brain regions and cell types develop [45]. This molecular signaling is a concern in the development of organoids from rosette clusters, since interactions between rosettes could create signaling patterns dissimilar from normal brain development. In fact, Gessi et al. have described the occurrence of multiple rosettes in vivo as a hallmark of a particularly malignant form of CNS Primitive Neuroectodermal Tumor. These extremely proliferative tumors most often result in death within a year of diagnosis [64]. To avoid the complications arising from multiple rosettes, organoids that grow around a single rosette lumen have recently been generated and may better recapitulate healthy development [12]. The inner lumen of cortical organoids was hypothesized to be a feature arising from development, similar to the rosette lumen and brain ventricle. This could be fully confirmed by showing the arrangement of cells around the lumen matched that of the brain, including ependymal cells lining the cavity and neuronal cells forming concentric layers around it based on maturity [45]. Alternatively, the organoid inner lumen could be a cavity left by many cells dying in the organoid center as an artifact of in vitro growth conditions. Therefore, a major goal of this research was to investigate ventricular characteristics of the inner lumen by examining cell death in the organoids. Cell death was examined using the marker anti-active caspase 3. Caspase 3 is essential in cellular processing leading to apoptosis [65]. Because of this role in the mechanism of apoptosis, it has been detected in a variety of cell death conditions, such as those following chemical injury [66], endoplasmic reticulum stress [67], and ischemia [68], [69]. In this study, caspase 3 was used to examine whether excessive cell death was occurring in the cortical organoids. 7 METHODS Study Design The goal of this study was to understand cell characteristics in cortical organoids. To accomplish this, we analyzed confocal microscopy images of immunostained organoid sections generated from stem cells in vitro. First, to determine whether the inner lumen present in the center of the organoid was an artifact of cell death, the quantity and distribution of apoptotic cells were examined in four sections from organoids from two different cell lines. Using an ANOVA test, the positions of apoptotic cells were compared to the positions of all non-apoptotic cells, and the results were also compared between the cell lines. To analyze the types of inhibitory neurons present, five inhibitory neuron subtypes were considered in relation to total inhibitory neurons, as well as organoid cells in general. The subtypes were examined in two organoid sections each from organoids derived from four different cell lines. An ANOVA test was used to compared the results from the four cell lines. A. B. Cortical Organoid Model The cortical organoids used were generated in the Shcheglovitov Laboratory (University of Utah), grown as follows with methods similar to published procedures [10], [16]. Inhibitory neuron analysis was completed using organoids from four different human stem cell lines which originated as follows. An embryonic stem cell (ES cell) healthy control line was purchased (H9 from WiCell WA09). An induced pluripotent stem cell (iPS cell) healthy control line was generated by electroporating plasmids with SOX2, KLF4, OCT3/4, L-MYC, LIN28, and shRNA factors into fibroblasts from Stanford University as described by Okita et al [70]. In addition to these two healthy control lines, we used CRISPR/Cas9 modified versions of both lines with SHANK3 gene deletions generated as described previously [71], [72]. SHANK3 is important for synaptic transmission between excitatory neurons, but is not important for the early development of cortical structure or for the formation of inhibitory neurons, so for the sake of this study all four lines were expected to develop similarly [72]. In the caspase 3 analysis, organoids from the unedited iPS cell line and the edited ES cell line were used. Pluripotency was maintained in all cell lines using Essential 8 media (ThermoFisher A1517001) and was confirmed by the University of Utah Cellular Translational Research Core when beginning differentiation. All cell lines underwent the same differentiation process to obtain organoids. Neural induction was performed with 1:1 N2/B27 media and dual SMAD inhibition using 2 µM dorsomorphin dihydrochloride (Tocris 3093) and 10 µM SB 431542 (Tocris 1614) as described previously [16], [73], [74]. N2 media was made from 0.1% N2 supplement (ThermoFisher A1370701), 0.1% non-essential amino acids (ThermoFisher 11140050), 2 µg/mL heparin (Stem Cell 07980), and 50 mg/ml penicillin/streptomycin (ThermoFisher 150700) in DMEM/F12 medium (ThermoFisher 11320082). B27 media was made from 0.1% B27 supplement (ThermoFisher 17504044), 0.5% GlutaMAXTM (ThermoFisher 35050061) and 50 mg/ml penicillin/streptomycin (ThermoFisher 15070063) in NeurobasalTM-A medium (ThermoFisher 10888022). After neuroepithelial cells were present [16] the media was switched to 1:1 N2/B27 (as before) with 10 ng/ml EGF (Stem Cell 78006) and 10 ng/ml FGF (ThermoFisher 68-878582) to promote formation of rosettes [63]. Once 2D neural rosettes were visible [63], individual rosettes were mechanically cut away from surrounding cells, scooped off the bottom of the plate with a bent glass pipette, and placed in individual wells in suspended culture to allow growth in 3D [12]. After 14 days, rosettes were embedded in undiluted MatrigelÒ (Thomas Scientific B003T15) and grown up to four months [10]. All differentiation and culture was performed by members of the Shcheglovitov Laboratory (University of Utah). 8 For apoptosis analysis, a total of 4 sections (sectioning described below) from 2 organoids were analyzed. These included 2 sections each from organoids derived from the edited ES cell line and from the unedited iPS cell line. For inhibitory neuron analysis 8 sections total were analyzed for each of 5 staining conditions. These included 2 sections each from organoids derived from the 4 different cell lines described above. C. Sectioning, Immunohistochemistry and Imaging Four-month-old organoids were fixed and sectioned for use in immunohistochemistry. Organoids were first fixed in 4% paraformaldehyde (Thomas Scientific C993M24) in PBS (Caisson Labs 1951, diluted from 10x in water) and stored overnight at 4oC. After rinsing 3x with PBS, the organoids were suspended overnight in 10%, 20%, and then 30% sucrose (by weight also in PBS from Caisson Labs 1951). Following the sucrose gradient, organoids were embedded in OCT compound (Fisher Scientific 23-730-571) before being frozen to -80oC. Sections 16 µm thick were cut on a Leica cryostat machine, adhered to positively charged microscope slides (Fisher Scientific 22-037-246), and stored at -20oC. Sections through near the center of the organoid were selected for immunostaining and imaging to obtain a large cross-section. Immunohistochemistry was performed according to established protocols as follows [10]. Samples were permeabilized and blocked using 0.3% Triton X-100 and 5% bovine serum albumin (BSA) (Sigma-Aldrich A4919) before applying primary antibodies in 1% BSA solution (all in PBS). For apoptotic analysis, the primary antibody was anti-active caspase 3 (rabbit, BDPharmingen 559565, 1:500). For inhibitory neuron analysis, anti-calbindin (CB) (mouse, Swant 300, 1:500), anti-parvalbumin (PV) (mouse, Swant 235, 1:5000), or anti-somatostatin (SST) (rat, Chemicon Ab5494, 1:500) subtype stains were used in combination with anti-GABA (rabbit, Sigma Aldrich Z031129-2, 1:500) to show all inhibitory neurons, and anti-Vasoactive Intestinal Peptide (VIP)(rabbit, Immunostar 20077, 1:500), or anti-calretinin (CR) (rabbit, Swant 7699/4, 1:2000) subtype stains were used in combination with anti-GAD67 (mouse, EMD Millipore MAB5406, 1:1000) to show major subtypes of inhibitory neurons. Primary antibodies were incubated overnight at 4oC and then rinsed off with Dulbecco’s Phosphate Buffered Saline (DPBS) (HyClone SH30378.03). Secondary antibodies, Alexa fluor anti-mouse 488 (goat, Invitrogen A11029, 1:500), Alexa fluor anti-mouse 594 (goat, Invitrogen A11005, 1:500), Alexa fluor anti-rabbit 488 (goat, Invitrogen A11034, 1:500), Alexa fluor anti-rabbit 568 (goat, ThermoFisher Scientific A11036, 1:500), and Alexa fluor anti-rat 488 (goat, Invitrogen A21212, 1:500) were then applied for 1 hour and rinsed off with DPBS. Finally, Hoechst 33342 dye (ThermoFisher Scientific H1399, 1:1000) was applied for 5 minutes, sections were rinsed, and a 0.15 mm coverslip was applied (Thomas Scientific 1217N68). 3 channel images of fully stained sections were collected. using a Nikon A1 confocal microscope with LASER illumination, a 20X objective (in air), and NIS elements software (Nikon). Staining and imaging was also performed on adult mouse tissue for isotype controls and to understand specific versus nonspecific staining. Immunohistochemistry and confocal microscopy were performed by Chad Russell (Shcheglovitov laboratory, University of Utah). D. Caspase 3 analysis In order to determine whether the inner lumen resulted from cell death in the center of the organoid, we examined both the proportion and position of apoptotic cells in 4 sections. Each section had a caspase 3 stain to show apoptotic cells and a Hoechst stain to show all nuclei. Nuclei were selected from the Hoechst stain using the spot detection feature of the Mosaic plugin for ImageJ [75]. Caspase 3-positive cells were selected manually. The proportion of apoptotic 9 cells was calculated and the means were compared between the two cell lines using a Student’s T-test with p=0.05. The inner and outer edges of the organoid were designated manually and saved as a set of coordinates. A custom program written in Python (Python Software Foundation) was used to determine the radial distance from all of the Hoechst-stained cells and from the caspase 3positive cells to the inner and outer edges of the cultured organoid in each image. Fractional position was defined as follows to quantify the relative positions of the cells in the organoids: ./01/2 0134/567 48 1557. 7097 𝐹𝑟𝑎𝑐𝑡𝑖𝑜𝑛𝑎𝑙 𝑝𝑜𝑠𝑖𝑡𝑖𝑜𝑛 = 0134/567 48 1557. 7097:0134/567 48 8;47. 7097 (1) This number describes the proportional distance between edges, with a fractional position near 0 describing cells close to the inner lumen and a fractional position near 1 describing cells close to the outer edge. The objective was to determine whether apoptotic cells were evenly distributed among the other cells, or whether they were disproportionately clustered near the central lumen. A two-factor ANOVA test with p=0.05 was conducted to determine whether the average fractional position of apoptotic and non-apoptotic cells was different, and whether the positions of both groups of cells differed between the unedited iPS cell line and the edited ES cell line. E. Inhibitory neuron analysis Inhibitory neuron analysis compared the specific subtype stains: CR, CB, SST, PV, and VIP, to stains for all inhibitory neurons: GABA or GAD67, in order to find the proportion of inhibitory neurons accounted for by each subtype. Each image had 3 different color channels corresponding to stains for all cells (Hoechst), inhibitory neurons, and specific subtypes. Positive cells for each stain were selected using Volocity software (PerkinElmer), which was manually calibrated to find positively stained cells on each channel using size and intensity ranges. First, a region of interest including all cells was designated using the Hoechst channel. Next, all inhibitory neurons were found by selecting positively stained cells on the GABA or GAD67 channel. Finally, cells positive for a specific subtype were selected within the inhibitory neurons using the subtype channel. The percentage of inhibitory neurons belonging to each subtype was determined from examining the output counts. An ANOVA test with p=0.05 was completed to compare ES cell vs iPS cell-derived organoids and control vs CRISPR/Cas9 edited lines with respect to the 5 subtype stain. 10 RESULTS A. Caspase 3 analysis To evaluate the proportion of apoptotic cells in 4 month old organoids, we performed immunostaining with anti-caspase 3 antibodies (Figure 1A) and counted caspase 3-expressing cells across the entire section. The organoids did not exhibit a large amount of apoptosis, as shown by the occurrence of the caspase 3 marker in only 1.10 ± 0.54 % (SEM) of cells (Figure 1C). No significant difference between mean rates of apoptosis was found in comparing the unedited iPS cell line-derived organoids and the edited ES cell line-derived organoids with a Students T-test (p=0.22), although it must be noted that statistical power was low given only 2 organoid sections were used for each case. Despite the small number of apoptotic cells, it was important to know whether they were clustered around the inner lumen. To determine this, we measured the distance from each cell to the inner lumen edge of the organoid. The results showed apoptotic cells were more populous near the outer edge than near the center of the organoid, as shown by the histogram in Figure 2. In order to confirm that this did not simply result from there being more total cells near the outer edge of the organoid, the positions of apoptotic and non-apoptotic cells were compared in all sections (Figure 3). A two-factor ANOVA was used to compare the average positions of caspase 3-positive cells and caspase 3-negative cells, as well as to compare the positions of cells between the edited ES cell line and unedited iPS cell line. The ANOVA indicated a significant difference in the positions of apoptotic and non-apoptotic cells (p=0.0003) and was not able to show a difference in the cell distributions between the two cell lines (p=0.876). This indicates that there is not significant apoptosis occurring in the center of the organoid. Together, the proportion and distribution of apoptosis in the organoids suggest the internal lumen is not a product of cell death and, albeit within our small sample, this holds regardless of organoid cell line origin. 11 A A B 30% C Percentage of cells in apoptosis 25% 20% 15% Apoptotic cells 10% 5% Non-Apoptotic cells 0% Edited ES cellControl iPS cellderived organoids derived organoids Figure 1. Proportion of cells in apoptosis. A: Example image of organoid cross-section (Chad Russell, Shcheglovitov Lab, University of Utah). B: With 2 organoid sections used per cell line, a significant difference between the mean proportion of apoptotic cells was not found using a Students T-test (p=0.22). C: A small percentage of cells, 1.10±0.54% were apoptotic on average. 12 Percentage of total apoptotic cells in each position Control iPS cell-derived organoids Edited ES cell-derived organoids 80% 70% 60% 50% 40% 30% 20% 10% 0% 0 0 To -- 0.2 0.2 0.2 To -- 0.40.4 0.4 To -- 0.6 0.6 0.6 To -- 0.8 0.8 0.8 To -- 1.01.0 Fractional Position Figure 2. Histogram of apoptotic cells positions. Fractional position is defined as (Distance from inner lumen edge)/(Distance between inner and outer edges). Apoptotic cells were more common near the outer edge of the organoid than near the organoid inner lumen. Distribution of apoptotic cells was similar between the two cell lines examined. Fractional position between inner and outer edge of organoid 13 1 0.9 Non apoptotic cells average position Apoptotic cells average position 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0 Edited ESC line section 2 Edited ESC line Unedited iPSC line Unedited iPSC line section 1 section 2 section 1 Organoid Section Figure 3. Apoptotic cells were positioned further away from the organoid inner lumen on average than non-apoptotic cells. Fractional position is defined as (Distance from inner lumen edge)/(Distance between inner and outer edges). The average position of apoptotic, caspase 3-positive, cells and non-apoptotic cells is shown for all four organoid sections. A two-factor ANOVA was used to compare both the average positions of apoptotic versus non-apoptotic cells and the edited ES cell line-derived organoids versus unedited iPS cell line-derived organoids. The ANOVA showed there was a significant difference between the positions of apoptotic and non-apoptotic cells (p=0.0003), but not between cell lines (p=0.876). 14 B. Inhibitory neuron analysis To evaluate the presence of inhibitory neurons in cortical organoids, we performed immunostaining (Figures 4 and 5) on 4-month-old organoids with anti-calbindin (CB), antiparvalbumin (PV), anti-somatostatin (SST), anti-calretinin (CR) and anti-vasointestinal peptide (VIP) antibodies and counted cells expressing each protein. The proportion of inhibitory neurons expressing CB, PV, or SST each was found by comparing their presence to a GABA stain for all inhibitory neurons. Similarly, CR and VIP stains were compared to a Gad67 stain for all inhibitory neurons. At least 4 of the 5 inhibitory neuron subtype markers tested were found (Figures 4 and 5), showing a broad range of cell types present in the organoids. CB, PV, SST, and CR each composed 4–6% on average of the inhibitory neurons in the organoid sections. VIP was only found in one of the 12 sections where it had been stained. However, the proportion of inhibitory neurons accounted for by each cell type was highly variable between sections, as shown in Figure 6. Given this high variability and the fact that only two sections from each cell line were used for each subtype, an ANOVA could not show any significant differences for ES cell-derived organoids versus iPS cell-derived organoids or edited versus unedited lines, using the 5 subtypes’ outcomes. These results suggest the human dorsal cortex may be capable of producing more diverse inhibitory neurons than previously shown, but the consistency of this outcome cannot be confirmed based on the data collected. Subtype specific 15 stains GABA parvalbumin GABA somatostatin calbindin All inhibitory neurons GABA All cells (Hoechst) Figure 4. Example stains for inhibitory neurons. Each section had a Hoechst stain for nuclei, GABA for inhibitory neurons, and a subtype stain with anti-calbindin (CB), anti-parvalbumin (PV), or anti-somatostatin (SST) antibodies. (Chad Russell, Shcheglovitov Lab, University of Utah, unpublished data). First row: CB was expressed in 4.7±2.9% of inhibitory neurons. Second Row: Parvalbumin PV was expressed in 4.4±2.7% of inhibitory neurons. Third Row: Somatostatin SST was expressed in 6.2±2.8% of inhibitory neurons. Subtype specific 16 stains Gad67 calretinin vasointestinal peptide All inhibitory neurons Gad67 All cells (Hoechst) Figure 5. Example stains for inhibitory neurons. Each section had a Hoechst stain for nuclei, Gad67 for inhibitory neurons, and a subtype stain with anti-calretinin (CR) or anti vasointestinal peptide (VIP) (Chad Russell, Shcheglovitov Lab, University of Utah). First row: CR was expressed in 3.8±0.2% of inhibitory neurons. Second Row: VIP was seen in only one section, 0.3±0.3% of inhibitory neurons. 17 Unedited ES cell-derived organoids Unedited iPS cell-derived organoids Edited ES cell-derived organoids Edited iPS cell-derived organoids 40% Percentage of inhibitory neurons 35% 30% 25% 20% 15% 10% 5% 0% CB PV SST CR VIP Figure 6. Inhibitory neurons subtypes were present in highly variable amounts among the sections analyzed. For each subtype, 8 sections from 4 different cell lines were analyzed. Bars show the mean of data between the 2 sections analyzed in each condition, with error bars indicated standard error between those two sections. An ANOVA test did not show significant differences between ES and iPS cell-derived organoids or edited and unedited lines. 18 DISCUSSION The aim of this study was to investigate two features of cortical organoids in relation to brain development: subtypes of inhibitory neurons and cell death in relation to an inner lumen. These two characteristics were examined by analyzing confocal microscopy images of immunostained organoid sections. The results showed that the ventricle-like cavity in the center did not result from cell death, as evidenced by the small number of apoptotic cells (Figure 1) and their positioning away from the cavity (Figures 2 and 3). We also found that a variety of inhibitory neurons were present, including 4 of the 5 subtypes for which we stained, but the proportion of each inhibitory neuron subtype was highly variable (Figure 6). A. Cell death analysis Since cortical organoids lack the vascular supply of the brain, understanding whether the cavity in the center might result from ischemic-like conditions was a particular concern. In fact, studies of non-vascularized tumor spheroids have shown that, both in vivo and in vitro, oxygen can be reduced to zero in the center of spheroids greater than 0.5 mm in diameter [76], smaller than our organoids. Moreover, Bell et al. showed that the central area of spheroid tumor models exhibited necrotic death [77], which would not involve, for instance, the caspase 3 activation we looked for in this study. However, they also saw apoptosis, which occurred almost exclusively in the area immediately surrounding the necrotic center, and likely in response to it [77]. In contrast, more than half of the apoptotic cells in our study were in the outer 20% of the organoid (Figure 2), making it unlikely that they represent the peri-necrotic apoptosis described by Bell et al. [77]. From this information we concluded that the organoids in this study must have better nutrient distribution than, for instance, the tumor spheroids described above, and so do not undergo ischemic-like cell death in the center. This supports the idea that the inner cavity could be a structural feature functionally resembling the ventricle. The pattern of apoptosis we observed in 4-month-old organoids is closer to the distribution of apoptotic cells seen in vivo by Rakic et al. near the 4 month time point of normal brain development. They reported 0.6% apoptotic cells in the ventricular and subventricular zones and 1.15% in the subplate and intermediate zones [78]. Although we do not have the ability to compare our data exactly in terms of individual zones, our 1.10% total rate of apoptosis (Figure 2) with a greater distribution away from the center of the organoid (Figure 3) seems reasonably similar to Rakic et al.’s findings in vivo [78]. Although our conclusions are limited by the use of only 4 organoid sections, the distribution of apoptosis was similar across those 4 sections, indicating the organoids are consistently healthy. A limitation of our cell death analysis is that we only considered a single time point, 4 months. Since active caspase 3 is only present in currently apoptotic cells, our staining would not be able to detect if there had been significant apoptosis that had previously completed. However, if there was a problem with, for instance, nutrient distribution in the organoids, we would expect ongoing apoptosis near the center that could be detected. It is possible that the cells in our organoids are undergoing necrosis without any of them expressing caspase 3, unlike in Bell et al. [77], [79]. It is also possible that the cells in the center remain alive despite deficiencies in oxygen or glucose through metabolism regulation and quiescence as seen in some tumor cells [80]. Otherwise, these findings suggest that the inner cavity of the cortical organoids does not result from cell death and could be a structure similar to the ventricle of the brain. This could make it useful as a landmark to study the 3D cortical structure and layering of developing tissue. Future work examining this cavity at different time points and looking for the presence of ventricular characteristics such as ependymal cells could further inform our conclusions. 19 B. Inhibitory neuron analysis In the second part of this study, we showed four of the five inhibitory neuron subtype markers, parvalbumin (PV), somatostatin (SST), calretinin (CR), and calbindin (CB), were frequently present in the organoids, while vasoactive intestinal peptide (VIP) was only seen in one section. While some studies have argued that all human inhibitory neurons, like those of mice, migrate from the ganglionic eminences in the ventral cortex (GEs) [18], the presence of four inhibitory neuron subtypes in our dorsal organoids is supported by others who have indicated inhibitory neurons in humans can originate in the dorsal telencephalon [6], [17], [55], [81]. The inhibitory neurons that have been shown most frequently to develop within the dorsal cortex in humans [55] and other primates [30] are the late-developing group expressing 5HT3A and CR [17]. This made it unsurprising that CR was the subtype present in most consistent quantities across our samples (Figure 6). The origins of the early developing groups of inhibitory neurons in vivo are less clear. Fertuzinhos et al. showed that SST neurons are absent from the cortex in cases of Severe Striatal Hypoplasia, while CR neurons are always present, implying that the SST group cannot come from the dorsal cortex itself [81]. The CB subgroup of SST neurons have also been seen to migrate from the MGE to the cortex in vivo [17]. Birey et al. showed migration of SST, CB, CR, and PV cells between separate dorsal and ventral spheroids in vitro [9]. These findings make the presence of SST and CB neurons in our dorsal cortical organoids surprising (Figure 6). However, while some studies indicate that only the late developing inhibitory neurons come from the cortex and early groups come from the MGE, Letenic found that 65% of inhibitory neurons came from the VZ and SVZ of the dorsal telencephalon, leaving only 35% to originate in the ganglionic eminences [6]. This is supported by the presence of PV and SST inhibitory neurons in the forebrain specific organoids of Qian et al. They additionally showed that these inhibitory neurons appeared without the typical Nkx2.1-expressing ventral progenitors, indicating that a dorsal progenitor cell may be able to produce inhibitory neurons [14]. Since our dorsal cortical organoids also exhibited PV, SST, and CB expressing inhibitory neurons, they would support the possibility that dorsal progenitors have the ability to produce inhibitory neurons. It is important to note that, assuming CB expressing neurons are a subset of the SST expressing cells, we have only accounted for 10-15% of total inhibitory neurons detected (Figure 6). The most obvious explanation for this would be that a large proportion of the inhibitory neurons in these organoids are from the subset of the 5-HT3A group that do not express any of the markers we examined. Further immunostaining would be needed to examine this possibility. These findings are limited by the large variability between our samples and the fact that we only examined inhibitory neurons at a single time point. In the future, considering both inhibitory neurons and their precursors over a longer time period would allow a better understanding of their development. In particular, our analysis thus far relies on knowing that the pluripotent (embryonic or induced) cells we began with were fully converted into dorsal neural progenitors as expected before differentiating further into excitatory and inhibitory neurons. This assumption was based on the fact that neural induction using dual SMAD inhibition along with N2/B27 media has been shown repeatedly to promote efficient loss of pluripotency and the rise of dorsal neural identity shown by the expression of markers such as Pax6 and FoxG1 [12], [73], [74], [82]–[84]. However, if the organoids did not start out from pure dorsal progenitor cells but had even a few contaminating ventral progenitor cells, the conclusion that the 4 inhibitory neuron types came from cells of the dorsal cortex would be invalid. In addition, research connecting in vivo and in vitro results needs to continue in order to determine whether the cells formed in this experiment followed a natural development trajectory 20 or were artificially pushed towards abnormal differentiation by the in vitro environment. In particular, showing dorsal neural progenitors can produce inhibitory neurons in vitro does not mean that they follow this path in vivo and may indicate a response to artificial signaling conditions rather than the existence of a development path that has not been observed before. Examining the morphology of individual cells and their complete protein expression over time would enhance our understanding of the subtypes present. Determining the sources of variation in these organoids in order to improve their consistency may also shed light on the exact proportions of cells being produced and their origins, as well as if there are differences between cell lines that are currently being obscured by the high variation among individual sections. In summary, our study of inhibitory neurons shows multiple subtypes may be produced by dorsal cortical organoids. This is corroborated by previous work indicating that inhibitory neurons in the human brain, unlike in mice, have origins in both dorsal and ventral telencephalic regions [55]. Continued investigation into the development of inhibitory neurons will improve our insight into human diseases that may be affected by inhibitory neuron dysfunction, such as epilepsy [47], autism [15], and schizophrenia [46]. CONCLUSION Overall, this work adds a new piece in understanding the development of cortical organoids as in vitro models of the embryonic dorsal telencephalon. Having a model that successfully replicates some of the cellular diversity and 3D structure in the brain opens up possibilities for better understanding the complex networks that develop in the cerebral cortex. Continuing to advance these models can improve our knowledge of healthy brain development, effectiveness at modeling disease states, and ability to test treatments for neurological disorders. ACKNOWLEDGMENTS P. A. Tarboton would like to thank Dr. Alex Shcheglovitov and Chad Russell for their significant guidance of this research. This work received funding from the University of Utah Office of Undergraduate Research. 21 REFERENCES [1] I. H. M. Smart, “Unique Morphological Features of the Proliferative Zones and Postmitotic Compartments of the Neural Epithelium Giving Rise to Striate and Extrastriate Cortex in the Monkey,” Cereb. Cortex, vol. 12, no. 1, pp. 37–53, Jan. 2002. [2] S. A. Fietz et al., “OSVZ progenitors of human and ferret neocortex are epithelial-like and expand by integrin signaling,” Nat. Neurosci., vol. 13, p. 690, May 2010. [3] D. V. Hansen et al., “Non-epithelial stem cells and cortical interneuron production in the human ganglionic eminences,” Nat. Neurosci., vol. 16, no. 11, pp. 1576–1587, Nov. 2013. [4] P. Arcelli, C. Frassoni, M. . Regondi, S. D. Biasi, and R. Spreafico, “GABAergic Neurons in Mammalian Thalamus: A Marker of Thalamic Complexity?,” Brain Res. Bull., vol. 42, no. 1, pp. 27–37, Jan. 1997. [5] D. G. Flood and P. D. Coleman, “Neuron numbers and sizes in aging brain: Comparisons of human, monkey, and rodent data,” Neurobiol. Aging, vol. 9, pp. 453–463, Jan. 1988. [6] K. Letinic, R. Zoncu, and P. Rakic, “Origin of GABAergic neurons in the human neocortex,” Nature, vol. 417, no. 6889, p. 645+, Jun. 2002. [7] B. Clancy, B. L. Finlay, R. B. Darlington, and K. J. S. Anand, “Extrapolating brain development from experimental species to humans,” NeuroToxicology, vol. 28, no. 5, pp. 931–937, Sep. 2007. [8] A. Fatehullah, S. H. Tan, and N. Barker, “Organoids as an in vitro model of human development and disease,” Nat. Cell Biol., vol. 18, p. 246, Feb. 2016. [9] F. Birey et al., “Assembly of functionally integrated human forebrain spheroids,” Nature, vol. 545, no. 7652, pp. 54–59, 2017. [10] M. A. Lancaster et al., “Cerebral organoids model human brain development and microcephaly,” Nature, vol. 501, no. 7467, pp. 373–9, 2013. [11] M. Eiraku et al., “Self-Organized Formation of Polarized Cortical Tissues from ESCs and Its Active Manipulation by Extrinsic Signals,” Cell Stem Cell, vol. 3, no. 5, pp. 519–532, Nov. 2008. [12] C. T. Lee et al., “CYP3A5 Mediates Effects of Cocaine on Human Neocorticogenesis: Studies using an In Vitro 3D Self-Organized hPSC Model with a Single Cortex-Like Unit,” Neuropsychopharmacology, vol. 42, no. 3, pp. 774–784, 2017. [13] A. M. Pasca et al., “Functional cortical neurons and astrocytes from human pluripotent stem cells in 3D culture,” Nat. Methods, vol. 12, no. 7, pp. 671–678, May 2015. [14] X. Qian et al., “Brain-Region-Specific Organoids Using Mini-bioreactors for Modeling ZIKV Exposure,” Cell, vol. 165, no. 5, pp. 1238–54, 2016. [15] J. Mariani et al., “FOXG1-Dependent Dysregulation of GABA/Glutamate Neuron Differentiation in Autism Spectrum Disorders,” Cell, vol. 162, no. 2, pp. 375–390, Jul. 2015. [16] Y. Shi, P. Kirwan, J. Smith, H. P. Robinson, and F. J. Livesey, “Human cerebral cortex development from pluripotent stem cells to functional excitatory synapses,” Nat Neurosci, vol. 15, no. 3, pp. 477–86, S1, 2012. [17] N. Zecevic, F. Hu, and I. Jakovcevski, “Interneurons in the developing human neocortex,” Dev. Neurobiol., vol. 71, no. 1, pp. 18–33, Jan. 2011. [18] T. Ma et al., “Subcortical origins of human and monkey neocortical interneurons,” Nat Neurosci, vol. 16, no. 11, pp. 1588–97, 2013. 22 [19] S. Davies, I. Heyman, and R. Goodman, “A population survey of mental health problems in children with epilepsy,” Dev. Med. Child Neurol., vol. 45, no. 5, pp. 292–295, May 2003. [20] D. M. Sikora, P. Vora, D. L. Coury, and D. Rosenberg, “Attention-Deficit/Hyperactivity Disorder Symptoms, Adaptive Functioning, and Quality of Life in Children With Autism Spectrum Disorder,” Pediatrics, vol. 130, no. Supplement 2, pp. S91–S97, Nov. 2012. [21] B. F. van Heijst and H. M. Geurts, “Quality of life in autism across the lifespan: A metaanalysis,” Autism, vol. 19, no. 2, pp. 158–167, Feb. 2015. [22] L. M. Lach et al., “The health and psychosocial functioning of caregivers of children with neurodevelopmental disorders,” Disabil. Rehabil., vol. 31, no. 8, pp. 607–618, Jan. 2009. [23] C. A. Boyle et al., “Trends in the Prevalence of Developmental Disabilities in US Children, 1997-2008,” PEDIATRICS, vol. 127, no. 6, pp. 1034–1042, Jun. 2011. [24] R. K. Rowntree and J. D. McNeish, “Induced pluripotent stem cells: opportunities as research and development tools in 21st century drug discovery,” Regen. Med., vol. 5, no. 4, pp. 557–568, Jul. 2010. [25] L. A. Glantz and D. A. Lewis, “Decreased Dendritic Spine Density on Prefrontal Cortical Pyramidal Neurons in Schizophrenia,” Arch. Gen. Psychiatry, vol. 57, no. 1, p. 65, Jan. 2000. [26] G. Quadrato, J. Brown, and P. Arlotta, “The promises and challenges of human brain organoids as models of neuropsychiatric disease,” Nat. Med., vol. 22, no. 11, pp. 1220– 1228, Nov. 2016. [27] E. Mouchlianitis, R. McCutcheon, and O. D. Howes, “Brain-imaging studies of treatment-resistant schizophrenia: a systematic review,” Lancet Psychiatry, vol. 3, no. 5, pp. 451–463, May 2016. [28] S. A. McCarroll, G. Feng, and S. E. Hyman, “Genome-scale neurogenetics: methodology and meaning,” Nat. Neurosci., vol. 17, p. 756, May 2014. [29] C. Luni, E. Serena, and N. Elvassore, “Human-on-chip for therapy development and fundamental science,” Curr. Opin. Biotechnol., vol. 25, pp. 45–50, Feb. 2014. [30] Z. Petanjek, B. Berger, and M. Esclapez, “Origins of Cortical GABAergic Neurons in the Cynomolgus Monkey,” Cereb. Cortex, vol. 19, no. 2, pp. 249–262, Feb. 2009. [31] J. A. Thomson et al., “Embryonic stem cell lines derived from human blastocysts,” Science, vol. 282, no. 5391, pp. 1145–1147, Nov. 1998. [32] M. J. Evans and M. H. Kaufman, “Establishment in culture of pluripotential cells from mouse embryos,” Nature, vol. 292, p. 154, Jul. 1981. [33] D. V. Hansen, J. L. R. Rubenstein, and A. R. Kriegstein, “Deriving Excitatory Neurons of the Neocortex from Pluripotent Stem Cells,” Neuron, vol. 70, no. 4, pp. 645–660, May 2011. [34] M. Schuldiner, O. Yanuka, J. Itskovitz-Eldor, D. A. Melton, and N. Benvenisty, “Effects of eight growth factors on the differentiation of cells derived from human embryonic stem cells,” Proc. Natl. Acad. Sci., vol. 97, no. 21, pp. 11307–11312, Oct. 2000. [35] K. Takahashi and S. Yamanaka, “Induction of Pluripotent Stem Cells from Mouse Embryonic and Adult Fibroblast Cultures by Defined Factors,” Cell, vol. 126, no. 4, pp. 663–676, Aug. 2006. [36] J. Itskovitz-Eldor et al., “Differentiation of human embryonic stem cells into embryoid bodies compromising the three embryonic germ layers,” Mol. Med. Camb. Mass, vol. 6, no. 2, pp. 88–95, Feb. 2000. 23 [37] J. B. Gurdon, “The Developmental Capacity of Nuclei taken from Intestinal Epithelium Cells of Feeding Tadpoles,” J. Embryol. Exp. Morphol., vol. 10, no. 4, p. 622, Dec. 1962. [38] A. E. Bigorgne et al., “TTC7A mutations disrupt intestinal epithelial apicobasal polarity,” J. Clin. Invest., vol. 124, no. 1, pp. 328–337, Jan. 2014. [39] K. Takahashi et al., “Induction of Pluripotent Stem Cells from Adult Human Fibroblasts by Defined Factors,” Cell, vol. 131, no. 5, pp. 861–872, Nov. 2007. [40] T. Sato et al., “Single Lgr5 stem cells build cryptovillus structures in vitro without a mesenchymal niche,” Nature, vol. 459, p. 262, Mar. 2009. [41] J. Shansky, J. Chromiak, M. Del Tatto, and H. Vandenburgh, “A simplified method for tissue engineering skeletal muscle organoids in vitro,” Vitro Cell. Dev. Biol. - Anim., vol. 33, no. 9, pp. 659–661, Sep. 1997. [42] M. Takasato et al., “Kidney organoids from human iPS cells contain multiple lineages and model human nephrogenesis,” Nature, vol. 526, no. 7574, pp. 564–568, Oct. 2015. [43] K. W. McCracken et al., “Modelling human development and disease in pluripotent stem-cell-derived gastric organoids,” Nature, vol. 516, no. 7531, pp. 400–404, Dec. 2014. [44] J. A. Barrera, L.-R. Kao, R. E. Hammer, J. Seemann, J. L. Fuchs, and T. L. Megraw, “CDK5RAP2 Regulates Centriole Engagement and Cohesion in Mice,” Dev. Cell, vol. 18, no. 6, pp. 913–926, Jun. 2010. [45] J. Stiles and T. L. Jernigan, “The Basics of Brain Development,” Neuropsychol. Rev., vol. 20, no. 4, pp. 327–348, Dec. 2010. [46] O. Yizhar et al., “Neocortical excitation/inhibition balance in information processing and social dysfunction,” Nature, vol. 477, no. 7363, pp. 171–178, Sep. 2011. [47] R. Cossart et al., “Dendritic but not somatic GABAergic inhibition is decreased in experimental epilepsy,” Nat. Neurosci., vol. 4, no. 1, pp. 52–62, Jan. 2001. [48] J. L. R. Rubenstein and M. M. Merzenich, “Model of autism: increased ratio of excitation/inhibition in key neural systems.,” Genes Brain Behav., vol. 2, no. 5, pp. 255– 267, Oct. 2003. [49] N. Zecevic and P. Rakic, “Development of Layer I Neurons in the Primate Cerebral Cortex,” J. Neurosci., vol. 21, no. 15, p. 5607, Aug. 2001. [50] S. Lee, J. Hjerling-Leffler, E. Zagha, G. Fishell, and B. Rudy, “The Largest Group of Superficial Neocortical GABAergic Interneurons Expresses Ionotropic Serotonin Receptors,” J. Neurosci., vol. 30, no. 50, pp. 16796–16808, Dec. 2010. [51] Q. Xu, “Origins of Cortical Interneuron Subtypes,” J. Neurosci., vol. 24, no. 11, pp. 2612– 2622, Mar. 2004. [52] G. Miyoshi et al., “Genetic Fate Mapping Reveals That the Caudal Ganglionic Eminence Produces a Large and Diverse Population of Superficial Cortical Interneurons,” J. Neurosci., vol. 30, no. 5, pp. 1582–1594, Feb. 2010. [53] Y. Wang et al., “Anatomical, physiological and molecular properties of Martinotti cells in the somatosensory cortex of the juvenile rat: Martinotti cells in somatosensory cortex,” J. Physiol., vol. 561, no. 1, pp. 65–90, Nov. 2004. [54] A. Caputi, A. Rozov, M. Blatow, and H. Monyer, “Two Calretinin-Positive GABAergic Cell Types in Layer 2/3 of the Mouse Neocortex Provide Different Forms of Inhibition,” Cereb. Cortex, vol. 19, no. 6, pp. 1345–1359, Jun. 2009. [55] X. Yu and N. Zecevic, “Dorsal Radial Glial Cells Have the Potential to Generate Cortical Interneurons in Human But Not in Mouse Brain,” J. Neurosci., vol. 31, no. 7, pp. 2413– 2420, Feb. 2011. 24 [56] A. Bechara, H. Damasio, D. Tranel, and S. W. Anderson, “Dissociation Of Working Memory from Decision Making within the Human Prefrontal Cortex,” J. Neurosci., vol. 18, no. 1, p. 428, Jan. 1998. [57] J. Lorenz, S. Minoshima, and K. L. Casey, “Keeping pain out of mind: the role of the dorsolateral prefrontal cortex in pain modulation,” Brain, vol. 126, no. 5, pp. 1079– 1091, May 2003. [58] D. A. Gusnard, E. Akbudak, G. L. Shulman, and M. E. Raichle, “Medial prefrontal cortex and self-referential mental activity: Relation to a default mode of brain function,” Proc. Natl. Acad. Sci., vol. 98, no. 7, pp. 4259–4264, Mar. 2001. [59] J. T. Morgan et al., “Microglial Activation and Increased Microglial Density Observed in the Dorsolateral Prefrontal Cortex in Autism,” Biol. Psychiatry, vol. 68, no. 4, pp. 368– 376, Aug. 2010. [60] G. Rajkowska, A. Halaris, and L. D. Selemon, “Reductions in neuronal and glial density characterize the dorsolateral prefrontal cortex in bipolar disorder,” Biol. Psychiatry, vol. 49, no. 9, pp. 741–752, May 2001. [61] D. R. Weinberger, K. Berman, and R. F. Zec, “Physiologic dysfunction of dorsolateral prefrontal cortex in schizophrenia: I. regional cerebral blood flow evidence,” Arch. Gen. Psychiatry, vol. 43, no. 2, pp. 114–124, Feb. 1986. [62] A. Pascual-Leone, B. Rubio, F. Pallardó, and M. D. Catalá, “Rapid-rate transcranial magnetic stimulation of left dorsolateral prefrontal cortex in drug-resistant depression,” The Lancet, vol. 348, no. 9022, pp. 233–237, Jul. 1996. [63] S.-C. Zhang, M. Wernig, I. D. Duncan, O. Brüstle, and J. A. Thomson, “In vitro differentiation of transplantable neural precursors from human embryonic stem cells,” Nat. Biotechnol., vol. 19, no. 12, pp. 1129–1133, Dec. 2001. [64] M. Gessi et al., “Embryonal Tumors With Abundant Neuropil and True Rosettes: A Distinctive CNS Primitive Neuroectodermal Tumor,” Am. J. Surg. Pathol., vol. 33, no. 2, pp. 211–217, Feb. 2009. [65] E. A. Slee, C. Adrain, and S. J. Martin, “Executioner Caspase-3, -6, and -7 Perform Distinct, Non-redundant Roles during the Demolition Phase of Apoptosis,” J. Biol. Chem., vol. 276, no. 10, pp. 7320–7326, Mar. 2001. [66] R. Nath, A. Probert, K. M. McGinnis, and K. K. W. Wang, “Evidence for Activation of Caspase-3-Like Protease in Excitotoxin- and Hypoxia/Hypoglycemia-Injured Neurons,” J. Neurochem., vol. 71, no. 1, pp. 186–195, Jul. 1998. [67] J. Hitomi, T. Katayama, M. Taniguchi, A. Honda, K. Imaizumi, and M. Tohyama, “Apoptosis induced by endoplasmic reticulum stress depends on activation of caspase3 via caspase-12,” Neurosci. Lett., vol. 357, no. 2, pp. 127–130, Mar. 2004. [68] S. Namura et al., “Activation and Cleavage of Caspase-3 in Apoptosis Induced by Experimental Cerebral Ischemia,” J. Neurosci., vol. 18, no. 10, p. 3659, May 1998. [69] B. Hee Han et al., “BDNF Blocks Caspase-3 Activation in Neonatal Hypoxia–Ischemia,” Neurobiol. Dis., vol. 7, no. 1, pp. 38–53, Feb. 2000. [70] K. Okita et al., “A more efficient method to generate integration-free human iPS cells,” Nat. Methods, vol. 8, no. 5, pp. 409–412, May 2011. [71] O. Shalem et al., “Genome-Scale CRISPR-Cas9 Knockout Screening in Human Cells,” Science, vol. 343, no. 6166, pp. 84–87, Jan. 2014. [72] A. Shcheglovitov et al., “SHANK3 and IGF1 restore synaptic deficits in neurons from 22q13 deletion syndrome patients,” Nature, vol. 503, no. 7475, pp. 267–271, Nov. 2013. 25 [73] A. Morizane, D. Doi, T. Kikuchi, K. Nishimura, and J. Takahashi, “Small-molecule inhibitors of bone morphogenic protein and activin/nodal signals promote highly efficient neural induction from human pluripotent stem cells,” J. Neurosci. Res., vol. 89, no. 2, pp. 117–126, Feb. 2011. [74] D.-S. Kim et al., “Robust Enhancement of Neural Differentiation from Human ES and iPS Cells Regardless of their Innate Difference in Differentiation Propensity,” Stem Cell Rev. Rep., vol. 6, no. 2, pp. 270–281, Jun. 2010. [75] I. F. Sbalzarini and P. Koumoutsakos, “Feature Point Tracking and Trajectory Analysis for Video Imaging in Cell Biology,” J. Struct. Biol., vol. 151, no. 2, pp. 182–195, Jul. 2005. [76] R. M. Sutherland, B. Sordat, J. Bamat, H. Gabbert, B. Bourrat, and W. Mueller-Klieser, “Oxygenation and Differentiation in Multicellular Spheroids of Human Colon Carcinoma,” Cancer Res., vol. 46, no. 10, pp. 5320–5329, Oct. 1986. [77] H. S. Bell, I. R. Whittle, M. Walker, H. A. Leaver, and S. B. Wharton, “The development of necrosis and apoptosis in glioma: experimental findings using spheroid culture systems*,” Neuropathol. Appl. Neurobiol., vol. 27, no. 4, pp. 291–304, Aug. 2001. [78] S. Rakic and N. Zecevic, “Programmed cell death in the developing human telencephalon: Apoptosis in human fetal CNS,” Eur. J. Neurosci., vol. 12, no. 8, pp. 2721– 2734, Aug. 2000. [79] T. Roberts, U. De Boni, and M. V. Sefton, “Dopamine secretion by PC12 cells microencapsulated in a hydroxyethyl methacrylate-methyl methacrylate copolymer,” Biomaterials, vol. 17, no. 3, pp. 267–275, Jan. 1996. [80] J. J. Casciari, S. V. Sotirchos, and R. M. Sutherland, “Variations in tumor cell growth rates and metabolism with oxygen concentration, glucose concentration, and extracellular pH,” J. Cell. Physiol., vol. 151, no. 2, pp. 386–394, May 1992. [81] S. Fertuzinhos et al., “Selective Depletion of Molecularly Defined Cortical Interneurons in Human Holoprosencephaly with Severe Striatal Hypoplasia,” Cereb. Cortex, vol. 19, no. 9, pp. 2196–2207, Sep. 2009. [82] S. M. Chambers, C. A. Fasano, E. P. Papapetrou, M. Tomishima, M. Sadelain, and L. Studer, “Highly efficient neural conversion of human ES and iPS cells by dual inhibition of SMAD signaling,” Nat. Biotechnol., vol. 27, no. 3, pp. 275–280, Mar. 2009. [83] A. Stoykova, D. Treichel, M. Hallonet, and P. Gruss, “Pax6 Modulates the Dorsoventral Patterning of the Mammalian Telencephalon,” J. Neurosci., vol. 20, no. 21, pp. 8042– 8050, Nov. 2000. [84] K. Yun, S. Potter, and J. L. Rubenstein, “Gsh2 and Pax6 play complementary roles in dorsoventral patterning of the mammalian telencephalon,” Development, vol. 128, no. 2, p. 193, Jan. 2001. University of Utah UNDERGRADUATE RESEARCH JOURNAL IMPROVING SUSTAINABLE INDUSTRIAL WASTEWATER TREATMENT Dana Tran, Saraswati Poudel Acharya, Dr. Jennifer Weidhaas Department of Civil and Environmental Engineering ABSTRACT Innovations in sustainable industrial wastewater treatment are needed to improve the cost effectiveness of treatment while protecting environmental resources. The US military is currently utilizing insensitive high explosives (IHEs) containing 1,2,3-triazol-3-one (NTO) to replace conventional and less safe munitions such as TNT and RDX. In the process of creating IHEs, munition manufacturers, load and pack facilities, and demilitarization facilities generate wastewater streams that contain concentrations of IHEs. Currently, facilities handling IHE munitions lack a cost effective and sustainable system for treating industrial wastewater containing these compounds. Ion exchange (IX) resins were investigated for their ability to remove NTO. Further, brine regeneration of the resins was investigated to increase the sustainability and cost effectiveness of the treatment system. The objective of this study was to (1) determine the potential for an anion exchange resins selective for nitrate and perchlorate to retain NTO and (2) evaluate brine recharge of anion exchange resin. Results indicated that NTO was exchanged with chloride on the resins at up to 28-78% of the theoretical exchange capacity. In 30% brine washing solution, between 73 and 100% of the NTO was removed from the resins. These results provide insight into alternative industrial wastewater treatment technologies that could be used in munition manufacturing facilities. University of Utah UNDERGRADUATE RESEARCH JOURNAL NICKEL-FUNCTIONALIZED SOLID-STATE TITANIA NANOTUBE ARRAY FOR THE ELECTROCHEMICAL DETECTION OF BREATH-BASED BIOMARKERS IN COLORECTAL CANCER Anurag Tripathy (Swomitra K. Mohanty, Ph.D.) Department of Chemical Engineering Colorectal cancer (CRC) is the second most common cancer in the United States with approximately 137,000 new cases each year, 50,000 of which are fatal due to belated screenings [1]. The gold-standard detection method is colonoscopy, a direct visualization tool that facilitates the removal of minor polyps [2]. The benefits, however, come with severe drawbacks such as prohibitive cost, extreme invasiveness, lengthy preparation and high complicacy [2]. Recently, breath-based volatile organic compounds (VOCs), or biomarkers, that are specific to colorectal cancer patients have been found, detection of which may provide a diagnosis of colorectal cancer [3]. This study aimed to synthesize a titanium dioxide nanotube array (TNA) sensor capable of detecting four critical breath-based biomarkers diagnostic of colorectal cancer: cyclohexane, 1,3 dimethylbenzene, methylcyclohexane, and decanal [3]. The TNA was synthesized via standard anodization procedures and functionalized with electrodeposited nickel. XPS studies showed this nickel was Ni(OH)2 on the surface, capable of oxidizing the four VOCs to facilitate their detection. The VOCs themselves were detected amperometrically. The sensor was not only able to detect all four VOCs, but the detection profile for each VOC was also distinct indicating unique interactions between Ni(OH)2 complexes and the VOCs. Reaction mechanisms have been proposed to explain features observed in peak currents. The sensor has demonstrated itself to be a potentially portable, cost-effective, and non-invasive diagnostic tool that resolves problems found in current CRC diagnostic methods. References [1] "Colorectal Cancer Statistics." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 20 June 2016. Web. 18 Sept. 2016. [2] "Colorectal Cancer Statistics | World Cancer Research Fund International." Colorectal Cancer Statistics | World Cancer Research Fund International. World Cancer Research Fund International, 16 Jan. 2015. Web. 14 Sept. 2016. [3] Altomare, " Exhaled volatile organic compounds identify patients with colorectal cancer", Br J of Surg, vol. 100, no. 7, pp. 980-986, 2013. University of Utah UNDERGRADUATE RESEARCH JOURNAL EVALUATING THE MOTOR BEHAVIORAL EFFECTS OF GRADUAL DOPAMINE DEPLETION IN RAT MODELS Geyu Weng (Alan Dorval, Heidi Febinger) Department of Biomedical Engineering Introduction: Parkinson’s disease (PD) is a common neurodegenerative disorder caused by the loss of dopaminergic neurons that project from the substantia nigra pars compacta (SNc) into the striatum; its symptoms include impaired motor functions such as rigidity, tremor, and difficulty with movements and coordination. Most of the current research in Parkinson’s disease only examines the symptoms of patients in the late stage of Parkinson’s disease. However, parkinsonian symptoms are generally progressive, and the relationship between symptom severity and the degree of dopamine loss is rarely investigated. The goal of our research is to develop a rat model to quantify the relationship between progressive behavioral symptoms and dopaminergic cell degeneration. Methods: To model different degrees of dopamine loss, the rats are injected with a low-dose of the neurotoxin 6-hydroxydopamine (6-OHDA) every two weeks. After each injection, the motor behaviors of the rats are observed through 3 different tasks: pasta handling, running wheel and a general locomotor task. After collection of behavioral data is finished, rats are sacrificed, and brain samples are analyzed by immunohistochemistry. Microscopic images of the samples are taken, and the percentage of striatal tissue with intact dopamine is quantified and normalized using MATLAB, by comparing the darkly stained area of interest for experimental rats to control rats. Results: There are 14 rats in total and the brain samples of 8 rats have been analyzed. From the results so far, these samples stained immunohistochemically confirm that the dopaminergic neurons projecting from SNc to striatum degenerate gradually with increasing injections of 6OHDA. Behavioral data have been collected but have not been fully analyzed yet. However, preliminary results show that the distance travelled for rats in the general locomotor task decreases as the amount of remaining dopamine decreases. We predict that other aspects of motor function, such as balance and coordination, will also deteriorate as the amount of dopamine decreases. Discussion: Although experimental data have not been fully analyzed, preliminary results confirm that dopamine neurons degenerate gradually with increasing neurotoxin exposure and support the prediction that rat motor deficits will gradually progress as the amount of dopamine in SNc and striatum decreases. One limitation of the study is that analyzing the video data from the behavioral tasks is very time consuming. The next steps of this research will be to develop a computational method that can increase the efficiency of video data quantification, and to finish analyzing the brain samples and behavioral data. College of Fine Arts University of Utah UNDERGRADUATE RESEARCH JOURNAL BACK TO BAGATELLES: REALIZING THE REMAINDER OF LIGETI’S MUSICA RICERCATA Mitchell Atencio (Luke Dahn) School of Music ABSTRACT György Ligeti completed Musica Ricercata in 1953, and shortly thereafter transcribed six of the movements into the 6 Bagatelles for wind quintet. Much of the scholarship surrounding Ligeti’s transitional period discusses Musical Ricercata, a pivotal work for Ligeti marking divergence in compositional style from his early works. One persistent question frequently arises: why did Ligeti leave five movements out of the transcription? Through study of the history surrounding the composition of Musica Ricercata and analysis of Ligeti’s approach to transcription, we can learn much about the Ligeti’s priorities and ideas. Using Ligeti’s own transcription as a stylistic template, this project suggests what could have been had Ligeti completed the transcription process. What results is Musica Ricercata for wind quintet—the remaining movements joining the original Bagatelles. INTRODUCTION & STRUCTURE György Ligeti is a hugely significant figure for composition in the Post-Modern era. Considered an important composer for his innovative and influential work, he remains a figurehead for the avant-garde movement. 1 His output is characterized by distinct periods of work and, as he progressed through his life, he developed techniques crucial to development of music in the twentieth century. One of the most-performed works for wind quintet, the Six Bagatelles, comes from Ligeti. While the 1953 Bagatelles are inextricably associated with the wind quintet ensemble, the work was not initially conceived for that medium: they constitute the composer’s reworking of a selection of movements from a work crucial to his own development as a composer—Musica Ricercata, for piano. Musica Ricercata contains a total of 11 movements, meaning only six of the movements were orchestrated. For this project, I transcribed the remaining movements to facilitate a complete performance of Musica Ricercata by wind quintet. The purpose of the project is to present a theoretical study in orchestration addressing what Ligeti might have done, had the need to transcribe the remaining movements presented itself, and an analysis of what made the transcription challenging to accomplish. This thesis includes four parts: First, a discussion of the background on the composition of and circumstances surrounding Musica Ricercata and the Six Bagatelles; second, an analysis of how Ligeti addressed challenges as he transcribed movements from Musica Ricercata for winds in the Bagatelles and the techniques used in understanding this process; third, the additional challenges made necessary to navigate while transcribing the rest of the movements and how these techniques were employed; and finally, the arrangement itself. 1 Cummings. Musica Ricercata was performed by wind quintet in its entirety for the first time on April 9, 2019, at the University of Utah Undergraduate Research Symposium. HISTORICAL BACKGROUND Musica Ricercata Beginning in 1951, György Ligeti began a personal reassessment of his compositional style, attempting seriously to redefine his creative process and product. Up until this point in his life, the Hungarian composer’s output demonstrated a heavily Bartókian influence.2 Musica Ricercata for piano represents Ligeti’s first foray away from his early style. Though Bartók’s influence would persist far longer than this point in time, the 28-year-old intentionally rejected all that he knew of music before this point: “I started to experiment with simple structures of rhythms and sounds, in order to evolve a new music from nothing, so to speak. I regarded all the music I had known and loved up to then as something I couldn’t use.”3 The work explores the possibilities of compositions limited by intervallic content, specific rhythmic situations, and either the absence of or a reinterpretation of functional harmony. Interestingly, this initial departure from his early style represents the earliest of Ligeti’s works regularly programmed today.4 The premise of Musica Ricercata remains a simple one: each of its 11 movements is restricted to only a set number of pitch classes. The project took a year and a half to complete, drawing to a close during March of 1953.5 The first movement comprises entirely of the pitch A (and every A available is utilized), up until its final note, where Ligeti writes a single D. This establishes a premise for the entire work’s structure: each movement includes progressively one additional pitch class more than its predecessor. (See Table 1.) In this way, the second movement includes three pitch classes and so on until the final movement, which uses all twelve half-steps 2 Steinitz, 53. Toop, 38; Burde, 29. 4 Kerékfy, 209. 5 Ibid., 210. 3 available in conventional Western music. Though Musica Ricercata does not employ an extraordinarily experimental rhythmic language, it does explore more limited rhythmic patterns. Harmonically and motivically, also, the piece clearly diverges from the aesthetic of Ligeti’s prior compositions. Table 1. Pitches used in each movement of Musica Ricercata Movement Available Pitch Classes 1 A, D 2 E♯, F♯, G 3 C, E, E♭, G 4 A, B♭, F♯, G, G♯ 5 A♭, B, C♯, D, F, G 6 A, B, C♯, D, E, F♯, G 7 A♭, A, B♭, C, D, E♭, F, G 8 A, B, C, C♯, D, E, F♯, G, G♯ 9 A, A♯, B, C, C♯, D, D♯, F, F♯, G# 10 A, A♯, B, C♯, D, D♯, E, F, G, G♭, G# 11 A, A♯, B, C, C♯, D, D♯, E, F, F♯, G, G# Ligeti seemingly did not intend for the project to progress in the way that it did, at least at first. He wrote the initial two movements as standalone studies in 1951, exploring the heavy pitch class restrictions. The middle movements were written during 1952, and by the time he started the third movement, the project was clearly beginning to take shape, as illustrated by the fact that two movements are reworkings of a previous composition; with the final movements completing the work during 1953.6 Two of the eleven movements actually represent reworkings of material from his 1950 “Sonatina” for piano, four hands: the third and seventh movements of Musica Ricercata correspond respectively to the first and second movements of this slightly earlier work.7 Remarkably, Ligeti opted to include these two movements in the original Six Bagatelles (movements one and three), meaning that the composer himself published three distinct formats of the same compositional material. It becomes quite apparent that by the time Ligeti approached the third movement of Musica Ricercata, he had the full scope of the project in mind. Rewriting the previously tonal movement from the Sonatina—which utilizes all available pitches—into a movement that contained only four clearly demonstrates an awareness of the work’s grand design. The movement, too, uses only C, E-flat, E, and G, which are the notes necessary for both C major and minor triads.8 The new movement rebukes any sense of functional tonality by interplaying the major and minor chords with increasing persistence, which illustrates perfectly how Ligeti was attempting to reject the music that he already knew. Knowing this, we can view the remainder of the composition as fitting into the goal of the rest of the work. The final movement, also, was composed initially prior to undertaking the overall process, though it provides the inspiration for the work’s name. It employs a variation on the highly chromatic ricercar style used in the 17th century, as used by composers such as Frescobaldi. (The movement proudly bears “Homage to Girolamo Frescobaldi” in Italian. 9) However, the technique gets employed in such an exaggerated and insistently regular fashion that the attribution is not without humor.10 Important to note, too, is that while the movement 6 Sallis, 103. Kerékfy, 211. 8 Ligeti, MR, 10. 9 Ligeti, Musica Ricercata, 34. 10 Toop, 38; Steinitz, 57. 7 employs both a subject and countersubject exemplifying twelve-note themes, Ligeti was at the time unaware of the techniques in use by the Second Viennese School, and the work therefore is not a reflection of them but an independent development.11 Simultaneously looking both forward in its harmonic language and backward in name and process—it exhibits many traits of a Bach fugue in treatment of the theme throughout—the movement typifies Ligeti’s developing style exceptionally. Musica Ricercata, while now programmed with relative frequency, actually did not see its public premiere until 1969 in Sweden.12 The cultural attitudes against Modernist art in Europe prevented the work from receiving the attention is merited for nearly fifteen years. However, its position in Ligeti’s catalog represents such an important juncture of style that it is rightfully remembered as one of his most significant early works. In addition, it allowed for the creation of the Six Bagatelles, which has gained even wider recognition than its source material, indeed becoming a true staple of the wind quintet repertoire today. Six Bagatelles In 1953, Ligeti reimagined Musica Ricercata shortly following its completion, commissioned in the same year to rework some of the movements into a piece for wind quintet. Ligeti accepted this challenge. Though he did not conceptualize the project as a productive one initially—the complete work, unsuitable in its time even to be heard on piano, could hardly prove more palatable once orchestrated—he still eagerly approached the project.13 Both in its original incarnation for piano and as the Six Bagatelles for wind quintet, the work received many private performances. In 1956, the first five Bagatelles saw the light of day during a Hungarian 11 Steinitz, 58. Ibid., 59. 13 Ibid., 59. 12 Music Week; however, the sixth movement was still deemed far too experimental, and the selection committee censored it from the performance.14 Ultimately, 1969 proved a fruitful year: both the Bagatelles and Musica Ricercata experienced their first complete public performances.15 Ironically, the premiere of Six Bagatelles occurred just six weeks prior to the premiere of Musica Ricercata. Furthering the circumstantial oddity, Ligeti’s other entry into the wind quintet repertoire, Ten Pieces (1968), was performed earlier that year, nine months before either Musica Ricercata or Six Bagatelles were heard for the first time.16 Much of the scholarship surrounding Ligeti includes discussion of his later works and style. The works from his transitional period centering around 1952, and even moreso the music written prior to them, have received far less scholarly attention. However, one question often arises from the research around Ligeti’s early works—why did he opt to transcribe only six movements from Musica Ricercata, and what motivated the omissions of the others?17 I do not attempt to speak for Ligeti in terms of artistic intent. However, in the following pages, I present the argument that Ligeti’s selection of only certain movements was motivated by neither his inability to complete a transcription, nor the unsuitability of the movements to reinterpretation. I posit that Ligeti would have completed the project had the right opportunity and circumstances presented themselves. Alas, the composer died 13 years prior to the writing of this thesis, and such a circumstance will never see realization. Accordingly, this thesis presents an attempt to suggest what could have been, were the composer tempted to see the transcription through to its fulfillment during his lifetime. 14 Grantham, 5. Steinitz, 59–60. 16 Busan, 10. 17 Ibid., 166. 15 LIGETI’S TRANSCRIPTION PROCEDURES Throughout the transcription process, Ligeti prioritizes certain elements of the original work. Not everything can be perfectly translated from a single piano to five wind instruments, requiring that Ligeti make adjustments to the music. While studying Ligeti’s transcriptions, I identified particular strategies he employs, as well as which components he considers important enough to preserve exactly versus where he made compromises or adjustments. One consistent concession Ligeti makes throughout the Bagatelles is that of octave. Rather than aiming for exact recreation of the octaves used in Musica Ricercata, register becomes the more significant consideration. Refer to Figure 2 below for an excellent illustration of this: immediately at the outset of the first Bagatelle, Ligeti already calls for the flute and oboe in octaves, creating a double not present in the original. Likewise, the use of piccolo at all in this movement shows that Ligeti is in his scoring asking for aggressive punctuation, not considering severely the technical octave displacements occurring during translation. I contend that octave choice, while still vital insofar as its consideration as a textural element, proves unimportant in Ligeti’s grand scheme of translating the music from its original format to wind quintet. One can find examples of octave modifications and doublings throughout the work on almost every page of the Bagatelles, so it does not serve to discuss this further except to emphasize that in my arrangement work, I tried to maintain the prioritizations that I observed reflected in my study of Ligeti’s work. Figure 2. Six Bagatelles, movement I. Throughout his transcriptions, Ligeti takes care to employ idiomatic characteristics of the instruments to enhance articulations and moments throughout piece. For an example of this, again refer to Figure 2. Though the oboe and flute take on the role of the right hand from the piano, the oboe also assists with the initial downbeat. Providing a powerful accent in the low register proves easy for an oboist, so this addition—Ligeti could have left the oboe out of the first note with good effect—shows just how aware Ligeti was with the capabilities of the instruments he was writing for. Rather than resulting in a merely adequate transcription, as a result of this awareness, small details highlighting the instruments’ capabilities provide significant flavor and interest in positions not always expected. Ligeti demonstrates his awareness of the characteristics of the instruments across all their registers throughout the transcription, and as such he employs them effectively to replicate the affect of many moments in Musica Ricercata. For example, in measure 40 of movement II (Figure 3), the horn and bassoon are used to their full potentials as low and powerful instruments, and the opposite extreme of lightness among the flute, oboe, clarinet, and bassoon as the movement closes. Figure 3. Six Bagatelles, movement II. Again, specific moments can be highlighted that display this sensitivity throughout the composition; it does not prove useful to detail and delineate every one. One should note, though, that in every divergence from Musica Ricercata, Ligeti clearly makes a conscious effort either to translate the musical ideas effectively or modify the existing material to function in a different but still effective manner. From the perspective of a player of a wind instrument, it becomes exceedingly clear that every discrepancy between the two works is an intentional choice aimed at creating successful translation. Numerous transformative elements between the two works serve to make the music function better in the new idiom. Regarding articulation specifically, the printed articulations themselves often diverge not just in scoring decisions and placement but also in actual notation. I observed that for the most part, whenever articulation discrepancies occur, the resulting effect ends up essentially the same as the original intention. In this way, were Ligeti transcribing to a different ensemble with instruments of a different makeup—for instance, a string quartet—I can confidently express that the resulting articulations would be different from either existing version. For examples of this, contrast Figure 3 above, with Figure 4 below. Notice how starting in measure 32, note durations vary among the woodwind parts, mimicking the effects from the corresponding piano passages. Take note, also, of how the various pedaling techniques and registral shifts called for in the original are recreated through dynamic changes and slight adjustments to the instructional markings. Finally, notice how as Ligeti changes the scoring in the passage leading up to measure 40, he also modifies the articulations to communicate the increasingly intensified affect of the section. Figure 4. Musica Ricercata, movement V. In this and other examples, handwritten 1, 2, 3, 4, and 5 refer to Flute, Oboe, Clarinet, Horn, and Bassoon, respectively. All other pencil marks highlight modifications Ligeti made in the Bagatelles differently than the original. Occasional structure changes do occur in the piece as well. One such change occurs at the ending to movement V, discussed immediately above. (Figure 3) The ending here uses a pianospecific technique, striking some loud repeated Gs with the damper pedal depressed, then releasing the pedal while silently holding down the keys to a G major chord. Ligeti’s ultimate decision to solve this complication was to present somewhat of a rewriting of the closing passage. Ligeti’s rewrite, as already discussed, involves maintaining and even amplifying the crescendo and stringendo before letting the bassoon and horn take over at their top volume—in a minor second, not a unison or octave as in the piano, calling reference to earlier motives. After this, the other woodwinds enter at their softest dynamic completely covered by the other two instruments, with the flute playing a C♯ (an added pitch not in G major, again heralding the opening theme). As the horn fades out and the bassoon diminuendos down to meet the others, the flute holds on for another measure before leaving the other woodwinds to hold the G major chord, reminiscent of the ending in the original iteration. Though this is a particularly significant instance, other rewrites are scattered throughout the work. Another change, even more significant than the one already described, appears during the seventh movement of Musica Ricercata (Bagatelle III). The piano features an ostinato played throughout by the left hand while the right hand plays a very lyrical (and fully independent) melody. (Figure 5) This would present challenging elements for a quintet if transcribed directly for two reasons: first, for pacing and fermatas among group members; and second, a single player repeating the same figure ad nauseum with more complex finger movements involved becomes exhausting both physically and mentally much more quickly. Ligeti ingeniously worked around this by translating the constant and independent figure into a constant but dependent figure, and also by always sharing the figure among two players. All five players except the oboist takes at least one turn repeating the septuplet figure, and rather than continuously repeating at an extreme pace, the players take a single measure of the (now-fully written-out) melody to complete the figure each iteration. In this way, not only does the movement become functional, it takes on a charming character while everyone shares the workload. Figure 5. Musica Ricercata, movement VII. Notice that the left hand maintains a constant and independent septuplet ostinato. The ostinato remains in the Bagatelles, but instead it is metered and trades off between players each statement. On a smaller scale, Ligeti also adjusts small components to become more suitable for the ensemble, including reversing musical elements such as dynamic or a compositional process. Two such instances occur in the third movement of Musica Ricercata (Bagatelle 1). The first occurs during the fifth measure. A diminuendo in measure 5 which sets up the second phrase in the original is replaced in the wind quintet version by a maintained forte dynamic and an implied crescendo. This appears to be designed at least partially with the flute’s register in mind, as this movement is the only place Ligeti asks for a C7 from the flute. However, the forte-pianissimo gesture at the outset of measure 6 turns the louder dynamic into just as effective a setup for the material that follows. Later in the same movement, a reversal not of dynamic, but of melodic treatment, occurs. In Musica Ricercata, Ligeti writes a retransition to the recapitulation by increasingly employing diminution and stringendo to the melodic fragment. In the Bagatelles, rather than speeding the fragment up, Ligeti has the bassoon slow the motif down through both augmentation and rallentando until the group relaunches into the recapitulation together. Though the melody here undergoes the opposite procedure, both iterations work effectively to set up the music that follows. Figure 6. Corresponding passages demonstrating reversed dynamic nuance in Musica Ricercata III (left) and Six Bagatelles I (right). Figure 7. Bassoon rallentando/diminuendo/augmentation. In Musica Ricercata I, this passage experiences opposite procedures in all regards. All of the discussion thus far about the suitability of the transcription is not to imply that the Bagatelles do not present a challenge in the ensemble setting—on the contrary, particularly as the movements progress, they become increasingly more difficult to execute effectively. The sixth Bagatelle—Musica Ricercata X—remains famously challenging for ensemble due to its mixed meter, complex tonal language, and quick speed: Ligeti marks the tempo at ♪=450, even faster than the original (♪=400). For another illustration of the challenges inherent to the quintet version of the piece, observe Ligeti’s use of the oboe’s low register, employed to such excellent effect in the first bagatelle, must now play quite soft and sustained low notes during the fifth movement. (Figure 8) However, Ligeti clearly again prioritizes the overall effect here; the rich overtones in the sound of an oboe at its low end work to establish the character of the piece. Again, just as in the first movement, the scoring would have been otherwise adequate, but when Ligeti calls for demands such as this in the extreme registers, the achieved result becomes extraordinary. Figure 8. Six Bagatelles, movement V. As the movements progress and increase the number of utilized pitch classes, Ligeti became faced with the challenge of using five instruments to address more than five simultaneous pitches. This becomes epitomized in the sixth movement of the Bagatelles. A moment is reached at the climax where ten unique pitches are called for—every note used in the movement except for D, and C, which is absent throughout. Obviously, five wind instruments cannot easily reproduce ten pitches sounding simultaneously, nor can they all play in the notated register. Ligeti’s solution: select a highly dissonant subset of the ten notes, one for each instrument, and score all five players in their respective upper registers so that the resulting color remains as harsh and aggressive as the original. The clarinet, remarkably, makes a jump on the final chord to written F♯6, the highest note Ligeti asks of the player in the entire Bagatelles. This is shown in Figures 9 and 10 below at the position marked “wie verrückt” (translated “as if mad” or “as though insane”). Figure 9. Musica Ricercata, movement X. Figure 10. Six Bagatelles, movement VI. One last area that Ligeti demonstrably put some effort into is the challenge of converting a solo work performed by one individual to an ensemble work with several musicians playing in consort. Figures 9 and 10 illustrate one such example where this occurrs—notice that in the Musica Ricercata version, measure 112 includes the instruction “oft wiederholden” (repeat often), indicating the performer should repeat the measure a few times. For a quintet to execute this successfully, a premeditated number must be determined in rehearsal. Rather than leave this up to chance and potential miscounting, Ligeti writes out a precise number of notes and entrances for the quintet to play together. In the section immediately prior to the one shown, Ligeti also rebars many of the sporadically alternating 3/8 and 2/4 measures, allowing for better ensemble communication. This consideration illustrates the level of care Ligeti put into the translation, ensuring that piece not only retains the musical content but was notated in the such a manner that an ensemble performance would be successful. ADDITIONAL TRANSCRIPTION CHALLENGES As illustrated in the previous section, Ligeti necessarily made compromises in the transcription of Musica Ricercata. As pointed out in other research, certain compositional and executional challenges are inherent to the wind quintet as an ensemble due to its nature as ensemble nature and its structure of five instruments of different types. Some scholarship argues that the Six Bagatelles and Musica Ricercata exist as wholly different and entirely independent works.18 Previous scholarly work highlights restrictions, such as range reduction and limitations presented by nature of playing as an ensemble instead of as a soloist, as factors preventing Ligeti from arranging the other movements successfully.19 Busan suggests that this apparent illsuitedness of medium translation presents substantial enough qualifications to justify a conscious decision by Ligeti to abandon the other movements from the project entirely. Speaking directly to this position, I argue that not only can the movements undergo successful transcription, they prove equally well-suited for the wind quintet as the original six Bagatelles. Arguments against this position range in scope—suggestions are presented at times that movements are too pianistic or unable to capture the same affect or are, simply, unsuited for translation. In the rest of this section, I will refute this by explaining how various challenges 18 19 Ibid., 6. Busan, 166. were broached and how, ultimately, a complete set of all eleven movements could be formed to unite the work as a whole in the other medium. What follows are details of how I overcame the more complicated facets of transcription. I took inspiration from Ligeti’s methods throughout this process, attempting to make the same type of concessions I see appearing in the composer’s work. My experience as a wind player, flautist, and arranger, as well as consultations with performers on the other quintet instruments, composers, and theorists all informed how I approached the transcriptions of the remaining movements. Challenges of academic integrity and musical preservation represent the primary focus of the project, though some performance considerations deserve mention as well. In terms of preserving the intent and spirit of the work, I thought it was important to imitate the priorities I observed in Ligeti’s own arrangements. For example, elements such as exact octave preservation were abandoned at times in favor of maintaining musical content and affect. Ligeti was striving for “maximum result from the minimum material.”20 I aimed, therefore, to create a musical translation that preserved musical substance and employed diversity in scoring and colors throughout. One specific challenge that immediately presents itself are the pianistic techniques lacking equivalence in the quintet world. The opening of the first movement of Musica Ricercata—truly, the first note of the piece—already presents a challenge: a tremolo that wide cannot be effectively executed on wind instruments. (Figure 11) I had three options to pull from: a sustained tone, a trill, or a flutter-tongue. A trill was, by my interpretation, too far off from the spirit of the movement, as a trill brings another note into play (which uses only As until the final tone). A sustained A from all five instruments would not have been a bad idea and, in practice, would have been sufficient; however, ultimately a flutter-tongue by all instruments got the sound 20 Steinitz, 54. the closest to the original’s tremolo effect. Although a flutter-tongue works more effectively on some instruments (flute, bassoon) than others (oboe), the overall effect with all members fluttering resulted in a close approximation of the tremolo. The opening, both original and transcription, follow in Figures 11 and 12. Figure 11. Musica Ricercata, movement I. Figure 12. Musica Ricercata arrangement, movement I. The second extended technique also appears in the first system of the piece. Like the end of the fifth movement of Musica Ricercata, Ligeti calls for a loud strike followed by sustain of only select keys. I essentially copied his concept at the end of the fifth movement, recreating a loud entry point and soft sustain entering thereafter. This practice is repeated at the end of the movement, with the introduction of the D. Another challenge from the first movement is that the repeated bass figure—which can only logically be executed by the bassoon for a combination of reasons including range, agility, and endurance—continues almost for the entire movement. Wind instruments have one particular limitation that others lack: the requirement of breath. One option to navigate this would be to have the horn or clarinet cover the upper note on occasion; however, this would require a lot of coordination and cause an unnecessary color change at times. That solution would also limit the bassoonist, requiring the player to breathe in all the indicated spots, which takes away from the ease with which they could complete the entire movement successfully. In order to facilitate breathing as needed (and to provide slight breaks for the embouchure and mind), I opted to highlight good breathing opportunities by surrounding certain eighth notes with a pair of parentheses, as in (♪). (Figure 13) These were always positioned so that the player could opt to breathe when another player was doing an accent, essentially masking the fact that a note was missing. This proved successful in performance. Figure 13. Musica Ricercata arrangement, movement I. Two apparent challenges presented themselves as a result of the gradual accelerando that occurs throughout the movement. First, rather than maintaining the octave leaps in the bassoon part throughout, a better result was achieved by sticking with the lower octave once a certain point in the accelerando was reached; that position was predetermined. This enabled the bassoonist to accelerate without getting held up by the repeated leap to satisfactory effect. Second, the climax of the movement presented what would appear at first glance to end up being quite challenging for an ensemble in the shortening of the rests, starting with two full measures of silence and ending with a septuplet in a single measure. However, this turned out not to be as challenging as one might think at first, and the quintet had no trouble performing this section as is. One final complication arose in terms of range and register. The original form of the movement utilized every A on the keyboard, from A0 to A7. The use of a piccolo helped extend the sounding range for the flutist by an octave to sounding A7. Normally, the bassoon can only get to A2, though through the use of a low A extension, an A1 is achievable. The low A extension prevents the ability to play a low B♭; however, since no B♭s occur in the movement, the extension can be fully inserted throughout the movement. The low A was saved for the equivalent moment in the original where the piano strikes its lowest A, measure 66, and likewise the piccolo’s highest A is used at the same metric position, measure 70. The resulting effect was one of a full and forceful sound from all registers, just as in the original, but with an expanded color palette. Movement II proved simpler to emulate as it did not require nearly the same extreme demands. One primary issue arose, that being the quick repetition of tones Ligeti requests once the third pitch is introduced halfway through the movement. The G features prominently after a page and a half featuring only E♯ & F♯—its entry is accompanied by an increase to the loudest dynamic yet and more than a doubling in tempo, as well as rhythmic diminution and crescendo as the pitch repeats. Upon arrival at measure 24 (Figure 14), the best solution to imitate the upper staff again was a flutter-tongue, this time executed by piccolo and punctuated at the louder moments with interjections from the oboe and very high clarinet. While a flutter-tongue does not directly imitate a rapid striking of a note, the product was close enough to the densification of sound and made for an effective adaptation. To accompany the piccolo’s flutter-tongue, on the first arrival, the clarinet also flutters while simultaneously executing a timbral/resonance trill. (Figure 15) This kind of trill causes enough fluctuations in the overtones that the pitch ends up producing a “wobbling” sound. These sounds together resulted in a sound mass around G that roughly approximate the effect Ligeti was seeking after his original work. Figure 14. Musica Ricercata, movement II. Figure 15. Musica Ricercata arrangement, movement II. The final measure of the piece was treated the same way as the earlier instance, the only difference being that at the appropriate time, the flutter was changed into a fast double-tongue that tapered down and ultimately slowed to quarter notes, as indicated by Ligeti. (Figure 16) This final measure proved initially difficult in rehearsal, so adjustments were made to facilitate easier performance. The addition of cues in the individual parts proved particularly helpful, facilitating easier comprehension of the other lines so that breaks, fermatas, and pauses could be acknowledged by all players. Figure 16. Musica Ricercata arrangement, movement II. (Other staves visible) The fourth movement, in terms of character, contains two elements. First, its Chopinesque quality of a lyrical melody atop a waltz; and second, Ligeti’s instruction to interpret the piece “freely, with rubati, ritenuti, accelerandi, just as an organ grinder would play his barrel organ.”21 At first, again, the tempo flexibility would seem to present a challenge for an ensemble without a conductor, but in reality this was not difficult to rehearse. What was difficult, though, 21 Ligeti, Musica Ricercata, 13. was the effort to score the piece in a way that both preserved the waltz-like character of the movement and also explored colorful scoring options in a way that Ligeti would have. To this end, all of the woodwinds, including the bassoon, get to take a turn playing the melody. Much in the way that Ligeti opts to employ unorthodox scoring—at times putting the flute underneath the oboe or clarinet, instead of the more conventional practice of keeping the flute on the top—and asking for higher notes from the bassoon and horn, similar practices are employed here. The colors develop as the movement progresses, too, meaning that the same configuration does not experience an identical return. In all, this results in a transcription both capturing the goals of the movement in the first place while still exploring what the quintet can accomplish from a timbral perspective. The sixth movement is the shortest, lasting only about 30 seconds. Its biggest challenges were the way that it stratified range and the instance where two hands of block chords are utilized simultaneously, octaves apart. However, the voicings of this movement were quite simple to orchestrate, allowing for easy coloration throughout. Figure 17 illustrates how the introductory gestures could be tossed around easily, creating a light and playful texture without bogging down any one specific player. Each gestural change is accompanied by a scoring change, helping to advance Ligeti’s ever-changing characters in the movement. Figure 17. Musica Ricercata arrangement, movement VI. As we progress through the piece, the number of pitch classes involved in each movement increases; to this end, we begin to run into problems of expressing every pitch used. Fortunately, during the instance in question for this movement at measure 23 (Figure 18), the pitches for each chord are covered, so rather than insisting on precise block chord imitation, the middle note of the lower chord was left out and instruments were assigned the most idiomatic note. The resulting approximation proved perfectly adequate at replicating the effect, still creating a bright color change from what occurs both directly before and directly afterwards. Figure 18. Musica Ricercata arrangement, movement VI. Figure 19. Musica Ricercata, movement VI. The final movement definitely represented the most challenging to accomplish from an arranging standpoint. The movement possesses an incredibly thick texture—as many as 4 staves occur simultaneously, with different voices represented on all of them—and both fugal and chromatic ricercar elements persist throughout. The challenges to navigate were fourfold: 1) how to make the movement more idiomatic for winds; 2) how to assure every voice gets covered; 3) how to handle when part of a motif falls outside the range of the instrument responsible for its beginning, or otherwise needs to involve a voice exchange for any reason; 4) how to handle the piece’s conclusion. First, in terms of adjusting the movement to be more suitable to wind instruments, I added articulations to emulate a style evocative of early music. Rather than leaving every note without any articulations, as in the original format, I added slurs highlighting the individual counterpoint going on with each line with the fugal, contrapuntal style in mind. This helped in terms of phrasing and in making the parts more comfortable for the players, making every element of the movement easier to execute. Figure 20. Musica Ricercata arrangement, movement XI. Handling range restraints proved by far the most significant ordeal for this movement. Often, the theme’s development and progression into the countersubject requires a significant range traversal, and in these instances voice exchanges became necessary. Ultimately, though, even at its thickest moment, every part was covered in an approximation of original placement and role, holding the piece intact. (Figure 22) Figure 21. Musica Ricercata, movement XI, measures 54–57. Figure 22. Musica Ricercata arrangement, movement XI, measures 54–57. Additionally, even when some voices had to pick up other loose ends to complete a few lines, this was accomplished without too much difficulty, as in Figure 23. Especially considering the progressively fragmented way in which the theme develops, the transitions all made sense in the context of the movement. Notably, in many cases, the ensemble challenges were lessened significantly by adding cues from other parts. Figure 23. Musica Ricercata arrangement, movement XI. Notice that the clarinet completes the flute melody when it drops beneath the instrument’s range. Finally, the movement’s conclusion proved a challenge orchestrationally. Ligeti again takes the piano to its extremes, requiring the instruments to go to their outermost limits. Furthermore, the low A that ends the piece can only be performed by the bassoon with the low A extension inserted, which problematically prevents the B♭ that immediately precedes it from being played. To solve this complication, the player to the bassoonist’s left—who is, at the time, resting—could insert the low A extension while the player breathes in between the last two notes. (Figure 25) This did require some practice to execute correctly and time the breath properly with the flute player so that they could move between the last two notes together with the assistance of the clarinetist, but once accomplished yielded a very satisfying conclusion to the work. Figure 24. Musica Ricercata, movement XI. Figure 25. Musica Ricercata, movement XI. Notice that the bassoonist can see the flute player’s part and, additionally, the clarinet player will insert the low A extension. This final movement, with all of its challenges, proved one of the most rewarding. Certainly, it was the most complex movement contrapuntally and established the most obstacles. However, it also became a very satisfying movements to perform. If this movement can undergo successful transcription, then there should be no question as to the possibility of transcription for the entire work. THE ARRANGEMENT BIBLIOGRAPHY Antonisse, Marcel. Composer Gyorgy Ligeti, head. Nationaal archief, 1984. Burde, Wolfgang. György Ligeti, Eine Monographie. Zurich: Atlantis Musikbuch, 1993. Busan, Robert. György Ligeti’s “Musica Ricercata” and Six Bagatelles for Wind Quintet: A Study in Transcription or Recomposition? ProQuest, 2005. Cummings, Robert. György Ligeti Artist Biography. AllClassical. Grantham, Daniel. Ligeti’s Early Experiments in Compositional Process: Simple Structures in “Musica Ricercata.” University of North Texas, 2014. Griffiths, Paul. György Ligeti. Otley: Bemrose Books, 1983. Kerékfy, Márton. A “New Music” from Nothing: György Ligeti’s “Musica Ricercata.” Studia Musicologica 49 no. 3/4, 2008. Ligeti, György. Musica Ricercata. Schott: Mainz, 1995. Ligeti, György. Musica Ricercata (manuscript). Explore the Score, 1953. Ligeti, György. Six Bagatelles for Wind Quintet. Schott: Mainz, 1973. Sallis, Friedemann. An Introduction to the Early Works of György Ligeti. Berlin: Studio, 1996. Steinitz, Richard. György Ligeti: Music of the Imagination. Boston: Northeastern University Press, 2003. Toop, Richard. György Ligeti. London: Phaidon Press Limited, 1999. ACKNOWLEDGEMENTS A few individuals who made this project possible deserve thanks. First, György Ligeti, for the inspiration and the composition upon which this project’s foundation is laid. The members of PANTS—Trent, Dylan, Michal, and Sean—for trying some crazy things for me and premiering the arrangement. Our coaches, Bob and Lisa. Darlene, for the composer’s perspective. Mom, for the support. Most importantly, to my mentor, Dr. Dahn, for assisting me with every aspect of this project—you helped me make the right decisions in every part of the process. You supported the idea every at every step in all the ways that mattered, and I could not have done it without you. University of Utah UNDERGRADUATE RESEARCH JOURNAL THE IMPACT OF POPULAR THEATRE ON THE AMERICAN WOMEN’S SUFFRAGE MOVEMENT WITH AN EMPHASIS ON PLAYWRIGHT GEORGE M. COHAN AND HIS PRODUCTION OF LITTLE JOHNNY JONES Sofia Filip (Dr. Elizabeth Craft) School of Music Abstract Playwright, actor, producer and composer George M. Cohan popularized American theatre in the early 20th century with his emphasis on comedy and contemporary plots. Much of Cohan’s work contained elements of social change and historic events such and World War I and II, the Great Depression, and the Women’s Rights Movement. Although Cohan’s portrayal of war, patriotism and immigrant identity is clearly stated throughout a number of his plays, his images of women, feminism and women’s suffrage are less obvious and change drastically throughout his career. These portrayals of social change also need to be analyzed in greater historical context due to their stark differences from today’s gender roles. This work will focus on what George M. Cohan’s work said about women and women’s rights in his first hit, Little Johnny Jones, and how and why these images changed throughout the rest of his career. Introduction Playwright George M. Cohan was born into show business in the late 1800’s. The son of two Vaudeville writers and actors, Cohan braised the stage at an incredibly young age and proceed to write and act for the rest of his life. 1 He would become a household name by the mid 1910’s for works such as Little Johnny Jones, Forty-Five Minutes from Broadway, The Little Millionaire, and The Man Who Owns Broadway.2 By the 1940’s, several of his plays and musicals, including Little Johnny Jones and Little Nellie Kelly, had already been turned into movies.3 Cohan’s work is known for strong American patriotism, Irish-American identity, and themes of money, theatre and war. Much of Cohan’s work was influenced by World War I and II.4 Cohan is credited with bringing Vaudeville and Broadway into the contemporary with his themes and comedy. 5 Although his work isn’t reproduced very often in the present, Cohan’s work greatly influenced popular theatre in the decades after, many of which we still see on Broadway and the West End. George M. Cohan’s work provides a nuance between theatre and the early 20th century as well as 20th century and 21st century theatre. Cohan started his writing career during the rise of the American Woman’s suffrage movement. His portrayal of the movement, and women as a whole, are potentially telling both of his personal beliefs and the beliefs of his audience. Cohan’s shows go through a variety of themes surrounding American patriotism, Irish pride, and his view of the theatre world. 6 Cohan’s 1 John McCabe, George M. Cohan: The Man Who Owned Broadway (New York, NY: Doubleday & Co., 1973). 2 McCabe, George M. Cohan. 3 Little Nellie Kelly, directed by Norman Taurog, 1940. and Little Johnny Jones, directed by Mervyn LeRoy, 1929. 4 Elizabeth Titrington Craft, "Becoming American Onstage: Broadway Narratives of Immigrant Experiences in the United States" (PhD diss., Harvard University, 2014). 5 McCabe, George M. Cohan. 6 Craft, "Becoming American." early plays are filled with a wide range of female characters. From the standard, girly, background dancers who flirt with all the boys (typical of musicals in the first half of the 20 th century) to the strong, working woman with a voice and a cause, Cohan gives all of these women a place in his shows. They hold almost equally respected opinions and stage time to their male counterparts.7 As Cohan’s career took off following the success of Little Johnny Jones in 1904, his plays started to shift in the opposite direction. Cohan’s shows portray a general shift away from strong female characters and the portrayal of controversial political topics, and towards his personal identity and very male-centric scripts. Little Johnny Jones George M. Cohan wrote and produced his first hit musical, Little Johnny Jones, in 1904. Little Johnny Jones was one of Cohan’s most famous musicals, and it included the famous tune “The Yankee Doodle Boy.”8 The musical was later made into a film (multiple times) and became a popular American piece. 9 Little Johnny Jones’s themes of wealth, royalty, fame, love and patriotism continue to play key roles in the majority of Cohan’s following theatre pieces. These themes were also representative of Cohan’s life and public identity. 10 Little Johnny Jones was a strong start to Cohan’s long and influential writing career. Little Johnny Jones surrounds a plot of a horse derby, a swindling scheme, and starcrossed lovers. Set in early 20th century London (modern at the time), Little Johnny Jones draws similarities from Shakespeare’s As You Like It with plot surrounding Jones and Goldie’s love 7 George M. Cohan, Little Johnny Jones (New York, NY: Sanger & Jordan, 1921). and George M. Cohan, "The Man Who Owns Broadway," 1909. 8 Cohan, Little Johnny. 9 Little Johnny Jones, directed by Mervyn LeRoy, 1929. and Little Johnny Jones, directed by Johnny Hines and Arthur Rosson, 1923. 10 McCabe, George M. Cohan. story. Goldie, the niece of female reformer Mrs. Kenworth, is set up with the Earl of Bloomsburg, a member of the British nobility. Goldie, however, is in love with American jockey Johnny Jones and vice versa. Goldie dresses up as the Earl in order to gain knowledge and perhaps sway her aunt and her aunt’s swindling fiancé from making her marry the Earl. Goldie is ultimately successful but confuses everyone in her methods of persuasion by dressing up as the Earl and later disappearing when Jones’ sportsmanship is questioned. At the same time, Anthony Anstey, our villain and an American businessman, is engaged to Mrs. Kenworth for her money and is in the process of striking up a business deal with Sing Song, a leader in the San Francisco Chinese lottery. The London derby, which Jones is participating in, brings all of these characters together. The women in Little Johnny Jones are particularly interesting from a social stand point. They represent an array of different opinions and social identities. One of the most intriguing groups of women are “the Reformers” (social reformers most likely). These women are against the Chinese lottery in San Francisco and any sort of gambling, while their name typically represents suffragettes. They’ve come to London to protest the horse derby. Cohan may have aligned these two beliefs as both “progressive,” but he is unclear in his reasoning. The Reformers in Little Johnny Jones are a seemingly made-up group to provide a plot point for Cohan. At the same time, their name connotates that they are also proponents of women’s suffrage. Quotes throughout the play surrounding women’s rights leads us to believe that they are in fact suffragettes who also happen to dislike gambling. 11 Although the Chinese lottery did exist in San Francisco, and the Women’s suffrage movement was made up of social reformers and gained momentum during this time period, there is no evidence that women social reformers were against the Chinese lottery. Cohan may have been trying to correlate the two merely to 11 Cohan, Little Johnny, [Act 1: p.2,26] draw two social issues into his play, however, we have no way of knowing his intentions behind correlating these two movements. These elements of social and political discourse do add to the play, especially toward the characters of Mrs. Kenworth and Anthony Anstey. Mrs. Kenworth, the leader of the San Francisco Reformers, and her allies in this play make multiple remarks throughout the production about being strong willed women. At the same time, comments about her being to “nosy” are also made behind her back. Although she is a feminist by many accounts, Mrs. Kenworth still believes that a young girl cannot know what she wants, especially when money is involved. This theme is a large paradox in Mrs. Kenworth’s character; Mrs. Kenworth is given a particular feminist freedom that many of the other women don’t possess in this musical. Other than her role as a suffrage leader, she aligns herself with other outspoken characters and speaks up equally. The fact that positive and somewhat feminist comments even exist in Cohan’s production says a lot about his views and the views of the people around him on the women’s suffrage movement, the role of theatre in social movements, and the role of women in society. The popularity of this show (leading two national tours) also shows the receptiveness of the American public to ideas of strong women and female suffrage. Mrs. Kenworth and the female Reformers are continuously ridiculed throughout Little Johnny Jones, mostly behind their backs. Mrs. Kenworth’s lying fiancé and a money seeking gambler, Anthony Anstey, is by far the most sexist character in Little Johnny Jones. Right from the beginning he makes fun of Mrs. Kenworth’s Reformers. This is mainly because he is a gambler and therefore disagrees with the Reformers values, but he makes sure to use their identities as females against them at the same time. He makes many comments throughout the musical that continue to belittle women from the Reformers and Mrs. Kenworth to Goldie and a female reporter named Florabelle Fly. Anstey makes sure to tell his male allies that he is taking Mrs. Kenworth for her money and that Goldie is too young and childish to make her own decisions. For example, in the first act Anstey remarks to his friend McGee, “Cheat me out of one hundred thousand dollars a year, will you? Wait till you are Mrs. Anstey…I’ll soon teach you and your crusading band of fool women to stay at home and mind your own business.” 12 Such lines continue throughout the play. Although the initial conclusion is that these lines play negatively on the women’s suffrage movement, I would argue that Anstey’s portrayal as an ‘unlikeable’ character acts to counter-act his negative notions about women therefore giving off a positive impression of the women’s suffrage movement. In a particularly striking scene towards the end of the show a male character named Wilson tells Mrs. Kenworth outright: “Give up this band of reformers and let the Chinamen alone. Don’t dictate to anyone whom they should marry. Stay at home, do your knitting and sewing and let the rest of the world take care of itself…Now don’t mind me that was on my chest and I had to get it off- that’s all.”13 Mrs. Kenworth isn’t given a chance to respond, and the scene continues on. This portrayal of Mrs. Kenworth, as a busy body, aligns with her persona as a female reformer and as a member of high-class setting Goldie up for marriage. These two images, as previously mentioned, are paradoxes to her persona as a feminist and advocate for women’s rights. The reasoning for this anti-suffrage outburst is most likely one or both of two reasons. It is an insertion of differing views on women, the suffrage movement, and feminism, or it simply there to get a reaction out of his audience. This line has no real impact on the plot itself. I would argue that although this line is very poignant and striking, Mrs. Kenworth and women’s rights are still portrayed in a positive light throughout the majority of Little Johnny Jones. Another character whose identity as a strong female prevails throughout Little Johnny Jones is San Francisco reporter Florabelle Fly. Florabelle is in London to report on high society 12 Cohan, Little Johnny, [Act 1: p.8]. 13 Cohan, Little Johnny, [Act 3: p.4]. at the derby. She has no romantic connections to anyone in the play. As her job is to report for the gossip section, she does come off as somewhat of a busy body or meddler, and comments are made about her position.That being said, the fact that Cohan has a single, working woman and a key character in this show shows his mild tolerance, or at least acknowledgement, of social change towards women’s rights. Unlike Mrs. Kenworth, Florabelle doesn’t have any defining moments with a male character belittling her other than a couple of snide comments. Henry, Goldie’s friend and ally, makes a comment to Goldie following a confrontation between the three of them. Henry says, “I’ve never liked those female newspaper men.” 14 Although this is in the context of Henry standing up for Goldie, this comment clearly shows a divergence from the norm that Florabelle is in the journalism industry. This may also be a dig at newspapers, a particular writer or a critic of Cohan’s as he was known to make public digs at critics and the media throughout his career. Generally, Florabelle is respected for her work aside from this comment. She also seems to be highly regarded by her fellow female characters, many of whom see her as a strong and outspoken woman and perhaps more outspoken than themselves. She has a particular feminist empowerment dialog with Mrs. Kenworth in one scene where they are discussing women’s rights. Mrs. Kenworth and Florabelle are talking to the Captain of their boat about sailors when the following dialog ensues: Mrs. Kenworth: Brave fellow. I like brave men. (Captain wells out.) I adore brave women who stand by their rights. (Turns to Fly and back again.) Fly: (Aside): Here’s one who stands by her rights alright, alright, alright. 15 14 Cohan, Little Johnny, [Act 2: p.10] 15 Cohan, Little Johnny, [Act 2: p.5] These lines act strongly in favor of women’s rights as Florabelle and Mrs. Kenworth make their stances on women’s suffrage public to one another and members of the ship. This scene, along with others, portrays Florabelle as a strong feminist and an advocate for women’s rights. 16 The respect she is given throughout the show, with regards to a couple lines from Goldie’s friend Henry, show her in a positive and empowered light. Goldie, the niece of Mrs. Kenworth, plays a very interesting role as a budding feminist and ridiculed female character. Because of Goldie’s age and social standing, everyone around her seems to have ideas of who she should marry and what she should do with her life. She is in school and exemplifies many characteristics of a strong female, such as her pursuit of Johnny Jones and her Shakespeare-esque act of cross dressing to get her way. She also has a platonic male friend by the name of Henry who acts as her co-conspirator and ally. The script almost makes the audience expect Henry to profess his love for Goldie by the end the show, but he respectfully doesn’t. Although Goldie does partake in some very childish acts, such as running away when she doesn’t get her way and confusing all of her friends and loved ones by dressing up as her potential future husband, she ultimately follows her heart and gets her way. Her actions identify her as a ‘modern’ woman while her social status and role models still see her as a young woman ‘too naive’ to make decisions that will impact her for the rest of her life. Johnny Jones, Goldie’s love, sees her as a lover and almost as an equal. He is attracted to her because of her tenacity when they first encounter each other: Johnny instantly falls in love with Goldie when she calls to him from the stands of a race that he “better win” for her because she bet money on him. 17 Jones elevates Goldie’s appearance as a strong woman by his love for her ‘fiery’ traits and outspokenness. He regards her highly for her personality above her identity 16 Cohan, Little Johnny, [Act 2: p.5] and Cohan, Little Johnny, [Act 1: p.4] 17 Cohan, Little Johnny, [Act 1: p.22] as a wealthy heiress. Jones’ treatment of Goldie acts as a positive portrayal of equality between men and women and therefore of women’s rights and feminism. Cohan using the story line of an American heiress marrying into British royalty is an accurate depiction of the daughters of American empires. During the turn of the century, rich American families, with almost everything, forced their daughters into royal marriages to receive an official title to their family name. 18 Members of British royalty often obliged purely for the means to support their empires. As British society began to rely less and less on these elite families, their money quickly faded away. Money from newly wealthy American families, eager to elevate their status in society, brought about the opportunity to support these traditional nobilities.19 American ‘princesses,’ as they’re commonly known, have made several appearances in more modern theatrical productions; the most famous production being ITV’s Downton Abbey.20 The stories of Americans becoming members of the nobility have captured audiences and authors for a century now. In Little Johnny Jones, Cohan, like the writers of Downton Abbey, makes a point to incorporate an interesting fact of American upper-class history while critiquing American obsession with status and money. The strong female characters in Little Johnny Jones are feminists and suffragettes. Their role in this production, 16 years before the 19th Amendment, shows social progress, and the turmoil surrounding it. 21 The fact that this show toured the United States and was so successful suggests that the American public in the early 1900’s was accepting of working women and 18 Million Dollar American Princesses, "Wedding of the Century," episode 2, Smithsonian Channel, first broadcast January 11, 2015, hosted by Elizabeth McGovern. 19 Anne de Courcy, The Husband Hunters: American Heiresses Who Married Into the British Aristocracy (New York, NY: St. Martin's Press, 2018). 20 de Courcy, The Husband. and Downton Abbey, ITV, first broadcast 2010. 21 U.S. Const. amend. XIX. women’s suffrage. Overall, Little Johnny Jones stands as a positive representation of the American women’s suffrage movement. Cohan’s Work Post-Little Johnny Jones Cohan’s plays that were produced after Little Johnny Jones follow similar romantic plots of a young, wealthy woman being set up to marry a wealthy man that she doesn’t love. 22 With the exception of a few lines in specific plays, Cohan shies away from themes of politics and feminism and focuses more on themes such as the theatre world, divorce, and even his own career. His plays also tend to be more male dominant in both casts and scripts. In the late 1910’s and early 1920’s, there was a large increase in male dominant plays and a decrease in feminism and strong female roles.23 As Cohan’s work became more and more well known, he shifted his script patterns and strategies to focus more so on the success of male characters, especially in their pursuit of women. In The Song and Dance Man, released in 1923, the entire first act is made up of male characters. 24 This strongly homosocial play leaves little room for female characters to develop and thrive on stage. Similarly, Little Nellie Kelly, released in 1922, also plays into a male-heavy script.25 Even in shows named after women, there is a stronger focus on the men fighting over Nellie for her heart than on Nellie herself. Nellie, a working girl from the Bronx, is constantly fought over by men of all social statuses and backgrounds. The show does 22George M. Cohan, "The Man Who Owns Broadway," 1909. and George M. Cohan, "The Little Millionaire," 1911. and George M. Cohan, "Little Nellie Kelly," 1922. 23 Cohan, "The Man Who Owns Broadway," 1909. and Cohan, "The Little Millionaire," 1911. and Cohan, "Little Nellie Kelly," 1922. 24 George M. Cohan, "The Song and Dance Man," 1923. 25 George M. Cohan, "Little Nellie Kelly," 1922. leave Nellie with the choice between the millionaire and the good Irish boy. In the end, Nellie stays with her Irish roots and goes for a good Irish boy. This play does show that a woman should be able to choose her man and that a respectable boy is better than a pushy man with money. However, this doesn’t change the heavy focus of the show on Nellie’s men rather than on her. Cohan diverges from female characters, like those in Little Johnny Jones, who have a career and money because they believe in a cause. Although Little Nellie Kelly was produced post the Woman’s suffrage movement, it still stands as a representation of decreasing feminism in Cohan’s plays. Another play, entitled The Man Who Owns Broadway, follows a character named Sylvia, who plays Goldie’s counter-part, is the victim of a series of sexist comments specifically from her father. Her father makes jokes about how she belongs in a mental institution and isn’t sane simply because she doesn’t want to marry the man she’s been set up with. The Man Who Owns Broadway is a very male dominated script with little room for female characters to grow and become interestingly complex.26 The male characters belittle the women without retribution. I would argue that because of the dominance of male characters throughout these scripts, they leave little room for female characters to grow and diversify. Because of this, we get very flat female characters that fit into stereotypes of sweet, docile women that don’t seem to have a cause or many feminist qualities in them. Overall, these shows tend to favor men a little more than women. In doing so, the women of these shows lose the feminist qualities they held in Little Johnny Jones. 26 George M. Cohan, "The Man Who Owns Broadway," 1909. Conclusion Little Johnny Jones may act as an anomaly in Cohan’s work, but it still stands as a potential representation of Cohan’s beliefs, the beliefs of the people around him at the time it was written, and the beliefs of his intended audience. The evidence of its success also exemplifies the tolerance, and perhaps acceptance, of strong female characters and pro-suffrage ideas by Cohan’s larger American audience. Little Johnny Jones also acts as a base from which we see Cohan’s scripts progress farther and farther towards male-dominance and noncontroversial themes. As his following grew and his audience diversified, Cohan increasingly started focusing his plays around a generic formula, negating his political thoughts on women as well as their portrayal as strong, working women. There are exceptions, of course, when Cohan participated in plays in his late career that are entirely political. For his general audience, Cohan centralizes around generic ideas of gender, money and love, while in his private life, he openly criticized politicians and supported a variety of causes. This shift in themes and script culture may be due to a variety of reasons including: a change in Cohan’s personal beliefs; an influence of the beliefs of individuals surrounding Cohan; or a change in the needs and wants of Cohan’s growing audience. These themes and beliefs have translated into how his work is performed and perceived today. Little Johnny Jones stands as a representation of theatre portraying multiple sides of the political spectrum. It makes fun of the women’s suffrage movement while also portraying critics of feminism in a poor light. Jones and Goldie ending up together, regardless of Goldie’s expected social standing, shows a breakdown of the ideas of high society marriages and power. Cohan ridicules the idea that nobility and namesake are more important than love and family. George M. Cohan’s plays, while being revolutionary to Broadway and Vaudeville, are not commonly produced in the present day. 27 This is due to a variety of factors including Cohan’s portrayal of women and the suffrage movement. Another key reason why Cohan’s plays are often forgotten is his racist representations of non-white characters, particularly Asian characters. This theme is very typical of plays and musicals produced during this time period and have continued to pollute theatre long after the end of Cohan’s career. This lack of racial and social tolerance goes hand in hand in Cohan’s case. Modern adaptions of Little Johnny Jones have been changed so much that the plot of the play is practically different, and still somewhat racist.28 In the present day, Cohan’s pieces act better for research and educational purposes than they do in the theatre. George M. Cohan’s work continues to act transformability as present-day historians and musicologists look to his work for these representations of society, change and innovation. Regardless of Cohan’s fade of popularity into the present day, his work stands as transformative in the theatre world due to its contemporary components and influence on theatre produced following his productions. Little Johnny Jones and the attention it gained is a historic example of the women’s suffrage movement in art and how these positive representations of the movement were accepted by the public. It also shows us how Cohan shifted away from these ideas and onto less controversial subjects in his pieces post his rise to fame. Cohan’s collection of plays and musicals potentially represent not only his personal beliefs on women, theatre and identity, but also that of his audience. These plays act as sociological time capsules during decades of war and global social transformation. With the changing roles of gender in society and identities as an American and an immigrant, Cohan captured these feelings and ideas and presented them in a comedic fashion that was pleasing to people of all walks of life. 27 McCabe, George M. Cohan 28 Little Johnny Jones, by George M. Cohan, Goodspeed Opera House, 1980. Bibliography Cohan, George M. "Broadway Jones." 1912. ———. "Broadway Jones." 1912. ———. Little Johnny Jones. New York, NY: Sanger & Jordan, 1921. ———. "The Little Millionaire." 1911. ———. "Little Nellie Kelly." November 13, 1922. ———. "The Man Who Owns Broadway." 1909. Craft, Elizabeth Titrington. "Becoming American Onstage: Broadway Narratives of Immigrant Experiences in the United States." PhD diss., Harvard University, 2014. ———. "Becoming American Onstage: Broadway Narratives of Immigrant Experiences in the United States." PhD diss., Harvard University, 2014. ———. "Musical of the Month: Little Johnny Jones." New York Public Library (blog). de Courcy, Anne. The Husband Hunters: American Heiresses Who Married Into the British Aristocracy. New York, NY: St. Martin's Press, 2018. Little Johnny Jones. Directed by Mervyn LeRoy. 1929. Little Johnny Jones. By George M. Cohan. Goodspeed Opera House, 1980. Little Nellie Kelly. Directed by Norman Taurog. 1940. McCabe, John. George M. Cohan: The Man Who Owned Broadway. New York, NY: Doubleday & Co., 1973. Million Dollar American Princesses. "Wedding of the Century." Episode 2, season 1. Smithsonian Channel. First broadcast January 11, 2015. Hosted by Elizabeth McGovern. U.S. Const. amend. XIX. University of Utah UNDERGRADUATE RESEARCH JOURNAL CLASSICISM HAS NO COLOR: EXAMINING THE CAREERS OF OFTENOVERLOOKED AFRICAN-AMERICAN BALLET DANCERS Victoria B. Holmes (Kate Mattingly, PhD) School of Dance – Ballet Program “[T]here have been beautiful dancers of color all along, I mean, throughout history there have been numerous ones… Yeah, I think that we have always had a large [impact]… as large as we were allowed to, in certain parts of history. Sometimes we were relegated to… a place on the periphery. Now we are able to be front and center…” (Dwight Rhoden) This research paper examines the impact of certain black ballet dancers on the landscape of American theatrical dance. While “diversity” is a buzzword today, I call attention to the significant presence of black dancers throughout American ballet history, as well as the reasons why their experiences have been overlooked by critics, historians, and those who construct the ballet canon. The five unsung heroes I focus on are Raven Wilkinson, Arthur Mitchell, Debra Austin, Lauren Anderson, and Katlyn Addison, with Dwight Rhoden featured in the conclusion. Each chapter begins with the dancer’s biographical information, as to give context to their story, and then features pivotal roles and experiences, interactions with mentors, encounters with discrimination, and through-lines from the individual to today. In the preface to his book Dancing Many Drums: Excavations in African American Dance, Dr. Thomas F. DeFrantz writes, “It is hardly an understatement that the history of African American dance performance has been documented insufficiently.” Because of this insufficient documentation, my research process was heavily influenced by interviews with Debra Austin, Lauren Anderson, Katlyn Addison, and Dwight Rhoden. Meeting with them in person, over the phone, or through video chat enriched my understanding of their legacies because they were able to share their own stories; stories that have been left out of the history books. I also conducted archival research into articles, reviews, films, and videos that related to each dancer; I relied exclusively on archives to research Raven Wilkinson and Arthur Mitchell, who are deceased. I have chosen to use the term “black” in this paper in lieu of “African-American” or “of African descent” because “black” is the racial identifier that these dancers have used when referring to themselves. Because it is my goal to honor their careers and legacies, I am committed to using the vocabulary that they feel best represents their identity. Each dancer in this paper has been categorized as the “first black ballet dancer in American history”—or some derivation of the moniker—which shows that those who have constructed the canon forget dancers of color as soon as they step out of the spotlight. Meanwhile, we remember dancers like Anna Pavlova or Fanny Elssler for centuries, showing that only the white version of history is preserved and perpetuated. This is also evident in “traditional” ballet history courses, which focus on the European origins of the art form and trace its development from one white dancer to the next. By foregrounding the importance of Wilkinson’s, Mitchell’s, Austin’s, Anderson’s, Addison’s, and Rhoden’s careers, I argue that dancers of color are more deeply engrained in American ballet history than typically acknowledged, and that their presence significantly enriches the form. University of Utah UNDERGRADUATE RESEARCH JOURNAL A 180° VIEW OF TURNOUT Emily Hug (Kate Mattingly) Department of Ballet As a young child, I broke a lot of Barbie dolls. I would dress the dolls up in ballet costumes and try to make them dance like the professionals I saw in pictures. Sadly, no matter how hard I tried to get a Barbie’s leg above her head or to get her in another dance position, the Barbie could not do it. I would push and pull her legs to help her stretch like I did in ballet class, most times accompanied by a sudden snap, leaving me with a limb in my right hand and a broken doll in the other. At first, I could not understand why the Barbie dolls could not perform these various dance positions. It was not until my parents explained to me that the dolls were not built to do so. Over the years, I have come to learn that humans are similar to Barbie dolls, given that our bodies are not built to form various positions. Standing in dance class at the barre, it is anatomically impossible for me to get my feet to create a 180° angle. There is only a certain amount of rotation that my hip sockets will allow before my femur bone cannot move anymore. I can force my turnout, breaking down my bones and putting strain on my body, eventually resulting in pain and injuries. During my fifteen plus years dancing, I have trained at various dance studios and attended a number of summer intensives. Though the style of ballet at these institutions varied, one aspect remained fairly consistent: the desire and continued focus on obtaining 180° of turnout. As a young dancer, this ideal came as second nature. In every ballet class, I would strive to hold each of my feet at a 90° angle from the start of pliés through reverence. It was not until I took my first anatomy class at the University of Utah my sophomore year that I finally learned that our hip joints are not made to sustain such an extreme range of motion. Being curious, I experimented with finding my anatomical range of external rotation and the muscles used to support it. Some of my teachers were supportive throughout this process, however, a few did not understand my exploration, sticking to the long-time belief that everyone can achieve 180° of external rotation in the hip joints. To better educate dancers and teachers on the subject of turnout, this paper addresses the concept of turnout in ballet technique and the importance that it holds within the art form. I argue that the ballet world has taken the concept of 180° turnout to an unnecessary extreme. By focusing on the evolution of turnout and the anatomy behind it, I will show how turnout has reached this extreme and the consequences that come as a result. My paper will challenge the idea that all ballet dancers should have 180° turnout, demonstrating that there is more to appreciate in ballet than a flat 5th position and perfectly pointed feet. i University of Utah UNDERGRADUATE RESEARCH JOURNAL DANCE AS ACTIVISM: EXPLORING GUN VIOLENCE THROUGH MOVEMENT AND TEXT Aileen Marie Norris (Satu Hummasti) School of Dance, Modern Dance Program ABSTRACT In my thesis, I explore the potential for dance to take on an activist role, serving to springboard conversations and personal understandings of social issues in ways that conventional activism does not access. Through creative and textual research, I created a 20-minute long dance work titled “Alert” that examines the embodied experience of women after incidents of gun violence in the United States. The work considers male rage and rejection, and how women situate their bodies in order to reduce, ignore, or oppose the potential of violence. I also incorporated literary text within my creative process in order to reflect on the similarities and differences between historical questions with war and current day issues with gun violence. Through creative process, I discovered the importance of context and negotiated the balance of explicit versus implicit content. I discuss the ways in which my dancers and I created movement and text for my work and the awareness that artistic work does not exist in a vacuum outside of current events. I conclude by describing my creative work and discussing the potential and limitations of activist art. ii TABLE OF CONTENTS ABSTRACT INTRODUCTION CHAPTER 1: RELEVANT TEXTS AND CONTEXTS CHAPTER 2: CHOREOGRAPHIC PROCESS CHAPTER 3: PERFORMANCE AND RECEPTION CONCLUSION REFERENCES i 3 6 8 14 18 20 3 INTRODUCTION In the preface to her collection, Dance, Human Rights, and Social Justice, Naomi Jackson notes that dance can be used to further social ideals and push for social change, or it can be used to reinforce repressive ideology: "Recognition grew that dance and human rights are not such unrelated spheres, but intimately and actively engage along a continuum of exchange from the most harrowing in which dancing is banned, and dancers tortured, to the ways in which dancers can be degraded in rehearsals" (Jackson x). Movement and performance have a long history of having the potential to work towards social change. Throughout different cultures and perspectives, dance has the potential to start conversation, question beliefs, and represent rebellion. My research aims to explore how dance and creative process can be the starting point for discussions about social issues. I specifically wanted to look at how gun violence in America can be processed through the site of the body, which resulted in the creation and performance of “Alert,” a 20-minute dance performance presented in December 2018. Throughout this creative process, I also looked at how text could interweave with movement and other performance elements to create a duplicity of meaning and understanding. With my research, I questioned what it meant to sit with trauma, what it means as a witness to watch someone else process trauma, and how a dance work could spark new discussions and understandings of a social issue like gun violence in a way that other forms of activism could not. Can the embodiment of movement add more nuance and clarity to discussions surrounding physical violence? My thesis has many different origin points, many of them personal. My awareness of the threat posed with guns heightened because I was stalked throughout junior high. The young man who stalked me, while he acted innocuous, was never hesitant to voice his love of guns. When he would contact me on social media, I would see an animated figure with a huge rifle staring back at me from my computer screen. Guns were a symbol of control and obsession to me from an early age. It became very clear to me that he thought of me as an object that could be possessed, and that if I angered him in the wrong way, he could attempt to harm me or my loved ones in order to have control over me. Although my stalker never threatened me with a gun, that time of fear in my life made me very aware of gun violence from an early age. Whenever real events of gun violence occurred, they would have a tremendous impact on me, in part because of this history and also because of the reality of tragedy. The first, and possibly most influential, was the Pulse nightclub shooting in Orlando, Florida. It was 2016, and as a somewhat-out nineteen-year-old, the news that a man had marched into a queer safe space and murdered 49 strangers and himself with guns rocked me to my core (“Orlando”). Why would he want to do such a thing? What was the purpose of taking a life? How could anyone be so cruel? How was it possible to harbor so much hatred in a body? I remember feeling hopeless, but also like I needed to let out these frustrations and confusions in some way. My whole body felt numb for that Sunday; I cried because it was all I could do to let all of that pain escape myself in some way. I briefly considered using an artistic outlet and choreographing something, but I did not feel ready or skilled enough to take on something as serious as a massacre. I had seen too many gauche or unnuanced works of art trying to tackle big picture issues like grief or war. Even though I did not feel ready to let myself process this incident through an artistic practice, it still stuck with me. I clearly felt the potential but also the ability to misstep, what Marcel Duchamp calls the art coefficient: “[the] difference between what he [the artist] intended to realize and did 4 realize” (43). In particular, I kept returning to the gun as a source of violence and why that specific vehicle for mass casualty seemed to be permitted by a large population of the United States, more so than an outbreak of an infectious disease or a bombing. I remember spending hours thinking about the fact that a gun’s function is to kill and asking why a vehicle for death would be so glorified and sacred to so many American people. There are other events that also stand out. Another key moment was the Parkland shooting, where a man walked into a high school and killed 17 high school students (Chuck). It happened in Spring 2018, and I again was reminded of the feeling of hopelessness and confusion that happened when Pulse occurred. Again, why? And why young people? There was something distinct about the Parkland shooting, however. The survivors started speaking out—and they started to get recognition for their voices. Never before had I seen a consistent and very public platform on gun reform activism last for as long as it has lasted for the voices of activists like Emma Gonzalez and David Hogg. It gave me hope at a time where I had previously felt only despair. And along with that hope, the inkling that perhaps I could contribute to the conversation through my art. Isolated incidents of gun violence on a local level also stick out in my memories. A week before I left for college, a man at my local mall murdered his co-worker, a woman named Andrea Farrington, shooting her in the back because she refused to date him (Mehaffey). I remember being aghast at that sort of violence. It was also a reminder that some men will go to extreme lengths to maintain control and possession over a woman and her body. This sort of instance of violence is something that feels uncomfortably familiar. In 2015, the number of deaths from firearms in the United States exceeded the number of deaths from car accidents at 36,252 deaths by firearm versus 36,161 deaths from car accidents (Bauchner). When it comes to domestic violence situations, guns also pose a significant issue. Fifty American women will be shot to death by an intimate partner in the average month, and American women are sixteen times more likely to be killed by a gun than women in other high-income countries according to a 2016 study published in the American Journal of Medicine (“Guns and Domestic Violence”). Mother Jones hosts an open source database on mass shootings occurring in the United States with the first entry dating back to 1982 (Follman). Because of this, I am focusing on incidents of American gun violence from 1982 onwards. Over and over again in media, we are barraged with stories and images of women losing their lives because a man cannot stand the thought of their autonomy. It is present in popular TV shows, like Netflix’s You, or in innumerable episodes of Law & Order: Special Victims Unit. These narratives, while fictitious, echo the realities of the news we consume as Americans. These are some of the events that led me to examine how dance could contribute to the heated conversation about gun violence in the United States today. Dance seems more than ever the proper medium for me, as it utilizes and highlights the body, the very site where violence occurs when someone is shot. Dance also occurs at the site of the body; there is a stark contrast between a dancer being present and alive in all parts of their body versus someone who has experienced trauma from a gunshot wound. Both of these experiences are intimately tied to the physical and kinesthetic existence of that person. Because of this shared site but vastly differing experiences, dance and gun violence felt diametrically opposed. Where guns kill and destroy, dance lives and creates. It is a place for life, where an individual can feel their heart beat, their breath quicken, and their limbs reach. I bring up the aforementioned events as they are a part of my narrative as creator and choreographer, but also a source of bias. I have never had a comfortable relationship with guns, 5 and while I entered my process wanting to allow a diversity of narrative, belief, and practice, I cannot dismiss my own perspective as it undoubtedly influenced this creation. In Chapter 1, I look at the literary texts that influenced my examination of gun violence not only through a modern lens, but also a historical one. I discuss the intrigue for me between literary text and choreographic creation, examine the shortcomings in representation of the narratives I chose to look at, and observe what I found compelling about each text when looking at creating a new work when looking at a similar but unique topic. In Chapter 2, I recount and reflect on the choreographic process to create “Alert.” This includes a background on the components contributing to the work, my artistic thought process, struggles, obstacles, and discoveries. During my choreographic process, I investigated how women could perform emotional struggle with regards to incidents of gun violence and how dance as a medium could comment on the physical threat of violence in a unique way compared to other artistic mediums. In Chapter 3, I take the reader through the sequence of performance, highlighting the images, sounds, and movement qualities that carry the narrative and create a source for making meaning. In my conclusion, I reflect on what dance can add to a conversation about gun and domestic violence while also considering the limitations of performance-based art. 6 CHAPTER 1: RELEVANT TEXTS AND CONTEXTS When looking at how the body can comment on, reflect, and question the aftermath of gun violence, I decided I wanted to explore how text could ground a choreographic work in ways that movement or sound scores alone could not. In my literature classes, I found stark similarities between the way authors would describe war and its aftermath, and the accounts I had heard or read from victims of gun violence. I became interested with how literary anti-war texts could inform, contrast, and bring new meaning to the movement I was starting to create. I started off my process with texts and literary concepts that I wanted to infuse into my choreographic concept. These were all texts I had read or heard of before embarking on my creative process and ones that resonated with me when I thought of how different generations dealt with death and violence. Texts and sources included Kurt Vonnegut’s Slaughterhouse-Five, T.S. Eliot’s “The Waste-Land,” Ambrose Bierce’s “Chickamauga,” and Childish Gambino’s “This is America.” I brought the texts in as aids in creation, investigation, and thematic process, using texts to create movement material, spark conversations with dancers, and set up movement sections that echoed ideas presented in the text. While most did not wind up in the final choreographic work, they are all intertwined into the DNA of the piece, through movement generation practices, or inspiration. For example, dancers would respond to text I brought in from a specific literary work and create a movement phrase correlated with the textual phrase. I will delve more into the specifics of this encoding of these texts during Chapter 2. It is important to note a couple of things about these texts. First and foremost, they are based in Western ideology and experience. Most of my formal English education has dealt with texts from Europe or North America, and this is reflected in the texts that I selected at the beginning of this process. This is not to say that it was bad for me to choose these texts; after all, I was specifically looking at the context of the United States and how history relates to the current moment. Still, my original selection of texts does not reflect a wider variety of location, experience, and perspective in regards to cultural backgrounds. Along these lines, all of the texts that I could think of off the top of my head were written by men. This intrigued me; it made a certain sense, as most of the texts look at wartimes when women were excluded from participating in battle. Still, I knew that the imagery of war was not male-exclusive, so it struck me that it was such a male-dominated field. One key text I wanted to incorporate was Kurt Vonnegut’s Slaughterhouse-Five. The novel deals with the pain, death, and confusion surrounding World War II and specifically the Dresden bombings (Vonnegut). One element of Slaughterhouse-Five that I really wanted to investigate is the nonchalance with which the narrator deals with death, even when it is clearly horrific for the characters involved. Each time any sort of death occurs—whether it is a flea or multiple people—Vonnegut follows the death by writing “so it goes” (Vonnegut 27). I was also deeply inspired by T.S. Eliot’s The Waste-Land, a long poem written after the end of World War I (“The Waste Land”). The Waste-Land is composed as a fragmented, multifocal narrative where just as the reader starts to grasp what is occurring, the frame shifts. It is also unique in that it uses many allusions to other texts, from Hamlet to the Bible to Greek mythology. This layer of ever-shifting perspective and scenes adds to Eliot’s attempt to grapple with death, infertility, and the loss of so much young life in London in the wake of World War I. One of the things that The Waste-Land grapples with specifically is how the loss of young life not only affects the current generation, but also the next generation of children. In this way, it is both a reflection of a present event and a concerned look towards what the future might hold. 7 Short stories by Ambrose Bierce also interested me. Bierce witnessed the tragedy of the American Civil War, and in his writings, he often found deeply ironic, deeply unsettling conclusions to conflict, such as siblings killing each other because they are on different sides of the war, or a civilian trying to act heroic but winding up dead. Bierce’s stories intrigued me because they are unflinching in their portrayal of the gruesomeness of death. I also wanted to incorporate the literary concept of Chekhov’s Gun; the concept states that “If you say in the first chapter that there is a rifle hanging on the wall, in the second or third chapter it absolutely must go off” (“Poet’s”). I was interested in the notion that an unused gun is considered bad storytelling. It also intrigued me that one of the most-cited literary tropes I had heard in my English career was in reference to an act of violence. The Beatles are notorious for their anti-war sentiments, but one song of theirs I was particularly influenced by: “Happiness is a Warm Gun.” The song is similar to The Waste-Land in that the narrative seems to jump and scramble a bit, but the main chorus states “Happiness, is a warm gun / … / When I hold you in my arms / And I feel my finger on your trigger / I know nobody can do me no harm / Because happiness is a warm gun” (Beatles). The song includes evocative imagery, comparing a warm gun to the body of a woman and suggesting that there is something both sensuous and sexual in that relationship. What was interesting to me is that the lyrics alone seem to suggest a pro-gun stance but the tone of the music combined with the track record of the Beatles suggests otherwise. I wanted to research how different parts of a work of art could speak to contrasting ideas, and how one goes about making meaning out of that. I also became very interested in Childish Gambino’s music video and song “This is America” less as a text to use in my own work and more as an example of how to look at the perspective of guns in America. The music video, heralded by many as “timely” and “remarkable artistic achievement”, takes a serious look at how black bodies are victimized and brutalized while also being extorted for entertainment and culture in the 21 st century of the United States (Cookney). Gambino’s use of dance in particular intrigued me, as in his music video it seemed to represent oppression and ignorance more so than a form with the potential for justice or activism. Dance is highlighted in the foreground of the video, distracting from the looting, violence, and chaos occurring in the background. “This is America” presents social dance and dance for entertainment as a way to ignore injustice happening. It became important to think about how my project could either serve as an attempt at a solution without any real action versus a work meant to provoke thought and discussion. When was a work overindulgent or self-important. What was productive and what was unnecessary? These texts and artworks laid the groundwork for the literary background I brought into my creative process. They influenced the work, whether in my consideration of structure or in the creation of my movement. While all circulating around similar themes, I also was very aware in what ways these texts were limited in scope. Nevertheless, they helped add an outside perspective and the layer of history to a work that primarily focuses on current events. 8 CHAPTER 2: CHOREOGRAPHIC PROCESS I. THE BEGINNNG OF PROCESS Every Monday evenings and Friday afternoons starting in August 2018 until early December 2018, I would work with two different casts of dancers as part of the choreographic process. Going into the process, I knew four of them to varying degrees and met two for the first time at the audition. All of them brought vulnerability and power to their dancing, depending on what was called for. I was interested in those qualities, as I wanted them to feel empowered, even if some of the themes I was interested in exploring involved loss of power or pain. I wanted dignity rather than succumbing to the difficult. The dancers ranged from college freshmen to one senior, each with their own background and life experiences. That being said, we all had some similar traits—we were all white, American women in the University of Utah’s Modern Dance Program. Because of this, I wanted to focus my choreographic interests at the intersection of womanhood and gun violence, rather than looking at gun violence and people of color or queer individuals. While both of those subjects are significant and important to examine and talk about, as a white woman with a white cast, I did not feel like it was appropriate for me to try and appropriate experiences that were not my own and put them on to bodies that also had not experienced the struggles that go along with blackness and violence. We started each rehearsal with a check in, where I would ask how everyone was doing. This was an important activity to build trust, community, and familiarity, both amongst my cast and between myself and each cast member. Sometimes we would get a little off track to discuss something big happening in someone’s life, or a big test coming up in a class, but it always worked as a good setup for diving into rehearsal after. Occasionally, I would bring in prompts to write about and discuss surrounding gun violence. I did this so that we could use knowledge from a collective rather than just using my own perspective. What did the phrase ‘gun violence’ bring to mind? Had gun violence affected their lives—and how? I found that we all had similar narratives; guns confused and scared us. Many of us had specific events in a town or nearby place where a specific instance of gun violence had happened. One dancer grew up where the Columbine shooting happened. Another vividly remembers hearing stories of her father’s best friend killing himself with a gun. Everyone had a connection, whether personal or on the outskirts. Some dancers chose to ignore or numb themselves to the news of a mass shooting. One dancer stated that she would always go down one of three paths—she would either purposefully shut herself off to the news after a tragedy, become seriously emotional and affected, or feel numb to the events even though she researched them well. It struck me that she knew herself well enough to know that she might react in three possible way to a tragedy, even if she did not always know which reaction she would choose. Overall, there were several reactions that our group recognized as familiar either through our own experiences or the experiences of those we knew. I became interested in the fact that while different people could react differently, patterns still emerged. Because I was working with multiple performers, I wanted to explore how unison might translate into sentiments of unity, whereas individual movement material might instead relate to dissonance within a group. These discussions allowed for a reflection on internal experience and how to translate that through group work. 9 As a choreographer, I recognized early on that I needed to establish a delicate balance. We were creating a choreographic work that dealt with difficult and heavy issues, but I did not want to bog the process with a serious tone the whole time. Finding time both to acknowledge the difficulty of what we were working on, but also the time for my dancers to enjoy themselves and the company around them, became an important priority to me. Building relationships and camaraderie could only strengthen the work, and also create something larger than the choreographic work itself. This process strengthened my viewpoint that the community and connection forged during a creative process is just as important to me as the work itself. While it is also vital to create a strong, rigorous piece when choreographing, this proved to be possible while still allowing relationships and community to flourish. From my observations, my dancers were more willing to dig into the hard pieces of material and give into the vulnerability that comes with performance because they had that bond of community. Allowing for moments of levity and lightheartedness let them also go to the extremes of emotional turmoil in order to fully realize the piece because they felt safe and valued. II. MOVEMENT GENERATION Creating movement for “Alert” came from different prompts. As discussed in Chapter 1, one of the main source materials for movement generation was historical anti-war texts. I would take quotes from a text, such as excerpts from T.S. Eliot’s The Waste-Land, and read them to my dancers. They would create a movement inspired by the text segment without pantomiming or acting out the words. We would repeat this process until each dancer had a set of seven or eight movements that they would then string together, after which I could manipulate the core phrases. This technique felt very true to choreographic ideals I was looking to uphold, as it allowed me to integrate text into the creative process, and also allowed for collaboration, as my dancers generated the core movement from which I would shape the rest of the work. I also worked with my some of my dancers to generate solos based on the unique but recognizable reactions to violent incidents. I wanted to use different movement qualities on different bodies to highlight that there was no sole way to respond to a violent incident. We worked with concepts of fear, rage, emotional distancing, numbness, and pain. This was important to me not only for the conceptual notion of creating different narratives, but also to establish each dancer as an individual with personal internal landscapes. As a group, we created a large unison phrase that originated from each performer creating a short phrase, after which I crafted the phrases into a cohesive longer phrase. Creating a unison that worked with each dancer’s personal movement qualities and idiosyncrasies allowed for a section that belonged to each of them while also belonging to the collective. This choreographic tool of crafting a section with all members of the work allowed for the piece to be unique not just to me but also to each one of them, something I strongly wanted out of this process. We also created duets through using the unison material and placing them into a duet with each member of the duet focused on a specific task. For example, one duet had a performer working on escaping and being alone while the other performer worked on trying to comfort or hold her partner. This allowed for the movement to stay in the same realm as other sections of the work while also creating additional context through different individual intentions. III. CONSIDERING AUDIENCE One thing I found myself especially interested in was the ability to derive a plurality of meanings from one movement section. This comes in part from being an English major—Roland Barthes’ “Death of the Author” interests me not only as an English scholar but also as a choreographer. Barthes writes, “thus is revealed the total existence of writing: a text is made of multiple writings, from many cultures and entering into mutual relations of dialogue, parody, 10 contestation, but there is one place where this multiplicity is focused and that place is the reader, not, as was hitherto said, the author” (Barthes 7). This notion that the power of interpretation and meaning-making lies not with the creator but with the audience is something I found especially important to ponder when creating a work where I had a very specific entry way. I found myself asking how important my personal meaning was to the presentation of the work, and if it was necessary for the audience to see the same issues of gun violence I was focusing on when they saw the piece. This question came up not only in the form and content of the piece itself, but in how to curate the experience of the audience from the time they saw promotional material to entering the performance space to the programs handed out to my pre-performance introduction. I became interested in applying the concepts of Reader Response Theory to my understanding of the creation of the work. Another literary theory, Reader Response Theory states that the creation of a text—or in this case, a dance—comes from an audience interacting with it; “Despite the content or nature of the written words, readers create unique understandings of stories. Each person carries out his or her own very subjective reading” (Brooks 76). While a literary theory does not always apply completely to dance and choreography, the concepts of Reader Response Theory allow for an understanding of how an audience might meet creative work. Under this theory, the received art is not one of absolute truth or with only one “right” conclusion or interpretation. This turns the work into less of a stagnant object and one more of conversation and interaction. Reader Response Theory allows for responsibility in creating a mesh of form and content while not requiring audiences to “get” or completely agree on the meaning of a work. These ideas remind me of a specific rehearsal, about halfway through my creative process. I had invited a friend in to watch my rehearsal and give feedback. After watching four of the solos we had created, she turned to me and told me that it made her think of all of the struggles she had seen women go through after being sexually assaulted and the process it took them to find themselves again. We both knew that my intention coming into the process had been to examine the trauma of gun violence on a community, but her words did not feel like they were undermining the work and process that had already been put in. After all, both scenarios dealt with violence, with violation of a body, and with trauma. And even though the specifics were not necessarily there, the same emotionality was conveyed. This brought up a unique challenge to me though: how explicit did I want to be? I could create a dance that had no direct allusions or references to gun violence, one that I knew originated from that in the studio, but that once viewed by an audience could be interpreted as a vast number of things or I could find specificity either in the movement, text, or sound score to locate the piece as one relating to gun violence for the audience. I struggled with this decision for quite some time, worrying that if I went for a more explicit presentation of my initial concept, it would come across as heavy-handed or maudlin. IV. THE MURDER OF LAUREN McCLUSKEY Throughout this choreographic process, I worked to consider the context of the moment when it came to discussing these issues. While I was interested in the historical element of antiwar texts and how it could contrast with the current discussion of gun violence, the focus was on the present. On October 22, 2018, the context of my thesis work drastically changed. It was a Monday night, about an hour after the weekly rehearsal with my quartet of dancers had finished, when we all received a university alert on our phones: “Shooting on campus. Secure-in-place. More info to come” (“EMERGENCY”). 11 What happened next is a narrative that is both too familiar and yet surreal to recount. A bizarre dance of reassuring loved ones that I was okay and checking in on everyone I knew who might be on campus ensued. “Yes, I’m safe. Are you?” I live on campus, so my roommates and I made sure the door was locked, closed the blinds, and turned out the lights. After the initial flurry to check in, I spent the next several hours streaming local news and looking for information on the internet to try and understand what was happening. It started to become clear that it was an isolated incident, but that the shooter had not been apprehended. Exhausted and knowing there probably would be no further information until the next morning, I went to bed. Falling asleep, I felt numb. I recount my experiences of that night not to put the spotlight on me but to ground the night in my lived experience—one that was shared by my performers and my University of Utah peers. Starting my thesis, I wanted to look at the reactions to incidents of gun violence, and in a cruel, appalling twist of fate it turned out both my dancers and I experienced an active shooter situation during our creative process. I realized the tenuous balance between acknowledging a perspective of those located near—both in location and relationship—to a victim of a violent crime and focusing those narratives around those who lose their lives and those who are directly impacted. At the heart of it all, the most important person in this narrative is Lauren McCluskey. Lauren was a University of Utah senior, a track athlete, a daughter, a friend to many, and so much more (Tanner and Means). Her story is now centered around her tragic murder, but I find it important to acknowledge that she is so much more than her death. Lauren started dating Melvin Rowland towards the beginning of the semester, but upon learning that he had lied about his age and that he was a registered sex offender, she broke things off (Tanner and Means). Despite contacting on-campus police and Salt Lake City police multiple times, Lauren was unable to get sufficient help. Rowland found her on campus on October 22, and murdered her with a borrowed gun. He died by suicide later that night. What quickly became clear to me and many of my peers is that this was not only an issue of domestic violence, but also of not listening to women’s voices. Had the University of Utah’s police force been adequately equipped to handle complaints about an ex-boyfriend stalking Lauren—that her roommates worried he had a gun in his possession—Lauren would have at least had more resources to stay safe. While University of Utah President Ruth Watkins claims that Lauren’s death could not be avoided, others beg to differ (Tanner and Means). Both of Lauren’s parents have voiced their disappointment and disagreement with Watkins’ statement and point out many steps on-campus security could have taken which are mentioned in a report created by the University of Utah (Tanner and Pierce). As details of Lauren’s murder surfaced over the following days, I knew that the tone and focus of my thesis inevitably had to shift. Using dark irony or being sardonic no longer felt right. One example of this is a piece of text I had in the work at the time of Lauren’s murder: “Breaking news: boy kills girl, completes journey into manhood.” Aspects of the piece like this text that once felt like an apt criticism now felt cheapening and disrespectful. Lauren’s murder also made me solidify the frame for this work. Rather than the vague umbrella of gun violence, which involves many different manifestations, I honed in on occurrences of women becoming victims because of men’s rage, rejection, and inability to accept autonomy. My movement research became about learning how to situate oneself as a woman in a world where this violence happens with enough frequency that it is a recognizable and credible threat. This specificity was not to ignore or delegitimize other forms of gun violence that are also social issues, but rather to have a defined perspective. 12 I chose to title the work “Alert” both because it reflected a state of “alertness” that women often find themselves inhabiting in order to protect themselves and because the notification of the active shooter on October 22 started off with “Alert.” To me, the word reflected awareness, the possibility of fear, and notification. It also felt vague enough that it could be open for personal interpretation while still maintaining personal meaning and significance. All of these lessons were difficult, and ones that I wish could have come about from a different source. The cost was too high. Still, it crystallized the fact that when creating dance work, context is key. V. DECIDING ON NARRATIVE ARC At this point the insight of my mentor and peers had an immense impact on how I proceeded. After talking through my concerns of being too explicit or too vague, I realized that if I was truly interested in researching how dance could work as activist art, I needed to at least try to incorporate a more explicit statement. If it didn’t work, I could always change it, but I owed it to the work and to my intention to attempt incorporating a clearer message. I also felt that I owed it to my community of dancers and women on campus to acknowledge the specificity of violence I was processing through the work. I started this by writing a script for one of my dancers that recounted one of my personal memories of a woman being killed by a man because of his desire to be with her. It is a story that I still get stuck on from time to time, and one that I always remember whenever I hear of a new incidence of male rage. Although the script went through many iterations, it eventually settled as the following: I knew a man once who thought he loved a woman. All he wanted was for her to give him one chance. So, day after day, month after month, he would plead with her to give him a shot. Until one day, he’d had enough. So, he marched home, grabbed the gun off his mantelpiece, returned to work, and shot her in the back. I was interested in the vagueness of it all—the characters are “a man” and “a woman”— while still having specificity in the order of events. It suggested both a clarity in a specific incident, while also creating the narrative of a trope; this is something that could occur again, has probably happened since. I also used the song “Bang Bang (My Baby Shot Me Down)” sung by Nancy Sinatra to more explicitly ground the violence within the contexts of guns and domestic issues. There is a specificity in a woman singing about how her lover has killed her that again reinforces the issues of gender when it comes to gun violence. Looking at the overarching narrative arc, I had to make many decisions about how each section created an order and how they related to one another. Putting sections next to one another versus at opposite ends of the work would create different meanings both for the individual sections and the work as a whole. Context operates in a choreographic work both through the reality of the “outside” world and through the way in which sections are layered next to each other. Because a dance work is experienced from the beginning until the end, understanding is built through the dimension of time; this influences the relationships between ideas, performers, and sections. After reflection, I decided to structure the work beginning from a point of isolation and moving into unity. I felt that this reflected my own process of healing after trauma, moving from isolation and processing on my own into realizing that community can help to bolster me out of my pain and remind me that there are still people worth fighting for. 13 The process of creating “Alert” took span over three months, and brought with it many challenges, discoveries, and experiences. It involved serious personal reflection, interpersonal discussion, and real lived experience. I learned many things, but chief among them was to collaborate with my performers so as to create a work that uses more than just my own voice, to talk through creative decisions with others, and to consider ever-changing contexts. 14 CHAPTER 3: PERFORMANCE AND RECEPTION I. “ALERT” EMBODIED A white, stark downpool lights the shoulders of a woman, facing away from the audience. Layers upon layers of clothes swathe her body, an extension of her movement and perhaps an extra layer of protection. She starts to move, and as she does, she hums a soft tune to herself, while unseen voices join her from offstage, supporting her as she holds the space alone. Her movement accentuates the amount of clothes on her body, and sometimes she seems to enjoy the weight; other times, it seems to restrict her. The chorus ends, and another woman emerges from upstage right. She oscillates between trying to connect with the woman in layers and paying attention to her own small gestures. The gestures grow larger and larger on a loop until she is flinging her limbs bombastically across the stage. She suspends with her arms reaching above her and then steps out of her movement to fully address the layered woman. “So, yeah, about two years ago, I started to feel like there was a bullet hole underneath my clavicle,” the previously dancing woman says to her companion. They take a long pause to look at each other, and then the woman who spoke continues her movement phrase, this time struggling to extend everything to its fullest potential, moving like a wounded bird or a broken marionette. The woman in layers drops her movement to follow her partner. As she does, she pauses to remove an article of clothing every foot or two. The clothes leave a trace of the dancer’s pathway on the floor, echoing where they both once stood. The woman struggling to fully move finishes and raises her eyes to look at her trailing partner one more time. They take a moment, everything still except their expanding chests working to pull in oxygen. Before the moment feels fulfilled, they both exit along the diagonal the clothes have established, parting ways as if two strangers on the street rather than two individuals who have just shared an intimate moment. A third woman enters with casual, almost lazy steps, walking along the same diagonal of clothes. As she reaches the end of the stage, she catches herself, looks to a different part of the room, and follows her gaze to her new location of interest. She does this a few more times, dancers briefly emerging from the wings to join her walk through the space and take the clothes on the ground, removing all physical traces of the first solo. Each new pass through the space becomes slightly more urgent, the pads of her feet striking the ground with increasing volume. Her ponytail whips with each new focus on a different target, emphasizing her desire for a place to rest. She does not find it. By her fifth pass, she has started to jog. By her seventh, it has become a run, each moment looking for a new spot, a new escape. She starts to skip and jump inbetween the points she finds, traveling further and faster with each step. In a new pass, she falls to the ground, catching herself and bringing herself to the edge of the space again before falling to the ground and rolling to a stop, back facing the audience, curled up on her side. A fourth woman exits from the wing to see the walking woman on the ground. She stands there for a beat, taking in the sight before slumping into her right side. Piano music by Joohyun Park enters the space along with her slump. She suspends in space for a moment before slumping further, each breath further collapsing her frame until she too has collapsed to the ground. As the running woman slowly crawls offstage, this new woman begins to tremble. Her shivers amplify until it pulls her to another position and she begins again, shaking until she convulses and knocks herself into a new 15 arrangement. Her focus, unlike the soloist before her, is internal, and her breath shakes with each shuddering moment. Her shudders pull her through the space, unable to find something that will stop them. Another woman enters in the upstage left corner, refusing to acknowledge the person with whom she shares the space. Facing into the corner, she starts to angrily gesture at some unseen person. She jabs her fingers, stomps her feet, and grips her hands, rage visible in her fingertips and in the way her back jolts through the space. The angry woman throws her arm and it drags her downstage until she is facing the audience. She begins her angry phrase again, this time directed at the people in front of her. As the music fades, she holds a silent scream, her arms thrown behind her, her face contorted in a way we rarely see people express their personal emotions. The woman who was walking and running earlier enters and sits at the front of the stage, facing the audience. She starts to speak while the other woman continues to stomp and point, contrasting the relaxed way in which the sitting woman recounts her narrative. She tells the audience the story of Andrea Farrington’s murder explained in Chapter 2. She sits and looks at the audience after she has told her story, daring them to really sit with the reality of what she has said. After letting the moment sink in, she rotates to observe another woman who has entered, shrugging her neck to keep her face hidden from the audience. As Nancy Sinatra’s “Bang Bang (My Baby Shot Me Down)” begins to play, the new performer’s hand swipes at her back, her fingers a stark contrast to her red top. It is impossible to ignore the story of a woman shot in the back as she continues to swipe and examine her hand. Her breath pulls her up into tension, anxiety held in her throat, before releasing her limbs into space. After stumbling upstage, she wheels around to finally face the audience. She freezes before slowly creeping to her right, oscillating between tense, tight poses and sighs of release. She finds herself swiping her back again, this time stuck in a repetitive loop, which each swipe getting faster, more desperate. The angry soloist bursts onstage, and wraps her arms around the woman swiping at her back in a gesture of comfort, but the latter woman is not interested and seeks escape. They repeat this duet of one trying to hold the other, and the other seeking space and separation. It is a frenetic duet, one that finds resistance between solace and separation. The shaking soloist enters to stand next to the woman still sitting on the ground, echoing their previous brief encounter. The shaking woman begins to shake again and collapses to the floor, at which point her duet partner jumps up in order to help her up off the ground. They work together, one bolstering the other up when she does not have the capacity to stay upright, swapping roles as they both stay present for each other. The woman who wore the clothes in the first scene enters and settles in the downstage right corner, the woman with the collarbone text trailing behind her. The latter woman tries to set her hand on her partner, but the woman violently shrugs her hand off, a refusal. After three repetitions of the collarbone woman trying calm her partner with the presence of her hand, they start to move together, the woman without her layers moving erratically, trying to shrug her partner’s hand off of her. These three separate duets settle into moments of comfort, most of them laying their hands on the woman trying to jerk hands off. All of a sudden, one woman bursts through the group and creates a new series of performer pairings to a jolting start to Doris Day’s “Que Sera Sera,” breaking the groups out of the patterned ruts they had begun to establish. The newly formed duet starts to dance together, shifting in a staccato fashion into new positions. They are close, but not touching, each movement an abrupt, almost violent jolt into the next one. Eventually, one of them picks the 16 other up and marches upstage, where they continue to jerk until they deteriorate to the floor, still jolting, this time into each other’s bodies. While this happens, one woman lies face up on the floor, unresponsive to all of the flurried, almost frantic movement happening around her. A trio emerges from the remaining dancers, two of them working to push the third into a corner. They pull and push on each other, unable to find compromise in direction. While distinct in movement from the jerking duet, this trio has a similar sense of urgency and conflict. The trio finds common ground in noticing the woman on the floor, and as the last chorus of “Que Sera Sera” plays, they run to help her back on her feet, circling the space as Doris Day sings “whatever will be, will be / the future’s not ours to see, / que sera sera” (Day). The group picks up momentum to bring them to the duet, now convulsing in a heap on the floor, and together the dancers help each other into a line as the first chords of Agnes Obel’s “September Song” permeates the space. All of them start to dance in unison, sweeping from stage right to left. A dancer breaks out of the group every once in a while, only for the rest of the performers to rush to her and through physical contact and cooperation help return her to the group, the unison once again sweeping all six women through the space. This pattern continues, until one performer breaks out to sink to the ground in the upstage left corner. Her fellow dancers help her up and for a moment she sinks into them before pushing herself out, moving similarly to the woman who had a hand on her back earlier. She travels on a downstage diagonal, letting out emotions through her face as well as her body, limbs snapping out into the space, spine contorting. One at a time, the other dancers leave the spot from where they have been watching this woman; they calmly walk towards her and place the palm of one hand on her.. With each successive hand, the woman finds a bit more breath and calm in her body until the group is all sighing up and down together, once again moving with one another, the music fading out. They continue to breath together as the lights fade with the music. II. AUDIENCE REACTION There were 36 audience members for the Saturday, December 1, performance, and 51 audience members on Sunday, December 2. They ranged from close friends and family, to Honors College peers, to partners of friends, to professors, to dance majors, to prospective students who were checking out a local performance. The reaction to “Alert” was overwhelmingly positive. Speaking to audience members after the show finished, I was able to get feedback about what they took from the show, what meaning they made for themselves, and what stood out to them. One man, who fiercely defends Second Amendment rights, was eager to find me and tell me how much he enjoyed the performance. It was his first dance performance, and he recounted to me his process of trying to incredibly hard to understand what was happening before just letting himself watch instead of trying to decipher everything that was going on. Talking to him reminded me that we all get to make personal meaning. Many members of the audience reflected on how they enjoyed watching the end when all of the performers come together. While not everyone articulated what about it moved them, they spoke to its power and presence. Not everyone focused on the aspect of guns, and as a creator I was okay with that. Some instead took away lessons about domestic violence, or just the power of movement itself. My paramedic friend enthusiastically found me after the show to let me know that my performer who constantly shook and trembled did a “fantastic job” of emulating seizures. 17 The December performance of “Alert” was the most complete or official iteration of my Honors Thesis work, and it was a fulfilling experience to share with an audience. Regardless of the message that was taken home, I hope that every person who watched it was able to leave “Alert” with something to think about or process. I could not have made it the work it became without each and every one of my performers or my support network. It was a lesson in humility, community, and art-making. I learned that activist art not only is possible to create in a positive way, but that it can have a real impact on the creators, performers, and viewers involved. 18 “But in moments of light, I know that my only way of fighting against this fatality is dance” --Germaine Acogny CONCLUSION After the second and last December performance of “Alert” I found myself both incredibly happy with the performances and process as well as with many new questions. My performers had embodied the work spectacularly; many people excitedly told me about how moved they were by their embodiment. I also found myself wondering what exactly the impact of “Alert.” Certainly, my total audience of around 75 was not about to go and convince the Utah legislation to tighten laws around domestic abusers and access to guns, let alone address the lack of gun legislation in the United States Congress. In that way, it could feel like not a lot was done in the grand scheme of things, and I will happily concede with anyone who suggests that this performance has not impacted the culture of gun violence in the United States at the legislation level. I will, however, note the change I witnessed within my audience, within my performers, and within myself. My cast and I had the privilege of presenting an abridged version of “Alert” at the Undergraduate Research Symposium at the University of Utah in April 2019, and after we had an engaging question and answer session with the audience. I was struck with how eager the audience was to share how they felt about violence, about fatigue with subjects like this one, and with how dance gave them new perspective. These are conversations people want to have, and I am glad that I was able to facilitate a situation where they could let themselves process their thoughts. My dancers also were able to speak to their time throughout the process, and they agreed that having the time to kinesthetically research how it felt to move surrounding these issues gave them better agency and understanding of how to process new events as they popped up. I think that in itself is incredibly powerful, even if it is on a very localized level. I also found empowerment through this process, finding new ways to give voice to personal trauma and allowing myself to acknowledge tragedy that often would feel like something to “buck up” and move on from. “Alert” taught me many lessons as a choreographer. Going in, I found myself wary of explicit imagery; I did not want to be too triggering or graphic because that felt easy but not necessarily productive. Through the process, however, I began to realize that it was important to still ground my choreography in some level of specificity. While this did not mean I needed to edit gun shot sounds into my sound score and have my dancers mimic a scene of extreme violence, it did mean that I needed to give the audience something to hold on to when it came to the process of meaning-making. It also taught me about the importance of structure and how relationships within a piece build over time. Naomi Jackson in her introduction reflects on the works of choreographers who wish to highlight the injustice they see in the world: Choreographers have long created works that represent and recreate a sense of the horror, suffering, and courage of the victims of human rights abuses, as well as the brutality of the victimizers. They also have created works that problematize or deconstruct the ways in which violence can become a part of everyday life, and search for ways to make visible the horror of injustice. (Jackson xxiv) 19 “Alert” felt like an acknowledgement and a peeling back of the issues surrounding gun violence and domestic abuse. While it might not have changed the world, I hope that it has begun to create small changes on an individual level. I want to end with a thought from the final episode of a local podcast, Cold. Cold is a true crime podcast that examines the disappearance of Susan Powell from West Valley, Utah, in 2009; she is largely believed to have been murdered by her husband. The host of Cold, Dave Crawley, takes the last ten minutes of his final episode to discuss Lauren McCluskey’s murder, as she was killed during his process of writing Cold. He says “Lauren McCluskey and Susan Powell should both be alive today, along with many, many other women who have been killed at the hands of a husband, a boyfriend, a date, a co-worker, or even just an acquaintance. So I’m less concerned with the question ‘where is Susan?’ than I am [with] the question ‘why does this keep happening?’” (“An Angel of Hope”). “Alert” also asks this question. Why are women continually victims of intimate partner violence? Why do we as a society continue to allow men to let their rage turn fatal? The reality of the matter is that we have systems in place that allow these things to happen. Had University of Utah police had a trained victim advocate or better understanding of intimate partner violence, more actions could have been taken to protect Lauren McCluskey. Likewise, if organizations like the National Rifle Association did not have so much economic influence in the United States Congress, there would be the possibility for sensible gun control reformation in United States law. By challenging these systems, we have the opportunity to work towards a safer, more equitable American society. “Alert” and this thesis was the beginning of this conversation in a more academic setting for me, but it is not the end of it. I will continue to use my voice and my art to push for a more just, more peaceful world. 20 REFERENCES “An Angel of Hope.” Cold, created by Dave Cawley, season 1, episode 18, KSL Podcasts, 13 Mar. 2019. Barthes, Roland. “The Death of the Author.” Tufts, Tufts University, sites.tufts.edu/english292b/files/2012/01/Barthes-The-Death-of-the-Author.pdf. Bauchner H, Rivara FP, Bonow RO, et al. Death by Gun Violence—A Public Health Crisis. JAMA Pediatr.2017;171(12):1142–1143. doi:10.1001/jamapediatrics.2017.4359 Beatles, The. Lyrics to “Happiness is a Warm Gun.” Genius, 2019, https://genius.com/The-beatles-happiness-is-a-warm-gun-lyrics. Brooks, Wanda, and Susan Browne. “Towards a Culturally Situated Reader Response Theory.” Children’s Literature in Education, vol. 43 no. 1, Mar. 2012, pp. 74– 85. EBSCOhost, doi:10.1007/s10583-011-9154-z. Chuck, Elizabeth, et al. “17 Killed in Mass Shooting at Florida High School.” NBC News, NBC Universal, 15 Feb. 2018, www.nbcnews.com/news/us-news/police-respondshooting-parkland-florida-high-school-n848101. Cookney, Daniel, and Kirsty Fairclough. “Childish Gambino: This is America uses music and dance to expose society’s dark underbelly.” The Conversation, The Conversation Trust (UK), May 10, 2018, https://theconversation.com/childishgambino-this-is-america-uses-music-and-dance-to-expose-societys-darkunderbelly-96379. Day, Doris. Lyrics to “Que Sera Sera.” Genius, 2019, https://genius.com/Doris-day-quesera-sera-lyrics. Duchamp, Marcel. “The Creative Act.” Marcel Duchamp, edited by Jean Tinguely, Cantz, 2002, pp. 43–43. “EMERGENCY ALERT: SHOOTING ON CAMPUS.” At the U, University of Utah, Oct. 2018, attheu.utah.edu/facultystaff/emergency-alert-shooting-on-campus/. Follman, Mark, et al. “A Guide to Mass Shootings in America.” Mother Jones, Mother Jones, 15 Feb. 2019, www.motherjones.com/politics/2012/07/mass-shootingsmap/. Jackson, Naomi, and Toni Shapiro-Phim, editors. Dance, Human Rights, and Social Justice: Dignity in Motion. Scarecrow, 2008. Mehaffey, Trish. “Lawsuit over Andrea Farrington's Murder Settled.” The Gazette, The Gazette, 30 Nov. 2016, www.thegazette.com/subject/news/public-safety/lawsuitfiled-by-andrea-farringtons-family-against-coral-ridge-mall-security-companyhas-been-settled-20161130. "Orlando nightclub Pulse shooting: What we know." UWIRE Text, 12 June 2016, p. 1. Academic OneFile, http://link.galegroup.com.ezproxy.lib.utah.edu/apps/doc/A454880861/AONE?u= marriottlibrary&sid=AONE&xid=0f1667d4. "Poet's corner; Chekhov's Gun,." Sunday Times [London, England], 14 June 2015, p. 7. Academic OneFile, http://link.galegroup.com/apps/doc/A417804810/AONE?u=marriottlibrary&sid=AONE &xid=dbef1a0e. Tanner, Courtney, and Scott D. Pierce. “Lauren McCluskey's Parents Say the University 21 of Utah Never Apologized - and Has Stopped Talking to Them - after Their Daughter's Murder on Campus. They're Considering a Lawsuit.” The Salt Lake Tribune, Salt Lake Tribune, 25 Jan. 2019, www.sltrib.com/news/2019/01/25/their-first-media/. Tanner, Courtney, and Sean P. Means. “Her Friends Warned Dorm Staff; She Kept Calling Police. But Risks Went Unrecognized before the Slaying of Utah Student Lauren McCluskey.” The Salt Lake Tribune, Salt Lake Tribune, 19 Dec. 2018, www.sltrib.com/news/2018/12/19/university-utah-announce/. Vonnegut, Kurt. Slaughterhouse Five. Dial Press, 2005. “The Waste Land.” The British Library, The British Library, 28 Sept. 2015, www.bl.uk/works/the-waste-land. University of Utah UNDERGRADUATE RESEARCH JOURNAL MADE IN HEAVEN? WHEN ART AND PORNOGRAPHY SHARE A BED Cory Wayman (Sarah Hollenberg, PhD) Department of Art & Art History This Art History thesis investigates the relationship between the categories of pornography and art primarily through a visual and textual analysis of American artist Jeff Koon’s series Made in Heaven in addition to works by contemporary artists Marilyn Minter, Ghada Amer and Thomas Ruff. I note that existing scholarship and critical response to the series downplays Koons’s engagement with pornography, arguing instead for the works’ “non-pornographic” contextual qualities and fixating on Koons’s celebrity, marriage and self-representation. I argue conversely for the centrality of pornography to the works, suggesting that Koons’s appropriation of pornography posits new understandings of the relationship between high art and popular visual culture. I study the peculiar lack of discussion of “the pornographic” in relation to representations of low-status yet highly-desired commodities that have been widely studied in Koons’s oeuvre, in addition to scholarship on the American Pop art of the 1960s. Comparing contemporary art by Koons and other artists which engages visual forms of pornography with Roy Lichtenstein reveals historical similarities in public receptions of art that engages “non-art” imagery. Reception of Koons’s Made in Heaven echoes many of the same modernist notions put forward in the public and critical discourse around Roy Lichtenstein’s comic book paintings. In both cases, contemporaneous audiences demonstrated a strong investment in concepts of stylistic originality and authorship while ignoring the critical effect of the artist’s practice of appropriation of pop cultural imagery. This thesis argues that the upholding of the belief in the incompatibility of art and pornography is neither an objective nor effective means of interpreting art. Figure: Jeff Koons, Made in Heaven, 1989, lithograph billboard on canvas, 125 x 272 inches College of Health University of Utah UNDERGRADUATE RESEARCH JOURNAL COMPARING LISTENING DIFFICULTIES OF SCHOOL-AGED COCHLEAR IMPLANT USERS AND NORMAL-HEARING LISTENERS Sherry Liao (Dr. Eun Kyung Jeon, Alisa McKay, Kyle Whittle) Department of Communication Sciences and Disorders Children diagnosed with severe to profound hearing losses can now receive a cochlear implant (CI) around their first birthday. The literature shows that long-term CI users can listen and learn to speak using electrical stimulation. This prepares them to achieve good academic proficiency as well. However, due to the limitations of CIs, children with CIs still struggle in difficult listening situations, for example, in noisy environments or when listening to music. These more challenging listening conditions are unfortunately typical for school, where CI users need to learn new information using degraded sounds via CIs. The objective of the study is to determine the listening difficulties in school-aged children using CIs and to compare them to those of their normal-hearing (NH) peers in school. The study has been recruiting ten mainstreamed schoolaged children with CIs who received their implant early in life, before three years old, and use it every day for communication. For NH peers, ten age- and sex-matched school-aged children are also being recruited. All participants are native English speakers. Listening difficulties have been measured using a self-report with a 0 to 100 scale (no effort to extreme effort) along with structured questions with open answers to report their levels of fatigue in regards to different listening situations. The parents of both the children with NH and CIs are also being given a questionnaire composed of structured questions with open answers to determine specific listening environments that the children may struggle with. Preliminary results showed that NH children also struggle in challenging listening conditions such as classes where there are multiple talkers including the teacher and students. However, CI users have rated a higher effort compared to NH peers for listening situations such as understanding multiple talkers in noise, when given a new listening condition, and when listening in large groups. In this presentation, we will discuss the results of these questionnaires and how these results can help guide counseling and aural rehabilitation for students with CIs. University of Utah UNDERGRADUATE RESEARCH JOURNAL THE EFFECT OF A PHYSICAL ACTIVITY INTERVENTION ON FACETS OF MENTAL WELL-BEING Ashley Nicole Mowery (Dr. Maria Newton, PhD.) Department of Kinesiology In adolescents, the annual rate of depression in the United States is 8% to 9% (Motl et al., 2004). Higher levels of physical activity in adolescents are associated with decreased depressive symptoms, more positive mood states and improvements in self-esteem (Motl et al., 2004; Scully, 1998). Overall, children who are more active have fewer emotional, behavioral and social problems (Griffiths et al., 2016). Health promotion research focused on enhancing mental wellbeing in children via physical activity interventions have been undervalued thus far (Christiansen et al., 2017; Patalay et al., 2016; Penedo & Dahn, 2005; Smedegaard et al., 2016). Therefore, the purpose of this study was to examine the effects of a physical activity intervention on children’s sense of thriving. It was hypothesized the physical activity intervention would increase positive facets of thriving (joy, friendship, strength, confidence) and decrease negative facets of thriving (anger, sadness). The sample included three children (1 boy, 2 girls, average age = 9 years old). The intervention occurred at the Midvale Boys and Girls Club in Utah on Wednesday and Friday afternoons from 3pm to 4pm for three weeks. The intervention consisted of discussions about joy, friendship, anger, sadness, confidence, and strength preceded sessions of physical activity. The children’s sense of thriving and physical activity were measured at pre-intervention and post-intervention using a modified version of The Physical Activity Questionnaire (PAQ-C) and an adapted version of the Brief Inventory of Thriving (BIT). The data were analyzed using means, standard deviations, and Wilcoxon Signed Ranks Tests (WSRT). Children’s amount of physical activity and joy increased while their levels of anger and sadness decreased following the intervention. However, children’s measures of friendship, strength, and confidence also decreased after the physical activity intervention. None of the changes in the constructs of thriving or physical activity were statistically significant (p > 0.05). Children’s perceived anger and sadness could have decreased because the intervention helped children release these emotions in a positive way. Children’s levels of joy potentially increased because they could interact with each other in an inclusive social environment and they internalized the idea of happiness. The unanticipated changes in friendship, confidence, and strength were influenced by one child, whose responses appeared to be outliers. Anecdotally the children involved in the physical activity intervention seemed to enhance their positive sense of thriving. The children appeared to have a more optimistic attitude and their ability to handle adverse situations without confrontation improved. Physical activity interventions have the potential to improve children’s mental well-being while increasing their levels of physical activity. Thus, further investigation into the design, delivery, and effect of physical activity interventions to improve thriving is needed. References Christiansen, L. B., Lund-Cramer, P., Brondeel, R., Smedegaard, S., Holt, A. -., & Skovgaard, T. (2018). Improving children's physical self-perception through a school-based physical activity intervention: The move for well-being in school study. Mental Health and Physical Activity, 14, 31-38. doi: 10.1016/j.mhpa.2017.12.005 Griffiths, L. J., Geraci, M., Cortina-Borja, M., Sera, F., Law, C., Joshi, H., . . . Dezateux, C. (2016). Associations between children’s behavioural and emotional development and objectively measured physical activity and sedentary time: Findings from the UK millennium cohort study. Longitudinal and Life Course Studies, 7(2), 124-143. doi:10.14301/llcs.v7i2.353 Motl, R. W., Birnbaum, A. S., Kubik, M. Y., & Dishman, R. K. (2004). Naturally occurring changes in physical activity are inversely related to depressive symptoms during early adolescence. Psychosomatic Medicine, 66(3), 336-342. doi:10.1097/01.psy.0000126205.35683.0a Patalay, P., & Fitzsimons, E. (2016). Correlates of mental illness and wellbeing in children: Are they the same? results from the UK millennium cohort study. Journal of the American Academy of Child and Adolescent Psychiatry, 55(9), 771-783. doi:10.1016/j.jaac.2016.05.019 Penedo, F. J., & Dahn, J. R. (2005). Exercise and well-being: A review of mental and physical health benefits associated with physical activity. Current Opinion in Psychiatry, 18(2), 189-193. Scully, D. (1998). Physical exercise and psychological well being: A critical review. British Journal of Sports Medicine, 32(2), 111-120. Smedegaard, S., Christiansen, L. B., Lund-Cramer, P., Bredahl, T., & Skovgaard, T. (2016). Improving the well-being of children and youths: A randomized multicomponent, schoolbased, physical activity intervention. BMC Public Health, 16(1), 1-11. doi:10.1186/s12889016-3794-2 University of Utah UNDERGRADUATE RESEARCH JOURNAL REACH FOR YOUR DREAMS Ronald Nguyen (Carolyn Bliss, Asia Susko) Health Sciences LEAP Program Mountain View Elementary is a Title I school with a dual immersion program featuring several languages including Spanish. These programs help students to become fluent in speaking, reading, and writing in another language. Title I schools are federally funded programs that provide additional resources to schools that are impacted by poverty in surrounding communities. 90% of these students qualify for free or reduced lunches. Many of the students don’t see college as an option for themselves. Another challenge faced by the school are low reading, math, and science levels compared to the Salt Lake City District. This project works to increase students’ understanding of what college is, introduce careers that require a college education, help them understand that college is a viable option for them, serve as role-models and mentors to these third grade students, and assist them in increasing their reading skills. If they’re not at grade level by the end of the third grade research has shown that they will never be on track or their chances of getting to where they need to be will decrease tremendously. For this project, two main methods were used to help boost reading scores and help foster an interest in higher education. In order to help with reading, mentors assisted with weekly reading and reading tests, for roughly two hours a week. To help the students become more interested in higher education there were four presentations done about varying careers that require higher education or technical schooling (Engineering, Architecture, Healthcare and Science, and Law Enforcement) along with weekly mentoring and a survey was given before the start of the mentoring and presentations and after the completion of the presentations. The data was then analyzed with an unpaired T-test to see if there was statistically significant change in the overall answers. When comparing the mean of the answers for the initial and final survey, we saw that results varied from question to question with no statistical significance. While there were a lot of variables that couldn’t be controlled for with the survey answers, we could definitely see a change within these kids throughout the year. One example of this was a student that in the beginning was very quiet and unwilling to participate much in class and in the weekly mentoring, but slowly he did open up to us and was more willing to participate in class and did well with the weekly mentoring. University of Utah UNDERGRADUATE RESEARCH JOURNAL TREATING DEPRESSION IN DYADIC RELATIONSHIPS THROUGH POSITIVE PSYCHOLOGY Jennifer Loya Prieto, Alexandra L. Terrill PhD Department of Occupational & Recreational Therapies Background Depressive symptoms in post-stroke patients occur in 30-50% of survivors and caregivers. When a stroke happens within a couple, there are major consequences on function and quality of life. Research suggests feelings within couples are contagious, when one partner is well the other seems to also be well, and when one is depressed it is likely the other partner is depressed as well. However, mental health issues post-stroke are primarily targeted towards the survivor, even though caregivers also experience negative mental health changes, including depression. More research and interventions are needed to better support the caregiver. Methods The current study explored the effectiveness of Positive Psychology Interventions (PPI’s) to promote psychological strengths and resources to increase well-being in dyads post-stroke. PPIs were used instead of Cognitive Behavior Therapy (CBT) due to the possible cognitive deficits in stroke survivors. The couples, which needed to be living together, and experiencing some depressive symptoms, completed positive psychology activities at home for 8 weeks, using an activity booklet and calendar provided. They would report on their activities and their feelings during weekly check-ins. The activities were targeted to promote self-worth, socialization, beliefs, and overall well-being, as well as other aspects of life. Results There were more male than female stroke survivors with an average age of 54 years old, which was younger than expected. There was an overall decrease in depressive feelings and fatigue. Most survivors and caregivers had higher levels of happiness, with reports of feeling more hopeful and healthier. They felt stronger social bonds and were more open when it came to communicating with one another. Conclusion Due to the experiment being a pilot study with ongoing development, only preliminary results are available. This pilot study suggested the intervention is feasible and may be effective for improving mood, well-being, and quality of life for dyads post-stroke. There are some limitations in the study, such as the need for increased diversity of participants. The next steps include finishing the development of an app to aid in obtaining more diversity, using this intervention in dyads coping with other neurological diagnoses, such as spinal cord injury and traumatic brain injury. University of Utah UNDERGRADUATE RESEARCH JOURNAL DON’T OVERESTIMATE THE POWER OF THE FORCE Kira K. Tanghe (James C. Martin) Department of Nutrition and Integrative Physiology Muscular power depends on force-velocity, activation, and deactivation characteristics, all of which adapt to training. Resistance training programs intended to improve power have produced mixed results. We used previously reported data from heavy and explosive training programs [1,2] to modify muscle-tendon model parameters and evaluated power during cyclic contractions. Heavy training greatly increased force (26.8%) but also increased time required for activation (20%) and deactivation (48%). Explosive training produced smaller improvements in strength (10.8%) and reduced time required for activation (20%) and deactivation (10%). Both programs led to similar increases in maximum power (13.5% for heavy and 14% for explosive) but with different power-frequency relationships (Figure 1). Heavy training produced maximum power at lower frequencies (1.6Hz) typical of swimming and speedskating, whereas explosive training produced maximum power at higher frequencies (2Hz) typical of sprint running and cycling, and balance recovery. Greater deactivation time (due to heavy training) compromised power by requiring earlier stimulation offset leading to reduced positive power production as well as the prolonged deactivation led to increased negative power during lengthening (Figure 2). These modeling results demonstrate the importance of activation and deactivation during cyclical contractions, particularly at higher frequencies. This underscores the importance of both strength and deactivation for power during cyclic contractions. 70 250 200 60 Power (W) Power (W) 50 40 30 150 100 50 0 20 -50 10 -100 0% 25% 50% 75% 100% 125% Cycle % 0 0 0.5 Baseline 1 1.5 2 Frequency (Hz) Post Heavy Training 2.5 3 3.5 Baseline Heavy Explosive Post Explosive Training Figure 1: Maximum power-frequency relationships. Figure 2: Optimized power production for one shortening-lengthening cycle at 2 Hz for each scenario. References [1] Hakkinen et al. (1985). Acta Physiol Scand, 125: 573-585. [2] Hakkinen et al. (1985). Acta Physiol Scand, 125: 587-600. [3] Bezodis et al. (2008). Med Sci Sports Exerc, 40: 707-715. [4] Han and Yang (2015). Hum Mov Sci, 44: 192-202 University of Utah UNDERGRADUATE RESEARCH JOURNAL EFFECTS OF FACEBOOK INTERACTIONS ON MENTAL WELL-BEING Caitlin Vance, Department of Health Promotion and Education Sara Weisenbach, Department of Psychiatry ABSTRACT Introduction The use of social media sites has increased significantly since the creation of Facebook in 2004. In 2005, only 5% of American adults used at least one social media platform, which increased to 69% of American adults by 2018. Facebook is the most used social media outlet, and the largest age group of Facebook users is 18-29 years old (Pew Research Center, 2018). Research on Facebook use is not unanimous concerning how usage affects mental and social well-being. This study examined how self-esteem and social support affect active or passive Facebook use, time on Facebook and other social media, and time engaging in offline interactions. Methods Participants (n=68) were recruited from the University of Utah campus and included both students and non-students ages 18-30. Participants completed baseline questionnaires regarding their mental well-being. Then, they used an app called WeFeel to track levels of self-esteem and social support as well as time on and off of social media, completing a survey five times each day for seven consecutive days. Afterwards, participants completed the questionnaires performed at baseline again and were asked to provide feedback on their experience with the study. A series of repeated measures ANOVA were performed with high/low self-esteem or high-low perceived social support (defined using a median split) as the between-subjects variable and time on Facebook, time on all social media, and time engaging in offline social interactions during the seven-day period as the within-subjects variables. Results Both self-esteem and perceived social support levels measured at baseline were not significantly associated with time on Facebook, active versus passive time on Facebook, time spent on other social media, nor with time spent in offline social interactions. Discussion Several limitations on the study may have affected accurate collection of data. These limitations include, but are not limited to inconsistency in receiving notifications from WeFeel, miscommunication about how to fill out the WeFeel survey completely, a sample not representative of the larger population, the fact that monitoring behavior may change normal behavior, estimation biases, and the presence of other psychosocial factors that may impact wellbeing. Future analyses will be completed using mixed-modeling to account for variability in selfesteem and perceived social support levels and how these predict variability in social media usage and offline social interactions. INTRODUCTION The nature of human social exchanges has shifted as new technology and communication mediums expand. Terms such as sharing, posting, liking, and commenting have become a part of U.S. vocabulary and culture. The use of social networking websites has increased significantly since the creation of Facebook in 2004. In 2005, 5% of American adults used at least one social media platform. In comparison, in 2018, 69% of U.S. adults were found to use some type of social media (Pew Research Center, 2018). Facebook is the most widely-used social media outlet, with 2.2 billion monthly active users. If Facebook were a country, it would be the largest in the world, exceeding the population of China (Hu, 2018). The largest age group of Facebook users is 18-29 years old, with 88% of this age group using at least one social media site. Also, Facebook use is correlated with education level. Around 79% of American college graduates use Facebook. Roughly three-quarters of all U.S. Facebook users visit the site daily (Pew Research Center, 2018). The rise of new technology, including smart phones, has made social networking easier and more accessible, but current research is not unanimous concerning how increased Facebook use affects mental health and social well-being. However, many individuals have seemed to notice an impact of Facebook on their behavior and mental health because they have voluntarily chosen to alter the amount of time they spend on Facebook. Around 42% of adult Facebook users in the U.S. have taken a break from checking their accounts for several weeks and 26% have deleted the Facebook app from their phone this past year (Gramlich, 2019). Social Support The current literature on social support received through Facebook interactions yields mixed results. Social support is closely linked with good mental health while a lack of social support is strongly related to psychological distress and/or depressive symptoms (McCloskey, Iwanicki, Lauterbach, Giammittorio, & Maxwell, 2015). A study examining Facebook and social support concluded that Facebook helps people access online social support, which can enhance offline social support for college students. However, Facebook does not directly improve wellbeing; it merely provides more opportunities to connect with people and then receive offline support (Liu & Yu, 2013). The results of a different study concluded that the number of Facebook friends was associated with strong perceived social support, reduced stress, and greater well-being. This study hypothesized that the more Facebook friends a person has, the more connected that person feels, regardless of actual support received (Nabi, Prestin, & So, 2013). Another study on social support online concluded that Facebook-based support is not the same as traditional social support and may help supplement, but not replace traditional social support (McCloskey, Iwanicki, Lauterbach, Giammittorio, & Maxwell, 2015). A study found two explanations to their conclusions that emotional support is associated with time on social media. One explanation is that individuals who have less emotional support in their offline relationships may spend more time on social media to alleviate this. Another explanation is that individuals who first spend more time on social media then feel less emotional support (Shensa, Sidani, Lin, Bowman, & Primack, 2015). Social support received through Facebook may depend on the intention of its use. A study compared the number of Facebook friends of freshman and upper-class students to the emotional and social adjustment they experienced. The results showed that the older students with a lot of Facebook friends experienced a positive correlation between their social connections on Facebook and emotional adjustment to college, demonstrating support through their Facebook friends. The freshman, however, experienced the opposite outcome and the number of Facebook friends they had was detrimental to their social support on campus. This study mentioned that the way in which Facebook was used among the two groups and the factors leading to the more effective use of Facebook could be a future research opportunity (Kalpidou, Costin, & Morris, 2011). Self-Esteem The literature on how Facebook affects self-esteem also reveals varying results. One study stated that spending a substantial amount of time on Facebook relates to low self-esteem (Kalpidou, Costin, & Morris, 2011). Another study found that Facebook users with lower selfesteem as compared to high self-esteem users, would engage in friending online more often as a way to make up for their low self-esteem (Lee, Moore, Park E., & Park, S., 2012). One study concluded that those with lower self-esteem seemed to have a “greater sense of belongingness to the Facebook community” (Tazghini & Siedlecki, 2013, p. 830). Another study found that Facebook users often feel like they have wasted their time and engaged in something that was not meaningful. The longer people are on Facebook and continue to feel like they are wasting time, the more negative is their mood (Sagioglou & Greitemeyer, 2014). Social comparison on Facebook use may affect self-esteem because viewing others’ life events may cause a Facebook user to carefully assess his or her own life. Although Facebook use alone may not affect mental health directly, it can lead to this social comparison, which often then leads to a decreased state of mental health (Jang, Park & Song, 2016). On the contrary, several studies found positive correlations between Facebook and selfesteem. One such study stated that within a college campus, the public displaying of an individual’s positive images and experiences can increase their psychological comfort (Park & Lee, 2014). Another study noted that social interactions on Facebook can be positive and boost self-esteem. This is because the online interactions allow for more time to enhance self-image, process information, and create communicative responses (Liu & Yu, 2013). Another study concluded that Facebook may help students who have low self-esteem overcome barriers and receive benefits such as “increased information and opportunities” (Ellison, Steinfield, & Lampe, 2007, p. 1163). Online versus Offline Relationships In a longitudinal study comparing Facebook activity and direct social interaction, offline social interactions increased well-being more than the online networks. This study also found that Facebook use is associated with lower life satisfaction while having real-life friends with whom to interact is associated with greater life satisfaction. As Park and Lee noted, “social relationships created and maintained outside Facebook…need to be simultaneously considered” in order to gauge satisfaction and support (2014, p. 617). Passive versus Active Use of Facebook One study stated that the quality of social media use may be more associated with mental health outcomes than the quantity of time spent on social media (Shakya & Christakis, 2017). The psychological outcomes of non-communicative use of Facebook, such as viewing profiles and browsing the news feed may differ as compared to communicative use, like messaging and commenting/liking photos (Kalpidou, Costin, & Morris, 2011). The passive and active use of Facebook and how this affects those variables was addressed in the current study. Passive usage refers to taking in information without directly exchanging, such as viewing posts, scrolling through news feeds, or reading news articles posted. Active usage involves direct exchanges with others, including posting photos or commenting/liking other posts (Verduyn et al., 2015). The purpose of the current study was to extend previous literature on relationships between self-esteem and social support and use of social media through use of ecological momentary assessment (EMA), also known as experience sampling. Participants were prompted five times daily through the app WeFeel to answer questions regarding their Facebook use, other social media use, time offline (which included face-to-face interactions, phone calls, texting, and instant messaging), the social support received from both platforms, and their current selfesteem. For the purpose of the current study, we asked how baseline self-esteem and perceived social support affect 1) time spent on Facebook; 2) time spent on other social media sites; 3) active versus passive Facebook use; and 4) time spent in non-social media interpersonal interactions. Based on previous literature, we hypothesized that baseline self-esteem and perceived social support would have a negative relationship with time spent on Facebook, time spent on other social media sites, and more passive use of Facebook. However, our hypothesis also included that baseline self-esteem and social support would have a positive relationship with time spent interacting offline and active use of Facebook. METHODS Participants The participant pool (n=68) was drawn from both students and non-students between the ages of 18 and 30 years, recruited at the University of Utah through a variety of outlets. Advertisements were made across campus, including paper and electronic listings, as well as classroom announcements. Participation was not limited to students, but most of the people who heard about the study were enrolled in classes. This study was also added to a psychology participant pool to expand recruitment options. Students enrolled in psychology classes could access this portal and find research opportunities to participate in and receive class credit. Participants were required to be between the ages of 18 and 30 years old and be an active Facebook user, which was defined as using Facebook daily for at least 30 minutes. They were also required to use an application through their smartphone called WeFeel. Out of the 68 participants, 64.7% were female. The majority of participants were Caucasian (86.8%), and not Hispanic or Latino (76.5%), and undergraduate students at the University of Utah (92.6%). The study was approved by the University of Utah Institutional Review Board and all participants provided voluntary consent prior to completing study procedures. Procedure Once participants indicated interest in the study, they scheduled an in-person meeting to provide informed consent, receive instructions on using WeFeel for data collection, and complete several baseline questionnaires (see measures below). This included having participants indicate through WeFeel any previously diagnosed mental health conditions and agreeing to share their information anonymously. This meeting took place somewhere on the University of Utah campus in either individual or group settings and the questionnaires were administered online through RedCap. Participants received compensation as either class credit through the Psychology Department or being entered into a raffle for a $200 Amazon gift card, which one participant received. After the initial visit, participants completed the study remotely through WeFeel. They were sent 5-7 random reminders/day to track a number of items, including their levels of selfesteem, perceived social support online and offline, and the nature of their social media use (see measures below). They were given no notice as to when the reminders would come, but were asked to answer questions 90 minutes within receiving the notification from WeFeel. The study required that participants fill out five of these surveys/day for seven consecutive days. In order to be compensated, participants were required to fill out 75% of all the WeFeel surveys. After the week of filling out WeFeel surveys, participants completed the same questionnaires received at the initial meeting, thus providing data on their overall well-being before and after the study. These questionnaires were completed through a RedCap survey that was sent to participants through email. Lastly, participants were asked to answer questions in order to debrief their experience and give feedback to the PI and app developer. Measures Baseline/Post-Study Measures Demographics Questionnaire (given only at baseline): A 9-item questionnaire asking respondents their name, phone number, email address, age, gender, ethnicity, race, and education status. Rosenberg Self-Esteem Scale: (Rosenberg, 1965). Asks respondents to rate the extent to which they agree with 10 items regarding feelings toward self on a 4-point Likert scale. Multidimensional Scale of Perceived Social Support (MSPSS): (Zimet, Dahlem, Zimet, & Farley, 1988). A 12-item scale asking respondents to rate amount of perceived social support from family, friends, or a significant other on a 7-point Likert scale. WeFeel Survey Participants were asked to rate their levels of self-esteem and social support from low to high, both through Facebook interactions and offline interactions. Participants also estimated the percentage they spent actively versus passively on social media. [See Figure 1]. Participants tracked (in minutes) time spent on social media sites other than Facebook, time spent on Facebook, and time engaging in interactions outside of social media. [See Figure 2]. Figure 1 Figure 2 Data Cleaning and Statistical Analyses Participants answered the questions on WeFeel considering the time since they had filled the survey out last. The amount of time between each entry was calculated for all participants. For the time between the last entry of the day and the first entry of the next day, eight hours was subtracted from that total time difference to account for sleep. Then, the total time spent on Facebook, other social media, and offline for each entry was multiplied by this time difference to produce a percentage of time on each of those activities during that time period. A series of repeated measures ANOVA were performed with high/low self-esteem or high/low perceived social support (defined using a median split) as the between-subjects variable and time on Facebook, time on all social media, and time engaging in offline social interactions as the withinsubjects variables. The medians and standard deviations for high/low self-esteem and high/low social support can be found in Table 1. As a result of extant missing data, only time points 2-20 were used in analyses. Age and gender were entered as covariates for all analyses. Table 1 Median Split Measure Low Self-Esteem High Self-Esteem Low Social Support High Social Support Median 16.89 22.55 4.70 6.60 Standard Deviation 4.24 4.37 0.16 0.35 RESULTS Baseline self-esteem did not significantly predict time spent on Facebook, time spent on other social media sites, time spent in offline social interactions, nor passive vs. active use of Facebook (all ps<.05; see Tables 2-5). Table 2 Effect of Self-Esteem on Time Spent on Facebook Source Between-Subjects Self-esteem Error Within-Subjects Time Spent on Facebook Time Spent on Facebook * Self-esteem Error df F p 1 54 0.64 0.43 18 18 972 0.58 1.14 0.91 0.3 Table 3 Effect of Self-Esteem on Time Spent on Social Media Source Between-Subjects Self-esteem Error Within-Subjects Time Spent on Social Media Time Spent on Social Media * Self-esteem Error Table 4 Effect of Self-Esteem on Time Spent Offline Source Between-Subjects Self-esteem Error Within-Subjects Time Spent Offline Time Spent on Offline * Self-esteem Error Table 5 Effect of Self-Esteem on Passive vs. Active Use of Facebook Source Between-Subjects Self-esteem Error Within-Subjects Time Spent Passively vs. Actively Time Spent Passively vs. Actively * Self-esteem Error df F p 1 54 1.14 0.29 18 18 972 0.68 1.25 0.83 0.21 df F p 1 54 0.55 0.46 18 18 972 1.9 0.91 0.01 0.57 df F p 1 58 0.38 0.54 18 18 1044 0.72 0.87 0.79 0.62 Baseline perceived social support did not significantly predict time spent on Facebook, time spent on other social media sites, time spent in offline social interactions, nor passive vs. active use of Facebook (all ps<.05; see Tables 6-9). Table 6 Effect of Social Support on Time Spent on Facebook Source Between-Subjects Social Support Error Within-Subjects Time Spent on Facebook Time Spent on Facebook * Social Support Error Table 7 Effect of Social Support on Time Spent on Social Media Source Between-Subjects Social Support Error Within-Subjects Time Spent on Social Media Time Spent on Social Media * Social Support Error Table 8 Effect of Social Support on Time Spent Offline Source Between-Subjects Social Support Error Within-Subjects Time Spent Offline Time Spent Offline * Social Support Error df F p 1 54 0.01 0.93 18 18 972 0.76 1.26 0.75 0.2 df F p 1 54 0.86 0.36 18 18 972 0.95 1.65 0.52 0.04 df F p 1 54 0.11 0.74 18 18 972 1.81 0.83 0.02 0.66 Table 9 Effect of Social Support on Passive vs. Active Use of Facebook Source Between-Subjects Social Support Error Within-Subjects Time Spent Passively vs. Actively Time Spent Passively vs. Actively * Social Support Error df F p 1 58 0.56 0.46 18 18 1044 0.77 1.31 0.74 0.17 DISCUSSION Contrary to hypotheses, self-esteem and perceived social support levels measured at baseline were not significantly associated with time on Facebook, active versus passive time on Facebook, time spent on other social media, nor with time spent in offline social interactions. Although analyses performed yielded statistically insignificant results, many participants voluntarily answered debriefing questions regarding their experience with the WeFeel app and the study overall. This feedback may prove useful in combatting some of the limitations of the study. The literature on how self-esteem and perceived social support affect time spent on social media or in offline interactions are not entirely in line with the results of the current study. One study found that Facebook users with lower self-esteem as compared to those with higher selfesteem, would engage in friending online more often as a way to make up for their low selfesteem (Lee, Moore, Park E., & Park, S., 2012). A second study concluded that those with lower self-esteem seemed to have a “greater sense of belongingness to the Facebook community” (Tazghini & Siedlecki, 2013, p. 830). A third study concluded that Facebook may help students who have low self-esteem overcome barriers and receive benefits such as “increased information and opportunities” (Ellison, Steinfield, & Lampe, 2007, p. 1163). Finally, a study on social support concluded that individuals who have less emotional support in their offline relationships may spend more time on social media to alleviate this (Shensa, Sidani, Lin, Bowman, & Primack, 2015). One study looked at passive vs. active use of Facebook and concluded that passive use is the dominant activity on social media sites and passive usage is associated with depression and reduced perceived social support (Escobar et al., 2018) Feedback from participants tended to agree with this study. One participant noticed that they were in a better mood when they were active compared to passive on social media. Another participant said that the more time they spent online passively browsing through various social media feeds, the more negatively they tended to view themselves. The topic of passive vs. active use of Facebook is relatively new in the literature and may need to be explored further. In regards to comparing offline interactions and relationships, one study found that “real-world social networks” had a positive association with well-being, while use of Facebook had a negative association with well-being (Shakya & Christakis, 2017). From the debriefing questions, a participant noticed a tendency to be happier when they had more face-to-face interaction. Another person agreed that the more they were with actual people, the happier they were, but when on Facebook, they felt grumpier. The current study tried to account for outside factors that may have an effect on well-being by asking about offline social interactions. Possible reasons for the disparate results (from the current study’s findings) include 1) use of different measures to study social support and time on Facebook (Lee, Moore, Park E., & Park, S., 2012; Shakya & Christakis, 2017; Shensa, Sidani, Lin, Bowman, & Primack, 2015; Tazghini & Siedlecki, 2013); and 2) using retrospective reports of online interactions as opposed to ecological momentary assessment methods (Ellison, Steinfield, & Lampe, 2007; Escobar et al., 2018; Shensa, Sidani, Lin, Bowman, & Primack, 2015; Tazghini & Siedlecki, 2013). The current set of analyses necessitated treating self-esteem and social support as stable, categorical variables, and were unable to consider missing data points. In consultation with a biostatistician, future analyses will examine how variability in self-esteem and social support during the entire assessment period predict variability in social media usage behaviors using mixed modeling. A number of other study limitations are important to consider. First, using the app WeFeel provided an outlet for participants to easily access surveys and answer questions remotely on their mobile devices. However, the app had some notification issues for a few participants, due to the app being fairly new and participants using a variety of mobile devices. Many of these problems were sorted out quickly and participants were able to resume the study, but other participants continued to have problems with not receiving any notifications. This led to either data that was not randomized because participants would fill out the survey based on their own time preference (since the notifications were not working normally) or missing data points. A few participants did not complete the required amount of surveys or dropped out in the middle of the week. Second, participants were using the app WeFeel for the first time and may not have been sure of how to fill out the survey accurately. On the WeFeel survey, participants rated other items besides self-esteem and social support, which may be used in future analyses. Participants were asked to rate emotions such as anger, sadness, and disgust, but it was explained to them by the PI that if they had not experienced a particular emotion during that time period, they could either indicate this by putting the scale all the way to the left side or they could not open the scale at all. These scales may not have been clearly distinguished from scales of self-esteem and social support, which needed to be rated from low to high. This became problematic during the study because there was a discrepancy between whether participants had low levels of self-esteem and social support or if they just failed to open those measures. In hindsight, this measurement would need to be more clearly defined in order to receive more accurate results. Third, participants were mostly college students and although people ages 18-30 are often students, this is not always true. The sample may not have been representative of that population of people. Also, because participants were primarily Caucasian in this study, results may not generalize to individuals from other racial backgrounds. Fourth, the process of monitoring social media use and levels of mental well-being may have had an impact on reported data over the course of the week. For example, in response to the debriefing questions asked at completion of the study, one participant noted that they tried to restrain themselves from getting angry at work because they would feel embarrassed about reporting it. Several participants noted that doing this study made them more conscious of their time on social media and how it might have been associated with their mood levels. One participant noted that more time on social media tended to make them feel worse about themselves, while another person said that the more they were off social media the happier and more joyful they felt. Other participants noticed that their outlook and mood seemed better with less social media and the little things they saw on Facebook ate at their confidence. If they reported having a negative reaction to more time on social media, they tended to withdraw and spend less time on social media. Others said that although they cultivated a new awareness of their behavior, they felt like it did not change throughout the week. Some participants said that they tried to use social media more so that they would have more to report on. Fifth, participant ratings of time spent on social media and offline are subject to estimation biases. Finally, there are likely other psychosocial variables that were not considered that may impact outcome variables. For example, one participant noted that they wished the study had taken into consideration the other factors in their lives, such as stress in relationships, overall health status, sleep quality, etc. In conclusion, self-esteem and perceived social support levels measured at baseline were not significantly associated with time on Facebook, time on other social media, active versus passive time on Facebook, nor with time spent in offline social interactions. The limitations stated above may aid in designing similar studies in the future that take these points into account. Future analyses will examine how the variability in self-esteem and social support during the entire assessment period predict variability in social media usage behaviors using mixed modeling. REFERENCES Ellison, N. B., Steinfield, C., & Lampe, C. (2007). The Benefits of Facebook “Friends:” Social Capital and College Students’ Use of Online Social Network Sites. Journal of ComputerMediated Communication, 12(4), 1143-1168. doi:10.1111/j.1083-6101.2007.00367.x Escobar-Viera, C. G., Shensa, A., Bowman, N. D., Sidani, J. E., Knight, J., James, A. E., & Primack, B. A. (2018). Passive and Active Social Media Use and Depressive Symptoms Among United States Adults. Cyberpsychology, Behavior, and Social Networking, 21(7), 437-443. doi:10.1089/cyber.2017.0668 Gramlich, J. (2019). 10 facts about Americans and Facebook. Retrieved from https://www.pewresearch.org/fact-tank/2019/02/01/facts-about-americans-and-facebook/ Hu, J. C. (2018). Social networks make the world's largest nations seem small. Retrieved from https://qz.com/1386649/social-networks-make-the-worlds-largest-nations-seem-small/ Jang, K., Park, N., & Song, H. (2016). Social comparison on Facebook: Its antecedents and psychological outcomes. Computers in Human Behavior, 62147-154. doi:10.1016/j.chb.2016.03.082 Kalpidou, M., Costin, D., & Morris, J. (2011). The relationship between Facebook and the wellbeing of undergraduate college students. Cyberpsychology, Behavior, And Social Networking, 14(4), 183-189. doi:10.1089/cyber.2010.0061 Lee, J. R., Moore, D. C., Park, E., & Park, S. G. (2012). Who wants to be “friend-rich”? Social compensatory friending on Facebook and the moderating role of public selfconsciousness. Computers in Human Behavior, 28(3), 1036-1043. doi:10.1016/j.chb.2012.01.006 Liu, C., & Yu, C. (2013). Can Facebook Use Induce Well-Being? Cyberpsychology, Behavior, and Social Networking, 16(9), 674-678. doi:10.1089/cyber.2012.0301 McCloskey, W., Iwanicki, S., Lauterbach, D., Giammittorio, D. M., & Maxwell, K. (2015). Are Facebook “Friends” Helpful? Development of a Facebook-Based Measure of Social Support and Examination of Relationships Among Depression, Quality of Life, and Social Support. Cyberpsychology, Behavior, and Social Networking, 18(9), 499-505. doi:10.1089/cyber.2014.0538 Nabi, R. L., Prestin, A., & So, J. (2013). Facebook Friends with (Health) Benefits? Exploring Social Network Site Use and Perceptions of Social Support, Stress, and WellBeing. Cyberpsychology, Behavior, and Social Networking, 16(10), 721-727. doi:10.1089/cyber.2012.0521 Park, N., & Lee, S. (2014). College students' motivations for Facebook use and psychological outcomes. Journal of Broadcasting & Electronic Media, 58(4), 601-620. doi:10.1080/08838151.2014.966355 Pew Research Center. (2018). Demographics of Social Media Users and Adoption in the United States. Retrieved from https://www.pewinternet.org/fact-sheet/social-media/ Rosenberg, M. (1965). Society and the adolescent self-image. Princeton, NJ: Princeton University Press. Sagioglou, C., & Greitemeyer, T. (2014). Facebook's emotional consequences: Why Facebook causes a decrease in mood and why people still use it. Computers in Human Behavior, 35359-363. doi:10.1016/j.chb.2014.03.003 Shakya, H. B., & Christakis, N. A. (2017). Association of Facebook Use with Compromised Well-Being: A Longitudinal Study. American Journal of Epidemiology, 185(3), 203-211. doi:10.1093/aje/kww189 Shensa, A., Sidani, J. E., Lin, L. Y., Bowman, N. D., & Primack, B. A. (2015). Social Media Use and Perceived Emotional Support Among US Young Adults. Journal of Community Health, 41(3), 541-549. doi:10.1007/s10900-015-0128-8 Tazghini S., Siedlecki K. L. (2013). A mixed method approach to examining Facebook use and its relationship to self-esteem. Computers in Human Behavior, 29, 827–832. 10.1016/j.chb.2012.11.010 Verduyn, P., Lee, D. S., Park, J., Shablack, H., Orvell, A., Bayer, J., & ... Kross, E. (2015). Passive Facebook usage undermines affective well-being: Experimental and longitudinal evidence. Journal of Experimental Psychology: General, 144(2), 480-488. doi:10.1037/xge0000057 Zimet, G.D., Dahlem, N.W., Zimet, S.G. & Farley, G.K. (1988). The Multidimensional Scale of Perceived Social Support. Journal of Personality Assessment, 52, 30-41 College of Humanities University of Utah UNDERGRADUATE RESEARCH JOURNAL ECONOMIC, SOCIAL, AND SOCIETAL UNDERLININGS IN NOIR LITERATURE: MOTIVATIONS, UNDERTONES, AND CRITICISMS Dashiell Anderson (Robert Stephen Tatum) Department of English ABSTRACT American Noir was a literary crime fiction genre that spanned from the 1920s to the 1950s. The genre, characterized by pessimism, realism, existentialism, and immorality, was written very much as a criticism of American capitalism. The economic time periods associated with noir’s existence were almost all involved with advancing capitalism. My research analyzes and compares how noir (and in particular crime in noir) changes alongside the development and evolution of economic principles and economic structure. I attempt to conceptualize how trends and changes in production, consumption, corporate power, inequality, and general economic organization influence criminal motivation, the mode in which crime is committed, and how crime is policed within the noir genre. I focus on five noir novels each from different economic time periods – Dashiell Hammett’s 1929 novel Red Harvest, James M. Cain’s 1934 novel The Postman Always Rings Twice, Raymond Chandler’s 1939 novel The Big Sleep, Dorothy B. Hughes’s 1947 novel In a Lonely Place, and Raymond Chandler’s 1953 novel The Long Goodbye. I examine how the evolution of capitalism from the prosperous 1920s, to The Great Depression, to The New Deal, to World War II, and finally to The Golden Age of Capitalism translates to issues such as class struggle, class-consciousness, social anxiety, and power structure – all of which are causations and motivations for crime in noir. Several noir themes, including crime, remain present throughout the genre’s history. However, the nature of these themes change and are dependent on the economic time period in which a given noir novel was written. University of Utah UNDERGRADUATE RESEARCH JOURNAL EXECUTIVE TIME: THE MEANING AND REACH OF PRESIDENTIAL TWEETS REGARDING MIDDLE EAST POLICY IN THE PRESS Emily Anderson (Dr. Shannon McGregor) Department of Communication ABSTRACT This research looks at tweets about the Middle East by former President Barack Obama and President Donald Trump to determine whether there is a pattern in coverage of the tweets by the news media. It takes tweets from the first year of Obama’s second term and Trump’s first year and codes them for tone and purpose, then examines the number of media outlets which quoted each tweet. It demonstrates a significant discrepancy between Obama and Trump in the number of tweets made about the Middle East, as well as the tendency of the press to cover tweets about the Middle East which contain criticism. Through analyzing journalists’ responses to types of tweets made about the Middle East, this work highlights developments in press-state relations in the Twitter era. INTRODUCTION President Donald Trump announced on Dec. 19, 2018, via a video posted to Twitter, that the US military would withdraw from Syria. The decision was met with bipartisan backlash — both on and off Twitter. “I want troops home too, but leaving Syria abruptly is betrayal to Kurds who have sacrificed and shed blood for Americans and it leaves Syrian Christians as sitting ducks,” tweeted Mike Huckabee, a TV personality and a former Republican governor of Arkansas1. Quoting a tweet in which Trump said the US has defeated ISIS in Syria, Rep. Adam Kinzinger — a Republican representing Illinois — said, “This is simply not true.”2 Just after midnight the next morning, Trump took to the social media platform to defend his widely criticized decision. “Does the USA want to be the Policeman of the Middle East, getting NOTHING but spending precious lives and trillions of dollars protecting others who, in almost all cases, do not appreciate what we are doing? Do we want to be there forever? Time for others to finally fight,” he tweeted, going on to cite support from Republican Sens. Rand Paul and Mike Lee. While one could certainly engage in a fascinating analysis of the reasoning behind Trump’s policy in the Middle East, I am more interested in the mode of communication the head of state used in this spat — Twitter — and how the media engages with this speech. Since Trump took office, journalists have made checking the commander-in-chief’s Twitter feed part of their daily morning routine. The president makes many of his major announcements — and inflammatory remarks — on the social media site. Throughout the administration’s first year, Trump’s tweets addressed a wide range of issues, including the still raging Syrian Civil War and the decades-long Israeli-Palestinian conflict. This thesis is part of research conducted by Dr. Shannon McGregor at the University of Utah and Dr. Regina Lawrence at the University of Oregon about how journalists have navigated coverage of tweets made by both Trump and former President Barack Obama. Many in the media are still debating what tweets mean legally and diplomatically, as well as how they impact public opinion. As politicians, specifically the president, increasingly turn to Twitter to make statements and disseminate information to the public, this project analyzes how journalists choose which tweets to cover and embed in stories, and how that decision is influenced by assumptions about the site’s effect on the political climate. Within this framework, my thesis takes a closer look at tweets related to the Middle East. The research considers how presidential press relations have evolved throughout time, how presidents use social media, and how the press covers social media. In my work, I will attempt to answer the questions: How have presidents addressed issues in the Middle East on social media? How have journalists covered statements made by presidents regarding the Middle East on social media? To address the topic, we collected all tweets sent by Obama in the year following his inauguration in 2013 and all of those sent by Trump in the year following his inauguration in 2017. I then used a dictionary of terms to separate tweets that discussed the Middle East. I coded whether the tweets have a tone that contains praise, criticism, or is neutral. I then coded each tweet by purpose — call to action, announcement, ceremonial, attack on the press, other forms of attack, policy, commentary, personal, or unknown. Using the database Factiva, I searched news media sources for the text of presidential tweets, enabling me to track through time the tweets that were — and were not — fodder for news stories. I subsequently examined which types of presidential tweets make the news. 1 https://twitter.com/govmikehuckabee/status/1075605274268971008?lang=en 2 https://twitter.com/repkinzinger/status/1075414512482668544?lang=en LITERATURE REVIEW Traditionally, the relationship between the president and the press is one that has been theorized as being simultaneously symbiotic and competitive. In 1990, W. Lance Bennett debuted his indexing theory, which contends that news organizations base the range of perspectives in a story on the dominant viewpoints of those whom reporters perceive as having the authority to impact the outcome of an issue (Bennett 1990). He argued that journalists were dependent on official lines of communication from the White House in their coverage. So, under the indexing theory, the relationship between the administration and the press is mutually beneficial, as the president creates the news and the media disseminates the president’s message. This approach to journalism can be either beneficial or problematic, depending on the state of American politics. When the government is operating democratically and elected officials come to the table with some valid alternatives for solving policy issues, coverage includes a variety of viewpoints that helps the public think critically about solutions. However, if political actors are sending messages that are deceptive or untruthful, those viewpoints are frequently given equal credence as those alongside its more plausible competitors (Bennett 2016). As the media turns to politicians and political actors for news content, these parties are meanwhile competing to determine who and what will shape the news (Cook 2005). While these theories still contain truth, and help to explain the way the media covers government and politics, the environment in which news happens has changed. The White House no longer relies solely on a press corps to spread its messages. Presidents now have direct access to the public through numerous social media platforms, including Facebook, Instagram, and Twitter. The latter, however, has emerged as the preeminent platform for political discourse and has been used frequently in recent years for presidential communication to political actors, journalists, and the public. Twitter was founded in 2006 as a microblogging social media site which initially allowed users to post messages in 140 characters or less, along with photos and videos. In 2017, the character limit was doubled. Since the site’s inception, two presidents have used it to share information and interact with the public, often circumventing the press. Before becoming president, Donald Trump in 2012 described the platform as “like owning your own newspaper — without the losses” (Aldroubi & Karam 2017). Twitter, especially in Trump’s case, has allowed the commander-in-chief to take on an additional role — one popularly known as “tweeter-in-chief.” Emily Bell in 2017 observed in the Columbia Journalism Review, “Trump’s behavior is not that of a ‘normal’ president, or even a regular politician per se, but of a loud, competitive, digitally attuned, populist media organization. For Trump, the medium is not just the message, it is the office, too” (Bell 2017). Trump has gone beyond using Twitter as his own personal media outlet to attack the press, transforming the relationship between the president and journalists away from being symbiotic, or even competitive, to being predatory. Although there has at times been contention, and even anger, between the media and past presidents, no other executive has worked to undermine the credibility of the press in the same way Trump has. While the changing communication methods of presidential administrations make the question of press coverage significant, journalists’ response to this behavior takes on particular interest. When Barack Obama began campaigning for president, he used social media unlike any other candidate before. Because he took advantage of new communication technologies, the public associated him with youth, progress, and volunteerism (Losh 2012). Obama’s use of these new media platforms ushered in an era of increased intimacy and communication that is more widespread and targets specific audiences. Throughout his time in office, Obama distanced himself from some of the online activities that he used in his campaign as he confronted the subversive side of technology brought by projects such as Wikileaks. However, many members of his staff continued to stay connected to social media, including Twitter, to spread political messages with few incidents of controversy (Losh 2012). Obama used Twitter primarily as an official platform, having his staff compose tweets for the official White House Twitter account — @POTUS. Although he didn’t personally produce the tweets on the account, he reportedly approved each one before it was sent out (Lanktree 2016). During his campaign and presidency, Donald Trump has taken a different approach to social media than his predecessor — especially on Twitter. On November 10, 2012, he tweeted, “Thanks- many are saying I’m the best 140 character writer in the world.” Although many users challenged this opinion, it reflects his attitude toward the platform and how he uses it to influence his followers (Ott 2017). The current president primarily tweets from his personal account, @realDonaldTrump, rather than from the @POTUS account. The account was created in 2009 — years before he entered politics — as a marketing tool. His staff reportedly composed all tweets on the account until 2011 (Brooking & Singer 2018). After being elected president, Trump said of the account in an interview with The Times of London, “I think I’ll keep it,” citing his following (Diekmann & Gove). He now has approximately 2.3 times as many followers as the @POTUS account. Trump tweets an average of 7.5 times everyday (Anderson 2017). On 17 percent of these days, the president creates “tweetstorms” when he tweets more than average and stirs up widespread controversy, which corresponds with an average 0.86 point fall in his Gallup approval rating the following day (Cassino 2017). According to research by Brian Ott at Texas Tech University, Twitter is separated from other social media sites by its simplicity, impulsivity, and incivility. Ott argues that every communication medium conditions its users to behave in a certain way, and that Twitter ultimately trains users to “devalue others, thereby, cultivating mean and malicious discourse.” Ott suggests that one of the reasons Twitter appeals to Trump is that he is able to mirror the simplicity and aggressiveness of his speech in tweets (p. 60, Ott 2017). In March 2016, a researcher at the Massachusetts Institute of Technology programmed a Twitterbot named “DeepDrumpf” to create tweets using an algorithm based on Trump’s speech in hundreds of hours of debate transcripts. Many of the tweets came out remarkably similar to those posted on the president’s account (Garfield 2016). Trump’s behavior on Twitter has raised questions as to whether or not his tweets should be taken as official presidential communication. Then-White House press secretary Sean Spicer told reporters in June 2017 that Trump’s tweets are official statements, however, his handling of content and interactions with the public on that account have raised legal challenges. The National Security Archive, a nonprofit focused on government secrecy, sued the Trump administration in June 2017 over deleted tweets, which it contended was a breach of public records laws. In July 2017, the Knight First Amendment Institute at Columbia University sued the president to stop him from blocking Twitter users who criticized him or his policies (Allsop 2017). As Trump has increasingly used Twitter for a wide variety of purposes, from announcing policy decisions to criticizing lawmakers, the news media has devoted more coverage to his statements on the site. In 2017, Pew Research Center reported 67 percent of U.S. adults got their news from social media (Shearer and Gottfried 2017). For the remainder of American adults, however, the press remains a gatekeeper of presidential messaging. In a landscape where the press’ relationship with the president is not the symbiotic one it once was, the way in which the media relays his Twitter messaging to the public becomes a significant question. It becomes even more critical when the demographics of Twitter — specifically political Twitter — are taken into consideration. The social media site is dominated by political elites, and they are to whom journalists look for news. Research indicates that on Twitter, journalists are especially attuned to other journalists, as well as to politicians and other political actors (McGregor & Molyneux 2018; Hanusch & Nölleke 2018; Molyneux & Mourao 2017; Mourao 2015; Usher, Holcomb & Littman 2018). Many political journalists report checking Twitter on almost a minute-by-minute basis (Bane 2017; Lawrence 2015; McGregor 2018), lending credence to the aphorism that “If the news is the first draft of history, Twitter is the first draft of journalism” (Stross 2016). In accordance with Bennett’s indexing theory, the issues which ratchet up the most controversy and public debate are also those which can best reflect the health of the news media. Throughout both the Obama and Trump presidencies, issues in the Middle East and how the country should approach them have remained in the headlines. From terrorism to oil, Middle East policy has been a hot topic among American politicos. When Obama began his second term in 2013, Syria was already in the midst of its civil war. ISIS, formed in 2004 under the name “alQaeda in Iraq,” began to reemerge in 2011. As its presence intensified, it changed its name to the Islamic State of Iraq and Syria (ISIS) in 2013 (Caves, Glenn, Nada, & Rowan 2019). At the time, there were only 150 American troops in Iraq (Nelson 2016) and troops in Afghanistan had declined to 46,000 (Associated Press 2016). Obama in 2013 began negotiations with Iran that would result in the 2015 nuclear deal (Nelson 2016). Meanwhile, then-Egyptian President Mohamed Morsi was deposed in a coup d’etat in July 2013. Although the first year of Obama’s second term appears eventful in terms of American policy in the Middle East, it seems significantly less so relative to Trump’s first year. Syria’s civil war was still raging and ISIS had developed into a more threatening force. There were 11,000 troops in Afghanistan, which Trump ordered be increased by 4,000 in August of that year. In Iraq, there were 5,200 troops and in Syria there were 500 — although the Defense Department acknowledged that both of those numbers were most likely undercounts (Cooper 2017). A war in Yemen wreaked havoc in the region, and joined the war in Syria as yet another proxy war between Iran and its allies and Saudi Arabia and its allies — the U.S. favoring the latter. Trump intensified tensions in the region by recognizing Jerusalem as the capital of Israel and threatening to leave the Iran nuclear deal — which he eventually followed through with in 2018. To take a closer look at both presidents’ use of Twitter, my first research question is: RQ1: How frequently did each president tweet about the Middle East? The apparent disjunct and the widespread discourse regarding issues that fall within the realm of policy in the Middle East makes tweets surrounding the subject a topic of interest when considering journalists’ coverage of presidential communication. To analyze the presidents’ behavior and how the press responds, respectively, my second and third research questions are: RQ2: What kinds of tweets did each president post about the Middle East in terms of their tone and function? RQ3: What kinds of presidential tweets about the Middle East did journalists feature in their news stories? METHODS Through a quantitative analysis of tweets about the Middle East by the two presidents of the Twitter era, Barack Obama and Donald Trump, I document how frequently each president took to Twitter, as well as the function and tone of their tweets. I then match these tweets to news stories, quantitatively assessing the extent to which each tweet was, or was not, featured in news media. Twitter Data In preparation for the larger study, Dr. McGregor and Dr. Lawrence gathered the full corpus of tweets sent by President Obama in the first year of his second term, January 20, 2013, through January 20, 2014 (N=2,212). Likewise, they gathered the full corpus of tweets sent by President Trump in the first year of his term, January 20, 2017, through January 20, 2018 (N=2,516). The Twitter data was collected via Crimson Hexagon, a suite of social media analysis tools that access the full Twitter firehose. They created a query for each president’s handle, @barackobama and @realDonaldTrump, respectively, and gathered all the tweets for the given time periods. To compile tweets regarding the Middle East, I compiled a list of terms used by both presidents when discussing the region. I then searched for and compiled all tweets from the collected set that contained those terms. The terms included: 9/11, Afghanistan, al-Qaeda, Arab, Beirut, Benghazi, Coptic, Egypt, Extremism, foreign oil, Guantanamo, Iran, Iraq, ISIS, Islam, Israel, Jerusalem, Jordan, Kuwait, Lebanon, Middle East, Muslim, Netanyahu, Palestine, Palestinian, Saudi Arabia, Somalia, Syria, Taliban, terror, terrorist(s), terrorism, Travel Ban, and Turkey. This list is obviously not an exhaustive list of all terms related to the Middle East, but was instead based on the language both presidents used in their tweets. Between the two presidents, there were a total of 149 tweets made about the Middle East. News Media Data I also collected information about whether or not — and with what intensity — tweets from presidents were featured in news stories. In order to gather this information, I queried the Factiva news database for the text of each of the 149 collected tweets about the Middle East. If the tweet text resulted in a match, I recorded the number of media outlets which published a story containing the tweet. Content Analysis Each tweet was coded for two mutually exclusive variables: tone and function. Tone The tone variable was intended to capture the character of each tweet with classifications of praise, criticism, and neutral. Tone was selected as an operationalization because Twitter, as a social media platform, is a public forum which is most commonly used to express opinion. In terms of tweets, if its message is positive or negative, that is because someone or something is being targeted with praise or criticism. In this analysis, for a tweet to be coded as praise or criticism, it must also contain an object (person, country, party, policy, etc.) of the criticism or praise. Generally, “positive” or “negative” sounding tweets that did not single out someone or something for praise or criticism were coded as neutral. Praise tweets were defined as those that praised someone or something else or included self-praise. For example, this tweet from Trump would be coded as praise: “Unprecedented success for our Country, in so many ways, since the Election. Record Stock Market, Strong on Military, Crime, Borders, & ISIS, Judicial Strength & Numbers, Lowest Unemployment for Women & ALL, Massive Tax Cuts, end of Individual Mandate - and so much more. Big 2018!”; as would this tweet from Obama: “FACT: Since President Obama took office, America’s dependence on foreign oil has decreased every year. #ActOnClimate.” Criticism tweets that critiqued other people or entities were coded as such even if they also contained praise. For example, this quote from Trump contains some self-praise, but also a criticism of the news media, so it was coded as criticism: “At some point the Fake News will be forced to discuss our great jobs numbers, strong economy, success with ISIS, the border & so much else!!” Neutral tweets were defined as tweets that contained neither praise nor criticism. For example, this tweet from Trump would be coded as neutral: “Looking forward to meeting with Prime Minister @Netanyahu shortly. Peace in the Middle East would be a truly great legacy for ALL people!” Function The function variable intended to capture the apparent purpose of the tweet. The function categories were mutually exclusive: if more than one category was present in a tweet, I chose the code that encapsulated the evidently dominant function of the tweet, except in certain circumstances. Tweets were coded as either a call to action, an announcement, ceremonial, press attack, other attack, policy statement, commentary, or personal. Tweets in the call to action category must feature an explicit call to action, like this tweet from Obama: “We #ActOnClimate to save the planet, grow our economy, create jobs and reduce carbon pollution. Will you act?” This category also includes tweets that contain a call to interaction, asking people to do things like retweet, reply, or answer a question, like this tweet from Obama: “Retweet if you are proud that immigration is a part of our nation's heritage.” Announcement tweets included statements about what a president is currently doing, like this tweet from Trump: “Israel, Saudi Arabia and the Middle East were great. Trying hard for PEACE. Doing well. Heading to Vatican & Pope, then #G7 and #NATO.”; or this tweet from the Obama feed: “Watch live: President Obama addresses the nation on Syria.” Announcement tweets also include those announcing an accomplishment (called “credit-claiming” in political science literature), like this tweet from Trump: “Few, if any, Administrations have done more in just 7 months than the Trump A. Bills passed, regulations killed, border, military, ISIS, SC!” Ceremonial tweets include holiday messages, like this tweet from Obama: “‘I wish Muslims across America & around the world a month blessed with the joys of family, peace & understanding.’ — President Obama #Ramadan.” They may also express pride or sadness to commemorate something historically significant happening on that day, such as the death of a world leader or other well-known figure, as well as tweets memorializing certain moments in time, like this tweet from Trump: “May God Forever Bless the United States of America. #NeverForget911.” This category also includes broad statements of American values, like this Trump tweet: “America's men & women in uniform is the story of FREEDOM overcoming OPPRESSION, the STRONG protecting the WEAK, & GOOD defeating EVIL! USA🇺🇸” or this Obama tweet: “We, the people, recognize that this government belongs to us ... we can't just sit on the sidelines.” Press attack tweets included those attacking the press as an institution, particular news media organizations, and/or on individual journalists. For example, this tweet from Trump was coded as an attack on the press: “The Failing New York Times foiled U.S. attempt to kill the single most wanted terrorist, Al-Baghdadi. Their sick agenda over National Security.” Other attack tweets were those which attacked someone or something other than the media. The attacks could be implicit, like this tweet from Trump: “At some point, and for the good of the country, I predict we will start working with the Democrats in a Bipartisan fashion. Infrastructure would be a perfect place to start. After having foolishly spent $7 trillion in the Middle East, it is time to start rebuilding our country!” The attacks could also be more explicit, like this tweet from Trump: “The people of Iran are finally acting against the brutal and corrupt Iranian regime. All of the money that President Obama so foolishly gave them went into terrorism and into their ‘pockets.’ The people have little food, big inflation and no human rights. The U.S. is watching!” Attacks on the press, news media, or specific journalists were not included in this more general attack category, and were coded instead as “press attack.” Policy statement tweets included specific statements of policy intent, policy beliefs (values), or policy changes. Trump’s tweets promoting Executive Order 13769, which prevented individuals from Syria, Libya, Iran, Somalia, Yemen, and North Korea from entering the country, would fall into this category. An example of a policy statement tweet is this one, from Trump: “That's right, we need a TRAVEL BAN for certain DANGEROUS countries, not some politically correct term that won't help us protect our people!” Commentary tweets were those which included statements about current events that express the president’s opinion on those events, including non-attack reactions to current events — for example, this tweet from Trump: “Horrible and cowardly terrorist attack on innocent and defenseless worshipers in Egypt. The world cannot tolerate terrorism, we must defeat them militarily and discredit the extremist ideology that forms the basis of their existence!” This category also captures President Trump’s well-known habit of watching the news and tweeting his reactions to what he is seeing on the news, as well as retweeting those pieces. For example, this retweet would be coded as commentary: “RT @foxandfriends FOX NEWS ALERT: ISIS claims responsibility for hostage siege in Melbourne, Australia that killed 1 person and injured 3 cops.” Such tweets were coded as commentary unless they included an attack or an attack on the press, in which case the attack aspect overruled the commentary and the tweet was coded as an attack or an attack on the press. This methodological choice was made because Trump’s use of Twitter to attack others is frequently noticed among the public, and because we suspected that attack tweets might garner more news attention than those not containing an attack. Personal tweets contained self-disclosure or descriptions of the president’s personal characteristics. For example, this tweet from Obama was coded as personal: “Of all that I've done in my life, I'm most proud to be Sasha and Malia's dad. To all those lucky enough to be a dad, Happy Father's Day!” A tweet about a holiday without self-disclosure, such as, “Happy Father’s Day to all the dads out there!” was not coded as personal, but as ceremonial. RESULTS My analyses of presidential tweets and their news coverage were conducted using descriptive statistics. I did not include tests for statistical significance because my analysis included the census of tweets about the Middle East for each president during their first year in office. Inferential statistics were not necessary. First, with respect to the frequency of each president’s Twitter use, as earlier stated Obama in the first year of his second term — January 20, 2013, through January 20, 2014 — tweeted 2,212 times. In the first year of his term — January 20, 2017, through January 20, 2018 — Trump tweeted 2,516 times. The spread between the executives’ total tweets was 304. In other words, Trump tweeted about 13.7% more than Obama. Addressing RQ1, the difference between their tweets about the Middle East was much starker. During the respective time period, Obama tweeted about the Middle East eight times, while Trump made 141 tweets about the region. Trump made 133 tweets more than Obama about the Middle East, or 1,662.5% more. Proportionately, about 0.4% of Obama’s tweets were about the Middle East, while about 5.6% of Trump’s tweets were about the Middle East. 2500 Number of Tweets 2000 1500 1000 500 0 Obama Non-Middle East Tweets Trump Middle East Tweets Figure 1. Proportion of presidential tweets about the Middle East Tone and Function of Tweets In regard to RQ2, because Obama tweeted so few times about the Middle East, it is impossible for me to effectively and fairly compare the tone and function of his tweets to Trump. I will still, however, look at each president’s tweets on an individual basis. Table 1. Tone of presidential tweets about the Middle East (percent) Neutral Praise Criticism Total Obama 87.50 12.50 0.00 100.00 Trump 41.13 14.18 44.68 100.00 Figure 2. Tone of Obama’s tweets about the Middle East In terms of the tone of his tweets about the Middle East, Obama was primarily neutral, with one instance of him using praise — in this case it was a tweet about his policy, in which he said, “FACT: Since President Obama took office, America’s dependence on foreign oil has decreased every year. #ActOnClimate.” Obama did not make any tweets about the Middle East that were critical of someone or something. Figure 3. Tone of Trump’s tweets about the Middle East When it came to the tone of his tweets, Trump’s account was noticeably negative. Of the three categories, Trump most frequently made tweets that were classified as criticism, with 44.68% of his tweets falling into that category. Targets include the Democratic party and its politicians, including Obama, as well other countries and their leaders, like the UK’s prime minister, Theresa May. He also made a point to include the press in much of his criticism, like in this tweet: “At some point the Fake News will be forced to discuss our great jobs numbers, strong economy, success with ISIS, the border & so much else!” The next category that Trump’s tweets most frequently fell into was neutral, with a close 41.13%. Generally, those were announcements, ceremonial, or commentary. Only 14.18% percent of his tweets about the Middle East were praise. All of these praised military leaders, other world leaders, or his own administration, like this tweet: “Few, if any, Administrations have done more in just 7 months than the Trump A. Bills passed, regulations killed, border, military, ISIS, SC!” Table 2. Function of presidential tweets about the Middle East (percent) Call to action Announcement Ceremonial Attack the press Other attack Policy Commentary Personal Unknown Total Obama 0.00 50.00 50.00 0.00 0.00 0.00 0.00 0.00 0.00 100.00 Trump 0.00 38.30 7.09 4.26 26.95 12.06 10.64 0.00 0.71 100.00 Figure 4. Function of Obama’s tweets about the Middle East In his eight tweets about the Middle East, Obama’s messages could only be categorized as two functions — announcement and ceremonial. His tweets were divided evenly between the two functions. Most of his announcements were notifying the public of an address he was making to the American people regarding the civil war in Syria, although one was creditclaiming. His ceremonial tweets commemorated 9/11, as well as recognized Muslim and Coptic Christian holidays, like this one on January 7, 2014: “‘Michelle and I wish Coptic Orthodox Christians in the United States and around the world a joyous Christmas.’ — President Obama.” Figure 5. Function of Trump’s tweets about the Middle East The most frequent function of Trump’s tweets was announcement, which comprised 38.3% of all tweets about the Middle East. Many of these discussed Trump’s interactions with world leaders, like this tweet: “Looking forward to meeting with Prime Minister @Netanyahu shortly. Peace in the Middle East would be a truly great legacy for ALL people!” Others included policy announcements, like this one: “I have determined that it is time to officially recognize Jerusalem as the capital of Israel. I am also directing the State Department to begin preparation to move the American Embassy from Tel Aviv to Jerusalem.” There were a few that were classified as announcement because they contained credit-claiming. Consistent with the earlier noted negativity of his tweets about the Middle East, the next most frequent function was an attack on people, institutions, or objects outside of the press. These included: Democrats, Obama, Tennessee Republican and former-Sen. Bob Corker, New York Democratic Sen. Chuck Schumer, the US Justice Department, the US 9th Circuit Court of Appeals, British Prime Minister Theresa May, London Mayor Sadiq Khan, Scotland Yard, Qatar, Iran, a variety of terrorists and terrorist organizations, as well as Muslim refugees in general. Among those coded as other attack were his retweets of now-suspended account @JaydaBF, which was run by Jayda Fransen, the former deputy of the Britain First Party. The far-right political organization is known for organizing “Christian Patrols” and “mosque raids.” Fransen was convicted under a UK law in March 2019 of stirring up hatred during a speech about Islam in Belfast. One of the tweets Trump retweeted was a video captioned, “Muslim migrant beats up Dutch boy on crutches!” British Prime Minister Theresa May condemned the action, with a spokesman quoted as saying, “British people overwhelmingly reject the prejudiced rhetoric of the far right, which is the antithesis of the values that this country represents — decency, tolerance and respect. It is wrong for the president to have done this” (Middle East Eye 2019). One of the least used functions — besides call to action and personal, which Trump didn’t use at all — was attacks on the press. He did, however, make six tweets about the Middle East that included attacks on the press. Trump specifically targeted The New York Times, Washington Post, and CNN. Other tweets disparaged the press in general, using the phrases “fake news” and “very biased media.” This included tweets like this thread from Trump: “The Amazon Washington Post fabricated the facts on my ending massive, dangerous, and wasteful payments to Syrian rebels fighting Assad..... So many stories about me in the @washingtonpost are Fake News. They are as bad as ratings challenged @CNN. Lobbyist for Amazon and taxes?” As discussed by New York Times reporters Alicia Parlapiano and Larry Buchanan (2017), this category of tweets seemed designed by Trump not just to disagree with press coverage, but to undermine the media’s credibility among his followers. Press Coverage of Presidential Tweets Of Trump’s 141 tweets about the Middle East, 127 — or 90% — were quoted in at least one news story. Four of Obama’s eight tweets about the Middle East — or 50% — were covered in at least one news story. Similar to RQ2, the results of press coverage of Obama’s and Trump’s tweets cannot be compared because of the low volume of tweets Obama made about the Middle East. In terms of the function of presidential tweets, all of Obama’s tweets that were covered in at least one news story were ceremonial. Of Trump’s tweets, 88.89% of announcements were covered, 90% of ceremonial tweets were covered, 83.33% of attacks on the press were covered, 92.11% of other attacks were covered, 94.12% of policy statements were covered, and 86.67% of commentary tweets were covered. 100 90 80 70 Announcement 60 Ceremonial 50 Attack on Press Other Attack 40 Policy Statement 30 Commentary 20 10 0 Figure 6. Percent of Trump’s tweets about the Middle East, by function, featured in news stories Of Obama’s tweets, his one tweet containing praise was not covered, and 57.14% of his neutral tweets were covered. When it came to tone, Trump’s emotive tweets were most frequently covered in at least one article published by the news media. Among his tweets, 87.93% of neutral tweets were covered, 90% of tweets containing praise were covered, and 92.06% of tweets containing criticism were covered. Because of Trump’s high ratio of tweets that were critical or neutral and his low ratio of tweets that contained praise, of all his tweets quoted in at least one story published by the media 45.67% contained criticism, 40.16% were neutral, and 14.17% contained praise. This compares to the corpus of his tweets, which is comprised of 44.68% containing criticism, 41.13% that are neutral, and 14.18% that contain praise. 100 90 80 70 60 Neutral 50 Praise Criticism 40 30 20 10 0 Figure 7. Percent of Trump’s tweets about the Middle East, by tone, featured in news stories The above analysis relies on a dichotomous variable for a news “mention.” However, I also collected a count variable — the number of media outlets in the Factiva database that featured a given tweet in at least one story. Using this count variable, we ran an OLS-regression predicting news intensity (Althaus & Coe, 2011), with the tweet author, the tweet’s tone, and the tweet’s various functions as independent variables. The model suggests that the strongest antecedents for news intensity among tweets about the Middle East are a tweet containing criticism and a tweet functioning as an attack on someone or something other than the press. The prevalence of coverage of tweets containing criticism is especially notable, as there is a 9.9% variation in news intensity around tweet tone. Table 3. OLS Regression Model Testing Tweet-level Antecedents of News Intensity News Intensity Block 1: Tweet Author Trump ∆R2 (%) .154*** 2.4% Block 2: Tweet Tone Criticism Praise ∆R2 (%) .331*** .029*** 9.9% Block 3: Tweet Function Announcement Ceremonial Press Attack Other Attack Policy Commentary ∆R2 .120 .161 -.035 .349 .252 .140 5.5% Total R2 17.8% F(11, 1120)=22.158, p<.001. Note: Sample size = 149. Cell entries are final-entry OLS standardized Beta (β) coefficients. * p < .05; ** p < .01; *** p<.001. DISCUSSION In this study, I set out to explore how the first American presidents of the Twitter era utilized that platform to engage with issues surrounding the Middle East, and how journalists responded, by comparing Obama and Trump’s Twitter use during the first year of Obama’s second term and Trump’s first term. I found that Obama posted far less about the Middle East during that time period than Trump did, respectively. This may be explained by the difference in volume and gravity of current events related to the Middle East during the two time periods. Although media coverage of the tweets is not comparable due to the few tweets Obama made about the Middle East, it is notable that opposed to the 50% of Obama’s tweets that were covered, a total of 90% of Trump’s tweets about the Middle East were covered. This reflects the sentiment that communication scholar Susan Douglas (2018) observed during the 2016 presidential election — that the press covered nearly every tweet made by Trump — and suggests that this pattern may have carried over into his term. Trump’s tone in his tweets about the Middle East was most frequently critical, which is probably not surprising to those who follow his account on Twitter. The tone he used least was one containing praise. This was also true for Obama — of his eight tweets, only one contained praise. The rest were neutral. For the same reason I cannot compare the tone used in the presidents’ tweets, I likewise cannot compare press coverage of the tweets. On an individual basis, though — specifically when it comes to Trump’s tweets — it appears that one of the driving determinants as to whether or not a tweet is covered by the media is its tone. Tweets containing criticism were much more likely to be covered than those that were neutral or included praise. In Trump’s case, this may partially be prompted by Trump’s tendency to attack the press — a phenomenon that does not go unnoticed by reporters. Another explanation for the media’s emphasis on negative tweets may be that the tone of news stories about Trump that featured his tweets were themselves likely to be negative in order to draw up a critical assessment of the administration, as observed in an analysis by the Pew Research Center (Grieco and Gottfried 2017). The attention given to these tweets may also be due to the ways in which they violate the norms of presidential speech. Politico’s senior media writer Jack Shafer has said of Trump’s tweets, “This is the first time we’ve had this type of open access to the subconscious of the president” (Ingram 2017). CNN’s senior media correspondent, Brian Stelter, has said that “even after covering Trump for months, he is still surprised by how the president uses Twitter. ‘When I’ve gone on vacation and reinstalled my account and seen the president’s Twitter feed, I can’t help but be shocked by some of the things he shares’” (quoted in Ingram 2017). More research is needed to understand presidential communication regarding the Middle East in the Twitter era and how that impacts press coverage of both the White House and the region. Questions to be examined in future research include: How are presidential tweets about the Middle East contextualized in news stories? Are the amounts of retweets and likes on a tweet taken into account when making coverage decisions, or to gauge public opinion? How do the Twitter habits of American executives, as well as patterns of coverage, compare to those of heads of state in the Middle East? As new presidents are elected, it is unlikely they will revert from the use of Twitter as a mode of communication back to a traditional relationship with the press. Likewise, journalists’ tendency to quote messages posted to the social media site, specifically those critical of others, will probably become precedent. REFERENCES Aldroubi, M. & Karam, J. (2017). Trump and Twitter: How platform plays central role in presidency. The National, November 6. https://www.thenational.ae/world/theamericas/trump-and-twitter-how-platform-plays-central-role-in-presidency-1.673537 Allsop, J. (2017). Seven legal questions about Trump deleting his tweets. Columbia Journalism Review, September 29. https://www.cjr.org/covering_trump/trump_delete_tweets_twitter.php Althaus, S.L. & Coe, K. (2011). Priming Patriots: Social Identity processes and the dynamics of public support for war. Public Opinion Quarterly, 65-88 Anderson, B. (2017). Tweeter-in-Chief: A Content Analysis of President Trump's Tweeting Habits. Elon Journal of Undergraduate Research in Communications, 36-47. Associated Press. (2016). A timeline of US troops in Afghanistan since 2001. Associated Press, July 6. https://apnews.com/fe3ec7e126e44c728978ce9f4b5ebabd Bane, K. C. (2017). Tweeting the Agenda: How print and alternative web-only news organizations use Twitter as a source. Journalism Practice, 1-15. Bell, E. (2017). Donald Trump Is a Media Organization. Columbia Journalism Review, January 10. https://www.cjr.org/tow_center/donald_trump_media_organization.php Bennett, W. L. (1990). Toward a Theory of Press-State Relations in the United States. Journal of Communication, 103-125. Bennett, W. L. (2016). News: The Politics of Illusion, tenth edition. Chicago: The University of Chicago Press. Brooking, Emerson & Singer, P.W. (2018). The Little-Known Story of Donald Trump’s First Tweet. Time, October 20. http://time.com/5412016/donald-trump-realdonaldtrumptwitter-first-tweet/ Cassino, D. (2017, June 13). President Trump's approval ratings are being driven down by his 'tweetstorms'. Retrieved from http://blogs.lse.ac.uk/usappblog/2017/06/13/presidenttrumps-approval-ratings-are-being-driven-down-by-his-tweetstorms/ Caves, J., Glenn, C., Nada, G., & Rowan, M. (2019). Timeline: The Rise, Spread and Fall of the Islamic State. Retrieved from Wilson Center: https://www.wilsoncenter.org/article/timeline-the-rise-spread-and-fall-the-islamic-state Cook, T. E. (2005). Governing with the News: The News Media as a Political Institution, 2nd ed. Chicago: University of Chicago Press. Cooper, Helen. (2017). U.S. Says It Has 11,000 Troops in Afghanistan, More Than Formerly Disclosed. The New York Times, August 30. https://www.nytimes.com/2017/08/30/world/asia/afghanistan-troop-totals.html Diekmann, Kai & Gove, Michael. (2017). Full transcript of interview with Donald Trump. The Times of London, January 16. https://www.thetimes.co.uk/edition/news/fulltranscript-of-interview-with-donald-trump-5d39sr09d Douglas, S. J. (2018). “Breaking the Rules of Political Communication: Trump’s Successes and Miscalculations.” In Trump and the Media, eds. Boczkowski, P. & Papacharissi, Z. Cambridge: MIT Press, 133-42. Garfield, L. (2016, September 27). 3 things an MIT scientist learned about how Donald Trump speaks by studying his debates. Retrieved from Business Insider: http://www.businessinsider.com/how-donald-trump-talks-2016-9 Grieco, E. & Gottfried, J. (2017). In Trump’s first 100 days, news stories citing his tweets were more likely to be negative. Pew Research Center, October 18. http://www.pewresearch.org/fact-tank/2017/10/18/in-trumps-first-100-days-news-storiesciting-his-tweets-were-more-likely-to-be-negative/ Hanusch, F., & Nölleke, D. (2018). Journalistic Homophily on Social Media: Exploring journalists’ interactions with each other on Twitter. Digital Journalism, 1-23. Ingram, M. (2017). The 140-character president. Columbia Journalism Review, Fall. Lanktree, Graham. (2016). Who writes the president’s tweets? Newsweek, September 6. https://www.newsweek.com/who-writes-trumps-tweets-660074 Lawrence, R. G. (2015). Campaign news in the time of Twitter. Controlling the message: New media in American political campaigns, 93-112. Losh, E. (2012). Channelling Obama: YouTube, Flickr, and the Social Media President. Comparative American Studies, 255-268. McGregor, S. C. (2018). Social (media) construction of public opinion by elites (Doctoral dissertation). McGregor, S. C., & Molyneux, L. (2018). Twitter’s influence on news judgement: An experiment among journalists. Journalism, October 5. https://static1.squarespace.com/static/570ef9191bbee0bb3dfef44f/t/5bbbb13a71c10b b893195be0/1539027259272/McGregorMolyneux2018.pdf Middle East Eye. (2019). Ex-Britain First deputy leader Jayda Fransen convicted of hate speech: Reports. Middle East Eye, March 30. https://www.middleeasteye.net/news/ex-britain-first-deputy-leader-jayda-fransenconvicted-hate-speech-reports Molyneux, L., & Mourão, R. R. (2017). Political Journalists’ Normalization of Twitter: Interaction and new affordances. Journalism Studies, 1-19. Mourão, R. R. (2015). The boys on the timeline: Political journalists’ use of Twitter for building interpretive communities. Journalism, 16(8), 1107-1123. Nelson, Michael. (2016). Barack Obama: Foreign Affairs. Retrieved from Miller Center: https://millercenter.org/president/obama/foreign-affairs Ott, B. L. (2017). The age of Twitter: Donald J. Trump and the politics of debasement. Critical Studies in Media Communication, 59-68. Parlapiano, A. & Buchanan, L. (2017). “@realDonaldTrump: Cataloguing every tweet by the president in his first 100 days.” New York Times, April 28. https://www.nytimes.com/interactive/2017/04/28/us/politics/donald-trump-twitter-100days-of-tweets.html Shearer, E., & Gottfried, J. (2017). News Use Across Social Media Platforms 2017. Pew Research Center. Stross, R. (2016). Twitter has an old media problem. Here’s a solution. New York Times, October 27. https://www.nytimes.com/2016/10/27/opinion/twitter-has-an-old-mediaproblem-heres-a-solution.html Usher, N., Holcomb, J., & Littman, J. (2018). Twitter Makes It Worse: Political Journalists, Gendered Echo Chambers, and the Amplification of Gender Bias. The International Journal of Press/Politics, 23(3), 324-344. University of Utah UNDERGRADUATE RESEARCH JOURNAL VOLUNTEER TOURISM IN CAMBODIA: PERSUASIVE STRATEGIES OF RECRUITMENT AND POSTCOLONIAL IMPACTS By Shaelyn Barber, under the mentorship of Professor Glen Feighery and Professor Brent Steele Department of Communication Department of Political Science TABLE OF CONTENTS Abstract ii Introduction 1 Scholarship on Volunteer Tourism 7 Political Theory and Volunteer Tourism 13 A Summary of Cambodia’s Recent History 17 Research Questions and Methods 23 Analysis of Volunteer Tourism Organizations 25 Discussion 67 Conclusion 76 References 81 i ABSTRACT An emergent area within tourism is volunteer tourism, in which people journey to developing countries and perform service as part of their trip. These volunteers are typically young, well-educated Westerners. International volunteering is an increasingly popular option for tourists traveling abroad, and it is one of the fastest-growing markets for people interested in alternative tourism experiences. Volunteers genuinely want to do good by participating in service work, and many feel pressure as privileged global citizens to “help” or “save” the less fortunate. However, these sentiments become part of a problematic “white savior” complex. This thesis focuses on Cambodia to illustrate some of the problems that volunteer tourism brings, and it discusses the contribution of volunteer tourism to Western supremacy and the white savior complex. ii 1 INTRODUCTION When Sady, a 12-year old Cambodian girl, found herself at an orphanage in the region of Battambang, it wasn’t because she was an orphan. It was because her parents didn’t see another way to free her from the extreme poverty she faced at home. But, Sady’s situation was only worsened by her parents’ good intentions. Like many Cambodian children, she was used by private orphanage operators as a way to solicit gifts and cash from visiting volunteer tourists (Carmichael). Many orphanages in Cambodia are run as for-profit organizations, using disadvantaged children to bring in money for personal benefit. Children are often kept in deliberate poverty and treated poorly in order to maximize monetary donations from outsiders. Some orphanages even allow volunteers and donors to take children out on special day trips, allowing sex offenders and other criminals to take advantage of them (Ruhfus). However, most volunteer tourists do not know about these corruptions and often end up inadvertently contributing to a system that supports and allows the mistreatment of children like Sady. Tourism is defined as the act of people traveling to and staying in places outside of their usual place of residence for a period shorter than a year. It is typically categorized into two sectors: domestic and international. Domestic tourism is when a person travels within their country of residence, while international tourism is when a person travels outside their country of residence (Ralston). Tourism itself has undergone substantial changes in the last 25 years. Widespread developments in the global economy, technology, and social and cultural societies have globalized the phenomenon of tourism (Cohen and Cohen, 2177-2178). For centuries, tourism and travel have been associated with a person’s social status and money (Fordham, 9). But as rapid global changes occur, 2 tourism has expanded into middle-class groups. These changes have also opened up a new type of tourism: social tourism. Social tourism focuses on economically weak groups both globally and within developed countries, and pays attention to the sustainability of tourism practices both culturally and environmentally (Cohen and Cohen, 2187-2188). One emergent area is the practice of volunteer tourism, where foreigners journey to a developing country and perform service work as part of their trip. Volunteer travel overseas began in the early 20th century, and it has continued to gain popularity since (Hernandez-Maskivker et al.). Volunteer tourism has become an increasingly popular option for tourists traveling abroad, and it is one of the fastest-growing markets for people interested in alternative tourism experiences (Conran, 1454). The typical volunteer tourist is well-educated, from the middle or upper classes, and is sensitive to global inequalities (Conran, 1456). They are often young, white, and liberal-minded (Henry, 9). Most volunteers come from developed countries and travel to areas considered less developed, such as the Global South or East (Hanchey). Volunteers genuinely want to do good by participating in service work, and many feel the pressure as privileged global citizens to “help” or “save” the less fortunate. However, these sentiments frequently become part of a problematic “white savior” complex. As will be examined further in this thesis, a “white savior” is a white person who feels as though it is their responsibility to save less fortunate people from their poverty. By bringing Western ideas and aid, the white savior hopes to be the hero by bringing their “superior” ideas of development and aid to developing countries. Jenna N. Hanchey describes the fantasy of the white savior: “The US American volunteer can ‘find herself’—that is, find 3 wholeness, be complete—in other countries, by saving other people. By making a difference, a volunteer can be the Self she wants to be” (4). This idea of the white savior plays into American exceptionalism, the belief that the United States is one-of-a-kind in its superiority and ignores the possibility that the US could do any harm. In this way, volunteer tourism is hailed as ethically valorous and an undeniably positive act through which poor and impoverished nations can be saved (Hanchey, 4). However, as much as the volunteer desires and views their acts to be “doing good” in the world, this is often a false reality in which the volunteer unwittingly brings harm to the communities they believe they are helping (Guiney, 412). The fantasy of the white savior overshadows the actual needs and desires of the community in favor of Western ideals. In some cases, the involvement of volunteers actually contributes to host country corruption and dependence. This thesis focuses on Cambodia as an example of some of the problems generated by volunteer tourism. Tourism plays an important economic role in Cambodia: It is the second-largest GDP contributor in Cambodia, and volunteer tourism is the fastest-growing niche tourism market in many developing countries, including Cambodia (Guiney, 410). Because of the large economic contributions of tourism and the growing importance of volunteer tourism, it deserves investigation. Cambodia is one of the poorest countries in Asia, and because of this it is viewed as an area where people have a unique ability to change the country for the better (Guiney, 411). Cambodia’s poverty stems from its recent and violent history of war and genocide, which destroyed the nation’s economy, education and schooling, political system, and rich cultural background (Chandler). Many volunteers are ignorant about 4 Cambodia’s recent history prior to their visit to the country, but they do often cite the Khmer Rouge’s genocidal regime as a reason behind their choice of volunteer destinations (Guiney, 412). There is a wide variety of areas in which volunteers participate in international service projects, including medical work, manual labor, building schools or houses, teaching in schools, working in orphanages, planting trees, helping with scientific studies, and more. In Cambodia, the three most popular forms of volunteer tourism are medical-related projects, teaching English, and working within orphanages. Volunteering in a medical area is a popular option for medical students, in part because they want to “do good” and in part because this volunteer experience is a great resume-builder. While such opportunities do require a more specialized volunteer with some sort of medical background, these student volunteers are not yet licensed medical practitioners and would not be allowed to practice any sort of medicine within the United States. Thus, they choose to volunteer abroad in a setting where they can participate in these activities before they are licensed (Bruce, 7). Learning English is often viewed as a necessity for children in developing countries. English is a globally dominant language, due to Britain’s wide colonial reach and the proliferation of US trade and culture. Volunteers often choose to work in schools or with Non-Governmental Organizations (NGOs) giving English lessons (Guiney, 410). However, volunteer-run English programs are often ineffective. Volunteers usually have little to no experience teaching, and they often are given beginner-level lessons to teach, which the children have already been through (Henry, 15). As students experience the same lesson over and over again, they do not gain any new information and usually know 5 the material very well (Guiney, 414). Because of this, the children are trapped in classrooms and given lessons they already know, all for the satisfaction of the volunteer. This is time that these students could be using to learn new information from their teachers, instead of participating in an ineffective volunteer program that does not benefit them. In a similar vein, language and literacy scholar Cori Jakubiak has observed that “Promotional literature is rife with suggestions that English alone promotes international understanding, global connection, and cross-cultural exchange” (252). Jakubiak’s research points out that many volunteers consider English language learning the tool that will help developing countries enter into the larger global network. However, this is often a large misconception, especially considering the ineffective ways that volunteers attempt to teach. Orphanage tourism in Cambodia is arguably one of the most damaging areas that volunteers participate in. The commodification of orphanage volunteering causes a large number of problems, permanently harming and damaging the children within these orphanages. For-profit orphanages in Cambodia use children for monetary gain, instead of actually helping them. These orphanages have increased their numbers dramatically, jumping two-thirds between 2005 and 2011 (Carmichael). The increase in number corresponds to supply and demand. As more volunteers pour in, more orphanages are needed to satisfy their desires. In fact, many of the children in orphanages are not actually orphans and still have at least one living parent. But, families are induced by orphanages with the idea of a better life for their children (Guiney, 414). Once the children arrive at the orphanage, these promises of a better life are broken. Instead, the children are kept in deliberate poverty for the purpose of soliciting 6 gifts and money from volunteers (Carmichael). When volunteers see appalling conditions within orphanages, they believe that their money can help. Little do they know that the owners of these orphanages pocket the cash, and very little of it makes its way to the children themselves (Child Protection: UNICEF Country Programme 2016-2018, 2). Beyond the volunteers’ misused funds, orphanages themselves pose developmental risks for children. Children who live in the orphanage system are often damaged physically, socially, and emotionally (Child Protection: UNICEF Country Programme 2016-2018, 2). Such damage is caused by a large number of risk factors, including malnutrition and social deprivation (Johnson and Gunnar). Moreover, there is the potential for emotional harm. Tourists often look for an intimate experience, bonding with local community members (Conran, 1459). In the case of orphanages, tourists bond with young and vulnerable children, and many of these relationships are genuine. However, when children experience repeated meaningful relationships where the volunteers leave them after a day or a week, they face emotional damage that is difficult to reverse. Given the strong belief that volunteers can “do good” in Cambodia and the ironic truth of the harm they cause, this thesis will focus on volunteer tourism through a study of Cambodia and organizations within it. There is also a personal reason for the choice of Cambodia. When I was 15, I made the first of four volunteer tourist trips of my own, two of which were to Cambodia. On my first trip to Cambodia, I was part of a committee focused on breaking down the barriers between volunteers and host community members through song, dance, and games. On my second trip to Cambodia, I was in charge of a committee teaching women (about my age and older) from the host community how to sew and run a business. None 7 of these trips were completed through any of the six organizations mentioned in this thesis. SCHOLARSHIP ON VOLUNTEER TOURISM As volunteer tourism continues to grow worldwide, so too does interest in research on this topic. This comes as part of an increase in social-justice based research on tourism (Cohen and Cohen, 2186). Scholars across numerous disciplines have written on volunteer tourism, exploring everything from effects on institutionalized children living in orphanages and the crossing and breaking down of cultural boundaries, among other topics. I will focus mainly on research intended to help understand the intended and unintended effects of volunteer tourism on both visiting volunteers and local residents. The practice of volunteer tourism spreads across the world and into developing countries in all areas. Research focuses largely on areas in the Global South, Africa, Central America, and parts of Asia. While there are many studies on countries such as Thailand and India, volunteer tourism in Cambodia has not been explored in as great of depth. Research on volunteer tourism thus far has mostly focused on the volunteer tourists themselves as opposed to the local communities in which these volunteers work (Woosnam and Lee, 310). This poses a problem, as scholarship in the area disproportionately emphasizes the Western tourists instead of the residents in the countries affected by the practice. In this way, the Western benefits from volunteering abroad are overrepresented and overshadow the often negative effects experienced by local communities and destinations. 8 While much research remains to be done in the area of voluntourism, there is debate across academic fields about the merit of the practice. In many ways, these arguments and issues are complex, intertwined, and difficult to separate from one another. First, I will look at the effects on local communities and volunteer tourists. Then, I will explore some of the communication research about volunteer tourists and humanitarian organizations. Effects on Volunteer Tourists and Host Communities Research on volunteer tourism has typically focused more on how it affects volunteers in a positive way (Woosnam and Lee, 310). While tourists usually desire to contribute to positive change on an international scale, there are often self-oriented factors that drive people abroad to do volunteer work (Guiney, 410). These self-oriented factors provide benefits for volunteers, but often at the cost of real change within the communities to which they travel. While much research on volunteer tourism comes from a Western viewpoint that highlights benefits for tourists themselves, some research has shown that the effects on host communities in developing countries has not been as positive. While Westerners experience many beneficial effects from their time abroad, the burden is often borne by locals in the communities they claim to help. Through community-based studies, researchers have uncovered more about the dark side of volunteer tourism. In a 2016 study Tess Guiney looked at volunteer tourism in Cambodia and the effects, both intentional and unintentional, that volunteer tourists cause. Guiney noted both positive and negative consequences of volunteer tourism, but ultimately pointed to the fact that many volunteers are unwittingly committing acts that contribute to the very 9 system they want to improve. Guiney observed that while tourists do have the potential to bring funding, special skills for particular jobs, and resources to build physical facilities, they do not always meet these lofty goals (413). Instead, Guiney pointed out that the needs of local communities are not taken into account by volunteer programs. Many volunteers come for a holiday or vacation, and they are not fully committed to the roles they will be fulfilling once they are in country. They are often not prepared for their tasks or are not properly trained on how to perform them. They come with presuppositions that their knowledge as Westerners is more valuable than locals’ knowledge, and visitors believe they can help despite their lack of training or preparedness (Guiney, 413-414). Guiney found that organizations are not doing enough to prepare participants, and she looked at the participants themselves as part of a corrupted system. In order for volunteer tourist efforts to be successful, both the organizations and the tourists themselves must work more closely with local communities to ensure that the work they do is helping rather than hurting, she concluded (Guiney, 416). Volunteers seek intimacy in their volunteer experiences. Mary Conran discussed the desire and expectation for human connection and asserted that “The consumption of intimate experiences is at the heart of volunteer tourism” (1459). In fact, the presence of intimate experiences is viewed as proof of the “authenticity” of their experiences abroad (Conran, 1462-1463). Without bonding between volunteers and locals, volunteers often feel disappointed in their experience. This forces locals to give performances of intimacy in order to provide volunteers with the feeling that they are “helping.” Additionally, these performative intimate relationships often reinforce a binary of “us,” the volunteers, and “them,” the local community (Conran, 1464). This binary contributes to the idea that 10 Westerners are needed to address local problems and strengthens the belief that volunteers are the only ones who can help local communities rise from poverty. Research has suggested that one way to minimize these problems is to use service-learning as a tool to help Western volunteers critically engage with their involvement in developing countries. However, even service-learning contains a complex web of issues. Melissa Bocci discussed how service-learning reinforces the norms and privileges experienced by white people. It is important to note that service-learning is a very specific type of volunteer work in which students actively learn and process the work they are doing, whereas most volunteers do not have this type of processing as a part of their program. Service-learning is primarily carried out and experienced by white people and aimed at serving communities of poor people of color. Despite the emphasis on processing, oppressive systems and power dynamics are still reinforced through systems of service-learning (Bocci, 5). Although Bocci discussed service-learning within the United States, these concepts can be applied to international service-learning. It is primarily Westerners who journey to developing countries. Much as white people inadvertently reinforce practices and systems of oppression within the US, they can support similar systems on an international scale through volunteer tourism abroad. Robbin D. Crabtree studied the outcomes of service-learning abroad. The impact of service-learning abroad is complex and varied, producing some intentional positive impacts and many unintentionally harmful impacts. The intent of service-learning is often to expand viewpoints and expose students to cultures, lifestyles, and places that they would not otherwise experience. If given the proper care and reflective aspects of servicelearning, students can have experiences that alter their perception of the world and cause 11 them to strive for more just actions (Crabtree, 57). But, Crabtree pointed out that “It is also important to acknowledge that the impact of our work is not all positive, regardless of our intentions” (51). The outcomes of service-learning projects often address only short-term goals and fail to recognize or change institutional failures within host countries (Crabtree, 49). Crabtree argued that the difference between a successful service-learning experience and an unsuccessful one is critical reflection on the experience and the empowerment of volunteers as agents of change in the world (62). Although many scholars have discussed the benefits of volunteer tourism as a way to overcome cultural boundaries and form positive relationships, some argue that this cross-cultural exposure actually works to reinforce stereotypes. Kyle M. Woosnam and Yoon Jung Lee looked at how volunteers’ uninformed preconceptions of local residents may actually deepen during volunteer tourist trips. Additionally, residents within local communities were less accepting of volunteers who appeared to have a higher degree of social distance, both physically and culturally (Woosnam and Lee, 310). However, if approached in a sensitive way, volunteers and local residents may both experience a breaking down of stereotypes and prejudices through close interaction and exposure (Woosnam and Lee, 311). Communication and Volunteer Tourism Jenna N. Hanchey studied Western volunteers at an NGO and considered their involvement with Western supremacy, American exceptionalism, and the white savior complex. While most of the volunteers Hanchey interviewed recognized and understood the problems associated with these practices, they found ways to distance themselves from them and construct a fantasy in which they were unaffected by these problems. 12 Because volunteers thought of themselves as an exception to the rule instead of a part of the postcolonial system, they could not see the problems they were perpetuating and did not grasp the true context of their work abroad. Hanchey describes this irony: “The very white supremacist and neocolonial attitudes that underlie the fantasy of white saviorism counterintuitively provide grounds for volunteers to avoid recognizing themselves as partakers of the fantasy, and instead posit themselves as different or exceptional volunteers” (10). Hanchey pointed out that Western volunteers might never fully break out of these contradictions. However, the only way that people can work against the postcolonial system is by actively attempting to confront it and their part within it (Hanchey, 14-15). Simon Cottle and David Nolan investigated the impact of media on global humanitarianism. They argued that the presence of media in an area can be a decisive factor in the desire of people to offer humanitarian aid or services. However, news media face an impossible task; they must inform the public of global events without losing public interest. So, media coverage tends to jump rapidly from one event to the other, leaving past crises to be forgotten in favor of newer and more exciting coverage. Consumers of news respond to the “pornography of suffering,” in which the most recent and most tragic events attract the most attention. Because of rapidly changing news coverage and public interest, humanitarian organizations are confronted with the challenge of staying relevant in the eyes of media consumers (Cottle and Nolan, 863). In order to attract the media and the restless public eye, they must participate in the “pornography of suffering” or risk falling into oblivion. This results in the perpetuation of Western supremacy and white saviorism because aid organizations must seek monetary 13 donations and support. When organizations are the subjects of news coverage, they emphasize the plight of the less fortunate and, implicitly, the need for help from “superior” people. Much research remains to be done concerning the practice of volunteer tourism and its effects on both volunteers and local populations. This thesis seeks to make an important contribution to the research on volunteer tourism, because little or no research yet exists to analyze the online presences and persuasive strategies of volunteer tourist companies for their postcolonial impacts. This research is particularly important in order to understand postcolonialism and its effects on developing countries through the practices of recruitment used by international service work providers. By analyzing these strategies through a postcolonial lens, this thesis will add to the research surrounding the growing practice of volunteer tourism. POLITICAL THEORY AND VOLUNTEER TOURISM In order to understand the complex workings of international relations in the form of international aid-giving and volunteer tourism, it is necessary to give a brief overview of several of the main theories used by political researchers. The theories discussed in this section are realism, liberalism, radicalism, and post-colonialism. Realism is based on the core belief that people are fundamentally self-serving. Realists believe that people are selfish and will ultimately choose the option that benefits them the most, regardless of the effects on others. This extends to the national entity as well. A nation is assumed to act the part of an individual in the context of global politics, serving its own interests before consideration of others. In realism, these nation-states are 14 unitary entities which are the primary actor in international politics, including war and alliance-making. These nation-states are assumed to be rational actors that have the ability to use logic and decision-making to determine the best course of action, usually the option which will help them enhance their own security and minimize potential threats (Mingst and Arreguin-Toft, 79-80). Realism rarely takes into account the actions of humanitarian aid groups or NGOs, because in a realist view closely collaborating with these activities or organizations would be an illogical thing for a nation to do. In a nation’s self-interest, it would choose to remain an independent and solitary actor to maintain its own wealth and power. While realists acknowledge the fact that nations will form alliances and join organizations with other countries, they attribute this to the desire of each nation to multiply its own power (Mingst and Arreguin-Toft, 242). Liberalism is nearly the opposite of realism in their core belief: As opposed to realism’s view of human nature as selfish and calculating, liberalism supposes that humans are well-intentioned creatures who desire to do good in the world. In an international context liberals believe that nations primarily want to do good as well. For example, liberals believe that forming alliances, engaging in international trade and commerce, or participating in other such agreements will ultimately benefit all countries involved by increasing the ultimate cost of war and decreasing the likelihood that it will break out (Mingst and Arreguin-Toft, 86-88). In this way, liberals believe that collaborating with NGOs or assisting with humanitarian aid will ultimately be the best course of action by building up the international community and lowering the likelihood of conflict among parties. 15 Radicalism draws from the writings and beliefs of Karl Marx, emphasizing how relationships are defined in terms of control over the means of production, social standings, and the distribution of power. Above all, radicals look at the effects of economic organization and wealth distribution. Radicals believe that those who control money and the means of production are those who hold the most power in society. That is, the wealthy “bourgeoisie” class hold most of the power and the working “proletariat” class holds very little. In international relations, radicals look at a hierarchical structure of nation-states, the order of which is an effect of imperialism. They believe that developed countries expand into developing countries to find new markets. However, the positive effect for imperialist countries is more often than not a major problem for the developing countries that are being exploited by wealthier nation-states (Mingst and Arreguin-Toft, 92-94). For radicals, the phenomenon of international aid and volunteer tourist activity is a product of wealthy and powerful countries looking for ways to expand their influence into other areas of the world. The last theory, postcolonialism, is the most important to this thesis and constitutes the primary lens that I will apply to the research conducted here. Postcolonialism is a relatively new political theory compared with the others mentioned above, but it has become widely studied, especially in the context of developing countries that were formerly colonized by European powers (Tyson, 399). In essence, postcolonialism looks at former colonizers and the ways in which they still influence former colonies. This includes an acknowledgement of the history and continuance of exploitation of developing countries (Huggan, 23). Colonialism itself was based on the colonizer’s assumption of their own superiority, which was contrasted with the perceived 16 inferiority of “savages” dwelling outside Europe (Tyson, 400). Although colonization formally ended in the decades after World War II, there are lingering effects (Tyson, 409). Cultural colonization has left behind colonizers’ structures of education and government, erasure of local languages in favor of European languages, and values that often degrade the traditional cultures of local people (Tyson, 400). Postcolonial analysis also identifies the phenomenon of neocolonialism, or “the domination and exploitation that occurs after a country has decolonized” (Bruce, 15). Neocolonialism functions through coercion as opposed to military force or actual colonization, instead using measures such as economic policies or threats of withheld aid (Bruce, 15). In many political and international relations theories, it is suggested that humanitarianism, aid, and development assistance are ways to fix the problems experienced by developing countries. However, postcolonialism scrutinizes the ways that these theories contribute to assumptions about what makes a “developed” country based on Western ideals, and how this aid is often a way for former colonizers to relieve guilt associated with their colonial periods (Dunne et al., 225). In the context of volunteer tourism, postcolonialism acknowledges that there is often exploitation involved in tourism to developing countries and their tourist destinations. This is exacerbated by the struggling economies of developing countries and corruption of elites (Tyson, 412-413). Both international aid and individual volunteer work serve as an emotional affective function to assuage guilt associated with exploitation of developing countries by former colonizers and Western countries that still rely on developing countries to bolster their own wealth and comfort. Additionally, tourism and volunteer tourism perpetuate the 17 images and cultural hegemony created by colonizers, and these images are often exploited as a form of marketing by tourism organizations (Park, 115). It is important to note that most of the scholars mentioned in this section come from Western countries. Postcolonialism considers the biases of Western scholars, and some have even suggested that the only true postcolonial research is conducted by nonWesterners (Tyson). Indeed, even theorists originating from non-Western countries are often educated in Western institutions, thereby accidentally reproducing these hegemonic Western power structures and ideas. As stated, this thesis will rely primarily on the theoretical perspective of postcolonialism with particular attention paid to the issue of neocolonialism. These theories are the most relevant to the phenomenon of tourism and international volunteering, as they help explain the extension of former colonizers’ influence over previously colonized countries. A SUMMARY OF CAMBODIA’S RECENT HISTORY In order to understand Cambodia’s current situation, it is important to review the recent history of the country. Between 1975 and 1979 Cambodia suffered under a genocidal regime led by the communist Khmer Rouge, during which an estimated 2 million Cambodians died (Power, 143). But this was not the beginning of Cambodia’s struggles. This bloody regime followed a long colonization by France, a tumultuous claiming of independence, and a civil war that ultimately resulted in the communist takeover. As France colonized the renion, it primarily had one goal: to slow the widespread influence of Britain while building its own beneficial colonies (Chandler). 18 While Britain dominated the Western world, France’s influence spread across Asia and Africa, including Cambodia, Laos, and Vietnam (Kwon). France controlled Cambodia between 1863 and 1953, nearly a century (Chandler). In 1863 the French, who had already been steadily advancing their influence through Catholic missionaries, signed a treaty with the unpopular ruler Norodom, giving them control of the nation in exchange for protection and coronation (Chandler, 71-72). Cambodia filled the role of an agricultural nation whose export revenue filtered straight into the hands of the French (Chandler, 71). In exchange for crops and money, France offered only “guidance” and “civilization” (Chandler; Kwon). When Cambodia’s agricultural revenue failed to satisfy France’s need for more money, it began to finance their colonial activities by placing heavy taxes on crops and demanding expensive fees for all government services rendered (Chandler, 78). In 1941, Prince Sihanouk was placed on the throne by France (Chandler, 84). He was largely considered a puppet of the French, working closely with them and strongly favoring their governance over any of Cambodia’s emerging political parties (Chandler, 87). For France, World War II marked the beginning of the end of colonial activities in Indochina. With France weakened by involvement in the war and Vietnam’s increasing power in the region, it was only a matter of time before Cambodia gained independence (Chandler, 82). In 1946 French and Cambodian officials begin negotiations to decrease France’s involvement. Cambodians won the right to a constitution and were allowed to form political parties, but France maintained control over finance, defense, and foreign affairs (Chandler, 86). 19 In 1952, Sihanouk and his advisors finally turned towards independence, staging a peaceful coup and putting him in the position of Prime Minister (Chandler, 91). France acquiesced and handed over control of the armed forces, judiciary, and foreign affairs in October 1953. They continued, however, to keep a strong influence on the economics of the country (Chandler, 92). Sihanouk is credited with Cambodia’s independence, earning him popularity across the country and a continuing legacy as one of Cambodia’s greatest rulers. Unfortunately, France’s colonial system left Cambodia ill-equipped for economic, political, and educational development. In fact, France’s colonial strategies helped set up its Asian colonies for failure across the board. French concern for monetary gain from their colonies and restriction of trade with other colonial powers crippled Cambodia’s economy even after it gained independence (Kwon). Additionally, France left behind an educational system that was focused not on learning but on the assimilation of Cambodians into French culture and the “civilization” of the country (Kwon, 62-63). For these reasons, Cambodia and other former French colonies have developed far more slowly than other Asian nations. As France weakened during World War II, Vietnam began its steady uprising. In July 1946, the communist Viet Minh began a guerrilla war against France. In July 1954, the Geneva Accords officially establish North and South Vietnam as different entities, the South led by US-backed Ngo Dinh Diem and the communist North under Ho Chi Minh. As the US became progressively more involved in the war, bombings and attacks against communist forces steadily expanded into surrounding countries, including Cambodia. Between March 1969 and May 1970, the US conducted “Operation Menu,” a series of secret bombings targeting communist camps based in Cambodia. On January 27, 1973, 20 President Richard Nixon signed the Paris Peace Accords, withdrawing the United States of America from the war. Hostilities continued in Vietnam until the Viet Cong and North Vietnamese troops captured Saigon in April 1975. In July of that year, the war ended as North and South Vietnam were officially joined as the communist Socialist Republic of Vietnam (Vietnam War Timeline). The United States bombings during the secret “Operation Menu” had kickstarted a five-year-long civil war in Cambodia between the pro-American dictator Lon Nol and the Khmer Rouge. The combination of bombings by the US and the civil war sent Cambodia’s economy into a massive downward spiral, destabilizing markets and leading to dependence on foreign aid. The country virtually stopped trade with the outside, leaving their rice exports to crumble, unable to feed even its own citizens. After the long Vietnam War and the civil war within Cambodia itself, Khmer Rouge promises of peace appealed to Cambodian citizens, who resented the violence faced by their country. They promised to free Cambodia from imperialists at last and restore their country to justice. On April 17, 1975, the Khmer Rouge captured the capital city of Phnom Penh and began their bloody regime. Their goal was to bring the country back to “year zero,” to an ideal where agriculture was the only profession and the government took care of citizens (Ung). To fulfill this plan, drastic and violent measures were taken. Immediately after the takeover, the Khmer Rouge began to evacuate the city, claiming that American bombers were planning to attack. Over 2 million people were forced to leave, including the elderly, the sick, and children (Power). After marching for days, families were placed in small towns in the countryside. Their belongings were taken away and they were given Khmer Rouge-approved black outfits and red plaid scarves. The Khmer Rouge promised 21 that it would take care of relocated people and provide them with food and shelter. In exchange, they were to work for the new government. Children and adults were forced to labor long days in the rice fields with little food and no break from the beating sun. If they fell behind or did not work, they were beaten or killed by Khmer Rouge soldiers. People were given extraordinarily small rations of food, often less than a tin of rice a day. Many starved to death, and mothers became unable to produce milk for their young babies (Power). The Khmer Rouge regarded the hard-working farmer to be the most pure embodiment of an ideal citizen, and wanted to purge the country of anyone who posed a threat to the plan to bring Cambodia back to “year zero” (Ung). They sought out former government officials, foreigners, people of mixed heritage, religious leaders, anyone who disagreed with the Khmer Rouge government, and people of a higher economic class. The abuses went so far as to include anyone who wore glasses, had soft hands, or were literate because these traits were associated with power and potential threats against the regime (Ung, Power). As the regime progressed, the Khmer Rouge began to employ child soldiers. They would separate children from their families early on and submit them to harsh training and indoctrination. Sometimes, as a symbol of allegiance to the government, children were told to kill their own parents and families (Ung). These atrocities were largely concealed from the outside world. The country was tightly controlled, and foreign media received news only from formal press releases and intercepted messages. The first photographs from the regime were not smuggled out of Cambodia until April 1977, and their contents shocked the world. They depicted forced labor camps and starvation, death and cruelty, but still they did not show the extent of the 22 genocide happening within the country (Power, 121). It was only after Vietnamese forces invaded and overthrew the Khmer Rouge government on January 7, 1979, that the outside world began to get a picture of what had really happened during the Khmer Rouge’s four-year-long slaughter (Power). Mass graves were uncovered, some containing hundreds of people. Rotting corpses were found in Tuol Sleng and other torture centers. Victims began to speak about the terrors that they had faced. Yet, even after the true nature of the Khmer Rouge regime was unveiled, many world powers, including the United States, backed a new government headed by former Khmer Rouge officials rather than allow the Soviet-backed Vietnamese to take over the country. Khieu Samphan, former head of state of the Khmer Rouge, was appointed as the new Cambodian prime minister in December 1979 and denied abuse by the regime, citing “mistakes” and “shortcomings” and promising future reform (Power, 147-148). It wasn’t until 1985 that the United Nations allowed for a formal investigation of the genocide in Cambodia (Power, 153). Since then many former officials, including Samphan, have been tried in the Extraordinary Chambers in the Courts of Cambodia (ECCC), “a Cambodian court with international participation that will apply international standards” (Extraordinary Chambers in the Courts of Cambodia). These trials are still going on more than 30 years later, a fact which many believe is a testimony to the inefficient handling of the criminal offenses of those involved. These developments over more than a century left Cambodia vulnerable to the effects of a postcolonial world. Practices like humanitarian aid, volunteer tourism, and international meddling in Cambodian genocide investigations contribute to the postcolonial and neocolonial effects felt throughout the country. Weakened by former 23 French colonization and war, Cambodia now experiences different forms of Western influence. These influences continue to keep Cambodia in a weakened state, relying on outside assistance. RESEARCH QUESTIONS AND METHODS This thesis is informed by previous scholarly research on similar topics. Adriana Campelo, Robert Aitken, and Juergen Gnoth researched ethics in destination marketing using a visual rhetorical strategy, focusing on the visual rhetoric and ethical representation of social and symbolic capital when branding (7). They examined landscape, people, and culture as three elements used to generate awareness of a destination (Campelo et al., 4). Many organizations put an emphasis on the landscape of a country, the characteristics of its people, and its heritage and culture when presenting the destination to potential visitors. This includes the use of feelings about being “at home” and generating friendship and companionship with local community members (Campelo et al., 8-9). Their interdisciplinary and mixed-method approach is useful for the analysis of the marketing, branding, and persuasive techniques used to promote volunteer tourism. Heejun Kim researched the persuasive methods used by tourism companies and how the internet has affected the way people search for information when planning a trip. His emphasis on persuasive presentations helped to highlight the ways tourists are influenced in an age of technology use. This thesis combines the disciplines of political science and communication to take an interdisciplinary approach to the function and problems of volunteer tourism. These two fields together provide a more comprehensive picture of the effects of 24 volunteer tourism on host communities. As noted above, this research analyzes volunteer tourism through a postcolonial lens, because Cambodia spent nearly a century under French colonial rule, and suffers distinct negative effects on economic, political, and educational structures (Kwon). From a communication perspective, this thesis examines rhetorical strategies, especially in relation to white saviorism. This thesis poses two questions: What are the persuasive strategies of voluntourism organizations? How does the practice of voluntourism contribute to postcolonialism and the white savior complex? While this thesis does not undertake a formal rhetorical study, it does incorporate a qualitative and descriptive analysis of the persuasive techniques employed by volunteer tourist companies. More specifically, I looked at the websites of six different volunteer tourism organizations and analyzed their pictures and words used to communicate with potential volunteers. These organizations were chosen by examining academic literature, reports from international agencies like UNICEF, and the results of online searches and popularity. As noted above, young people are the typical recruiting demographic for volunteer tourism organizations. Considering the ubiquity of Google in young people’s lives, I used it to search for various volunteer tourism-related terms. These included “Education volunteer trip Cambodia,” “Orphanage volunteer trip Cambodia,” and “Medical volunteer trip Cambodia.” During these searches, several organizations were recurring and contained volunteer opportunities in a number of different disciplines, including education, orphanage assistance, and medical work. Together, these methods resulted in the selection of these six organizations: Volunteering Solutions, New Hope 25 Volunteers, International Volunteer HQ, Plan My Gap Year, Love Volunteers, and Projects Abroad. Once these volunteer tourist organizations were selected, I examined the information provided on each organization’s home page, “About” section, and similar sections. I analyzed the persuasive techniques used on each organization’s website via wordage and imagery. Then, I drew conclusions based on these findings. ANALYSIS OF VOLUNTEER TOURISM ORGANIZATIONS Organization Base Location Function Website Volunteering Solutions India Varied international volunteer work, including: childcare, teaching, medical and healthcare, community development, and marine conservation https://www.voluntee ringsolutions.com/ New Hope Volunteers United States (Texas) Varied international volunteer work, including: teaching, medical, orphanage, and wildlife conservation https://www.newhope volunteers.org/ International Volunteer HQ New Zealand Varied international volunteer work, including: teaching, childcare, construction, environmental conservation, and community development https://www.voluntee rhq.org/ Plan My Gap Year United Kingdom Varied international volunteer work, https://www.planmyg apyear.co.uk/ 26 including: teaching, childcare, medical and healthcare, wildlife conservation, and mental health Love Volunteers New Zealand Varied international volunteer work, including: childcare, medical, women’s empowerment, teaching, and education support https://www.lovevolu nteers.org/ Projects Abroad United States (New York) Varied international volunteer work, including: childcare, teaching, conservation, business, and healthcare https://www.projectsabroad.org/ Information in the following sections was drawn from the organizations’ websites. Volunteering Solutions Volunteering Solutions began in 2006 with the goal of “changing the face of volunteer traveling.” Since then, it has had over 13,000 volunteers participate in a tourist trip through the organization. Most volunteers are high school students, couples, corporate groups, and people traveling abroad for a school break or gap year. Volunteering Solutions offers volunteer opportunities in over 20 different countries, including Cambodia, and boasts more than 100 different options for volunteer work or internships. These programs range in length from two weeks to six months. The longer programs are typically internships, and the shorter ones are typically volunteer tourist 27 experiences. Their internships are for medical and healthcare or journalism and media. Volunteer experiences include medical work, women’s empowerment, childcare, language-learning, environment and wildlife conservation, sports coaching, disabled care, community development, and teaching. Volunteering Solutions claims to adhere to responsible, ethical, and sustainable volunteer tourism practices, and it presents the concept of a “socially impactful journey” in which volunteers and host communities receive maximum benefits through their work with Volunteering Solutions. As a part of these efforts, Volunteering Solutions has a cross-cultural setup in their offices, which are located across the globe, and employees come from a variety of countries, cultures, and ethnicities. It also has designated coordinators at each volunteer site who work with host organizations and volunteers. In Cambodia, Volunteering Solutions programs range from two weeks to 24 weeks and cover a range of opportunities including teaching English, childcare, medical work, and NGO support. These programs are based out of the capital city, Phnom Penh. The costs of these programs range from $450-600 for two weeks with an additional $100 cost for each additional week the volunteer will be staying. It is worth noting that the NGO support program is a minimum of five weeks in length, starting at $700. This cost includes food, accommodations, airport pickup, program orientation, pre-departure information, and in-country staff support. 28 Volunteering Solutions homepage, March 23, 2019 The Volunteering Solutions homepage displays a large image of a Western volunteer tourist holding a young black child. The young child is wearing a bright pink shirt. The Western volunteer appears to be Caucasian and has a weave. The volunteer is looking at the child affectionately, and both of them are smiling. Superimposed on this image are the words “Be a Volunteer And Drench [sic] these little ones with love.” There are also logos and 4-5 star ratings from five websites which advertise the success of the programs based off of the reviews of former volunteers. As one scrolls down further, the website highlights several of its locations and programs, and visitors can browse by destination or program using a toggle feature. There is a small section towards the bottom showcasing three recent blog posts: “Top 10 Affordable Volunteering Abroad Destinations to Explore in 2019,” “How to Volunteer Abroad—A Comprehensive Guidebook,” and “Top Summer Volunteer Abroad Programs for 2019.” Each blog post is accompanied by a picture of a volunteer participating in a program with Volunteering 29 Solutions. Finally, the home page has a section titled “Why Volunteer Abroad With VOLSOL?” This lists the organization’s arguments for their opportunities, experience, affordability, and in-country team. They claim that with more than dozen years of experience and many opportunities to choose from, their participants have “effectively contributed to the development of the projects and made a change in several lives.” Volunteering Solutions also focuses on the affordability of their project fees, and how “a certain amount of the money also goes to the project fund.” Additionally, they emphasize that the safety of their volunteers is their “top priority” and is supported by an in-country staff and team at each destination, which gives support to volunteers during the entirety of their stay. Volunteering Solutions: Volunteer in Cambodia, March 24, 2019 On the Volunteer in Cambodia page, there is a large picture of three volunteer tourists surrounded by young children making peace signs and holding what appear to be 30 gift bags. Below is a brief description of the projects in Cambodia and the benefits that can be experienced by volunteer tourists. Next to this is a short video about volunteering in Cambodia with Volunteering Solutions. In this portion, there are buttons leading website visitors to Volunteering Solutions’ social media pages. Below this, there are some quick facts about Cambodia and a map of the country’s location. Finally, there are four tabs to explore further: “Choose Affordable Programs in Cambodia,” “Weekend Travel Options List,” “Reviews,” and “FAQs.” The only time the Khmer Rouge regime is referenced on this page is under the Weekend Travel Options List. This section talks about potential options for weekend travel around Cambodia. One of these options is a weekend trip to Phnom Penh, and the description briefly mentions that people can learn more about “a place where millions of Cambodians were killed during the 1970s” on a visit to the Killing Fields. Volunteering Solutions relies heavily on imagery that features volunteers interacting with host community members while participating in various volunteer projects. The volunteers pictured appear to be primarily young, attractive, white women, and the host community members pictured appear to be mostly smiling young children. Many of the volunteers shown are in close and intimate positions in regards to the community members, often holding them in an embrace or helping them with tasks such as homework or learning. Some examples of this imagery are shown below. 31 Picture from the Volunteering Solutions Volunteer in Cambodia page, “Teaching English Program,” March 28, 2019 Picture from the Volunteering Solutions Volunteer in Cambodia page, “NGO Support Program,” March 28, 2019 32 Picture from the Volunteering Solutions homepage, “Ghana,” March 28, 2019 This intimate and caretaking imagery is coupled with language that reinforces the benefits for the volunteer. Programs are described as “life-changing” and potential volunteers are assured that through their service, they will be transformed by this opportunity. Visitors to the Volunteer in Cambodia page are assured that, in addition to their valuable experience volunteering, Cambodia “has a lot more to offer to the visitors” as they “explore the beauty of the country, and know more about the lifestyle and culture of the locals.” In fact, the needs of the volunteers are addressed even more than the supposed benefits of the projects for host community members. One example of this is the description of medical volunteering found on the “Volunteer in Cambodia” page. This short project description fails to mention benefits for host community members, and 33 instead is described as “specifically designed for medical Students or practitioners who are looking for international work.” Volunteering Solutions draws future volunteers into the program by displaying a combination of photographs depicting nurturing relationships and the assurance that visitors themselves will experience a unique and life-changing program focused on them. Through these persuasive techniques, potential volunteers are led to believe that not only will they be performing a good service during their time abroad, but that they themselves will experience gratitude from host community members and “life-changing” benefits as a result of their participation in the program. New Hope Volunteers New Hope Volunteers is a U.S.-based 501(c)3 nonprofit organization. It offers volunteer opportunities, language learning programs, and internships in 18 countries. Internships last from two to 12 weeks, according to the volunteer’s desires. Language learning programs are typically a week long. New Hope Volunteers’ volunteer programs last from one to 12 weeks. Their internship opportunities include social work, healthcare, education, women’s issues, language and culture, and environment and conservation. Their volunteer opportunities include orphanage work, teaching English, community development, healthcare and medical projects, and nature conservation. New Hope Volunteers claims that it offers a quality trip at one of the lowest prices in the industry. As a 501(c)3 nonprofit organization based in the United States, it does not operate to make money from the volunteers and the work that they do. Because of this, New Hope Volunteers claims that they are able to keep their prices as low as possible and contribute most of their proceeds to its international volunteer causes. 34 In Cambodia, volunteers can participate in an orphanage project, teach English in rural schools, engage in community development, help a local NGO, and assist with healthcare and medical projects, including HIV/AIDS care. These projects are primarily based in the capital city, Phnom Penh, but some take place in the rural regions of Battambang and Pursat. The program cost is $350 for a two-week program, with an added cost between $85 and $110 for each additional week. The exception to this is the medical projects, which require a minimum of four weeks and start at $750. For all programs, there is an additional registration fee of $279. The program fee pays for accommodation, food, airport pickup, program orientation, in-country support, personalized project costs, pre-departure information, certificate of completion, and fundraising assistance. New Hope Volunteers homepage, March 23, 2019 35 New Hope Volunteers home page features a large picture of a female Western volunteer holding a young child. The volunteer’s face is tilted down towards the child. The child looks directly into the camera as he snuggles into the volunteer’s shoulder. The image is overlaid with the words “Humanitarian Work To Make a Difference: Together We Volunteer To Help Poor Communities & Children, And Change The World For The Better.” Below this image, there is a short description of New Hope Volunteers and a section showcasing their different kinds of projects. Off to the right, there is a column with two lists: “Top 10 Popular Trips,” and “11 Reasons To Choose Us.” New Hope Volunteers: Volunteer In Cambodia, March 24, 2019 The “Volunteer In Cambodia” page starts with a list of why potential volunteers should choose a program in Cambodia. This list overlays an orange-tinted image of a couple of small Cambodian children. Below this, there are a few paragraphs describing Cambodia and its people, and what makes Cambodia a particularly meaningful 36 destination volunteers. This section mentions the Khmer Rouge regime, but fails to give any information about what exactly occurred or why it was important in Cambodia’s history and refers only to “its ill-fated past under the Khmer Rouge regime.” Next to this description, there is a picture of a white female volunteer smiling with a young boy and a baby girl. After this, there is a list of the volunteer programs offered in Cambodia. This is followed by a description of New Hope Volunteers’ program fees and a list detailing prices based on how long the volunteer wants to stay. Next, there is a short description of the provided meals and accommodations. Finally, there is a list of FAQs with links to more detailed answers. In total, there are six buttons on this page inviting visitors to “Find a Program Now.” New Hope Volunteers uses surprisingly few photographic elements, leaning more heavily on the written word. The few images that it does use depict either smiling and happy host community members or primarily white volunteers interacting with host community members during a project. The host community members are pictured as either grinning and happy, or intensely focused on the pictured volunteer. The volunteers are in the foreground of the pictures and seem to be the focal point where the viewer’s eye is automatically drawn. The focus on the volunteer puts the volunteer in a place of high importance by making them the center of attention not only in the eyes of the host community members, but in the picture itself. Some examples of this are below. 37 Picture from the New Hope Volunteers homepage, “INTERNSHIP ABROAD,” March 29, 2019 Picture from the New Hope Volunteers homepage, “VOLUNTEERING ABROAD,” March 29, 2019 The Volunteer in Cambodia page opens with the words “Are you seeking a meaningful volunteer experience in one of the most mystical countries in South East Asia?” The use of the word “mystical” plays into stereotypes surrounding many Asian countries, a stereotype that has drawn many Westerners towards the area as a way to find themselves or their spirituality. New Hope Volunteers embraces this idea, promising volunteers will be “changing the world and at the same time, changing yourself.” It promises volunteers that the trip will “bring a difference in you, the way you perceive the world, accept differences and adapt to changes.” By embracing the mysticism assocaited with Western depictions of Asia, New Hope Volunteers gives the potential volunteer 38 strong reasons to believe that their trip will be a transformative and life-changing experience for them. On top of this stereotypical portrayal of the East, New Hope Volunteers assures potential volunteers that Cambodians will welcome them with joy. Their description continues: “Cambodians are one of the friendliest and most welcoming people in South East Asia, making it a growing tourist hotspot. Behind their wide and perpetual smiles however, many Cambodians still live very arduous lives. Volunteer in Cambodia, and put a true smile on the faces of Cambodians.” This puts the potential volunteers at ease, assuring them that the “magnanimity” of the Cambodian people will make them feel welcome. This depiction of Cambodians as smiling and happy people obscures factors like personal individuality and the tragedy of Cambodia’s recent past. Additionally, the suggestion that volunteers will be the factor that will give Cambodians a “true smile” leads potential volunteers to believe in the altruism of volunteering abroad and the hope that they can make a positive difference in the world. International Volunteer HQ International Volunteer HQ began in 2007 and has “grown to become the world’s leading volunteer travel company” with over 40 destinations around the world. Each year, International Volunteer HQ sends thousands of volunteers to international destinations, and it states that is has served 99,614 volunteers in its lifetime. International Volunteer HQ was founded by New Zealand entrepreneur Dan Radcliffe after he went on a volunteer trip to Africa in 2006. When he returned from his trip, he wanted to start an organization that would make international volunteering “responsible, high quality, and affordable.” Thus, International Volunteer HQ was born. International Volunteer HQ 39 asserts that its approach makes the company “different” from others. According to their materials, this approach pays special attention to host community involvement, affordability, transparency, volunteer support, best practices and volunteer training, a consistent number of volunteers, community values, and a traveler experience. Additionally, International Volunteer HQ states that it adheres to its own responsible volunteering practices, which include a long-term commitment to each site, a code of conduct including child protection, animal welfare policies, and sustainable projects. In Cambodia volunteers can choose among eco-oriented volunteering, teaching English, childcare, NGO projects, medical work, computer support, special-needs care, and animal care. Volunteers stay in Cambodia from one week up to one year and spend time living in volunteer houses and homestays with local community members. The program fee starts at $360 for two weeks, and each additional week costs between $95 and $115. The exception is the medical project, which has a minimum length of three weeks and starts at $675. There is a registration fee for all programs of $299. The program fee covers in-country support, airport pickup, program orientation, volunteer placement, accommodations, and meals. 40 International Volunteer HQ homepage, March 23, 2019 The International Volunteer HQ homepage shows a large image of seven young adults. Three are female and four are male; the three women stand on the left side of the picture and the four males stand on the right. Two of the young women are holding shovels, one of which rests in what appears to be a wheelbarrow filled with cement, implying that these volunteers are participating in some sort of construction project. It is interesting to note that in the opening picture on the homepage, the only volunteers holding tools for their project are the female volunteers on the left, and the male volunteers on the right are not holding anything. On the wall behind the volunteers, there is a colorful mural depicting what appears to be Mickey Mouse standing in a green landscape next to a rainbow with hot air balloons and butterflies. On top of this image are the words “WORLD’S MOST TRUSTED,” “99,614 volunteers since 2007,” and “Choose from the world’s best range of affordable volunteer abroad programs, available year-round in 40+ destinations.” There are also two buttons website viewers can select, 41 one to explore the program further and one to fill out an application. Below this, potential volunteers can scan through options based on where they would like to go or what kind of project they are interested in doing. Next is a section titled “VOLUNTEER ABROAD WITH THE WORLD’S LEADING VOLUNTEER TRAVEL ORGANIZATION,” which describes International Volunteer HQ and contains another button that interested parties can click to apply. In this section, there is also a graphic advertising that if a person applies now, they will be entered in a drawing for 100% volunteer fees to celebrate International Volunteer HQ’s 100,000th volunteer. Next, there is a slideshow showcasing prestigious institutions that previous volunteers have come from and media sources in which International Volunteer HQ has been featured. After this, there is a section titled “Volunteer abroad inspiration and tips” that showcases three recent blog posts: “QUIZ: Where Should You Volunteer Abroad In 2019?” “Best Volunteer Abroad Programs,” and “Top Volunteer Programs For Solo Travelers.” Each blog post is accompanied by a picture of volunteers participating in a project with International Volunteer HQ. Next there are two pictures of volunteers interacting with children accompanied by two buttons, one leading to the application page and one leading to a page about why potential volunteer tourists should choose International Volunteer HQ. After that, there are three reviews from previous volunteers with International Volunteer HQ: Alicia, a female volunteer from Australia; Sidney, a female volunteer from the U.S.; and Craig, a male volunteer from the United Kingdom. Finally, there is a section titled “How to get started,” which outlines steps for potential volunteers wanting to get involved and includes yet another “Apply” button. 42 International Volunteer HQ: Volunteer In Cambodia, March 24, 2019 The International Volunteer HQ Volunteer In Cambodia page has a large picture at the top of a male Western volunteer coloring with a couple young Cambodian children. The child next to him is drawing what appears to be a figure wearing a button-up and a tie. Below this image, there is a description of the different projects offered in Cambodia and the affordability of International Volunteer HQ. Next, there is a short video about volunteering in Cambodia with International Volunteer HQ. Below this, there is a section with brief facts about volunteering in Cambodia, focusing on the affordability of the program as well. Then, there is a quote from Annie, a former volunteer from New Zealand: “I have been put out of my comfort zone and in return I am more wise, confident and warm. It was an absolute privilege to live with my host family for 2 months. I enjoyed playing with the children and teaching them. I also enjoyed coming home to a delicious meal, eating with the other volunteers, learning Khmer and meeting local people.” Last, there is a click-to-expand index with more information about the 43 programs, costs, schedule and activities, volunteer requirements, and other pertinent details. There is not a single mention of the Khmer Rouge or Cambodia’s violent history anywhere on this page. The images used by International Volunteer HQ focus on volunteers participating in various projects and the scenery and tourist attractions that can be experienced in the projects’ host countries. The volunteers pictured are mostly white and mostly female. Many of the volunteers in the pictures are interacting with children, and several of the pictures appear to show volunteers giving homework help or teaching. These pictures appear to be showing nurturing scenes, where volunteers are helping children and therefore improving their lives. These nurturing images reinforce the idea that as a volunteer generously giving time to children in need, one can help such children better their lives through the projects that International Volunteer HQ offers. It is also interesting to note the hyperfocus on tourist destinations. In fact, on the home page, several of the destinations listed did not show any pictures of volunteers or projects, and instead showcased a nearby tourist attraction. This indicates a focus that is not necessarily on the host communities, but on the once-in-a-lifetime experiences that International Volunteer HQ will provide to volunteers. Some examples of these images are shown below. 44 Picture from the International Volunteer HQ homepage, “Costa Rica,” March 30, 2019 Picture from the International Volunteer HQ homepage, “Kenya,” March 30, 2019 Picture from the International Volunteer HQ homepage, “Italy - Rome,” March 30, 2019 45 Picture from the International Volunteer HQ homepage, “Thailand - Hua Hin,” March 30, 2019 The language used by International Volunteer HQ focuses on the trustworthiness of the organization and the importance of the volunteer to host communities. International Volunteer HQ claims to be the “world's most affordable and trusted volunteer organization.” They claim this is due to their focus on volunteer safety and support systems while in country. This leads potential volunteers to believe they are in good hands and will be taken care of while abroad, giving them a sense of security as they enter into a new country, and perhaps a country where stereotypes have led them to believe that they will be in danger while there. International Volunteer HQ portrays the role of the volunteer as one who is invaluable to the host community in which they work. For example, the project description for teaching English in Cambodia open with this paragraph: “The level of education in Cambodia is considerably low, leading to a high level of poverty and unemployment throughout the country, and many families cannot afford to access education for their children. By Teaching [sic] English in Cambodia, you will play an important role in helping increase opportunities for Cambodians to learn the English language, which is a requirement for employment in their futures.” This paragraph opens 46 by blaming Cambodia’s extreme poverty on low education rates in the country. Then, it says that the high levels of poverty are the reason that parents cannot afford to send their children to school. Finally, it tells volunteers that by helping to teach English, they are breaking the cycle because when a child knows English, they will be able to get a job later in life. Another example of this can be found in the description for the childcare project in Cambodia. This description says that childcare centers in Cambodia are “typically underfunded and in need of volunteer assistance.” This sets up the volunteer to believe that their presence will make a huge difference to these childcare centers and the children within them. However, the description later says that “As you will be volunteering alongside the local placement staff, you do not need to hold any specific qualifications or experience to participate on this project.” This is an interesting dichotomy, as the unskilled and unqualified volunteers may not have the knowledge to provide useful assistance, and they may be unprepared for the less desirable tasks needed at a childcare center. Despite this, the website indicates that their presence and assistance are vital for these centers. Plan My Gap Year Plan My Gap Year is an international volunteer tourist organization that focuses on providing international service opportunities for young people taking a gap year— time between life stages—or choosing to travel overseas. Plan My Gap Year offers opportunities in 17 international locations. International volunteers can choose from a variety of projects, including childcare, English teaching, community development, family projects, medical and healthcare, mental health and psychology, and wildlife 47 conservation. In order to participate in a trip, volunteers with Plan My Gap Year must be at least 18 years old and undergo a criminal background check. Plan My Gap Year states that it takes pride in the social element of its programs, where volunteers are able to meet like-minded travelers across the globe. They believe that by living and working with other volunteers, people will develop strong and lasting relationships. In Cambodia, volunteers can choose between teaching English or volunteering in an orphanage. These programs are located in the region of Takeo and last between two and 24 weeks, depending on the volunteer’s preferences. There is also an option for a “PMGY Real South East Asia Encounter,” which takes volunteers to Vietnam and Bali, Indonesia, in addition to Cambodia. For consistency in the comparisons conducted in this thesis, I have excluded the PMGY Real South East Asia Encounter. During their trips, volunteers stay with other volunteers in dormitory-like rooms near the project’s location. On the weekends, volunteers can travel to other areas for sightseeing. Programs start at £240 with an additional £25 to £50 for each week after that. For each program, there is also an additional registration fee of £149. The program fee pays for accommodation, meals, airport pickup, in-country orientation, and in-country support. 48 Plan My Gap Year homepage, March 23, 2019 Volunteer Abroad’s homepage has a video at the top displaying clips of volunteers working on their projects, smiling host community members, dances and performances in the host country, tourist activities, and wildlife. On top of this video are the words “VOLUNTEER ABROAD: OPEN TO ALL NATIONALITIES WITH PLAN MY GAP YEAR,” “17 DESTINATIONS | 1-36 WEEKS | FEES FROM £150” and a seal that declares the program is protected by ATOL (Air Travel Organiser’s Licence), a British form of travel insurance. Below this image is a section about Plan My Gap Year and the positive experience volunteers will have. This section also includes six pictures, each of which can be clicked to learn more about different projects, and a video about the organization. These pictures depict volunteers having fun in their locations, volunteers working with host community children, and wildlife. Next, there are four recent reviews of Plan My Gap Year, all of which rate it 4-5 stars. Then, there is a map highlighting all the countries that host projects for Plan My Gap Year. Next, there are three panels titled “SOLO VOLUNTEER PROJECTS,” “WHY VOLUNTEER ABROAD WITH PMGY?” 49 and “SCHOOL VOLUNTEER EXPEDITIONS.” These three panels offer information and brief facts about the program for potential volunteers. Finally, there are six short videos highlighting projects located in Cambodia, Tanzania, Morocco, Indonesia, Ghana, and Vietnam. Plan My Gap Year: Cambodia, March 24, 2019 Plan My Gap Year’s page on Cambodia is dominated by a panoramic picture of Angkor Wat, a famous and beautiful ancient Buddhist/Hindu temple that draws enormous crowds of tourists to the country. No information about the volunteer programs in Cambodia is immediately visible. As one scrolls down, there are a few paragraphs describing Plan My Gap Year and what a volunteer should expect from programs in Cambodia. There is also a longer video, nearly 10 minutes, which showcases the programs. Below this, there are two lists with key features of the program and destination highlights for Cambodia. There is also a button linking the potential volunteer to a Plan 50 My Gap Year Facebook group, as well as a button linking to options for weekend travel while in Cambodia. After this, there are short descriptions and pricing for the program options in Cambodia. This is followed by a gallery of Instagram posts from volunteers. After the Instagram gallery, there is a click-to-expand section with more information about flights, safety, transportation, weather, and other pertinent details. On the right side of this section, there is a column with volunteer reviews for Plan My Gap Year programs in Cambodia. Finally, there is another Instagram gallery with more content pulled from Plan My Gap Year’s accounts. Again, this website neglects to mention the Khmer Rouge or Cambodia’s violent recent history. The pictures used by Plan My Gap Year appear to picture mostly young, attractive, white female volunteers. These volunteers are often pictured teaching or helping young children with homework. There are also many pictures depicting the volunteers having fun with other volunteers where no host community members are present. These pictures may carry gendered connotations. Despite the heavily female population, the only picture where a male volunteer is the center of attention is the picture used on the homepage to advertise for medical volunteer projects, whereas the childcare projects are advertised by displaying a female volunteer. On the Cambodia page, there is a heavy focus on scenery and tourist destinations. As mentioned above, the primary visual element on this page is a large and beautiful picture of the most famous Angkor Wat temple. This focus on Angkor Wat as the key image overshadows pictures of volunteers or projects, indicating that the main interest of potential volunteers is likely directed towards this temple and the projects themselves may be more of an afterthought. Some examples of other photos used can be seen below. 51 Picture from the Plan My Gap Year homepage, “MEDICAL” March 30, 2019 Picture from the Plan My Gap Year homepage, “CHILDCARE” March 30, 2019 Picture from the Plan My Gap Year Cambodia page, “CAMBODIA ENGLISH TEACHING VOLUNTEERS” March 30, 2019 The words used by Plan My Gap Year focus on the authentic experience that each volunteer will supposedly have during their time working on their chosen project. Specifically, they emphasize how the time abroad will bring the volunteer closer to the true essence of their host country and give each one of them a “unique cultural 52 experience.” In Takeo, the province where the projects in Cambodia are located, volunteers engage with rural life and interact with host community members in a way that is seen as more authentic than a traditional tourist experience. In this way, volunteers are able to “immerse themselves in the roots of traditional Cambodian life.” The impoverished agricultural region is hailed as the authentic representation of Cambodian life and culture. Thus, when volunteers choose to engage in international volunteer service in this place, they are assured that “a true Cambodian experience is awaiting you!” Love Volunteers Love Volunteers was started in 2009 by a brother and sister, Julian and Kelly Phillips. They said they were shocked by the expensive prices that many volunteer tourist organizations charged for their trips, and they were inspired to create an affordable international volunteer program. Since then, they have expanded their service to 38 countries across the globe. Their program types include childcare and development, community development, construction and outdoor work, healthcare and medical, specialized placements, and teaching and education. To participate in a program, volunteers go through nine steps, as presented on the Love Volunteers website: 1. Choose where you’d like to go and what you’d like to do. 2. Once you’ve chosen your perfect program, click Apply. 3. We’ll review your application and respond within 48 hours. 4. Pay the registration fee to secure your place. 5. We’ll finalize your placement with the local team. 53 6. Once the local team confirms, you’ll get full access to your Volunteer Dashboard so you can learn more about your program and start planning your trip. 7. Follow the step-by-step guide in your Volunteer Dashboard to prepare for your trip. 8. Pay your program fee and receive your placement details. 9. Start your life-changing adventure! Love Volunteers prides themselves on affordable prices and transparent fees. They claim that there are no surprise fees added to the program fee. They also claim that 90% of the program fees go to local charities and organizations in host communities. In Cambodia, volunteers can choose from childcare and development, community development, education support, law and human rights, or medical projects. These program range in length from two weeks to four weeks and are based out of Phnom Penh. Prices vary for each project. The childcare program starts at $389 for two weeks, with an $70 to $120 for each additional week. The community volunteering program, teaching program, and human rights program all start at $609 for four weeks, with an additional $70 to $120 for each week after that. The healthcare volunteer program starts at $609 for two weeks, with $100 to $200 for each additional week. Each program also charges a registration fee of $299. Program fees cover airport pickup, orientation, safety briefing, accommodations, food and meals, local support, project placement, onsite supervision, and local transportation. 54 Love Volunteers homepage, March 23, 2019 The Love Volunteers homepage features a large image of a female Western volunteer and a male teenage host community member. The teenage boy is wearing a blue shirt and a white cap, and he has white markings on his face. The Western volunteer is wearing a patterned shirt, and her hair has been styled into cornrows. They are seated at a wooden table, and both of them are looking down at an open notebook and smiling. The host community member is holding a pen, implying that the volunteer is assisting the teenage boy with his schoolwork. On top of the image are the words “LIFE-CHANGING INTERCULTURAL EXPERIENCES” and “Truly rewarding volunteer and internship opportunities in developing countries around the world!” Towards the bottom of the image there is a search bar where potential volunteers can browse by filtering for regions, countries, or project types. Below this, there is a video about volunteering with Love Volunteers. The image for this video is a different female Western volunteer surrounded by four young black children. Next to this, there is an unattributed quote that says, “Great 55 projects. Awesome service. Lowest fees. Love Volunteers is the REAL deal!” and a button that site visitors can click to read volunteer stories. Below this, there is a section titled “FEATURED DESTINATIONS” where one can scroll through the different locations that Love Volunteers goes to. Each of these destinations is accompanied by a scenic picture of a tourist destination, local resident, or wildlife. Next, volunteers are invited to choose their destination on a map featuring the names of all the countries in which Love Volunteers has projects. Each of the names redirects the site visitor to a page about volunteering in that location. After the map, the site visitor can browse through “FEATURED PROJECTS,” all of which are accompanied by a picture of host community members or volunteers participating in a project. Next, there are three reviews of Love Volunteers from Miguel, a male volunteer from the United States, an unnamed female volunteer from Canada, and Victor, a male volunteer from the United States. Finally, there is a section at the bottom titled “SEE WHO’S TALKING ABOUT US” with four seals from different organizations that have recognized Love Volunteers. Love Volunteers: VOLUNTEER WORK IN CAMBODIA, March 24, 2019 56 The information about volunteering in Cambodia is accessed through the search function on the homepage for Love Volunteers. The opening image is of a rice farmer carrying rice plants over his shoulder on a long pole. He is wearing a cone-shaped hat, black shorts, and no shirt. It is interesting to note that none of the projects offered in Cambodia have anything to do with rice farming or agriculture. Next, there are a few short paragraphs about programs in Cambodia with Love Volunteers and why volunteering abroad is a good experience. To the right, there is a short quote from Chloe, a female Australian volunteer, which reads, “I can not recommended [sic] volunteering highly enough. It really is the experience of a life time [sic] and Love Volunteers made it easy and hassle free.” Below this, there is a list of the five programs in Cambodia that volunteers can choose from. Each of these programs is accompanied by a picture of a volunteer with some host community members or working on a project, some fast facts about the project, a short description, and a button to learn more. There was no mention of the Khmer Rouge regime or Cambodia’s violent recent past on this page. Most of the pictures used by Love Volunteers depict either volunteers assisting with a project or aesthetically pleasing views of the host country, particularly if the host country contains a popular tourist destination or famous site. The volunteers pictured are predominantly female, young, and white. Most of the host community members pictured are young children. Particularly on the Volunteer Work in Cambodia page, the volunteers and the children are in close and intimate positions, embracing or snuggling. They are usually smiling or posing for the camera and appear happy and engaged. The positioning of the volunteers and host community children signifies the extent to which Love 57 Volunteers portrays their volunteers as nurturing and loving, giving back to their host community and making authentic connections. The emphasis on the aesthetics of the destination may cater to the young volunteer looking for a unique and beautiful setting for their international experience. In addition, the young volunteer may be focusing on the aesthetics of the location as a way to please their social media audiences. Some examples of the pictures used may be found below. Picture from the Love Volunteers VOLUNTEER WORK IN CAMBODIA page, “Childcare & Development,” March 30, 2019 Picture from the Love Volunteers VOLUNTEER WORK IN CAMBODIA page, “EVA (SPAIN → CAMBODIA),” March 30, 2019 58 Picture from the Love Volunteers homepage, “Guatemala,” March 30, 2019 Picture from the Love Volunteers homepage, “The West Bank,” March 30, 2019 Love Volunteers uses language to highlight the authenticity of the experience, and how it will be a genuinely life-changing adventure for their volunteers abroad. On their homepage, they describe their projects as “Truly rewarding volunteer and internship 59 opportunities in developing countries around the world!” By presenting these projects as “truly rewarding” they are sending a message to the volunteer that their time volunteering abroad will be more genuinely beneficial for them than it would be with other organizations. Additionally, they back this message up with a quote that presumably comes from an unnamed past volunteer, saying, “Great projects. Awesome service. Lowest fees. Love Volunteers is the REAL deal!” They highlight the attributes of their program that they feel will be convincing to people looking into the program while using the words of a previous volunteer to seem more trustworthy. Finally, they refer to their projects as “life-changing” and “unforgettable” experiences to further reinforce the benefits that participating in their program will bring for volunteers, promoting it as “one of those times in your life when you feel most alive.” Interestingly, benefits to the host countries and communities are barely mentioned, and this is done almost as an afterthought. By catering their persuasive strategies towards the egos of the volunteers and their desire for an authentic experience, they are erasing consideration of their effects on local communities in favor of ensuring that the volunteer is satisfied with their experience. Projects Abroad Projects Abroad was created 25 years ago by an English university professor and his overseas colleagues in order to give young people the opportunity to volunteer overseas. They believed that by giving young people the ability to volunteer abroad, they could learn new skills and contribute to host communities at the same time. Over the years, 115,000 people have volunteered globally with Projects Abroad. The organization offers trips to 25 locations across the globe. They have 64 different volunteer and 60 internship projects in areas including, archaeology, building, childcare, conservation and environment, business, journalism, law and human rights, medicine and healthcare, social work, teaching, and veterinary care. Project Abroad’s stated mission is: “We’re here to provide the gold standard of support and safety, so our volunteers and interns can fulfill their potential, discover themselves and create positive change in the world.” They believe that the process of volunteering abroad is transformative and empowers people to explore the larger world, encounter different cultures from their own, and gain an understanding of the places they visit and the communities they work in. Cambodia is one of Project Abroad’s top five destinations. The organization has 13 projects in Cambodia, including childcare volunteering, Khmer cultural immersion, medical internship, micro-finance, and teaching. These programs range in length from one week to four weeks, and there is a set length for each project. They are based out of Phnom Penh. These projects range in price from $2,020 to $3,155. Project fees pay for accommodation, food, travel and medical insurance, airport pickup and drop-off, orientation, transport to and from volunteer locations, in-country support, emergency assistance, project equipment and materials, training and workshops, social events and community activities, internet, visa support, fundraising support, and personalized fundraising website, pre-departure preparation, cultural awareness course, and membership in Projects Abroad volunteer social media groups. 61 Projects Abroad homepage, March 23, 2019 The Projects Abroad homepage shows a group of volunteers walking along a beach. The image is shot from behind and the viewer can only see the backs of the volunteers, not their faces. The closest volunteer is the only one in focus and the rest are blurred. The closest volunteer appears to be a female, and her blond hair is pulled up into a ponytail. Her shirt, which seems to match the blurrier shirts of the other volunteers, is a Projects Abroad shirt declaring that she is a volunteer for the shark conservation project. Superimposed on the image are the words “Discover what you’re capable of” and a search bar where one can browse through Projects Abroad opportunities by filtering for projects and destinations. There are also links that the website visitor can click to learn about top projects and top destinations. Below this image, potential volunteers can look through the three different kinds of projects that Projects Abroad offers: “Volunteer Abroad,” “Intern Abroad,” and “Under 18s.” Next, there is a section titled “Volunteer and Intern Abroad with Projects Abroad,” which gives a short summary of what Projects 62 Abroad is and what they do. Then, there is a section called “What makes us different?” which outlines three reasons why Projects Abroad believes they are the best international volunteer tourist company: the gold standard of staff support, a hassle-free approach, and making a real impact. Each of these reasons includes a link where potential volunteers can read more. Next, there are three reviews from volunteers, one male and two females. Their countries of origin are not listed. Below this is a section encouraging volunteers to call for support if they cannot find what they are looking for so that Projects Abroad can help them create a custom project. Scrolling down further, there is a section called “Meet Us,” which lists events hosted by projects abroad, career fairs and other events they will be at, and how to schedule one-on-one meetings. Next, the section “Trip Formats” lets potential volunteers peruse the different styles and packages for trips. Finally, Projects Abroad displays the logos of various media sources that it has been featured in. Projects Abroad: Volunteering in Cambodia, March 24, 2019 63 Projects Abroad’s volunteering in Cambodia page features a large picture of a group of volunteer tourists at Angkor Thom, a famous temple in the Angkor Wat temple complex. Superimposed on the picture are the words “Volunteering in Cambodia” and “SUPPORT COMMUNITY DEVELOPMENT WHILE EXPLORING THE ANCIENT RUINS AND HISTORY OF CAMBODIA.” As one scrolls down, there is a short description of the projects offered in Cambodia by Projects Abroad. Below this description, potential volunteers can browse through the 13 different projects offered in Cambodia. Next, there is a section that duplicates a portion of the home page, encouraging volunteers to call for support if they cannot find what they are looking for so that Projects Abroad can help them create a custom project. After this, page visitors can “Meet the team in Cambodia” by looking through pictures and job titles of the Projects Abroad staff in Cambodia. This is accompanied by a section about safety and support while in country. Finally, there is a description of Phnom Penh and a map showing where it is in Cambodia to get potential volunteers more acquainted with the location. This section briefly mentions that there are historical sites in Phnom Penh where one can learn about the events of the Khmer Rouge regime, but there is no explanation of the regime or what happened during it. Interestingly, Projects Abroad made the choice to use relatively few images on their home page and instead rely more on graphic design. These images are light and fun and appeal to younger audience, even using images with the Facebook like icon and a red heart similar to the Instagram like button. This speaks to the fact that the typical volunteer tourist demographic is younger and more likely to engage in social media. This also indicates that Projects Abroad hopes volunteers will share their experiences abroad on 64 social media. However, this often turns the host community and its members into a spectacle to be enjoyed by the Western volunteer and their social media audience. Image from the Projects Abroad homepage, “Make A Real Impact,” April 1, 2019 Projects Abroad uses more imagery on its Volunteering Abroad page. They include images of volunteers engaging in projects and various activities. These volunteers are primarily young, white, and female. The primary image is of a group of volunteers standing in front of Angkor Thom. Similar to the other organizations, they also depict volunteers engaged in projects with the organization. Projects Abroad displays a wide variety of activities, for which volunteers might not have the skills needed. Volunteers are pictured farming rice, walking water buffalo, and assisting with medical work. This can be problematic because of how it reinforces the fact that most volunteer tourist 65 organizations do not require volunteers to come with any prior training, leading to lowquality projects. Some examples of this imagery can be found below. Picture from the Projects Abroad Volunteering in Cambodia page, “Childcare Volunteering for Groups in Cambodia,” April 1, 2019 Picture from the Projects Abroad Volunteering in Cambodia page, “Khmer Cultural Immersion Project in Cambodia,” April 1, 2019 66 Picture from the Projects Abroad Volunteering in Cambodia page, “Khmer Cultural Project in Cambodia for Volunteers over 50,” April 1, 2019 The words used on the Projects Abroad website highlight their focus on the customer’s safety and support, the benefits the volunteer would receive from working with Projects Abroad, and the tourist experience. The website mentions often that they hold the “gold standard of safety and staff support.” This promotes the idea that their program provides the highest level of safety in comparison with other programs, and it subtly tells potential volunteers that they need professional protection in order to be “safe” in their host country. While there are, of course, safety concerns, Projects Abroad indicates that they distrust the host community. Similar to the other websites, Projects Abroad emphasizes the benefits that volunteers will experience through their time abroad. On the homepage, they claim that “With our help you’ll learn new skills, meet new people, make a real difference, and have the experience of a lifetime. You’ll grow as a person and become a truly global citizen.” This is a wide array of benefits ranging from personal growth, once-in-a-lifetime experiences, and new skills that the volunteer can add to their repertoire and resume. One example of this is the description of the physiotherapy internship in Cambodia, which claims that volunteers can “gain practical work experience 67 in a rehabilitation centre.” This implies that unskilled or inexperienced workers are able to use their volunteer work as a resume builder and get experience in the field that they would likely not be qualified for in their home countries. Finally, Projects Abroad emphasizes the tourist aspects of their projects as a way to further draw in potential volunteers. Coupled with the picture of the volunteers at Angkor Thom on their Volunteering in Cambodia page, they advertise that volunteers can “SUPPORT COMMUNITY DEVELOPMENT WHILE EXPLORING THE ANCIENT RUINS AND HISTORY OF CAMBODIA.” Further down, the organization describes the areas of Phnom Penh where their projects are located, saying that “As you walk the streets, you’ll be greeted by saffron-clad monks, chaotic traffic, and friendly people.” This provides a picturesque mental image of Phnom Penh while still blanketing the area in visions of Asian mysticism and uniform friendliness, leading potential volunteers to believe that they can expect a magical personal transformation in the midst of a crowd of friendly and grateful host community members. DISCUSSION In this section, I will examine the visual and textual elements used on the websites of these six volunteer tourist companies to illustrate how they connect with the scholarly literature examined above. As noted in the methods section, this thesis examines two broad questions: What are the persuasive strategies of voluntourism organizations? How does the practice of voluntourism contribute to postcolonialism and the white savior complex? 68 First, I will more fully investigate the observations I made in the previous section via their visual and textual persuasive strategies. Then, I will discuss these general findings through the lens of postcolonialism and neocolonialism. Visual Many of the websites used similar visual components, especially when looking at the demographics of the volunteers and the activities that they are engaged in. Most of these websites displayed volunteers who were mostly young, attractive, white, and female. This is consistent with the observations of scholars such as Mary Conran, Jenna Hanchey, and Jacob Henry about the typical volunteer tourist: young, white, Western, and well-educated. One example of this representation is the image below. Picture from the Volunteering Solutions Volunteer in Cambodia page, “NGO Support Program,” April 2, 2019 Two of the websites studied, Volunteering Solutions and Love Volunteers, featured images at the tops of their homepages which displayed white female volunteers 69 wearing hairstyles which are often considered to be forms of cultural appropriation when worn by white women. In the context of a volunteer trip abroad, one can only wonder if these hairstyles were intentional fashion choices made by these women or part of a cultural exchange that they took part in with the host community members at their volunteer site. Either way, the active choice by these organizations to use these images may point to a lack of understanding or consideration of the complexities of these issues of cultural appropriation. This expectation of implicit cultural exchange (presumably benefiting both community members and volunteers) is similar to Cori Jakubiak’s 2016 research findings, where she suggests that the possibility of cultural exchange is often part of the promotional material and advertisements used by volunteer tourism companies. Volunteers were most often pictured interacting with host community members during projects or enjoying tourist activities on excursions. Many of the host community members pictured were young children. They were frequently displayed in positions of reliance on, and intimacy with, the volunteer. Examples of this are images where the volunteer was hugging or snuggling a child, or where the volunteer was teaching the child or helping them with homework. The stark contrast presented between the educated Western volunteer and the reliant young host community member being helped with their homework symbolizes that these young people need volunteers to progress in their education and, more broadly, the “civilization” of their societies. These images illustrate the fantasy of intimacy and caretaking. By showing what appear to be close relationships between the volunteer and the host community members, particularly children, Volunteering Solutions offers a convincing visual argument of the merits of their 70 program and the heartfelt connections that volunteers will supposedly make. This helps potential future volunteers subscribe to the fantasy that they, too, could have these relationships and make positive differences in the lives of disadvantaged children. The depictions of these dependent relationships align with the concept of white saviorism. Because volunteer tourism organizations perpetuate the idea that their Western volunteers are changing lives and saving people, these volunteers hold the belief that they are the key to the change the world needs to see. As Jenna Hanchey observes, even those volunteers who are familiar with the concept of the white savior find a way to distance themselves from it, further entangling themselves in the fantasy (6). The visuals that were not focused on volunteers interacting with host community members often highlighted tourist experiences in the host country. Four of the six pages about volunteering in Cambodia included images of scenic activities that could be experienced on excursions. Three of the six Cambodia pages included images of Angkor Wat or other structures in the Angkor Wat temple complex. One example of this is the primary image used by Plan My Gap Year, picturing a stunning view of Angkor Wat in front of a bright blue sky. 71 Picture from the Plan My Gap Year Cambodia page, April 2, 2019 The imagery emphasizing the tourist opportunities offered in host countries is beautiful, but for volunteers acting under the facade of performing volunteer service they might account for more of a distraction. This imagery intentionally or unintentionally overshadows pictures of the volunteer projects, and volunteers sometimes are more focused on the location they are traveling to than the people they are serving. This may lead to some distraction away from the purpose or goal of the trip itself as volunteers wait in anticipation for their tourist excursion days. Textual Most of the organizations analyzed highlighted the low costs of their programs, the safety and security of their volunteers, and the benefits experienced by volunteers through authentic experiences abroad. Five of the six volunteer organizations mentioned the affordability of their programs. The only one that did not was Projects Abroad, the most expensive of the six organizations. Many of the origin stories of these organizations mentioned that their creators wanted to make international volunteer trips more 72 accessible. One example of this was the origin story for International Volunteer HQ, which appeared on the History of IVHQ page. The founder, Dan Radcliffe, participated in a volunteer tourism trip to Africa in 2006. He was surprised by the high prices that many companies charged and wanted to create a company that was more affordable. The focus on the cost of the programs correlates with the increasing desire for affordable programs that middle-class people can participate in, as pointed out by Conran, as well as by Cohen and Cohen. Some examples of this focus on affordability included New Hope Volunteers, a U.S.-based nonprofit organization. They claimed that as a nonprofit, more of the money they collect from volunteers goes straight to the projects they are working on. They also asserted that since they are not able to make money as a nonprofit, they are able to charge lower prices than their competitors. Amid this discourse on affordability is an ironic twist. While these lower costs do enable more people from middle-class families to participate in an international program, there is still a huge income gap between these people and the host community members they are journeying to help. Beyond the focus on affordability, many of the organizations also put a heavy emphasis on the safety and security that they provide for their volunteers. For example, Projects Abroad’s mission statement promised, “We’re here to provide the gold standard of support and safety, so our volunteers and interns can fulfill their potential, discover themselves and create positive change in the world.” They stress support and safety and claim that this is the reason that their participants are able to have the incredible experiences they claim to provide. Projects Abroad wasn’t alone in their emphasis on safety and security for volunteers. All six organizations assured safety for their volunteers, and four of them included a promise of safety on their homepages. 73 Considering that the majority of volunteer tourists are young, this focus on safety may be a ploy to convince parents that a trip will not pose any danger for their children, making it more likely for them to agree to allow their children to participate in a program abroad. Another common element of organizations’ text was to highlight broader benefits to volunteers. In fact, every single organization studied mentioned some aspect of a lifealtering experience, using language like “life-changing,” “the experience of a lifetime,” “changing the world and at the same time, changing yourself,” and “unforgettable,” along with the more modest claim of “satisfaction of the giver.” This language promises volunteers that their time abroad will bring lasting benefits to them even after they return home. This life-altering experience is apparently achieved through the intimate and authentic relationships that volunteers are promised on their trips abroad. This illustrates the work of Mary Conran, who explored how intimacy, or at least performed intimacy, leads the volunteer to believe that they are truly helping the host community. Promoting close ties between volunteers and host community members makes a dual claim: Helping others yields “life-changing” effects for volunteer tourists. These volunteer tourism organizations draw potential volunteers into the fantasy that not only will they be helping change the lives of host community members, they will be changing their own lives as well. But, when volunteer tourism organizations direct their persuasive strategies towards the egos of the volunteers and their desire for an authentic experience, they downplay consideration of their effects on local communities in favor of ensuring that the volunteers feel empowered and satisfied with their experience. As discussed above, such text reinforces the idea of white saviorism. As noted, New Hope Volunteers assures potential volunteers will be welcome by Cambodians, 74 whom the organization describes as “one of the friendliest and most welcoming people” in the region. This description makes it seem that all Cambodians are the same, and all Cambodians are happy to have volunteers and the supposed good they bring with them. This description sets up the expectation that Cambodians will play the part of smiling and grateful recipients. Host communities may cater to the volunteers’ desire for intimacy and allow them to live out their savior dreams of helping the less fortunate who cannot help themselves. By acting in any other way, they risk alienating volunteers and losing funding or other benefits. While this section has focused on what the text on these websites says, it is just as interesting to note what has been omitted. One example is International Volunteer HQ’s omission of the reasons why teaching English is important for young Cambodians. This project description failed to mention any systemic or institutional problems with education in Cambodia, instead focusing on how the contribution of the volunteer will bring children out of poverty. Additionally, it failed to address the fact that volunteers often teach only low-level lessons, and it did not mention any higher-level lessons or continued English learning after these basics. The sole focus on the volunteer’s ability to help leaves much to be desired. Can any real change occur for the Cambodian children as a result of these English lessons? Another example is the contrast between the mention of Angkor Wat and the omission of the Khmer Rouge. While five out of the six websites referred to the Angkor Wat temple complex, only three mentioned the Khmer Rouge regime. Of these, Plan My Gap Year only mentioned it in part of a volunteer review, and Projects Abroad and New Hope Volunteers devoted only a single sentence to the topic. There was no mention of any of the details of the regime or the atrocities that occurred. 75 There are a few reasons that could help explain the neglect of the Khmer Rouge regime on volunteer tourism organization websites. First, this may support the emphasis on the safety which is advertised to potential volunteer tourists, as discussed above. Second, the historical influence of the Khmer Rouge on Cambodia has contributed to continuing poverty and systemic problems in Cambodia. By neglecting to discuss certain historical events and their modern-day influences, volunteer tourism organizations shift the problems from historical and systemic issues to small individual issues. Volunteer tourists are helpless to change an entire system, but they may believe they can change individual problems in small communities if the issues are not deeply rooted. This gives volunteers the idea that, as helpers and mentors, they can counteract the negative influences within the community and provide the means for real change. Analysis Through A Postcolonial Lens These words and visuals point to even deeper issues of postcolonialism and neocolonialism. As discussed above, postcolonialism is concerned with the lingering effects of colonialism on formerly colonized countries (Tyson). Neocolonial analysis argues that these countries are still being dominated and exploited by former colonizing countries (Bruce). The visuals and language discussed above place volunteers in the center and host community members in the periphery. The persuasive techniques used to address the volunteer tourist while neglecting the host community may contribute to postcolonial and neocolonial attitudes and effects. When volunteer tourism organizations use these kinds of words and imagery to attract potential volunteers, they are perpetuating the postcolonial character of international volunteer service in host countries and host communities. 76 This is reinforced by the way that host community members are depicted as dependent on volunteers. When volunteer tourism organizations show host community members as being taught, receiving gifts, sharing physical affection, and so on, they strengthen the idea that these communities need help from volunteers in order to advance. On a larger scale, these portrayals perpetuate the narrative that Westerners must provide aid, advice, and assistance in order for developing countries to become developed. These ideas contribute to a postcolonial worldview because it reinforces the idea that developing countries, often former colonies, require the presence of Westerners, often former colonizers. By pushing the idea that developing countries are reliant on the charity of developed countries, continued domination and exploitation of these countries is implicitly justified. The idea that “the West knows best” — that Western development is a universal model — fails to consider systemic and cultural differences may make such methods impractical or even impossible. CONCLUSION This thesis has presented an analysis of the visual and textual persuasive strategies employed by volunteer tourism companies to advertise and draw in potential volunteers, and has shown how these strategies contribute to postcolonialism, Western supremacy, and the white savior complex. I examined the websites of six volunteer tourism organizations to see how their images and words sought to persuade volunteers to participate in one of their programs. Each website’s home page and page about volunteering in Cambodia were reviewed and described thoroughly, providing a picture of the similarities and differences in how they use their online presences. Many of the 77 websites displayed similar methods of persuasion. The volunteers pictured on all websites were predominantly young, attractive, white females. Volunteers were usually pictured with young children, usually teaching or embracing them. Other pictures often portrayed attractive landscapes or tourist destinations as another way to lure potential volunteer tourists to their programs. These organizations invoked similar themes and even used similar language. There was a focus on safety and security, low program costs, and lifechanging benefits to volunteers through “authentic” experiences abroad. The persuasive techniques used by the six volunteer tourism companies draw heavily on postcolonial attitudes and the white savior ideal. By painting a picture of the developing country and its host communities as dependent on the goodwill of the volunteer tourist, these organizations actively perpetuate feelings of American exceptionalism and white saviorism. This could lead to a sort of guilt or duty felt by Westerners to “save” these developing countries by asserting Western ideas of development on them, with little regard to the actual needs or desires of the host countries themselves. Additionally, many of these organizations did not require any sort of experience or expertise for their projects. This implies that, although these volunteers are inexperienced and lack practical knowledge of the projects they are doing work on, their presence and assistance is valuable anyway simply because they are Westerners. This research seeks to make a timely contribution to the scholarly fields surrounding volunteer tourism by analyzing the online persuasive techniques of volunteer tourism organizations. Considering the fact that volunteer tourism is a rapidly growing industry, and that most volunteer tourists are young people, this analysis of online persuasive techniques aims to provide more insight into how volunteers are recruited. 78 Understanding online advertising and persuasion can help shed light on why volunteer tourism is such a rapidly growing industry. Additionally, it helps to explain some of the postcolonial and white savior ideas that influence volunteers before, during, and after their participation in a trip. Although this thesis has addressed areas of volunteer tourism that have not yet been explored, there are many other areas that deserve further research. One possibility is a similar study using the approach of critical rhetorical theory, where the researcher would be an active observer within the system. Such researchers could stay in the locations they are studying with the subjects they are studying, gaining trust over time and immersing themselves in projects. A study such as this would focus on a critique of the systems governing domination and freedom, and work to identify specific power imbalances within these systems. It would also look at how these systems of power are reinforced by rhetoric used by institutions and people involved in volunteer tourism. This methodological approach would be especially important in instances where the research concerns contrasting parties and complex cultural relations, which is precisely what is involved with volunteer tourism. A critical rhetorical theorist could also apply this research over a longer period of time and analyze the sentiments of volunteer tourists and host community members concerning the persuasive strategies used online by volunteer tourist companies. Other future research questions could include: How do persuasive strategies by volunteer tourism companies differ on social media platforms? Do benefits for Westerners override the burden on the Global South? How can we better prepare participants for international service in order to amplify the positive effects? How can we 79 bring an awareness of Western supremacy and the white savior complex? How can Westerners better support local communities and their needs? In the meantime, as scholarly research works to document the rapidly growing field of volunteer tourism, there are other voices speaking up about the issues of international volunteer tourism. As a high school student, Pippa Biddle participated in a volunteer trip abroad to Tanzania, where she and her fellow volunteers worked to build a library at an orphanage. Originally, they believed that the local men who helped them every day would show up late because they were not invested in the project they were working on. But, one morning, Biddle saw something that changed her view entirely. She woke up early to go outside and run laps along the wall of the building where she and the other volunteers stayed. Biddle was on a cross country team at home, and she wanted to make sure she practiced while she was away. On one of her early-morning runs, she noticed a group of local men laboring at the site of their construction project. It was apparent that the local men had to redo the labor that the group of volunteers had done the day before, and redo it early enough that the volunteers would not notice when they arrived. In effect, the volunteers had increased the workload on the local community. This was why the men were always late to help with construction: they needed a break after their early-morning labor. Now, Biddle is just one of many individuals and organizations working to publicize the problems associated with volunteer tourism. She tries to raise awareness about issues with volunteer tourism abroad, including the ineffectiveness of many programs and the burden placed on host community members. Biddle has sparked a global debate on the ethics of voluntourism, and her story is a cautionary tale for would-be volunteers (Biddle; Brown). As people consider the text 80 and images of various websites, they need to carefully weigh not only the benefits they might gain from their volunteer tourist experience abroad, but also the impact of their visits on host communities. 81 REFERENCES Biddle, Pippa. “The Problem With Little White Girls (and Boys): Why I Stopped Being a Voluntourist.” PippaBiddle.com, 18 Feb. 2014, pippabiddle.com/2014/02/18/theproblem-with-little-white-girls-and-boys/. Bocci, Melissa. “Service-Learning and White Normativity: Racial Representation in Service-Learning's Historical Narrative.” Michigan Journal of Community Service Learning, 2015. Brown, Beverly. “Can Help Hurt?” Harvard Political Review, 11 June 2018, harvardpolitics.com/online/can-help-hurt/. Bruce, Marc E. “Portrayals of Voluntourism through a Postcolonial Perspective.” Bachelor’s thesis, Lund University, 2018. Campelo, Adriana, et al. “Visual Rhetoric and Ethics in Marketing of Destinations.” Journal of Travel Research, vol. 50, 2010, pp. 3–14., doi:10.1177/0047287510362777. Carmichael, Robert. “UNICEF Children as Commodities: Combating Cambodia’s Orphanage Racket.” UNICEF Cambodia, UNICEF, 30 Mar. 2016, unicefcambodia.blogspot.com/2016/03/children-as-commodities-combating.html. Chandler, David P. A History of Cambodia. 4th ed., Westview Press, 2008. “Child Protection: UNICEF Country Programme 2016-2018.” 2018. Cohen, Erik, and Scott A. Cohen. “Current Sociological Theories and Issues in Tourism.” Annals of Tourism Research, vol. 39, no. 4, 2012, pp. 2177–2202, doi:10.1016/j.annals.2012.07.009. 82 Conran, Mary. “They Really Love Me! Intimacy in Volunteer Tourism.” Annals of Tourism Research, vol. 38, 2011, pp. 1454–1473, doi:10.1016/j.annals.2011.03.014. Cottle, Simon, and David Nolan. “Global Humanitarianism And The Changing AidMedia Field.” Journalism Studies, vol. 8, no. 6, 2007, pp. 862–878, doi:10.1080/14616700701556104. Crabtree, Robbin D. “The Intended and Unintended Consequences of International Service-Learning.” Journal of Higher Education Outreach and Engagement, vol. 17, 2013. Dunne, Tim, et al. International Relations Theories Discipline and Diversity. 4th ed., Oxford University Press, 2007. Fordham, Traci. “Pedagogies of Cultural Change: The Rotary International Youth Exchange Program and Narratives of Travel and Transformation.” Journal of Tourism and Cultural Change, vol. 3, no. 3, 2006, pp. 143–159, doi:10.1080/14766820608668492. Guiney, Tess. “Destination Cambodia: A Volunteer Tourism Boom.” The Handbook of Contemporary Cambodia, 14 Sept. 2016. Hanchey, Jenna N. “All of Us Phantasmic Saviors.” Communication and Critical/Cultural Studies, vol. 15, no. 2, 21 Feb. 2018, doi:10.1080/14791420.2018.1454969. Henry, Jacob. “Volunteer Tourism: The Potentiality of a Public Pedagogy.” Master’s thesis, Memorial University of Newfoundland, 2017. 83 Hernandez-Maskivker, Gilda, et al. “The Impact of Volunteer Tourism on Local Communities: A Managerial Perspective.” International Journal of Tourism Research, vol. 20, no. 5, 2018, pp. 650–659., doi:10.1002/jtr.2213. Huggan, Graham. “The Neocolonialism of Postcolonialism: A Cautionary Note,” Links & Letters, vol. 4, 1997, pp. 19–24. “Introduction to the ECCC.” Extraordinary Chambers in the Courts of Cambodia, Extraordinary Chambers in the Courts of Cambodia, 2019, www.eccc.gov.kh/en/introduction-eccc. Jakubiak, Cori. “Ambiguous Aims: English-Language Voluntourism as Development.” Journal of Language, Identity & Education, vol. 15, no. 4, 2016, pp. 245–258, doi:10.1080/15348458.2016.1195270. Johnson, Dana E., and Megan R. Gunnar. “Growth Failure In Institutionalized Children.” Monographs of the Society for Research in Child Development, vol. 76, no. 4, 2011, pp. 92–126., doi:10.1111/j.1540-5834.2011.00629. Kwon, Roy. “How the Legacy of French Colonization Has Shaped Divergent Levels of Economic Development in East Asia: A Time-Series Cross-National Analysis.” The Sociological Quarterly, vol. 52, no. 1, 2011, pp. 56–82, doi:10.1111/j.15338525.2010.01194. “LIFE-CHANGING INTERCULTURAL EXPERIENCES.” Love Volunteers, Love Volunteers, www.lovevolunteers.org/. Mingst, Karen A., and Ivan M. Arreguin-Toft. Essentials of International Relations. 6th ed., W. W. Norton & Company. 2014. 84 Park, Hyung Yu. “Tourism as Reflexive Reconstructions of Colonial Past.” Annals of Tourism Research, vol. 58, 2016, pp. 114–127., doi:10.1016/j.annals.2016.03.001. “Plan My Gap Year Affordable & Trusted Volunteer Abroad Programmes.” Plan My Gap Year, www.planmygapyear.co.uk/. Power, Samantha. A Problem from Hell: America and the Age of Genocide. Harper Perennial, 2002. “Projects Abroad US | Volunteer Abroad Programs.” Projects Abroad Inc., Projects Abroad Inc., www.projects-abroad.org/. Ralston, Linda. “Tourism Planning and Sustainable Development,” Materials for PRT 5610, International Tourism, University of Utah, Spring 2019. Ruhfus, Juliana. “Cambodia’s Orphan Business.” Aljazeera, 27 June 2012, www.aljazeera.com/programmes/peopleandpower/2012/05/201252243030438171 .html. Tyson, Lois. “Postcolonial Criticism.” Critical Theory Today: A User-Friendly Guide, 3rd ed., Routledge, 2014, pp. 398–442. Ung, Loung. First They Killed My Father. Harper Perennial, 2006. “Vietnam War Timeline.” History.com, A&E Television Networks, 13 Sept. 2017, www.history.com/topics/vietnam-war/vietnam-war-timeline. “Volunteer Abroad Programs with IVHQ - Most Affordable & Trusted.” International Volunteer HQ, International Volunteer HQ, www.volunteerhq.org/. Volunteering Solutions. “Why Volunteer Abroad With VOLSOL?” Volunteering Solutions, www.volunteeringsolutions.com/. 85 “WELCOME TO NEW HOPE VOLUNTEER ABROAD.” New Hope Volunteers, New Hope Volunteers, www.newhopevolunteers.org/. Woosnam, Kyle M., and Yoon Jung Lee. “Applying Social Distance to Voluntourism Research.” Annals of Tourism Research, vol. 38, no. 1, 2011, pp. 309–313., doi:10.1016/j.annals.2010.06.003. 100 Name of Candidate: Shaelyn Barber Birth date: October 30, 1996 Birth place: Salt Lake City, Utah Address: 952 East Millstream Way Bountiful, Utah, 84010 University of Utah UNDERGRADUATE RESEARCH JOURNAL THE LANGUAGE OF CONSENT by Austin Buttars Department of Linguistics and the Honors College With Dr. Scott Jarvis Abstract There has been a lot of focus in academic institutions and in the media on what can/cannot constitute consent and how people should go about obtaining consent in a very prescriptive way. They have failed to ask themselves how people are utilizing consent in a colloquial manner, ignoring how people currently understand and utilize language in order to request and give consent. Attempts made to improve this understanding lack direction, because they do not fully understand from where they are trying to improve. This is an empirical study that will compare how males and females understand and use the language of consent, specifically in contrast to the legal language that governs consent, as well as the potential gender difference in how consent is utilized and understood. This study focused on two different conditions for how participants interpret the language surrounding consent. The first condition included Utah’s state laws on the use of consent in courts, and the second did not. Both surveys were comprised of a discourse completion task and a judgment task. In the discourse completion task the subjects were asked to complete a dialog with the goal of either giving or denying consent in each situation. In the judgment task the subjects read a situation and then were tasked with judging whether or not consent had been given based on the dialog they read. The data from all scenarios were run through a chi square test to see if people’s gender, age, or if seeing the laws caused a difference in how people interpreted if consent had been given. ii TABLE OF CONTENTS ABSTRACT ii INTRODUCTION 1 PARTICIPANTS 5 STIMULI 8 PROCEDURE 10 RESULTS 10 DISCUSSION 12 REFERENCES 16 iii INTRODUCTION Consent is something that everyone thinks is important to understand, but struggle to explain. Young adults in particular are not certain what exactly constitutes consent, and in response both the media and universities have tried to prescribe particular language to use to ask for and to give consent, with mixed results. This approach ignores how people are currently using language to this end, and is effectively an attempt to solve a problem without first identifying the source of the problem. Without first examining how people use language for consent differently, any prescribed language will struggle to bridge any communication gaps that may exist. The laws that govern consent are not widely known, and they are supposed to provide a framework for what does and does not constitute consent. This study was interested in looking at how people understand the language of consent in particular situations, with the goal of identifying any situations in which people could have different expectations about what constitutes consent. Universities have been struggling with the issue of consent now for a while, leading many of them to issue guidelines for what does and does not constitute consent. Here is one example created by a university in order to teach high school students about consent: (FLASH 2) 3. Rob and Elena are in the library, working on a school report. At the computer station, Rob begins to give Elena a backrub. “This research is boring,” he says. Elena shrugs her shoulders under his hands. Rob puts his arms around her from behind and pulls her close to him. Elena leans forward and hisses, “Cut it out, you’re going to get us in trouble.” Rob pulls her into the corner. As Elena puts her hands on his chest and tries to push him away, he pulls her to him and kisses her.  Was there consent in this scenario? What did the person say or do to let you know?  If you have time, read and discuss Scenario 4. While these kinds of examples are useful to a limited extent, they have several limitations. Firstly they rarely focus on situations where consent is given, instead focusing on how a party should deny consent. While this is obviously useful for young adults to see what consent does not look like, it leaves them just as in the dark over what consent does look like. This could lead students to assume that as long as the response looks different it could be consensual. The bigger problem with these kinds of examples, though, is that these situations are usually just not realistic. Many young adults will not find themselves in situations where the question of consent can be answered in such a black-and-white manner. Other universities have used their freshman orientations to try and prescribe how their students should use language in order to ask for and give consent. At the University of Utah, staff tell students that they should always obtain “enthusiastic consent” before engaging in any sexual acts. This interaction would look something like: Brian: Hey Sam! Wanna have sex? Sam: Hey Brian! Of course I would! I’m so excited! This recommendation also falls into the same trappings of the previous. While not strictly bad advice, it just simply is not practical advice. This advice has its roots in the way language is frequently used in law. In 1962, when J. L. Austin was describing his taxonomy of the performative uses of language, he described legal language as words that preformed specific legal actions as long as certain situational factors were in place. This has led courts, particularly when people’s language has been involved, to interpret what people say extremely literally. For example, when people have tried to invoke their Miranda Rights, courts have been liable to only consider their rights invoked if suspects used very specific language in order to invoke them (Ainsworth 2008). So universities have looked to this to provide a framework for how consent should be judged. People should be very direct and clear with their langauge in order to be sure that the way that they are interpreting the sitution is correct and that courts will agree with that interpretation of the situation. Again, on the face of it there does not seem like very much is wrong with that advice. However, just as Ainsworth observes in how Miranda Rights are used, in practice many problems start to appear. For starters, people tend to not be familiar with exactly what the laws that cover consent are, or with legal language in general. As Ainsworth observes in her examination of Miranda Rights in Practice: “Legally naive speakers are often unaware that a script exists prescribing the language needed for legal efficacy. When their language fails to track the script, they are unable to achieve their desired legal ends” (Pg. 2). When you restrict what has to be said in order to achieve a desired outcome, there will inevitably be people who think they have effectively communicated something, and, although anyone could see what they were trying to say, they will not have done exactly what they were supposed to do legally. Interpreting consent like this, just like how courts are interpreting whether or not people had invoked their Miranda Rights, fails to allow room for linguistic interpretation. Part of the problem relates to Gricean implicature. H. P. Grice (1989) set up the pragmatic structure that explains how two people can understand what is being communicated, even if what is literally being said would make little to no sense if take individually. For example: 1: Hey, there’s a movie on later? 2: Eh, I have work tomorrow. 3. Okay maybe on Saturday. If you take each line literally and on its own with no context this would seem nonsensical. One person begins with naming a time for a movie, the second mentions work at an even later time, then the first person mentions an even later time with no context. Through Gricean implicature, however, we can see that what each line implies connects each statement. When the movie is mentioned it is implied that the second person is invited to go to that movie with the first. The second person then mentions work, which implies that they cannot go to the movie later because of work the next day, a common excuse for not being able to go to an activity with an associate. The first person then mentions Saturday as an attempt to extend the invitation to the movie for Saturday instead of later that day. The contest and cultural knowledge of both parties are vital for the conversation to make sense. As Ainsworth puts it, “In order for Gricean implicature to result in successful communication, the parties to the exchange must share frames of cultural meaning” (p. 6). According to the principles of normal conversation that Grice describes, people would frequently give and ask for consent without explicitly verbalizing what they think is going on because they think it is implied by the context of the conversation. This is where many miscommunications can occur, however, because if both parties do not “share frames of cultural meaning” they will have different ideas of what exactly is implied by their actions and/or statements. There is also the significant question of power imbalances. Sexual situations can create power vacuums that will change the way both parties communicate and how they should be understood. “Someone will express themselves using hedged or indirect language is increased (more frequent) when there is power asymmetry between the parties, with the relatively powerless speaker unlikely to make direct and unhedged demands upon the more powerful party” (Ainsworth 2008 p. 7). Basically, people use various strategies to soften demands upon someone who they perceive to have more power than themselves (O’Barr and Atkins 1980). In addition to this, Stygall (2008) pointed out in relation to interrogation: “Some among them may want to please the interrogator and say what they believe the interrogator wants them to say, while others may believe that it is disrespectful to contradict a police officer” (p. 1). While interrogation is obviously a different kind of situation than a sexual one, many of the same factors would come into play with a lover as with an interrogator. Everyone wants to their love interest to be pleased and believe what they have to say, and rejection as a negative emotion could be perceived as a slight against someone whose opinion is very important to you. So you can expect many of the more sensitive rejections to be full of hedging, not direct as courts seem to expect. People use this language to soften the blow of rejection as much as they can manage. This clearly shows that a requirement for things like “enthusiastic consent” will only ever be a partial solution, and it will accurately judge all these kinds of situations. Why then should Linguistics be involved with in issue? Well, this comes at a time when linguists are becoming more involved in courtrooms (Shuy 2007). As experts in the structure of language as well as the cultural factors associated with it, it makes sense that linguists would help to clarify the situation. To this end, I have designed a study to look into how people use the language of consent colloquially. Hopefully this will begin to build a foundation for how this language looks in realistic situations. It will also help identify when different groups of people have different cultural understandings of the same situation, what might explain that difference, and pave the way for bridging those gaps in understanding for future generations. This study will focus primarily on heterosexual relationships, and present participants with eight situations. They judge if they think that consent had been given, and then I will run a chi square test to test for differences. PARTICIPANTS Participants were recruited using Mechanical Turk, an online survey service operated by Amazon that allows researchers to pay for people to complete their surveys. At a cost of one cent per participant I was able to gather around four hundred responses within 48 hours of putting both surveys online. Each survey had a fairly even gender distribution between males and females, with a small minority identifying as genders other than those two. The age distribution for both surveys was slightly skewed toward younger participants, but not in a way that had an effect on the resulting data. Many participants only completed part of the survey, so the data on the questions did not always match up with the demographic information, as that was the very first part of the survey. Even so, the demographics represented on the graphs were representative of the age and gender distributions of all the resulting questions. Figure 1 and Figure 2 below show the gender and age distribution of the survey that presented the laws before the situations. Survey With Laws Gender Distribution Number of Participants 250 189 200 150 94 100 93 50 2 0 Male Other Female Total Gender Figure 1 Survey 1 Age Distribution Number of Participants 250 186 200 150 100 80 61 34 50 11 0 0 0-17 years old 18-30 31-45 46-60 Age Ranges Figure 2 60+ The following graphs show the gender and age distributions of the second survey, which did not include the laws before the scenarios. Survey Without Laws Gender Distribution Number of Participants 250 196 200 150 106 87 100 50 3 0 Male Other Female Total Gender Figure 3 Survey Without Laws Age Distribution Number of Participants 250 195 200 150 100 75 82 50 21 17 46-60 60+ 0 0 0-17 years old 18-30 31-45 Total Age Range Figure 4 STIMULI Participants were first asked a series of demographical questions in which they identified their gender, age group, native language, and how long they have lived in the United States. Then, depending on the survey that they were taking, the participants would either see Utah’s laws governing consent taken from the state’s website (shown below) or they would move straight into the scenarios. Directions: Please mark if you think consent was or was not given in each scenario. Consider the following laws before you make your decision. Under Utah law, sexual offenses “without consent” of the victim arise when: 1. The victim expresses lack of consent through words or conduct; 2. The actor overcomes the victim through the actual application of physical force or violence 3. The actor is able to overcome the victim through concealment or by the element of surprise; 4. The actor coerces the victim to submit by threatening to retaliate in the immediate future against the victim or any other person, and the victim perceives at the time that the actor has the ability to execute this threat; or (“to retaliate” includes threats of physical force, kidnapping, or extortion) 5. The actor knows the victim is unconscious, unaware that the act is occurring, or physically unable to resist; 6. the actor knows that as a result of mental disease or defect, or for any other reason the victim is at the time of the act incapable either of appraising the nature of the act or of resisting it; 7. The actor knows that the victim submits or participates because the victim erroneously believes that the actor is the victim's spouse; 8. The actor intentionally impaired the power of the victim to appraise or control his or her conduct by administering any substance without the victim's knowledge; 9. The victim is younger than 14 years of age; 10. the victim is younger than 18 years of age and at the time of the offense the actor was the victim's parent, stepparent, adoptive parent, or legal guardian or occupied a position of special trust in relation to the victim; 11. the victim is 14 years of age or older, but younger than 18 years of age, and the actor is more than three years older than the victim and entices or coerces the victim to submit or participate, under circumstances not amounting to the force or threat required under Subsection (2) or (4); or 12. the actor is a health professional or religious counselor, the act is committed under the guise of providing professional diagnosis, counseling, or treatment, and at the time of the act the victim reasonably believed that the act was for medically or professionally appropriate diagnosis, counseling, or treatment to the extent that resistance by the victim could not reasonably be expected to have been manifested. Utah Code Ann. §76-5-406. The scenarios consisted of 12 situations, four multiple choice tasks and eight fillin-the-blank tasks. For the multiple choice tasks, participants were asked to read a given situation and then mark if they thought consent had, or had not, been given. For example: Addison and Alex are best friends and are at a party together. Addison notices that Alex is drinking a lot and starting to slur her words. Ashton, a cute guy at the party, approaches Alex, who is totally drunk. Ashton says “Hey Alex, you wanna go upstairs?” Alex doesn’t really say anything, but she nods. Ashton takes her by the hand and they go upstairs and have sex. Do you think consent was given? For the fill-in-the-blank tasks, participants would read a particular scenario, and then be asked to fill in what they would say in that situation in order to give consent, and also what they would say in order to deny consent. There were four scenarios, with two questions each which made for a survey of 12 questions, not including demographical questions. For example: Jaime and Jayden are best friends and are at a Halloween party together. Jaime notices that Jayden is drinking a lot and starting to slur her words. Jese, a cute guy at the party, approaches Jayden, who is totally drunk. Jese says “Hey Jayden, you wanna go upstairs?” What would Jayden say to give consent? What would Jayden say in order to not give consent? PROCEDURE In order to test if seeing the laws before the scenarios would have any effect on how participants interpreted the different situations, I constructed two surveys. The first included the laws before the different scenarios, and the second did not. Then, after the data was gathered I used a chi square test to test for the effects of gender, age, and seeing the laws. RESULTS After running all of the statistical tests, I found two statistically significant results. The first was a statistically significant difference between males and females in their responses to the following situation in the task where participants saw the laws. Devon walked Dakota home after they saw a movie together Friday night. When they got to Dakota's house, they stood talking for a while. When Devon gave Dakota a hug goodnight, Dakota responded with a quick kiss on the lips. Devon smiled and said, “Can we do that again?” Dakota laughed, and they kissed for a long time. They went inside and kept kissing. “Maybe we can really have some fun now?” asks Devon. Dakota only manages to say “well..” before he starts kissing her again. They then are intimate. Do you think consent was given? As can be seen in Figure 5, males (56/75) were more likely than females (50/84) to interpret the scenario above as consensual, with a chi square test yielding a p-value of < 0.05. Gender Comparison 60 56 50 Number of Participants 50 40 34 30 19 20 10 0 1 Male Yes 2 3 Male No Female Yes 4 Female No Figure 5 The second statistically significant result was a difference between participants who had seen the laws and those that hadn’t. This scenario is shown below: Cameron and Charlie are in the library, working on a school report. At the computer station, Cameron begins to give Charlie a back rub. “This research is boring,” he says. Charlie turns around and grins at him. “Yeah, it is, compared to what we could be doing,” she says. Cameron puts his arms around her and pulls her close to him. Charlie puts her arms around his neck and laughs, “Cut it out, you’re going to get us in trouble.” Cameron pulls her into the corner. Giggling, they kiss. Do you think consent was given? As can be seen in Figure 6, participants were more likely to interpret the scenario as consensual if they had seen the laws (139/158) than if they hadn’t seen the laws (127/159). This difference yielded a p-value of < 0.05. Law Comparison 160 140 139 127 Participants 120 100 80 60 32 40 19 20 0 1 2 3 4 Yes Without Laws No Without Laws Yes With Laws No With Laws Figure 6 DISSCUSSION I think that the feature that explains the male/female difference shown in Figure 5 can be found in this line: Dakota only manages to say “well..” before he starts kissing her again. This sentence comes towards the end of the scenario and seems to indicate hesitation from Dakota. Since males were more likely to interpret this as consensual than females were, males may be more likely to interpret hesitation as consensual than females are. The feature that could explain the difference between participants who saw the laws first and those who did not see them at all can be found in this excerpt from the laws provided: 1. The victim expresses lack of consent through words or conduct; Many universities now prescribe what they refer to as ‘enthusiastic consent’, where both participants are asked if they consent to a particular answer, and their answers should be something like “Yes!” The law, however, does not necessarily require that same moment, and this first rule indicates that consent can be given non-verbally. The situation in question does not include a moment of ‘enthusiastic consent’, but both participants’ behavior (conduct) seems to indicate consent for both parties. This explains why subjects were more likely to mark that scenario as consensual after they had read the laws than if they had not read the laws. As this was an online survey, there were a number of factors that I could not control for. One of the biggest factors was whether or not subjects of the first survey actually read the laws provided before clicking next or if they just skipped over it. With the benefit of hindsight and after talking to several people about my project, there were a couple of ways that I could have better controlled for the later situation. Within Qualtrics, which was the tool I used to build my surveys, there is a function to make it so that subjects would have to spend a certain amount of time on a particular page before moving on. This way I could have been more sure that the subjects had actually spent some time looking at the laws before they moved on. Alternatively, I could have had some comprehension questions after the laws in order to test subjects on how well they had absorbed what they had read. Unfortunately I thought of neither of those things until long after I had gathered all of my data. Secondly, I had a big problem with people only completing parts of the survey instead of the whole thing, including an large number of subjects who simply filled out the demographical information and answered none of the other questions, which meant that not all of the questions had the same population answering them, which could have skewed the data on any of the given questions. And, lastly, I have no real way of controlling for participants who simply clicked through my survey as fast as they could, and did not actually complete all of the tasks thoroughly. I had a small control for this in the form of the last eight questions, which asked the subjects to fill in the blank for several scenarios, which highlighted the most uncooperative subjects because they would input answers like “;afjdkl” or “ “ which clearly showed that they were not taking the survey seriously. Ultimately, even with this, it is difficult to say how engaged my subjects actually were with the tasks. To solve some of these problems I think that the next step in this research would be to replicate this study on a smaller scale, but in a more controlled environment to see if the differences found here persist when these variables are controlled. Subjects being monitored in labs as they took the survey on the computer would ensure that the survey was taken more seriously, although the population represented would be more constrained as most likely such a study would draw mostly college-aged participants, where this study had a much broader population. Further research should also be done to examine how consent is communicated and understood in other kinds of relationships. This study focuses on heteronormative relationships, and other kinds of relationships warrant their own studies. When I was setting up the surveys to distribute for this study, I considered trying to include more kinds of relationships in my scenarios, but this would have been assuming that heterosexual relationships are exactly the same as homosexual and other kinds of relationships. Since I had no evidence that they were the exact same, I would have had to have many more questions in the survey in order to still adequately cover all types of relationships, so I decided to focus on a particular kind of relationship in order to allow me to put out a smaller survey. Additionally, and it may just be male bias coming through me as the writer, but most of my scenarios had male ‘aggressors’ if either participant could be seen as one. It would be interesting to do another study with female ‘aggressors’ to see if that affects how people interpret the same kinds of situations. More studies in these areas are clearly required, as well as studies that focus more on court cases and how their rulings differ from how experts and the public would interpret the situation, like Ainsworth did in her 2008 study. In addition, a study into how power dynamics affect how people use language in sexual situations, similar to the study run by Stygall (2008) would be very beneficial. It would be important to identify common power dynamics in different relationships and how those couples communicate. Furthermore, I think it is very important that linguists continue to try to answer this very tough question. So many young people are still very confused about what does and does not constitute consent, and when people have different ideas about what consent could look like, the results can be terrible. Research by linguists can show what gaps there are in what different people think is consent, which then could make it possible to design more effective programs to teach people about consent. We need to know what differences are real and why they occur in order to solve this very real problem. Like Ainsworth’s 2008 study that showed the issues many people were having with the language courts used to decide if someone had invoked their Miranda Rights, this study was trying to identify differences between how consent is judged in court and how it is judged in everyday life. Finally, below are links to one of the surveys, so you can go through all the questions and see what this survey was like. Also feel free to use them in any future research. https://qtrial2018q4az1.az1.qualtrics.com/jfe/form/SV_cU98BlVShYczJaZ References Ainsworth, Janet. "‘You have the right to remain silent...’ but only if you ask for it just so: the role of linguistic ideology in American police interrogation law." The International Journal of Speech, Language, and the Law (2008): 2-19. Article. Atkins, W. O'Barr and B. "Women's language or powerless language." Women and Language in Literature and Society (1980): 98110. Austin, J. L. "How to do Things with Words. (Second edition.) ." Harvard University Press (1962). Journal. Eades, Diana. "Language and disadvantage before the law." University of New England, Austrialia (2008): 179-195. Jounal. Erlam, Bronwen Innes and Rosemary. "Did he understand his rights? Assessing the comprehensibility of police cautions in New Zealand." The International Journal of Speech, Language, and the Law (2018): 22-51. Article. FLASH. "Coercion and Consent Scenarios." Seattle and King County (n.d.). Grice, P. "Studies in the Way of Words." Harverd University Press (1989). Group, Communication of Rights. "Guidelines for communicating rights to non-native speakers of English in Australia, England, and Wales, and the USA." Communication of Rights Group (2015): 1-12. Web. Shuy, Roger W. "Language in the American Courtroom." Language and Linguistics Compass (2007): 100114. Journal. Stygall, Gail. "“Did They Really Say That?” The Women of Wenatchee: Vulnerability, Confessions, and Linguistic Analysis." Journal of English Linguistics (2008): 220-238. Journal. University of Utah UNDERGRADUATE RESEARCH JOURNAL THAT’S WHAT SHE SAID: AN AUTOETHNOGRAPHIC STUDY ON CROSSGENERATIONAL FILIPINA-AMERICAN LANGUAGING AND LITERACIES Joanne Rose Andres Castillo (Dr. Christie Toth) Department of Writing & Rhetoric Studies Varying generations of Filipina-Americans communicate differently. The difference in the ways information is synthesized and perceived or received causes a significant amount of friction in the relationships between the generations as expectations and reality clash. In this autoethnographic project, I explored how meaning was intended to transfer and what meaning was received by three different generations of Filipina-Americans in a single family. Fieldnotes and interviews of three different women were coded and analyzed to identify emergent themes involving implicit expectations, contextualization, and what elements were deemed necessary in communicating information. Though this data analysis is ongoing, the following trends were noticed: the initial generations of Filipina-Americans were more likely to rely on implicit communication and a hierarchy of knowledges based on familial/social status. Younger generations seemed more likely to utilize digital technologies to determine specific locations to contextualize new knowledges. Continued analysis of the data gathered seeks to identify further themes which might indicate ways in which different generations make and relate knowledge. This research seeks to identify the literacies needed to transfer knowledge effectively in all directions between generations. University of Utah UNDERGRADUATE RESEARCH JOURNAL PLOSIVE ASPIRATION OF BILINGUAL, HARD-OF-HEARING CHILDREN Maison Evensen (Researcher), Tanya Flores (Mentor) Department of World Languages and Cultures This preliminary research is an examination of the language acquisition of bilingual (Spanish and English) children with and without hearing disorders over a two-semester period (Fall 2017 and Spring 2018). Stop consonants /p/, /t/, and /k/ demonstrate a burst of energy measured as VOT. In English, these include aspiration (notated as [pʰ] [tʰ] and [kʰ]). VOT is the time between the start of the consonant and the vibration of the vocal tract and average VOT ranges differ across languages (Appendix A). In English, average ranges are 20-90 ms for [pʰ], 30-100 ms for [tʰ], and 50-100 ms for [kʰ] (Lisker 1970). In Spanish, these values are much shorter and average ranges are 0-20 ms for [pʰ], 0-10 ms for [tʰ], and 10-50 ms for [kʰ]. As VOT is measured most clearly before vowels, consonant clusters in the data were excluded for this project. In the literature, it states that bilingual (English and Spanish) children may express English /p, t, and k/ tokens with shorter VOT’s (Fabiano-Smith & Goldstein, 2010b). In addition, deaf individuals showed abnormally short VOT’s pre-cochlear implant with some post-implant improvement (Lane & Perkell 2004). My research questions were the following: What effect(s) does bilingualism/hearing impairment have on VOT? What effect(s) do bilingualism and hearing impairment, together, have on VOT? The two variables are bilingualism and hearing impairment and the duration is a two-semester period from Fall 2017 to Spring 2018. There are three groups with 24 children total from grades pre-kindergarten to second grade. Control group one (C1) was made up of hard-of-hearing, monolingual English speakers, the target group (T) was hard-of-hearing, bilingual (English and Spanish) speakers, and control group two (C2) was made up of bilingual (English and Spanish) speakers with no hearing disorder. To capture the speech of the children, recording software was set up on a stable surface and the kids were prompted to tell a story to the data collector about pictures in a book without words. If needed, the collector would suggest possible actions taking place in the scenes to elicit more vocabulary output in order to obtain word-initial /p/, /t/, and /k/ tokens. In order to measure the duration of VOT, the recordings were transcribed and analyzed using the audio recordings and PRAAT, a computer software used for speech analysis. All the children were becoming English dominant as other research performed by Dr. Flores and I showed increasing difficulty with pronunciation of Spanish vocabulary and a growing English vocabulary. Various factors, such as Spanish-language influence, are included in the overall analysis. The results are preliminary. Overall, there was more production for all groups in the Spring, yet only 6 of the 24 children produced in both Fall and Spring (Appendix B). There was a large variation in the values for /k/ VOT across all groups and within group, some of which is expected due to language development and bilingualism in two of the three groups (Appendix C). Across the semesters, both the C1 and T groups' phonetic systems were constrained with little production and limited ranges for /p,t,k/ VOT values. I would hypothesize that this trend is due to the hearing impairment(s) of the children, however further testing would be needed to confirm. Future research is needed to collect more tokens of data and answer the research questions. Future experiments would involve word tasks that are English specific with only /p,t,k/ word-initial prompts. It would also be worthwhile to explore intervocalic and word-final tokens in addition to solely word-initial position. These modifications would expand the amount of data collected and it would be possible to compare aspiration in the same words, over time, by the various participants. Citations: Fabiano-Smith, L., & Goldstein, B. A. (2010b). “Phonological acquisition in bilingual Spanish Englishspeaking children”. Journal of Speech Language and Hearing Research, 53, 160-178. Johnson, K. (2012). Acoustic and auditory phonetics. Chichester: Wiley-Blackwell. Ladefoged, P. (2003). Phonetic data analysis: an introduction to fieldwork and instrumental techniques. Malden, MA: Blackwell Pub. Ladefoged, P. (2006). A course in phonetics. Southbank, Victoria, Australia Boston, MA: Thomson, Wadsworth. Lane, H., & Perkell, J. (2004). “VOT and hearing impairment”. The Journal of the Acoustical Society of America, 115.5, 10.1121/1.4782383. Retrieved from https://asa.scitation.org/doi/10.1121/1.4782383 Lisker, L., & Abramson, A. (1970). “The Voicing Dimension: Some Experiments in Comparitive Phonetics”. Proceedings of the Sixth International Congress of Phonetic Sciences, 6, 563-567. Appendices: (A) Measuring technique for /peso/ (English & Spanish pronunciations) (B) Mean VOT in ms for 6 participants (tokens recorded) (C) /k/ VOT range University of Utah UNDERGRADUATE RESEARCH JOURNAL VOICE ONSET TIME IN YOUNG SPANISH-ENGLISH BILINGUALS Student’s Full Name Ellie A. Kaiser (Tanya Flores) Department of World Languages and Cultures Literature Review One of the most fascinating lines of research in the field of linguistics today is the investigation of bilingual speech production and perception. While in many cases the prototypical linguistic subject has been a monolingual native speaker, there is now an increased interest in what bilinguals can tell us about the human capacity for language – even beyond the subfield of Second Language Acquisition. One of the major questions about bilingualism is whether bilinguals effectively function as two monolinguals, or whether they have a coexistent mental system for both languages – or somewhere in between these two ends of the spectrum. To begin to answer this question, we can look at the pronunciation of bilinguals in both languages. In more technical terms, we can study the phonetics (the physical properties of how sounds are articulated and produced) of their language to understand their phonology (the mental representations of sounds that are the beginning of making meaning from the arbitrary soundmeaning relationship). In particular, we tend to look at situations where a particular sound (or more technically, a phoneme) exists in both of the languages but is produced slightly differently in each. Flege and Hillenbrand (1984) hypothesized that in this case, second language (L2) learners would be unable to produce the sound authentically (meaning like monolinguals) in their L2 because the similarities in the sounds would interfere with their ability to distinguish the differences in the sounds (Flege and Eefting, 1987). Flege and Eefting (1987) explained some possibilities of how bilinguals may mentally map the sound systems of the two languages: they may have a “merged” system, meaning that they have a separate mental category for the sound in each language, or they may have a “coexistent” system in which each sound falls into the same mental category. Within the coexistent system, they may have mental rules which change the pronunciation in each language, but ultimately the sounds would have the same underlying representation. They hypothesize that a merged system (two separate phonetic categories) is beneficial to helping bilinguals produce the sounds in an authentic manner. For English and Spanish bilinguals, some of the most commonly studied sounds are the unvoiced stop consonants /p t k/ and their voiced /b d g/ counterparts, respectively. Sounds are called voiced when the vocal folds vibrate during their production, and vice versa. All of these sounds are called stops because they involve a complete obstruction of airflow followed by a release burst. Phonologically (according to our mental maps of what sound differences are meaningful), both English and Spanish have a voiced and unvoiced stop consonant category, but phonetically (in terms of the actual production of said sounds), the difference is articulated quite differently. Historically, linguists have looked at different acoustical cues to find what property of the sound it is that actually differentiates these categories. Glottal buzz, presence of aspiration, and amount of articulatory force are some of the acoustic properties that were studied, but these were inconsistent and hard to study. In 1964, Lisker and Abramson were the first to explore Voice Onset Time (VOT) as a measurement of the voicing distinction (Banov, 2014). VOT is the time between the release burst and the beginning of the pronunciation of the following sound (Zampini & Green, 2001). Since the 1970s, VOT has been the most common way of measuring the voicing distinction in bilinguals (Banov, 2014). In English, /p/, /t/, and /k/ are produced as long-lag stops: they have VOTs of more than 30-35 ms and are said to be “aspirated”. Their voiced counter parts /b/, /d/, and /g/ are produced as short-lag stops with VOTs less than 35 ms. In Spanish, however, the unvoiced /p/, /t/, and /k/ are short-lag stops with VOTs less than 35 ms, while the voiced /b/, /d/, and /g/ are prevoiced with a negative VOT – vibration of the vocal folds begins before the release burst. Therefore, in terms of VOT, there is a phonetic overlap between English /b d g/ and Spanish /p t k/ (Zampini & Green, 2001). Additionally, the idea of a “critical period” is important for understanding bilingual language. It is the idea that humans are only capable of learning a language to a monolingual standard by a certain age (often around the onset of puberty). Not only is there a lot of argument around when and why the critical period ends, but there is a lot of evidence for rejecting this theory (Flege & Eefting, 1987), leading to many scholars arguing instead for a “sensitive” period. In their 1987 study on the perception and production of stops by English-Spanish bilinguals, Flege and Eefting compared early childhood bilinguals to late childhood bilinguals and found that age of learning English alone could not account for all of the variation in mean VOT, but they did suggest that learning an L2 at an earlier age may assist in the creation of a merged phonetic system. Thornburgha and Ryallsb (1998) found that bilinguals who learned English after the age of 12 differentiated voiced from unvoiced stops to a greater degree, but that there wasn’t a significant correlation between age of learning and the overall mean VOT difference. Therefore, although the age at which one acquires their second language does have an effect on one’s mean VOT and differentiation between voiced and unvoiced stop, it is not the only variable of importance here. Some studies have found significant differences between genders, but the exact effect is inconclusive: Banov (2014) found females to have more monolingual-like VOTs than males in English /t/ and /k/, while Thornburgha and Ryallsb (1998) found that males contrasted voicing to a greater degree than females did. The quality of the L2 input may also have an effect (Flege & Eefting, 1987). Grosjean 1992 (as cited in Zampini & Green 2001) suggested that a failure to control for such factors may be what has lead to such varying results about bilingual production. It has also been shown that even among monolingual English speakers, there are systematic individual differences in mean VOTs (Allen & DeSteno, 2003). Another factor that has been identified as crucial in bilingual language production is that of language mode – perhaps bilinguals have different mental settings that can be activated by different situations and knowledge about the person or people they are speaking to. Different studies controlled for this factor in different ways, sometimes by starting half of the participants in one language mode and half in the other, sometimes by collecting data for each language on a different way, and sometimes by leading participants to believe that they had been recruited for two completely different studies (Banov, 2014; Flege & Eefting, 1987; Green & Zampini, 2001). To complicate matters further, Zampini and Green have conducted several studies highlighting the importance of an entirely different acoustic cue for differentiating voiced and unvoiced stops in Spanish: Voiceless Closure Interval (VCI), which is a measure of “the amount of time that elapses between the obstruction of the airflow and its release” (2001, p. 23). While in English, word-initial stops show no difference in VCI (Crystal & House, 1988), VCI alone is enough to distinguish unvoiced and voiced word-initial stops in Spanish (Martínez Celdrán, 1993) (as cited in Zampini & Green, 2001). Because VCI is essentially a measurement of the silence produced by the blockage of air to produce a stop consonant, it is indistinguishable in waveform from other unmeaningful silences. Thus, we can only measure it when it occurs in continuous speech after at least one other word. Zampini and Green’s work found that bilinguals and L2 learners may have different degrees of success in manipulating VOT vs. VCI to create the voicing distinction in Spanish. This shows that both the voicing contrast and the question of bilingual phonetic categories is complicated and multi-faceted. A final important piece of the puzzle is that of language acquisition. While the previous literature has focused on production of the voicing distinction in adult bilinguals, there is also some research on how this production is developed in both languages and in bilinguals at young ages. Most studies agree that the English short vs. long-lag distinction is acquired early – around the age of 2 years (Deuchar & Clark, 1996), while the Spanish short lag vs. prevoiced distinction is acquired later – Macken and Barton (1979, 1980 as cited in Deuchar & Clark, 1996) found that child speakers of Mexican Spanish did not have an adult-like contrast even by 4 years old, but that a contrast in the short-lag range was still possible at this age. Other studies found that by four years old, children have developed an adult-like voicing distinction including prevoiced stops. This difference has been hypothesized to be due to phonological differences in Spanish dialects, and the relatively late acquisition of prevoiced stops is suspected to be due to its low perceptual salience and difficulty to produce (Eilers, Oller, & Benito Garcia 1984). At the end of his thesis, Ivan Banov (2014) brings up some important questions about the nature of this line of study. First of all, the custom in the field is to compare bilinguals and L2 learners to “native” monolinguals, but how valuable is that standard? It is becoming increasingly recognized that the global standard is not monolingualism, and perhaps we should adjust our standards accordingly. Second of all, we know from studies such as Allen and DeSteno (2003) that individual monolinguals have systematically longer or shorter mean VOTs, but we judge bilinguals by the interpersonal averages. This begs the question of what the acceptable ranges of native VOT production are and where bilingual VOTs fit into this. Finally, Banov suggests that it might be useful to have a panel of monolinguals evaluating whether bilinguals’ productions sound native-like to see whether any systematic differences we see are significant enough to be perceived by monolingual speakers. While the present study does not seek specifically to address these issues, they are still important to keep in mind as we evaluate the purpose and scope of this work. The crucial distinction to make here is that while we compare bilingual production to monolingual production, we do so to answer interesting questions about how bilingual minds work rather than to judge bilingual differences as inadequacies. More research is needed to resolve some of the inconsistencies that have been found. While Deuchar and Clark (1996) and Eilers, Oller, and Benito-Garcia (1984) have analyzed the acquisition of these sounds by young bilinguals, they found results that differed from each other and from other studies. Additionally, newer research by Green and Zampini (2001) has brought up many concerns that they believed may have accounted for the great differences in results that have been found: fluency in L1 and L2, age of L2 acquisition, quality of L2 input, and language mode. They also looked at the additional acoustic factor of Voiceless Closure Interval, but this hasn’t been analyzed in young children’s acquisition. Because there is so much variability in these factors and therefore the results of studies, collecting data from a variety of sociocultural backgrounds and contexts can help add to the picture. The present study takes many of these factors into account and collected language background from the parents to better be able to understand what effect their linguistic experience may have. Additionally, this study will analyze natural speech rather than word lists or word repetition that some past studies have used. Finally, this study takes into account VCI in addition to VOT, as well as the cognate status of a word because recent theories of bilingual systems have suggested that a cognate words may activate both languages’ sound systems to a greater extent; Brown and Amengual (2015) found that for Spanish-English bilinguals, words starting with a dental stop (/t/ and /d/) in Spanish that were cognates with an English word were pronounced with more English-like VOTs. The Present Study The present work began as part of a larger study analyzing various aspects of the language development of young (3-4 years old) hard-of-hearing Hispanic children who are exposed primarily to Spanish in their homes but are enrolled in English-speaking schools (T. Flores, personal communication July 2017) . Unfortunately, because of difficulties with participant turnover and data collection, the original goal of comparing the pronunciations of hard-of-hearing and normal hearing children was unable to be realized. Instead, data from the “control” group of normal hearing bilinguals will be analyzed here. The previous research on acquisition of the voicing contrast in Spanish-English bilinguals suggests that the ages of 3-4 are critical in the development of the voicing contrast in Spanish, but many contradictory results have been found. Thus, more research is needed on these age groups to begin to understand the complexities of bilingual voicing contrasts and this analysis is valuable even without the comparison to hard-of-hearing groups. Because VCI can only be measured in non-utterance-initial position in continuous speech, the first data collection didn’t have enough tokens so it will not be analyzed in depth here. Also, there were too few cognate words to make a meaningful comparison so this data will not be discussed extensively here either. Thus, this analysis will measure the VOT of 10-15 tokens of /p t k/ and /b d g/ for six bilingual children. Prevoicing will also be measured both as part of the VOT and separately. Participants The participants in this study are six children – four female and two male – attending preschool in the Salt Lake Valley who speak Spanish in their homes and are exposed to English in the classroom and community. Their teacher is a Spanish-English bilingual. They were all between 3 and 4 years of age and had varying degrees of language dominance. None of them had any hearing or language deficits. Participants 13F, 14M, 17F, and 18F all produced data in both Spanish and English. 12F and 19M, however, only produced data in English and Spanish, respectively. Methodology Natural speech was collected from the children using “frog stories” (short picture books with illustrations but no words) about various adventures involving a boy and his pet frog. For each language a different story was used, and children were directed in that language to explain what was happening on each page of the book. This data was collected alongside a more structured language elicitation mechanism that was not used for the analysis in the present study. In most cases, data from different languages was collected on different days to avoid the possible conflating effect of language mode. The program Praat was used to create waveforms and spectrograms and to annotate these onto textgrids. First, an orthographic transcription was made of all the files and the children that produced the most tokens of word-initial /p t k/ and /b d g/ in each language were selected for this study. Four children had at least ten tokens in each language and were thus selected for this analysis. The participant with the fewest tokens was 17F, who had only ten tokens in English. Additionally, all of these tokens were used during the participant’s Spanish frog story; their English frog story had no usable tokens. Thus, 17F was the only participant for whom all the data was collected in the same session and with the same frog story. The first 10-15 tokens for each participant were collected. If the child produced a stop as its approximant allophone or some other non-stop form, or if the token was produced in such a highly coarticulated manner that it was impossible to distinguish the consonant, that token was skipped. Cognate status was determined by the judgments of the author, an L1 speaker of English and advanced L2 learner of Spanish. They were then corroborated by the research advisor, a Spanish-English bilingual. There was some question of the cognate status of the word “gato” (“cat”), which will be discussed later. In addition to these four participants, two more were chosen who had at least 15 tokens in one of their languages but few or no tokens in the other language. 12F had many tokens in Spanish but none in English; 19M had many tokens in Spanish but very few in English. VCI was measured only when the token occurred in running speech and there was not an audible pause before the word, as the length of the silence is only significant when it is part of the production of the consonant, not when it is merely a pause in speech. For this reason, tokens that occurred after the filler word “um” were also omitted because the use of a filler word would be expected to preclude a pause (and this is what was observed in many cases). In some cases, prevoiced tokens were produced with a release burst that moved straight into the vowel. In this case, VOT was reported as a negative number with the same absolute value as the prevoicing. When the consonant was prevoiced but also had a short-lag stop, both the prevoicing and the VOT were recorded as positive numbers. Thus the unique energy segments can be analyzed separately. Results As expected for natural language data from children so young, there was very little data; nevertheless, some tentative patterns emerge. At this point, no patterns in VCI or cognate status could be found. There were very few tokens to begin with, and because VCI is only meaningful in running speech and a very small portion of the words were cognates, neither of these measurements suggested any meaningful patterns. It is also possible that VCI has not yet been acquired by these children as a means for distinguishing their Spanish consonants. While Green and Zampini’s work on VCI didn’t include any research on acquisition by children, they do suggest that it is perceptively less salient than VOT, so it is possible that children don’t begin to utilize this acoustic cue until later. The following table shows the mean VOTs for each subject in each language for the various consonants. The consonants are paired with their voiceless and voiced counterparts according to place of articulation to make it clear what the consonant-specific voicing distinction looks like. While some of these means are based on as many as 10 tokens, others are an average of only one token, so they should not be taken as robust statistical measures, but merely as suggestions of a larger pattern. Because prevoiced tokens are by convention described with negative VOTs (because voicing begins before the release burst), they would not make meaningful averages when combined with positive values. Thus, they were excluded from this chart but indicated by an asterisk. They will be discussed separately later. Table 1 Results for Mean VOT by Language and Subject Mean English VOTs (ms) Mean Spanish VOTs (ms) Subject p b t d k g p b t d k g 12F 145.5 15.0 80.5 18.5 60.0 26.0 13F 43.0 17.5* 14.7 66.5 15.0 * 27.0 26.1 14M 10.0* 102.0 17.4 94.0 10.4 * 21.0 20.0 17F 15.9 59.0 34.0 43.0 33.0 38.2 18F 135.0 13.5 16.3* 14.0 14.0 10.8 17.0 70.0 19M 9.7 13.0 16.5 *The asterisk indicates a value for which prevoiced tokens were produced but omitted from this chart. Values for the prevoiced tokens are discussed below. Conclusions Now preliminary results will be discussed for each subject. To give a preliminary sense of the data, each child’s mean VOT by consonant will be compared to the means discussed by Lisker and Abramson’s data (as cited in Deuchar & Clark 1996): Table 2 Lisker and Abramson’s Mean VOTs by Language and Consonant English Voiced Voiceless /p/ 20-120 ms /b/ 0-5 ms /t/ 30-105 ms /d/ 0-25 ms /k/ 50-135 ms /g/ 0-35 ms /t/ 0-15 ms /d/ -170 - -75 ms /k/ 15-55 ms /g/ -165 - -45 ms Spanish Voiced Voiceless /p/ 0-15 ms /b/ -235 - -60 ms Subject 12F, who had no Spanish data, appears to have a fairly clear distinction for voiced and voiceless consonants. In each case, her unvoiced consonants are much larger than her voiced consonants. All of her means are within the monolingual English ranges suggested by Lisker and Abramson (1964) except for /p/ and /b/, which are both slightly above the upper range suggested (as cited in Deuchar & Clark 1996). All of 13F’s mean English VOTs were within the ranges suggested by Lisker and Abramson, except for /b/. Interestingly, she did produce some prevoiced /b/ tokens in English, which is not expected for monolingual English. Her voiceless Spanish VOTs were also within these ranges, and she produced the expected prevoicing for /b/. Unfortunately, she didn’t produce any tokens of the other voiced Spanish stops to compare. The only place of articulation for which she had both a voiced and voiceless token was the bilabial stop in English. For this pair, the voiceless stop /p/ is much larger than the voiced /b/, showing evidence of a monolingual-like voicing distinction. All of 14M’s English means are within the Lisker and Abramson ranges, except for their /b/ tokens. Like 13F, he did produce some /b/ tokens with prevoicing, which is not to be expected for English. His voiceless Spanish tokens were also within these ranges, but only his /b/ tokens and not his /d/ tokens presented the expected prevoicing. Both his English and Spanish /p b/ pair demonstrate a close-to-monolingual-adult voicing distinction. While 17F’s English /t/ and /g/ means were within Lisker and Abramson’s ranges, her /p/ mean was shorter than the bottom bracket of this range – in fact, her average for this consonant was much shorter than those of the rest of the subjects. Her Spanish /p/ and /t/ were both above the top bracket of the range, while her /k/ fell within the range. Unfortunately, she did not produce enough tokens to see how she is producing the voicing distinction at any place of articulation. 18F’s English and /p/ and /b/ were both larger than the Lisker and Abramson ranges, her /d/ and /g/ were within the expected range, and the /k/ mean was much shorter than the bottom of the range. Both her /p/ and /k/ tokens in Spanish were within the expected ranges, but her /g/ was much higher than the range and was actually higher than her /k/ average; this means that the voicing distinction actually went in the opposite direction from what we expect. Interestingly, this average was based on only two tokens of /g/, both for the word “gato”. One of these tokens had a VOT of 17ms, and the other had a much greater VOT of 123ms. This second VOT was so large that it sounded much more like “cato”. It is debatable whether this word is truly a cognate, but this very English-like VOT for the Spanish word suggests that some amount of crosslinguistic influence was occurring in the mind of this speaker. 18F produced something close to a monolingual-adult like voicing distinction for the English /p b/ pair, but for the /k g/ pair, there was no difference in mean VOT. 19M, who only produced Spanish data, also only produced voiceless tokens, so it isn’t possible to see how he articulated the voicing distinction in either language. However, his means for /p t k/ were well within the Lisker and Abramson ranges. An interesting surprise in the data was that most words in English beginning with a voiced dental fricative [ð] (one of the two sounds orthographically represented by “th”) were pronounced by the children as the voiced stop [d]. While this is an accepted variant in many dialects of English, it is most likely not the standard in this community. It is more likely that this is an interlanguage development as the [ð] phoneme has been known to be difficult to acquire and is learned relatively late by monolingual English children. However, it is also possible that the children’s teachers or parents or other caregivers may have this variant in their speech, influencing the pronunciation. If it is the case that this is a stage in their language development but that they are moving toward a [ð] pronunciation, then the pronunciation of this class of words won’t tell us much about the subjects’ underlying phonology. Nevertheless, it still appears phonetically as a [d] token, and because of its overwhelming prevalence, it was decided to include these tokens in the data. At further phases in the larger study, it may be possible to analyze whether these tokens are produced significantly differently from other [d] tokens, which could indicate whether these groups of words truly have the same underlying phonological representation. Discussion Despite the small amount of tokens, it is still possible to provide some descriptive patterns in this data. By this age, most of the children appeared to producing some kind of voicing distinction in both English and Spanish. Many produced the characteristically long VOTs of English voiceless stops, but only three of the children produced any prevoiced tokens, and only two children produced these in Spanish, where they were expected. However, the other subjects had very few voiced Spanish tokens to begin with, so it wouldn’t be fair to conclude that they systematically don’t produce prevoiced Spanish stops, although if more data collection shows this to be the case, it would be consistent with some past studies that have found prevoicing hasn’t been acquired by this age. Unfortunately, there were so few voiced Spanish tokens that it isn’t clear whether these children might have a voicing contrast within the short-lag range. Additionally, there are some anomalies in the data that stick out. For example, 18F’s voiced velar stop /g/ had a significantly longer mean VOT than her voiceless velar stop /k/, which is exactly the opposite of what we would expect. The token that made the mean voiced VOT so high was for the word “gato” (“cat” in English). While this word wouldn’t usually be considered a cognate because it is too dissimilar from the English word, the child’s pronunciation of it sounded distinctly more like “cat-o” (based on my judgments as an advanced L2 learner of Spanish). Thus, this may be an example of some sort of morphological codeswitching that could explain why this token broke from patterns to such a great degree. This goes to show that this data is very messy and involves many confounding factors that will require more data and more analysis to disentangle. Limitations and Future Directions The most obvious limitation of this study is that it is merely a preliminary result from the first round of data and was not able to be continued from there. There are very few tokens, especially for the voiced Spanish consonants. Additionally, this paper doesn’t include any results from cognate status, VCI, or the language background information that was collected from participants’ families. Finally, because of time and resource constraints, we were not able to control for language mode as well as we would have liked to. The larger study of which this work is a part will continue, but because of difficulties with participant retention, the researcher decided to no longer pursue this particular project. Instead, she is directing her attention to other aspects of bilingual stop pronunciation in other groups. References Allen, J.S., Miller, J.L., & DeSteno, D. (2003). Individual talker differences in voice-onset time. Journal of the Acoustical Society of America, 113(1), 544-552. Banov, I. K. (2014). The Production of Voice Onset Time in Voiceless Stops by Spanish-English Natural Bilinguals. Retrieved from BYU ScholarsArchive. (4340) Brown, E. B., & Amengual, M. (2015). 2015. Studies in Hispanic and Lusophone Linguistics, 8(1), 59-83. http://doi.org/10.1515/shll-2015-0003. Deuchar, M., & Clark, A. (1996). Early bilinguals acquisition of the voicing contrast in English and Spanish. Journal of Phonetics, 24, 351-365. Eilers, R. E., Oller, D. K., & Benito-Garcia, C. R. (1984). The acquisition of voicing contrasts in Spanish and English learning infants and children: a longitudinal study. J. Child Lang, 313-336. Flege, J. E., & Eefting, W. (1987). Production and perception of English stops by native Spanish speakers. Journal of Phonetics, 15(1), 67-83. http://ezproxy.lib.utah.edu/docview/58190349?accountid=14677 Kaiser, E. A. (2018). Voice Onset Time in Young Spanish-English Bilinguals. Unpublished manuscript, University of Utah. Thornburgha, D. F., & Ryallsb, J. H. (1998). Voice onset time in spanish-english bilinguals: early versus late learners of english. Journal of Communication Disorders, 31(3). Retrieved from https://doi.org/10.1016/S0021-9924(97)00053-1 Zampini, M. L. & Green, K. P. (2001). The voicing contrast in English and Spanish: The relationship between perception and production. In J. L. Nicol (Ed.), One mind, two languages: Bilingual language processing (23-48). Malden, MA: Blackwell. University of Utah UNDERGRADUATE RESEARCH JOURNAL 19TH-CENTURY SLEEPING BEAUTIES: ANALYSIS OF AN ARCHETYPE Vasiliki Karahalios (Christine Jones) Department of World Languages and Cultures Physical representation is one way humans understand each other. Historically, portraits have been important for state and familial records, as well as remembrances. Regardless of when a portrait was painted, viewers are able to gain insights into the anxieties and ideals of an age based on visual nuances in portraiture. For example, viewers of Leonardo da Vinci’s Mona Lisa are offered insights about Renaissance Humanistic ideals and the priority of masculinity in her smile and body. Indeed, the images we project about people matter because they communicate what humans value. Fairy tales also project an image of what it is to be human while weaving that story around gender relations. This research argues the necessity of fairy tales in the Pre-Raphaelite period, when fairy tales and painting together expressed their visions of humanity through gender relations. When Sleeping Beauty reached peak popularity in the late nineteenth century, it impacted the diverse discourses of literature, psychology, architecture, and the political economy of English Victorian society, as well as the fine arts. I argue that the most famous painters of the period, the Pre-Raphaelites, used fundamental conventions of Renaissance art to represent the tale, and in turn, used conventions of the tale to visually represent docile and voluptuous women in painting. The dialogue between Pre-Raphaelite Victorian art and the Sleeping Beauty tale that so heavily influenced the period offers us insights into how men understood women in the nineteenth-century. Both art forms have historically played a part in shaping the image we have today of what it means to be a woman. This research reminds its audience that representation is a powerful way for culture to tell its story and exposes gender stereotypes promoted through the Golden Age of illustration. University of Utah UNDERGRADUATE RESEARCH JOURNAL IN OUR ELEMENT: OUTDOOR RECREATION AS A TOOL FOR FEMALE EMPOWERMENT AND COMMUNITY BUILDING Maya Kobe-Rundio (Dr. Robin E Jensen) Department of Communication ABSTRACT This research investigates the meanings of outdoor recreation in the lives of college-aged femaleidentified and non-binary individuals. Qualitative, semi-structured interviews with 16 current students and recent graduates of the University of Utah generated rich narratives on the themes of challenges to involvement, benefits of participation, and negotiation of gender identity through communication. The participants in this research displayed a high level of awareness for how their intersecting identities affect their experiences outside. The findings from this study suggest multiple directions for future research and strategies for advocating the outdoors to diverse audiences. 1 University of Utah UNDERGRADUATE RESEARCH JOURNAL DIFFERENCES IN VOICE-ONSET TIME (VOT) FOR FIRST-LANGUAGE (L1), SECOND-LANGUAGE (L2), AND HERITAGE SPEAKERS OF SPANISH Tyler Watson Laws (Dr. MaryAnn Christison) Department of Linguistics Abstract This study examines how heritage speakers of Spanish who are relearning their L1 in an academic context pronounce English and Spanish words with stops. The heritage speaker group is being compared to adults who are learning Spanish as a foreign language and who have not had previous exposure to learning Spanish as children. To collect data on VOT, novel words and phrases are used with stops occurring in different positions. The researchers hypothesize that VOT may occur on a continuum, with those who moved from a Spanish-speaking environment to an English-speaking environment at an early age having less fully developed L1 skills and having more English-like VOTs than those who moved to an English-speaking environment later on with more fully developed L1 skills. They also hypothesize that VOT for English speakers learning Spanish as a foreign language as adults will exhibit more English like VOTs than the heritage speaker group. Heritage speakers are individuals who acquire their first language (L1) in a naturalistic setting, such as the home. After partial acquisition of the L1, they experience a change in linguistic environments and acquire a second language (L2) in the new environment, such as school, usually before the onset of adolescence. It is “the second language that manifests ultimate attainment” (Polinsky, 2015, p.163). Thus, heritage speakers’ language abilities exist on a continuum that includes the L1 they acquired from birth and the L2 that they adopted later on, which serves as the primary language. A heritage speaker’s history with an L1 endows them with unique language experiences that may assist them when they relearn their L1 as an L3 later in life. 2 Thus, heritage speakers can be informative for L2 researchers in terms of describing and learning about how multiple languages develop and what functions underpin heritage speakers’ language learning. For heritage speakers, the L1 is no longer the dominant language. Nevertheless, the non-dominant L1, which they learned in childhood, can affect the process of relearning the L1 as an L3. The question that researchers ask is whether the L1, which could have been learned at various levels of proficiency in childhood, is helpful when heritage speakers return to the L1 as an L3. Heritage Speakers Heritage speakers are not bilinguals, but they are not monolinguals either. A bilingual speaker would have been exposed to their two languages more or less throughout their childhood, whereas a heritage speaker is exposed to one language before some circumstance, such as immigration, which may be either voluntary or involuntary, abruptly halted L1 language development. Heritage speakers have different individual profiles relative to their L1 and L2, with some heritage speakers learning an L2 before reaching puberty while others do so after puberty. Heritage speakers experience both benefits and hindrances when attempting to relearn or improve their L1 and have language characteristics that may be somewhere between their primary language, which is the heritage language, and their dominant language, which is their L2. There are some issues in identifying heritage speakers. For example, drawing the line between who is and is not a heritage speaker can prove difficult, especially in situations where speakers are born into multilingual environments. When some heritage speakers move to a new linguistic environment, they may find that their new environment does not entirely exclude the L1 of the former environment. This situation is quite different from a situation where the L1 of 3 the former environment is rarely, if ever, used in the new linguistic environment. These different profiles can make heritage speakers a group with diverse language experiences and, thus, make it difficult to study the effects of heritage language environments and the L2 development of heritage speakers. Nevertheless, it is also likely that similar life experiences relative to multiple language use and age of acquisition will create similarities in in language development. Unique Characteristics of Heritage Speakers In spite of the difficulties associated with identifying heritage speakers, the unique linguistic profile of heritage speakers makes them ideal participants for research studies in second language acquisition (SLA). In particular, studying heritage speakers’ language can reveal critical information about the long-term effects of L1 development in young children. As opposed to their bilingual counterparts who were raised in bilingual environments, heritage speakers use one language primarily and then switch to a different language, which becomes the dominant language. Because some heritage speakers relearn their L1 as an L3, the age at which they switch from one language environment to another can be informative in helping researchers understand the effects of age of acquisition on SLA, as well as how different environments, such as naturalistic vs. instructed SLA, impact L2 development. Studies of heritage speakers can also answer specific questions about the importance of vowel and consonant development, the stages of development, and the effects of non-traditional development contexts on SLA. The unique characteristics of heritage speakers make them interesting participants in research studies. Heritage Speaker Difficulties Heritage speakers also encounter difficulties arising from the unique experiences they have with the L1. It is possible that the L1 acquired by a heritage speaker as a child may not be of the same variety as the academic language one taught in a classroom, and this difference may 4 cause problems for heritage speaker as they relearn the L1. The forces that cause individuals of a certain language variety to change language environments early in life often are not the same forces that raise one language variety to the level of prestige or that cause it to be taught in the context of a classroom. For example, a heritage speaker born in rural Venezuela may encounter cognitive dissonance when attempting to relearn the Spanish language as taught in foreign and second language classrooms in the United States, which is often a prestige variety of Spanish that is spoken in urban centers in either Spain or Mexico. This situation could create a unique set of circumstances for heritage speaker learners in educational contexts. It is possible for heritage speakers to exceed expectations in terms of native-like accent; however, they may fall behind in terms listening comprehension, especially when dealing with language features unique to a prestige variety. Motivation for the Current Study Though there have been several studies that have examined the relationship between monolingual and heritage speaker accents in the shared L1, but no studies to date have compared heritage speakers to adults L2 learners, who are essentially monolinguals, especially in circumstances where heritage speakers are relearning their L1 as an L3. This study attempted to fill that gap in the research by comparing how heritage speakers of Spanish who are relearning their L1 as an L3 to young adult English speakers who are learning Spanish as a foreign language and who have not had previous exposure to learning Spanish as children. The comparison was focused on the features of pronunciation for English and Spanish words with stops, specifically voice-onset time (VOT). VOT is a feature of the production of stop consonants. It is the duration of time between the release of a stop and the beginning of vocal 5 fold vibration for the following vowel. English and Spanish have different VOTs for the voiced and voiceless pairs of stop consonants. To collect data on VOT, novel words and phrases were used with stops occurring in different positions. The research questions that frame this study are the following: 1. Does the accent of a heritage speaker relative to VOT more closely resemble a monolingual speaker of the heritage language or an adult monolingual speaker of the L2? 2. Does the accent of a heritage speaker relative to VOT more closely resemble a monolingual speaker of the heritage language or an adult speaker of the L2 who is learning the heritage language as an L2? In terms of length of VOT, I hypothesize that heritage speakers of Spanish will have VOTs more closely related to L1 Spanish speakers than L1 English speakers. I further hypothesize that adult foreign language learners of Spanish, who learned Spanish later in life, will have VOTs more closely related to L1 English speakers. I expect the VOTs produced by monolingual speakers to be located at the opposite ends of the VOT continuum. Literature Review Researchers in the field of SLA have traditionally been interested in studying the differences between a learner’s L1 and other non-native languages (e.g., L2, L3, etc.). Studying L3 learners is relatively new area of research in SLA, particularly, the study of heritage speakers who are relearning their L1 as an L3. Heritage speakers who are language learners have the following language profiles: (1) an L1, which they were first exposed at home; (2) an L2, which has become their dominant societal language; (3) an L3, which is their L1, which they are relearning, and which is most often the standard academic variety of the L1. As more heritage speakers are beginning to relearn their L1s in formal classroom environments, researchers have 6 become more interested in studying the L3 of the heritage speakers to understand the ways in which the process of learning an L3 may be subtly different from the process of learning an L2. Therefore, heritage speakers who are relearning their L1 as an L3 are seen as valuable participants in SLA studies as they can help researchers understand the long-term effects of age of acquisition. In other words, even if heritage speakers do not reach native-like proficiency in the L1 before they shift to the socially dominant L2, the L1 may still have an effect on the process of learning an L3 even years later and into adulthood. It is often true that heritage speakers have a more native-like accent when relearning the L1 as an L3 than adult L2 learners. For example, VOT is more native-like in heritage speakers when speaking the L1 than the VOT for adult learners when speaking the same language as an L2. Polinsky (2015) showed that heritage speakers of Spanish, Korean, and Arabic were nearly indistinguishable from the corresponding L1 speakers who have no additional language experience, particularly in terms of VOT. English and Spanish have different VOT for the voiced and voiceless pairs of stop consonants. It appears that sounding like native speakers relative to VOT is the heritage speaker’s most obvious advantage. Thus, when a heritage speaker later returns to their L1 to relearn or improve it, they find that they have a great advantage in comparison to their peers who are learning an L2. Though they may not consciously remember their language, it seems that the minds of heritage speakers have stored native VOT in some capacity and uses the information to advantage during language refinement. Montrul and Foote (2012) highlight this idea and expand upon it and by showing that heritage speakers have advantages in terms of lexical access. This advantage expresses itself as an increase response time in lexical decision-making tasks, even though the advantage did not result in an increase in response accuracy. The accuracy for both late bilinguals and heritage 7 speakers was not significantly different. Polinsky (2015) shows that there is an advantage for heritage speakers in phonological production. She conducted a test on Russian heritage speakers and found that the VOT production of heritage and L2 speakers was significantly different, indicating that there was a clear boundary between the two groups. Studying heritage speakers offers researchers a glimpse into child language acquisition. Au et al. (2002) and Kent and Murray (1982) found that infants have distinctive periods of phoneme development. Kent and Murray studied infants at three, six, and nine months and found that infant sounds rapidly evolve during this period of development, from disorganized vocalizing to organized and language-specific babbling. Au et al. (2002) sought to uncover the advantages of exposure to phonemes without necessarily reproducing them, and the effect it has on native-like productions of Spanish. They also found that the early years are formative in learning phonemes for infants. There was a good deal of variation for the overhearers that heard Spanish regularly before age two, and the longer the speaker had heard Spanish, the better their productions became. The act of studying heritage speakers also proves to be mutually beneficial for heritage speakers that participate. As mentioned in Polinsky (2015), which was expanded version of original research conducted Valdés (2005), heritage speakers have unique learning needs distinct from the needs of non-heritage speakers. For example, a small amount of variation between the language varieties exposed to as a child and as an adult can cause learners to fixate on some differences, thereby making it difficult to relearn the heritage language. Instead of using the L1 to form mental representations, heritage speakers seem to form new mental representations for a third unique language, even though the third language (L3) is similar to the L1. Valdés (2005) encourages language educators to take advantage of the knowledge of how heritage speakers 8 process language to create higher-quality educational experiences, for example, explicit guidance for heritage speakers in making connections between their L1 and the L3. In summary, the research already conducted on heritage speakers found mixed benefits and challenges that are unique to the heritage speaker group. While heritage speakers may experience challenges related to learning different dialects and varieties for their L1 and may experience intrusive transfer (Ringborn & Jarvis, 2011) with their dominant L2, they also experience benefits from more native-like production. These differences set them apart from traditional learners of Spanish as a foreign language in academic contexts and create a unique learning experience for heritage speakers. An awareness of the potential advantages that heritage speakers have as language learners, as well as knowledge of the pitfalls associated with relearning the L1 as an L3, can help them adjust and create language learning experiences that will help them reap the greatest benefits. Methodology This section presents the methodological framework for this study and provides a description of the research design, participants, the procedures for data collection, and processes for data analysis. The current study seeks to provide empirical data to contribute to our understanding more about the heritage speaker advantage in language learning. The research design that we have chosen to integrate the different components of the study and address the research questions is a descriptive study. Participants The participants were recruited through the undergraduate linguistics and Spanish courses at the University of Utah or through personal contacts made by the first author. They fell into four different groups: (1) monolingual Spanish speakers, (2) monolingual English speakers, (3) 9 adult L1 English speakers who were learning Spanish as their first foreign language, and (4) heritage speakers of Spanish who were relearning their L1 as an L3 in an academic context. To determine the categorization of each participant, they were asked to self-report whether they were bilingual in English and Spanish or not, in other words, whether or not they used both English and Spanish in their daily lives. Participants were also asked if they were fluent in any other languages and were asked to provide information about the extent of their formal training in those languages. This process was carried out because a knowledge of other languages could affect pronunciation and, therefore, could influence the results of the study. There were 48 individuals who provided data for this study. Twenty-one adult learners of Spanish (L2 Spanish), 13 speakers with no Spanish experience (L1 English), 11 heritage speakers (Heritage), and three native Spanish speakers (L1 Spanish). To balance the number of participants in each category and due to constraints on time, the following number of participants were selected—three L1 Spanish and L1 English speakers were selected for Groups 1 and 2, four heritage speakers for Group 4, and four L2 Spanish speakers for Group 5 were selected. These speakers were selected by eliminating participants who had experience with additional languages and randomly selecting individuals from the remaining speakers. Those who self-identified as bilingual, in other words, they spoke English and Spanish to some degree and at varying levels of proficiency, were asked to complete the Bilingual Language Profile (BLP), which is an instrument that is provided to researchers by the University of Texas at Austin (Birdsong, Gertken, & Amengual, 2012). This profile provides a score of language dominance and provided the information necessary to determine how the participants fit the profile for a heritage speaker. From this survey, the participants were divided into two groups of speakers; heritage speakers and adult learners of Spanish. Also, the data that were 10 collected from monolingual speakers of English and Spanish were retained to use as a baseline. These categories did not account for other potential language fluencies, though other language fluencies were captured in the survey. Data Collection Procedures To carry out the experiment we asked participants to read through four lists of words: (1) isolated words in English and Spanish, (2) isolated words that were experimental and not real words, (3) phrasal verbs and phrases in English or Spanish, and (4) phrasal verbs or phrases that were experimental. The English/Spanish lists 1 had tokens representing all possible combinations of four continuums: language, place, manner, and word position. The voiced/voiceless continuum had tokens that were minimal pairs of each other. The experimental lists 2 included tokens representing all possible combinations of four continuums: (1) place of phoneme of interest, (2) manner of phoneme of interest, (3) place of filler consonant, and (4) word position. All the vowels were represented as /o/. The isolated lists had one word per line, whereas the phrasal lists inserted the words into either an English environment (e.g., Is this (a) ___ or not?) or a Spanish environment (e.g., ¿Es esto (un/a) ___ o no?). In order to maintain a natural English or Spanish environment, determiners were included or deleted depending on whether they made the sentence correct according to English or Spanish syntax. If adjusting the determiner was insufficient to create a natural English or Spanish sentence, an alternative sentence was used that placed the token in a similar phonological environment based on the four continua. 3 Data Analysis 1 See Appendix A. See Appendix B. 3 See Appendix C. 2 11 The recordings of the participants were saved originally as .m4a files, which were then converted into .wav files using Adobe Premiere. The .wav files could then be analyzed by Praat, and the voice-onset times could be extracted using its text grid function. The voice-onset times were then saved in Microsoft Excel for further analysis. Results The results of the Bilingual Profile Survey appear in Table 1. L1 Spanish speakers also shared that they had some English experience although, as the data show, it was not enough to change their dominance in favor of English. Tables 2 and 3 show the spectra that were present in both the Spanish and English conditions, respectively. Table 1 Bilingual Language Profile Results Category History Heritage L1 Spanish L2 Spanish Spanish 64 110 12 English 83 29 109 Spanish 15 3 46 English 35 11 47 Proficiency Spanish 20 24 13 23 14 24 Spanish 23 24 12 English 22 13 24 Spanish 143 209 64 English 179 85 208 37 -124 144 Use English Attitudes Global Dominance 12 Each category is rated on its own unique scale. The scale for History has a maximum of 120, the maximum for the Use scale is 50, for Proficiency and Attitudes the maximum is 24, and for Global the maximum is 218. These scores were then weighted and averaged to produce Dominance scores that can range from -218 to 218. A negative score suggests Spanish dominance, whereas a positive score suggests English dominance. As age of language acquisition plays a role in the differences in ability between heritage speakers and L2 language learners, the participants were initially sorted by age of acquisition, using age 12 as the cutoff age. This age proved to be a natural cutoff age as well, as participants either started learning both English and Spanish before age 10, or they learned one language before age 10 and one language after age 13. This cutoff was reflected in the Dominance score; heritage speakers had Dominance scores between 15 and 60 while L2 learners had Dominance scores over 125. The VOT of the participants are shown in Tables 2 and 3 as continua for each phonemic environment. Table 2 represents the phonemes as produced in Spanish environments, whereas Table 3 represents the phonemes as produced in English environments. Separating the languages in this way is appropriate because the linguistic environment influenced how speakers handled the tokens given. This influence was made apparent by verbal reports from the participants after participation and observation by the researcher. Table 2 The continuum of speaker VOT’s in Spanish. Environment Shortest VOT Longest VOT /b/ (Word-Initial) L1 English L2 Spanish L1 Spanish Heritage /p/ (Word-Initial) L2 Spanish Heritage L1 English L1 Spanish 13 /d/ (Word-Initial) L1 English L2 Spanish L1 Spanish Heritage /t/ (Word-Initial) L2 Spanish L1 Spanish Heritage L1 English /g/ (Word-Initial) L1 English L1 Spanish L2 Spanish Heritage /k/ (Word-Initial) L1 Spanish Heritage L1 English L2 Spanish In Table 2, only word-initial VOT are presented. Word-final VOT is not reported because Spanish phonology doesn’t allow for word-final stops, and so there are no tokens available to test this environment in Spanish naturally. Word-medial VOT is removed because Spanish phonology causes underlying word-medial stops to be presented on the surface as fricatives. Though some of the participants did not produce fricatives in these environments, there were some who did, thus making it difficult to compare the two groups. In Table 2, the group with the shortest VOT is shown on the left and the group with the longest VOT is shown on the right. L1 English speakers had the shortest VOT in seven environments and the longest VOT in two. L2 Spanish speakers had the shortest in four environments and the longest in three. L1 Spanish speakers had the shortest in one environment and the longest in one. Heritage speakers never had the shortest VOT and the longest in six. When averaging these results, L1 English speakers had the shortest VOT, L2 Spanish speakers had the next shortest, L1 Spanish speakers had the second longest, and Heritage speakers had the longest VOT. Table 3 The continuum of speaker VOT’s in English. Environment Shortest VOT Longest VOT 14 /b/ (Word-Initial L2 Spanish Heritage L1 Spanish L1 English /b/ (Word-Medial) L1 Spanish L1 English L2 Spanish Heritage /b/ (Word-Final) L2 Spanish L1 English L1 Spanish Heritage /p/ (Word-Initial L2 Spanish L1 English Heritage L1 Spanish /p/ (Word-Medial) L2 Spanish Heritage L1 Spanish L1 English /p/ (Word-Final) L2 Spanish Heritage L1 Spanish L1 English /d/ (Word-Initial L1 Spanish L2 Spanish Heritage L1 English /d/ (Word-Medial) L2 Spanish Heritage L1 Spanish L1 English /d/ (Word-Final) L1 English Heritage L1 Spanish L2 Spanish /t/ (Word-Initial L1 Spanish L2 Spanish Heritage L1 English /t/ (Word-Medial) Heritage L2 Spanish L1 Spanish L1 English /t/ (Word-Final) L1 Spanish L2 Spanish L1 English Heritage /g/ (Word-Initial Heritage L1 English L1 Spanish L2 Spanish /g/ (Word-Medial) L2 Spanish Heritage L1 Spanish L1 English /g/ (Word-Final) L1 English Heritage L1 Spanish L2 Spanish /k/ (Word-Initial L2 Spanish L1 Spanish Heritage L1 English /k/ (Word-Medial) L1 English L1 Spanish L2 Spanish Heritage /k/ (Word-Final) L2 Spanish L1 Spanish L1 English Heritage The group with the shortest VOT is shown on the left and the group with the longest VOT is shown on the right. L1 English speakers had the shortest VOT in three and the longest in nine. L2 Spanish speakers had the shortest in nine environments and the longest in three, L1 15 Spanish speakers had the shortest in four environments, and the longest in one, and heritage speakers had the shortest VOT in two environments and the longest in five. The data presented above shows that heritage speakers have VOT that more closely match the VOT of L1 Spanish speakers than L1 English speakers, though not in the pattern hypothesized. It is most frequently the case that the Heritage speakers lie at the long extreme of the VOT continuum, with L1 Spanish speakers being the next longest group. In addition, the data shows that Heritage speakers have VOT closer to L1 Spanish speakers than L2 Spanish speakers. Though L2 Spanish speakers were not as different from Heritage speakers as their monolingual English counterparts, they were more different than their monolingual Spanish counterparts. Discussion The description of the results shows that VOTs showed more variation in the different continua than the hypothesis predicted. The hypothesis was that the monolingual speakers would form the ends of a VOT continuum with heritage speakers closer to the Spanish end than the English end and the adult learners of Spanish being closer to the English end than the Spanish end. The results suggest, however, that all speakers modify their VOTs, and do so more frequently than was predicted. For example, English speakers learning Spanish as a foreign language had the shortest VOTs in Spanish, which may suggest that as they consciously try to obtain a native-like accent, they are overcompensating for VOT. Word-initial /g/ in Spanish environments takes a different pattern that the other Spanish environments. Whereas L1 English speakers and L2 Spanish speakers cluster around the short end of the continuum and L1 Spanish speakers and Heritage speakers cluster around the long end, /g/ shows L1 Spanish speakers having a shorter VOT than L2 Spanish speakers. One possible explanation for this effect is that the data presented was unable to produce a large 16 enough effect size to overcome individual differences in the L1 Spanish speakers. As two of the L1 Spanish speakers came from Venezuela and one came from Spain, it’s possible that regional differences are showing through in the data. It is worth noting that due to language history many participants were eliminated from the study. The largest group was the of participants was the L1 English speakers learning Spanish; however, to balance the groups, I selected only four participants for data analysis. There was range of proficiency levels, which may have also affected the results. In addition, Spanish is the second most commonly spoken language in the world (Eberhard, Simons, & Fennig, 2019) with a great deal of variation among its speakers, so it is natural to assume there would be variation in VOT. To make inferences to a larger population, I plan on recruiting more participants so that I have at least 20 speakers in each group, which will allow me to compare means using ANOVA and make inferences to a larger population. I also plan to use L2 learners of Spanish with a narrower range of language proficiencies and heritage speakers with similar profiles relative to age at which they began learning the L2 and the exposure to the L1 once L2 learning had begun. 17 References Au, T. K.-f., Knightly, L. M., Jun, S.-A., & Oh, J. S. (2002, May). Overhearing a Language During Childhood. Psychological Science, 13(3), 238-243. Birdsong, D., Gertken, L. M., & Amengual, M. (2012, January 20). The Bilingual Language Profile: An Easy-to-Use Instrument to Access Bilingualism. Retrieved from COERLL, The University of Texas at Austin: http://sites.la.utexas.edu/bilingual/ Eberhard, D. M., Simons, G. F., & Fennig, C. D. (2019). Summary by language size. Retrieved from Ethnologue: https://www.ethnologue.com/statistics/size Kent, R. D., & Murray, A. D. (1982, August). Acoustic features of infant vocalic utterances at 3, 6, and 9 months. The Journal of the Acoustical Society of America, 72(2), 353 - 365. Kroll, J. F., & Tokowicz, N. (2005). Models of Bilingual Representation and Processing: Looking Back and to the Future. In J. F. Kroll, & A. M. de Groot, Handbook of Bilingualism: Psycholinguistic Approaches (pp. 531 - 553). Oxford University Press. Montrul, S., & Foote, R. (2014). Age of acquisition interactions in bilingual lexical access: A study of the weaker language of L2 learners and heritage speakers. International Journal of Bilingualism, 18(3), 274-303. Polinsky, M., & Del Pilar, M. (2015, April). When L1 becomes an L3: Do heritage speakers make better L3 learners? Bilingualism: Language and Cognition, 18(SI2), 163-178. Ringbom, H., & Jarvis, S. (2011). The importance of cross-linguistic similarity in foreign language learning. In M. H. Long, & C. J. Doughty (Eds.), The handbook of language teaching (pp. 106-118). Oxford, United Kingdom: Oxford University Press. 18 Valdés, G. (2005). Bilingualism, Heritage Language Learners, and SLA Research: Opportunities Lost or Seized? The Modern Language Journal, 89(3), 410-426. 19 APPENDIX A: ENGLISH/SPANISH WORDS English word-initial word-medial word-final /b/ /p/ /d/ /t/ /g/ /k/ bee pea den ten gap cap beach peach door tore goal coal bark park dart tart girl curl stable staple model motel logger locker mobbing mopping wader water wagon whackin’ nabbing napping header heater begging baking pub pup ride write bag back robe rope hard heart pig pick cub cup send sent clog clock Spanish word-initial word-medial /b/ /p/ /d/ /t/ /g/ /k/ bata pata dos tos gana cana boca poca día tía gaza casa bola pola deja teja gola cola cabo capo boda bota vaga vaca taba tapa saldar saltar pega peca sube supe tienda tienta manga manca *Spanish does not allow for stops in the word-final coda position. 20 APPENDIX B: EXPERIMENTAL TOKENS /l/ /b/ /p/ /d/ /t/ /g/ /k/ word-initial bolo polo dolo tolo golo kolo word-medial lobo lopo lodo loto logo loko word-final lolob lolop lolod lolot lolog lolok /n/ /b/ /p/ /d/ /t/ /g/ /k/ word-initial bono pono dono tono gono kono word-medial nobo nopo nodo noto nogo noko word-final nonob nonop nonod nonot nonog nonok /b/ /p/ /d/ /t/ /g/ /k/ word-initial boro poro doro toro goro koro word-medial robo ropo rodo roto rogo roko word-final rorob rorop rorod rorot rorog rorok /r/ 21 APPENDIX C: ALTERNATIVE PHRASES USED Token Phrase baking They were surely baking over in Franklin. begging They were surely begging over in Franklin. deja Por favor, deja la mascota. mobbing They were surely mobbing over in Franklin. mopping They were surely mopping over in Franklin. nabbing They were surely nabbing over in Franklin. napping They were surely napping over in Franklin. poca Bebí poca horchata. pola No pola la ventana. saldar ¿Quiere saldar este argumento? saltar ¿Quiere saltar en el hueco? send They will surely send Olivia a letter today. sent They surely sent Olivia a letter today. sube Por favor, sube la caja. supe Yo supe que no está aquí. tore They surely tore Olivia’s backpack today. whackin’ They were surely whackin’ over in Franklin. write They will sure write Olivia the letter today. 1 University of Utah UNDERGRADUATE RESEARCH JOURNAL DIFFERENCES IN VOICE-ONSET TIME (VOT) FOR FIRST-LANGUAGE (L1), SECOND-LANGUAGE (L2), AND HERITAGE SPEAKERS OF SPANISH Tyler Watson Laws (Dr. MaryAnn Christison) Department of Linguistics Abstract This study examines how heritage speakers of Spanish who are relearning their L1 in an academic context pronounce English and Spanish words with stops. The heritage speaker group is being compared to adults who are learning Spanish as a foreign language and who have not had previous exposure to learning Spanish as children. To collect data on VOT, novel words and phrases are used with stops occurring in different positions. The researchers hypothesize that VOT may occur on a continuum, with those who moved from a Spanish-speaking environment to an English-speaking environment at an early age having less fully developed L1 skills and having more English-like VOTs than those who moved to an English-speaking environment later on with more fully developed L1 skills. They also hypothesize that VOT for English speakers learning Spanish as a foreign language as adults will exhibit more English like VOTs than the heritage speaker group. Heritage speakers are individuals who acquire their first language (L1) in a naturalistic setting, such as the home. After partial acquisition of the L1, they experience a change in linguistic environments and acquire a second language (L2) in the new environment, such as school, usually before the onset of adolescence. It is “the second language that manifests ultimate attainment” (Polinsky, 2015, p.163). Thus, heritage speakers’ language abilities exist on a continuum that includes the L1 they acquired from birth and the L2 that they adopted later on, which serves as the primary language. A heritage speaker’s history with an L1 endows them with unique language experiences that may assist them when they relearn their L1 as an L3 later in life. 2 Thus, heritage speakers can be informative for L2 researchers in terms of describing and learning about how multiple languages develop and what functions underpin heritage speakers’ language learning. For heritage speakers, the L1 is no longer the dominant language. Nevertheless, the non-dominant L1, which they learned in childhood, can affect the process of relearning the L1 as an L3. The question that researchers ask is whether the L1, which could have been learned at various levels of proficiency in childhood, is helpful when heritage speakers return to the L1 as an L3. Heritage Speakers Heritage speakers are not bilinguals, but they are not monolinguals either. A bilingual speaker would have been exposed to their two languages more or less throughout their childhood, whereas a heritage speaker is exposed to one language before some circumstance, such as immigration, which may be either voluntary or involuntary, abruptly halted L1 language development. Heritage speakers have different individual profiles relative to their L1 and L2, with some heritage speakers learning an L2 before reaching puberty while others do so after puberty. Heritage speakers experience both benefits and hindrances when attempting to relearn or improve their L1 and have language characteristics that may be somewhere between their primary language, which is the heritage language, and their dominant language, which is their L2. There are some issues in identifying heritage speakers. For example, drawing the line between who is and is not a heritage speaker can prove difficult, especially in situations where speakers are born into multilingual environments. When some heritage speakers move to a new linguistic environment, they may find that their new environment does not entirely exclude the L1 of the former environment. This situation is quite different from a situation where the L1 of 3 the former environment is rarely, if ever, used in the new linguistic environment. These different profiles can make heritage speakers a group with diverse language experiences and, thus, make it difficult to study the effects of heritage language environments and the L2 development of heritage speakers. Nevertheless, it is also likely that similar life experiences relative to multiple language use and age of acquisition will create similarities in in language development. Unique Characteristics of Heritage Speakers In spite of the difficulties associated with identifying heritage speakers, the unique linguistic profile of heritage speakers makes them ideal participants for research studies in second language acquisition (SLA). In particular, studying heritage speakers’ language can reveal critical information about the long-term effects of L1 development in young children. As opposed to their bilingual counterparts who were raised in bilingual environments, heritage speakers use one language primarily and then switch to a different language, which becomes the dominant language. Because some heritage speakers relearn their L1 as an L3, the age at which they switch from one language environment to another can be informative in helping researchers understand the effects of age of acquisition on SLA, as well as how different environments, such as naturalistic vs. instructed SLA, impact L2 development. Studies of heritage speakers can also answer specific questions about the importance of vowel and consonant development, the stages of development, and the effects of non-traditional development contexts on SLA. The unique characteristics of heritage speakers make them interesting participants in research studies. Heritage Speaker Difficulties Heritage speakers also encounter difficulties arising from the unique experiences they have with the L1. It is possible that the L1 acquired by a heritage speaker as a child may not be of the same variety as the academic language one taught in a classroom, and this difference may 4 cause problems for heritage speaker as they relearn the L1. The forces that cause individuals of a certain language variety to change language environments early in life often are not the same forces that raise one language variety to the level of prestige or that cause it to be taught in the context of a classroom. For example, a heritage speaker born in rural Venezuela may encounter cognitive dissonance when attempting to relearn the Spanish language as taught in foreign and second language classrooms in the United States, which is often a prestige variety of Spanish that is spoken in urban centers in either Spain or Mexico. This situation could create a unique set of circumstances for heritage speaker learners in educational contexts. It is possible for heritage speakers to exceed expectations in terms of native-like accent; however, they may fall behind in terms listening comprehension, especially when dealing with language features unique to a prestige variety. Motivation for the Current Study Though there have been several studies that have examined the relationship between monolingual and heritage speaker accents in the shared L1, but no studies to date have compared heritage speakers to adults L2 learners, who are essentially monolinguals, especially in circumstances where heritage speakers are relearning their L1 as an L3. This study attempted to fill that gap in the research by comparing how heritage speakers of Spanish who are relearning their L1 as an L3 to young adult English speakers who are learning Spanish as a foreign language and who have not had previous exposure to learning Spanish as children. The comparison was focused on the features of pronunciation for English and Spanish words with stops, specifically voice-onset time (VOT). VOT is a feature of the production of stop consonants. It is the duration of time between the release of a stop and the beginning of vocal 5 fold vibration for the following vowel. English and Spanish have different VOTs for the voiced and voiceless pairs of stop consonants. To collect data on VOT, novel words and phrases were used with stops occurring in different positions. The research questions that frame this study are the following: 1. Does the accent of a heritage speaker relative to VOT more closely resemble a monolingual speaker of the heritage language or an adult monolingual speaker of the L2? 2. Does the accent of a heritage speaker relative to VOT more closely resemble a monolingual speaker of the heritage language or an adult speaker of the L2 who is learning the heritage language as an L2? In terms of length of VOT, I hypothesize that heritage speakers of Spanish will have VOTs more closely related to L1 Spanish speakers than L1 English speakers. I further hypothesize that adult foreign language learners of Spanish, who learned Spanish later in life, will have VOTs more closely related to L1 English speakers. I expect the VOTs produced by monolingual speakers to be located at the opposite ends of the VOT continuum. Literature Review Researchers in the field of SLA have traditionally been interested in studying the differences between a learner’s L1 and other non-native languages (e.g., L2, L3, etc.). Studying L3 learners is relatively new area of research in SLA, particularly, the study of heritage speakers who are relearning their L1 as an L3. Heritage speakers who are language learners have the following language profiles: (1) an L1, which they were first exposed at home; (2) an L2, which has become their dominant societal language; (3) an L3, which is their L1, which they are relearning, and which is most often the standard academic variety of the L1. As more heritage speakers are beginning to relearn their L1s in formal classroom environments, researchers have 6 become more interested in studying the L3 of the heritage speakers to understand the ways in which the process of learning an L3 may be subtly different from the process of learning an L2. Therefore, heritage speakers who are relearning their L1 as an L3 are seen as valuable participants in SLA studies as they can help researchers understand the long-term effects of age of acquisition. In other words, even if heritage speakers do not reach native-like proficiency in the L1 before they shift to the socially dominant L2, the L1 may still have an effect on the process of learning an L3 even years later and into adulthood. It is often true that heritage speakers have a more native-like accent when relearning the L1 as an L3 than adult L2 learners. For example, VOT is more native-like in heritage speakers when speaking the L1 than the VOT for adult learners when speaking the same language as an L2. Polinsky (2015) showed that heritage speakers of Spanish, Korean, and Arabic were nearly indistinguishable from the corresponding L1 speakers who have no additional language experience, particularly in terms of VOT. English and Spanish have different VOT for the voiced and voiceless pairs of stop consonants. It appears that sounding like native speakers relative to VOT is the heritage speaker’s most obvious advantage. Thus, when a heritage speaker later returns to their L1 to relearn or improve it, they find that they have a great advantage in comparison to their peers who are learning an L2. Though they may not consciously remember their language, it seems that the minds of heritage speakers have stored native VOT in some capacity and uses the information to advantage during language refinement. Montrul and Foote (2012) highlight this idea and expand upon it and by showing that heritage speakers have advantages in terms of lexical access. This advantage expresses itself as an increase response time in lexical decision-making tasks, even though the advantage did not result in an increase in response accuracy. The accuracy for both late bilinguals and heritage 7 speakers was not significantly different. Polinsky (2015) shows that there is an advantage for heritage speakers in phonological production. She conducted a test on Russian heritage speakers and found that the VOT production of heritage and L2 speakers was significantly different, indicating that there was a clear boundary between the two groups. Studying heritage speakers offers researchers a glimpse into child language acquisition. Au et al. (2002) and Kent and Murray (1982) found that infants have distinctive periods of phoneme development. Kent and Murray studied infants at three, six, and nine months and found that infant sounds rapidly evolve during this period of development, from disorganized vocalizing to organized and language-specific babbling. Au et al. (2002) sought to uncover the advantages of exposure to phonemes without necessarily reproducing them, and the effect it has on native-like productions of Spanish. They also found that the early years are formative in learning phonemes for infants. There was a good deal of variation for the overhearers that heard Spanish regularly before age two, and the longer the speaker had heard Spanish, the better their productions became. The act of studying heritage speakers also proves to be mutually beneficial for heritage speakers that participate. As mentioned in Polinsky (2015), which was expanded version of original research conducted Valdés (2005), heritage speakers have unique learning needs distinct from the needs of non-heritage speakers. For example, a small amount of variation between the language varieties exposed to as a child and as an adult can cause learners to fixate on some differences, thereby making it difficult to relearn the heritage language. Instead of using the L1 to form mental representations, heritage speakers seem to form new mental representations for a third unique language, even though the third language (L3) is similar to the L1. Valdés (2005) encourages language educators to take advantage of the knowledge of how heritage speakers 8 process language to create higher-quality educational experiences, for example, explicit guidance for heritage speakers in making connections between their L1 and the L3. In summary, the research already conducted on heritage speakers found mixed benefits and challenges that are unique to the heritage speaker group. While heritage speakers may experience challenges related to learning different dialects and varieties for their L1 and may experience intrusive transfer (Ringborn & Jarvis, 2011) with their dominant L2, they also experience benefits from more native-like production. These differences set them apart from traditional learners of Spanish as a foreign language in academic contexts and create a unique learning experience for heritage speakers. An awareness of the potential advantages that heritage speakers have as language learners, as well as knowledge of the pitfalls associated with relearning the L1 as an L3, can help them adjust and create language learning experiences that will help them reap the greatest benefits. Methodology This section presents the methodological framework for this study and provides a description of the research design, participants, the procedures for data collection, and processes for data analysis. The current study seeks to provide empirical data to contribute to our understanding more about the heritage speaker advantage in language learning. The research design that we have chosen to integrate the different components of the study and address the research questions is a descriptive study. Participants The participants were recruited through the undergraduate linguistics and Spanish courses at the University of Utah or through personal contacts made by the first author. They fell into four different groups: (1) monolingual Spanish speakers, (2) monolingual English speakers, (3) 9 adult L1 English speakers who were learning Spanish as their first foreign language, and (4) heritage speakers of Spanish who were relearning their L1 as an L3 in an academic context. To determine the categorization of each participant, they were asked to self-report whether they were bilingual in English and Spanish or not, in other words, whether or not they used both English and Spanish in their daily lives. Participants were also asked if they were fluent in any other languages and were asked to provide information about the extent of their formal training in those languages. This process was carried out because a knowledge of other languages could affect pronunciation and, therefore, could influence the results of the study. There were 48 individuals who provided data for this study. Twenty-one adult learners of Spanish (L2 Spanish), 13 speakers with no Spanish experience (L1 English), 11 heritage speakers (Heritage), and three native Spanish speakers (L1 Spanish). To balance the number of participants in each category and due to constraints on time, the following number of participants were selected—three L1 Spanish and L1 English speakers were selected for Groups 1 and 2, four heritage speakers for Group 4, and four L2 Spanish speakers for Group 5 were selected. These speakers were selected by eliminating participants who had experience with additional languages and randomly selecting individuals from the remaining speakers. Those who self-identified as bilingual, in other words, they spoke English and Spanish to some degree and at varying levels of proficiency, were asked to complete the Bilingual Language Profile (BLP), which is an instrument that is provided to researchers by the University of Texas at Austin (Birdsong, Gertken, & Amengual, 2012). This profile provides a score of language dominance and provided the information necessary to determine how the participants fit the profile for a heritage speaker. From this survey, the participants were divided into two groups of speakers; heritage speakers and adult learners of Spanish. Also, the data that were 10 collected from monolingual speakers of English and Spanish were retained to use as a baseline. These categories did not account for other potential language fluencies, though other language fluencies were captured in the survey. Data Collection Procedures To carry out the experiment we asked participants to read through four lists of words: (1) isolated words in English and Spanish, (2) isolated words that were experimental and not real words, (3) phrasal verbs and phrases in English or Spanish, and (4) phrasal verbs or phrases that were experimental. The English/Spanish lists 1 had tokens representing all possible combinations of four continuums: language, place, manner, and word position. The voiced/voiceless continuum had tokens that were minimal pairs of each other. The experimental lists 2 included tokens representing all possible combinations of four continuums: (1) place of phoneme of interest, (2) manner of phoneme of interest, (3) place of filler consonant, and (4) word position. All the vowels were represented as /o/. The isolated lists had one word per line, whereas the phrasal lists inserted the words into either an English environment (e.g., Is this (a) ___ or not?) or a Spanish environment (e.g., ¿Es esto (un/a) ___ o no?). In order to maintain a natural English or Spanish environment, determiners were included or deleted depending on whether they made the sentence correct according to English or Spanish syntax. If adjusting the determiner was insufficient to create a natural English or Spanish sentence, an alternative sentence was used that placed the token in a similar phonological environment based on the four continua. 3 Data Analysis 1 See Appendix A. See Appendix B. 3 See Appendix C. 2 11 The recordings of the participants were saved originally as .m4a files, which were then converted into .wav files using Adobe Premiere. The .wav files could then be analyzed by Praat, and the voice-onset times could be extracted using its text grid function. The voice-onset times were then saved in Microsoft Excel for further analysis. Results The results of the Bilingual Profile Survey appear in Table 1. L1 Spanish speakers also shared that they had some English experience although, as the data show, it was not enough to change their dominance in favor of English. Tables 2 and 3 show the spectra that were present in both the Spanish and English conditions, respectively. Table 1 Bilingual Language Profile Results Category History Heritage L1 Spanish L2 Spanish Spanish 64 110 12 English 83 29 109 Spanish 15 3 46 English 35 11 47 Proficiency Spanish 20 24 13 23 14 24 Spanish 23 24 12 English 22 13 24 Spanish 143 209 64 English 179 85 208 37 -124 144 Use English Attitudes Global Dominance 12 Each category is rated on its own unique scale. The scale for History has a maximum of 120, the maximum for the Use scale is 50, for Proficiency and Attitudes the maximum is 24, and for Global the maximum is 218. These scores were then weighted and averaged to produce Dominance scores that can range from -218 to 218. A negative score suggests Spanish dominance, whereas a positive score suggests English dominance. As age of language acquisition plays a role in the differences in ability between heritage speakers and L2 language learners, the participants were initially sorted by age of acquisition, using age 12 as the cutoff age. This age proved to be a natural cutoff age as well, as participants either started learning both English and Spanish before age 10, or they learned one language before age 10 and one language after age 13. This cutoff was reflected in the Dominance score; heritage speakers had Dominance scores between 15 and 60 while L2 learners had Dominance scores over 125. The VOT of the participants are shown in Tables 2 and 3 as continua for each phonemic environment. Table 2 represents the phonemes as produced in Spanish environments, whereas Table 3 represents the phonemes as produced in English environments. Separating the languages in this way is appropriate because the linguistic environment influenced how speakers handled the tokens given. This influence was made apparent by verbal reports from the participants after participation and observation by the researcher. Table 2 The continuum of speaker VOT’s in Spanish. Environment Shortest VOT Longest VOT /b/ (Word-Initial) L1 English L2 Spanish L1 Spanish Heritage /p/ (Word-Initial) L2 Spanish Heritage L1 English L1 Spanish 13 /d/ (Word-Initial) L1 English L2 Spanish L1 Spanish Heritage /t/ (Word-Initial) L2 Spanish L1 Spanish Heritage L1 English /g/ (Word-Initial) L1 English L1 Spanish L2 Spanish Heritage /k/ (Word-Initial) L1 Spanish Heritage L1 English L2 Spanish In Table 2, only word-initial VOT are presented. Word-final VOT is not reported because Spanish phonology doesn’t allow for word-final stops, and so there are no tokens available to test this environment in Spanish naturally. Word-medial VOT is removed because Spanish phonology causes underlying word-medial stops to be presented on the surface as fricatives. Though some of the participants did not produce fricatives in these environments, there were some who did, thus making it difficult to compare the two groups. In Table 2, the group with the shortest VOT is shown on the left and the group with the longest VOT is shown on the right. L1 English speakers had the shortest VOT in seven environments and the longest VOT in two. L2 Spanish speakers had the shortest in four environments and the longest in three. L1 Spanish speakers had the shortest in one environment and the longest in one. Heritage speakers never had the shortest VOT and the longest in six. When averaging these results, L1 English speakers had the shortest VOT, L2 Spanish speakers had the next shortest, L1 Spanish speakers had the second longest, and Heritage speakers had the longest VOT. Table 3 The continuum of speaker VOT’s in English. Environment Shortest VOT Longest VOT 14 /b/ (Word-Initial L2 Spanish Heritage L1 Spanish L1 English /b/ (Word-Medial) L1 Spanish L1 English L2 Spanish Heritage /b/ (Word-Final) L2 Spanish L1 English L1 Spanish Heritage /p/ (Word-Initial L2 Spanish L1 English Heritage L1 Spanish /p/ (Word-Medial) L2 Spanish Heritage L1 Spanish L1 English /p/ (Word-Final) L2 Spanish Heritage L1 Spanish L1 English /d/ (Word-Initial L1 Spanish L2 Spanish Heritage L1 English /d/ (Word-Medial) L2 Spanish Heritage L1 Spanish L1 English /d/ (Word-Final) L1 English Heritage L1 Spanish L2 Spanish /t/ (Word-Initial L1 Spanish L2 Spanish Heritage L1 English /t/ (Word-Medial) Heritage L2 Spanish L1 Spanish L1 English /t/ (Word-Final) L1 Spanish L2 Spanish L1 English Heritage /g/ (Word-Initial Heritage L1 English L1 Spanish L2 Spanish /g/ (Word-Medial) L2 Spanish Heritage L1 Spanish L1 English /g/ (Word-Final) L1 English Heritage L1 Spanish L2 Spanish /k/ (Word-Initial L2 Spanish L1 Spanish Heritage L1 English /k/ (Word-Medial) L1 English L1 Spanish L2 Spanish Heritage /k/ (Word-Final) L2 Spanish L1 Spanish L1 English Heritage The group with the shortest VOT is shown on the left and the group with the longest VOT is shown on the right. L1 English speakers had the shortest VOT in three and the longest in nine. L2 Spanish speakers had the shortest in nine environments and the longest in three, L1 15 Spanish speakers had the shortest in four environments, and the longest in one, and heritage speakers had the shortest VOT in two environments and the longest in five. The data presented above shows that heritage speakers have VOT that more closely match the VOT of L1 Spanish speakers than L1 English speakers, though not in the pattern hypothesized. It is most frequently the case that the Heritage speakers lie at the long extreme of the VOT continuum, with L1 Spanish speakers being the next longest group. In addition, the data shows that Heritage speakers have VOT closer to L1 Spanish speakers than L2 Spanish speakers. Though L2 Spanish speakers were not as different from Heritage speakers as their monolingual English counterparts, they were more different than their monolingual Spanish counterparts. Discussion The description of the results shows that VOTs showed more variation in the different continua than the hypothesis predicted. The hypothesis was that the monolingual speakers would form the ends of a VOT continuum with heritage speakers closer to the Spanish end than the English end and the adult learners of Spanish being closer to the English end than the Spanish end. The results suggest, however, that all speakers modify their VOTs, and do so more frequently than was predicted. For example, English speakers learning Spanish as a foreign language had the shortest VOTs in Spanish, which may suggest that as they consciously try to obtain a native-like accent, they are overcompensating for VOT. Word-initial /g/ in Spanish environments takes a different pattern that the other Spanish environments. Whereas L1 English speakers and L2 Spanish speakers cluster around the short end of the continuum and L1 Spanish speakers and Heritage speakers cluster around the long end, /g/ shows L1 Spanish speakers having a shorter VOT than L2 Spanish speakers. One possible explanation for this effect is that the data presented was unable to produce a large 16 enough effect size to overcome individual differences in the L1 Spanish speakers. As two of the L1 Spanish speakers came from Venezuela and one came from Spain, it’s possible that regional differences are showing through in the data. It is worth noting that due to language history many participants were eliminated from the study. The largest group was the of participants was the L1 English speakers learning Spanish; however, to balance the groups, I selected only four participants for data analysis. There was range of proficiency levels, which may have also affected the results. In addition, Spanish is the second most commonly spoken language in the world (Eberhard, Simons, & Fennig, 2019) with a great deal of variation among its speakers, so it is natural to assume there would be variation in VOT. To make inferences to a larger population, I plan on recruiting more participants so that I have at least 20 speakers in each group, which will allow me to compare means using ANOVA and make inferences to a larger population. I also plan to use L2 learners of Spanish with a narrower range of language proficiencies and heritage speakers with similar profiles relative to age at which they began learning the L2 and the exposure to the L1 once L2 learning had begun. 17 References Au, T. K.-f., Knightly, L. M., Jun, S.-A., & Oh, J. S. (2002, May). Overhearing a Language During Childhood. Psychological Science, 13(3), 238-243. Birdsong, D., Gertken, L. M., & Amengual, M. (2012, January 20). The Bilingual Language Profile: An Easy-to-Use Instrument to Access Bilingualism. Retrieved from COERLL, The University of Texas at Austin: http://sites.la.utexas.edu/bilingual/ Eberhard, D. M., Simons, G. F., & Fennig, C. D. (2019). Summary by language size. Retrieved from Ethnologue: https://www.ethnologue.com/statistics/size Kent, R. D., & Murray, A. D. (1982, August). Acoustic features of infant vocalic utterances at 3, 6, and 9 months. The Journal of the Acoustical Society of America, 72(2), 353 - 365. Kroll, J. F., & Tokowicz, N. (2005). Models of Bilingual Representation and Processing: Looking Back and to the Future. In J. F. Kroll, & A. M. de Groot, Handbook of Bilingualism: Psycholinguistic Approaches (pp. 531 - 553). Oxford University Press. Montrul, S., & Foote, R. (2014). Age of acquisition interactions in bilingual lexical access: A study of the weaker language of L2 learners and heritage speakers. International Journal of Bilingualism, 18(3), 274-303. Polinsky, M., & Del Pilar, M. (2015, April). When L1 becomes an L3: Do heritage speakers make better L3 learners? Bilingualism: Language and Cognition, 18(SI2), 163-178. Ringbom, H., & Jarvis, S. (2011). The importance of cross-linguistic similarity in foreign language learning. In M. H. Long, & C. J. Doughty (Eds.), The handbook of language teaching (pp. 106-118). Oxford, United Kingdom: Oxford University Press. 18 Valdés, G. (2005). Bilingualism, Heritage Language Learners, and SLA Research: Opportunities Lost or Seized? The Modern Language Journal, 89(3), 410-426. 19 APPENDIX A: ENGLISH/SPANISH WORDS English word-initial word-medial word-final /b/ /p/ /d/ /t/ /g/ /k/ bee pea den ten gap cap beach peach door tore goal coal bark park dart tart girl curl stable staple model motel logger locker mobbing mopping wader water wagon whackin’ nabbing napping header heater begging baking pub pup ride write bag back robe rope hard heart pig pick cub cup send sent clog clock Spanish word-initial word-medial /b/ /p/ /d/ /t/ /g/ /k/ bata pata dos tos gana cana boca poca día tía gaza casa bola pola deja teja gola cola cabo capo boda bota vaga vaca taba tapa saldar saltar pega peca sube supe tienda tienta manga manca *Spanish does not allow for stops in the word-final coda position. 20 APPENDIX B: EXPERIMENTAL TOKENS /l/ /b/ /p/ /d/ /t/ /g/ /k/ word-initial bolo polo dolo tolo golo kolo word-medial lobo lopo lodo loto logo loko word-final lolob lolop lolod lolot lolog lolok /n/ /b/ /p/ /d/ /t/ /g/ /k/ word-initial bono pono dono tono gono kono word-medial nobo nopo nodo noto nogo noko word-final nonob nonop nonod nonot nonog nonok /b/ /p/ /d/ /t/ /g/ /k/ word-initial boro poro doro toro goro koro word-medial robo ropo rodo roto rogo roko word-final rorob rorop rorod rorot rorog rorok /r/ 21 APPENDIX C: ALTERNATIVE PHRASES USED Token Phrase baking They were surely baking over in Franklin. begging They were surely begging over in Franklin. deja Por favor, deja la mascota. mobbing They were surely mobbing over in Franklin. mopping They were surely mopping over in Franklin. nabbing They were surely nabbing over in Franklin. napping They were surely napping over in Franklin. poca Bebí poca horchata. pola No pola la ventana. saldar ¿Quiere saldar este argumento? saltar ¿Quiere saltar en el hueco? send They will surely send Olivia a letter today. sent They surely sent Olivia a letter today. sube Por favor, sube la caja. supe Yo supe que no está aquí. tore They surely tore Olivia’s backpack today. whackin’ They were surely whackin’ over in Franklin. write They will sure write Olivia the letter today. 1 University of Utah UNDERGRADUATE RESEARCH JOURNAL GLIMPSES OF CHINESE AND INDIAN COOLIE RESISTANCE IN THE BRITISH WEST INDIES, C. 1834-1917 Hans Liu Department of History ABSTRACT Many people are relatively unaware of the hundreds of thousands of indentured workers from China and India, known as coolies, that labored in the British West Indies during and after the end of the trans-Atlantic slave trade between 1834 and 1918. While some scholars have acknowledged the presence of these foreign contract laborers, few have closely studied their acts of resistance during this time period. Consequently, this project seeks to better understand coolie labor experiences in the British West Indies amidst the decline of the trans-Atlantic slave trade and examine the ways in which coolies resisted their masters, related to other workers, and maintained their own identities amidst an oppressive plantation labor system. Through analyzing the daily methods of resistance that coolie laborers resorted to in plantation life, the illegal desertions of coolies, the conflicting relationships between coolie laborers and newly freed slave laborers, and the strategies that planters utilized in attempts to prevent effective coolie resistance, I find that while coolies faced several challenges in subverting the power of their employers, some found unique ways to maintain their autonomy and defy a coercive and deeply-rooted labor system. Despite these efforts, the ultimate decline of coolie labor in the British West Indies is best understood in the context of burgeoning anti-slavery attitudes and growing awareness of workers’ rights at the dawn of the 20th century. 2 D. gave him another shove, and knocked him down. He lay for about a quarter of an hour, and then got up, and was crying for his side . . . . After he got up, D. went to him again and said that he must work, and deceased still said that he wouldn’t work. D. then gave him two boxes right and left on the side of his face, with his open hand. He still insisted on not working. D. took up a lath about fifteen inches, and gave him two blows across the back at the shoulders… Mr. A. came about half-past four o’clock, and told deceased to work. He said he would not. 1 —Joseph Beaumont, The New Slavery, 1871 The above account chronicles the plight of a Chinese contract laborer who was forced to work on a Guianese plantation and eventually beaten to death for his defiant resistance of plantation authorities during the middle of the 19th century. Coolies challenged and subverted the power of their employers while maintaining their identities. Although workplace abuses like these were common occurrences on plantations across the British West Indies following the abolition of the trans-Atlantic slave trade, the plight of hundreds of thousands of indentured servants from China and India that labored in the British Caribbean islands during the 19th and 20th centuries are not well-known. While it is clear that these foreign contract laborers, Joseph Beaumont, The New Slavery: An Account of the Indian and Chinese Immigrants in British Guiana. (London: Ridgway, 1871), 117. 1 3 alsoknown as coolies, 2 worked in the fields during and after the end of the trans-Atlantic slave trade between 1834 to 1917, historians have less commonly explored the daily experiences of coolies and their acts of resistance. Consequently, this research will seek to better understand coolie labor experiences in the British Caribbean islands and the ways in which coolies resisted their masters and maintained their own identities amidst an oppressive labor system. Historiography While many historians frequently discuss the experiences of Chinese “coolie” laborers in areas like the Western United States while working as coal miners and railroad workers during the 19th and 20th centuries, few have examined the experiences of Chinese and Indian coolies in the Caribbean islands during the same time period. Even those interested in studying coolie labor in the Caribbean have limited much of their research to the Spanish Caribbean island of Cuba, while paying little attention to the British Caribbean islands of Guiana, Trinidad, Jamaica, Mauritius, and Barbados. The existing scholarship surrounding coolie laborers focuses on the geographical and socioeconomic factors that led to the coolie trade, the economic impacts of coolie labor in relation to the thriving sugar industry and the declining slave trade, and the reasons why coolie labor was preferred over other forms of labor. However, few scholars have addressed forms of resistance. In describing the geographic factors that led to the coolie trade, Walton Look Lai, in his work, Indentured Labor, Caribbean Sugar: Chinese and Indian Migrants to the British West Indies, 1838-1918, argues that the primary reason that most of the coolies in the British According to the Oxford English Dictionary, the term coolie refers to indentured laborers from South or East Asia. It originates from the mid-17th century term ‘kūlī’ in Hindi and Telugu, which means ‘day laborer’. Although it was widely used to describe an indentured laborer from Asia during the 19th and 20th centuries, it is regarded as a mildly offensive term in some parts of the world today, particularly in Asia and the Caribbean. 2 4 Caribbean islands were of Indian descent is because the British directly ruled India during the majority of the coolie trade, making it easier to coerce Indian laborers to enter the coolie system than workers from other regions. According to Lai, the British government initially sought to avoid officially sanctioning the new coolie trade for fear of appearing to create a new slave trade. However, with planters in the British Caribbean consistently lobbying the British Government to craft new policies that would increase available labor in the colonies and lower labor costs, the colonial office relented and allowed indentured immigrants to work for planters under fixed terms. 3 Lai is primarily interested in coolie labor as it relates to British power in India, and focuses less on the lives of coolies and their resistance once they reached the West Indies. Because the vast majority of coolies in the British Caribbean were of Indian descent, most of Lai’s work focuses on the labor experiences of Indian coolies rather than Chinese coolies. However, scholars Laurence Ma and Carolyn Cartier attempt to address the specific experiences of over 15,000 Chinese coolies that were sent to British Guiana, Trinidad, and Mauritius in their work, The Chinese Diaspora: Space, Place, Mobility, and Identity. 4 Together, these two authors assert that a combination of internal strife and economic instability in China, as well as British incentives to find as many alternative forms of labor as they could muster following the decline in the African slave trade, were the primary causes of the migration of Chinese laborers to the Caribbean. Because of these factors, the vast majority of coolies from China were low-income, uneducated workers fleeing high unemployment rates and inner turmoil in China during the 19th century. Ultimately, Ma and Cartier argue that these unique migration Walton Look Lai, Indentured Labor, Caribbean Sugar: Chinese and Indian Migrants to the British West Indies, 1838-1918, (Baltimore: Johns Hopkins University Press, 2003). 4 Laurence J. Ma, and Carolyn Cartier, The Chinese Diaspora: Space, Place, Mobility, and Identity, (Lanham: Rowman & Littlefield, 2003). 3 5 factors enabled Chinese workers in the Caribbean to develop distinct transnational Chinese identities in this region, in which Chinese laborers held onto some aspects of their language and customs while also adopting cultural practices of the Caribbean. While Ma and Cartier’s work is helpful in understanding the factors that led to the large influx of Chinese coolies to the West Indies, they do not address the experiences of these workers after they reached the West Indies in detail. Coolie labor also had a significant economic impact on the burgeoning Caribbean sugar trade. Economist Michael Dacosta and historian Moon-Ho Jung both argue that the decline in the African slave trade increased the utility and recruitment of coolie labor for plantation owners, which led to rising sugar profits during the height of the sugar industry in the later 19th century. Dacosta explains that the development of an indentured system dependent on coolies from India and China led to lower labor costs, improved sugar plantation prospects, and significant new industry investments by the British royal government in British Guyana and Barbados. 5 Thus, the recruitment of coolies to sugar plantations by both planters and British authorities in the British West Indies was essential to reestablishing England’s supremacy in international sugar markets. Moreover, Jung asserts that the reason that planters preferred to rely on coolies (rather than newly-freed slaves or other workers in the region as their primary labor source) was that plantation owners in the British Caribbean islands often perceived contractually-bound coolies as obedient, hard workers, who were less aggressive and rebellious than newly-freed slaves. 6 Michael Dacosta, "Colonial Origins, Institutions and Economic Performance in the Caribbean: Guyana and Barbados," IMF Working Papers 07, no. 43 (2007): 1-39. 5 6 Moon-Ho Jung. Coolies and Cane: Race, Labor, and Sugar in the Age of Emancipation. (Baltimore: Johns Hopkins University Press, 2009). 6 Historian Howard Johnson adds that coolies were easier to control than other forms of labor because not only were they contractually-bound to provide at least eight years of non-negotiable labor services for their owners in the British Caribbean, but they were also very unlikely to return to their home countries due to dismal economic conditions at home, outstanding debts they accrued while serving as indentured servants, or shrewd re-contracting ploys created by planters. While it is true that planters perceived coolies as more docile than newly-freed slaves, examining the various avenues of coolie resistance will demonstrate that this perception was not always true. Ultimately, while some historians have focused on the broader socioeconomic impacts of coolie labor in relation to slavery and the causes of coolie migration in the British West indies, there are major gaps in current scholarship regarding the daily experiences of coolie laborers and the conditions, relationships, and environments that they toiled under. To understand the various ways in which coolies resisted their masters, one must more carefully address these gaps in knowledge and examine the lives of coolie laborers in the British Caribbean islands in the 19th and 20th centuries. Historical Context When the trans-Atlantic slave trade was abolished in 1834, planters in the Caribbean islands faced a growing labor shortage problem. Sugar, the main cash crop of the British Caribbean islands, was an immensely profitable industry that required large-scale plantation labor. Yet, while the sugar industry was booming during this time—with production reaching record levels by the second half of the 19th century—the availability of African slave labor was 7 decreasing due to burgeoning anti-slavery movements among major slave-trading nations. 7 To supplement this growing need for a cheap and sustainable source of labor, the British turned towards the coolie trade. Between the abolition of slavery in 1834 to the abolition of the coolie trade in 1917 within the British empire, over 500,000 coolies migrated to the British Caribbean islands of Guiana, Trinidad, Mauritius, and Barbados. Of these coolies, 80% came from India, while 3.5% came from China. 8 The Spanish also recruited over 125,000 Chinese coolies to Cuba between 1847 to 1874. 9 The term “coolie” refers to migrant indentured workers from South Asia, Southeast Asia, or China, who were contractually bound to provide labor and other work services for a specific period of time in exchange for wages, which amounted to five years in the British Caribbean islands and eight years in Cuba and Peru. 10 Under contract, coolies were often promised working wages, free housing, healthcare services, and right of return passages in exchange for their labor, which, in the British West Indies, was primarily performed on sugar plantations. When these contracts were completed, workers were given the option to either continue working on the plantation and receive a small parcel of land or to return to their home countries. A complex combination of push and pull factors led to the massive influx of coolie laborers to the British West Indies between 1834 to 1917. Beyond the abolition of the trans- Deborah G. White, Mia Bay, and Waldo E. Martin. Freedom on My Mind: A History of African Americans, with Documents. 2nd ed. Vol. 1. (Boston: Bedford/St. Martins, 2017). 8 Walton Look Lai, Indentured Labor, Caribbean Sugar: Chinese and Indian Migrants to the British West Indies, 1838-1918, (Baltimore: Johns Hopkins University Press, 2003). 9 Ma, Laurence J. and Carolyn Cartier, The Chinese Diaspora: Space, Place, Mobility, and Identity, (Lanham: Rowman & Littlefield, 2003). 7 Walton Look Lai, Indentured Labor, Caribbean Sugar: Chinese and Indian Migrants to the British West Indies, 1838-1918, (Baltimore: Johns Hopkins University Press, 2003). 10 8 Atlantic slave trade and the subsequent need for planters to find new laborers, coolie laborers sought to escape the dismal economic and political conditions in India and China. 11 Economists David Clingingsmith and Jeffrey Williamson write that during the 19th century in India: Central authority waned, revenue farming expanded, the rent burden increased, warfare raised the price of agricultural inputs, and regional trade within the subcontinent declined, all serving to drive down the productivity of foodgrain agriculture. Grain prices rose, and given that ordinary workers lived near subsistence, the nominal wage rose as well. 12 The greatest factors contributing to such economic duress were a series of droughts and famines across India during the 19th century. For example, between 1866 to 1867, nearly a million Indians died from famine caused by severe droughts, and 4.3 million died from an even larger famine between 1876 to 1878. 13 Drought not only destroyed crops, but it also raised the price of available food, leaving millions to starve to death. However, such starvation and famine was often caused by British rulers’ blatant neglect of the basic needs of Indians out of their desire for economic efficiency, preferring to sell food at exorbitant prices during drought seasons to a starving population who could not afford it while failing to institute famine-relief measures. 14 Consequently, the difficulties of subsistence living in India during the 19th century increased the appeal of indentured labor work in the British West Indies. 15 For example, in Lomarsh Roopnarine, The Indian Caribbean: Migration and Identity in the Diaspora, (Jackson: University Press of Mississippi, 2018). 12 David Clingingsmith and Jeffrey G. Williamson. "Deindustrialization in 18th and 19th Century India: Mughal Decline, Climate Shocks and British Industrial Ascent." Explorations in Economic History 45, no. 3 (2008)., 233. 11 Marshall, Peter J. The Cambridge Illustrated History of the British Empire. (Cambridge, 2008), 132. 14 The Pioneer, Allahabad, India, February 6, 1867, 8. 15 Laurence, Keith Ormiston. 1994. A question of labour: indentured immigration into Trinidad and British Guiana 1875-1917. Kingston: Randle. 13 9 regards to the famine of 1866, one Indian newspaper at the time reported that “great distress, amounting almost to starvation, had prevailed… and that it was under the pressure of this distress that the emigrants of last season came forward.” 16 This article specifically explains that the dismal conditions caused by starvation compelled Indian workers to emigrate to the West Indies. The majority of these contract laborers were rural peasants who were not fully aware of the terms of their contracts or the arduous nature of the work that they agreed to perform. The British also imported coolies from China during this time period, albeit on a much smaller scale due to the fact that Indian workers, as British colonial subjects, were more accessible than Chinese workers. 17 Political and economic failures in late Qing China, exacerbated by the Taiping Rebellion in Southeastern China, led thousands of poor Chinese peasants to flock to the Southeastern ports of Guangdong and Fujian in search of employment, where some were recruited for labor in the British West Indies. 18 While the demand for coolie recruitment was driven by British planters in need of an alternative source of labor to slaves, the importation of Chinese and Indian coolies was often facilitated by other Chinese and Indian middlemen, who acted as intermediaries between the new recruits and the planters. The middleman who brokered new recruitments was often a former coolie himself, who had gained knowledge, experience, and a small amount of capital during his time working on the plantation. In exchange for a commission from the planter, the broker negotiated virtually all terms of work for new coolies and also assumed the risks of loss and The Pioneer, Allahabad, India, October 31st, 1866, 6. 17 Walton Look Lai, Indentured Labor, Caribbean Sugar: Chinese and Indian Migrants to the British West Indies, 1838-1918, (Baltimore: Johns Hopkins University Press, 2003). 18 Walton Look Lai, "The Chinese Indenture System in the British West Indies and Its Aftermath," In The Chinese in the Caribbean, edited by Andrew R. Wilson, 3-24 (Princeton: Markus Wiener Press, 2004), 7. 16 10 damage regarding new recruits. 19 Thus, while many subjects of colonial power were victimized by the greater coolie system, some benefited from it. Together, coolie labor from India and China sustained the growth of the profitable sugar trade in the British West Indies after the abolition of slavery by providing a consistent, accessible, and affordable labor source for British planters. The ways in which indentured workers were recruited also changed over time. For example, in the early years of the coolie trade, planation workers often forcibly recruited coolies by kidnapping, threatening, or seriously misleading workers into thinking that the compensations, destinations, and duties required of them would be much more appealing than they were in reality. 20 However, in the later years of the coolie trade, many indentured workers from China and India voluntarily chose to contract their labor abroad, primarily due to increasing economic turmoil in their home countries and the desire to create a better life overseas. 21 After being recruited from China and India, coolies often endured their own form of the “Middle Passage,” where atrocities like death, disease, abuse, and rape were common. While maritime technology had improved significantly since the trans-Atlantic slave trade, some coolies still traveled in infamous slave ships while suffering similarly abysmal conditions and nearly comparable mortality rates to African slaves. 22 Neglect in care and treatment during this middle passage often led to unnecessarily severe outbreaks of disease and insufficient food and water supplies, which compounded mortality rates. For instance, between 1851 to 1873, there W.L. Distant, "Eastern Coolie Labour," The Journal of the Anthropological Institute of Great Britain and Ireland 3 (1874), 142. 19 David Northrup, Indentured Labor in the Age of Imperialism: 1834-1922, (Cambridge: Cambridge University Press, 1995), 5. Such underhanded recruiting tactics led to unflattering nicknames of the coolie trade, such as “blackbirding” and “the pig trade.” 21 Ibid., 6. 22 Evelyn Hu-DeHart and Kathleen López, “Asian Diasporas in Latin America and the Caribbean: An Historical Overview” (Afro-Hispanic Review 27, no. 1, 2008), pp. 16 20 11 were approximately 64 deaths per 1000 indentured workers on the voyage from India to the British West Indies, 23 while between 1811 to 1863 there were 69 deaths per 1000 African slaves on voyages from West Africa to the Americas. 24 Chinese coolies did not fare much better on the voyage from China to the British West Indies, with 50 deaths per 1000 indentured workers. 25 This data shows that despite the fact that indentured workers from India and China were legally protected from mistreatment by their employers on their ocean voyages by British regulations, these protections were often not effectively enforced. 26 Across the British West Indies, coolies were legally distinct from African slaves, but their work conditions were similarly abysmal and arduous. On paper, the British colonial governments did not designate coolies as chattel or regard them as property, but their freedoms were limited. Coolies retained the rights to pursue legal remedies in court for mistreatment by their masters and to access government services like health care. Nonetheless, too often in practice, planters and colonial authorities often abused these rights and established elaborate labor ordinances that subjected coolies to their whims. For example, in contracting their labor to plantation authorities, coolies ceded their rights to freedom of movement. Coolies were often restricted from journeying more than two miles away from their allotted land during work hours. 27 Coolies also received disparagingly low incomes—about half the wage rates of free laborers—making it increasingly unlikely for coolies to earn enough money to return to their home countries. Ultimately, these harsh conditions caused many coolies to seek ways to resist their employers’ authority. Calculated from David Eltis, Economic Growth and the Ending of the Transatlantic Slave Trade (New York: Oxford University Press, 1987), pp. 133, 137. 24 Calculated from records of the Colonial Land and Emigration Commission (1851-1873). 25 Calculated from Arnold J. Meagher, "The Introduction of Chinese Laborers to Latin America: the 'Coolie Trade,' 1847-1874," (Ph.D. dissertation, University of California, Davis, 1975), 26 David Northrup, Indentured Labor in the Age of Imperialism: 1834-1922, (Cambridge: Cambridge University Press, 1995). 27 Ibid. 23 12 For coolies, life on a sugar plantation was harsh and demanding. Much like the slave laborers that they often replaced, coolies were organized into a gang system of plantation labor, meaning that workers were divided into groups, and planters assigned the toughest work such as planting, manuring, and cane-cutting to groups of workers that they deemed the strongest and healthiest. 28 Other, less physically demanding assignments, such as domestic chores, were given to gangs of weaker coolies, who were often either very young or elderly. Despite the fact that colonial authorities created work hour restrictions to avoid criticisms of creating a new form of slavery, planters often violated these rarely enforced restrictions and illegally forced coolies to work for twelve hours or more with no additional pay for their extra labor hours. 29 If planters were dissatisfied with the completion of labor assignments, they often punished the indentured workers harshly, lashing them or withholding daily wages and food provisions for prolonged periods of time. 30 All of these severe restrictions and punishments meant that coolies were often trapped in their positions as bound laborers, fully dependent on their employers for wages needed to survive for fear of not finding work elsewhere, but with little control over how they received their wages. 31 Acts of Resistance In response to the harsh realities of plantation life, a number of Chinese and Indian coolies turned to escapist activities such as drinking, gambling, and opium-smoking to provide temporary relief from the toils of their labor at the end of the workday or week. 32 However, even Joseph Beaumont, The New Slavery: An Account of the Indian and Chinese Immigrants in British Guiana. (London: Ridgway, 1871), 21. 29 Report of the West Indian Royal Commission, (HMSO, 1897), 97. 30 Joseph Beaumont, The New Slavery: An Account of the Indian and Chinese Immigrants in British Guiana. (London: Ridgway, 1871), 95. 31 Ibid., 96 32 Hugh Tinker, A New System of Slavery: The Export of Indian Labour Overseas: 1830-1920, (London: Hansib Publishing Limited, 1993), 212. 28 13 colonial authorities such as Joseph Beaumont, who served as British Guiana’s Chief Justice from 1863 to 1868, reported that these diversions were, “In fact, caused and fostered by poverty and distress rather than by prosperity and comfort.” Furthermore, suicide was a less common, but still existent avenue that some coolies took to escape their oppressive circumstances. Although more rare than other escapist activities, suicide rates were considerably higher for coolie laborers once they arrived in the British West Indies than in their home countries, with 728 suicides per million in some places in Mauritius and British Guiana as opposed to rates of 50 suicides per million in the areas in India from which many of these migrants came from. 33 One Indian newspaper even reported that after coolies leave for the Indies, “mortality among the emigrants is frightfully high, averaging 25 percent. Suicide is very common, and mutinies and riots not unfrequently dispose of the ablest members of a gang.” 34 However, as the coolie trade grew and indentured labor became more established and institutionalized in the British West Indies, increasing numbers of coolies turned from escapist strategies to more direct confrontations. 35 This shift likely occurred as criticisms of the coolie trade grew among colonial powers and as recruited laborers began more astutely realizing the exploitative nature of the coolie trade as it expanded. In the 1880s, a number of riots broke out across British Guiana and Trinidad due to workers’ discontent with dismal wages and abuses of power. In one riot on Plantation Enmore, five overseers were sent to the hospital after being beaten by their workers who were infuriated with their already-low wages being withheld from them, and it took over thirty police officers to eventually end the conflict. 36 Beyond outright Ibid., 213. The Pioneer, Allahabad, India, August 23, 1867, 2. 35 David Northrup, Indentured Labor in the Age of Imperialism: 1834-1922, (Cambridge: Cambridge University Press, 1995), 128. 36 Daily Chronicle, Georgetown, British Guiana, June 20, 1888. 33 34 14 violent protests, some workers also turned to traditional methods of sabotage, such as footdragging at work or destroying plantation equipment to hinder sugar production. In one instance reported in a local newspaper in British Guiana, an Indian coolie named Abodoolah set fire to the sugar cane field of his employer, destroying hundreds of dollars in sugar profits. 37 Coolies also occasionally used religious claims to both resist planter’s authorities and maintain their own identities. W.L. Distant, who visited several plantations in the British West Indies in 1874, found that some coolies would claim to convert to Christianity in order to receive touted benefits from their employers, such as greater pay and less work. 38 However, he reports that these supposed conversions were often feigned, writing that, “Minds possessed with these strong beliefs are very unremunerative ground for the reception of new religious dogmas. The need of money is what has really brought these different people together.” 39 In other words, coolies sometimes manipulated their master’s religions to receive personal benefits. Moreover, although few coolie laborers were well-educated and literate, those that were educated often used their abilities to directly challenge the indentured system. Bechu, a Bengali worker from Plantation Enmore, is one example of such efforts. In 1894, he sent a number of letters to colonial authorities outlining the abuses of planters, which included exploitation of Indian women by overseers, illegal threats, and the withholding of worker’s wages to hinder dissent. 40 In one of his letters he proclaimed: My countrymen like myself have had the misfortune to come to Demerara, the political system of which colony has very appropriately have divined and defined by Mr. Trollope under a happy inspiration as “despotism tempered by sugar.” To these twin forces, the Immigration system is as sacred as the old system of slavery in former days, and for one Daily Chronicle, Georgetown, British Guiana, May 17, 1888. W.L. Distant, "Eastern Coolie Labour," The Journal of the Anthropological Institute of Great Britain and Ireland 3 (1874), 144. 39 Ibid., 144. 40 Walter Rodney, A History of the Guyanese Working People, 1881-1905, (Baltimore: Johns Hopkins University Press, 1982), 156. 37 38 15 in my humble position to have ventured to touch it with profane hands or to have dared to unveil it is considered on this side of the Atlantic to be a capital and inexpiable offence. 41 Here, Bechu notes the difficulty of challenging the firmly-established British system of coolie labor. However, this account also reveals that despite the daily threats and challenges that coolie laborers experienced—which were designed to prevent them from resisting their masters—some still courageously voiced their concerns to weaken the system that entrapped them in servitude. Thus, while sometimes resistance was violent and illegal, at other times it was executed through legal means. Therefore, the notion of resistance demonstrated by coolie laborers takes on multiple meanings. Resistance by Illegal Migration and Desertion Notwithstanding the severe risks of punishment, coolies often deserted their plantations or resorted to illegal migration to other regions to subvert their employers. According to Indian Immigration Ordinance No. 135, planters required coolies to carry with them a certificate of exemption from labor granted to them by their employers at all times to avoid being designated as a deserter or absconder. If coolies were caught outside of plantation grounds and unable to produce a certificate, they would be arrested and taken to the nearest police station. 42 Desertion was illegal and carried with it the penalty of two months in prison or five pounds in fines—a substantial penalty considering the average wage of coolies was twenty-four cents a day. 43 Considering that it would require nearly one-hundred days of work to pay off the desertion fine, almost no coolies returned to their former plantations if they successfully deserted. Despite the harsh penalties for breaching their contracts, a considerable number of coolies escaped from their Ibid., 156. Indian Immigration Ordinance of Trinidad and British Guiana, (London: HMSO,1904). 43 Lomarsh Roopnarine, The Indian Caribbean: Migration and Identity in the Diaspora. (Jackson: University Press of Mississippi, 2018), 42. 41 42 16 home plantations to pursue independent survival, with nearly 13,988 coolies deserting between 1865 to 1890 in British Guiana alone. 44 Given the risks and punishments of desertion, why were desertion rates so high among coolies? To some, the mere notion of escape offered the hope of avoiding intensive labor obligations and creating an independent life with new freedoms. For instance, after 1870, increased numbers of indentured Indians deserted Trinidad for Venezuela, where they could more easily acquire their own land. 45 In some cases, coolies escaped indenture to pursue less restrictive employment opportunities such as working with the interior Amerindians in British Guiana and the cocoa farmers of Venezuela. 46 Perhaps most importantly, coolies often deserted to escape the hazardous working conditions of plantation life, the perils of which are indicated by the 32% mortality rate of coolie workers in British Guiana between 1908 to 1911. 47 The likelihood of such desertions were also aided by the proximity of the Caribbean islands to each other and the heavily forested terrain of many areas in the region such as British Guiana. 48 Ultimately, while coolie laborers pursued other methods of resistance such as riots, strikes, and sabotage, desertion was by far the most common form of resistance, as it offered more immediate hopes of escape and the creation of a new autonomous life in a more suitable environment. 49 While these deserters were never able to successfully form permanent communities akin to the Maroons of Jamaica and Suriname during the trans-atlantic slave trade, Lomarsh Roopnarine, “Indian Migration during Indentured Servitude in British Guiana and Trinidad, 1850– 1920,” Labor History 52, no. 2 (2011): 178. 45 David Northrup, Indentured Labor in the Age of Imperialism: 1834-1922, (Cambridge: Cambridge University Press, 1995), 127. 46 Lomarsh Roopnarine, The Indian Caribbean: Migration and Identity in the Diaspora. (Jackson: University Press of Mississippi, 2018), 45. 47 Ibid.,44. 48 Ibid.,45. 49 David Northrup, Indentured Labor in the Age of Imperialism: 1834-1922, (Cambridge: Cambridge University Press, 1995, 127. 44 17 the prevalence of desertion among coolies reveals a noticeable degree of resistance against plantation authorities to live independent lives. In other words, coolies most commonly resisted with their feet. Limits of Coolie Resistance As indentured workers, coolie laborers occupied a unique middle status as free but legally bound peoples, with severe restrictions on their mobility, occupational freedom, and their ability to challenge their employers. In 1864, the British Government passed an immigration ordinance that confined indentured workers to a two-mile radius of their plantations to prevent workers from subverting plantation authorities. In addition to making a violation of a civil contract a criminal offense liable to fines and imprisonment, coolie laws were designed to effectively prevent most coolie laborers from filing enforceable complaints against their employers and overseers. 50 For instance, to file a complaint in British Guiana, workers were required to go to the Immigration Office located in Georgetown. However, most plantations were several miles from Georgetown, meaning that in order to file a complaint in person, workers were required to receive a “travel certificate” from the very employers or overseers they were often bringing their grievances against. In one case, a worker was given a subpoena by a magistrate in Georgetown to testify against his master. However, upon leaving the plantation to provide his testimony, the worker was charged by his employer for missing work and imprisoned before his case could be heard. 51 50 An Ordinance to Extend the Term of Indentures of Immigrants Introduced from India and China, 1862 (No. 30); Papers re British Guiana, pp, 1863 (6830), XV. 139. 51 W. Kloosterboer, Involuntary Labour Since the Abolition of Slavery: A Survey of Compulsory Labour Throughout the World (Leiden: E.J. Brill, 1960), 13. 18 Additionally, while indentured workers were legally permitted to apply to return to their home countries once the terms of their contracts were met, planters could use their superior resources to prevent workers from leaving their plantations. For instance, in 1897, the Bengali coolie named Bechu was asked by the West Indian Royal Commission to testify about reported work conditions violations, such as compulsory twelve-hour workdays, on the Enmore Plantation in Demerera. When asked why coolie workers simply did not return to their home countries after experiencing such grueling labor conditions, Bechu stated: “I know for a fact that people are constantly making applications to the authorities and they do not get a chance to go. Only last year there was a man who on three occasions made application to go to India, he was refused, and on the last occasion he came to me and begged me to write a letter to the immigration agent general.” 52 This statement indicates that not only were applications to return home readily refused, but planters also capitalized on the illiteracy and uneducated status of many coolies and the required medium of an immigration agent to prevent coolies from leaving their plantations. In response to this testimony, G.W. Bethunh, an agent of the Enmore Plantation in Demerara, sent a letter to the West India Royal Commission in 1897, which denied Bechu’s claims about the labor violations found at Enmore. He wrote: The proprietor of this important sugar property, with a cultivated area of over 2,000 acres, naturally takes a deep interest in the welfare of the labourers on his land, and for many years past he has been the main support of a church on the estate… the immigrants on this property have the privilege of free pasturage for cattle, and are allowed to cultivate plots of land with provisions… I most emphatically deny the gist of the above mentioned immigrant’s report. 53 The above account highlights the ways in which immigration agents, who were charged with the task of providing fair and viable representation for the indentured workers, often sided with plantation authorities by downplaying the abuses and labor violations that occurred on 52 53 Report of the West Indian Royal Commission, (HMSO, 1897), 98. Ibid., 159. 19 plantations. Together, these statements by worker and agent demonstrate that although there were a few legal remedies available for coolie laborers to pursue in response to harsh plantation rule, planters possessed a diverse and vastly superior array of legal avenues to keep indentured workers subjugated. Tensions Between Coolies and Former Slaves Given the many strategies that planters employed to prevent coolies from effectively resisting their authority, it would seem that coolie laborers might attempt to collaborate with other types of workers to more effectively subvert their employers’ power. However, although coolie laborers shared many common experiences and conditions with former slaves and newlyfreed black laborers working in the British West Indies, a multitude of conflicting interests created tensions between the two groups. After the abolition of the slave trade in 1834, many former African slaves in the British West Indies decided to stay in the region to continue working as free, paid laborers. Yet, when thousands of indentured workers began arriving from India and China to replace the loss of slave labor at the same time, tensions quickly developed between coolies and freed slaves. 54 For one, freed slaves were taxed by the British colonial government in order to subsidize the costs of importing Chinese and Indian coolies to maintain the sugar industry, which led to increased animosity from free workers towards the new arrivals. 55 Moreover, the average pay of newly freed black workers was twice that of indentured workers, which also contributed to increasing tensions between the different groups. 56 Many former slaves anxiously viewed new Michael Dacosta, "Colonial Origins, Institutions and Economic Performance in the Caribbean: Guyana and Barbados," IMF Working Papers 07, no. 43 (2007), 13. 55 Alan H. Adamson, Sugar without Slaves. The Political Economy of British Guiana, 1838-1904, (New Haven and London: Yale University Press, 1972). 56 Clive Thomas, Plantations, Peasants, and State: A Study of the Mode of Sugar Production in Guyana. (Los Angeles: Center for Afro-American Studies, University of California, 1984), 21. 54 20 arrivals as potential competitors for limited work on the plantations, especially considering the common belief among free workers that the labor supply was already adequate and that the subsequent importation of indentured workers weakened the effects of strikes and lowered overall plantation wages. 57 This notion is given credence by firsthand accounts of planters. Sandbach Parker, one of the most prominent planters in the British West Indies, noted, “…so long as an estate has a large Coolie gang, Creoles must give way in prices asked or see the work done by indentured labourers—and this is a strong reason why the number of Coolies on estates must not be reduced…” 58 Parker’s statement indicates that planters acknowledged the distinctions between coolies and free workers and the fact that coolies were willing to work for much lower wages than free workers and capitalized on these disparities to maximize their profits. Besides these economic factors, cultural differences also played a role in heightening tensions between free blacks and Chinese and Indian coolies in the British West Indies. For instance, in Jamaica, the fact that small retail businesses were often owned by Chinese coolies who operated in tight-knit family and kinship structures that precluded other ethnic groups from joining created significant hostility towards Chinese workers that resulted in a series of antiChinese riots. Albert Chong, the mixed-race son of a Chinese-Jamaican shop-owner during the early 20th century recounted that the only reason that his father’s business was not attacked during the anti-Chinese riots in Jamaica was because his father had a history of hiring free blacks as well as Chinese workers. 59 Walter Rodney, A History of the Guyanese Working People, 1881-1905, (Baltimore: Johns Hopkins University Press, 1982), 38. 58 Ibid., 38 59 Evelyn Hu-DeHart and Kathleen López, “Asian Diasporas in Latin America and the Caribbean: An Historical Overview” (Afro-Hispanic Review 27, no. 1, 2008), pp. 17. 57 21 These conflicting interests, which were exacerbated by planter interventions, might help explain the fact that many coolies and free black workers not only refused to collaborate with each other, but also often played direct roles in limiting each other’s resistance efforts. For instance, in 1847, a strike led by freed slaves against planters for lowering their wages was unsuccessful because indentured workers continued to work through the strike, meaning that freed slaves could not disrupt production enough to receive the benefits of collective bargaining. 60 On the other hand, when coolies started a riot on the Plantation Enmore in 1888, some overseers were hidden and protected by free black workers from the estate, with one overseer claiming that he narrowly escaped the beatings of coolies because a black worker who was washing clothes nearby threw her clothes over him until his pursuers had passed. 61 Ultimately, the conflicting economic interests and cultural differences of indentured coolies and former black slaves effectively prevented coolies and free black workers from recognizing common objectives and working together to collectively create better opportunities for themselves during the system of indentured servitude. The End of Coolie Labor Throughout the period between the abolition of slavery in 1834 to the early 1900s, the use of coolie labor across the world was often widely-criticized as a deplorable form of coerced labor that sustained many of the same abusive practices ensued by the slave systems it was created to replace. 62 Consequently, British colonial authorities were no stranger to these criticisms, which grew increasingly louder as the abuses and failures of indentured servitude V.T Daly, A Short History of the Guyanese People, (London: Macmillan, 1976). Daily Chronicle. Georgetown, British Guiana. June 20, 1888. 62 Matthew Pratt Guterl, "After Slavery: Asian Labor, the American South, and the Age of Emancipation," Journal of World History 14, no. 2 (2003), 237. 60 61 22 were revealed over time. As a royal commissioner tasked with investigating mistreatment of indentured workers in British Guiana stated: The fact is, there is a prejudice against [indentured labor], partly-sentimental, because it is the symbol of defeat to the too sanguine hopes for the future of the African race which were entertained at emancipation; partly practical, because the government experiment in this direction failed, which was made in the apprenticeship of slaves. 63 This statement captures the notion that many people were opposed to indentured servitude from the very beginning due to its obvious similarities to both slavery and the denounced apprenticeship system that followed slavery. How indentured labor then widely existed for a century and finally collapsed is a complex question to answer. For one, while the essential premises behind the debate over indentured labor themselves did not change, the context of these debates did. As historian David Northrup points out, “The campaign to end slavery in the older British colonies had broadened during the nineteenth century, extending its geographical scope worldwide and including many other forced labor systems.” 64 For instance, in 1843, the Indian debt and caste-based peonage systems were banned as forms of slavery, while slavery in the United States and serfdom in Russia were finally outlawed by the end of the 1860s. Growing international sentiment against slavery and similar forms of coerced labor is captured by the League of Nations Slavery Convention of 1926. 65 Moreover, international campaigns against abusive forms of coerced labor also coexisted alongside burgeoning labor movements of the new industrial classes, which created widespread distaste against unfair wages, long hours, and hazardous working environments. 66 Additionally, budding nationalist movements in both India Report of the Commisioners Appointed to Enquire into the Treatment of Immigrants in British Guiana, 1871, Parliamentary Papers, 63. 64 David Northrup, Indentured Labor in the Age of Imperialism: 1834-1922, (Cambridge: Cambridge University Press, 1995), 141. 65 Ibid., 142. 66 Ibid. 63 23 and China began in response to imperialistic foreign interventions such as defeat in the Opium Wars in China and repeatedly denied sovereignty in India. These movements led both the Chinese and Indian governments to more strictly restrict the exportation of laborers from their shores. 67 In the context of increasing global awareness and national discontent with abusive labor systems, the British Royal Government eventually dismantled and outlawed the unpopular system of indentured labor in the British West Indies by the end of the 1930s. While it is difficult to measure the exact contributions of Chinese and Indian coolie resistance efforts to the elimination of the coolie trade in the 20th century, the various riots, protests, legal complaints, and desertions of coolies in the British West Indies certainly helped raise awareness of the extent of the abuses found in the indentured labor system, which was fundamental in gathering the necessary support to dismantle the system of indentured servitude. 68 Bibliography Adamson, Alan H. Sugar without Slaves. The Political Economy of British Guiana, 1838-1904. New Haven and London: Yale University Press, 1972. Beaumont, Joseph. The New Slavery: An Account of the Indian and Chinese Immigrants in British Guiana. London: Ridgway, 1871. Clingingsmith, David, and Jeffrey G. Williamson. "Deindustrialization in 18th and 19th Century India: Mughal Decline, Climate Shocks and British Industrial Ascent." Explorations in Economic History 45, no. 3 (July 2008): 209-34. Dacosta, Michael. "Colonial Origins, Institutions and Economic Performance in the Caribbean: Guyana and Barbados." IMF Working Papers 07, no. 43 (Jan. & feb. 2007): 1-39. doi:10.5089/9781451866070.001. Daily Chronicle. Georgetown, British Guiana. May 17, 1888. Daily Chronicle. Georgetown, British Guiana. June 20, 1888. Distant, W. L. "Eastern Coolie Labour." The Journal of the Anthropological Institute of Great Britain and Ireland 3 (January 1, 1874): 142. Accessed October 3, 2018. Erickson, Edgar L. "The Introduction of East Indian Coolies into the British West Indies." The Journal of Modern History 6, no. 2 (1934): 127-46. Edgar L. Erickson, "The Introduction of East Indian Coolies into the British West Indies," The Journal of Modern History 6, no. 2 (1934): 127-46. 68 Ibid., 146. 67 24 General Report of the Colonial Land and Emigration Commissioners, 1843. Great Britain, Emigration Commission, 1843. Guterl, Matthew Pratt. "After Slavery: Asian Labor, the American South, and the Age of Emancipation." Journal of World History 14, no. 2 (2003). Hu-Dehart, Evelyn. "Chinese Coolie Labor in Cuba in the Nineteenth Century: Free Labor or Neoslavery?" Contributions in Black Studies 12, no. 5 (1994): 38-54. Hu-DeHart, Evelyn, and López, Kathleen. “Asian Diasporas in Latin America and the Caribbean: An Historical Overview” Afro-Hispanic Review 27, no. 1 (2008): pp. 16 Johnson, Howard. "Barbadian Immigrants in Trinidad 1870-1897." Caribbean Studies 13, no. 3 (1973): 5-30. Jung, Moon-Ho. Coolies and Cane: Race, Labor, and Sugar in the Age of Emancipation. (Baltimore: Johns Hopkins University Press, 2009). Lai, Walton Look. Indentured Labor, Caribbean Sugar: Chinese and Indian Migrants to the British West Indies, 1838-1918. (Baltimore: Johns Hopkins University Press, 2003). Lai, Walton Look, "The Chinese Indenture System in the British West Indies and Its Aftermath," In Chinese in the Caribbean, edited by Andrew R. Wilson, 3-24 (Princeton: Markus Wiener Press, 2004), 7. Laurence, Keith Ormiston. 1994. A Question of Labour: Indentured Immigration into Trinidad and British Guiana 1875-1917. Kingston: Randle. Ma, Laurence J., and Cartier Carolyn. The Chinese Diaspora: Space, Place, Mobility, and Identity. (Lanham: Rowman & Littlefield, 2003). Marshall, Peter J. The Cambridge Illustrated History of the British Empire. Cambridge: Cambridge Univ. Press, 2008. Northrup, David. Indentured Labor in the Age of Imperialism: 1834-1922. Cambridge: Cambridge University Press, 1995. Port of Spain Gazette, 16 January 1886; 17 December, 1881; Report of Registrar General for 1886; Council Paper No. 6 of 1887. Report of the Commissioners Appointed to Enquire into the Treatment of Immigrants in British Guiana, 1871, Parliamentary Papers, 63. Rodney, Walter. A History of the Guyanese Working People, 1881-1905. Baltimore, MD: Johns Hopkins University Press, 1982. Roopnarine, Lomarsh. The Indian Caribbean: Migration and Identity in the Diaspora. (Jackson: University Press of Mississippi, 2018). Thomas, Clive Yolande. Plantations, Peasants, and State: A Study of the Mode of Sugar Production in Guyana. Los Angeles, CA: Center for Afro-American Studies, University of California, 1984. The Pioneer. Allahabad, India. October 31st, 1866. The Pioneer. Allahabad, India. August 23, 1867. The Pioneer. Allahabad, India, February 6, 1867. Tinker, Hugh. A New System of Slavery: The Export of Indian Labour Overseas: 1830-1920. London: Hansib Publishing Limited, 1993. Wolcott, George N. "Report on a Trip to Demerara, Trinidad, and Barbados during the Winter of 1913." Journal of Economic Entomologists 6 (1913). Accessed October 6, 2017. University of Utah UNDERGRADUATE RESEARCH JOURNAL “We Go Where They Go:” A History of Anti-Racist Action Douglas Wood Nagie (Robert Goldberg, PhD) Department of History Anti-Racist Action was a radical network of militant youth activists who counter-organized racists and far-right extremists between the late 1980s and 2013. It began in Minneapolis when a multi-racial skinhead crew named the Baldies mobilized in response to a new breed of neo-Nazi skinheads. Anti-Racist Action spread through skinhead and punk youth culture and chapters were soon established in American and Canadian cities. Organizing formalized after a 1995 conference solidified a framework for communication between chapters. The network became a major force in radical political organizing. It created a decentralized model that advocated progressive political change, primarily through militant and direct action against neo-Nazis, the Ku Klux Klansman, white supremacists, and radical anti-abortion organizations. This paper seeks to recreate the history of Anti-Racist Action from its beginning and ascension to its decline and dissolution. It is guided primarily by oral histories conducted with long-term organizers of the network and supplemented by contemporary media accounts and primary sources. It attempts to establish a chronology of events, analyze the context that made ARA’s mobilization possible, and recreate the culture and politics of the group and its participants. University of Utah UNDERGRADUATE RESEARCH JOURNAL DIGITAL HUMANITIES APPROACHES TO TRADITIONAL CHINESE STORY COLLECTIONS Lisa Richardson (Prof. Margaret Wan) Department of World Languages and Cultures In the past, much of the study of Chinese narrative literature has focused on a very small sample of novels – usually those that were best known. This project’s aim is to broaden the scope of fiction studied. In order to accomplish this, Digital Humanities approaches were explored. Making data abstract allows for easier visualization and facilitates the study of patterns, rather than of details alone. Ōtsuka Hidetaka’s ​A Bibliography of Chinese Popular Fiction ​was used to create a database which serves as the basis of all other work in this project, along with the other references cited below. In order to fully test some possible digital tools, six collections of Chinese vernacular short stories were chosen from this database for analysis. One in particular, ​Strange Views Old and New​ (Jīngǔ qíguān 今古奇觀) was of particular interest, as it seems to be one of the most popular works of vernacular fiction in Ming-Qing China, having 55 printed editions in total. For the purpose of analysis, information from the database was used to create graphs, and the text of these collections were run through “The Late Imperial Primer Literacy Sieve”. This tool allows for Chinese texts to be run against chosen primers, showing the percentage of unique characters that the subject would be able to read had they studied those primers. Supposing that the popularity of ​Jingu qiguan​ could be due to accessibility by wider audiences of readers, we chose the most basic primers- The ​Three-character classic ​(​Sān zì jīng​ ​三字經)​, Hundred family names​ (Bǎi jiā xìng 百家姓)​, ​and ​Thousand-character essay ​(Qiān zì wén 千字 文)​ -​ in order to analyze of the relative accessibility of each collection of vernacular fiction. A comparison of aggregate collections against chosen primers, the cross section representing the accessibility of the texts (on the left) if the subject had studied the primers (on the top). A complete view of output generated by the literacy sieve. On the bottom left is a visual representation of the stats on the right, the reddened and blacked out characters being the ones unknown to a subject who had studied the selected primers. Through the use of these digital tools, it was found that the accessibility of the texts tended towards an association with the time-period in which the story was written, the most accessible stories being those that were written in the middle period (ca. 1450-1550). However, the stories that were anthologized in the ​Jingu qiguan​ story collection were almost entirely late-period stories – those which our analysis showed were the least accessible of all the periods.The popularity of ​Jingu qiguan​ does not seem to be due to greater accessibility by a wider audience, so other explanations must be found. This brings to light some interesting questions and possible patterns relating to the process of anthologizing or transmitting of fiction, which may aid understanding of the history of the Chinese vernacular story. References Brokaw, Cynthia. ​Commerce in Culture.​ Cambridge, MA: Harvard University Asia Center, 2007. Burdick, Anne, et al. ​Digital_Humanities​. Cambridge, MA: The MIT Press, 2012. Hanan, Patrick. ​The Chinese Vernacular Story​. Cambridge, Mass. and London, England: Harvard University Press, 1981. Hegel, Robert. ​Reading Illustrated Fiction in Late Imperial China​. Stanford, Calif.: Stanford University Press, 1998, pp. 63-65. Idema, Wilt. (1980). Reviewed Work: ​Education and Popular Literacy in Ch'ing China​ by Evelyn Sakakida Rawski. ​T'oung Pao​, 66(4/5), second series, 314-324. Retrieved from http://www.jstor.org/stable/4528215 Moretti, Franco. ​Atlas of the European Novel​. New York and London: Verso, 1998. ________. ​Graphs, Maps, and Trees​. New York and London: Verso, 2007. Ōtsuka Hidetaka 大塚秀高. ​Zōho Chūgoku tsūzoku shōsetsushomoku ​増補中國通俗小説書目 [A Bibliography of Chinese Popular Fiction, Expanded Edition]. Tokyo: Kyūkoshoin, 1987. Schneewind, S., et al. (2013). The Late Imperial Primer Literacy Sieve. [online] Ctext.org. Available at: https://ctext.org/tools/literacy-sieve [Accessed 7 Apr. 2019]. Acknowledgement This work was supported by the University of Utah Office of Undergraduate Research. University of Utah UNDERGRADUATE RESEARCH JOURNAL THE BLACK PERSPECTIVE: HISTORICAL AND STRUCTURAL VIOLENCE TO THE BLACK COMMUNITY Jasmine Robinson (Dr. David Derezotes) Department of Peace and Conflict Studies ABSTRACT This paper explores evidence (past and present) of violence committed against African Americans in the United States and why The University of Utah should take concrete steps to decrease racism and make cultural changes. Addressed first is a brief summary of selected research on historical and structural violence against the Black community in the United States. The topics include slavery, Jim Crow laws, ethnic cleansing, the formation of ghettos, police brutality, mass incarceration, and the need to focus on intersectionality and Black Feminism. The paper then points to the racial problems facing the country and The University of Utah specifically. It also addresses the white centered counterarguments students at The University of Utah could bring up in opposition to focusing on the Black community, like the “All Lives Matter” movement, the idea of living in a post-racial America, the concept of disrespecting police, and the true seriousness around these issues. It also addresses why to view this need through a peace and conflict studies lens. The paper concludes with a sample syllabus of a proposed Praxis Lab centering on bringing awareness to the historical and structural violence African Americans face in this country and creating positive and effective change on the racial climate for Black people in our community. It can be concluded from the historical and structural violence committed against the African American community over centuries, that it is necessary to bring a Praxis Lab targeting the racism toward Black people to the Honors College in order to build bridges between African Americans and other races and ethnicities, and work toward positive and effective solutions and peace. Course Outline and Reading List This syllabus is meant to serve as an outline and guide for our course. Please note that the instructor may modify it for any reason with reasonable notice to you. Any changes will be announced in class and posted on Canvas under Announcements. [Please note: Readings will be discussed on the day corresponding to the day they appear on this schedule.] Week 1 Date August 22 Topic Introduction to History, Peace and Conflict Studies, Racism, and Praxis Lab • In Class Screening: The Danger of a Single Story Africa and the Atlantic World, and The Transatlantic Slave Trade • In Class Screening: clip from Amistad 2 August 29 3 September 5 Slavery in Colonial America, African Americans in the American Revolution, and Slavery in the New Republic • In Class Screening: Egalité for All 4 September 12 Life in the Cotton Kingdom, and Free People of Color in Antebellum America • In Class Screening: clip from Twelve Years A Slave Readings Read: Review the Course Syllabus and Canvas Page Read: Freedom on My Mind, Ch. 1 Read: Fields, “Slavery, race and ideology in the United States of America” Read: Excerpts from Thornton, Africa and Africans in the Making of the Atlantic World Read: Rediker, “Life, Death, and terror in the Slave Trade” Read: Freedom on My Mind, Ch. 2-3 Read: Excerpts from Melish, Disowning Slavery Read: Morgan, “Slavery and Freedom: The American Paradox” Read: Bay, “See Your Declaration Americans!” Read: Morgan “Towards Racism” Read: Freedom on My Mind, Ch. 4-6 Read: Excerpts from Baptist, The Half That Has Never Been Told Read: Excerpts from Berry, The Price for their Pound of Flesh Read: Lighter and Ragan, “Were African American 5 September 19 The Civil War, Slavery in Memory, and Legacies of Slavery in America • In Class Screening: 13th 6 September 26 Reconstruction, Lynching, Disenfranchisement, Jim Crow and the Formation of the Ghetto • Paper 1 Due 7 October 3 The Harlem Renaissance, Blacks in the Depression Era, WWII, and the Cold War 8 October 10 Fall Break – No Class Slaveholders Benevolent or Exploitative” Read: Shulz, “The Perilous Lure of the Underground Railroad” Read: Freedom on My Mind, Ch. 7 Read: Yacovone, “The FiftyFourth Massachusetts Regiments, The Pay Crisis, and the ‘Lincoln Despotism’” Read: Grimsley and Paul, “Free At Last: Emancipation during the Civil War” Read: Excerpts from Miles, Tales from the Haunted South Read: Gay, “I don’t Want to Watch Slavery Fan Fiction” Read: Coates, “The Case for Reparations” Read: Freedom on My Mind, Ch. 9-10 (first part) Read: Wiegman, “The Anatomy of Lynching” Read: Litwack, “Hellhounds” Read: Firebaugh & Acciai, “For blacks in America, the gap in neighborhood poverty has declined faster than segregation” Read: Massey & Denton, “The construction of the ghetto” Read: Freedom on My Mind, Ch. 10 (second part)-11 Read: Excerpts from Baldwin, Notes of a Native Son Read: Excerpts from Wright, Native Son Read: Schuyler “The Harlem Renaissance: George Schuyler Argues against ‘Black Art’” Read: Hughes, “The Negro Artist and the Racial Mountain” Read: Williams, Eyes on the Prize, Chapters 1-2 N/A 9 October 17 Civil Rights Movement, Black Power Movement, and the Black Arts Movement • In Class Screening: The Freedom Riders 10 October 24 Contemporary African American Thought in the 70’s, 80’s, 90’s, 00’s 11 October 31 12 November 7 The Rise of Black Feminism and Intersectionality • In Class Screening: WTF is Intersectional Feminism??? • In Class Screening: Dark Girls (Trailer) • In Class Screening: Good Hair (Trailer) • In Class Screening: Kimberlé Crenshaw On Intersectionality keynote - WOW 2016 • Paper 2 Due Police Brutality, Mass Incarceration, the School to Prison Pipeline, and Unequitable Treatment Read: Freedom on My Mind, Ch. 12-13 Read: King, “Letter from a Birmingham Jail.” Read: Harper, “The Influence of Malcolm X on Black Militancy” Read: Harris, “Revolutionary Black Nationalism: The Black Panther Party” Read: Maag, “New Push to Capture Woman in ’73 Killing of State Trooper” Read: Peterson, “Why the Assata Shakur case still strikes a chord” Read: Neal, “The Black Arts Movement” Read: Freedom on My Mind, Ch. 14 Read: Giddings, When and Where I Enter, Chapters 17-20 Read: Okihiro, “Cheap Talk, Er, Dialogue.” Souls Read: Excerpts from Collins, “The politics of black feminist thought” Read: Hartman, “Seduction and the ruses of power” Read: Excerpts from hooks, Ain’t I a woman: Black women and feminism Read: Painter, “Soul murder and slavery” Read: Freedom on My Mind, Ch. 15 Read: Gregg, “The new Jim Crow: Mass incarceration in an age of colorblindness” Read: Keller, “David Simon on Baltimore’s anguish: Freddie Gray, the drug war, and the decline of ‘real policing’” 13 November 14 14 November 21 15 November 28 16 December 5 Recent acts of Racism, Political Influence, and current movements (BLM, Say Her Name, pop culture influence) • In Class Screening: Alicia Garza: Why Black Lives Matter (Dangerous Ideas Festival – Sydney) • In Class Screening: Beyoncé Superbowl Halftime Performance • In Class Screening: Lemonade (Beyoncé film) No Class – Happy Thanksgiving! Practical Applications, Building Bridges, enacting Positive Peace and Change • In Class Screening: “Admissions” • Paper 3 Due Student Presentations Read: Lowery, “Aren’t more white people than black people killed by police? Yes, but no” Read: Martinot, “On the epidemic of police killings” Read: Vega, “For affluent blacks, wealth doesn't stop racial profiling” Read: Vibes, “Freddie Gray’s death reveals a dark history of 'nickel rides' and police van torture” Read: Wald & Losen, “Defining and redirecting a school to prison pipeline” Read: Sinclair-Chapman & Price “Black Politics, the 2008 Election, and the (Im)possibility of Race Transcendence Author(s)” Read: Bale, “Beyoncé’s 'Lemonade' Is a Revolutionary Work of Black Feminism: Critic's Notebook” Read: Zaru, “Beyoncé gets political at Super Bowl, pays tribute to 'Black Lives Matter'” Read: Heim, “Recounting a day of rage, hate, violence and death” N/A Read: Benford, “Peace movements” Read: Coates, Between the World and Me (finish for end of semester) Read: Baldwin, “The Fire Next Time” Read: Baldwin, “A Talk to Teachers” N/A University of Utah UNDERGRADUATE RESEARCH JOURNAL PILOT TESTING A RAPPORT BUILDING CHECKLIST WITH LAW ENFORCEMENT AND IMMIGRANT COMMUNITIES Rija Siddiqui (Caren Jean Frost) Department of International & Area Studies Objectives/Intro. In Salt Lake City a young 17-year-old Somali refugee named Abdi Mohamed was shot by police officers and critically wounded (Whitehurst, 2016). As the case was examined, there was a realization of disconnect and misunderstanding between law enforcement and the young Somali refugee. This occurrence sparked a dialogue around strengthening trust and the creation of stronger rapport between law enforcement agencies (LEA) and immigrant communities. Immigrants are a broad category of individuals who also consist of refugees. Refugees are people who have escaped their own country due to political, religious, economic, or war related conflicts. For this particular study I will refer to the broader term of "immigrant" because this problem is relevant to other communities outside of just refugees. If LEAs were more familiar with the hardships and struggles that immigrants face, then they may be able to prevent such unfortunate events. Similarly, if immigrants familiarize themselves with LEAs and gradually overcome their fear and suspicions, then they may feel safer and more willing to communicate their troubles. To develop positive ways of interaction and prevent the reoccurrence of circumstances such as Abdi Mohamed’s, I would like to construct a list of rapport building practices that LEAs and immigrants can implement to reach a greater understanding and trust. Methods. In order to construct an effective list of rapport building practices, it was necessary to gain a more precise perspective of the challenges surrounding the relationship between LEAs and immigrants in Salt Lake City. This process was accomplished through a qualitative study in the form of individual interviews, where there were eight total participants. Four of which were police officers from the Salt Lake City Police Department (SLPD) and the other four were immigrant and refugee service providers. Participants responded based on their background and experience. Their responses were recorded and transcribed. Results and Conclusion. This research is still active and on-going; therefore, the results are currently being compiled. However, the preliminary results indicate that a section specifically about refugees embedded in the diversity curriculum for LEAs, would lead to better communication with refugee communities. Since the language barrier can be a significant dividing factor between LEAs and immigrants, a resource for immigrants where they are able to contact an interpreter would aid them in times of crisis. These are some of the potential practices that can be used to build harmony in Salt Lake City and beyond. Through this research, I was able to analyze two distinct narratives: both the perspectives of LEAs and immigrant service providers. I had the opportunity to conduct interviews, and connect with many experienced and accomplished participants. This project would not have been successful if it were not for the participants who were willing to share their knowledge about this topic. University of Utah UNDERGRADUATE RESEARCH JOURNAL GROUP THERAPY LESSONS ON THE NEUROBIOLOGY OF ADDICTION AND ITS IMPACTS ON RECOVERY Katie Stokes, David Derezotes Department of Peace & Conflict Stud Abstract In the last 15 years there has been a surge in the amount medical emergencies and deaths related to opioid overdoses in Utah. With an increase in the magnitude of people seeking treatment, there is a concomitant need to provide a more holistic and efficient curriculum within drug treatment centers. There have been rapid advances in neurobiology which have illuminated cellular mechanisms associated with substance dependence and recovery. We aim to examine the treatment outcomes when education of the neurobiological basis of addiction and recovery is incorporated into the curriculum at the House of Hope treatment Center. A series of neurobiology group therapy lessons that focus on the neurobiological basis of addiction especially as it relates to trauma, and resiliency have been developed for the House of Hope treatment center whose current educational focus in on the psychosocial dynamics of addiction. Piolet data was collected using a qualitative assessment which surved participants experiences with the neurobiology group therapy lesson. Introduction Utah is ranked the 7th highest in the nation for drug overdose deaths [5]. In the last 16 years, there has been a surge in the amount medical emergencies and deaths due to prescription opioids and since 2002 the death toll from drug overdose has surpassed deaths caused by motor crashes, falls and firearms in Utah [4]. In comparison to all other categories of addictive substances, prescription opioids have outranked them all in the amount of lives lost due to overdose [5]. In 2015, 24 individuals died every month from a prescription opioid overdose in Utah [3]. The opioid crisis has increased the magnitude of people seeking lifesaving treatment and lack of funding on state and federal levels has left House of Hope unable to provide the most holistic curriculum. At the House of Hope there is a current focus on the psycho-social dynamics of addiction in the curriculum and lack of acknowledgment of the biological component of addiction. This project aims to integrate the neurobiological underpinnings of addiction back into the curriculum and asses its impact on recovery rates. Reintroduction of the neurobiological portion of the curriculum is important because addiction is an illness, that is better examined using the biopsychosocial model that incorporates and addresses each of the factors individual but recognizes them as part of complex interwoven meshwork[1]. Viewing addiction though just psychological, and/or social factors is an oversimplification of the complex truth, as there is a biological framework that it exists within [7]. Extensive research in addiction has demonstrated that there are genetic vulnerabilities that can lead addiction in some but not others that use the same substance, research suggests that up to 50% of the risk is heritable [6][7]. Therefore, there is a need for the curriculum at the House of Hope to reflect the biopsychosocial model in their approach by educating both the staff and clients in the biological dynamics of addiction, more specifically the neurobiological mechanisms of addiction especially as it relates to trauma and resiliency. Literature Review The Diagnostic and Statistical Manual of Mental Disorders-5, characterizes substance use disorder as a cluster of cognitive, behavioral, and physiological symptoms associated with continuation of substance use despite significant substancerelated problems, such as interpersonal conflict, loss of ability to fulfill responsibilities, and physical health deterioration [11]. Diagnosis of substance use disorder is solely based on pathological behavioral patterns, despite addiction being a neurobiological pathology at its core [11][7]. Underlying the behaviors associated addiction there is neural circuit changes that persist even after detoxification [2][11]. The longevity observed indicates that there are structural modifications on a neuronal level. The molecular mechanism of many substance addictions are thought to begin with the activation of the mesolimbic dopamine system located in the ventral tegmental area (VTA) causing the release of dopamine. The limbic system is the area of the brain that rewards the body for behaviors such as drinking, eating, sex, etc. However commonly abused substances create stronger rewards than those that naturally occur which is thought to create stronger motivation to obtain the substance and thus addiction [2]. Anecdotal evidence from clinical practice research provides support for teaching the neurobiological basis of addictions. After even a brief introduction to the information, a patient stated, “I thought I felt this way and drank because I was weak-willed.” Although there is anecdotal evidence supporting there has been little work done to scientifically confirm the benefits [8]. However, a study was conducted following the outcomes of a program that provided diabetes education and care management to patients with diabetes found there was significant improvement in patient outcomes, glycemic controls, and better quality of life in patients with diabetes mellitus[13]. By extension, teaching the neurobiological basis of addiction may have a similar impact on patients with addiction. The rationale for emphasizing the addiction as it relates trauma was founded on basis that many of the women being treated for addiction report high levels interpersonal violence and maltreatment, such as sexual, physical, emotional, economic abuse in both childhood and/or adult life. This narrative has led to extensive research that has shown that chronic traumatic stress arising from childhood interpersonal violence and adult revictimization has maturational consequences, which lead to increased vulnerability for addictive disorders [12]. Adults that were victimized have troubles with self-regulation systems that may mediate the relationship between trauma and the development of substance use disorder [12]. Neurobiological research indicates that adults with PTSD caused by trauma, demonstrate neurobiological changes in the volume and activity levels of major structures in the limbic system. These functional and structural changes in the limbic system can lead to dysregulation of arousal systems and the naturally occurring opioid systems within the human body, that are responsible for emotional regulation [12]. This is an example of the complex intertwining of psychosocial factors and biological factors that contribute to the addiction that clients should be aware of. The purpose of emphasizing resiliency is the neurobiology group therapy lesson is to counter the feeling of hopelessness a client may feel in response to learning that prolonged use of a substance can significantly alters structure and function of neural circuitry such as those found in the limbic system [7][2]. Emphasizing that neural plasticity is a powerful biological process that allows new connections to grow and change throughout life and implies life-long learning and possibility of recovery [9]. Research successful recovery from alcohol addiction showed to be associated with changes in alcohol-induced neuroadaptation and brain network rewiring [14]. Assessment Methods Assessment for macro-level impact was first considered. It was expected that by analyzing relapse/recovery rates of clients who had undergone the neurobiology group therapy lessons compared to those that did not would indicate the impact it has on recovery rate. However, after further exploration of this method of assessment it was found to be infeasible for a couple different reasons. First, collecting relapse data on clients is extremely difficult after they leave the program because they are a highly transitory population, they frequently relocate residence, change phone services, and jobs. Second, clients often do not truthfully self-disclose due to shame and perceived risk of re-incarceration. Third, there as a number of co-occurring variables and a large data set across different treatment centers and states would be needed to find a generalizable impact. These constraints on data make it nearly impossible to track the macro-level impact. Other modes of assessment were explored and assessing on a micro-level was found to be far more practical. Assessment of micro-level impact was found to be the most feasible and will include two phases, first a quiz and then an open-ended question survey. The quiz will be administered concluding the lesson and will provide quantitative data that will be used to analyze the learning outcomes. It will also include a question asking about their preferred learning styles (auditory, visual, social, tactical, etc.) and to what level they felt their learning style was incorporated into the lesson. The second phase will include a survey that gives open ended questions that will allow the clients to explain to what extent they felt each of the lesson topics (addiction, trauma, resiliency) were empowering, informative, and most important helpful for their recovery. Reference 1. Integrative Pain Science Institute. (n.d.). Is the biopsychosocial model a cure for the opioid epidemic? 2. Nestler, E. J., PhD. (2001). Molecular basis of long term plasticity underlying addiction. Nature, 2, 119-12 3. Utah Death Certificate Database, Office of Vital Records and Statistics, Utah Department of Health: 1999- 2015 data queried via Utah’s Indicator-Based Information System for Public Health (IBIS-PH) [cited 2017 January]. 4. Centers of Disease Control and Prevention (CDC). Web-based Injury Statistics Query and Reporting System (WISQARS) [Online]. (2013-2015). National Center for Injury Prevention and Control, CDC (producer). [cited 2017 January]. 5. Centers of Disease Control and Prevention (CDC). Web-based Injury Statistics Query and Reporting System (WISQARS) [Online]. (2013-2015). National Center for Injury Prevention and Control, CDC (producer). [cited 2017 January]. 6. Bieru, L. J. (2011). Genetic Vulnerability and Susceptibility to Substance Dependence. Neuron, 69(4). 7. Molecular Basis of Addiction and Depression. (2018). In: Icahn School of Medicine at Mount Sinai 8. Finnell DS (2009) The Case for Teaching Patients About the Neurobiological Basis of Addictions. Journal of Addictions Nursing 12:149–158. University of Utah UNDERGRADUATE RESEARCH JOURNAL HISTORICAL DEMOGRAPHY TRENDS OF OLD CALIFORNIA Evan Tayler (Prof. Shane Macfarlan) Department of World Languages and Cultures (Department of Anthropology) Very little is known about the demography of the Baja California peninsula (Mexico) during the 19th century. A detailed picture of the growth, structure, and distribution of individual communities, and the peninsula as a whole, is lacking because high resolution, nationwide censuses were not instituted until 1895 AD. In this study, we used historical birth, baptismal, marriage and death records contained in the Guía Familiar de Baja California 1700-1900 (Martinez, 1965) to unravel the demographic history of a single population, La Paz (the capital city of Baja California Sur). Using this source we were able to reconstruct 1) the age at which men and women married; 2) the age at which women first conceived a child; 3) the interbirth interval; 4) total fertility; and 5) overall population growth. Two hypotheses guided the study. Because Mexico did not experience demographic transition until after the Mexican Revolution (Bush, 2005), we initially expected people to marry at an early age, where women would have short intervals between births and high fertility rates during the 19th century- typical of natural fertility populations. However, because the Baja California peninsula is a harsh arid environment where people held a strong cultural preference for forming economically independent, nuclear family households centered on ranching and farming, we expected ecological constraints to cause individuals to delay reproduction producing a later age at marriage and reproduction – typical of an ecological constraints model. Analyses revealed that: 1) men were marrying at an abnormally late age (average age = 30 years). This finding held steady throughout the last half of the 19th century, even as population size increased dramatically; 2) during the 19th century, there was a strong correlation between the age of marriage of a woman and the age at which she gave birth for the first time; and 3) age of marriage for females was a strong positive predictor of total fertility. It appears that during the 19th century, La Paz, due to its unique ecological and social factors, did not follow the standard model of a pre-demographic transition population. References Martínez, Pablo L. Guia familiar de Baja California, 1700-1900: Vital Statistics of Lower California. Editorial Baja California, 1965 Virgilio Partida Bush, Demographic transition and the aging process in Mexico, Papeles de Población 45 (2005): 1-24 Acknowledgements Funding for this project was provided by the University of Utah Office of Undergraduate Research. University of Utah UNDERGRADUATE RESEARCH JOURNAL COMMUNITIES AND NEW AMERICANS: THE PROCESS OF JOINING AND BUILDING COMMUNITIES AMONG 1880-1920 IMMIGRANTS AND WORLD WAR II REFUGEES Landon Troester (Dr. Julie Ault) Department of History During the late 19th and early 20th century, the United States faced substantial changes in the nature of European immigration to the country. Unlike previous phases of immigration, many of the European arrivals were from Southern and Eastern Europe, and as a result struggled to identify existing culture groups or resources to assist in the adjustment process. World War II brought new changes to America’s migrants from Europe, as first refugees fleeing Nazi Germany and later Displaced Persons fleeing the instability of postwar Europe moved to the country. They too faced novel challenges as they arrived in the country, having to adapt to a new nation without the benefit of a more deliberate transition than was available to their predecessors. Due to the circumstances that each period of migration encountered, both phases developed their own unique adjustment process. Immigrants during the earlier period of migration commonly developed entire neighborhoods, with their origins in all-male boardinghouses which single men used to cut housing costs. In contrast, while Displaced Persons did build their own communities, they also had more opportunities to integrate into existing structures. However, despite major differences in both the type and timing of their movement to the United States, immigrants and refugees nonetheless also shared some commonalities in their efforts to adjust to America. Both groups participated in community building efforts, often in an effort to both establish cultural connections with their European pasts and to address shortcomings in whatever existing institutions offered new arrivals. The distribution of immigrants and refugees provides another commonality, with both groups concentrating in cities and urban areas for economic and cultural reasons, and resisting efforts by American observers to suppress the trend. University of Utah UNDERGRADUATE RESEARCH JOURNAL SLENDER MAN PANIC Holly Vasic (Faculty Mentor Sean Lawson, PhD) Department of Communications The last day of May, 2014, in the sleepy Midwest town of Waukesha Wisconsin, 12-yearold’s Morgan Geyser and Annissa Weier were discovered splattered with blood and walking along the interstate after stabbing a girl, they called their friend, 19 times. When asked why, they said that Slender Man, a creepy faceless figure from a website called Something Awful (www.somethingawful.com), made them do it (Blank, 2018). This crime was reported about all over the country, and abroad, by top media sources as well as discussed in blogs around the web. Using the existing research on the phenomenon of “moral panic,” my research investigates the extent to which news media reporting and parent responses to Slender Man qualify as a moral panic. To qualify, the mythical creature must be reported about in a way that perpetuates fear in a set of the population that believe the panic to be real (Krinsky, 2013). As my preliminary research indicated that Christian parenting blogs demonstrated a strong response to the Slender Man phenomenon, I will explore the subgenre of Christian parenting blogs to gauge the extent to which Slender Man was considered a real threat by this specific group. Thus, my primary research questions will include:  Q1: To what degree do mainstream media portrayals of Slender Man fit the characteristics of a moral panic as defined in the academic research literature?  Q2: In what ways do Christian parenting blogs echo, extend upon, or reject the moral panic framing of Slender Man in the mainstream media? Since the emergence of Slender Man, a decade ago, concerns about fake news, disinformation, and the power of visual “memes” to negatively shape society and politics have only grown. Slender Man was a forerunner to these contemporary concerns and can help us understand how we got to this point. More practically, however, whether Slender Man was perpetuated by news media as something parents should actually be afraid of is important. In seeking to protect their children, parents bear the ongoing burden of filtering fact from fiction, legitimate threats from clickbait headlines and sensationalized stories meant to drive advertising revenue for news publishers Moral Panic & Slender Man: The Current Research Considering my research question revolves around the character Slender Man I must first define the fictional entity. Trevor Blank’s 2018 book, “Slender Man is Coming,” explains in detail where the online boogie-man came from. Blank reveals what a creepy pasta is, derived from the words copy and paste because the online stories are shared through copying from one site and pasting to another either verbatim or re-imagined, and gives background on how the spooky figure spawned into life on the pages of the internet by a user named Victor Surge (2018). Blank also goes into detail about the crime which put Slender Man on the media’s radar. He discusses what the 12-year-old girls did to their victim, how they told the police Slender Man made them do it, and the pre-teens relationship with creepy pastas including Slender Man (Blank, 2018). This resource gives what I am exploring in my paper background and meaning by putting the main actor, Slender Man, into context with the 2014 stabbing. The next term to define is moral panic. Alice E. Marwick gives an outline in determining whether a moral panic occurred in her 2008 article, “To Catch a Predator? The Myspace Moral Panic.” Her piece discusses the way predators’ prey on the weak and vulnerable via the social media platform of MySpace. Though, Marwick draws on multiple resources to establish her own outline, the similarities between Slender Man and online predators, though one is fictional and one is real, and the use of new technology, like social media, makes Marwick’s outline particularly useful. The resources Marwick used to come up with her moral panic, or what she calls a technopanic, check-list are also a useful source to draw on. The check-list includes concern, hostility, consensus, disproportion, and volatility. For example, ‘The Ashgate Research Companion to Moral Panics’ says the second point for something to be considered a moral panic is hostility, which is described in the book as “the public, or a segment of the public, believes that certain parties are engaging in harmful or threatening behavior, and designate them as a folk devil or deviant” (Krinsky, 2013, p. 26). Marwick uses this definition for her own check point number two, also for hostility, but says “’the group is collectively designated as the enemy’ and viewed as evil, anti–social, and deviant” (2008, “Is this a moral panic?”, list). The language Krinsky uses better aligns with religious blogs literally believing Slender Man is a demon, of the devil, or that the fictional character became possessed by a demon after creation. This specific language may be more useful in my paper, though they are essentially stating the same thing. The chapter’s I will specifically be using in “The Ashgate Research Companion to Moral Panics” are Part 1 “The Evolution of the Moral Panic Concept”, Part 3 “The Media Panics”, and Part 4 “Moral Panics Over Children and Youth.” Given the example above, this could also be true for the book ‘Moral Panics: The Social Construction of Deviance’ (Gooed et. al. 1994). Marwick uses these two resources, Krinsky and Goode, to create her own framework. Thus, they are valuable in determining if the Slender Man phenomenon is a moral panic or to what degree when evaluating news media coverage and Christian parenting blogs reactions to Slender Man. Samantha Pegg’s 2007 thesis, “Child on child killing: Societal and legal similarities and dissimilarities 1840-1890 and 1950-2000,” uses the theoretical frame work of moral panic to discuss the thesis question she presents in her work. The child on child killing phenomenon does not always result in a moral panic, Pegg says (2007). The similarities in this research will be valuable to mine considering the two girls in Wisconsin were children attempting to murder another child. To further address moral panic in the news media I will use the article, “Moral panic: From sociological concept to the public discourse” (Altheide, 2009). The author discusses moral panic being a form of “social control” (Altheide, 2009, p. 79) and explores how the sociological concept is used in other places besides news, such as op-eds and editorials. The author also comments on moral panic being more prevalent in print. Another source for background information I will use is the HBO documentary, ‘Beware the Slender Man.’ This film tells the story of the Slender Man stabbing up until 2016, prior to the final court decision (Brodsky, 2016). The history of Geyser and Weier is demonstrated in this film through interviews with their parents as well as video footage from when they were being questioned by police following the crime (Brodsky, 2016) I most likely won’t use the documentary as a reference in my final paper but it is pertinent to me as a researcher on the subject to have the knowledge. Some aspects I may use, such as details about the day the actual crime took place, May 31, 2014, to give context to possible news sources when deciphering main stream media content. Primary Data To answer the questions I have presented, I will use articles from the Washington Post, New York Times, and Los Angeles Times to identify the role of mainstream media in attempting to cause a moral panic. I selected these sources because I wanted to represent the U.S. by having news sources from both coasts and a popular third source. I selected the New York Times due to its high circulation. I have chosen the Washington Post due to the location of the paper being the U.S. capitol and also having relatively high circulation. I selected The Los Angeles Times because it was one of the top five most circulated newspapers in the U.S. in 2014 and 2015, according to Statista (2018) and Cision (2018), and complements the east coast’s New York Times. I will also be using Christian parenting blogs to determine whether a panic was actually caused in a specific segment of the population. The websites, These Christian Times, Summit Ministries, Christian Thought Sandbox, and Ted Haggard Blog are some of the sites on which I have found articles concerning Slender Man and his demonic nature. Qualitative Research Method After reading all the blog posts and articles I have collected, disposing of any that are unrelated, I will create an initial codebook. As I do a second, third, and more readings of my research texts I will further define the codes I will be using. Through these codes I will uncover patterns and themes that will determine how well Slender Man fits the framework of moral panic. For example, many of the religious blog posts refer to Slender Man as a demon, thus a code I will be using is “Demon,” which is defined as any reference to Slender Man being a demon. After coding the blog posts and news articles I will be able to draw a conclusion about my research questions. Conclusion The Slender Man phenomenon and resulting crime is the precursor of what we are seeing in the world today as people struggle to tell fake from reality online. By gaining a better understanding, within the framework of moral panic, of how the media portrayed this generation’s boogie-man and how Christian parents reacted, new insights can be obtained. Continued research can provide a better understanding of how groups of people react to the way the news media reports on subjects that involve viral fictional characters, as fresh creatures crawl off websites into mass media more and more. Slender Man is like the patient zero of popular internet folklore. By examining this fictional being, a foundation of how media reports and specific groups react to these scary stories can be laid. Bibliography Altheide, D. L. (2009). Moral panic. From sociological concept to the public discourse. Crime, Media, Culture, 5, 79-99. doi: 10.1177/1741659008102063 Blank, T. (2018). Slender Man is Coming. University Press of Colorado. Brodsky, I. T. (Director). (2016). Beware the slenderman [Video file]. United States: HBO Documentary Films. Cision.com, (2018). Retrieved from https://www.cision.com/us/2014/06/top-10-us-dailynewspapers/ Goode, E., & Ben-Yehuda, Nachman. (1994). Moral panics: The social construction of deviance. Krinsky,, C. (Ed.). (2013). The Ashgate research companion to moral panics. Aldershot: Gower Marwick, A. E. (2008). To catch a predator? The MySpace moral panic. First Monday,13(6). Retrieved October 09, 2018, from http://firstmonday.org/ojs/index.php/fm/article/viewArticle/2152/1966 Pegg, S. (2007). Child on child killing: Societal and legal similarities and dissimilarities 18401890 and 1950-2000 (Order No. 10290632). Available from ProQuest Dissertations & Theses Global. (1840582038). Retrieved from http://ezproxy.lib.utah.edu/docview/1840582038?accountid=14677 Statista.com, (2018). Retrieved from https://www.statista.com/statistics/272790/circulation-ofthe-biggest-daily-newspapers-in-the-us/ University of Utah UNDERGRADUATE RESEARCH JOURNAL LOCALIZATION OF SYNAPTIC SPECIFICITY GENE KIRREL3 IN THE HIPPOCAMPUS Varun Adhvaryu (Matthew Taylor, Megan Williams) Department of Neurobiology and Anatomy ABSTRACT Synaptic specificity is the ability for neurons to form synapses with specific post synaptic partners. The hippocampus is a brain region involved in learning and memory and is a great model for understanding synaptic specificity. Kirrel3 is a synaptic specificity gene and mutations in the Kirrel3 gene are found in neurodevelopmental diseases such as autism and intellectual disability. Mice lacking Kirrel3 have an excitation-inhibition imbalance in the hippocampus. Within this region, Kirrel3 is expressed in two distinct cell types; DG and GABAergic interneurons, which are connected within a complex circuit called the mossy fiber synapse. While we know that Kirrel3 is expressed in DG and GABAergic interneurons, we do not know if Kirrel3 is localized to these synaptic structures or how it acts to facilitate synapse formation. Determining the localization of Kirrel3 is important as it will give more insight to the mechanism of Kirrel3 and how certain mutations in the gene may lead to neurodevelopmental disorders. We hypothesized that Kirrel3 localizes to mossy fiber filopodial synapses along the DG axon. We investigated Kirrel3 localization by introducing an epitope-tagged Kirrel3 in vitro and in vivo via an adeno-associated virus (AAV). We then immunostained for the epitope tag and examined its localization by confocal microscopy to determine if Kirrel3 localizes at filopodial synapses along DG axons. Our results indicated that Kirrel3 in vitro localizes to dendritic shafts and cell bodies. These results also found that the use of an AAV is an effective method of introducing and expressing a packaged Kirrel3 gene into cells. We found that Kirrel3 in vivo localizes to the dendritic shafts and cell bodies of DG neurons in the hippocampus. We propose that Kirrel3’s localization to DG dendrites in vivo could be due to posttranslational regulation of Kirrel3, undetectable epitope signal in the mossy fiber synapses caused by protein-protein interactions, or because this is the true area of localization of the protein. INTRODUCTION The brain is composed of a complex network of cells called neurons that work together to interpret sensory information from the environment, learn, drive behavior, and ultimately give rise to consciousness. Neurons send information to other neurons via connections called synapses. Synapses do not form randomly between neurons, but rather select specific targets amongst a dense environment of incorrect targets (Williams et al, 2010). This process, termed synaptic specificity, is the ability for neurons to form specific synapses with other neurons (Williams et al, 2010). The hippocampus, a brain region involved in learning and memory, is an excellent model to study synaptic specificity because the hippocampus is a highly laminar structure, in which different layers house relatively pure populations of distinct synapse types. Three distinct regions of the hippocampus defined by their principal glutamatergic neuron types are the Dentate Gyrus (DG), the CA3, and the CA1. There are also GABAergic interneurons in each region. One particular synapse that shows a high degree of synapse specificity is the mossy fiber synapse. Here, the DG axons synapse with GABAergic interneurons and CA3 neurons via the mossy fiber synapse. The DG mossy fiber has a large main bouton that synapses with CA3 neurons and filopodia that extend out from the main bouton and synapse with GABA dendrites (Figure 1). Mossy fibers synapse more frequently with inhibitory GABAergic interneurons than with excitatory CA3 pyramidal neurons (Acsady et al, 1998). This circuit of DG-GABA-CA3 allows for regulation of the relative excitation and inhibition of CA3 neurons. The main bouton directly excites the CA3 neuron while filopodial synapses excite nearby GABAergic interneurons, which then inhibit CA3 neurons via feed-forward inhibition (Figure 1). Excitation-inhibition balance is important so that the CA3 neurons do not get overexcited (Torborg et al, 2010). Rett syndrome is an example of a disease that occurs in the hippocampus due to improper excitation-inhibition balance. Autism is another disease that likely involves an imbalance of excitation and inhibition in the hippocampus, with studies reporting too much excitation in the autistic brain (Baroncelli et al, 2011). The formation of synapses is a process that requires recruitment of many different factors for proper function. This includes vesicles for neurotransmitters and homophilic binding proteins that act as cell adhesion molecules. Each synapse type has a unique set of factors required for proper specificity. This is proven by the protein neurexin that has various different splice forms used in different synapse types. Cell adhesion molecules are an essential part of proper synaptic functioning. Cell adhesion molecules are located on the surface of cells and function by binding to cell adhesion molecules on nearby cells. These proteins link to each other via domains located on the extracellular domain of these proteins. In synapses, cell adhesion molecules are homophilic and presynaptic cell adhesion molecules bind a copy of itself located on the post-synaptic cell. These interactions help cells stick together and allow neurons to recognize their synaptic partners. The gene Kirrel3, is a homophilic binding protein that regulates mossy fiber synapse development within the hippocampus (Martin et al, 2015). Kirrel3 is a transmembrane protein that contains 5 immunoglobulin domains on the extracellular portion of the protein (Martin et al, 2015). The intracellular domain has a PDZ binding region which may bind a protein known as CASK (Gerke et al, 2006). Kirrel3 has been shown to be synaptically localized by various methods. First, Kirrel3 was found to be in the synaptosomes, which is an isolated synapse. Next, Kirrel3 localized in vitro alongside post-synaptic markers in wild type cells (cells with Kirrel3) but did not in cells that had the Kirrel3 gene knocked out. Lastly, Kirrel3 clusters at cell junctions. These three pieces of evidence suggest that Kirrel3 is a synaptic cell adhesion molecule. Interestingly, Kirrel3 has is associated with various neurological diseases. A translocation in the chromosome that contains the Kirrel3 gene is thought to lead to intellectual disability among humans (Bhalla et al, 2008). A 2.899 mega base interstitial deletion on the chromosome 11 of the human genome, which deletes part of the Kirrel3 gene, has been found to play a role in Jacobsen’s syndrome (Guerin et al, 2012). A recent study found that Kirrel3 knockout mice exhibited abnormal social behaviors related to neurodevelopmental disorders (Hisaoka et al, 2018). Kirrel3 is also a hotspot gene that is implicated in autism spectrum disorder (Michaelson et al, 2012) (Neale et al, 2012) (Liu et al, 2015). The specific R205Q mutation in the Kirrel3 gene is one that has been linked specifically to autism. The R205Q point mutant is a mutation on the extracellular domain that changes an arginine residue to a glutamine. It is hypothesized that this mutation on the extracellular domain affects homophilic binding between presynaptic and postsynaptic Kirrel3 molecules in the mossy fiber synapse. This leads to loss of synaptic specificity, which leads to overexcitation of the CA3 neurons in the hippocampus. Through the use of in situ hybridization studies, the mRNA of Kirrel3 was shown to express in the DG neurons of the hippocampus and in GABAergic interneurons in the hippocampus (Martin et al, 2015). This finding suggests that Kirrel3 acts within the DG neurons and interneurons. The protein plays a vital role in the regulation of the mossy fiber synapses that are found between these neurons. Mossy fiber synapses were analyzed in wild-type and Kirrel3 knockout mice. The results found that the knockout mice had fewer mossy fiber filopodia than the wild-type suggesting that Kirrel3 plays a role in the development of mossy fiber filopodia (Martin 2015). Kirrel3 also plays a strong role in excitation-inhibition within CA3 neurons. Wild type neurons and Kirrel3 knockout neurons were studied and their excitation/inhibition ratios were measured. Knockout neurons had higher excitation than wild type. Kirrel3 likely allows for more inhibition since knocking out the gene causes overexcitation of the CA3 neurons. When Kirrel3 is not present, mossy fiber filopodial synapses between the DG neurons and GABAergic interneurons are likely not formed. This leads to lower amounts of mossy fiber filopodia and overexcitation of the CA3 neurons. The defects in mossy fiber synapses found in Kirrel3 mice last through to adulthood. There are generally less mossy fiber filopodia in adult mice than in younger ones but the difference in filopodia is still significant between adult wild type and Kirrel3 knockout mice (Martin et al, 2015). Importantly, mice during development have three distinct mossy fiber synapse states. The first is when the mossy fiber filopodia lack any synaptic vesicles nearby nor any post synaptic densities and are described as synapse-free. The second has clusters of synaptic vesicles but no post synaptic densities which are considered partial synapses. The third has synaptic vesicle clusters near a post synaptic density and these synapses are considered “complete synapses”. Knockout Kirrel3 has been found to have more synapse free filopodia and a lower number of synapses that are partial or complete suggesting that Kirrel3 plays an important role in regulating the formation of the mossy fiber filopodial synapses (Martin et al, 2017). Kirrel3 knockout mice form less mossy fiber filopodial synapses with GABAergic interneurons. The morphology of the filopodia in these synapses, however, are unaffected when Kirrel3 is knocked out. This suggests that Kirrel3 regulates the formation of these filopodial synapses with GABA neurons but does not play a role in affecting the morphology of the either the main bouton or the filopodia themselves (Martin et al, 2017). The overall implications of these findings indicate the nature of Kirrel3 in synaptic development and how the lack of the protein plays a noticeable effect in the development of mossy fiber filopodial synapses. While we currently know that Kirrel3 regulates the formation of mossy fiber filopodia, we do not know the where the protein exactly localizes in the hippocampus. Knowing this is crucial as it can help explain its mechanism of action and how mutations in the protein may cause the diseases that are associated with mutations in the Kirrel3 gene. Furthermore, no current studies in the field of neuroscience have examined localization of transmembrane proteins such as Kirrel3 in neurons. This makes the task challenging as we have to design our own tools and methods to determine Kirrel3 localization. Determining the localization will make future localization studies for transmembrane synaptic proteins a lot easier. From in situ hybridization studies, the mRNA of Kirrel3 is expressed in the DG and GABAergic interneurons and importantly not the CA3 neurons. The DG and GABAergic interneurons are also where mossy fiber filopodia form synapses. Furthermore, Kirrel3 knockouts have impaired filopodial development at these synapses, suggesting that Kirrel3 is important in maintaining the development and growth of the mossy fiber filopodial synapses. For these reasons, we hypothesize that Kirrel3 will localize to the mossy fiber filopodia between the DG and GABA neurons (Figure 1). We will test our hypothesis by infecting an AAV containing the Kirrel3 gene and an epitope tag into mice hippocampi, and determine its localization by antibody immunostaining and confocal microscopy. METHODS Determining the localization of Kirrel3 requires multiple steps. The general workflow involves cloning an expression vector containing the Kirrel3 gene and an epitope tag for detection, packaging this plasmid into a virus, and injecting the virus into CD1 mice and harvesting the hippocampal tissue for analysis (Figure 2). Cloning Plasmids First, an expression vector encoding the Kirrel3 protein was cloned. An expression vector is essentially a piece of circular bacterial DNA that has the gene for Kirrel3 inserted into it. Bacterial DNA is circular shaped and are called plasmids. In an expression vector, there are multiple important regions that play a role in transcribing the DNA to messenger RNA. First, the gene being inserted to a plasmid is crucial. The gene we used is a construct known as GFP-2A-3xHA-Kirrel3 (Figure 3D). This construct is polycistronic meaning that the gene codes for the production of more than one polypeptide. The GFP protein acts as a cell filler and allows for visualization of cell morphology when viewing under fluorescence in a microscope. This is essential as we need to be able to see what part of the cell we are examining. Next is the 2A peptide, which is a peptide that can link two genes (Kirrel3 and GFP) and self-cleaves itself post translationally. This is essential as it allows us to insert a cell filler and our gene of interest in the same construct. Thus, every cell that contains GFP must contain Kirrel3 as well. The alternative to this method involves co-transducing a cell filler virus along with a virus containing our gene of interest. This method is more difficult as different cells may get different viruses and it is hard to tell which cells received which virus. Using the 2A peptide construct, we know that if a cell got transduced with the cell filler, then it must contain the Kirrel3 protein. The Kirrel3 gene itself must be part of the gene insert as it is the protein we are analyzing for localization. The Kirrel3 gene has an epitope tag attached to the extracellular domain. Currently, there are no useful antibodies that can recognize Kirrel3. To get around this, the epitope tag is used as there are effective antibodies that can recognize the epitope and if we see epitope fluorescence we know it is from the same protein as Kirrel3. Antibodies are important as they are required for inducing fluorescence of various proteins as discussed later. Next, the promoter region of a plasmid is also essential. The promoter region of a gene is what initiates transcription of DNA to mRNA. RNA polymerase binds the promoter sequence and then cruises down the DNA and produces and RNA transcript. There are two strands of DNA, the sense strand and antisense strand. The RNA transcript is the exact same as the sense strand except thymine bases are replaced with uracil. The promoter in a plasmid is important as certain sequences can be stronger or weaker or be more active earlier or later in the development of a cell. Promoters can also be specific to certain cell populations. We used the CamKII promoter sequence. This sequence is derived from the promoter for a protein called calmodulin dependent kinase II, that functions in excitatory neurons. This sequence is known to be on the weaker side, but becomes stronger later in the development in the cell. Furthermore, this promoter sequence was small enough to allow us to package the full construct into a virus. The inverted terminal repeat (ITR) segment and the WPRE segment of a plasmid are essential for packaging the plasmid in a virus. The ITR region is in a plasmid as it allows for efficient packaging of the plasmid into a viral vector. The virus we are using is the adeno-associated virus (AAV) and the ITR region is an essential element for AAV packaging of DNA. The WPRE element enhances expression of the gene when delivered in a virus. Furthermore, each mRNA transcript has a polyadenylated tail, which stabilizes the transcript in the cell. This is also an important feature of a plasmid so that the mRNA remains stable before being translated. In order to clone the GFP-2A-3xHA-Kirrel3 gene we needed to use two plasmids and insert one into the other. The first plasmid was the Kirrel3 pBOS vector. This plasmid contained Kirrel3 under a EF1 promoter, but did not contain the elements required for packaging into an AAV. The second plasmid was the plasmid containing the CamKII promoter, ITR regions, and other AAV elements, but not Kirrel3. Restriction enzymes were used to cut Kirrel3 from pBOS and to cut open the CamKII AAV vector and paste Kirrel3 into our desired plasmid. We found restriction sites on our CamKII plasmid and needed to insert this restriction enzyme sequence into our Kirrel3 plasmid. The restriction enzymes we used were HindIII and Xho1, both of which produce sticky ends. Our first step required polymerase chain reaction (PCR) to add a restriction enzyme sequence to the Kirrel3 vector. PCR amplifies segments of DNA. The first step in PCR is to design primers that the DNA polymerase can bind to and replicate the DNA. Usually there are forward and reverse primers between two segments of DNA that polymerases bind to and amplify. Primers must be complementary to the DNA sequence they anneal to. Primers also usually contain a restriction site, which allows us to cut open parts of our DNA and paste in what we want. PCR uses a special type of DNA polymerase called Taq, which can work under high temperatures. The first step of a PCR reaction requires denaturation of the DNA causing base pairs to come apart. The primers then anneal to their complementary sequence. The temperature is changed to the optimum temperature of the polymerase is most active to allow for elongation of the sequence. This cycle repeats itself and each cycle causes a doubling in the amount of DNA. Once the DNA was amplified, we tested the PCR samples for proper amplification using DNA gel electrophoresis. We ran a PCR using a forward primer containing the Nhe1 restriction enzyme and a reverse primer containing the Xba1 restriction enzyme. Once we ran a PCR, we needed to ensure we amplified the correct region of DNA. Sometimes primers may bind each other and form primer dimers or may amplify the wrong regions of DNA. We used DNA gel electrophoresis to do this. DNA gel electrophoresis is a technique to separate DNA fragments according to size. The gel is made of agarose and an electric current is run through the gel to run DNA through the agarose. The top of the gel contains wells to load the DNA and a negative charge. The bottom of the gel contains a positive charge. Since, DNA has an inherent negative charge, the DNA will run from the top (negative) to the bottom (positive) and separate based on size. Larger segments of DNA will not run as far on the gel as smaller segments. Ethidium bromide is added to the gel mix and acts as an intercalating agent that goes in between DNA base pairs and fluoresces under ultraviolet light so that bands can be observed. We noticed bands consistent with the size we expected from our PCR. We concluded that we amplified the correct DNA segment and were ready to move on to the next step. The next step involves setting up a restriction digest using restriction enzymes, our target plasmid, and the plasmid containing our gene. Restriction enzymes are enzymes that cut at a specific sequence in the DNA. By cutting our target plasmid and pBOS plasmid using the same restriction enzymes, we created the same sticky ends on both pieces of DNA. This allowed for our gene product that was cut out to anneal to the sticky ends of our target plasmid. We ran the restriction digest on a gel and saw bands. Some bands corresponded to the plasmid reannealing but the band we looked for was that of our gene being inserted into the CamKII plasmid, which has a specific band on our gel. The next step was to use DNA ligase to connect the ends of the Kirrel3 genes into the plasmid. Annealing involves base pairs forming, but ligation is the linkage of the sugar-phosphate backbone, which is held together by covalent bonds. The DNA ligase enzyme catalyzes this covalent bond formation and allows for the gene to become linked to the rest of the plasmid via a phosphodiester bond between the sugarphosphate groups on each nucleotide. Once we ligated our gene to our vector, we sent the DNA off for sequencing to ensure that we had the right product from our restriction digest and ligation steps. We also double checked our ligated product by running it on a gel. Once ligation was complete, the next step was to transform the plasmid in bacteria to grow more of it. Transformation is when bacteria incorporate DNA from the environment. When we give bacteria exogenous DNA, they can amplify it for us, which is extremely useful as the amount of DNA we obtained from ligation is not enough for further experiments. We transformed DH5alpha bacterial colonies and used ampicillin resistance to select for colonies that incorporated the plasmid. Once this was completed, we grew a colony in liquid broth overnight. After inoculation, the DNA was extracted from the broth through a process called a MiniPrep. In a MiniPrep, we centrifuge the bacterial cells until it forms a pellet. We removed the supernatant to ensure we had cells in our pellet. After this, we lysed the cells open and centrifuged once again to separate portions of the cellular lysate. The DNA is located in the supernatant during this step so we extracted the supernatant and we washed it with buffer and toxin removal solution to purify our DNA sample. Lastly, we eluted the DNA with a centrifugation in distilled water. In order to check the purity of our sample, we checked absorbance on a spectrophotometer. Once the DNA was MiniPrepped, a restriction digest was run to make sure the proper plasmid was isolated. The digest was run on a gel to ensure that the correct size bands appeared and that we indeed had the plasmid we wanted. The next step in the process is to determine if our cloned plasmid actually expresses in cells. We cultured HEK-293 cells and transfected the plasmid along with known plasmids that worked as a positive control and no transfection as a negative control. To determine expression of a construct, a process known as immunostaining is used. Prior to immunostaining, the cells are fixed in paraformaldehyde to freeze cellular processes and keep subcellular structures in place. The first step of immunostaining involves using antibodies grown towards a protein (primary antibody) to selectively bind the protein. Antibodies have a high affinity for the protein they bind to and are usually highly specific. Next, a secondary antibody that is tagged to a fluorophore is generated against a primary antibody. This method is used to amplify fluorescence signal when analyzing cells under a microscope. We immunostained our 293 cells and used antibodies raised against HA as well as antibodies against 2A. Antibodies against HA label the epitope tag that is attached to the extracellular domain of Kirrel3. If we see signal from HA, we know that we are also looking at Kirrel3. Antibodies against the 2A protein that allows post-translational cleavage of GFP from 3xHA-Kirrel3.The 293 cells expressed both proteins as expected so we repeated the same experiment using neurons. We also found significant expression in neurons (Figure 4D). Packaging Viruses The next step of the process was to package our plasmid into the AAV for brain injections (Figure 2). We cloned an adeno-associated virus using an exosome prep (Hudry et al, 2016). Viruses are prepared by transfecting 3 separate plasmids into HEK293 cells. One plasmid codes for the viral coat protein. One plasmid is our plasmid of interest that we want to express in mice. One plasmid is a helper plasmid which expresses adenovirus genes and helps the virus come together and become functional. As stated previously, the ITR and WPRE regions of our plasmid assist in the association of this virus in 293 cells. These cells were collected and subjected to multiple rounds of centrifugation. These spins separate the exosomes containing the virus from the rest of the cellular substances. The exosome is a vesicle that contains most of the virus. Thus, by purifying the exosome, we also have a relatively concentrated AAV preparation. This method works well to create a virus as it is efficient, however there may be some other substances in the exosome as well. Testing Viruses In Vitro Once the viruses were packaged with our Kirrel3 gene, we needed to test its infectivity and expression in cultured cells. The Kirrel3 viruses were infected into HEK 293 cells and neurons and immunostained and analyzed for expression. We observed sufficient expression of our virus in vitro and were ready to move on the inject the virus into E14 mice (Figure 4C). Testing Viruses In Vivo We injected pregnant mice in utero at postnatal day 14 with our AAV. The pups were born and at day 14, we began to harvest brain tissue. Harvesting brain tissue required a few steps. First, the pups were given various anesthetics and narcotics. Then, we performed a perfusion by injecting phosphate buffered saline (PBS) then paraformaldehyde (PFA) into the circulation of the pup and dissected out the brains. The PBS clears the brain vasculature of blood and other fluids. The PFA fixes the brain tissue. After perfusion of the brain tissue, the brains were sectioned into 50-100 micrometer thick coronal slices using a vibratome. The slices containing the hippocampus were used for further immunostaining. We immunostained the tissue sections and used antibodies for GFP-2A-3xHA-Kirrel3 and our cell filler protein and analyzed under the confocal microscope. Using this same workflow, we had cloned 3 other constructs in order to determine the AAV that best drives Kirrel3 expression in neurons (Figure 3). Each of the constructs was made using the same techniques and methods and each was packaged into an AAV and tested for expression using the immunostaining and confocal imaging. One construct contained a pMECP2 promoter instead of CamKII, was not packaged in a polycistronic plasmid, and used the FLAG epitope tag rather than HA. This virus was cotransduced with another virus containing GFP. The second construct contained a CAG2 promoter instead of CamKII, was also not packaged in a polycistronic plasmid and also contained FLAG. This virus was also co-transduced with GFP. The third plasmid was a polycistronic construct consisting of mCherry as the cell filler rather than GFP. The construct used FLAG and a CamKII promoter. RESULTS Development and Testing of Various AAV Constructs To accomplish detection of Kirrel3 in vivo, we needed to design a method of detection for Kirrel3. Currently, there are no antibodies for Kirrel3 that can detect endogenous protein in situ, thus we cloned various constructs with different promoters and epitope tags in order to optimize antibody detection and Kirrel3 expression in vivo. We then packaged each construct into an AAV and tested the levels of Kirrel3 expression in vitro and in vivo. Table 1 describes the many constructs we developed and the result of testing in vivo. Figure 3 depicts the expression vectors created and the components of each vector. The first construct used the promoter MECP2 (Figure 3A). MECP2 is a promoter that is common in neurons. The advantage of using this promoter is that the sequence was small and thus there was less risk of reaching the packaging limit of 4.7 kb for the virus, perhaps resulting in better expression of our gene of interest. The disadvantage to using an MECP2 promoter is that since it has a small sequence there was a chance it would be weak and not drive strong enough expression of our large packaged gene. Along with the pMECP2 promoter, we included FLAG as the epitope tag and attached it to the extracellular domain of the Kirrel3 gene. For this construct, we cotransduced FLAG-Kirrel3 and a GFP construct to determine localization in vitro and in vivo (Figure 3A). This construct did not yield effective Kirrel3 expression in vitro or in vivo. Promoter Virus Prep Epitope Tag Result pMecp2 Exosome FLAG No expression in vitro. ` Exosome FLAG Poor expression in vitro. No detectable signal in vivo CAMKII Crude FLAG Good expression in vitro. Detectable mCherry signal in vivo. No detectable FLK3 signal in vivo. CAMKII Crude 3xHA Good expression in vitro. Detectable GFP signal in vivo. Detectable 3xHA-K3 signal in cell bodies and dendrites in vivo. CAG2 Table 1. Each of the constructs designed and tested for Kirrel3 expression. The next construct we used was the similar to the pMECP2 construct except a different promoter was used. The promoter used this time was pCAG2 (Figure 3B), which is larger than pMECP2 and can better drive expression of the gene. CAG2 is a synthetic promoter used to drive high expression of a gene. Furthermore, CAG2 recruits transcription factors and other transcriptional regulators that can drive higher expression of the Kirrel3. The downside to this was that it would push the overall size of our construct close to our packaging limit. This construct also used the FLAG epitope tag. This construct was cotransduced with a GFP construct as well. The CAG2 construct showed low expression in vitro and no detectable expression in vivo. This is likely due to CAG2’s large size causing the construct to approach its packaging limit. Following this, we decided to create a new type of construct in which our cell filler and our gene of interest would be expressed together in one polycistronic construct. This construct involved the cell filler mCherry, a 2A linker peptide, the FLAG epitope tag and our Kirrel3 gene (Figure 3C). The advantage of this construct is that any cell visualized by the cell filler will also express the Kirrel3 protein. Furthermore, the promoter was switched out from a CAG2 to a CamKII promoter. The CamKII promoter is the promoter for the calmodulin dependent kinase II, which is a protein commonly found in neurons. Since we used a polycistronic construct that contains a lot of DNA, we decided to use this smaller CamKII promoter so that the construct was less likely to reach the packaging limit of the AAV. Furthermore, the polyA tail from the CamKII construct was smaller, giving us more room to fit the polycistronic construct into our packaged virus. The last construct we made was similar to the previous construct. Instead of using mCherry as the cell filler, we decided to use GFP, which is well tolerated by cells. From our in vitro experiments, mCherry was found to have a lower signal than GFP. GFP, on the other hand, is a well-used cell filler with a well-known antibody that causes increased fluorescence in vitro and in vivo. We also changed the epitope tag from FLAG to 3 copies of HA in order to potentially increase detection of the epitope tag in vitro and in vivo. This construct also used the CamKII promoter which was proven to be reliable in the prior construct (Figure 3D). Expression In Vitro In these set of experiments, the Kirrel3 AAV constructs were used to infect cultured neurons 5 days in vitro and were harvested at 14 days in vitro, after synapses form in culture. We expected transduction by 14 days in vitro to aid in detection of Kirrel3 signal in the cultured neurons. One control for this experiment was transfecting a previously tested and verified Kirrel3 plasmid and a previously tested and verified GFP plasmid into cultured neurons 14 days in vitro (Figure 4D). The results from the control experiment showed strong expression of GFP lighting up cell bodies, dendrites, and axons. Kirrel3 expression was also very strong in control experiments as Kirrel3 is detected throughout the cell body, dendritic shafts, dendritic spines, and axons. We used the results of the control as a point of comparison to determine the level of expression of the viral constructs in vitro. In vitro testing showed that Kirrel3 is expressed in neurons via AAV transduction but at different levels of expression depending on the construct. The first virus tested, was the virus containing the pMecp2 promoter. Transduction with the AAV:pMECP2FLAG-Kirrel3 yielded no detectable expression. In contrast, AAV:pMECP2-GFP was easily detected when co-transduced in the same cultures (data not shown). We conclude that this virus did not properly express Kirrel3 at detectable levels in vitro and thus is unviable for an experiment in vivo. This is likely due to the pMECP2 promoter being too weak to drive expression of the Kirrel3 protein. The use of the CAG2 virus yielded more positive results. The CAG2 AAV showed weak expression of Kirrel3 in vitro (Figure 4A). The signal detected in this experiment was concentrated mostly in the cell bodies of the neurons. Sparse signal of Kirrel3 was found in the dendrites, dendritic spines, and axons, however the signal was too low to draw any conclusions about the localization of the protein. Based on the images, it appeared that the signal found outside the cell body was likely background noise that occurs during immunostaining experiments. This noise was undiscernible from possible true signal from Kirrel3. Interestingly, FLAG-Kirrel3 signal was not detected at higher concentrations of the virus nor at lower concentrations. This finding indicated that FLAG-Kirrel3 expression was highest at an intermediate concentration. The next construct tested in vitro was the polycistronic construct including the mCherry cell filler protein. The advantage of this construct was that we knew that any cell that contained mCherry must have also received the Kirrel3 gene as well. This allowed us to confidently determine that the AAV was packaged and expressed and to quickly identify transduced cells. In this experiment, we found weak to average expression of Kirrel3 and strong expression of mCherry in vitro (Figure 4B). The strongest Kirrel3 signal came from the cell bodies of the neurons. Furthermore, Kirrel3 appeared to localize along the shaft of the dendrites. The Kirrel3 signal appeared stronger than it did for the CAG2 construct, but weaker than the expression in the transfection control experiment. The last construct we transduced into neurons was the polycistronic construct with GFP as the cell filler molecule and Kirrel3 having the HA epitope tag. This experiment yielded strong expression of both GFP and Kirrel3 (Figure 4C). As compared to the previous constructs tested, this virus showed a definite improvement in detection of both the cell filler and 3xHA-Kirrel3 signal. Kirrel3 appeared to localize along dendritic shafts and some signal was also detected along axons of these neurons. The signal of Kirrel3 was similar to signal from the transfection control experiment and was noticeably stronger than the previous constructs. Each of the in vitro results were interesting and gave insight as to where Kirrel3 would localize in cultured neurons. Using the GFP-2A-3xHA-Kirrel3 virus, Kirrel3 localized to dendritic shafts, areas at which synapses are formed (Figure 4C). Since Kirrel3 is a synaptic cell adhesion molecule, we expected it to localize at the dendritic shafts. Neurons in vitro, however, do not build mossy fiber synapses as seen in vivo between the DG, CA3 and interneurons. Thus, we needed to perform in vivo experiments to determine whether Kirrel3 localizes to these synaptic structures. Expression In Vivo Each of the constructs that showed expression in vitro was tested in vivo to determine localization. We decided not to test the pMecp2 construct in vivo as this construct did not even show expression in vitro. Thus, the construct was not used in an in vivo experiment. When we tested the CAG2 construct in vivo, we injected pups with 2 separate viruses (GFP and FLAG-Kirrel3). After analyzing 50 uM thick sections, we noticed no noticeable FLAG-Kirrel3 signal from this experiment. The GFP virus expressed well indicating that the injections were successful. Next, we tested the mCherry polycistronic construct. The mCherry signal was strong and expressed in many cells indicating that the virus was efficiently packaged and that the injections were successful. Surprisingly, we did not detect FLAG-Kirrel3 signal above background levels despite its expected polycistronic expression with mCherry (Figure 5B). This is likely due to a combination of post-translation down-regulation of FLAG-Kirrel3 protein levels (compared to the mCherry) and poor detection of the single FLAG-tagged protein using the mouse anti-FLAG antibody in the mouse brain. When cells are overexpressed with the Kirrel3 protein, it is possible that the cell may tag excess Kirrel3 molecules with ubiquitin to tag for degradation to prevent negative effects of having too much of the protein. Furthermore, it is possible that the FLAG epitope induces improper folding with the Kirrel3 protein causing a nonsense folding of the Kirrel3 protein. Lastly, we tested the GFP-2A-3xHA-K3 construct in vivo. The results from this experiment were that GFP expresses well and that 3x-HA-Kirrel3 was found to localize within the cell bodies of DG neurons and along the dendritic shafts of DG neurons (Figure 5A). The appearance of Kirrel3 followed puncta like pattern indicating the presence of synapses (Figure 5C). Kirrel3 was not detected at the mossy fiber boutons nor at mossy fiber filopodia above background levels. This construct showed the best expression of Kirrel3 in vivo and was the only construct that allowed us to visualize Kirrel3 signal in mouse hippocampi. Interestingly, despite strong GFP expression, we only detected 3xHA-Kirrel3 in few cells. Notably, these cells also had the strongest GFP expression. DISCUSSION Challenges to Studying Kirrel3 Localization Determining the localization is a challenging prospect and to our knowledge, no previous studies have examined the localization of transmembrane proteins in neurons in vivo. Additionally, determining the localization of a lowly expressed transmembrane protein involved in synaptic specificity such as Kirrel3 is even more difficult. The first major challenge in determining Kirrel3 localization is figuring out a way to express Kirrel3 in a mouse. A useful tool in neuroscience, is the AAV, which delivers a gene to the cells in vivo. Another possible tool, is to genetically engineer a mouse that has the Kirrel3 gene and a fluorescent marker tagged onto it for visualization with antibodies. A third possibility is using CRISPR-Cas9 technology to knock in Kirrel3 and a fluorescent marker into a mouse’s genome and visualize it with antibodies to amplify detectable Kirrel3 signal. We decided to use an AAV as it is much less costly and provides a method of overexpressing the Kirrel3 gene in a mouse hippocampus. Using an AAV has its challenges and one of the major challenges is the packaging limit of an AAV. AAVs can house 4.7 kilobases of nucleotides before it cannot package anymore DNA. After 4.7 kilobases, the use of an AAV is ineffective and another virus such as a lentivirus may need to be used. It is difficult to balance the size of the construct with the packaging limit. Initially, we co-transduced two separate AAVs; one with FLAG-Kirrel3 and one with GFP, and we could not determine which cells received Kirrel3 and GFP together. Thus, we had to use a polycistronic construct in which we know that if a cell received GFP, it also received Kirrel3. The issue with the polycistronic construct is that it pushed the size of the gene close to the packaging limit of the AAV which was one reason we picked the smaller sized CamKII promoter. When working with AAVs, this is a challenge to consider and it may be useful to use a lentivirus if working with larger constructs. Another major challenge with studying Kirrel3 is the lack of suitable antibodies that can tag the Kirrel3 protein. Currently, there are no useful antibodies for Kirrel3 detection, which required us to introduce an epitope tag on the extracellular domain of Kirrel3. This method brings others issues. Signal from epitope tags may be masked in vivo due to true protein-protein interactions occurring in the cells. In our experiments, we may have not been seeing HA-Kirrel3 signal in mossy fiber filopodia because the Kirrel3 was interacting with other Kirrel3 molecules to maintain synaptic specificity. Thus, antibodies were not able to bind the epitope tag and give us detectable signal. To determine whether the antibody binds the epitope, we will need to run a western blot of our hippocampal sample. With this technique, the epitope tagged Kirrel3 will be solubilized and no longer be wrapped up in interactions with other Kirrel3 molecules and we can determine whether antibodies are able to bind the epitope or not. Lastly, when performing any type of overexpression experiment, there is the possibility that overexpressing a protein leads to cellular regulation of that protein. In our experiment, we overexpressed Kirrel3 and it is possible that we could not detect signal due to the cell post translationally down regulating Kirrel3 trafficking to its area of effect. It is important to keep in mind the effects of overexpressing a gene when using this methodology. Development of Tools for Studying Kirrel3 Localization The results of the in vitro experiments concluded that an AAV is a viable method of introducing the Kirrel3 gene to a population of neurons both in vitro and in vivo. This was evident from the noticed expression of both cell filler and GFP at comparable levels to the transfection control. Each of the constructs revealed different levels of expression and that may come down to various factors. The pMecp2 construct that yielded no expression was likely due to the fact that the promoter was small and was likely too weak to drive expression of the FLAG-Kirrel3 gene. Thus, we were not able to detect any expression from this experiment. Furthermore, it was difficult to determine expression in this experiment due to the fact that we co-transduced two different viruses. It is likely that the Kirrel3 virus and the GFP virus hit different cell populations and the only way of determining localization is if a cell was hit by both viruses. The CAG2 construct worked better than the pMECP2 construct but still did not yield strong expression in vitro nor in vivo. The CAG2 construct likely had better expression than the pMECP2 because the CAG2 promoter is a larger and stronger promoter for the expression of this gene. The stronger promoter likely led to better expression of Kirrel3 which is why we were able to detect signal in neurons. This signal, however, was still weak in the dendrites compared to the transfection control polycistronic constructs. A possible reason for this is that the CAG2 promoter is large and pushed the virus to its packaging limit. An AAV2 virus can only fit 4.7 kilobases of DNA in it and our construct was 4.6 kilobases. This construct did not provide detectable levels of FLAG-Kirrel3 in vivo as well. For this reason, we could not get conclusive Kirrel3 expression in vivo with this construct. The polycistronic construct containing the mCherry cell filler protein, the 2A linker peptide and FLAG-Kirrel3 yielded strong expression of Kirrel3 in the cell bodies and weak expression of Kirrel3 out in the dendrites. This construct had increased cell body expression than the CAG2 construct and detectable signal in the dendrites in vitro. The use of the polycistronic construct was helpful in detection of Kirrel3. We knew that any cells that contained mCherry must have also had Kirrel3. Kirrel3 was detected along dendritic shafts of neurons. This result was consistent with the finding that Kirrel3 is a synaptic cell adhesion molecule. The expression of Kirrel3 in dendrites made this construct a good candidate for in vivo expression. We posited that if we were able to detect Kirrel3 signal out in the dendrites of neurons, then this construct would be useful in the detection of Kirrel3 in hippocampal neurons. This construct, however, did not yield favorable results during in vivo trials and we had to move on to another construct. The cell filler mCherry showed expression, however, there was no detectable FLAGKirrel3 signal above background. Furthermore, the use of the anti-mouse antibody led to signal in the Cy3 channel likely coming from the vasculature of the mouse brain being tagged by fluorescent antibodies. A common aspect in all previous constructs was the epitope tag FLAG. We hypothesized that the FLAG tag may be a reason that we did not detect Kirrel3 in vitro or in vivo. This epitope may have been tough for the antibodies to bind to and fluoresce from due to Kirrel3’s nature of being synaptic. One reason for this could be that the antibody’s signal is masked by the interaction of Kirrel3 with its post- synaptic partner. This interaction may have prevented the antibodies from binding the FLAG tag. The polycistronic construct containing the GFP filler protein, the 2A linker and 3xHA-Kirrel3 yielded strong expression in the cell body and the dendrites of the neurons in vitro. This result showed similar expression levels to the transfection control experiment. The GFP showed more signal than the mCherry which was useful for illuminating the features of the cell, including dendritic spines and axons. Kirrel3 expressed at a higher level and the increased signal is likely due to the switching out of epitope tags. We incorporated 3 copies of the HA epitope tag so we could increase fluorescence from antibody staining. The 3xHA tag overall increased Kirrel3 detection. This viral construct was the most viable of all the constructs as a method of overexpressing the Kirrel3 gene to neurons in vitro. The GFP-2A-3xHA-Kirrel3 construct served to solve some of these antibody detection problems. We used the 3xHA epitope tag to try and yield stronger detection of Kirrel3 in vivo. The results of this experiment showed expression of Kirrel3 within the cell bodies and dendrites of the DG neurons in the hippocampus. These results are consistent with the previous finding of Kirrel3 mRNA expressing in DG neurons and GABAergic interneurons. Localization of 3x-HA-Kirrel3 Kirrel3 was found to localize at dendritic shafts in vitro. This finding is an indication that Kirrel3 goes to synapses and acts as a cell adhesion molecule. The dendritic shafts in vitro have been found to be areas of inhibitory synaptic connections. The finding that Kirrel3 localizes here in vitro suggests that Kirrel3 may be functioning at inhibitory synapses. This finding is consistent with the known expression of Kirrel3 mRNA being expressed in DG neurons and inhibitory interneurons in the hippocampus. It is possible that Kirrel3 plays a role in mediating synapse formation between GABAergic interneurons and DG neurons. In order to determine whether Kirrel3 is truly localizing to inhibitory synapses in vitro, we will need to immunostain for a marker that is found at inhibitory synapses such as Vgat, which is found in synaptic vesicles from GABAergic pre-synapses. We can compare Kirrel3 localization to the localization of the inhibitory synaptic marker and determine if Kirrel3 is localizing to these locations in vitro. Another possible explanation for Kirrel3’s localization at dendritic shafts is that Kirrel3 is being trafficked along the dendrite to another location. While we may see fluorescence of Kirrel3 in the dendritic shaft, it may be that the protein actually functions elsewhere. One way to properly determine whether Kirrel3 is being trafficked or not is to do a live-labelling experiment in cultured neurons. Live labelling will allow us to track the trafficking of Kirrel3 and determine whether it truly localizes at the dendritic shafts or is just trafficked through the shaft. In vivo, Kirrel3 shows expression in the somas of DG neurons and out into their dendrites in a punctate pattern. Importantly, Kirrel3 is not detected with the mossy fiber boutons of the stratum lucidum layer of the hippocampus. These mossy fiber boutons, are the hypothesized area of localization of Kirrel3, as filopodial development here is regulated by Kirrel3. One possible explanation for this result is that since Kirrel3 is being overexpressed via AAV, that the cells are modifying Kirrel3 in such a way that it is not trafficked out to the mossy fiber boutons. One possible mechanism for this, is that excess Kirrel3 molecules are being ubiquitinated and degraded. Thus, we are able to detect signal just in the cell bodies and dendrites but not out at the mossy fibers in the axons of the DG neurons. Another possible explanation for this result is that Kirrel3 truly does not localize to the mossy fiber filopodia and that Kirrel3 functions in the dendrites of DG neurons. This hypothesis, however, would suggest that Kirrel3 has functions that cause downstream effects out into the axons of DG neurons that affect filopodial development and mossy fiber bouton formation. As seen in vitro, it is possible that Kirrel3 is acting at synapses between inhibitory neurons and DG neurons since it has been found to localize in the dendritic shafts of DG neurons. A third explanation for not detecting Kirrel3 is that there is a problem with antibody detection that is not allowing us to detect fluorescence of our epitope tag out in the axons of the DG neurons. One issue could be with antibody penetrance where the antibody is not recognizing and binding the epitope tag. A solution for this is to move the epitope tag to the intracellular domain, which may allow for antibodies to more easily tag the epitope. Furthermore, expressing a similar cell adhesion molecule to Kirrel3 with the same epitope tag will give further insight as to whether there is a problem with epitope tag detection, or whether Kirrel3’s signal is decreased due to a biological reason. Overall, this is a challenging project and it is unclear as to where exactly Kirrel3 localizes in vivo and future studies will need to be conducted. We know that Kirrel3 is being produced in the DG neurons and has puncta in the dendrites of the DG neurons. We also know that an AAV is an effective method of overexpressing the Kirrel3 gene in neurons in vitro as well as in vivo. Although we are unable to detect Kirrel3 in mossy fiber synapses, we now understand that Kirrel3 is being made in the DG neurons and is possibly being regulated by cells due to overexpression of the gene. We now need to move forward with future studies to determine why Kirrel3 is not being detected at mossy fiber synapses and whether that reason is biological due to overexpression or whether it is due to detection issues with antibodies. REFERENCES Acsády, László, Anita Kamondi, Attila Sı ́k, Tamás Freund, and György Buzsáki. “GABAergic Cells Are the Major Postsynaptic Targets of Mossy Fibers in the Rat Hippocampus.” The Journal of Neuroscience 18, no. 9 (May 1, 1998): 3386. Bhalla, Kavita, Yue Luo, Tim Buchan, Michael A. Beachem, Gregory F. Guzauskas, Sydney Ladd, Shelly J. Bratcher, Richard J. Schroer, Janne Balsamo, Barbara R. Dupont, Jack Lilien, and Anand K. Srivastava. "Alterations in CDH15 and KIRREL3 in Patients with Mild to Severe Intellectual Disability." The American Journal of Human Genetics 83.6 (2008): 703-13. Web. Frotscher, M. "Mossy Fiber Synapses on Glutamate Decarboxylase-immunoreactive Neurons: Evidence for Feed-forward Inhibition in the CA3 Region of the Hippocampus."SpringerLink. Springer-Verlag, 1989. Web. 09 Mar. 2017. Gerke, P., Benzing, T., Höhne, M., Kispert, A., Frotscher, M., Walz, G. and Kretz, O. “Neuronal expression and interaction with the synaptic protein CASK suggest a role for Neph1 and Neph2 in synaptogenesis. “ J. Comp. Neurol., 498: 466–475. doi:10.1002/cne.21064 (2006) Guerin, Andrea, Dimitri J. Stavropoulos, Yaser Diab, Sébastien Chénier, Hilary Christensen, Walter Ha Kahr, Riyana Babul-Hirji, and David Chitayat. "Interstitial Deletion of 11q-implicating the KIRREL3 Gene in the Neurocognitive Delay Associated with Jacobsen Syndrome." American Journal of Medical Genetics Part A 158A.10 (2012): 2551-556. Web. Hisaoka, T., Komori, T., Kitamura, T., & Morikawa, Y. “Abnormal behaviours relevant to neurodevelopmental disorders in Kirrel3-knockout mice. “ Scientific Reports, 8(1), 1408. (2018). https://doi.org/10.1038/s41598-018-19844-7 Hudry, E., Martin, C., Gandhi, S., György, B., Scheffer, D. I., Mu, D., … Maguire, C. A. “Exosome-associated AAV vector as a robust and convenient neuroscience tool.” Gene therapy, 23(4), 380–392. (2016). doi:10.1038/gt.2016.11 Laura Baroncelli, Chiara Braschi, Maria Spolidoro, Tatjana Begenisic, Lamberto Maffei, and Alessandro Sale, “Brain Plasticity and Disease: A Matter of Inhibition,” Neural Plasticity, vol. 2011, Article ID 286073, 11 pages, 2011. doi:10.1155/2011/286073 Liu, Y. F., Sowell, S. M., Luo, Y., Chaubey, A., Cameron, R. S., Kim, H. G., & Srivastava, A. K.. “Autism and Intellectual Disability-Associated KIRREL3 Interacts with Neuronal Proteins MAP1B and MYO16 with Potential Roles in Neurodevelopment.” PloS one, 10(4), e0123106. (2015). doi:10.1371/journal.pone.0123106 Martin EA, Muralidhar S, Wang Z, Cervantes DC, Basu R, Taylor MR, Hunter J, Cutforth T, Wilke SA, Ghosh A, and Williams ME. "The Intellectual Disability Gene Kirrel3 Regulates Target-specific Mossy Fiber Synapse Development in the Hippocampus." ELife. ELife, 17 Nov. 2015. Web. 09 Mar. 2017. Martin, E. A., Woodruff, D., Rawson, R. L., & Williams, M. E. (2017). Examining Hippocampal Mossy Fiber Synapses by 3D Electron Microscopy in Wildtype and Kirrel3 Knockout Mice. eNeuro, 4(3), ENEURO.0088–17.2017. http://doi.org/10.1523/ENEURO.0088-17.2017 Michaelson JJ, Shi Y, Gujral M, Zheng H, Malhotra D, Jin X, Jian M, Liu G, Greer D, Bhandari A, Wu W, Corominas R, Peoples A, Koren A, Gore A, Kang S, Lin GN, Estabillo J, Gadomski T, Singh B, Zhang K, Akshoomoff N, Corsello C, McCarroll S, Iakoucheva LM, Li Y, Wang J, Sebat J. Whole-genome sequencing in autism identifies hot spots for de novo germline mutation. Cell. 2012;151:1431–1442. doi: 10.1016/j.cell.2012.11.019. Neale BM, Kou Y, Liu L, Ma'ayan A, Samocha KE, Sabo A, Lin CF, Stevens C, Wang LS, Makarov V, Polak P, Yoon S, Maguire J, Crawford EL, Campbell NG, Geller ET, Valladares O, Schafer C, Liu H, Zhao T, Cai G, Lihm J, Dannenfelser R, Jabado O, Peralta Z, Nagaswamy U, Muzny D, Reid JG, Newsham I, Wu Y, Lewis L, Han Y, Voight BF, Lim E, Rossin E, Kirby A, Flannick J, Fromer M, Shakir K, Fennell T, Garimella K, Banks E, Poplin R, Gabriel S, DePristo M, Wimbish JR, Boone BE, Levy SE, Betancur C, Sunyaev S, Boerwinkle E, Buxbaum JD, Cook EH, Devlin B, Gibbs RA, Roeder K, Schellenberg GD, Sutcliffe JS, Daly MJ. Patterns and rates of exonic de novo mutations in autism spectrum disorders. Nature. 2012;485:242–245. doi: 10.1038/nature11011. . Torborg, Christine L., Toshiaki Nakashiba, Susumu Tonegawa, and Chris J. McBain. “Control of CA3 Output by Feedforward Inhibition Despite Developmental Changes in the Excitation–Inhibition Balance.” The Journal of Neuroscience 30, no. 46 (November 17, 2010): 15628. doi:10.1523/JNEUROSCI.3099-10.2010. Williams, Megan E., Joris de Wit, and Anirvan Ghosh. “Molecular Mechanisms of Synaptic Specificity in Developing Neural Circuits.” Neuron 68, no. 1 (n.d.): 9–18. doi:10.1016/j.neuron.2010.09.007. ACKNOWLEDGEMENTS Special thanks to Matthew Taylor for working with me throughout this project. Your guidance and mentorship has greatly advanced my knowledge of the biological sciences. Thank you to Dr. Megan Williams for assistance with this project and providing guidance throughout. Thanks to the Williams’ lab for supporting and assisting with experiments and procedures. This project was financially supported by the Undergraduate Research Opportunities Program (UROP) and by Dr. Megan Williams. School of Medicine University of Utah UNDERGRADUATE RESEARCH JOURNAL THE ROLE OF DIFFERENTIAL VIRAL PROFILES IN THE PATHOGENESIS OF SJÖGREN’S SYNDROME Vineeth Bajji, Amir H. Ghazitabatabei, Melodie Weller, Ph.D. Department of Oral Biology Background Primary Sjogren’s syndrome (pSS) is a chronic autoimmune syndrome that predominantly impacts females and is characterized by decrease in saliva and tear production, salivary gland inflammation and development of autoantibodies1. The underlying triggers of pSS are attributed to chronic viral exposures in conjunction with genetic susceptibility factors that limit patients’ abilities to effectively clear viral infections. The Weller lab has identified the presence of multiple unique virus profiles in pSS patients and has shown the capacity of viral antigens to trigger the complete pSS phenotype in vivo2. Preliminary studies were conducted on 3 murine strains (NODShiltJ, C57Bl/6 and BALB/c) to identify viral signatures present in the salivary gland tissue. Here we demonstrated that NOD-ShiltJ murine model of pSS has a significant increase in Mouse Mammary Tumor Virus (MMTV), a Retrovirus, in disease affected salivary gland tissue. Presence of MMTV in salivary gland tissue in NOD-ShiltJ has not been previously characterized. This study details the detection of MMTV and other viral signatures in the NOD-ShiltJ pSS model. Methods CLC Genomics Workbench (Qiagen bioinformatics, USA) was utilized to analyze viral gene expression in salivary glands of 12 week old female C57BL-6, BALB/c and Nod-ShiltJ mice and from 4, 8 and 12 week old female NOD-ShiltJ mice. Microarray data was normalized using quantile normalization protocols in CLC workbench. Background threshold was set for normalized expression intensity above 50 and fold change above 1.5 or below -1.5. T-test and ANOVA statistical analysis was performed and false discovery rate (FDR) algorithm was applied to identify statistically significant (p<0.05) viral probes in each analysis group. GeneVenn (genevenn.sourceforge.net/) was used to perform Venn diagram analysis and identify shared viral probes between NOD-ShiltJ 4, 8, and 12-weeks of age datasets. Results In Aim 1, we characterized baseline viral profiles of 12-week NOD murine strain against BALB/c and C57BL-6 (C57) control strains. Analyses showed there were minimal differences between the two control strains, BALB/c and C57. Only 6 viral probes were significantly different between the two control groups (Figure 1). In addition, there were a total of 18 probes shared between the NOD-C57 and the NOD-BALB/c comparison (Figure 1). Further analysis yielded 4 significant probes, which were upregulated and shared between the aforementioned comparisons (Table 1). This analysis identified a significant upregulation of retroviral transcript probes in the salivary glands of NOD-ShiltJ relative to both C57 and BALB/c controls. These results warranted further investigation of Retroviridae profiles as potential contributors to the pSS phenotype. In Aim 2, we characterized the natural history of viral profiles present in the NOD-ShiltJ salivary gland tissue over 4, 8, and 12 weeks of age. Based on our finding in Aim 1, we further narrowed our focus to further investigate significant Retroviridae probes observed over 4-12 weeks. Retroviridae 2342 and Retroviridae 297 showed statistically significant upregulation in expression over the course of our study. Retroviral expression did not change in any single direction over the 4-8 week course, however it increased between 8-12 weeks consistent with the natural progression of pSS phenotype in vivo (Figure 2). Figure 1. Comparative viral transcript profiles between NOD-ShiltJ and control strains, BALB/c and C57/BL6, identified viral signatures upregulated in the NOD-ShiltJ salivary gland. Eighteen viral probes were differentially expressed in the NOD-ShiltJ relative to control strains and 4 of these probes were significantly upregulated in the NOD-ShiltJ. Table 1. Viral probes upregulated in NOD-ShiltJ salivary gland relative to C57BL/6 and BALB/c control murine strains. Four viral probes were positively upregulated and shared between the BALB/c vs NOD and C57 vs NOD comparisons. Note that all values included in this table are statistically significant with a p-value<0.05. Positively Upregulated and Statistically Significant NOD- Viral Probes Probe ID Retroviridae 2217 Retroviridae 2342 Retroviridae 297 Totiviridae 3050 Normalized Fold Change (NOD vs BALB/c) 103.0637834 2.997221619 2.167464964 10.68498606 Normalized Fold Change (NOD vs C57) 8.905814401 2.581586854 1.889341271 16.78546753 Viral Family Retroviridae Retroviridae Retroviridae Totiviridae 4wk NOD 300 Mean Microarray Intensity 250 8wk NOD * 12wk NOD 200 * 150 100 50 0 Retroviridae 2342 Figure 2. Increased expression of MMTV transcripts in female NOD-ShiltJ salivary gland tissue. A natural history study of NOD-ShiltJ at 4, 8 and 12 weeks of age further confirmed the increase of MMTV transcripts in NOD-ShiltJ salivary gland tissue. ANOVA analysis of all significant microarray viral probes over the course of pSS progression in the NOD mice were analyzed. The mean expression values are plotted at 4, 8 and 12-week for each relevant viral family. (*p-value < 0.05) Retroviridae 297 Conclusions Our analysis identified a unique Retroviridae viral profile in the salivary glands of female NOD-ShiltJ mice. Retroviridae probes are significantly upregulated between 8-12 weeks during the natural history of pSS murine model. Prior studies have identified NOD-ShiltJ mice start to present disease phenotype after 8 weeks of age3. Thus, the increase in the Retroviral signature coincides with the development of the pSS phenotype in the NOD-ShiltJ model. Our finds suggest there may be a relationship between the pSS phenotype and retroviruses. Further studies are required to confirm the presence of MMTV in NOD-ShiltJ salivary gland and the association between MMTV replication and/or gene expression with the development of pSS phenotype in the NOD-ShiltJ murine model. References 1. 2. 3. Shiboski, C. H. et al. 2016 American College of Rheumatology/European League Against Rheumatism classification criteria for primary Sjögren’s syndrome: A consensus and datadriven methodology involving three international patient cohorts. Ann. Rheum. Dis. 76, 9– 16 (2017). Weller, M. L. et al. Hepatitis Delta Virus Detected in Salivary Glands of Sjögren’s Syndrome Patients and Recapitulates a Sjögren’s Syndrome-Like Phenotype in Vivo. Pathog Immun 1, 12–40 (2016). Roescher, N. et al. Temporal changes in salivary glands of non-obese diabetic mice as a model for Sjögren’s syndrome. Oral Dis 18, 96–106 (2012). University of Utah UNDERGRADUATE RESEARCH JOURNAL PROMOTING CRISPR HOMOLOGY DIRECTED REPAIR IN INDUCED PLURIPOTENT STEM CELLS BY COMBINING SMALL MOLECULES Constance Caparas (UROP Awardee) Colin Maguire (Research supervisor) Martin Tristani-Firouzi (UROP mentor) Center for Clinical and Translational Sciences CRISPR-Cas9 is a bacterial system that has been artificially synthesized so it can be harnessed to edit the human genome. In the synthesized version, a small piece of RNA with a “guide” sequence binds to a specific DNA sequence in the genome and the enzyme Cas9. The Cas9 enzyme can identify the targeted DNA sequence and cut it. After the DNA is cut, it is repaired in one of two ways: Non-homologous End Joining (NHEJ) or Homology Directed Repair (HDR). NHEJ, the more common pathway, typically results in an insertion or deletion (indel) that results in a truncated gene product leading to loss of function (“knock-out) of the gene of interest. HDR, the more technically challenging method, is used to knock-in a genetic modification into a cell line or animal model (often a mutation associated with a certain disease). Despite the research community’s high interest in HDR, the process remains very inefficient. To improve the efficiency of the HDR system, our lab hypothesized that treating the induced pluripotent stem cells (iPSCs) with small molecules would synergistically increase donor DNA insertion into the genome. Various concentrations of SCR7, L755507, and Resveratrol dissolved in DMSO were tested, and the least cytotoxic mixture was chosen. This project focused on using HDR to insert a point mutation into the transcription factor gene NFATC1, converting the wild-type ATG sequence to TTG, substituting a methionine for leucine at amino acid position 527. This gene was chosen because NFATC1 has been identified as a novel candidate atrial fibrillation susceptibility gene. To test our hypothesis, a combination of Scr7 (6.3µM) and L755507 (3.6µM ) dissolved in 1µl of DMSO was used to treat half of the cells that went through the CRISPR process. Preliminary results • iPSCs tolerated DMSO, but at increasing concentrations, entire colonies collapsed. • Resveratrol was extremely cytotoxic to iPSCs, even at low concentrations. • The least cytotoxic combination of molecules was Scr7 (6.3µM) and L755507 (3.6µM ) dissolved in 1µl of DMSO, keeping more cells alive for expansion post-electroporation. • 69% of iPSC clones that were Sanger sequenced exhibited a variety of indel mutations at target site. • No HDR events have been identified in 70 iPSC clones screened. Conclusion We conclude that even though this approach efficiently generated a number of different indel mutations in the iPSC clones, the combination of small molecules Scr7 (6.3µM) and L755507 (3.6µM) does not increase HDR efficiency. Work in progress Based on statistics for 1% probability, our lab must isolate, expand, and sequence at least 230 iPSC clones in order to find a single HDR clone. We currently are expanding the next set of 67 clones. If we do not find an iPSC clone containing the desired HDR insertion, we may explore testing other small molecules or different combinations of small molecules. University of Utah UNDERGRADUATE RESEARCH JOURNAL EFFECT OF ERYTHROPOIETIN RECEPTOR SIGNALING ON RETINAL GANGLION CELL NUMBER AND VISUAL ACUITY AFTER OXYGEN-INDUCED DAMAGE Ivan Cardenas (Aaron B. Simmons, Colin A. Bretz, Eric Kunz, M. Elizabeth Hartnett) Department of Ophthalmology Purpose: Premature infants are at risk of developing vision-threatening retinopathy of prematurity (ROP), which can result in lifelong vision impairment and is one of the leading causes of childhood blindness. Clinical studies have shown that one-third of infants with severe ROP develop childhood glaucoma, a disease associated with degeneration of retinal ganglion cells (RGCs). RGCs are critical for detecting features of vision and transmitting visual information to the brain. Recent studies have demonstrated that Erythropoietin (EPO) signaling through its receptor (EPOR) may be neuroprotective. The purpose of this study was to test the hypothesis that EPOR signaling protects RGCs and preserves functional vision against oxygen stresses experienced by infants born prematurely that develop ROP. Methods: A mouse oxygen-induced retinopathy (OIR) model was used to represent the oxygen stresses experienced by the retina in ROP in which juvenile mice were placed in a high oxygen environment (75% O2) for 5 days (from postnatal day (P) 7 to P12) then returned to room air. To test the effects of EPOR signaling, transgenic mice with reduced EPOR signaling (EPORlow) were compared to wildtype littermate controls (EPORwt). At 8 weeks of age, visual acuity thresholds were determined using the OptoMotry System (CerebralMechanics, Inc.). Visual acuity threshold was defined as the highest grating frequency (cycles/degree, c/d) responded to by the mouse. The optic nerve thickness, made up of RGC axon projections to the brain, was measured in micrometers (µm) after whole eye enucleation. Whole retinas were then stained with the RGC marker RBPMS and imaged with a confocal microscope. RGC counts were manually performed using ImageJ software. Data were statistically analyzed using a two-tailed ttest with a significance level of 0.05. Results: The study found that visual acuity significantly decreased in OIR model compared to room air (RA) controls (p<0.001), but there were no significant differences when comparing EPORlow and EPORwt mice in OIR or RA (OIR p=0.339; RA p=0.107). Likewise, optic nerve was significantly thinned in OIR compared to RA mice (p<0.05), but there was no difference in thickness between EPORlow and EPORwt in OIR or RA conditions (OIR p=0.395; RA p=0.472). Lastly, there was a significant decrease in central RGC counts in EPORlow compared to EPORwt mice in OIR (p<0.05), and a significant increase in central RGC count in EPORlow compared to EPORwt mice in RA (p<0.05). Conclusion: The current model suggests that EPOR signaling may have an effect on RGC number but does not affect optic nerve thickness, or visual acuity in oxygen induced damage. The differences observed between OIR and RA give evidence that oxygen stresses contribute to reduced RGC health and visual function. University of Utah UNDERGRADUATE RESEARCH JOURNAL GLUTATHIONE DISULFIDE REGULATION OF δ-ENAC SUBUNIT PLAYS AN IMPORTANT ROLE IN RENAL INJURY Camila Coca1 (Garett J. Grant2, My N. Helms3) Department of Internal Medicine, University of Utah, Salt Lake City UT Keywords— two electrode voltage clamp (TEVC), oocytes, glutathione disulfide ABSTRACT + Renal handling of Na and water is significantly compromised in renal injury and disease. Epithelial Na+ Channel (ENaC) dysfunction has been implicated in the pathogenesis of renal injury/disease because it is responsible for generating the osmotic gradient needed for net solute transport across the renal epithelium. ENaC is a trimeric structure made up of α or δ, β, and γ subunits. Recent studies have suggested a link between ENaC dysfunction and oxidative stress in renal injury/disease, however, the precise mechanisms responsible for progression of renal disorders remain unclear. Since δ-ENaC subunit is primate specific, we investigated the response of αβγ- and δβγ-ENaC under prooxidizing conditions as it may occur in renal patients (and not easily appreciated in pre-clinical animal models of renal disorder). Because δβγ-ENaC generate large conducting channels, we hypothesized that the δ-ENaC subunit plays a significant role in renal disorders. In order to test our hypothesis, we measured whole cell current (2 electrode voltage clamp) of heterologously expressed αβγ, δβγ, and αβγδ-ENaC cRNA in a Xenopus laevis oocyte model system. We modeled redox stress by perfusing oxidized glutathione (GSSG; 400μM) across the cell membrane during recordings. GSSG significantly decreased ENaC activity in oocytes expressing αβγ-ENaC (n=10; p<0.05). Conversely, GSSG significantly increased whole cell current by 38% in oocytes expressing δβγ-ENaC (n=12; p<0.05). Although whole cell current in βγ (only) injected oocytes were low, GSSG did not alter βγ transport. This suggests that δ-ENaC confers GSSG sensitivity in δβγ channels. Interestingly, when αβγδ cRNA was injected at equal ratios, GSSG significantly increased whole cell current by 65% in all 13 independent observations from 2 distinct batches of oocytes. Together, our results indicate that αβγ- and δβγ- ENaC are regulated differently under redox stress, and that the δ-ENaC subunit may play an important role in renal injury. A. Introduction Amiloride-sensitive ENaC is a membrane bound ion channel with selective inward permeability to Na+ under resting cell membrane potentials. To date, four ENaC subunits (α-, β-, γ-, and δENaC) and splice variants have been cloned in mammalian species (1). Based on high sequence identity to the acid-sensing ion channel (ASIC) family of voltage insensitive channels, and heterologous expression studies, it is clear that trimeric assembly of αβγ and δβγ- ENaC subunits comprise functional sodium channels in the cell membrane. In mice, αβγ-ENaC subunits are largely responsible for net Na+ transport across an epithelial monolayer. In humans the physiological role(s) of δ comprising sodium channels remain unclear. Herein, we evaluate heterologous expression of ENaC subunits in Xenopus oocyte membrane which allows for distinctions between the functional regulations of αβγ versus δβγ to be drawn. The aim of this study is to better understand redox regulation of αβγ and δβγ ENaC under experimental conditions that model a pathophysiological scenario, where high levels of extracellular glutathione disulfide (GSSG) can accumulate in the lung epithelial lining fluid during oxidative stress. Furthermore, we tested the hypothesis that glutathione disulfide has divergent effects on αβγ vs. δβγ ENaC. B. Materials and Methods Vectors: Human α, β, γ, and δ ENaC cDNA’s were cloned in pTNT Vector (Promega). Xenopus Oocytes: Defolliculated stage V Xenopus oocytes were purchased from Ecocyte Bioscience. Reagents and Chemicals: All chemicals and reagents were purchased from Sigma-Aldrich. The extracellular solution used for voltage-clamp experiments contained: 98 NaCl, 2 KCl, 1 CaCl2, 1 MgCl2, 5 HEPES; pH was adjusted to 7.6 with NaOH. ENaC expressing oocytes were pretreated with 10µM N-Ethylmaleimide (NEM) prepared in extracellular solution immediately prior to experimentation. Electrophysiology: Whole cell ENaC currents were recorded with two-electrode voltage-clamp techniques. Oocytes were placed in a Plexiglas chamber and continuously perfused with extracellular solution at a flow rate of 75mL/hour. Recording electrode resistances were between 0.5-1.0 ΩM. Oocytes were voltage clamped at holding potentials between -80mV to +60 mV applied in 10 mV increments. GeneClamp 500 amplifier, Digidata 1322A data acquisition system and pCLAMP ver. 8.2 software were used. Single channel patch clamp analysis was conducted as previously described in (2). Tissue Culture: Primary human epithelial cells (SAEC) were purchased from Lonza (Alpharetta, GA) and maintained in epithelial cell media (Lonza) supplemented with BPE, insulin, hydrocortisone, GA-1000, retinoic acid, BSA, transferrin, triiodothyronine, epinephrine, and hEGF per manufacturer suggestions. Immunohistochemistry: ENaC subunits were individually labeled using rabbit anti- α−, β−, γ−, or δ−ENaC antibodies purchased from StressMarq (Victoria, BC, Canada). A 1:350 fold dilution of the primary antibody was applied to formaldehyde fixed cells overnight, followed by incubation with Alexa488-conjugated goat anti-rabbit secondary antibody diluted 1:250. Cells were fixed and mounted using DAPI anti-fade reagent. Cell images were captured using an Olympus IX inverted microscope with a digital camera mount and processed using NIH Fiji ImageJ imaging software. C. Results Divergent Redox Sensitivities of α- and δ- epithelial sodium channel (ENaC) subunits. Amiloridesensitive whole cell αβγ -ENaC current is inhibited by glutathione disulfide (GSSG). We showed GSSG’s inhibitory effect on Amiloride sensitive whole cell αβγ -ENaC current in an oocyte expression system (Fig 1AC). Additionally, voltage clamping oocytes shows that inward rectification of Na+ current does not shift following 400µM GSSG perfusion across cell membrane, and that membrane voltages negative to the Na+ equilibrium potential are significantly affected by GSSG. Since the resting Fig 1 cell membrane potential of epithelial cells is near -60mV, this finding indicates that the GSSG induced decrease in αβγ -ENaC would be relevant at physiological potentials. The decrease in ENaC whole cell current is statistically significant (n=10, p<.0001). Washout of excess GSSG indicates stable current and that GSSG covalently modifies ENaC protein (Fig 1B). Real time study of whole cell current indicates that GSSG significantly decreases ENaC function within 10 seconds of perfusion (Fig 1C). Amiloride-sensitive whole cell δβγ-ENaC current is activated by GSSG. We tested the effect of GSSG on whole cell current using both δ1 and δ2 slice variants alongside βγ-ENaC subunits. We found that δ1 or δ2 expression alongside βγ ENaC cRNA expression in oocytes resulted in Amiloride sensitive, nonvoltage-dependent sodium current (Fig 2a). GSSG significantly increases δβγ whole cell current (n=12, p<.05) (Fig 2b). This immediate increase in ENaC activity (Fig 2c) is in stark contrast to the significant decrease in αβγ ENaC current that we observed earlier. We also found that βγ -ENaC expression alone did not respond to GSSG (data not shown). GSSG modulates δβγ-ENaC via direct thiol modification. Bioinformatics and predictive analysis of αβγ-ENaC strongly suggests that these subunits are post-translationally modified at conserved Cys thiol sites. We evaluated the mechanism by which GSSG regulates δ1βγ ENaC activity by pretreating cells with a thiol modifying agent termed NEthylmaleimide (NEM). NEM is an alkene agent reactive towards thiols and is commonly used to modify cysteine residues in proteins. Oocytes expressing δβγ-ENaC were pre-treated with 10µM NEM approximately 1 min before GSSG perfusion (400µM). In these groups of δ1βγ (n=8) ENaC pre-treated cells, GSSG failed to inhibit whole cell current. These outcomes show that Cys thiols play an important role in post-translational modification of all ENaC subunit isoforms and splice variants. GSSG regulates net Na+ transport in primary human epithelial cells. Given that human epithelial express each of the four ENaC subunits (shown using confocal microscopy in Fig 3), we next evaluated the effect of GSSG on SAEC Na+ transport using single channel patch clamp analysis. Our preliminary data indicates that GSSG does not significantly change ENaC NPo in human epithelial cells (n=8; data not shown). D. Discussion The physiological role of δ -ENaC subunit remains unclear. It is important to better understand δ-ENaC subunit because it is widely expressed in the human body. As such, addressing this gap in scientific knowledge can be directly applicable towards several diverse disease systems (hypertension, acute lung injury, psoriasis, and carcinomas to name a few). Our study shows that sodium channels comprised of αβγ -ENaC subunits respond to GSSG (which accumulates under Fig 2 Fig 3 pro-oxidizing conditions) with net increase in Na+ transport in oocytes. This is in stark contrast to the decrease in Na+ transport in αβγ -ENaC expressing oocytes and mouse epithelia previously reported. Thus far, our preliminary single channel patch clamp analysis of primary human epithelial cells shows that GSSG fails to significantly alter ENaC activity (neither significant increase nor decrease was observed). Additional studies are needed to better understand and dissect out the different regulatory mechanisms influencing α- and δ-ENaC subunit function at the apical membrane. E. References 1. 2. 3. . Ji HL, Zhao RZ, Chen ZX, Shetty S, Idell S, Matalon S Am J Physiol Lung. Yu L, Helms MN, Yue Q, Eaton DC Am J Physiol Renal Downs CA, Kreiner L, Zhao XM, Trac P, Johnson NM, Hansen JM, Brown LA, Helms MN Am J Physiol Lung. University of Utah UNDERGRADUATE RESEARCH JOURNAL DEVELOPMENT OF A MULTI-LEVEL INTERVENTION FOR THE IMPLEMENTATION OF HPV EDUCATION & THE INTEGRATION OF HEALTHCARE SYSTEMS TO IMPROVE HPV VACCINATION RECEIPT AMONG YOUNG DENTAL PATIENTS Maya Correa, (Deanna Kepka) Huntsman Cancer Institute Background Currently in the United States human papillomavirus (HPV) linked oropharyngeal cancer is on the rise. Even though, in the United States we have access to the vaccine that prevents HPV infection less than half of adolescents are completing the recommended HPV vaccines. In Utah the rates of HPV vaccination are extremely low. To lower rates of HPV infections that cause HPV oropharyngeal cancers, the HPV vaccination recipient rate must increase significantly for adolescents. Hypothesis/Purpose The goal is to investigate the most feasible and promising approaches to educate parents, dentists, and dental teams about HPV and HPV oropharyngeal cancers. The research team will also explore strategies to work with primary care providers to improve HPV vaccination rates among dental patients ages 11 to 26 years old. This study will also be assessing clinical, personal, and cultural barriers dental providers have in regard to including HPV education and promoting the HPV vaccine in their practice. Methods As a pilot test, the methodology of this project will include a multi-level HPV vaccination education and HPV vaccination delivery intervention for parents, dental health providers, and dental health teams at four dental practices that have affiliated primary healthcare systems who offer the HPV vaccination. Several practicing dental providers in Utah will be given access to a multi-step survey that includes questions related to clinical, personal, and cultural barriers in connection to HPV education and the HPV vaccine. Results/Summary This pilot study is now in the process of reaching out to these practices and collecting data so no results are available at this time. However, we are confident that educating parents, dental health providers, and dental health teams about HPV linked oropharyngeal cancer through alternative venues we will be able to increase HPV vaccination rates and decrease the rate of HPV linked oropharyngeal cancers. Dental practices offer more access to children and parents and are an important focus as they contribute to expanding the utilization of the HPV vaccine and improving HPV oropharyngeal cancer education among adolescents and parents. University of Utah UNDERGRADUATE RESEARCH JOURNAL ANALYSIS OF EYES SHUT (EYS) DURING INTESTINAL REGENERATION OF DROSOPHILA MELANOGASTER Heather Marie Cummins (Bruce Edgar, Clothilde Pénalva) Department of Oncology Introduction: The intestine is a self-renewing organ under constant stress. It is the first line of defense against toxins and bacteria and enables digestion and nutrient absorption. Its homeostasis (controlled regulation) plays a critical role in maintenance of organ function and prevention of tumor generation. Eyes-shut (eys) is an important extracellular protein conserved from Drosophila to humans that plays a role in the eye and the nervous system formation and function (Cook et al., 2008) (Husain et al., 2006). While the role of eys is well known in these organs, it has never been studied in the intestine. Normally, eys is not expressed in the intestine. However, data from Dr. Bruce Edgar’s lab has shown that after intestinal stress, eys’ RNA is upregulated, suggesting a possible function in stress-induced intestinal regeneration. Hence, we investigated its role in the intestine together with rumi and promin (prom), known partner of eys in the eye. Rumi Oglucosylates eys to regulate its secretion and stability, while prom is a transmembrane receptor that binds to eys to promote cellular integrity (Gurudev et al., 2014) (Cook et al., 2008). Methods and Materials: In order to discover the possible function of eys and its partners in the Drosophila gut, I have performed several experiments together with Dr. Pénalva, the post-doc working on this project and directly supervising me at the bench. First, I confirmed upregulation of eys in the Drosophila gut post-stress treatment both by RT-qPCR and immunofluorescence. Second, I analyzed rumi expression by RT-qPCR. Third, I performed knockdown (KD) experiments of eys and rumi in order to determine whether they are required for ISC regeneration. Finally, I tested whether eys is sufficient for cellular regeneration. Results: When compared to a negative control of sucrose, in response to intestinal challenge, eys is upregulated from both oxidative stress, detergent feeding, and bacterial infection. Each stress saw a logarithmic fold induction greater than 1, with P.e. infection resulting in a statistically significant 17.34 fold increase in mRNA expression. Since eys is stress-responsive, it could have a role in intestinal regeneration. While the expression of eys RNA in unchallenged conditions is extremely low and increases after stress, rumi shows stronger basal levels of expression but is not upregulated after stress. It seems as if stress has no significant effect on RNA levels of rumi as qPCR results show no statistically significant changes. Thus, rumi is not regulated at the RNA level in the intestine but could still regulate eys when eys is expressed. In KD experiments, the amount of ISC proliferation was scored using phospho-histone 3, a marker of mitosis. When compared to the control of the same genetic background, ISC proliferation is decreased in response to P.e., Ecc15, SDS, and Bleo in the midgut expressing eys RNAi specifically in the ECs. However, it was not decreased in response to H2O2. Since ISC response is visibly decreased in 4/5 stresses when eys expression is reduced, it can be determined that proper eys function is required for intestinal regeneration. I also observed that the knockdown of rumi also decreased the stem cell proliferation level in response to all stresses tested. This shows that rumi is also required for intestinal regeneration. When compared to a control line, overexpression does not affect the number of pH3+ divisions after 2, 5, or 7 days. This suggests that increasing eys level in the ECs is not sufficient to trigger ISC proliferation. It is possible that eys activity is not sufficient or eys is not stable and/or secreted in absence of stress. Conclusion: We have shown that eys and rumi are required for proper intestinal homeostasis. However, eys is not sufficient to produce an intestinal response when simply overexpressed. Further studies are needed to determine if rumi is sufficient to induce intestinal stress-response when overexpressed and if prom is required/sufficient for intestinal regeneration. The investigation into eys and its partners is crucial to understanding cellular regeneration of the intestine and could help devise new therapeutic strategies for gastrointestinal diseases or cancers. References: Cook, B., Hardy, R.W., McConnaughey, W.B., and Zuker, C.S. (2008). Preserving cell shape under environmental stress. Nature 452, 361–364. Gurudev, N., Yuan, M., and Knust, E. (2014). chaoptin, prominin, eyes shut and crumbs form a genetic network controlling the apical compartment of Drosophila photoreceptor cells. Biol. Open 3, 332–341. Husain, N., Pellikka, M., Hong, H., Klimentova, T., Choe, K.-M., Clandinin, T.R., and Tepass, U. (2006). The Agrin/Perlecan-Related Protein Eyes Shut Is Essential for Epithelial Lumen Formation in the Drosophila Retina. Dev. Cell 11, 483–493. University of Utah UNDERGRADUATE RESEARCH JOURNAL A NEW METHOD FOR QUANTIFYING LIVER SIZE IN ZEBRAFISH BY MECHANICAL ISOLATION AND HEMOCYTOMETER ANALYSIS Gabriel DeNiro1, Liam O’Brien1, Richard Smith1, Kimberley Evason1,2 Huntsman Cancer Institute1, Department of Pathology2, University of Utah, Salt Lake City Background Over the last several decades, the zebrafish has emerged as a major genetic model in basic science research. Quantification of larval liver size in zebrafish is a pivotal application in studies that target hepatocellular carcinoma, fibrosis, oxidative stress, development, and organ regeneration. Current methods include quantifying liver area or volume based on images generated with confocal or light microscopy. These methods are technically challenging and labor-intensive, and they do not have the ability to distinguish between changes in cell size (hypertrophy) and changes in cell number (hyperplasia). Here we report the development of a new, simple and cost-effective method for quantifying zebrafish liver size via mechanical isolation of cells from florescent livers and cell counting. A major advantage of our new method is the ability to detect changes in cell number, which is particularly relevant for studies of cancer, development, and regeneration. Methods The proposed method is to use zebrafish larvae with fluorescently labelled livers and dissect out the liver under a florescent microscope. Livers are then placed into 1ml Eppendorf tubes with 10 µl of TrypLE Express. Liver samples are then given a quick spin down, then incubated on a heat block at 37℃ for 10 minutes. The liver is then brought back under the florescent microscope and using a p2.5 µl pipette, it is gently crushed up into a cellular mass. The sample(s) is then stained with 3 µl of Trypan Blue and analyzed on a hemocytometer under a light microscope. Cells are then quantified using standard hemocytometer cell count analysis. Current standard method Shown below is an image of an untreated wild-type (WT) zebrafish larvae at 6 days postfertilization (dpf), with the liver area being visually outlined and measured. This is the currently the favored method amongst various researchers whom conduct liver size experiments with fish livers. Evason, K. J., et al. (2015). Identification of chemical inhibitors of beta]catenin-driven liver tumorigenesis in zebrafish. PLoS Genetics Goldsmith, Jason Jobin, Christian “Think Small: Zebrafish as a Model System of Human Pathology” 2012 10.1155/2012/817341 Journal of Biomedicine & Biotechnology Determining Methodological Efficacy Before any method in research can be put into the scientific community for frequent use, a standard of efficacy must be established to determine if a specific technique is prone to a high error rate. Hence data was collected to determine the error rate generated by the coefficient of variance (CV), from 6 dpf WT fish expressing green fluorescent protein (GFP). Four cell count trials were conducted using this method. Data showed percent CVs of 27.26, 27.9, 9.58 and 11.77. These were compared alongside two sets of randomized sample tests using 6 dpf WT liver data from fellow zebrafish researchers using the standard method. These samples generated CVs of 9.4% and 25.7% respectively. Results Zebrafish crosses were set up using an even number of WT (AB) fish with GFP fluorescent livers and fish that express hepatocyte-specific activated beta-catenin (fish will express larger livers) with GFP fluorescent eyes. Hence progeny from all clutches will produce different four phenotypes with respect to green liver and eye color; +/+, +/-, -/+, -/-. Fish with fluorescent livers, regardless of eye color, had their livers quantified using the new cell count method. Fish with non-fluorescent livers were quantified using the standard method, measuring liver area and volume from images. P v a lu e < 0 . 0 0 0 3 P v a lu e < 0 .0 0 0 1 *** **** 8000 0 .0 0 0 8 2 L iv e r A r e a c m C e ll C o u n t 6000 4000 2000 0 0 .0 0 0 6 0 .0 0 0 4 0 .0 0 0 2 0 .0 0 0 0 + L iv e r /+ E ye s + L iv e r /- E ye s - L iv e r /+ E ye s - L iv e r /- E ye s Discussion Livers quantified using the standard method resulted in a P value of <0.0003 whereas the new cell count method had a P value of <0.0001. Hence there is a clear indication of tight and defined results which can be used to quantify liver size in zebrafish. Furthermore, we are able to use this as a supplementary method alongside the current standard method by measuring liver area, as we are now also able to quantify the number of cells within a specified liver. References 1. Evason KJ, Francisco MT, Juric V, et al. Identification of Chemical Inhibitors of βCatenin-Driven Liver Tumorigenesis in Zebrafish. PLoS Genet. 2015;11(7):e1005305. 2. Goldsmith, Jason Jobin, Christian 817341 Think Small: Zebrafish as a Model System of Human Pathology 2012 (Book) University of Utah UNDERGRADUATE RESEARCH JOURNAL PARP INHIBITION IMPROVES RADIOTHERAPY EFFECTIVENESS IN MENINGIOMA CELL CULTURE Jonathan Harper (Randy Jensen MD, PhD) Department of Neurosurgery, Huntsman Cancer Institute INTRODUCTION Medical therapies and radiological adjuvants are currently limited for aggressive meningiomas. Inhibitors of poly (ADP-ribose) polymerase (PARP), such as ABT-888, plays a role in cancer by preventing DNA repair. PARP inhibitors can improve sensitization to radiation and alkylating treatments in gliomas and other tumors but have not yet been studied in meningiomas. We hypothesize that ABT-888 and radiation therapy combine to show synergistic anti-tumor effects in meningioma cell lines. Furthermore, we hypothesize that this effect is mediated by hypoxia inducible factor 1A (HIF1A). METHODS A primary meningioma cell line developed by our lab (GAR-Neg) along with a cell line with a shRNA-HIF1A knockdown (GAR1589) were used. After treatment with ABT-888, TMZ and radiotherapy, cells were evaluated using a cell viability assay (Cell Titer-Glo) and real-time cell microscopy (e.g. Incucyte). Experiments were performed in triplicate and statistically analyzed. RESULTS TMZ (3.125 uM, 1.563 uM, 0.75 uM) and ABT-888 (3.125 uM, 1.563 uM, 0.75 uM, and 0.1 uM) significantly reduced viability and proliferation of GAR-Neg cells (p<0.05, One-way ANOVA). While TMZ inhibited GAR-Neg cells in a dose-dependent manner (3.125 uM, 1.563 uM, 0.75 uM), PARP (3.125 uM, 1.563 uM, 0.75 uM, and 0.1 uM) resulted in varying effects on viability. Combination therapy with TMZ and ABT-888 showed synergistic effects in combination compared to either dose individually (p<0.05). Combination of ABT-888 and radiotherapy showed additive effects when evaluated with real-time cell microscopy. GAR1589 cell showed a modest increase in sensitivity to certain combined drug doses. CONCLUSION TMZ and ABT-888 combinations showed synergistic anti-tumor effects while radiotherapy and ABT-888 combinations showed additive anti-tumor effects in meningioma cell lines. These results suggest improved methods for combination, targeted treatment of patients with meningioma with lower overall doses of toxic therapies. In addition, HIF1A may play a role in promoting resistance to combined treatments. Neuro-Oncology, Volume 20, Issue suppl_6, 5 November 2018, Pages vi101– vi102, https://doi.org/10.1093/neuonc/noy148.425 Published: 05 November 2018 University of Utah UNDERGRADUATE RESEARCH JOURNAL EVALUATION OF NEUROPATHIC PAIN AND MITOCHONDRIAL FUNCTION AFTER SPINAL CORD INJURY Brianne Jacobson, Lonnie E. Schneider Ph.D. University of Utah School of Medicine, Division of Physical Medicine and Rehabilitation ABSTRACT The overall goal of this project is to elucidate novel mitochondrial bioenergetic and oxidative stress mechanisms that underlie the formation of neuropathic pain after traumatic spinal cord injury. Of the people who suffer from a spinal cord injury (SCI) 70% develop neuropathic pain (NP). It is well known that mitochondria play a role in SCI pathophysiology. However, it is unknown the specific role of mitochondria in the formation of neuropathic pain, in particular, the mechanisms, and timing of mitochondrial dysfunction and how it relates to NP. As such, a highly effective and viable mitochondrial based treatment for this mechanism of SCI-NP does not yet exist. The overall aim of this investigation was to understand the role of mitochondrial bioenergetics in the spinal cord and the role it plays in the formation and maintenance of neuropathic pain after SCI. Utilizing a previously established and highly relevant supraspinal-pain outcome measure, these experiments will establish a model in which to evaluate specific molecular mechanisms of SCINP. We hypothesized that the evaluation of supra-spinal pain using the Grimace Scale can detect changes in mitochondrial function and oxidative stress related to SCI-NP. For the experiment, age and weight matched adult male and female Sprague Dawley rats were randomly assigned to one of the following groups: laminectomy (LAM) uninjured controls or spinal cord injured (SCI vehicle). Antioxidant treatment groups were high dose weekly (SCI-HDW), spinal cord injured given high dose daily (SCIHDD), and spinal cord injured given low dose daily (SCI-LDD). The animals received a C5 hemi-contusion SCI, induced on the right cervical spinal cord with a force of 300kDy followed by a 5-second dwell to induce ischemia. The LAM animals received all surgical procedures except the impact and ischemic dwell. The mitochondrial bioenergetics were evaluated from isolated spinal cord mitochondria using Oroboros High Resolution Respirometry. Oxidative stress was evaluated using Amplex Red for hydrogen peroxide production. We found that NP begins in week 3 post-SCI and continues at least until week six indicating that chronic NP can result from this model of spinal cord injury. Interestingly, administration of the MnSOD mimetic MnTnHex-2-PyP 5+ ameliorates NP starting at week three, suggesting that there is a mitochondrial based oxidative stress mechanism the underlies chronic pain. Next we evaluated mitochondrial function and found that abnormalities in electron transport chain persist at 6weeks post-SCI and this dysfunction is associated with increased hydrogen peroxide (H2O2) production. We identified mitochondrial complex I as decreased post-SCI, however the contribution to overall bioenergetics was variable. Overall, we concluded that the Grimace Scale can determine the onset of SCI-NP and evaluate the analgesic effects of antioxidant drugs. The changes in oxidative stress and bioenergetics are coincident with NP at 6-weeks post-SCI and may be differentially contributing to SCI-NP. H2O2 production from complex I may be a key variable for SCI-NP in which there is global mitochondrial dysfunction. Future studies will evaluate the specific effects of MnTnHex-2-PyP 5+ on mitochondrial function in chronic SCI and identify the role of H2O2 using the Grimace scale for supra-spinal neuropathic pain. University of Utah UNDERGRADUATE RESEARCH JOURNAL CLINICAL MANAGEMENT OF ANTIEPILEPTICS DURING PREGNANCY Lea Karabegovic (Kathleen Job, PhD) Department of Pediatrics, Division of Pediatric Clinical Pharmacology, University of Utah School of Medicine Background With over 65 million afflicted worldwide today, epilepsy is one of the most common neurological diseases known [1]. Epilepsy is especially of concern during pregnancy. Risks associated with maternal epilepsy include fall secondary to epileptic events and miscarriage, among others. However, some antiepileptic drugs (AEDs) are known to cause teratogenic outcomes. As such, it is recommended that women be appropriately counseled and treated for epilepsy [2]. The American Academy of Neurology (AAN) and American Epilepsy Society (AES) introduced new guidelines for the clinical management of epilepsy during pregnancy in 2009 [3]. The AEDs with the most likely safe outcomes in pregnancy included carbamazepine and lamotrigine, whereas it was recommended that the use of valproate and phenytoin be avoided [3, 4]. Aims and Methods The aim of this study was to determine AED prescription patterns for a pregnant population, and whether the published guidelines were followed, using a retrospective chart review. The data included demographic and drug prescription information for a set of pregnant women exposed to at least one AED at an Intermountain Healthcare facility between January 1, 2006 and December 31, 2016. The data was separated so as to include each pregnancy as a separate point (even though a single patient may have had several pregnancies during which she was exposed to an AED). The time-stamped “Drug Administration Date” information was used to further separate the data by the trimester during which the AED exposure event occurred. Excel software was then used to determine trends in AED prescription, both in pregnancy as a whole, as well as across trimesters. Results The results of the study were based on a total of 201 pregnancies exposed to a total of 251 AEDs at some point during pregnancy. Clonazepam was the most commonly prescribed AED, with lamotrigine closely following. A summary of AED prescription patterns throughout pregnancy and by trimester can be found in Figure 3 (below). The general prescription patterns were found to be similar throughout all ten years included in this study—which included dates both before and after the AAN and AES guidelines were published. One concerning incidence of valproate use in the first trimester was included, and about 5% of all pregnancies in this study were exposed to phenytoin. AED Prescribed Phenobarbital Phenytoin Fosphenytoin Clonazepam Carbamazepine Oxcarbazepine Valproic Tiagabine Lamotrigine Gabapentin Levetiracetam Zonisamide Pregabalin Lacosamide All Pregnancies: N (%) 1st Trimester N (%) 2nd Trimester N (%) 7 (2.8%) 12 (4.8%) 3 (1.2%) 66 (26.3%) 13 (4.8%) 4 (1.6%) 1 (0.4%) 1 (0.4%) 63 (25.1%) 31 (12.4%) 33 (13.1%) 5 (2.0%) 7 (2.8%) 5 (2.0%) 1 (1.3%) 1 (1.3%) 2 (2.2%) 10 (10.8%) 2 (2.2%) 25 (26.9%) 3 (3.2%) 2 (2.2%) 17 (18.3%) 11 (11.8%) 15 (16.1%) 2 (2.2%) 1 (1.1%) 3 (3.2%) 24 (31.2%) 2 (2.6%) 1 (1.3%) 1 (1.3%) 20 (26.0%) 11 (14.3%) 10 (13.0%) 1 (1.3%) 3 (3.9%) 2 (2.6%) 3rd Trimester N (%) 4 (4.9%) 1 (1.2%) 1 (1.2%) 17 (21.0%) 8 (9.9%) 1 (1.2%) 1 (1.2%) 26 (32.1%) 9 (11.1%) 8 (9.9%) 2(2.5%) 3 (3.7%) - Total Prescriptions: 251 77 (30.7%) 93 (37.1%) 81 (32.2%) Table 1: Antiepileptic Drug Prescription Throughout Pregnancy and By Trimester. A total of 251 prescriptions (or AED exposures) occurred between the 201 pregnancies included in the study. The number of patients prescribed an AED was similar across all trimesters. Clonazepam and lamotrigine were consistently the most commonly prescribed AEDs, both within and across the three trimesters. Summary and Future Directions Though the AAN and AES guidelines were followed in the treatment of the majority of the pregnancies, incidents of valproate and phenytoin prescriptions are concerning. The single exposure of valproate and the majority of the phenytoin exposures occurred in the years after 2009, when the use of these two drugs during pregnancy were specifically advised against. This suggests that providers are not aware of the guidelines, or have not implemented these suggestions into their practice. It also leads to questions of whether medication decisions were guided by patients or physicians. Future studies should also look into why clonazepam exposure was greater than what was anticipated, and whether this may have had any association with the treatment of non-epileptic conditions. References [1] Epilepsy Foundation. N.p., n.d. Web. 29 Mar. 2017. [2] Tricco, Andrea C, Elise Cogo, Veroniki A Angeliki, Charlene Soobiah, Brian Hutton, Brenda R Hemmelgarn, David Moher, Yaron Finkelstein, and Sharon E Straus. "Comparative Safety of Anti-epileptic Drugs among Infants and Children Exposed in Utero or during Breastfeeding: Protocol for a Systematic Review and Network Meta-analysis." Systematic Reviews 3.1 (2014): 68. [3] C. L. Harden, K. J. Meador, P. B. Pennell, W. A. Hauser, G. S.Gronseth, J. A. French, S. Wiebe, D. Thurman, B. S. Koppel, P. W.Kaplan, J., N. Robinson, J. Hopp, T. Y. Ting, B. Gidal, C. A. Hovinga, A., N. Wilner, B. Vazquez, L. Holmes, A. Krumholz, R. Finnell, D.Hirtz, C. Le Guen. “Practice Parameter update: Management issues for women with epilepsy−−Focus on pregnancy (an evidence-based review): Teratogenesis and perinatal outcomes: Report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society.” Neurology 2009;73;133-141 [4] Groot, Mark C. H. De, Markus Schuerch, Frank De Vries, Ulrik Hesse, Belén Oliva, Miguel Gil, Consuelo Huerta, Gema Requena, Francisco De Abajo, Ana S. Afonso, Patrick C. Souverein, Yolanda Alvarez, Jim Slattery, Marietta Rottenkolber, Sven Schmiedl, Liset Van Dijk, Raymond G. Schlienger, Robert Reynolds, and Olaf H. Klungel. "Antiepileptic drug use in seven electronic health record databases in Europe: A methodologic comparison." Epilepsia55.5 (2014): 666-73. University of Utah UNDERGRADUATE RESEARCH JOURNAL DEDICATED EMERGENCY DEPARTMENT PHYSICAL THERAPY REDUCES IMAGING, OPIOID ADMINISTRATION, AND LENGTH OF STAY Asal Kareem ,HBS (Andrew Pugh, MBBS, Keith Roper, PT, DPT, Jake Magel, PhD, MSPT, DSc, Julie Fritz, PhD, PT, ATC, Nazaret Colon, BS, Sadie Robinson, BS, Caitlynn Cooper, BSN, John Peterson, BS, Troy Madsen, MD) School of Medicine Background Emergency department (ED)-initiated physical therapy (PT) is an emerging resource nationwide. Early data suggest that PT in the ED has a positive effect on a number of clinical and operational outcomes in patients presenting with musculoskeletal pain. However, there are few published narratives on this topic. This study assesses the impact of ED PT on imaging studies obtained, rates of opioids prescribed, and ED length of stay. Methods We prospectively identified patients presenting with musculoskeletal pain to an urban academic ED in Salt Lake City between January 2017 and June 2018. During the study, a physical therapist was in the ED three days a week and was available to evaluate and treat patients after consultation by the ED provider. We noted patient demographic information, imaging performed in the ED, medications administered and prescribed, and ED length of stay. We classified patients as those who received PT in the ED and those who did not and compared clinical outcomes between groups. Results Over the 18-month study period, we identified 524 patients presenting to the ED with musculoskeletal pain. 381 (72.7%) received ED-initiated PT. The PT and non-PT groups were similar in average age (42.8 years vs. 45.1 years, p=0.155), gender (% female: 53% vs. 46.9%, p-0.209), and primary presenting chief complaint (cervical, thoracic, or lumbar pain: 57.7% vs. 53.1%, p=0.345). Patients who received PT had lower rates of imaging (38.3% vs. 51%, p=0.009), ED opioid administration (17.5% vs. 32.9%, p<0.001), and a shorter average ED length of stay (4 hours vs. 6.2 hours, p<0.001). Rates of outpatient opioid prescriptions were similar between groups (16% vs. 21.7%, p=0.129). Conclusion In our experience, physical therapy within the ED reduced the use of imaging and time spent in the ED. Patients receiving PT were also less likely to receive an opioid in the ED, a potentially significant finding given the need for opioid reduction strategies. University of Utah UNDERGRADUATE RESEARCH JOURNAL GRADUATING TO ADULT CARE: A COMPREHENSIVE PROGRAM TO IMPROVE TRANSITION FROM PEDIATRIC TO ADULT CARE FOR ADOLESCENTS WITH TYPE 1 DIABETES Shelby Kirby, BS2, Mentor-Aimee Hersh, MD4 Rachel Bensen, MD1, Karen Valentine, MStat, BS2, Shelby Kirby, BS2 ,Stephanie Sund, MSN, RN2, Carolyn Reynolds, MS, APRN2, Katrina Jensen, MS, RN2, Justin Poll, PhD3, Korey Hood, PhD1, Diana Naranjo, PhD1, Mary Murray, MD4 , and Aimee Hersh, MD4 (1)Stanford Medical School, Stanford, CA, (2)Intermountain Healthcare, Murray, UT, (3)Intermountain Healthcare, salt lake city, UT, (4)University of Utah, Salt Lake City, UT Department of Medicine, Pediatrics Division Transition of care from pediatric to adult care can present many challenges resulting in declining health in adolescents and young adults (AYA) with a chronic disease. Lapses in health care and self-care are common for this population during this period. To decrease this common occurrence a multidisciplinary team has developed a program to support AYA as they transition from pediatric to adult healthcare. The study population includes AYA diagnosed with type 1 diabetes aging 1618 years. The intent of this program is not only to gain a better understanding of the experiences patients go through during this transition, but to also assess the potential impact of this program on the short and long-term healthcare outcomes of this population. In a randomized control trial, the intervention group participates in the GRAD program along with usual care. The intervention participants are also screened for depression and anxiety at enrollment that may also qualify them for health coaching, care management, or both. Throughout the program HbA1c levels are tracked and monitored to contribute determining effectiveness of the program. Based on provisional selfreported data, Currently the data shows there is a positive correlation between the PAM (Patient Activation Measure) and DSTAR (Diabetes Strength and Resilience) and hemoglobin A1C levels p0.001) at baseline and at the 6-month follow-up. As of January 25, 2019, 75% of GRAD participants completed 2 or more of the 6 transition modules and 23% of GRAD participants transferred to adult care. The retention rates are currently 69% for Intervention, and 94% for control. Remaining participants have rated program satisfaction as 56% very helpful, 40% somewhat helpful. The interim data supports the grad program to be a promising approach to reduce these healthcare lapses and improve self-confidence and resiliency in the AYA population. University of Utah UNDERGRADUATE RESEARCH JOURNAL COMORBIDITIES ASSOCIATED WITH ATRIAL FIBRILLATION: AN OVERVIEW OF PATIENTS WITH A HISTORY OF STROKE AND SLEEP APNEA Karen Cardenas Lara, Ariana Bernuy (LEAP HS Program, CARMA Center, Nassir Marrouche, MD, Gagan Kaur, BS, Andy Rivera, BS, and Benjamin Hardisty, PhD. Department of Cardiology Purpose To identify the prevalence of comorbidities in patients with atrial fibrillation and an existing history of obstructive sleep apnea and stroke. Background Atrial Fibrillation (AFib) is the most common heart arrhythmia, affecting between 2.7-6.1 million people in the U.S. Afib occurs when the upper chambers of the heart (atria) beat irregularly, reducing blood flow to the lower chambers (ventricles). About 15% to 20% of ischemic strokes are caused by AFib. Throughout the study the most common comorbidities observed with AFib are obesity, hypertension and diabetes. Throughout our patient population obesity was found in 25% of patients. It is also implicated as a risk factor for progression from paroxysmal to permanent Afib. Patients with type 2 diabetes are at a 35% to 60% greater risk for developing AFib. The last comorbidity seen throughout the patient population was obstructive sleep apnea also known as OSA. Obstructive sleep apnea is prevalent in approximately half of all AFib patients. Use continuous positive airway pressure (CPAP) devices in treating OSA has been documented as reducing the risk of AFib episodes to nearly half. Methodology Utilizing the Comprehensive Arrhythmia Research & Management Center Atrial Fibrillation Database, records were searched to identify patients who have a documented diagnosis of atrial fibrillation, stroke, and sleep apnea. Also, a medical history which includes taking at least one cardiac medication (current or historical). A total of 4,639 patients were identified as satisfying the initial criteria. Once all duplicates or invalid records were removed, a total of 199 patient charts underwent an in-depth chart review. Descriptive statistics were used to describe the prevalence of comorbidities, utilization of cardiac medications, type of stroke, and atrial fibrillation treatment history. Results Initially there was 4,639 patients, however only 199 patients met the inclusion criteria. In the study there were 71 female and 128 male patients, regardless it is demonstrated that these issues are more prevalent in the male population. Age wise 69±14.1 were female and 71.2±11.5 were male. However, for our deceased population 28.2% were females and 29% were males. For AFib treatment we see five common treatments Ablation, Cardioversion, Maze, AADs (antiarrhythmic) , and NOACs (anticoagulants) the highest treatment used within the population is NOACs which was being used by 50.8% of the population. We also see three common comorbidities Coronary Artery disease (44.3%), Hypertension (75.4%), and Diabetes (46.2%). the usage of CPAP or BIPAP for OSA. Implications One of the factors that limited other possible outcomes was the lack of diversity, this study consisted mainly of a predominantly white male population. Inclusion of all diverse populations are crucial to better understand how these issues affects humanity as a whole rather than focusing on one specific population. Another contributor was the age limitation requirement of all patients which consisted of 55 years and older, this narrowed the quantity of the study. Throughout patient’s medical history there were some participants who fit almost all of the inclusion criteria requirements except they were underaged therefore, unable to partake in the study. By expanding populations in the study regardless of age, race or gender would allow a positive comprehensive approach to the issue and potentially result in a successful qualitative outcome. Conclusions Older males were almost twice as likely to have a history of atrial fibrillation, stroke, and OSA. However, most patients were less likely to use a CPAP or BiPAP for management of their obstructive sleep apnea. Also half of all patients were on some form of novel oral anticoagulant as part of their AFib treatment. The most prominent cardiac comorbidities were coronary artery disease, diabetes, and hypertension which were all present in nearly half of the sample population. It is also crucial to be aware of the correlation that hypertension, diabetes and coronary artery disease share and by potentially treating one could eventually lead to the impediment of the other from progressing. Citations: 1. Atrial Fibrillation: Risks, Comorbidities, and Differential Diagnoses. (n.d.). Retrieved from https://www.thecardiologyadvisor.com/slideshow/arrhythmia/atrial-fibrillation-risks-comordities -and-differential-diagnoses/ 2. Wang, T. J. (2004, November 24). Obesity and the Risk of New-Onset Atrial Fibrillation. 3. Management of atrial fibrillation in diabetes. (n.d.). Retrieved from https://www.practicaldiabetes.com/article/management-atrial-fibrillation-diabetes/ 4. Gleeson, J. R. (n.d.). Sleep Apnea and Atrial Fibrillation: How They're Connected. 5.Marulanda-Londoño, E., & Chaturvedi, S. (2017, December 11). The Interplay between Obstructive Sleep Apnea and Atrial Fibrillation. USING REAL TIME MAGNETIC RESONANCE TO STUDY VOCAL TREMOR Bryce Larson (Julie Barkmeier-Kraemer PhD, CCC-SLP, Ganesh Adluru, PhD) Division of Otolaryngology Background Vocal tremor is a neurogenic voice disorder characterized by nearly periodic changes of pitch and loudness. To date, vocal tremor has been primarily characterized using acoustic measures of fundamental frequency (fo) and amplitude/sound pressure level (SPL). A listener can hear these acoustic measures as a the fluctuation of pitch and loudness, ultimately leading to a shaky voice.1-4 However, literature describing limb tremor characterizes etiologic differences by measures of rate and extent of tremor movements.5 To date, little is known about the kinematics of speech structure tremor associated with the acoustic patterns of vocal tremor. This research gap is largely due to limitations of current clinical tools for imaging speech structures. Real-time magnetic resonance imaging (rtMRI) offers a method for recording and measuring vocal tract structures during speech.6,7 However, rtMRI spatial and temporal resolution levels for measuring speech structure oscillation rate and extent during voicing is unknown. Spatial resolution refers to the number of pixels utilized in the image while temporal resolution is how often data is collected in the same area. Due to Heisenbergs uncertainty principle, we trade spatial resolution for temporal, making it difficult to maximize both simultaneously. Since there is a trade off between the two we see smaller pixel size leads to a greater spatial resolution. Another factor that effects Spatial resolution is our voxel size. The voxel is both the pixel size and slice thickness measured in mm3. In-plane resolution is the base unit of the voxel, with its pixel sizes being measured in mm. An increased voxel size lowers the overall resolution of the image. Therefore, we wanted to produce the smallest voxel size while maintaining a proper spatial and temporal resolution. The purpose of this study was to determine the feasibility and specifications for using rtMRI to measure rate and extent of speech structure oscillations associated with vocal tremor. Methods Institutional Review Board: This pilot study was completed as part of an approved University of Utah IRB protocol #0094980. Participants: One normal speaker (1 female) and 4 speakers diagnosed with vocal tremor (1 male, 3 female) were recruited and consented to participate. Equipment: A Siemens MAGENTOM Prisma 3 Tesl machine was used to acquire mid-sagittal and axial imaging of participants. Imaging methods varied by in-plane resolution and slice thickness across subjects until measures of tremor oscillation were achieved. Nasoendoscopic recordings using PentaxMedical HD Video Laryngostroboscope (EPK-1000) equipment were reviewed to obtain kinematic estimates of structural rates of oscillation in affected structures under similar phonation conditions to verify dynamic real-time MRI findings. Speech Tasks: All participants completed 1 minute of quiet breathing to obtain referent recordings of non-moving upper airway structures during the mid-sagittal and axial imaging planes of view. Thereafter, all participants completed three trials each of sustained phonation of /a/ and then /i/ for as long as possible at comfortable pitch at comfortable, soft, and loud phonation levels, and then during high pitch and low pitch voicing. All trials of voicing were recorded during imaging in the mid-sagittal plane whereas only trials of sustained phonation of /i/ were recorded during recordings in the axial plane of view. MR data acquisition: Continuous real time MR images were acquired during sustained phonation using a radial GRE pulse sequence with golden ratio. This acquisition scheme enabled retrospective reconstruction of images at a temporal resolution showing all of the oscillatory cycles. Spatial resolution parameters were adjusted across participants until speech structures observed to oscillate during endoscopy showed similar oscillatory cycles on Reconstructed MR images (FIG 1). Image reconstruction: Reconstruction of under-sampled data was done offline using a multi-coil spatiotemporal constrained reconstruction method with total of variation as well as a patched based low rank constraints. FIG 1. Using an anchor point of the vertebrae, we measured the rate and extent of structure oscillations to measure the maximum range (i.e. extent) and rate of the tremor cycle for the soft palate, pharyngeal wall, tongue, and larynx (mid-sagittal plane) and the lengthwise and lateral oscillations of the vocal fold slow-rate oscillations (that is, ~4-8 Hz) in the axial plane. The figure to the left shows the mid-sagittal plane MR image. The figure on the right shows the axial plane MR image. Results/Conclusion Findings showed that rtMRI was a feasible imaging modality for acquiring and measuring vocal tract and laryngeal oscillations during voicing in those with vocal tremor. Optimal temporal resolution was achieved at 30 fps. Image resolution for target measures was achieved with midsagittal in-plane resolution of 1.4 x 1.4 mm2 with a slice thickness of 8 mm and axial in-plane resolution of 1.3 x 1.3 mm2 with a slice thickness of 3 mm (FIG 2). Horizontal vocal fold and laryngeal vertical oscillation during vibrato in a normal subject was successfully measured and found to be comparable to acoustic measures of pitch and loudness. Participants Sagittal resolution Axial resolution 1 In-plane: 1.6x1.6 mm2 Slice thickness: 8 mm In-plane: 1.6x1.6 mm2 Slice thickness: 5 mm Comments No tremor Oscillation observed. Movements were too subtle to detect in the upper airway. 2 In-Plane: 1.6x1.6 mm2 In-plane: 1.6x1.6 mm2 Pitch and loudness Slice thickness: 8 mm Slice thickness: 5 mm tasks used to identify condition of largest tremor movements. Ideal temporal resolution is 30 FPS. 2 2 3-5 In-plane: 1.4x1.4 mm In plane: 1.3x1.3 mm Pitch and loudness Slice thickness: 8 mm Slice thickness: 3 mm tasks used to identify condition of largest tremor movements. Idea temporal resolution is 30 FPS. FIG 2. The optimal temporal resolution needed to capture tremor oscillations is > 30 fps. Inplane resolution is adequate at 1.4 x 1.4 mm2 in the sagittal plane and 1.3 x 1.3 mm2 in the axial plane when speech structure oscillation is clearly visible during nasoendoscopic examination. References 1.Lederle A, Barkmeier-Kraemer J, Finnegan E. Perception of vocal tremor during sustained phonation compared with sentence context. J Voice. 2012;26(5):668 e661-669. 2.Brown JR, Simonson J. Organic voice tremor. A tremor of phonation. Neurology. 1963;13:520-525. 3.Dromey C, Warrick P, Irish J. The influence of pitch and loudness changes on the acoustics of vocal tremor. J Speech Lang Hear Res. 2002;45(5):879-890. 4.Gamboa J, Jimenez-Jimenez FJ, Nieto A, et al. Acoustic voice analysis in patients with essential tremor. J Voice. 1998;12(4):444-452. 5.Louis ED. Diagnosis and Management of Tremor. Continuum (Minneap Minn). 2016;22(4 Movement Disorders):1143-1158. 6.Perry JL, Sutton BP, Kuehn DP, Gamage JK. Using MRI for assessing velopharyngeal structures and function. Cleft Palate Craniofac J. 2014;51(4):476-485. 7.Lingala SG, Zhu Y, Kim YC, Toutios A, Narayanan S, Nayak KS. A fast and flexible MRI system for the study of dynamic vocal tract shaping. Magn Reson Med. 2017;77(1):112-125. University of Utah UNDERGRADUATE RESEARCH JOURNAL ONABOTULINUMTOXINA EFFECTS ON CUTANEOUS ALLODYNIA IN CHRONIC MIGRAINE Sofia Loucao (Faculty Mentor: Melissa Cortez, DO) Department of Neurology University of Utah Autonomic Physiology Laboratory Migraine is one of the most prevalent diseases worldwide, yet it has a high rate of disability. Chronic migraine disorder is a complex, progressive headache disorder affecting approximately 1.3-2% of the general adult population (1). According to The International Classification of Headache Disorders, chronic migraine is defined as greater than or equal to 15 days each month in which a patient has a headache (2). Chronic migraine has a significant impact on quality of life and disability, and is associated with increased depression, anxiety, insomnia and fatigue (1). Various studies have shown that OnabotulinumtoxinA therapy is an effective form of treatment for patients suffering from chronic migraine. Although proven to be a beneficial treatment for chronic migraine, more research is needed on its physiological effects pertaining to chronic migraine disorder, in order to understand the mechanisms of its efficacy. Cutaneous allodynia (CA) is skin pain provoked by non-noxious stimuli. Cutaneous allodynia is a very common symptom of patients suffering from chronic migraine. CA can be assessed by patient questionnaire, and by use of quantitative mechanical sensory testing (e.g. von Frey Hair testing), which is performed by skin contact with varying degrees of pressure in order to assess at which levels pain vs. non-painful touch sensations are felt. Our clinical experience suggests that chronic migraine patients with CA may respond better to OnabotulinumtoxinA therapy than those without CA. We aim to test the effect of 2-3 cycles of OnabotulinumtoxinA on interictal mechanical pain thresholds and allodynia symptom severity in chronic migraine patients. We hypothesize that OnabotulinumtoxinA “responders” will show reduced allodynia symptom severity and increased mechanical pain thresholds (reduced sensitivity to cutaneous mechanical stimulation as pain), compared to baseline pre-OnabotulinumtoxinA therapy assessments. We expect that OnabotulinumtoxinA “non-responders” will not have significant change in allodynia symptoms or pain thresholds. We also expect that “non-responders” may have lower baseline allodynia symptom severity compared to “responders.” References (1) Neurol Sci. 2016 Jun; 37(6):987-9. Fatigue, sleep-wake pattern, depressive and anxiety symptoms and body-mass index: analysis in a sample of episodic and chronic migraine patients. Lucchesi C1, Baldacci F, Cafalli M, Dini E, Giampietri L, Siciliano G, Gori S. (2) Cephalalgia. 2011 Jan;31(1):6-12. doi: 10.1177/0333102410365108. Epub 2010 Apr 7. Episodic and chronic migraineurs are hypersensitive to thermal stimuli between migraine attacks .Schwedt TJ, Krauss MJ, Frey K, Gereau RW. University of Utah UNDERGRADUATE RESEARCH JOURNAL DEVELOPMENT OF A BONE GRAFTING DEVICE FOR PEDIATRIC CRANIOFACIAL DEFECTS Janet Munoz (Sujee Jeyapalina) Department of Orthopaedic and Plastic Surgery With the complications that arise when using rigid metal fixations for treating craniofacial defects, the emergence of bioresorbable fixations have been used commonly to decrease the complications. In addition, rigid metal fixations must be removed from pediatric patients through a second invasive surgery because they have developing skulls that increase the risk of fixation migration. In my work, a bioresorbable fixation device that allows for storage of bone grafts was designed (Fig. 1). The cell adhesion properties of poly-lactic-co-collide (PLG) and hydroxyapatite (HA), two materials commonly used in craniofacial reconstruction, were also experimented. The results of the cell culture experiments helped us determine that PLG was the optimal material to 3D print our bone grafting device we designed using SolidWorks. The dimensions of the 3D printed models were tested via in vitro surgery on a pig skull (Fig. 2). This work ultimately demonstrated the final design for the bone grafting device that we plan to use in a future animal study. The findings in this study brings the research lab a significant step closer towards using the bone grafting device for upcoming animal studies and creating a better treatment option for treating craniofacial defects in pediatric patients. Figure 1: Illustration giving an example of the bone grafting device implanted in a skull. Note that it is porous to allow vasculature access, it has an overhang for screws to attach the device to the skull, and a reservoir for storing osteogenic materials. A B C Figure 2: A) Image showing the 3D printed model made out of PLG. Here it is inserted into a pig skull defect made by a craniofacial surgeon. B) The same implant with bone graft shavings inside the reservoir. C) The same implant with the corresponding lid that was 3D printed and 3 screws to secure it to the skull. University of Utah UNDERGRADUATE RESEARCH JOURNAL ASSESSMENT OF THE NUMBER OF NEURONAL PROGENITOR CELLS IN THE BRAIN OF FORMER PRETERM LAMBS Akbarali Syed Nabi, Kurt Albertine, L. Pettet, A. Rebentisch, Z. Wang, E. Dawson, M. Dahl, B. Yoder, D. Null Department of Pediatrics, Neonatology Division Purpose of study: Although brain injury happens in chronically ventilated preterm infants, pathogenic mechanisms remain to be identified in part because brain tissue is not typically part of clinical material for study. We showed that preterm lambs supported by mechanical ventilation (MV) have more apoptosis, and less proliferation, of neurons and glial subtypes compared to non-invasive support (NIS). These results suggest that cell survival may be decreased in the brain of preterm lambs that are managed by MV. Disruption might lead to shift to more progenitor cells as a compensatory response. Neural stem cells give rise to neuronal progenitor cells, which are identifiable by doublecortin. We hypothesized that decreased neuron survival during MV may increase the number of neuronal progenitor cells in the brain. Methods used: Preterm lambs, treated with antenatal steroids and postnatal surfactant, were managed by MV or non-invasive support for either 3d or 21d (n=4/group). We use non-invasive support (NIS, by high-frequency nasal support) as the positive gold-standard for alveolar formation in the lung. At the end of 3d or 21d of respiratory support, cortical brain tissue from the temporal lobe was fixed. We used immunohistochemistry to localize doublecortin-positive neuronal progenitor cells. We used stereology to quantify numerical density of doublecortinpositive neurons in Layer II, using systematic, uniform, random sampling. Summary of results: We found no difference in numerical density of doublecortin-positive neuronal progenitor cells in cortical Layer II of the temporal lobe at 3d (PT MV 2.4±0.3×105 µm and PT NIS 2.9±0.5×105 µm, respectively) or 21d (PT MV 2.1±0.2 105 µm and PT NIS 2.7±0.5×105 µm, respectively) between the two modes of respiratory support. Conclusions: We conclude that MV of preterm lambs for 3d or 21d does not alter the number of neuronal progenitor cells in layer II of the temporal lobe of the brain. Current analyses are quantifying doublecortin-positive neuronal progenitor cells in white matter and in the periventricular zone. University of Utah UNDERGRADUATE RESEARCH JOURNAL NOVEL SURVEILLANCE OF MIDDLE EAR FLUID IN TRISOMY 21 PATIENTS Amy Nguyen (Albert H. Park, MD) Primary Children’s Division of Otolaryngology Down syndrome or Trisomy-21 is a genetic chromosomal disorder affecting approximately 1/700 to 1/1000 live births [1]. Previous studies demonstrate that there is a high incidence rate of middle ear fluid in Down syndrome children that can lead to adverse effects such as hearing loss. Those with Down syndrome exhibit physical manifestations such as stenotic ear canals which make it difficult to examine these children [2]. Stenotic ear canals occur in up to 50% of newborns with DS, making the diagnosis of otitis media with effusion challenging [3]. To address these challenges, we recommend for this population group to undergo tympanometry testing because it is difficult to examine them due to their developmental delay and narrow ear canals. This study is a retrospective chart review and will look at clinical charts of patients who have undergone tympanometry testing and compare their outcomes to those who have not undergone this testing. Other pertinent information will also be included and considered such as patient demographics and comorbidities (i.e., age, gender). We hypothesize that the time to diagnose middle ear fluid in Down syndrome children who undergo tympanometry is shorter than for those who do not undergo tympanometry. If the approach of this study is demonstrated to be efficient, its conclusions could impact clinical practices and may result in a change in patient care. The results from this study may provide physicians, audiologists, parents and educator’s potential methods to improve evaluation and treatment plans for children with Down syndrome. This work was supported by funding from the Health Sciences LEAP program. Special thanks to the Park lab at Intermountain Primary Children’s Hospital. 1. Jorde LB, Carey JC, Bamshad MJ, White RL, Medical Genetics. Mosby Inc. 2006. 3rd Edition: p2. 2. Park, Albert H., et al. “Identification of Hearing Loss in Pediatric Patients with Down Syndrome.” SAGE Journals 3. Shott SR. Down syndrome: common otolaryngologic manifestations. Am J Med Genet C Semin Med Genet. 2006; 142:131-140. University of Utah UNDERGRADUATE RESEARCH JOURNAL QUANITIFYING AMINOARABINOSE ON BACTERIAL CELL MEMBRANES Ronald Nguyen (Kari Aoyagi, Mark Fisher) Department of Pathology Yersinia pestis is the bacterium responsible for plague, which has decimated human populations throughout history, with the Black Death being the most infamous instance. Plague remains a modern-day concern since hundreds of infections occur every year and, although generally treatable, Y. pestis strains have been identified in Madagascar that are resistant to multiple antibiotics. Additionally, because it causes a highly contagious disease with a high mortality rate if left untreated, Y. pestis has been used as a biological weapon by humans for centuries, and it is currently classified by the CDC as a Tier 1 Select Agent. Yersinia pestis is usually transmitted to humans via flea bite, causing bubonic plague. To undergo transmission to mammals, Y. pestis must first be able to initiate and maintain a successful infection in the flea. It was recently confirmed that Y. pestis modifies lipid A in its outer membrane with aminoarabinose (Ara4N) and that this modification confers resistance to cationic antimicrobial peptides (CAMPs) and allows the bacteria to successfully infect fleas. In the absence of Ara4N, CAMPs can form pores in the outer membrane, leading to cell death. The current method of detecting Ara4N modifications in Y. pestis is by mass spectrometry using isolated lipid A, which requires expensive instruments and has its own constraints regarding quantifiable data. To better investigate the mechanisms of CAMP resistance in Y. pestis, a new method to detect and quantify the amount of Ara4N-modified lipid A is needed. This project used phage display to search for peptide sequences that would specifically bind Ara4N-modified lipid A that could be modified to use as a tool for Ara4N detection and quantification. Phage display uses bacteriophages that display different short peptides on their outer surfaces to study specific interactions with target molecules. This project used two commercial phage display kits (NEB Ph.D. 7-mer and 12-mer libraries) with whole cell Y. pestis strains as targets. Phage libraries were first bound to a mutant Y. pestis strain that cannot synthesize Ara4N to remove general membrane-binding phages. Remaining unbound phages were then used against wild type (WT) cells that do produce Ara4N-modified lipid A. Bound phage were eluted from the WT cells and then amplified via E. coli. This binding and amplification process, called panning, was repeated twice more per library, and then individual phages were tested for their binding abilities against mutant and WT Y. pestis and sequenced. After several rounds of panning with the 7-mer library, it was observed that recovered phages bound to both the mutant and WT Y. pestis cells, indicating the recovered sequences did not bind Ara4N specifically. The 12-mer library has undergone three rounds of panning and assays to determine the binding specificity of the resulting sequences are in process. If peptide sequences that specifically bind Ara4N-modified lipid A are not identified from the 12-mer library, other avenues will be pursued, such as using isolated LPS as the target for phage display or using aptamers in a similar manner. If an Ara4N-binding molecule can be identified via these methods, it would greatly enhance future research on mechanisms of CAMP resistance in Y. pestis. University of Utah UNDERGRADUATE RESEARCH JOURNAL PSYCHOLGOICAL HEALTH AMONG BARIATRIC SURGERY PATIENTS Melinda Salisbury (Larissa A McGarrity, PhD) Division of Physical Medicine and Rehabilitation Background 40% of Americans have obesity, which places them at risk for morbidity and mortality. The most effective intervention for morbid obesity is bariatric surgery. Before a patient undergoes bariatric surgery, they receive a psychological evaluation to predict risk factors and potential challenges after surgery. However, existing research has focused primarily on weight outcomes and little is known about patients’ psychological health post-surgery. The purpose of this study is to characterize psychological health in patients with obesity before and after undergoing bariatric surgery, and to define trajectories of psychological symptoms over time. Methods Participants in the follow-up study will be patients who completed a preoperative psychological assessment in conjunction with either Roux-en-Y gastric bypass or sleeve gastrectomy surgery at the University of Utah 1.5-3 years ago (and for whom we have data from pre-surgery psychological assessment). Those who choose to participate will be asked to complete a followup survey that evaluates their psychological health post-surgery. Measures will include depression, anxiety, eating disorders, and the impact of weight on quality of life. Analyses will evaluate changes in psychological health before and after bariatric surgery. Results Pre-surgery data includes 929 participants who presented for initial psychological evaluation. Average BMI in the sample falls into the class IV category for morbid obesity. Mean score of 15.3 on the Binge Eating Scale in this sample falls just below the traditionally accepted threshold of 17 concerning for problematic binge eating behaviors. Pre-operative analysis found that average scores for depression and anxiety in this sample fall into the mild range. 10% of patients reported a history of psychiatric hospitalization. There are no results for the postsurgery aims of the research at this time because recruitment is in process. Discussion Using a subset of measures from the pre-surgical evaluation, psychological health in patients post-surgically will be evaluated by an online questionnaire. Surveying patients who underwent surgery between 1.5-3 years ago will demonstrate how quality of life and psychological health is affected over time. This research can improve pre-bariatric psychological assessments by allowing for improved prediction of psychological health in this vulnerable patient population. University of Utah UNDERGRADUATE RESEARCH JOURNAL EVALUATING THE ROLE OF AUTONOMIC DYSFUNCTION IN MULTIPLESCLEROSIS RELATED FATIGUE Harini Srinivasan (Cortez, Melissa D.O.) Department of Neurology Division of Diagnostic and Clinical Neurology Background Autonomic dysfunction presents itself in a multitude of symptoms including nausea, bloating, and abdominal pain that are prevalent in patients diagnosed with multiple sclerosis and has previously been found in 45% to 80% of the MS-population (Racosta et al, 2015 p. 1). Numerous studies have determined the applicability of evaluating for autonomic dysfunction in individuals exhibiting multiple-sclerosis (MS) which includes quantitative measurements suggesting the interaction between autonomic dysfunction and MS duration and evolution. Autonomic dysfunction—specifically cardiovagal, sudomotor, and adrenergic dysfunction—has been well established in prior MS-populations, which contributes to the heterogenous, multifocal nature of this specific disease burden. One of the main clinical symptoms that is anchored to cardiovascular autonomic dysfunction is fatigue (Pinter et al, 2015). Fatigue is a prevailing symptom that many MS patients experience which can manifest both mentally and physically and has the ability to influence daily function in these individuals. These manifestations can be evaluated both subjectively and objectively. The potential contributing neuroanatomical structures that contribute to MS-related fatigue include the vagus nerve and interoceptive brain portions, which are also considered to be central parts of the autonomic nervous system (Sander et al, 2017) . Further evaluation and understanding of present autonomic dysfunction in MS patients as well as the role between dysfunction and fatigue could provide valuable insight into the overlapping symptomatic burden experienced by these individuals. This understanding could have lasting effects clinically and could elucidate a more comprehensive treatment plan that emphasizes this cross-correlation. Method and Objective Our group has previously established a link between MS-related fatigue and patientreported autonomic symptom burden in MS patients (Cortez et al, Mult Scler Relat Disord (2015) 4:258-63). One of the main objectives of this study is to confirm the severity of fatigue by the means of a short standardized and validated questionnaire, combined with evaluation of autonomic symptoms and physiological function in MS patients. For this, we plan to test autonomic function through a standardized battery of autonomic reflex testing, and co-administer the Composite Autonomic Symptom Score 31 (COMPASS 31) with the Fatigue Severity Scale (FSS). Lastly we will used this data to determine whether there is a correlation between autonomic function and fatigue scores, allowing us to test the hypothesis as to whether autonomic dysfunction in a contributor to MS-related fatigue. University of Utah UNDERGRADUATE RESEARCH JOURNAL BEAT-TO-BEAT BLOOD PRESSURE ACCURATELY PREDICTS SUBSEQUENT ARM CUFF BLOOD PRESSURE VARIABILITY AFTER ACUTE ISCHEMIC STROKE Fa Tuuhetaufa (Adam de Havenon, MD; Ka-Ho Wong, BS) Stroke Center Department Background: - Higher blood pressure variability (BPV) is associated with worse outcome after ischemic stroke - Accurate quantification of blood pressure variability requires frequent measurements, which is not practical with conventional arm cuff sphygmomanometry. - Finger photo-plethysmography (Figure 1) allows accurate beat-to-beat measurement of blood pressure. o Figure 1: Finger photo-plethysmography unit on patient. The study protocol specified that all patients be supine, with no arm movement or talking during the 15 minute period of monitoring. LabChart Pro software was used to extract blood pressure readings and exclude data with movement artifact. o Hypothesis: - 15 minutes of beat-to-beat BPV (bBPV) will accurately predict arm cuff BPV (aBPV) for acute ischemic stroke patients' entire hospitalization. Methods: - We prospectively enrolled 32 patients hospitalized for acute ischemic stroke. - BPV was measured using systolic and diastolic blood pressure to calculate standard deviation (SD), coefficient of variation (CV), absolute real variability (ARV), successive variation (SV), and residual standard deviation (rSD). - bBPV = 15 minutes of photo-plethysmography. - aBPV = arm cuff blood pressure during hospitalization. - We measured bBPV with an ADInstruments NIBP System for 15 minutes, ~2 measurement/second, with three 5 minute epochs per patient. - To examine if bBPV could predict subsequent aBPV in the patients hospitalized for stroke, we restricted the analysis to stroke patients with bBPV measured within 48 hours of stroke onset and at least 20 subsequent arm cuff blood pressure readings. We report Pearson’s correlation coefficient for five different statistical estimations of variability. Results: - Mean±SD Age of 60.1±13.9 years, and 19/30 of enrolled patients were male. - Average NIHSS in the study was 5.1. - Mean±SD discharged mRS was 2.2±1.3 - The mean±SD time from stroke onset to bBPV measurement was 2.2±1.5 days. - There was a mean±SD of 1830±54 photo-plethysmography readings for bBPV per participant. - For the comparison between bBPV and subsequent aBPV, 30 patients met criteria with a mean of 62 arm cuff readings. - For systolic blood pressure, the correlation between aBPV and bBPV was moderate to excellent (Table 1 and Figure 2). - For diastolic blood pressure, the correlation between aBPV and bBPV was only poor to moderate (Table 1 and Figure 2). o Table 1. Pearson’s correlation coefficient between arm cuff and finger photoplethysmography BPV, showing superior agreement for systolic BPV. Blood Pressure Variable Pearson’s Correlation Coefficient - Systolic Mean Systolic Standard Deviation Systolic Coefficient of Variation Systolic Absolute Real Variability Systolic Successive Variation Systolic Residual Standard Variation 0.687 0.762 0.543 0.830 0.723 0.604 Diastolic Mean Diastolic Standard Deviation Diastolic Coefficient of Variation Diastolic Absolute Real Variability Diastolic Successive Variation Diastolic Residual Standard Variation 0.599 0.517 0.298 0.410 0.458 0.448 Conclusions: - This pilot study demonstrates the feasibility of predicting longer-term BPV with 15 minutes of finger photo-plethysmography in the first two days after acute ischemic stroke onset. - As opposed to deriving BPV from arm cuff measurements, which takes days, our approach allows early and rapid identification of patients who will subsequently have high BPV and may benefit from therapeutic intervention. References: 1 Manning LS, Rothwell PM, Potter JF, et al. Prognostic Significance of Short-Term Blood Pressure Variability in Acute Stroke Systematic Review. Stroke 2015;46:2482–90. University of Utah UNDERGRADUATE RESEARCH JOURNAL OPTIMIZATION OF NFATc1 IMMUNOSTAINING IN ZEBRAFISH HEARTS Alexandra Kandas Yengich (Natalia Torres, Martin Tristani –Firouzi) University of Utah Leap Health Science Program Nora Eccles Harrison Cardiovascular Research & Training Institute (CVRTI) Atrial Fibrillation is the most common type of cardiac arrhythmia and is usually presented as a progressive disease in the elderly (> 65 yrs.). It is characterized as a very fast atrial rate causing an increased risk of stroke, complications, and mortality. We have identified a family with youngonset of atrial fibrillation where the phenotype segregates with a missense mutation on the cardiac transcription factor NFATc1. While this gene has been proven to be essential for cardiac development its role in AF has not been determined. To study this mechanism we used CRISPR/Cas9 genomic editing to introduce a 31bp deletion in exon 2 of nfatc1 gene in zebrafish. This deletion is predicted to cause a premature stop codon and loss of NFATc1 function. The purpose of the present study is to confirm the NFATc1 deletion at the protein level in a nfatc1 -/zebrafish model that we developed. We explanted hearts from wild type (WT) and nfatc1 -/- adult zebrafish, fixed them and sectioned them using a vibratome (Leica VT1200S). To optimize our immunostaining protocol we tested different section thickness, blocking solution composition, mounting agent, and concentration/incubation of the primary and secondary antibodies. We used two antibodies against NFATc1 (TA345589, OriGene or AAS10311C, Antibody Verify), a cTnT antibody (RVC2, DSHB) and DAPI to mark the nucleus. We scanned the slices with a confocal microscope (Leica SPE) and processed the images with ImageJ software. Using our optimized protocol, we found a positive NFATc1 staining on the hearts from the WT zebrafish. In contrast, we did not find any signal in the NFATc1 channel when scanning the hearts from the nfatc1-/- adult zebrafish. This confirms that our nfatc1-/- zebrafish do not express NFATc1 protein. This is in agreement with the reduced levels of NFATc1 mRNA that we found previously. Future experiments include immunostainings of other proteins of interest (ion channels) as well as structures present in the heart (fibroblast, collagen). University of Utah UNDERGRADUATE RESEARCH JOURNAL DUAL SUPPRESSION OF GROWTH FACTORS IN THE TREATMENT OF AGERELATED MACULAR DEGENERATION Mingyang Zhang; Daniel Fang (Balamurali Ambati, Lara Carroll) Department of Ophthalmology & Visual Sciences Age-related macular degeneration (AMD) affects more than two million Americans every year. AMD is caused by growth factors, leading to angiogenesis in the retina, destroying the membrane and causing blindness. Current treatment methods involve inhibiting those growth factors, but they do not have long term viability. To improve this, we hypothesized that suppressing the two separate growth factors in eye, Vascular Endothelial Growth Factor (VEGF) and Platelet Derived Growth Factor (PDGF) would increase the decreased size of induced lesions in a mouse model. First, we injected mice adeno-associated virus (AAV) and a plasmid gene for each of the inhibitors. Next, laser lesions were induced on the mice eye before final volume images were calculated. We found that dual suppression of VEGF and PDGF was not associated with a significant decrease in lesion volume (p>0.05) in both timepoint trials (1 month and 4 month). We concluded that a) dual suppression with genes localized on the same virus is not viable compared to current treatment methods, b) all treatment methods, including dual suppression group, exhibited decreased activation in the later time point group, and c) subretinal injections and using AAVs as a transport vector are a viable option for treatment of AMD (p<0.05 for positive controls compared to negative controls). Over all, these findings suggest that despite our dual suppression method not returning the desired results, a clear direction has been established in the future treatment for patients with AMD. Figure 1. 1 Month Lesion group, group 6 (experimental) was not statistically significant to either of the positive controls (Flt23k and PDGFRB) Figure 2. 4 Month Lesion group, the experimental group 6 did not have significant smaller volumes than the positive controls. P values: *p<0.05; ** p<0.01; **** p<0.0001 College of Mines & Earth Sciences University of Utah UNDERGRADUATE RESEARCH JOURNAL SEISMIC MONITORING OF MASS WASTING EVENTS FOLLOWING THE 2017 BRIAN HEAD WILDFIRE IN SOUTHERN UTAH Nicholas Forbes (Keith D. Koper, Relu Burlacu, and Paul Jewell) Department of Geology and Geophysics During the 2017 Brian Head wildfire in southern Utah, over 63,000 acres of steep terrain was burned, leaving hydrophobic soil and an increased probability of mass wasting, especially during the annual monsoon season of July through September. Following the fire, we began a two-year experiment with the goal of capturing the seismic signature of debris flows and related events. Between 12 August 2017 and 7 October 2017, we deployed ten 3component, short-period (Sercel L-28) seismometers in a quasi-linear array about 10 km long. The instruments were provided by IRIS/PASSCAL (with the network code ZV) and recorded continuous ground motion at 250 Hz. We applied frequency-dependent polarization analysis to the continuous data and observed a strong diurnal pattern across a wide frequency range as well as some weather-related transient signals, possibly related to thunder; however, we did not record any signals unambiguously related to mass wasting. We returned to the Brian Head region the following year and between 31 July 2018 and 7 October 2018 we deployed 28, 5Hz, 3-component Nodal instruments recording continuous ground motion at 500 Hz. We installed a linear, 20-node array with ~275 m spacing along a creek that flowed consistently throughout the experiment and at increased rates during and after rainfall. The remaining eight Nodals followed separate drainages towards a NW-SE running ridge at a gradient of ~30 degrees. Three trail-cameras were also deployed in hopes of having time-stamped evidence of any mass wasting events. We processed the 2018 seismic data with frequency-dependent polarization code and correlated the output with meteorological data from a nearby NOAA station. We tentatively identified ~12 signals related to mass wasting events and are currently characterizing their duration and intensity. University of Utah UNDERGRADUATE RESEARCH JOURNAL INVESTIGATING MELT-ROCK INTERACTIONS IN GABBROIC ROCKS FROM THE ATLANTIS MASSIF: IMPLICATIONS FOR OCEANIC CRUSTAL ACCRETION William Haddick, Sarah Lambart Department of Geology and Geophysics Background Igneous petrologists have been using mid-ocean ridge basalts (MORB) and plutonic rocks at spreading ocean ridges as a tool to gain a better understanding of the upper mantle and crustal processes for the past forty years. Early assumptions to explain melt evolution in oceanic crustal magma chambers relied mostly on fractional crystallization. However, fractional crystallization cannot account for these processes alone as MORB is likely to undergo many other modifications prior to eruption, such as magma-mixing or melt-rock reaction. This is evident in the complex nature of MORB’s where major, minor and trace element chemical disequilibrium prevent petrologists from establishing fractional crystallization as the primary melt migration mechanism. ​Minor element investigations on gabbroic rocks located at the Hess Deep rift valley​(1) ​support this assumption, where Cr​2​O​3​ contents in clinopyroxenes reach 1.11% within primitive MORB at the Hess Deep, inconsistent with ~0.5% Cr​2​O​3​ predicted for melts produced by fractional crystallization​(1)​. ​Hence, melt-rock interactions should exert a significant role during oceanic crustal accretion and it has been suggested that reactive porous flow (RPF) could provide a better explanation for melt evolution at fast-spreading ridges​(2)​. RPF suggests that migrating oceanic melts react as they travel upwards through a crystalline mush containing a small percentage of melt (Fig. 1). Figure 1.​ ​Conceptual models for melt circulation at (a) a fast spreading ridge​(1)​ and (b) a slow-spreading ridge(5) ​ ​. In fast spreading ridges, a large mush zone exists where intensive magma-rock reaction could occur. At slow spreading ridges, the mush zone could be significantly smaller and individual pools of melt could crystallize forming small gabbroic intrusions and potentially limiting melt rock reactions. The Atlantis Massif provides a unique opportunity to determine if RPF can occur during crustal accretion at a slow-spreading ridge. The massif is a large undersea dome formed 1.5 to 2 million years ago from low angle detachment faulting along a transform boundary, located at the Mid-Atlantic Ridge​(3)​. The eastern portion of the massif contains volcanics within the hanging wall, while the central and southern portions contain intrusives characteristic of an ultramafic oceanic core complex in the footwall​(3)​. In 2004 and 2005, the Integrated Ocean Drilling Program (IODP) carried out expeditions 304 and 305 to extract core samples from the Atlantis Massif within the footwall​(3)​. ​The main hole, Hole U1309D, penetrated 1415.5 mbsf (meters below sea floor) and recovery averaged 75%​(3)​. Over 96% of Hole U1309D is made up of gabbroic rock types (Fig. 2), which consist of the most primitive and freshest plutonic rocks recovered from the ocean floor​(5)​.​ In an attempt to characterize the intra-sample chemical disequilibrium, major element profiles were constructed on adjacent clinopyroxene and plagioclase grains within these gabbroic rocks using electron microprobe analysis (EMPA). These results will then be combined with data recovered from trace element analysis via Laser Ablation-Inductively Coupled Plasma-Mass Spectrometry (LA-ICP-MS), and utilized in a Magnesium-Rare Earth Element (Mg-REE) geospeedometer​(4)​ to construct a thermal history for the Atlantis Massif. Method Petrographic analysis Out of the thirty total samples, nine were selected for EMPA and LA-ICP-MS analysis from petrographic observations summarized in Table 1. Selection criteria were: medium to large grain size (>5mm), low degree of alteration, and evidence for intra sample or intra crystal chemical zoning. An Olympus BHA cross polarized microscope was used to locate adjacent grains of clinopyroxene and plagioclase. Table 1.​ ​Petrographic observations made with an Olympus BHA cross polarized microscope Sample Grain Size Degree of Alteration Chemical zoning 73R2 124-129 Large Moderate N/A* 90R3 22-26 Large Moderate Mg-Ti core to rim zoning in cpx 174R1 86-89 Large Low Fe zoning east to west in cpx 214R1 128-133 Small Moderate N/A 250R1 83-87 Large Low N/A 250R2 60-66 Large Moderate-High N/A 262R2 35-39 Large Moderate Cr-Ti core to rim zoning in olv 268R3 6-12 (large) Large Low N/A 268R3 6-12 (small) Medium High N/A *N/A is noted for samples who either had faulty elemental maps or did not have elemental maps Microprobe analyses Major element analyses took place where linear profiles were set across adjacent grains of clinopyroxene and plagioclase in the nine samples selected during petrographic analysis to determine major element weight percents using EMPA. Samples were carbon coated (∼20 nm thick). ​Profiles across adjacent clinopyroxene and plagioclase grains were characterized using a Cameca SX100 electron microprobe (Fig 2). Figure 2.​ Backscatter electron (BSE) image of a major element profile ran across clinopyroxene (CPX) and plagioclase (PLG) grains in sample 73R2 124-129 using a Cameca SX100 electron microprobe. In situ analyses were performed using a 15 keV accelerating voltage, and 10 µm diameter spot size with the following mineral and oxide standards: diopside (Ca, Mg, Si), sanidine (Al, K), San Carlos olivine (Mg, Fe), rhodonite (Mn), rutile (Ti), chromite (Cr), apatite (P), and celestite (S). Counting times were 10s on peak for Na, 25s on peak for Si, Al, Mn, Fe, K, Ca, and Mg, and 40s on peak for Ti, Cr, P, and S. Half of the peak time were used on high and low backgrounds. ​Each profile was approximately 1500-2000 µm in length (one profile was set at 7800 µm) with a ~100 µm step. ​San Carlos olivine​ was analyzed as a secondary standard before and after each profile to help remove inter-session variability. Results Despite multiple calibrations, the oxide totals in major element analyses were high (on average 101.95% +/- 3.17% for clinopyroxene, and 101.48% +/- 3.35% for plagioclase). Consequently, analyses with totals lower than 98% and higher than 105% were rejected. Analyses showing obvious signs of contamination (e.g. MgO > 1 wt % in plagioclase) were also rejected. Data reported in Table 2 are analyses collected for each profile that passed through these filters. Table 2. ​Average totals for anorthite content in plagioclase (column 3) Mg # in clinopyroxene (column 4) and Cr​2​O3​ ​/TiO​2​ ratio in clinopyroxene (column 5) for profiles that underwent major element analysis via a Cameca SX100 electron microprobe Sample ID Profile ID An (%) Mg # Cr​2​O​3​/TiO​2 73R2 124-129 P2C-1 71.99 80.15 0.77 C2P-2 81.68 81.36 0.88 P2C-1 76.19 82.73 1.00 P2C-2 69.96 83.98 0.47 C2P-3 74.57 82.10 0.86 P2C-1 60.56 77.37 0.64 P2C-2 60.41 80.07 0.76 P2C2P-1 70.71 84.67 0.57 P2C-2 69.43 86.04 0.50 C2P-1 74.86 80.09 0.56 P2C-2 73.25 84.06 2.16 C2P-1 72.55 82.39 2.09 P2C-2 72.84 80.49 2.63 C2P-1 64.30 77.39 0.22 P2C2P-2 70.62 80.97 2.07 P2C2P-1 67.31 74.97 0.15 P2C-2 60.51 80.95 0.12 P2C2P-3 69.99 84.94 0.44 P2C2P-4 67.79 84.31 0.49 C2P-5 72.09 86.42 1.85 90R3 22-26 174R1 86-89 214R1 128-133 250R1 83-87 242R2 35-39 268R3 6-12 (large) 268R3 6-12 (small) Figure 3a presents the log of the U1309D with the locations of the nine selected samples indicated with colored circles. For each sample, Figure 3b-d present the range of Anorthite (An) content in plagioclase and Mg# and Cr​2​O​3​/TiO​2​ ratio in clinopyroxene for each profile. Figure 3. Depth log for samples recovered at hole U1309D showing (a) lithologies, (b) anorthite % in plagioclase, (c) Mg # in clinopyroxene, (d) Cr2​ O ​ ​3​/TiO​2 ​ratio in clinopyroxene. In Figure 4, four profiles were selected which plot the chemical variation (An in plagioclase, Mg# and Cr​2​O​3​/TiO​2​ ratio in clinopyroxene) from core to core. Figure 4.​ Major element profiles showing anorthite percentage in plagioclase (An %), Mg # in clinopyroxene, and Cr​2​O3​ /TiO ​ 2​ ​ ratio in clinopyroxene. Discussion High oxide totals present during major element analysis introduce some degree of error in representing anorthite percentage, Mg #, and Cr​2​O​3​/TiO​2​ totals within these samples. However, even with this marginal degree of error, chemical disequilibrium is still observed between adjacent plagioclase and clinopyroxene grains within samples recovered at the Atlantis Massif. This chemical disequilibrium is observed at the core log, profile, and mineral grain scales. At the core log scale, there appears to be no systematic trends with depth for anorthite percentage, Mg #, and Cr​2​O​3​/TiO​2​ totals across all nine samples that were analyzed, as depicted in Figure 3. This indicates that fractional crystallization is not present as the main melt migration mechanism for this massif, since fractional crystallization predicts a linear trend of primitive (larger) values near the surface with more differentiated (lower) values as depth increases. Figure 4 depicts chemical variability at the profile scale across adjacent plagioclase and clinopyroxene grains. An example of this is the systematic increase in anorthite percentage in plagioclase in comparison to the flat consistent Mg # observed in clinopyroxene for profile 73R2 124-129. Another example is seen between the two profiles in sample 268R3 6-12 (large), where Cr​2​O​3​/TiO​2 ratios in profile C2P-1 average out at 0.22 while reaching up to an average of 2.07 in ​ profile P2C2P-2. This is an interesting result considering these two profiles in sample 268R3 6-12 (large) are separated by approximately 3 centimeters. Examples of chemical disequilibrium at the mineral scale are also observed in Figure 4, where Mg # and Cr​2​O​3​/TiO​2 ​ decoupling in clinopyroxene occurs in all four profiles. Along with this, a high degree of anorthite percentage in plagioclase is observed for profile 268R3 6-12 (large), in comparison to the lower and consistent anorthite percentages in profile 174 86-89 P2C-1. Conclusions MORB’s and plutonic rocks recovered at spreading ocean ridges provide a unique challenge in understanding melt migration mechanisms for these magma chambers. Chemical disequilibrium prevalent within mineral grains at these locations prevent petrologists from describing thermal histories exclusively through fractional crystallization. Major element analysis that took place between adjacent plagioclase and clinopyroxene grains within gabbroic rocks recovered at the Atlantis Massif quantifies and confirms this chemical disequilibrium taking place at the core log, profile, and mineral grain scales. Plausible explanations for this chemical variability include melt-rock interactions, magma mixing, and multiple melt injection sites during development of these magma chambers. The next step in compiling a thermal history for the Atlantis Massif is acquisition of trace element data, through LA-ICP-MS analysis. This trace element data will then be combined with major element data acquired through EMPA and utilized in a Mg-REE coupled geospeedometer to estimate crystallization temperatures, which will then be compared to previous studies conducted on the East Pacific Rise, a fast spreading ocean ridge. References (1) Lissenberg, C Johan, et al. “Pervasive Reactive Melt Migration through Fast-Spreading Lower Oceanic Crust (Hess Deep, Equatorial Pacific Ocean).” ​Earth and Planetary Science Letters 361,​ 2012, pp. 436–477. (2) Lissenberg, C Johan, and Christopher J MacLeod. “A Reactive Porous Flow Control on Mid-Ocean Ridge Magmatic Evolution.” ​Journal of Petrology,​ vol. 57, no. 11 & 12, 2016, pp. 2195–2220. (3) Miller, Dee J, et al. “Oceanic Core Complex Formation, Atlantis Massif, Mid-Atlantic Ridge: Drilling into the Footwall and Hanging Wall of a Tectonic Exposure of Deep, Young Oceanic Lithosphere to Study Deformation, Alteration, and Melt Generation.” Proceedings of the Integrated Ocean Drilling Program,​ 304/305, 2004. (4) Sun, C., and C. J. Lissenberg, “Formation of Fast-Spreading Lower Oceanic Crust as Revealed by a New Mg–REE Coupled Geospeedometer.” ​Earth and Planetary Science Letters 487​, 2018, 165–178 (2017) (5) Blackman, D. K. et al. Drilling constraints on lithospheric accretion and evolution at Atlantis Massif, Mid-Atlantic Ridge 30°N. J. Geophys. Res. 116, B07103 (2011). University of Utah UNDERGRADUATE RESEARCH JOURNAL CREATING A METHOD USING LANDSAT 8 IMAGERY AND ENVI TO MEASURE NDVI AND CALCULATE AMOUNT OF DISCHARGE FROM BLUE LAKE, UTAH Emily Kam (Dr. Brenda Bowen, Jory Lerback, PhD candidate, Mark Radwin, undergraduate) Department of Geology and Geophysics Flow meters and other traditional techniques used to measure diffuse discharge at large springs is difficult due to variable field conditions, cost and past data availability. Landsat imagery can provide a highly reproducible, cost effective alternative that stretches back 35 years. We used Landsat imagery in combination with the image analysis program, ENVI, to calculate the amount of discharge from Blue Lake, an aridland spring in Utah’s West Desert from June 2014 to July 2018. Past measures of discharge from Blue Lake were larger than the proposed amount of recharge into the lake which we believed did not accurately represent the water budget of this area. We hoped that the method created would solve this problem. Landsat Level 2 images were processed using a modified framework taken from papers by Rachael F. Thomas et al. In this paper, the authors used ENVI, the normalized difference vegetation index (NDVI) and the normalized difference water index (NDWI) to classify three types of pixels: water, mixed and vegetation in Landsat 5 and 7 images. NDVI gives the number of pixels that the program identifies as vegetation using a ratio of two equations using spectral reflectance data from Landsat. The ratio of equations yields a range from -1 to 1, where areas with large amounts of greenery have values from about .3 to 1 (according to NASA). Pixels have a specific area depending on which type of Landsat data is being analyzed. In this case with Landsat 8, one pixel is 30 meters by 30 meters. We chose a threshold of vegetation verses non-vegetation spectra using field observations of average vegetation extent and used these values in a United States Geologic Survey eddy covariance evapotranspiration. This equation uses established evapotranspiration rates of vegetation types in western Utah and Nevada to derive an equation that calculates spring discharge based on vegetation area. It was found that our calculated amount of discharge was about 50-64% of the proposed amount of recharge. This is a much more accurate picture of the water budget for Blue Lake and its surrounding wetlands. Therefore, we conclude that this method could be used in place of flow meters. With populations growing and water becoming scarcer, having methods in place to more conveniently and accurately measure water resources is vital. Blue Lake, Utah University of Utah UNDERGRADUATE RESEARCH JOURNAL Land Erosion and Coastal Sedimentation in the Sub-Tropics During Rapid Planetary Warming: Environmental Magnetism of the Zumaia, Spain Paleocene-Eocene Thermal Maximum Record James Kowalski Department of Geology & Geophysics Faculty Supervisor: Peter C. Lippert, Assistant Professor Abstract Climate events in the geological record, like the Paleocene-Eocene Thermal Maximum (PETM), are widely studied because they provide important analogues to the current climate system on Earth (e.g. Burke et al., 2018). The PETM is a ~200 ka-long global ~4-5 per mil negative carbon isotope excursion that occurred ~56 Ma; during the PETM, temperatures rose ~5-8°C globally and ~3-4°C in within the sea surface (McInerney and Wing, 2011). Although the magnitude of the PETM is most analogous to present-day warming, the duration of warming and environmental change took place over a much longer time scale compared to warming in the Anthropocene. In addition to warming, the PETM coincides with the largest benthic foraminiferal extinction in the past 60 Ma (removing 30-50% of benthic foraminiferal diversity), the first appearances of many North American terrestrial mammalian taxa, and a change in terrestrial plant communities (McInerney & Wing, 2011). At Zumaia, Spain, a subtropical marine environment close to the western Catabrian-Iberian coast during Paleocene and Eocene time, sedimentological and isotopic observations suggest a dramatic change in the amount and style of physical and chemical weathering at the onset of the PETM. Based on experiments made in other settings and time periods, magnetic properties may also record clues about precipitation and extreme weather events (Maxbauer et al., 2016), but this approach has not been applied to the Zumaia record. Here we present analyses of the magnetic mineral properties, including magnetic grain size, shape, and composition, in sediment samples to describe the iron delivery, (re)mineralization, and preservation that occurred at Zumaia while submerged in a marine depositional environment. Our magnetic measurements— which include magnetic susceptibility vs. temperature curves, hysteresis loops, remanent backfield curves, and FORC diagrams— all suggested the presence of a mixture of magnetite and hematite in the samples. Stratigraphic plots of the magnetic data show an increase in magnetic concentration (Ms), magnetic hardness (Bcr), and hematite concentration (S300) at the beginning and throughout the PETM. A fluvial detrital proxy (Rb/Al) decreases during the carbon isotope excursion, so we tentatively interpret the increase in hematite to suggest that the mineral was not weathered on land and transported to the site, but rather produced in situ. We hypothesize that the environmental magnetism of the PETM record at Zumaia appears to be more sensitive to local redox and bottom water conditions than to surface runoff and hydrologic change on the Iberian-Catabrian coast. With future work, we will test this interpretation by comparing our magnetic record to benthic foraminifera assemblages preserved in the Zumaia section (Alegret et al., 2018). Our magnetic approach also allows us to test the degree to which mineral magnetism in this record is consistent with previous sedimentological and geochemical studies (Schmitz & Pujalte, 2003; Schmitz & Pujalte, 2007; Alegret et al., 2018). High-stratigraphic-resolution magnetic methods may provide an economical baseline from which to select and complement more expensive and time-consuming geochemical studies. REFERENCES Alegret, L., Reolid, M., Vega Pérez, M., 2018. Environmental instability during the latest Paleocene at Zumaia (Basque-Cantabric Basin): The bellwether of the Paleocene-Eocene Thermal Maximum. Palaeogeography, Palaeoclimatology, Palaeoecology 497, 186-200, doi:10.1016/j.palaeo.2018.02.018. Burke, K.D., Williams, J.W., Chandler, M.A., Haywood, A.M., Lunt, D.J., Otto-Bliesner, B.L., 2018. Pliocene and Eocene provide best analogs for near-future climates. Proceedings of the National Academy of Sciences 115, 13288-13293, doi:10.1073/pnas.1809600115. Maxbauer, D.P., Feinberg, J.M., Fox, D.L., 2016. Magnetic mineral assemblages in soils and paleosols as the basis for paleoprecipitation proxies: A review of magnetic methods and challenges. Earth Science Reviews, Vol. 155, 28-48, doi:10.1016/j.earscirev.2016.01.014. McInerney, F.A., Wing, S.L., 2011. The Paleocene-Eocene Thermal Maximum: A Perturbation of Carbon Cycle, Climate, and Biosphere with Implications for the Future. Annual Review of Earth and Planetary Sciences, Vol. 39, 489-516, doi:10.1146/annurev-earth040610-133431. Schmitz, B., Pujalte, V., 2003. Sea-level, humidity, and land-erosion records across the initial Eocene thermal maximum from a continental-marine transect in northern Spain. Geology 31, 689-692. Schmitz, B., Pujalte, V., 2007. Abrupt increase in seasonal extreme precipitation at the Paleocene-Eocene boundary. Geology 35, 215-218, doi:10.1130/G23261A.1.     University of Utah UNDERGRADUATE RESEARCH JOURNAL Environmental Conflict and Water Quality in Nambija, Ecuador Kate Nicponski Faculty Mentor: Bill Johnson Department of Geology and Geophysics 12.14.2018                           1.  Abstract     In  July  2018,  a  group  of  students  from  the  University  of  Utah  traveled  to  Ecuador  as  part   of  a  learning  abroad  program  to  research  water  quality  and  associated  environmental   impacts  of  mining  in  the  country.  The  Nambija  River  in  southeast  Ecuador  is  a   characteristic  example  of  mining  operations  and  visual  effects  of  resulting   contamination  on  the  surrounding  environment.  Water  samples  were  collected  along   the  Nambija  River  to  teach  students  how  to  gather,  analyze  and  interpret  data.  The   purpose  of  this  report  is  to  characterize  the  geochemical  qualities  of  the  Nambija  River   and  quantify  local  mercury  and  trace  metal  contamination  due  to  artisanal  gold  mining   in  the  Nambija  Mineral  District.     2.  Introduction   Artisanal  mining  is  an  important  source  of  livelihood  for  rural  communities  worldwide,   especially  in  developing  countries.  In  Ecuador,  Artisanal  and  Small-­‐scale  gold  mining  is   one  of  the  oldest  and  most  traditional  forms  of  mineral  extraction  (Sánchez-­‐Vázquez  et   al.  2016).  According  to  a  United  Nations  case  study  in  2012,  Ecuador  has  over  1,349   artisanal  operations  of  which  1,069  are  gold  operations.  In  2002,  artisanal  and  small-­‐ scale  gold  mining  generated  65%  of  the  direct  employment  within  the  broader  artisanal   mining  sector  in  Ecuador  (60,000  of  92,000  jobs)  and  by  2005,  small  scale  mining  was   responsible  for  75%  of  the  5  tons  of  national  gold  production  (Spiegel,  2012).     The  Zamora-­‐Chinchipe  Province,  located  in  in  the  Paquisha  canton  in  the  south  east  of   Ecuador  is  one  of  the  most  economically  highly  valued  areas  for  artisanal  gold  mining  in   the  Country  (Sánchez-­‐Vázquez  et  al,  2016).  Mining  activities  in  the  Zamora-­‐Chinchipe   area  extend  as  far  back  as  colonial  and  pre-­‐colonial  times.  However,  it  was  not  until  the   1980’s  that  there  was  extensive  growth  in  artisanal  mining  to  the  Nambija  Mineral   District  (Ramírez  et  al,  2003).  As  shown  in  Figure  1,  the  Nambija  Mineral  District  is   located  east  of  Zamora  in  the  Ecuadorian  Amazon.   Like  most  active  artisanal  mines  in  Ecuador,  mining  operations  in  the  Nambija  Mineral   District  have  been  performed  in  a  rudimentary  manner,  without  any  technical  guidance.   Gold  in  the  Nambija  occurs  primarily  in  vugs  and  veins  within  and  close  to  skarn  bodies   developed  on  volcano-­‐sedimentary  rocks  (Markowski  et  al.  2006).  Afterwards,  the  gold   is  recovered  through  gravimetric  concentration  and  amalgamation  with  mercury.  The   resulting  residues  are  deposited  in  the  ground  or  discarded  to  nearby  streams.  (Carling   et  al,  2013).  In  addition  to  gold,  the  remaining  sulfur-­‐rich  polymetallic  ore  contains  high   concentrations  of  Mn,  Cd,  Pb,  As,  Cu  and  Zn.  Inadequate  management  of  mine  tailings   results  in  the  discharge  of  toxic  cyanide  effluents  and  sediments  highly  enriched  with  Hg   and  other  metals  into  the  Nambija  River.   Nambija  mining  concessioners  worked  with  learning  abroad  students  to  navigate  the   area  and  select  6  optimal  water  sampling  sites  (Figure  2).  The  principal  objective  of  the   study  was  the  characterization  and  geochemical  evaluation  of  local  mercury  and  trace   metal  contamination  of  the  Nambija  River  due  to  artisanal  gold  mining  in  the  Nambija   Mineral  District.                                       Figure  1.  Map  of  the  Location  of  the  Nambija  Nambija  River  and   mine Figure  2.  Sampling  Locations  down  the  Nambija  River   3.  Methods    3.1  Water  Sample  Collection  Overview                   Water  samples  were  collected  at  6  sites  along  the  Nambija  River  transect  to   characterize  stream  chemistry.  These  sites  are  located  upstream  of  the  Nambija  mine,   downstream  of  the  mine  and  in  a  nearby  clean  creek  tributary  for  comparison.  Samples   were  collected  in  low-­‐density  polyethylene  (LDPE)  or  fluorinated  high-­‐density   polyethylene  (FLPE)  bottles  using  a  peristaltic  Geopump.  20%  hydrochloric  acid  was   used  to  clean  all  LDPE  and  FLPE  bottles  before  sample  collection.    0.45  µm  cartridge   filters  were  attached  to  the  Geopump  for  the  collection  of  filtered  samples.                   To  ensure  quality  samples  representative  of  the  Nambija,  a  clean  hands-­‐dirty   hands  protocol  (Radtke,  1997)  was  used  at  all  times  of  the  sampling  process.  Field   working  class  members  assigned  to  the  “Clean  Hands”  task  oversaw  of  all  operations   involving  equipment  that  contacts  the  sample.  Members  assigned  to  “Dirty  Hands”   handled  all  operations  involving  contact  with  potential  sources  of  contamination.    Once   collected,  all  samples  were  shipped  to  the  United  States  and  analyzed  within  2  months   at  the  University  of  Utah,  Freddrick  Albert  Sutton  building  Labs.           3.2  Field  Parameters A   YSI   field   probe   was   used   to   measure   temperature,   dissolved   oxygen   (DO),   conductivity,  barometric  pressure  and  pH  at  each  of  the  5  sample  sites.  The  probe  was   calibrated  for  conductivity,  pH,  and  DO  at  the  beginning  of  each  sampling  period. 3.3  Ion  concentrations Filtered  samples  for  major  anions  and  cations  were  collected  in  30mL  LDPE  bottles  and   were   analyzed   by   ion   chromatography   (IC).   Samples   were   filled   to   the   top   bottles   to   preserve  redox-­‐sensitive  ions  such  ammonia/nitrate  and  sulfide/sulfate.   3.4  Trace  element  concentration For  trace  element  sample  preservation,  2.4%  nitric  acid  was  added  to  30ml  LDPE  bottles   prior  to  sample  collection.  Filtered  and  unfiltered  samples  were  collected  to  distinguish   the  particle-­‐bound  trace  element  species  from  the  dissolved  species.  Bottles  were  filled   to  the  neck  to  avoid  loss  of  preservation  acid.  Samples  were  analyzed  for  47  elemental   concentrations   using   an   inductively   coupled   plasma   mass   spectrometry   (ICP-­‐MS)   for   both  filtered  and  unfiltered  samples.   3.5  Total  and  methyl  mercury For   mercury   sample   preservation,   1%   HCL   was   added   to   250ml   FLPE   bottles   prior   to   filtered  and  unfiltered  sample  collection.  Bottles  were  filled  to  the  neck  to  avoid  loss  of   preservation  acid.  Total  mercury  samples  were  prepared  using  in-­‐bottle  BrCL  oxidation,   and   methyl   mercury   samples   were   distilled   prior   to   analysis.   Both   THg   and   MeHg   concentrations   were   analyzed   using   a   Brooks   Rand   Model   3   cold   vapor   atomic   fluorescence  spectrometer  (CVAFS).     3.6  Alkalinity Filtered  samples  were  collected  in  125mL  LDPE  bottles  with  no  headspace  at  each  site.   Alkalinity   was   measured   in   the   lab   through   titration,   using   a   known   concentration   of   sulfuric  acid.   3.7  Total  suspended  solids  and  particle  sizes. Unfiltered   samples   were   collected   in   250mL   LDPE   bottles.   Total   suspended   solids   concentrations  were  analyzed  gravimetrically  by  difference  between  filter  mass  before   and   after   passage   of   50   mL   of   sample.   A   Particle   Size   Analyzer   identified   the   size   distribution  of  the  particles  in  each  sample.   4.  Results     The  sample  collected  at  Quebrada  Nambija  (upstream  of  the  mine)  displays  a   specific  conductance  value  of  40.1  µS/cm.  Specific  conductance  values  of  samples   taken  downstream  of  the  mine  show  modest  variation  ranging  from  74.6  to  84   µS/cm.    Temperature  values  increase  steadily  upstream  to  downstream  from  14℃   to  20℃.                  Figure  3.  Nambija  River  Transect  basic  field  parameters       Out  of  the  47  elemental  concentrations  analyzed,  Manganese,  Aluminum  and  Iron   demonstrate  concentration  values  that  exceed  the  Maximum  Containment  Levels   (MCL).  These  levels,  established  by  the  Environmental  Protection  agency,  are   surpassed  at  all  four  sampling  sites  downstream  of  the  Nambija  mine  for  each  one  of   these  elements.  Samples  taken  at  the  Quebrada  Nambija  and  Namijba  Clean  creek   contain  concentrations  <0.5mg/L  for  all  three  metals.  Concentrations  of  metals  are   randomly  distributed  along  the  downstream  segment  of  the  sampling  transect.    The   majority  of  elements  at  each  site  are  largely  particle  bound  rather  than  dissolved   (fraction  that  passed  through  the  0.45-­‐[micro]m filter).             Figure  4.  Nambija  River  Transect  trace  element  concentrations  (Mn,  Al,  Fe)           Total  and  methyl  mercury  concentrations  are  below  0.5ng/L  for  samples  taken  at   Quebrada  Nambija.  Total  Mercury  concentrations  for  the  downstream  sampling   sites  range  from  302.22  ng/L  to  1442.13  ng/L.  Methyl  mercury  concentrations   range  from  0.06  to  0.15  at  sites  down  stream  of  the  mine.         Figure  5.  Nambija  River  Transect  Total  a nd  Methyl  Mercury  concentrations           5.  Discussion     Temperature  Differences  measured  using  the  field  probe  are  due  to  elevation   differences  at  each  sampling  site.    Conductivity  increase  from  sites  upstream  to   downstream  is  due  to  higher  concentrations  of  dissolved  solids  and  possibly  the   addition  of  metals  from  the  mining  processes.  The  majority  of  the  47  elements   measured  did  not  exhibit  concentrations  exceeding  that  of  maximum  contaminant   levels,  but  can  still  be  considered  threating  to  the  surrounding  environment.       Total  mercury  concentrations  are  considerably  high  but  do  not  surpass  that  of  the   MCL  set  for  mercury  contamination  by  the  EPA  (2000  ng/L).    Concentration  values   for  MeHg,  the  most  toxic  and  bio  accumulative  form  of  Hg,  were  comparatively   lower  than  that  of  total  mercury  (by  a  magnitude  of  3).  Methyl  mercury  is  produced   in  aquatic  systems  by  sulfate-­‐  and  iron-­‐reducing  bacteria  in  the  presence  of  organic   matter.  A  study  done  by  P.  Velasquez-­‐Lopez  indicated  low  methylation  rates   downstream  of  mining  operations  that  used  cyanide  leaching  for  gold  extraction.  It   was  concluded  in  this  study  that  there  were  potential  negative  correlations  between   cyanide  and  mercury  methylation  (Carling  et  al,  2013).     It  is  unknown  whether  or  not  the  the  Nambija  mine  uses  cyanide  leaching  as  a   method  for  gold  extraction  in  addition  to  mercury  amalgamation.  If  so,  this  may  be  a   possible  explanation  for  low  methyl  mercury  levels  relative  to  total  mercury   concentrations  in  the  Nambija  River.  Further  research  on  this  correlation  is   necessary  to  fully  understand  the  controls  on  methylation  in  these  mining  areas.   Suggestions  for  continued  research  include  studying  the  influence  of  cyanide   leaching  on  water  quality,  the  addition  of  sediment,  core  and  tailings  sampling,  and   further  water  sample  collection  along  the  Nambija  River  transect.           References  Cited     Carling,  G.,  Diaz,  T.,  Ponce,  X.,  Perez,  M.,  Nasimba,  L.,  Pazmino,  L.,  .  .  .  Johnson,  P.  (2013).   Particulate   and   Dissolved   Trace   Element   Concentrations   in   Three   Southern   Ecuador   Rivers  Impacted  by  Artisanal  Gold  Mining.  Water,  Air,  &  Soil  Pollution,  224(2),  1-­‐16. Spiegel,   S.   (2012).   Analysis   of   Formalization   Approaches   in   the   Artisanal   and   Small-­‐Scale   Gold   Mining   Sector   Based   on   Experiences   in   Ecuador,   Mongolia,   Peru,   Tanzania   and   Uganda:  Tanzania  Case  Study.  United  Nations  Environment  Programme   Radtke,   D.   (1997).   Techniques   of   Water-­‐Resources   Investigations   of   the   United   States   Geological   Survey,   Techniques   of   Water-­‐Resources   Investigations   of   the   United   States   Geological  Survey.   Sánchez-­‐Vázquez,   Espinosa-­‐Quezada,   &   Eguiguren-­‐Riofrío.   (2016).   "Golden   reality"   or   the   "reality   of   gold":   Artisanal   mining   and   socio-­‐environmental   conflict   in   Chinapintza,   Ecuador.  The  Extractive  Industries  and  Society,  3(1),  124-­‐128. Ramírez  Requelme,  Ramos,  Angélica,  &  Brabo.  (2003).  Assessment  of  Hg-­‐contamination   in   soils   and   stream   sediments   in   the   mineral   district   of   Nambija,   Ecuadorian   Amazon   (example  of  an  impacted  area  affected  by  artisanal  gold  mining).  Applied  Geochemistry,   18(3),  371-­‐381.   Betancourt,  O.,  Narvaez,  A.,  &  Roulet,  M.  (2006).  Small-­‐scale  gold  mining  in  the  Puyango   River  Basin,  Southern  Ecuador:  A  study  of  environmental  impacts  and  human  exposures.   Epidemiology,  17(6),  S432-­‐S433.   Velásquez-­‐López,   P.   C.,   Veiga,   M.   M.,   &   Hall,   K.   (2010).   Mercury   balance   in   amalgamation   in   artisanal   and   small-­‐scale   gold   mining:   Identifying   strategies   for   reducing   environmental   pollution   in   Portovelo-­‐Zaruma,   Ecuador.   Journal   of   Cleaner   Production,  18(3),  226-­‐232.   Guimaraes,   Jean   Remy   Davée,   Betancourt,   Oscar,   Miranda,   Marcio   Rodrigues,   Barriga,   Ramiro,   Cueva,   Edwin,   &   Betancourt,   Sebastián.   (2011).   Long-­‐range   effect   of   cyanide   on   mercury  methylation  in  a  gold  mining  area  in  southern  Ecuador.  The  Science  of  the  Total   Environment,409(23),  5026-­‐33. A   Muñoz,   G   &   Pazmino,   Isabel   &   Ayala,   Diana   &   A   Espinosa,   P   &   Velasquez-­‐Lopez,   Patricio.  (2014).  Gravity  concentration  of  gold  in  Nambija  -­‐Ecuador:  The  importance  of   process  analysis  for  recovery  success.     Markowski, A., Vallance, J., Chiaradia, M., & Fontboté, L. (2006). Mineral zoning and gold occurrence in the Fortuna skarn mine, Nambija district, Ecuador. Mineralium Deposita,41(4), 301-321. doi:10.1007/s00126-006-0062-x   University of Utah UNDERGRADUATE RESEARCH JOURNAL VALIDATION OF DYNAMICALLY DOWNSCALED PRECIPITATION OVER NAVAJO NATION Kaitlin K. Winter (Courtenay Strong, Adam Kochanski) Department of Atmospheric Sciences Forests are susceptible to being threatened by changes in climate conditions including precipitation and drivers of evapotranspiration including temperature. About a third of the global population relies on forests to provide heating and cooking fuel and in total, their economic livelihood. Changes in climate have been associated with changes in phenology (the timing of seasonal events in the life cycle of plants and animals) and changes in the frequency, extent, duration, and severity of fires and outbreaks of forest pathogens (Fleishman et al., 2013). Understanding is limited on how the future trajectory of climate in the Southwest region will affect pinonjuniper woodlands, and how human harvesting will interact with these changes. Degradation of this important ecosystem Figure 1. Simplified diagram of the coupled would harm wildlife and human life in the surrounding areas. human-natural system. Natural system This project focuses on residents of the Navajo Nation in the dynamics are structured primarily by climate Southwestern U.S., who rely on pinon-juniper woodlands for gradients. Human system dynamics are fuel and economic enrichment. These woodlands are driven by access to fossil fuels. Both systems threatened by the impacts of climate change as well as are affected by exogenous climate (s. and w. overexploitation, both of which alter the dynamics structuring ecosystem health. Analyzing the dynamics and indicate summer and winter, respectively). future of this coupled human-natural system requires detailed The human and natural components are and validated simulation of climate (Figure 1). This project coupled by supply and demand. thus focuses on historical validation of high-resolution climate modeling performed for the Navajo Nation by Professors Court Strong and Adam Kochanski. The simulation data I worked with were hourly, 4-km resolution NetCDF output from the Weather Research & Forecasting (WRF) model. I focused primarily on precipitation. All of this work was done through the program MATLAB. For validation I used a recently assembled and published proprietary monthly precipitation data set collected by the Navajo Nation. The locations and types of measurements in the Navajo Nation data set are shown in Figure 2. Figure 2. Navajo Nation Water Management Branch’s Water Monitoring and Inventory Section hydrometeorological sites, including 90 rain gages, 12 tipping buckets, 8 snow courses, and 8 stream gauges. University of Utah UNDERGRADUATE RESEARCH JOURNAL PALEOREDOX CONDITIONS, PALEOPRODUCTIVITY, AND DEPOSITIONAL ENVIRONMENT OF AN EOCENE BLACK SHALE: MAHOGANY ZONE, GREEN RIVER FORMATION, EASTERN UINTA BASIN, UTAH Katherine Worms, Lauren Birgenheier, Michael Vanden Berg Department of Geology and Geophysics Abstract: Black Shales are commonly assumed to record anoxic, productive paleoenvironments. The Mahogany zone of the Green River Formation is a world class example of a black shale. It is thought to record a period of high lake level conditions in which algal productivity combined with prolonged anoxia resulted in the preservation of this highly prolific source rock. This research tests the classic anoxic, black shale model, using the Mahogany zone as a case study. The stratigraphic variability of paleoredox conditions, paleoproductivity and mud depositional processes through the Mahogany zone are further investigated using a newly drilled core (PR-157C) from the eastern Uinta Basin. High-resolution stratigraphic (5 mm spacing) handheld X-ray fluorescence analysis has been performed on the Mahogany zone (~12.8 m thick) of the core, which provides inorganic major and trace element abundance data. This was combined with quantitative red-green-blue (RGB) analysis of optical core photographs, which provides a proxy for organic richness at high stratigraphic resolution (up to a few hundred microns). Visual core description and standard thin section analysis of mudstone samples were used to determine different sedimentary processes of mud deposition (i.e. suspension settling versus hydrodynamic currents) in the lake system recorded by the Mahogany zone. Paleoproductivity proxies, specifically Ni and Cu content, are positively correlated with Total Organic Carbon (TOC), but are both below the published average marine shale values, suggesting further investigation is needed to accurately apply these proxies to lacustrine systems. Therefore, we interpret TOC as a more reliable indicator of paleoproductivity in this system. Paleoredox proxies, specifically U and Mo content, are in agreement with published average marine shale values. Elevated levels of U and Mo indicate anoxic to euxinic conditions, with Mo displaying periods of euxinia in addition to baseline anoxia. Mo displays stratigraphic cyclicity, with average cycle lengths of about 16 kyr, based on bounding Ar-Ar dates from tuffs and an assumed linear sedimentation rate. This research suggests that the Mahogany zone records anoxic, highly productive conditions, in line with classical interpretations of anoxic black shale successions. The periodic prevalence of euxinic conditions is a new finding and warrants further consideration of the preservation mechanisms in paleolacustrine systems. College of Nursing University of Utah UNDERGRADUATE RESEARCH JOURNAL LOST IN TRANSLATION: PERCEPTIONS OF PATIENTCENTERED CARE AMONG IRAQI MUSLIM WOMEN Stephanie Hopkins (Deb Penney, CNM, MPH, PhD) Department of Nursing ABSTRACT Iraqi Muslim women encounter many barriers to receiving patient-centered care in the U.S. health system. When expectations between the patient and provider differ and a disconnect or misunderstanding occurs, Iraqi women can be at risk for unintended poor quality care. Health providers have incentives to implement patient-centered care and yet face multiple challenges in doing so when patients’ values, religion, culture, gender and language are different from their own. This study aimed to identify sources of misunderstanding (referred to as disconnects) between health provider and Iraqi Muslim female patients as a means of informing providers about possible accommodations when caring for this population. To achieve this aim, a secondary analysis was conducted using 15 Iraqi Muslim female patient interviews from a previous qualitative research study that explored the perspectives and experiences of the women in the primary health care encounter. The six dimensions of patient-centered care provided a means of structural coding to identify disconnects and describe examples of what Iraqi Muslim women may be expecting in the healthcare visit. Resulting themes revealed sources of disconnects between provider and patient that are embedded in the health system and interpersonal aspects of the health encounter. Sources of disconnection between provider and patient presented as barriers to achieving patient-centered care included communication, discordant expectations and lack of cultural knowledge of the other. The findings suggest that a provider who accommodates a patient based on cultural knowledge and empathy may potentially see better patient outcomes through improved patient understanding and participation in care. Health providers who are aware of a patient’s expectations and cultural norms have the knowledge to tailor patient-centered care dimensions to individual patients and potentially decrease health disparities. University of Utah UNDERGRADUATE RESEARCH JOURNAL DAILY EXPERIENCES OF CHILDREN REPORTED THROUGH A GAME-BASED APP Caitlin Linder (Mentor: Lauri Linder PhD, APRN, CPON) College of Nursing Background/objectives: Childhood cancer disrupts children’s day-to-day experiences. The purpose of this study was to analyze children’s responses to two questions included in a daily symptom reporting app: “What is the best thing about today?” and “What is bothering you the most today?” Responses were part of a larger study evaluating the feasibility and acceptability of the app. Children used the app to record daily symptoms and answer short questions about their day. Design/methods: Children completed a trial of the app between visits at the hospital for chemotherapy. Daily responses to each question were analyzed using descriptive qualitative content analysis with each response serving as a unit of analysis. Coding was completed by each author and reviewed together to reach agreement. Children’s responses were organized into categories and subcategories. Results: Participants were 19 children 6-12 years of age (median 8 years) (12 boys) receiving chemotherapy who used the app for a total of 83 days (median 4.5 days/child). Children provided 72 responses about the best thing about their day that were organized into nine categories: Activities (n=22), People (n=14), Food (n=9), Well-Being (n=9), School (n=7), Nothing (n=5), Object (n=4), Going Home (n=3), and Don’t Know (n=1). Children provided 60 responses about the most bothersome aspect of their day that were organized into six categories: Nothing (n=22), Symptoms (n=17), Port (n=7), Cancer Treatment (n=5), Day-to-Day Stuff (n=5), and People (n=4). Conclusions: Children’s responses provide perspective of the impact of cancer on their daily lives. Their responses indicate the importance of maintaining developmentally normal activities and family relationships. Children’s responses further indicate the pervasiveness of the cancer experience, such as symptoms, even on days when children are away from the hospital. Mobile health apps can help children not only track symptoms but also reflect on their day. Clinicians can use children’s information to better understand children’s experiences. University of Utah UNDERGRADUATE RESEARCH JOURNAL DISTANCE-TECHNOLOGY DELIVERED GRIEF SUPPORT PROGRAMPERCEIVED QUALITY AND SATISFACTION OF TRAINING PROVIDED TO SOCIAL WORKERS Daniela McCroby (Dr. Katherine Supiano, PhD, LCSW) College of Nursing Abstract: Death of a close family member or friend can be overwhelming for an individual. The loss of someone initiates the natural response of grief. Grief covers a wide variety of challenging emotions and thoughts; and guidance in a form of grief support in how to cope with these can be very helpful. Grief support can be found through individual counseling, grief support groups, reading materials, hospice organizations, other local organizations, websites, etc. However, not everyone has access to grief support. Those who live beyond cities or towns have very limited access to grief support. Caring Connections: A Hope and Comfort in Grief Program, a non-profit organization located in the College of Nursing at the University of Utah, has been awarded a research grant to extend grief support groups to rural/frontier Utah via distance-technology. The mission of Caring Connections is to provide excellent evidence-based bereavement care to grieving persons in the intermountain west through clinician facilitated support groups; and, in keeping with the academic mission of the University and the College of Nursing, to provide opportunity for clinical education in grief and loss to students in the health care professions, and to conduct research which promotes greater understanding of loss, grief and bereavement. Caring Connections offers a range of grief groups relating to a variety of losses and serves over 400 individuals each year. Through this grant, Caring Connections grief support program will increase accessibility to bereavement care, demonstrate innovative ways to extend bereavement care in outpatient and community settings, and reduce the health care gap in underserved communities. Utah currently has 93 licensed hospice agencies and only eight of them serve the rural-frontier Utah. Hospice professionals in the eight agencies are faced with the challenges of driving long distances to reach their patients to provide care. This program will also decrease the challenges of time and travel for hospice professionals and the bereaved population in this area for grief support. My role in this research project is to: (1) Collaborate with Dr. Supiano and the research team in developing study and social work participant relevant satisfaction questions and quality improvement questions regarding the training of social workers in grief support group skills, (2) Collaborate in developing the interviewing method for obtaining data (telephone vs. telehealth platform), (3) Conduct quality assurance and participant satisfaction interviews with social work facilitators prior and immediately after training, and upon completion of an eight- week grief support group. (4) Assist with evaluating facilitator protocol adherence data. (5) Assist with data entry and evaluation. Through this we will be able to evaluate quality of support provided to the bereavement population in rural/frontier Utah via distance technology and diminish healthcare discrepancies. University of Utah UNDERGRADUATE RESEARCH JOURNAL SOME KEY QUESTIONS: REPRODUCTIVE JUSTICE & PREVENTATIVE REPRODUCTIVE HEALTHCARE Stephanie St Clair, Sara Simonsen, Susan Dearden & Lauren Clark University of Utah College of Nursing INTRODUCTION: This study aims to analyze the expansion of the ONE KEY QUESTION (OKQ) algorithm from primary care settings into community-based settings. ONE KEY QUESTION (OKQ) is an algorithm-based program that asks a single question, “Would you like to become pregnant in the next year?” to all reproductive-aged women. This study explored the utilization of Community Health Workers (CHWs) to expand the use of OKQ into community-based settings. CHWs have an intimate understanding of the community they serve, and may be key partners in providing culturally competent preventative reproductive healthcare to underserved populations. BACKGROUND INFORMATION: In 2014-2015, an estimated 20.8% of Utah women reported a birth resulting from an unintended pregnancy. Unintended pregnancy is defined as a pregnancy that is mistimed or unwanted, and has been associated with increased infant and maternal mortality rates, poor obstetric outcomes, increased birth defects, and undue financial burden. METHODS: A systematic literature review was conducted to highlight critiques of the OKQ approach, identifying three main areas of focus: the exclusion of men, trust between patients and providers, and the efficacy of CHWs in decreasing social distance and improving health outcomes. We conducted focus groups with 46 Spanish and English-speaking CHWs in Salt Lake City. Participants were trained on the OKQ algorithm, and were asked to identify barriers and facilitators to implementing OKQ in their communities. The interviews were transcribed and coded by researchers using thematic and open coding techniques. RESULTS: Pregnancy intention screening was perceived positively by CHWs, who indicated that trust is a key facilitator to conversations about pregnancy intention with women in their communities. Barriers identified by CHWs include cultural taboos in discussing sex and pregnancy, lack of trust between formal healthcare providers and women in their community, and female bias ingrained in the OKQ algorithm. CONCLUSION: OKQ offers a simple approach to addressing unintended pregnancy in primary care settings, but fails to account for the numerous complex social and political factors that determine reproductive health. In addition, many women will not be accessible via formal healthcare settings. CHWs offer an alternative avenue for implementation of OKQ that addresses many of these barriers. NEXT STEPS & POLICY IMPLICATIONS: Researchers are finalizing thematic analysis of the coded data, and plan to publish their results in Spring 2019. The results are expected to have significance in supporting the expansion of preventative reproductive healthcare interventions into community-based settings. The data offer key insights into reproductive justice-inspired critiques of the OKQ approach, and encourage the incorporation of reproductive justice principles into future interventions on reproductive healthcare in marginalized communities. These findings support policy initiatives aimed at expanding training and education for Community Health Workers and improving services available in primary care settings for women of color in particular. College of Science University of Utah UNDERGRADUATE RESEARCH JOURNAL Characterizing Fungal Community on Blue-gray Gnatcatchers (Polioptila caerulea) Bryce Alex, Prof. Bryn Dentinger School of Biological Sciences The fungal kingdom is a highly diverse group of eukaryotic organisms, containing a multifarious set of life cycles, morphologies, and ecologies. Many species of fungi produce propagules, or structures that facilitate an organism’s transition between stages of its life cycle. While fungal propagules are mainly transferred by wind, animals have been shown to serve as dispersal vectors. Birds acting as vectors are of particular interest, given the varied behavior among species and the ability to travel over long distances. Understanding bird-propagule dispersal is essential for modeling the spread of fungal pathogens and understanding fungi distribution, plant-pollinator interactions, and fungi phenological trends. However, tracking and identifying microscopic propagules is difficult. Light microscopy is a common method for identifying propagules, but can be laborious and inaccurate, especially when dealing with small quantities. Growing fungi cultures to make identification easier only yields culturable taxa. It has not been until recently researchers are able to survey the microbiome with incredible accuracy and resolution with the use of Next Generation Sequencing (NGS). Using NGS, we conducted a marker gene survey to characterize the fungal community on bird feathers from Rio Mesa, Utah. Three different primer pairs were used to capture the widest range of fungal taxa. The relative abundances of assigned taxonomy generated from our ITS sequence primers is pictured below, using a Krona charts template (https://github.com/marbl/Krona). University of Utah UNDERGRADUATE RESEARCH JOURNAL EXPLORING THE OUTER SOLAR SYSTEM THROUGH ANALYSIS OF WISE TELESCOPE DATA Teddy Elizabeth Anderson, Dr. Benjamin Bromley Department of Physics and Astronomy During the 2017-2018 school year, I worked with Dr. Ben Bromley and a collaborator from the University of California, Berkeley, Dr. Aaron Meisner. They were working on a project that takes data from the Wide Infrared Survey Explorer telescope, gathered over the course of several years, and converts it into usable files. Their first goal was to join in the search for a hypothesized ninth planet on the outer edges of the solar system that astronomers call Planet Nine. Absent the discovery of Planet Nine, other objects of interest that showed up in the data could be examined in more detail, including asteroids and brown dwarf stars. As the data was processed, I was able to assist in combing through the objects located by our Python scripts. We had culled the set down to about 2,000, which I then checked against existing astronomical databases. Our results were that if Planet Nine exists, it isn’t emitting strongly in the W1 infrared waveband. These results were published in The Astronomical Journal in January, 2018, in a paper titled “A 3π Search for Planet Nine at 3.4µm with WISE and NEOWISE” by Meisner et al. In the following months, I worked with Dr. Bromley to write a Python script to simulate thousands of found objects, in order to determine the best parameters for brightness and speed. These results would be used to set parameters for a second search through the WISE data, this time in the slightly longer W2 waveband. As my participation in this project wrapped up, the search in W2 had been completed over a small part of the sky, in anticipation of a full-sky search. This project gave me the opportunity to explore the research process first-hand. It has helped me make better decisions about graduate school programs and areas of interest. It also gave me many opportunities to present research to an audience, both in speeches and poster sessions. I am grateful for the opportunity given to me by the Office of Undergraduate Research, and by my research mentor, Dr. Ben Bromley. University of Utah UNDERGRADUATE RESEARCH JOURNAL OPTIMIZING USE OF JANELIA FLUOR® DYES IN THE C. ELEGANS GERMLINE TO INVESTIGATE THE ROLE OF HTP-3 PROTEIN IN SYNAPTONEMAL COMPLEX ASSEMBLY Presley Azarcon (Ofer Rog) Department of Biological Sciences Meiosis is a cell division process that is crucial for sexual reproduction. It occurs by way of two rounds of chromosome segregation, resulting in four haploid gametes that are necessary for an organism to produce offspring. It is prior to the first round of meiosis (meiosis I) that synapsis between homologous chromosomes occurs and the synaptonemal complex (SC) is formed. The SC is also thought to take part in crossover (CO) events. COs are unique to meiosis in that they allow for exchange of genetic information between the maternal and paternal chromosomes that will eventually be passed to offspring through sexual reproduction. This recombination creates genetic variability that is important for diversity and future adaptation. COs also play a vital role in meiotic chromosome segregation. Despite its conserved role in sexual reproduction, the structure of the SC and its mechanisms of action are still largely unknown. With my research, I am focusing on optimizing the attachment of Janelia Fluor® Dyes onto proteins found within the chromosomes of the nematode C. elegans in order to enhance imaging capabilities and better understand the function of cellular proteins. Previous studies within the Rog Lab have utilized different methods to produce images such as the use of green fluorescent protein (GFP) or antibodies. However, there can be significant drawbacks with these uses. Some of these could include disruption of the original protein, aggregation, bleaching, and dimly fluorescent images. The innovation of Janelia Fluor® Dyes has provided an advanced option for imaging, being substantially brighter, more stable, and localizing more specifically to proteins of interest which will ultimately provide a better image and also contribute to the ability of live imaging. Through these improved imaging capabilities, I plan to apply the fluorescent dyes to proteins involved in the process of meiosis in C. elegans, particularly in the assembly of the SC. The fluorescent dyes have previously been used in the Jorgensen Lab at the University of Utah and generated superior results to other labeling methods. However, to image C. elegans precisely when the SC is forming, worms must be in the adult stage so that they have germ cells that are going through meiosis. This poses an issue because staining of C. elegans at the adult stage creates a buildup of dye within the gut of the worm, which lessens image quality. I am seeking to find alternative methods of staining C. elegans with Janelia Fluor® Dyes and establish an efficient and reproducible staining protocol. To determine the best protocol, I will collect data across a number of different alterations to the staining process, quantify image quality, and determine the most common outcome of the protocol. This protocol could then be applied to many proteins that are involved with the function of the SC. University of Utah UNDERGRADUATE RESEARCH JOURNAL DESIGNED SWARMING BEHAVIOR USING OPTIMAL TRANSPORTATION NETWORKS Justin Marlin Baker (Elena Cherkaev) Department of Mathematics ABSTRACT Models of swarming behavior aid in disaster planning, direct the actions of warehouse robots, and can map the foraging characteristics of insects. These models use the optimal behavior of individual agents to determine the behavior of the larger population. Optimal transportation is one such model that has been used to successfully describe the behavior of swarming agents[3] . The MongeKantorovich formulation of the optimal transportation problem models the best direct route for individual agents in a swarm. The presented work investigates optimal transportation and duality in a Monge-Kantorovich formulation. We reduce the Monge-Kantorovich formulation to the linear programming problem which can be efficiently solved numerically. However this formulation is not applicable in the case where the domain of travel is restricted, so that agents must travel along a particular network of paths. For instance, robots traveling throughout a warehouse must navigate through a network of aisles, and foraging bugs may prefer to travel along premade routes. We extend the Monge-Kantorovich formulation to a network of paths which differs from transfer over a direct route. We show that this extended formulation can also be reduced to the linear programming problem. Finally, we investigate various applications of both the direct and network transfer using numerical simulations. ii TABLE OF CONTENTS Abstract ii Optimal Transportation Problem 1 Variational Formulation . . . . . . . . . . . . . . . . . . . . . 2 Langrangian Duality . . . . . . . . . . . . . . . . . . . . . . . 3 Dual Convex Functions . . . . . . . . . . . . . . . . . . . . . . 5 Reduction to the Linear Programming Problem 7 Discretized Formulation . . . . . . . . . . . . . . . . . . . . . 7 Primal Problem . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Dual Problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Dual Convex Functions . . . . . . . . . . . . . . . . . . . . . . 11 Solution Methods . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Linear Transfer Analysis . . . . . . . . . . . . . . . . . . . . . 12 Extension of Monge-Kantorovich Formulation to a Network 13 Problem Formulation . . . . . . . . . . . . . . . . . . . . . . . 13 Network Transfer as a Linear Programming Problem . 16 Network Transfer Analysis . . . . . . . . . . . . . . . . . . . 17 Network Cost Variation Analysis . . . . . . . . . . . . . . . 18 19 Applications Linear Swarm Transfer . . . . . . . . . . . . . . . . . . . . . . 21 N-Dimensional Redistribution . . . . . . . . . . . . . . . . . . 23 Palette Swapping . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Contour Descent . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Acknowledgments 29 References 30 iii 1 1. OPTIMAL TRANSPORTATION PROBLEM Optimal transportation describes the transfer of mass from one location to another with the least amount of work. The classical problem was formulated by Gaspard Monge in the 1780s as “How should one transfer, with minimal work, a pile of sand from one location to fill a given hole?”. Coming from a background of industry and economics, Monge was interested in extending this problem to the transport goods between supply factories and distributed demand. Thus the problem is concerned with how smaller amounts of sand are particularly redistributed, or to which location each individual good travels. The original problem is rather ill-posed. It is unclear if there is an optimal transportation route, and process of transportation is unconstrained. For this reason, it wasn’t until two hundred years later in 1979 that the first general proof was proposed by V.N. Sudakov. However, several years prior Leonid Kantorovich had proved a relaxed version of the problem using the linear programming techniques that he helped develop. The Monge-Kantorovich formulation imposes conditions on the cost of work and requires that the masses are transferred along the network in identical amounts. Due to its history, transportation theory is often motivated by spacial transfer. Physical applications include compression modeling, semi-geostrophic system modeling, kinetic theory, optimal design of lenses, irrigation design and network design. Therefore visualization techniques are highly effective in the study of optimal transportation theory. Section four will discuss these visualization techniques along with the applications of palette swapping, particle swarm optimization, material science, emergency planning, and Weistrass Generative Adversarial Networks (WGAN). The primary aim of this paper is to extend the Monge-Kantorovich problem to the transfer masses along a directed graph. This modification of the problem requires an understanding of the initial Monge-Kantorovich formulation discussed in sections one and two. Then in section three an adjusted cost function will 2 be introduced along with the extension of the Monge-Kantorovich formulation to directed graphs. Variational Formulation The Monge optimal transportation problem is formulated as a problem of calculus of variations. The goal is to formulate the problem mathematically so that the solution is the network which minimizes the cost of transportation. Consider an initial domain X ∈ Rn with mass distribution µ+ (x) for x ∈ X. The target domain Y ∈ Rm has a distribution which describes the capacity for masses µ− (y) for y ∈ Y . Figure 1: Optimal transporta- The objective is to find the tion path between two probabil- transportation network or mapping s(x), ity distributions which maps µ+ (x) onto µ− (x). s(x) : µ+ (x) → µ− (y), x ∈ X, y ∈ Y This mapping is only feasible if it satisfies a mass balance equation. Thus we constrain the system to having equivalent mass in the initial domain to space in the target domain. Z + Z µ (x)dx = X µ− (y)dy Y Additionally a cost density function is used to describe the work of moving masses along the network. In general this cost function is a non-negative real valued function which might take infinite values. c(x, s(x)) : Rn × Rm → [0, ∞) The mass transfer problem optimizes the cost of redistribution of all particles in the initial domain by selecting an optimal mapping. This process is mathematically 3 formulated as optimization of the following integral, sometimes called the work functional or goal functional. Z c(x, s(x))dµ+ (x) I[s(x)] = Rn The variational problem is to select the particular transportation network which minimizes this functional. In addition this network must satisfy the mass balance equation. Let s∗ denote the map which minimizes the functional so that I[s∗ ] ≤ I[s] for all possible mappings s. Z ∗ I[s (x)] = min c(x, s(x))dµ+ (x) s(x) Rn Z Z + s.t. µ (x)dx = µ− (y)dy X (1) Y This formulation is referred to as the primal problem. From the primal problem it is not apparent that a mapping s∗ which minimizes this functional always exists. And if it exists it is not clear how to find it. This problem can be reformulated using Lagrangian duality.[2] This will allow us to show that an optimal mapping does exist. Langrangian Duality The primal problem is formulated as a constrained optimization problem. The constraint is the mass balance equation. To reformulate the problem, we introduce a Lagrange multiplier λ accounting for this constraint. This serves as a penalty if the constraint is not satisfied. The Lagrange dual formulation is the reformulation of the primal problem utilizing this penalty term. The augmented Lagrange functional has the following form L(λ, x) = max min{I(x, s(x)) + λG(x)} λ s(x) where Z Z + µ (x)dx − G(x) = X So that this L(λ, x) is Z L(λ, x) = max min λ s(x) Rn µ− (s(x))dx = 0. X + Z + Z µ (x)dx − c(x, s(x))dµ (x) + λ X − µ (s(x))dx X . 4 The dual formulation identifies both the optimal path s∗ and penalty λ. However, the dual variation only provides a lower bound on the solution, which may not be exact. Therefore it must be shown that for the particular problem the solution to the Lagrange dual problem is equivalent to the solution to the primal problem. This is referred to as strong duality and we prove here that strong duality is satisfied. Theorem 2.1. Let λ ∈ R+ , λµ+ (x) = −u(x), and λµ− (y) = v(y). The solution to the Lagrangian dual problem Z ∗ L (λ) = max { v(y)dµ− (y)} u(x)dµ (x) + u(x),v(y) s.t. Z + X (2) Y c(x, y)) ≥ u(x) + v(y) satisfies the strong duality condition. That is L∗ (λ) = I[s∗ (x)]. Proof. First to see that this is indeed the Lagrangian dual problem let L̂(s(x), λ) = min max{I(x, s(x) + λG(x)}. s(x) λ The optimal value of this functional is equal to I[s∗ (x)]. However, to solve the Lagrangian dual problem, the order of minimization and maximization is switched introducing the duality gap. max min{I(x, s(x) + λG(x)} ≤ min max{I(x, s(x) + λG(x)} λ s(x) s(x) λ The solution of the functional L(s(x), λ) is given by L∗ (λ) = max min{I(x, s(x) + λG(x)} λ s(x) = max{I(x, s∗ (x)) + λG(x)} λ First we find the minimum over s(x). Because u(x) and v(s(x)) are functions of λ d [I(x, s∗ (x) + we have that the minimum is not necessarily exactly zero but that dx λG(x)] ≥ 0. d I(x, s (x)) + λG(x) = dx ∗ Z + Z c(x, s(x))dµ (x) − Rn u(x)dx − X = c(x, s∗ (x)) − u(x) − v(s∗ (x)) ≥ 0 ⇒ c(x, s∗ (x)) ≥ u(x) + v(s∗ (x)) Z v(s(x))dx X 5 Then this cost function is substituted into the Lagrangian for c(x, s(x)), and this constraint is added. Note the change of integration to integration over the measures dµ+ and dµ− rather than the spatial variable dx. The Lagrangian dual problem is then Z ∗ L (λ) = max{ λ Z + u(x)dµ (x) + X v(y)dµ− (y).} Y s.t. c(x, s∗ (x)) ≥ u(x) + v(s∗ (x)) Strong duality requires that λG(x) = 0 so that L∗ (λ) = max{I(x, s∗ (x)) + λG(x)} = I(x, s∗ (x)) λ Therefore, Z + Z µ (x)dx − λ X µ (s(x))dx = 0 − X which is true if the mass balance equation is satisfied along the entire transportation network. Dual Convex Functions The final step in showing that there exists a unique transportation route requires the tools of convex analysis. Therefore, the final reformulation of the problem formulates the Lagrange multipliers from the dual problem into dual convex functions. Suppose that the costs functional is uniformly convex and of the form 1 c(x, y) = |x − y|2 . 2 Then the work functional is given by Z 1 I[s] = |x − s(x)|2 dµ+ (x). 2 Rn Furthermore suppose that s(x) is essentially one to one. Then the graph of {(x, s∗ (x))|x ∈ X} ⊂ Rn × Rn is cyclically monotone.[2] Which implies that the optimal mapping s∗ lies in the subdifferential of a convex mapping of Rn to R.[5] Thus for some differentiable convex function φ∗ and its gradient Dφ∗ (x), s∗ = Dφ∗ 6 The problem is now to find a change of variables from u(x), v(y) to φ(x), ψ(y) that satisfies this differentiable function. For the given cost function above, this change of variables is 1 φ(x) = |x|2 − u(x) 2 1 ψ(y) = |y|2 − v(y). 2 The constraints in (2) become c(x, y) ≥ u(x) + v(y) 1 −u(x) − v(y) ≥ − |x − y|2 2 1 1 2 φ(x) + ψ(y) = |x| − u(x) + |y|2 − v(y) 2 2 1 2 1 2 1 φ(x) + ψ(y) ≥ |x| + |y| − |x − y|2 2 2 2 φ(x) + ψ(y) = x · y Thus the convex dual problem is Z ∗ L [φ, ψ] = min φ,ψ Z φ(x)dx + X ψ(y)dy (3) Y s.t. φ(x) + ψ(y) ≥ x · y The following proof is the crux of the Monge-Kantorovich solution and shown in the work by L.C. Evans[2] . Theorem 2.2. (i) There exists (φ∗ , ψ ∗ ) which uniquely solves the minimization problem (3). (ii) Furthermore, (φ∗ , ψ ∗ ) are dual convex functions, in the sense that φ∗ (x) = max(x · y − φ∗ (y)) (x ∈ X) ψ ∗ (y) = max(x · y − ψ ∗ (x)) (y ∈ Y ) y∈Y x∈X Proof. If φ, ψ satisfy the constraint of (3) then φ(x) ≥ max(x · y − ψ(y)) := φ̂(x) y∈Y and φ̂(x) + ψ(y) ≥ x · y (x ∈ X, y ∈ Y ). 7 Furthermore, ˆ := ψ̂(y) ψ(y) ≥ max(x · y − φ(x)) x∈X so that, φ̂ + ψ̂ ≥ x · y (x ∈ X, y ∈ Y ) Where if ψ ≥ ψ̂ max(x · y − ψ̂(y)) ≥ φ̂(x). y∈Y 2. REDUCTION TO THE LINEAR PROGRAMMING PROBLEM We will now discretize the problem problem and reduce it to the linear programming problem. This allows us to solve the problem computationally. Linear programming is a method which optimizes an objective function subject to linear constraints. It can be generally formulated as min f (x) (4) s.t. g(x) = 0 h(x) ≤ 0 where g(x) and h(x) are systems of linear equations. Each of the functionals discussed in the previous section can be formulated as a linear programming problem if considered in a discrete setting. This us to find a computational solution for the variational problems. Discretized Formulation To find a numerical solution, we first discretize over the domain space. In the following figure two discretization methods are considered. 8 (a) Grid spaced discretization (b) Discretization with equivalent point masses Figure 2: Comparison of discretization schemes In both instances the problem is discretized by considering the atomic measure. In other words, the total mass is the sum of several small regions δxi of masses. + µ (x) = µ− (x) = n X i=0 m X µ+ i (x)δxi µ− j (x)δyj j=0 In the grid spaced discretization, each small region is a square on a grid. However, this does not assure that the masses are equivalent in each region. Instead selectively spacing and sizing each δxi so that each small region contains equal mass, assures that the transportation map is one to one. Recall that the optimal mapping must be one to one to have a unique minimum. Therefore, the second method is preferred because it transfers masses in equivalent amounts. Then for each central location xi and yj the cost function and the network are discretized as follows. c(xi , yj ) = cij = |xi − yj |2 s(xi , yj ) = sij Then the discrete version of (1) is given by min µij n X m X cij sij (5) i=1 j=1 n X i=1 µ+ i = m X j=1 µ− j 9 Primal Problem The method of linear programming can be applied to this discretized version of the primal problem. The relaxed transportation problem can be formulated as the following linear programming problem. min c · s s.t. As = b x≥0 − n m Consider the vector dimensions of each of these, where µ+ the i ∈ R , µj ∈ R cost function is given by cij ∈ Rmn , and sij ∈ Rmn describes the transportation network. The mass balance constraints over the entire network are formulated as m X sij = µ+ i , j=1 n X sij = µ− j . i=i The objective is to minimize the cost function over the network subject to the constraints above, min n X m X cij µij . i=1 j=1 To formalize the linear programming problem we define each of these terms. Let s ∈ Rmn , where s = (s11 , s12 , ..., s1m , s21 , ..., snm ). Write b as the right hand side of the constraints, b ∈ Rm+n , where + + − − b = (µ+ 1 , µ2 , ..., µn , µ1 , ..., µm ). 10 Then construct A so that the constraints are satisfied. A is an (n + m) × nm matrix composed of ones vectors 1 ∈ Rm and the basis vectors em ∈ Rm .    1 0 ... 0     0 1 ... 0       ... ... ... ...         0 0 ... 1    A=   e1 e1 ... e1       e2 e2 ... e2       ... ... ... ...      em em ... em The constraints in the problem are then satisfied by the linear function As = b. Thus for some c, s∗ is the minimizer of c·s and the unique transportation network. Dual Problem Developing on the same vectors and matrices A, b and c as in the primal problem, the Lagrangian dual problem may be formulated as. max b · y s.t. AT y ≤ c. Here y describes the Lagrange dual pair (u, v). Recall from (2) that the goal is to R R maximize the value of the (u, v) pair applied to X dµ+ and Y dµ− . The discrete formulation is to minimze the inner product of u and v with the distribution µ+ and µ− . To show that the Lagrangian dual problem can be formulated from the discretization of the primal problem consider the constraints given in the discrete primal problem n X µij − µ+ i = 0 i=1 m X j=1 µij − µ− j = 0 11 The discrete Lagrangian dual problem is given by n m X X + L(u, v) = min{f + u( µij − µi ) + v( µij − µ− j )} x i=1 j=1 and f = cij · µij . Solving for the minimum over all x gives ui + vj ≤ cij . Substituting for cij L(u, v) = min{cij µij + u( n X x ≥ (ui + vj )µij + u m X µij − µ+ ) + v( µij − µ− i j )} i=1 n X j=1 m X µij − ui µ+ i +v i=1 =u n X µij + v i=1 m X µij − vj µ− j j=1 µij j=1 This gives us the discrete Lagrangian dual formulation as max u u,v n X µ+ i +v i=1 m X µ− j j=1 s.t. ui + vj ≤ cij Formally, construct y so that y ∈ Rn+m , and y = (u1 , u2 , .., un , v1 , v2 , ..., vm ). Then the Lagrangian dual variation is formulated as the linear programming problem described above. Dual Convex Functions The same technique may be applied to the dual convex conjugate problem. The linear programming problem is min b · p s.t. AT p ≥ v − + − Where A and b are defined above, p = (φ1 , ...φn , ψ1 , ..., ψm ), and v = (x+ 1 , ..., xn , x1 , ..., xm ). This directly follows from (4) as the convex conjugate functions are coordinate transformations of the dual problem. 12 Solution Methods There are two approaches to solving a linear programming problem. First note that the solutions to the LP are lie along the boundary points of a convex polytope. The simplex method minimzes over the boundary points. The interior point method minimizes along the interior adding a penalty to the boundary. In addition to direct LP solvers, there are second order conic solvers (SOCP) which can solve for linear programming.[1] For the purposes of programming the embeded conic solver (ECOS) was used as a solver to the linear programming problem. This solver uses an interior point method to solve for second order conic problems (SOCP). However, SOCP solvers generalize to LP solvers. Thus the method can be used for all of the linear programming problems discussed above. Linear Transfer Analysis Consider two mass distributions, one which is bimodal and convex and the other is unimodal and concave. The goal is to push the bimodal distribution onto the unimodal distribution using the discretization and linear programming techniques discussed so far. The distributions are discretized along the real number line and then shaded by approximate initial location. This local approximation is necessary to view the distribution in this histogram fashion where the sum of the masses within a given region are stacked onto one discrete point. The discretization method itself reduces the mass transfer to equivalent amounts. The colored shading shows the redistribution of each of the cumulative masses between the initial distribution and the final distribution. They are shaded based on initial location, and then this shading is maintained in the final distribution. 13 (a) Initial distribution with shading (b) Redistribution shaded by initial location Figure 3: Discretization and transfer of masses using linear programming 3. EXTENSION OF MONGE-KANTOROVICH FORMULATION TO A NETWORK Building upon the techniques used so far, consider the case where the transportation network s(x) may contain multiple linear or nonlinear paths between two regions. Each path has a starting node and an ending node. All possible transportation networks from x to y are the simple paths along the directed graph between each of the nodes. The cost function is the sum over the entire transportation network of the individual costs between each node. This problem can be formulated and solved similarly to the direct transportation formulations discussed above. This section will describe the necessary modifications to the problem along each of the formulations. Problem Formulation First note that several key features between the problems are identical. The primal problem (1) has no constraints on the cost function or network and remains the same. Z ∗ I[s (x)] = min c(x, s(x))dµ+ (x) s(x) Rn Z Z + s.t. µ (x)dx = µ− (y)dy X Y 14 This implies that the Lagrangian dual problem (2) is also consistent. Z Z ∗ L (λ) = max{ λ u(x)dx + X v(s(x))dx} X s.t. c(x, s∗ (x)) ≥ u(x) + v(s∗ (x)) Utilizing a similar argument for the dual convex problem, formulate the cost function as the individual cost along each of the nodes. Let {X0 } be the set of starting nodes, XN be the set of final nodes and Xi=2,...,N −1 be the set of nodes along each step in the directed graph. Then for x ∈ X the cost function is determined by c(x0 , s(x)) = N X 1 2 i=1 |xi − xi−1 |2 . This cost function is the sum of uniformly convex functions and is therefore uniformly convex. Therefore by extension of the argument for uniform convexity in §1, the network s∗ (x) is cyclically monotone and one to one under the same discretization scheme. This implies that there exists some convex potential function φ∗ (x) so that the optimal transportation scheme lines within the gradient of φ∗ . What remains is to verify the coordinate transformation that formulates the dual convex functions (φ∗ (x), ψ ∗ (y)) such that s∗ (x) ⊂ Dφ∗ (x). Following the proof by L.C. Evans, we here show that this extends to this formulation as well. Theorem 4.1. There exists convex dual functions (φ∗ (x), ψ ∗ (y)) given by φ∗ (x0 ) = ∗ ψ (xN ) = N −1 X 1 |xi − xi−1 |2 − u(x0 ) 2 i=1 N X 1 i=2 2 |xi − xi−1 |2 − v(xN ) such that s∗ (x) ⊂ Dφ∗ (x) and φ∗ (x0 ) = max{ĉ − ψ(xn )} xN ψ ∗ (xN ) = max{ĉ − φ(x0 )} x0 where ĉ = max { x0 ,...,xN N X i=1 xi · xi−1 }. 15 Proof. Note that because ĉ is a sum of inner products between each of the components in the graph, thus the solution is invariant to the order in which the points are maximized. If φ, ψ satisfy the constraint of (3) then φ(x) ≥ max(ĉ − ψ(y)) := φ̂(x) xN and φ̂(x) + ψ(y) ≥ ĉ (x ∈ X, y ∈ Y ). Furthermore, ˆ := ψ̂(y) ψ(y) ≥ max(ĉ − φ(x)) x0 so that, φ̂ + ψ̂ ≥ ĉ (x ∈ X, y ∈ Y ) Where if ψ ≥ ψ̂ max(ĉ − ψ̂(y)) ≥ φ̂(x). xn Finally to see that this is indeed consistent with φ∗ (x0 )+ψ ∗ (xN ) ≥ PN i=1 xi ·xi−1 c(x0 , xN ) ≥ u(x0 ) + v(xN ) −u(x0 ) − v(xN ) ≥ − φ(x0 ) + ψ(xN ) = φ(x0 ) + ψ(xN ) ≥ φ(x) + ψ(y) = N X 1 2 i=1 |xi − xi−1 |2 N −1 X N X 1 1 |xi − xi−1 |2 − u(x0 ) + |xi − xi−1 |2 − v(xN ) 2 2 i=1 i=2 N −1 X N N X X 1 1 1 |xi − xi−1 |2 + |xi − xi−1 |2 − |xi − xi−1 |2 2 2 2 i=1 i=2 i=1 N X xi · xi−1 i=1 Thus the convex dual formulation is given by Z min φ,ψ Z φ(x)dx + X s.t. φ(x) + ψ(y) ≥ ψ(y)dy Y N X i=1 xi · xi−1 (6) 16 Network Transfer as a Linear Programming Problem The cost function evaluated as the sum over each network component requires a modification to the discrete network vector sij and thus the linear programming problem. First note that the dimension of s is increased for each set of points added between xi and xj . In our change of notation we let xi ∈ X0 and xj ∈ XN . Consider the problem when N = 2 so that there is one set of k interior nodes X1 . Then the vector s is then given by sitj = s000 s010 ... s0km s100 ... snkm In general denote the set of all sets of interior points as Xk=1,...,N −1 = {K} with `k −1 nodes in the kth set, and then the dimension of K is given by ` = ΠN k=1 `k . Thus the vectors for the network s and the cost c are both in Rm`n . Thus the matrix A is modified so that the primal problem is consistent min c · s s.t. As = b s≥0 The constraints are consistent m X j=1 sikj = µ+ i , n X sikj = µ− j . i=i and so the vector b is invariant. Where b ∈ Rm+n is given by + − − + b = (µ+ 1 , µ2 , ..., µn , µ1 , ..., µm ). Then construct A so that the constraints are satisfied. A is an (n + m) × nm` matrix composed of ones vectors 1 ∈ Rm·` and basis vectors em where there is a vector of ones of length 1̂ ∈ R` . in the j · ` spot for j = 1, ..., m. If ` is 2 and m is 17 3 then e1 = 1 1 0 0 0 0 .   1 0  0 1    ... ...    0 0 A=   e1 e1    e2 e2    ... ...   em em ... ... ... ... ... ... ... ... 0  0   ...     1   e1    e2    ...    em Because the Lagrange dual is preserved, so is the dual linear programming problem with A given above. max b · y s.t. AT y ≤ c where y ∈ Rn+m , and y = (u1 , u2 , .., un , v1 , v2 , ..., vm ). The linear programming problem for the dual convex functions must be modified more substantially. It is easier here to separate φ and ψ from the vector p. Then the dual convex linear programming problem is defined as min µ+ · φ + µ− · ψ s.t. φ(x) + ψ(y) ≥ ĉ (x ∈ X0 , y ∈ XN ) where ĉ is defined above. The same techniques from direct transfer can be applied to resolve the optimal transportation problem with a directed graph. It is important to note that with each additional set of points the size of the problem grows exponentially. Thus these systems can become very large and difficult to solve. Network Transfer Analysis In the following example four masses are transferred from an initial location to their target solutions by lattice points. From each lattice point the masses may 18 redistribute themselves to any of the eight neighboring lattice points. Thus a directed graph is formed between each of the lattice points. The network is formed from each set of simple paths connecting the initial location to the corresponding final location. However, lattice movement restricted in the first region to only lattice points above the initial location, and along the boundary of a 5 × 4 grid. With these constraints, the masses attempt to reduce the cost of movement by maximizing transfer along the diagonals. Figure 4: Optimal transportation along a directed graph of lattice points Network Cost Variation Analysis Suppose that the cost function is varied over two different regions. Then a set of intermediate nodes may be added along the boundary between the cost variation and the cost function discussed above is modified to reflect the variation between the two regions. In particular for some αi acting as a scalar modifier of the cost function in each 19 region, the cost function is defined as c(x0 , s(x)) = N X αi |xi − xi−1 |2 . i=1 This cost function is still uniformly convex and thus the analysis holds. In the following example, the cost is higher in the darker region. While there may be numerous points that are discretized, the visualization displays the primary transfer locations for the masses. In this example the masses are redistributed in the low cost region, and then move linearly to their final location. This is because the cost of moving along a diagonal is higher than moving along a straight line. Thus diagonal transfer occurs in the low cost region . Figure 5: Cost variation over two regions 4. APPLICATIONS Many applications of the optimal transportation problem model spatial relations between objects. Thus the development of visualization tools can be directly applied to optimal transportation problems. Two primary aspects of visualization 20 are considered here. First is the redistribution network for each individual particle. The second is cost of movement. Consider the following transfer problem. Figure 6: Discrete redistribution by color scheme One option for visualization is to color the location of masses in the initial location to visualize where they are redistributed to. This technique may be combined with a heat map of the cost for transfer between two locations. This visualization technique is useful in the study of deep learning networks to visualize the network. This particular technique is used in the study of Weirstrauss Generative Adversarial Networks. Utilizing the MongeKantorovich formulation, this process trains a generator and a discriminator on several images. The objective of the generator is to generate images which are close to the images that the discriminator is trying to discriminate between. A further discussion of images as distributions will be introduced in palette swapping, however the generator can be improved by finding optimal redistributions of known image distributions. The implementation of WGAN can reduce the workload on the learning network by reducing the number of updates needed to balance the discriminator and generator. This visualization technique helps remove some of the ambiguity of what happens within the deep learning network. 21 Figure 7: Cost of transportation visualized as a heatmap Linear Swarm Transfer These techniques scale up to two and three dimensional representations. Consider the two dimensional transfer problem of redistributing points along a circle. In this particular problem the mass at each point is the same, however the scale of the dots representing masses may be increased to visualize increased mass. The transfer network is represented by the directional arrows. A color gradient denotes the cost of transfer for each of the points, with lighter colors representing higher cost. 22 (a) Mass distribution visualization (b) Mass transfer network Figure 8: Two dimensional swarm transfer This particular example is the application of optimal transportation to particle swarm optimization. Consider this visualization applied to the problem of redistributing particles into an optimal configuration with control over the particle’s velocity. The goal is to align all of the particles along the circle at the same time. Then the color of the arrows describing the cost to transport also indicates the necessary velocity to transfer along the ray to align at the appropriate time. These particles may be robots in a factory, swarms of drones or other redistributing particles. This application may also be scaled to three dimensions. In the following problem particle swarms is redistributed (suppose they are drones) to a constant altitude, beginning from the same starting location on the ground. 23 Figure 9: Three dimensional swarm transfer This type of network is also useful in modern air traffic control. There has been significant developments towards implementing a new generation of air traffic control that reduce delays, holds and separation while maintaining aircraft safety. Aircraft travel along directed graphs between airborne waypoints. Thus the extension of this three dimensional visualization to a network of simple paths along a directed network can be utilized to simulate aircraft transportation. N-Dimensional Redistribution It is possible that the problem at hand is larger than three dimensions but visualization is still useful. In this instance the masses may be ordered and then transfer considered by transferring along the ordered masses. In the following example transfer is visualized along lattice points sufficiently spaced so that the network can be sufficiently visualized. 24 Figure 10: Transfer along a network between ordered nodes This particular visualization is useful in modeling atmospheric conditions where the transfer is not only a transfer of space but also a transfer of states. In atmospheric studies the transportation of momentum, temperature trace gasses and water or ice crystals are considered along with spatial transfer in three dimensions. Nodes can be ordered into groups by state variables. This technique of visualization can help map out both transportation of states along with physical transportation. Palette Swapping Palette swapping is the process of pushing the color palette of one image onto the color palette of a target image. This process has applications in graphic design and photo editing, as well as steganography and object detection and tracking. The problem is formulated by creating a probability distribution of the pixel values in each image, and then pushing one distribution onto the other. Several different distributions may be considered. In the following example the distribution is taken in terms of the pixel values. Other image related swappings include image intensity for brightening or pixel variation for blending. Consider the following target and palette image. 25 (a) Palette (b) Target Figure 11: Initial images for palette swapping To help reduce run time pixels are grouped into a k-nearest neighbors distribution. The k-means average of each pixel cluster is then the probability distribution pushed between each of the images. Here the clustered images are displayed where each original pixel is assigned to its clustered average. (a) Palette (b) Target Figure 12: Clustered images for palette swapping Each unique pixel color in the reconstructed images are given a mass of one and the optimal transfer between them minimizes the three dimensional cost function c(x, y) = .5|x − y|2 where x and y are pixel values in the palette and target images respectively. 26 Figure 13: Clustered target image with new palette This is an example of direct transformation between each of the probability distributions. It may be expected that the butterflies wings remain orange. However, in this case the red of the flower and the orange of the butterfly wings are minimized by transferring orange to red and green to orange. These results can be changed by varying the amount of mass at each location, the number of pixels in the clustering and the cost function. Contour Descent Contour descent is an example of minimization over an undirected graph. The objective of contour descent is to minimize the distance traveled between two points along a contour map, while avoiding steep descents. The cost function is then given by c(x0 , xn ) = n−1 X αi |xi − xi+1 |2 i=0 where αi represents a variable cost between each of the contours. In the following example α scales with the darkness of the region, so that α is highest in the darkest regions. Two variations of the problem are considered. In the first case the contours are exact circles. In this case, the minimal distance between the initial location (the center of the contours) and the target points on the boundary of the final contour is the direct line between the center and the boundary. However, if the contour shape is varied to form an elipse, then the masses begin to transfer in various 27 patterns which are dependent on the shape of the contours and the value of αi in that particular region. These contours can also be extended to any closed polygon (a) Circular contours (b) Eliptical contours Figure 14: Comparison of contour descents by contour shape Consider the application to descending a mountain slope where a rescue team wants to transfer an individual over as short of a distance as possible while avoiding steep terrain. This problem describes the best path for traversal. The value of α can be varied to correspond to the cost of traversing a particular domain. Conclusion The success of the Monge-Kantorovich problems modeling capability encourages further study. This paper extends the Monge-Kantorovich formulation of optimal transportation problem to a network of paths. We reformulate the problem and reduce it to the linear programming problem which allows us to efficiently compute the numerical solution This extends the applications of the Monge-Kantorovich formulation. These applications include but are not limited to, multi-step disaster relief planning, warehouse robotic movement along a restricted set of paths, and improved national air traffic control. LIST OF FIGURES 1 Optimal transportation path between two probability distributions . 2 2 Comparison of discretization schemes . . . . . . . . . . . . . . . . . 8 3 Discretization and transfer of masses using linear programming . . . 13 4 Optimal transportation along a directed graph of lattice points . . . 18 5 Cost variation over two regions . . . . . . . . . . . . . . . . . . . . 19 6 Discrete redistribution by color scheme . . . . . . . . . . . . . . . . 20 7 Cost of transportation visualized as a heatmap . . . . . . . . . . . . 21 8 Two dimensional swarm transfer . . . . . . . . . . . . . . . . . . . . 22 9 Three dimensional swarm transfer . . . . . . . . . . . . . . . . . . . 23 10 Transfer along a network between ordered nodes . . . . . . . . . . . 24 11 Initial Images for Palette Swapping . . . . . . . . . . . . . . . . . . 25 12 Clustered images for palette swapping . . . . . . . . . . . . . . . . . 25 13 Clustered Target Image with New Palette 14 Comparison of contour descents by contour shape . . . . . . . . . . 27 28 . . . . . . . . . . . . . . 26 29 ACKNOWLEDGMENTS I would like to thank my mentor, Elena Cherkaev, for her guidance. I would also like to thank the Department of Mathematics and the Undergraduate Research Opportunities Program at the University of Utah for funding this REU project. 30 REFERENCES 1. Domahidi, Alexander, Eric Chu, and Stephen Boyd. ECOS: An SOCP solver for embedded systems. 2013 European Control Conference (ECC). IEEE, 2013. 2. Evans, L. C. Partial differential equations and Monge–Kantorovich mass transfer. In Current developments in mathematics, 1997 (Cambridge, MA). Int. Press, Boston, MA, 1999, pp. 65–126 3. Krishnan, Vishaal and Sonia Martı́nez Distributed optimal transport for the deployment of swarms 2018 (arXiv:1804.01572) 4. Pitié, François, and Anil Kokaram. The linear monge-kantorovitch linear colour mapping for example-based colour transfer. 2007 (Trinity Colegge Dublin, Irelnad) 5. Rockafellar, Ralph Tyrell. Convex analysis. Princeton university press, 2015. 6. Xia, Qinglan Motivations, ideas, and applications of ramified optimal transportation. ESAIM: Mathematical Modelling and Numerical Analysis. Volume 49, Number 6, November-December 2015. Special Issue - Optimal Transport. pp 1791 - 1832 University of Utah UNDERGRADUATE RESEARCH JOURNAL DRUGS AND PREGNANCY: CLINICAL MANAGEMENT WITH A CYSTIC FIBROSIS FOCUS Micah Ballif (Kathleen Job, PhD) Department of Chemistry ABSTRACT Despite the large number of women who become pregnant and use a medication during their pregnancy, there is very little information about the safety of the majority of medications. Most drugs approved by the FDA have undetermined teratogenic risk, but their use is prevalent in the management of disease during pregnancy. Physicians are faced with the daunting challenge of prescribing a dose that will have the intended therapeutic effect without putting the mother and fetus at risk, should they choose to prescribe at all. Section 1 describes trends and practices of medication use among pregnant women. As many as 90% of pregnant women take at least one medication during their pregnancy to manage other morbidities. Research into perinatal medicine has been extremely neglected and the majority of FDA drug classifications for pregnant women conclude that there is insufficient information and human data to make any conclusive statement about the drug’s safety. It is an extremely precarious challenge to prescribe a dose that is neither so low that it is ineffective or so high that it is toxic and harmful. Often, a doctor or pharmacist will simply recommend stopping the medication during pregnancy, if possible. In other instances, continued use of the medication during pregnancy is inevitable, despite the risks. Section 2 is a literature review that examines the prevalence of common morbidities during pregnancy and common medications used as treatments, the respective drug’s FDA pregnancy ranking, and consequences to the mother and fetus if the disease is left untreated. An average of 11.87% (± 1.83%) of pregnant women have at least one of the examined conditions, and an average of 82.75% (± 17.0%) of each disease’s treatment options have unknown risk. The most common consequences of untreated disease in the mother are worsening of symptoms, preeclampsia, and risk of future disease, while those in the fetus are premature birth, miscarriage, and low birth weight. The results illustrate the need for both established treatment options during pregnancy as well as further research into this vulnerable population. Section 3 is a retrospective chart review of pregnant cystic fibrosis patients at the University of Utah Hospital. The goal of the review is to understand what antibiotics pharmacists are prescribing and in what dosages in order to illuminate any prescribing patterns despite the lack of guidelines. Data collected includes demographics, antibiotic information, and pulmonary function as a measure of health. The University of Utah Hospital’s database contained records for 32 patients for a total of 44 pregnancies. Analysis showed that most pregnancies showed up to a 199% higher usage of antibiotics outside of pregnancy, though some patients’ usage was over 1000% greater. An average of 5.63 (± 5.93) antibiotic dosages were prescribed for use during pregnancy, and 50% of those drugs were prescribed for use the day the pregnancy ended. These elucidated trends point to areas of future research to understand the informal guidelines or physician discretion behind them. Introduction Each year, approximately four million women become pregnant and give birth in the United States. Many of these women have a pre-existing health condition or chronic illness they must continue to manage with medication during pregnancy. As many as 90% of pregnant women take at least one medication during their pregnancy to manage these morbidities1. Despite the frequency of both pregnant women becoming sick and sick women becoming pregnant, research into perinatal medicine has been extremely neglected. The vast majority of FDA drug classifications for use during pregnancy communicate there is insufficient information and human data to make any conclusive statement about perinatal drug safety. It is an extremely precarious challenge to prescribe a dose that is neither so low that it is ineffective or so high that it is toxic and harmful. Often, a doctor or pharmacist may simply recommend stopping the medication during pregnancy, if possible. In other instances, continued use of the medication during pregnancy is inevitable, despite the risks. Neither situation is completely safe, or one in which a physician or pregnant woman can rest confidently. It is essential that ethical research is conducted on drug use in pregnant women in order to eliminate a dangerous and harmful gap of knowledge. In this thesis, I will examine the current management of various morbidities during pregnancy and create an overview of recommendations about medication usage. In Section 1 I will review literature to understand the situation regarding current medication usage and the status of clinical research involving pregnant women. Specifically, I will examine the available data to serve as the basis for prescribing decisions, describe the ethical dilemma of research on pregnant women, summarize consequences of unmanaged maternal illness, and point to directions of future research. In Section 2, I will create an overview of illness in pregnancy in order to examine what morbidities are common among pregnant women, what medications are regularly used to manage the disease or condition, and the respective drug’s FDA status for use during pregnancy. I will compile a list of consequences to both mother and fetus when the condition is not managed. In Section 3, with my research group in clinical pharmacology at the University of Utah, I will examine one specific disease, cystic fibrosis (CF) in depth, as it is an illustrative and important example of a disease that must be managed by medication, even during pregnancy. CF is unique because the disease requires a host of medications to ensure health. The use of medication, especially antibiotics, has increased the life expectancy of those with CF to a point that women are able to become pregnant. Antibiotics combat bacterial infections, one of the most prevalent and detrimental issues common to CF. Stopping those medications presents an extremely high risk to the mother as well as the fetus. A wealth of information is included in the University of Utah Hospital’s Electronic Data Warehouse (EDW), which gathers data on individuals treated at the hospital. The research group wishes to use the information available in the EDW to understand medication usage, hospital management, outcomes, and demographic characteristics of pregnant women with CF. A retrospective chart review will be performed to collect the necessary data. Subjects will include women with CF who have at some point become pregnant, ages 18-65. Data collected will include demographics, antibiotic information, pulmonary function, and type of infection. This in depth study aims to understand antibiotic prescribing patterns and outcomes associated with treatment of pregnant women. SECTION 1-THERAPEUTIC ORPHANS: NEED FOR MEDICATION STUDIES WITH PREGNANT WOMEN Millions of women give birth every year, and medication usage during those pregnancies is far from rare. More than 90% of women use one or more medications during the course of their pregnancies, as many as 80% during the first trimester alone1.Overall, this high usage rate is only continuing to increase. Over the last four decades, medication use increased 68%, and nearly half of pregnant women use at least four medications over the course of their pregnancy1. There are several explanations for the recent increase in medication usage. Primarily, the demographic of women who are becoming pregnant has shifted to a later age1-3. Women are choosing to start families and become pregnant at later stages in life. Generally, women in older age demographics use more medicines to manage their health. Additionally, women are developing both chronic and acute conditions at younger ages, which overlap with pregnancy. Several studies specify chronic conditions, including diabetes, depression, hypertension, and acute obstetric complications, including nausea and cholestasis, that have increased in prevalence in younger populations in recent years4-7. Those conditions, among many others, require treatment with medication. Thus, as the prevalence of such diseases and conditions in younger demographics grows larger, so does the use of their respective medications in those age groups. Women of childbearing age are a significant part of such a demographic. Two illustrative examples of increased disease prevalence among pregnant women are that of diabetes and hypertension. In a study of United States pregnancies, the CDC reported a 56% increase in gestational diabetes and a 37% increase in pre-pregnancy type I and type II diabetes8. Similarly, in 2005 antihypertensive medications were prescribed at nearly twice the rate of 1996 9-11. It is also interesting to note the case of depression-an illness which has not only increased in prevalence but one for which the practice of medication management has become more common. Currently, it is estimated that 10.5% of pregnant women are prescribed a psychotropic medicine- a drastic increase from less than 1% decades earlier9. In addition to antidepressants, nearly 2% of pregnant women are also prescribed another psychotropic medicine, typically an anxiolytic12. The aforementioned use of medication is informed and intentional, as women continue to manage acute and chronic conditions that existed prior to pregnancy or that developed during gestation. However, some medication use is a result of unintentional exposure which may or may not be realized. Several studies report high numbers of pregnant women who are exposed to drugs over the course of pregnancy. The largest exposures are to FDA class B and C drugs at a combined 78%, which have unknown teratogenic risk.6, 14 Exposure to classes D and X drugs occurs at 3.4% and 1.1%, respectively5. Both classifications indicate known risk of harm to the fetus and are more dangerous for pregnant women and fetuses. An especially important scenario to note is that of exposure during the early first trimester before the mother is aware of the pregnancy. If a mother is unaware that she is pregnant, it is entirely possible that she would not modify or avoid potentially harmful behaviors during that time period. After a pregnancy is confirmed at approximately eight weeks, the mother would have already experienced the developmental stage corresponding to the largest risk of malformation15. Intentional medication use or accidental exposure during this time could have severe consequences, so it is important to have data on medication safety in the time period prior to pregnancy as well. The frequency of both exposure and intentional usage is clearly significant. However, such usage is concerning when one considers the small percentage of drug studies and clinical trials that include data for use during pregnancy. Pregnant women have been described as “therapeutic orphans” due to the void of information regarding drug metabolism and safety during pregnancy. An overwhelming majority, 99%, of pharmacokinetic studies completed in recent years do not include drug metabolism data for pregnant women16. Lack of studies have a severe and immediate consequence-the inability to understand safety, risks, and proper dosages during pregnancy. An investigation with the Teratogen Information System showed that among 172 medications which were approved by the FDA from 2000 to 2010, a mere 2% of had been sufficiently studied in order to reveal teratogenic risk, and more than 70% of the drugs were devoid of any pregnancy data at all17. However, despite the stark lack of safety, risk-benefit analysis, and dosing studies for pregnant women, this knowledge gap has been filled in ways that hinder proper treatment of illness during pregnancy. Currently, most dosing practices and treatment guidelines for pregnant women, where they do exist, are created with standard adult doses in mind. These practices and guidelines were developed using safety and efficacy data from healthy, majority male populations18. Neither of those characteristics are representative of pregnant women with an illness. As such, there is no evidence that such results are applicable to pregnant women19. Even studies among women are not relevant to pregnant women. Conducting drug pharmacokinetic studies with female individuals who aren’t pregnant is insufficient because the risks and benefits of a drug are different for pregnant women than non-pregnant women due to physiological and pharmacokinetic differences of pregnant individuals19. None of these dosing guidelines can guarantee the intended therapeutic effect of the medicine. In rare instances, pharmacokinetic trials are created for pregnant women, but examination of such studies revealed that rather than focusing on risk to mother and fetus during pregnancy, the trials focused on labor and delivery16. Ultimately, there are very few clinical sources of information for both physicians and mothers that adequately describe safety, efficacy and dosing information for pregnant women. Some information does exist, however, and is often “low-hanging fruit” that is simple to collect. Some of these more illustrative instances of drug use in pregnancy occur in random and uncontrolled settings. The FDA has recognized the practice of collecting data in a post-marketing setting, primarily from exposure registries or observational studies, in which an individual may elect to continue the use of certain drug during gestation, despite possible risks20. Such examples may provide glimpses of successful drug use during pregnancy and illuminate possibilities for future research. These instances, however, are far too rare and uncontrolled to provide adequate data or serve as the basis for comprehensive guidelines regarding safety and dosage information for pregnant patients. Despite the many challenges surrounding the discovery and implementation of proper medication use in pregnant women, the motivations to do so are clear. Above all else, women need effective and safe medications and treatment while they are pregnant. Failure to elucidate and develop such therapy may negatively affect the health of both mother and fetus. Therefore, the lack of dosing and safety data for pregnant women must be treated as a public health issue, and a recent statement by the FDA recognizes it as such21. Pregnant women may experience many of the same chronic and acute conditions that their non-pregnant counterparts do, but these illnesses pose different risks to pregnant patients as well as their fetuses. Some of the most common conditions in both populations include diabetes, depression, asthma, and cardiovascular and renal diseases22. These conditions are not only a detriment to the mother’s quality of life, but can also be extremely dangerous if uncontrolled. Maternal illnesses, whether pre-existing or developed during pregnancy, have been identified as the leading cause of death among pregnant women23. For example, depression in women who stop antidepressant medication completely can result in increased morbidity and hospitalization and ultimately lead to maternal death24. Investigation of treatment options to avoid such severe and even fatal consequences is essential. It is also necessary to consider the outcome of the fetus when treating illness during pregnancy. Many medications used to treat various maternal conditions can be harmful to the fetus, but leaving the condition unmanaged in the mother is not necessarily a safer option. For example, if a mother with type 1 or 2 diabetes experiences high blood sugar near conception, the fetus has an increased risk of being stillborn or premature and developing birth defects25. Mental illnesses such as depression also carry severe consequences for the fetus if left untreated, including spontaneous pregnancy loss and low birth weight24. Ultimately, action and inaction both have potentially fatal consequences for the fetus and mother, and neither physician nor pregnant patient can make most decisions about medication therapy with confidence. Pregnant women and physicians are left to navigate pregnancy without a sufficient knowledge base of information. Attempts at standardization have been made, however, for the sake of communication and accessibility. One of the most complete sources of data concerning safety and risks of drug use while pregnant is that of the Food and Drug Administration (FDA) drug ranking system. Until 2015, a simple letter classification was used exclusively, in which each drug was assigned an “A,” “B,” “C,” “D,” or “X” rating, which represents a specific level of safety and knowledge about use and risk. Though this system is gradually being replaced with a more comprehensive, in depth description of each drug to better equip physicians and patients alike, it will still be described in this thesis due to the common knowledge of the system, the gradual phasing out of the system for drugs approved before the new system was implemented, and the continued reference to the previous system by many reputable sources of information directed at pregnant women. Description of the previous system also serves to elucidate the lack of knowledge of teratogenic risk from an official, regulated standpoint. In the previous system, each letter ranking corresponds to a certain level of risk involved with taking the drug during pregnancy as well as the level of research done to investigate teratogenic risk. “A” corresponds to adequate research that has failed to show that the medication poses a risk to the fetus during the first trimester of pregnancy, and there is no evidence of harm during the rest of gestation. “D” and “X” both correspond to positive evidence of risk to the fetus, but the benefits that a “D” medication provides may warrant its use during pregnancy. The same is not true for “X,” where the risk of using the medication significantly outweigh possible benefits and should therefore be avoided at all costs. “B” and “C” communicate the ambiguity of the vast majority of medications approved by the FDA. Both correspond to a lack of sufficient research in a human population to validate its use. “B” also lacks evidence from animal studies of harm to the fetus, while a “C” ranking does show evidence of risk from animal studies. “B” and “C” rankings essentially embody the FDA’s lack of data and knowledge about the teratogenic risk of those drugs. Though the simplicity of such a ranking system appears useful and accessible by many, it is also evident that the lack of conclusiveness presented by the rankings is a detriment to both pregnant women and their caregivers. Of all drugs approved by the FDA from 1980 to 2010, over 90% had unknown teratogenic risk17. Less than 10% of the medications have a definitive “A,” “D,” or “X” ranking, while the vast majority have an inconclusive “B” or “C” ranking. Moreover, the simplicity of such rankings fails to properly describe important subtleties of each medication, including the effects of dosages and timing during specific trimesters. For example, a drug may be especially risky during the first trimester, but far safer for use one the time associated with high risk of fetal malformation has passed. The FDA letter categories fail to impart this important information. One study notes how blanket references to the categories alone in complex situations can create unnecessary risk and improperly convey necessary information26. Thus, even when teratogenic data is known, it is not represented correctly or at all in the FDA category system. Additionally, it is important to note that while implementation of the new system provides patients and physicians with descriptions of more specific areas of concern and more thoroughly compiles known information, the vast majority of medications still have undetermined teratogenic risks and are insufficiently studied. The task of properly understanding the use of medication in pregnant women remains daunting. Ultimately, when physicians consider prescribing a medication during pregnancy, the resources available to them do not properly communicate data regarding safety, dosage, and timing. Often, physicians prescribe medications to pregnant women without knowledge of the dosage necessary to obtain the intended therapeutic effect27. As a result, medicinal therapy during pregnancy exists on a fine line. The physician faces the precarious challenge of prescribing a dose high enough that it is therapeutically effective while still low enough that it is not harmful to either mother or baby, and that is if the physician chooses to prescribe at all. In any other therapeutic setting, uncertainty on this scale is intolerable. Specifics of this fine line are detailed further in Section 2. This dire situation may lead to prescribing decisions that lead to serious consequences. For example, in many instances asthma is well managed by proper medication, but more than 25% of surveyed doctors would lower the dosage or completely stop the prescription of the medication for a pregnant patient, in spite of well-known potential consequences of uncontrolled asthma to the fetus28. There are many factors that contribute to the lack of knowledge surrounding drug use in pregnancy and the fine line of prescription decisions. However, many are preventable, and doing so could significantly elevate the situation of pregnant women from the last remaining “therapeutic orphans” of drug metabolism studies. One of the primary sources of the lack of information about drug use in pregnant women is the simple lack of motivation for drug studies. There is no governmental incentive or mandate for pharmaceutical companies to pay for clinical trials that study pregnant women or include them as participants in a separate study. Less than 9% of studies that do consider pregnant women were sponsored by the pharmaceutical industry16. However, government incentives, funding, and mandates could significantly improve this number and lessen the burden of taking on such research. Several studies point to evidence of success of such programs and call for these incentives and mandates to be put into effect29, 30. A higher percentage of drug studies including pregnant women is key to creating a larger knowledge base for physicians to properly understand medication use among their pregnant patients. Another contributing factor to the hesitation to treat pregnant patients with medication is significant ethical concern about enrolling pregnant patients in clinical trials and the possibility of putting the fetus at risk. This concern is largely responsible for pregnancy historically being an exclusion criterion in the vast majority of clinical trials. However, as the consequences of such exclusion are coming to light, ethicists are now arguing the opposite-it is unjust to exclude pregnant women from clinical trials because of the detrimental knowledge gap it creates31. In fact, exclusion harms the very population that drug companies and ethicists alike initially sought to protect. Individual bioethicists and physicians are not alone in the argument for ethical inclusion of pregnant women in studies. The Food and Drug Administration, European Medicines Agency, and US Institute of Medicine all formally recognize the damage done by exclusion of pregnant women from clinical trials and call for more adequate and well-controlled studies among this population32-35. Ethical analysis is an important part of addressing the insufficient treatment and knowledge of pregnant women, as the ultimate goal of healthcare and research is to improve one’s health and wellbeing. Finally, a significant factor in whether or not a medication is used to manage a condition during pregnancy is the mother’s own hesitation due to lack of knowledge about correct use and uncertainty of harmful perinatal outcomes. The majority of women state that unknown or conflicting information about risks to the fetus would prevent them from taking medication36. Even women with health conditions predating their pregnancies often stop medication usage, particularly during the early stages of gestation37, 38. Notably, non-adherence rates are much higher among pregnant women than among a general adult population37, 39. It is logical that a mother’s desire and natural instinct is to protect her baby and make the best health decisions possible for her fetus. However, this concern in combination with the lack of definite information regarding medication safety can cause pregnant patients to overestimate the risk caused by usage and exposure40. Overestimation of risk ultimately may lead to a loss of opportunity to properly manage a condition during pregnancy, which could result in better maternal and fetal outcomes. Overall, lack of research involving medication use among pregnant women and its resultant prescribing practices have consequences that research is just now illuminating. There are compelling reasons and areas of potential for future work. Primarily, far more pregnant women and their fetuses are put at risk by medication exposure during pregnancy than those who would undergo drug development clinical trials in well-controlled studies41. There is less risk and far more benefit to be had by conducting a rigorous study than relying on uncontrolled data and largely refraining from including pregnant women in clinical trials. New studies may have an extremely large impact and redefine the way in which research involving pregnant women is completed by focusing on the following: 1. Compilation of evidence to support clinical prescribing practices based on research. 2. Existing data and current studies that may be used to answer new research questions. 3. Development of studies to address pressing questions with large implications for pregnant women and their fetuses. 4. Repurposing already-approved drugs for use in pregnancy. 5. Investigation into far-reaching effects of drug use during pregnancy for both mother and child. 6. Better diagnostic tools for faster detection of other diseases during pregnancy. 7. Implementation of government incentives for pharmaceutical industry-funded trials. 8. Mandatory reports of unlicensed drug use among pregnant women in order to reduce ad hoc random reporting. 9. Better control of drug regulation and intellectual property pathways in order to facilitate future investigations19, 42. Research is everyone’s concern, including pregnant women and their fetuses. Prioritization of these studies can ultimately improve outcomes for both mother and fetus by allowing physicians to successfully manage morbidities during pregnancy with minimal risk and increased confidence. SECTION 2: COMMON CONDITIONS DURING PREGNANCY AND THEIR THERAPEUTIC OPTIONS Introduction There are many notable conditions with high prevalence both among women of childbearing age and their pregnant counterparts. As discussed in Section 1, such illnesses, both acute and chronic, are becoming increasingly common and occurring and younger ages than in recent decades. As this prevalence increases, so does the practice of managing the condition with medicinal therapeutics. In order to more fully understand this practice, this section presents an analysis of the most common morbidities among pregnant women, what medications are regularly used to manage the disease or condition, and the respective drug’s FDA status for use during pregnancy. Additionally, a list of consequences to both mother and fetus when the condition is not managed is presented. All information was compiled into a single table. Methods The table is not intended to be a comprehensive collection of conditions, medications, and consequences. Rather, it is intended to illustrate through specific and common examples both the lack of knowledge surrounding use of medication during pregnancy as well as possible outcomes of common morbidities during pregnancy if left unmanaged. Selected Conditions The included diseases were selected for their significant prevalence and frequency of discussion in literature examined for this paper. Diseases that are exceedingly rare, affect men only, or generally are prevalent among populations of women that are not of childbearing age were excluded in order to present the most common treatment scenarios that pregnant patients and their physicians encounter. Due to the excessive number of cancers that plague the world’s population, the unique drugs and specifics actions that are often required as treatments, and the additional harm that chemotherapy and radiation can bring to pregnancy, cancer and its respective treatments are not included in this chart. All sources are denoted within the chart. Medications Lists of medications for treatment were obtained from consumer information publications from the FDA. If the FDA did not have a comprehensive list published, alternate reputable sources such as the Mayo Clinic were used. If, within the publication, medications were described as “less commonly used,” “rare,” “used less frequently,” “secondary treatment options,” or “alternative,” they were excluded from the list in order to better present the most common scenarios which pregnant patients and physicians encounter. Some medications in the list are used to treat multiple diseases. In these instances, the medication is listed under each disease for which it is a therapy in order to present a more complete picture of treatment options available for each condition. However, duplicates were eliminated in the calculation of statistics (see “Statistics” below.) All sources are denoted within the chart. Consequences if Left Untreated Consequences to mother and fetus if left untreated were obtained from peer-reviewed literature published in various obstetrics, gynecology, and pharmacology journals. All sources are denoted within the chart. Statistics Numerical variables were summarized by means (+/- SD). Binary and categorical variables were summarized by frequency (in %). Transformed numerical variables were used if their original variables were found to be a departure of Gaussian distribution assumptions before formal analyses were performed. For each disease, the percentage of each drug classification was determined for the drugs included as treatment options. In order to understand the relative treatment safety for the different diseases, the following descriptions were used: “low risk” describes conditions for which 0-50% of the medication options have an undetermined risk, “moderate risk” describes conditions for which 50-89% of the medication options have an undetermined risk and “high risk” describes conditions for which 90-100% of the medication have an undetermined risk. Undetermined risk is defined as FDA categories “B”, “C”, or “not assigned”. Additionally, each FDA category’s overall percentage was determined for all medications examined in order to obtain a description of medication management during pregnancy as a whole. For this calculation, duplicate medications in the table were excluded. For both consequences to the mother and to the fetus if the disease is left unmanaged, the frequency of consequences for all conditions were tabulated in order to elucidate any common outcomes when conditions during pregnancy are left unmanaged. Results and Discussion The complete table of all medications, FDA pregnancy rankings, and consequences to mother and fetus when the condition is left unmanaged is presented in Appendix A, along with all references, and not included here due to its large size. Below is a summary of the findings. Condition Prevalence of Conditions among Pregnant Women Renal Diseases Epilepsy Diabetes, Type 2 Diabetes, Type 1 Autoimmune Disease Bipolar Disorder Cardiovascular Diseases Hypertension Flu Asthma Depression Anxiety Bacterial Infection Allergies Pain 0 10 20 30 40 50 60 70 % of Pregnant Women with Condition Figure 1. The percentage of all pregnant patients with the respective condition, who may or may not require medicinal treatment for it51,55,64,66,71,75,79,82,83,89,93,98,103,108,112. On average, 11.87% (±1.83%) of pregnant women have at least one of the examined fifteen diseases during their pregnancy. If approximately four million women become pregnant every year in the United States, this corresponds to an average of 474,800 women who have at least one of the diseases listed in Figure 1. The most common condition, pain, is experienced by 60% of all pregnant patients, or 2,400,000 women. The least common, renal disease, is experienced by 0.12% of all pregnant patients, or 4,800 women. Even the least common of the fifteen conditions examined results in a significant population that must choose either medication management with unknown levels of risk to the fetus or face potentially severe consequences of uncontrolled disease. FDA Pregnancy Categories for Examined Medications 23, 5% 0, 0% 20, 5% 69, 16% 122, 28% 199, 46% A B C D X Not Assigned Figure 2. In the chart, the raw number of medications for the respective category is listed first, out of a total of 433, followed by the percentage of the total medications for the respective category. Because there are no category “A” medications, there is not a corresponding section of the chart52,56,64,67,72,76,80,84-85,90,94-95,99,104,109,113. A total of 433 medications were examined as treatment options for fifteen conditions or diseases that commonly occur during pregnancy. No condition had a medication with an “A” pregnancy category, the only ranking that conveys safety during pregnancy. The largest category, “C,” contain nearly half of all medications examined at 46%. The overall percentage of medications with unknown risk, composed of categories “B,” “C,” and “Not Assigned,” was found to be 67%-a clear majority. This is lower than the 90% value reported by Adam, Polifka, and Friedman, however, though this is likely due to the specific selection of diseases that are common during pregnancy instead of considering every single medication approved by the FDA17 for a wide range of diseases. Percentage of Medications with Unkown Risk Medications with Unknown Risk by Disease 120 100 80 60 40 20 0 Condition Figure 3. Overall percentage of unknown risk for each disease shown by decreasing prevalence52,56,64,67,72,76,80,84-85,90,94-95,99,104,109,113. On average, 82.75% (±17%) of each condition’s respective medications had unknown risk. This value is much closer to Adam, Polifka, and Friedman’s value of 90%17. Of the fifteen diseases examined, seven were high risk, specifically type 1 and type 2 diabetes, depression, asthma, allergies, flu, and bipolar disorder. In fact, 100% of the medications examined for type 1 and type 2 diabetes, flu, bipolar disorder, asthma had undetermined teratogenic risk. Epilepsy, hypertension, bacterial infection, pain, cardiovascular disease, autoimmune disease, and renal disease were all moderate risk. There was only one low risk condition-anxiety. However, even though only 27% of anxiety medications examined had unknown teratogenic risk, 73% were proven to be harmful, meaning those medications are still unsafe for use during pregnancy. Consequently, pregnant patients with anxiety may still be unable to manage the condition and may potentially face severe consequences, including loss of pregnancy even though the risk is known. FDA Medication Ranking by Condition 120 A Percentage 100 B 80 60 C 40 D 20 X 0 Not Assigned Condition Figure 4. Each medication’s respective therapeutic options shown as FDA pregnancy categories52,56,64,67,72,76,80,84-85,90,94-95,99,104,109,113. By visual inspection of the graph, it is evident that a majority of medication options for each disease are category “C.” There is only one disease, type 1 diabetes, for which there are more category “B” medicines than category “C”. This indicates that if a medication has undetermined teratogenic risk, is more likely to be category “C” than “B” or “Not Assigned.” Allergies, asthma, type 1 diabetes, type 2 diabetes, and flu have no medication treatments with definitive teratogenic risk. Anxiety, autoimmune diseases, cardiovascular diseases, epilepsy, and renal diseases are the only diseases with category “X” rankings. The medications for anxiety, autoimmune diseases, cardiovascular diseases and renal diseases have the most diverse treatment options in terms of FDA categories. Frequency of Consequences of Uncontrolled Disease to Mother 0.7 0.6 Frequency 0.5 0.4 0.3 0.2 0.1 0 Worsening of Symptoms Preeclampsia Risk of Future Disease or Complications High Blood Pressure Cardiovascular Issues Major Organ Damage Consequences Figure 5. Consequences of uncontrolled disease to mother shown by decreasing prevalence51,5355,57-62,65,73,77-78,81,86-87,89,96,100-103,105-106,110-112,114 . When examining consequences to the mother if the condition is left unmanaged, several consequences appeared frequently. The most prevalent consequence was worsening symptoms of the condition, which was noted for 60% of the diseases, specifically diabetes, depression, asthma, anxiety, epilepsy, pain, allergies, autoimmune diseases, and bipolar disorder. Many of these symptoms correspond to increased pain, physical strain on the body, and worsening mental health. Preeclampsia and risk of future disease or complications were the second most common consequences, a risk for 53% of the diseases examined. Other frequently occurring consequences are high blood pressure, cardiovascular issues, and major organ damage. Frequency of Consequences of Uncontrolled Maternal Disease to Fetus 0.7 0.6 Frequency 0.5 0.4 0.3 0.2 0.1 0 Consequence Figure 6. Consequences to fetus of uncontrolled disease in mother shown by decreasing prevalence 51,53-55,58-63,65,68-70,74,77-78,81,86,88,81-92,97,100-101,105,107,110-112,114. The most common health consequence for the baby when the mother’s disease goes unmanaged is premature birth, which is observed for 67% of the diseases examined, including depression, epilepsy, hypertension, bacterial infection, allergies, flu, autoimmune diseases, bipolar disorder, and renal disease. Miscarriage and low birth weight were the second most common consequences and occurred for 47% of all diseases examined. Birth defects and growth restriction occurred for one third of diseases. Other severe consequences, including stillbirth, birth injury, increased mortality rate, and placental abruption were observed for multiple diseases. It is evident that for fourteen of the fifteen conditions examined, the physician and mother must choose between using medications, a majority of which have unknown risk to the fetus, and facing potentially severe and sometimes fatal consequences of uncontrolled disease for both the mother and infant. For the one remaining disease, anxiety, the physician and mother choose between similarly severe consequences of the uncontrolled disease and therapeutic options where most of the medications are proven to be harmful. Conclusion Even in instances when there is definitive information about the safety of a medication, it is that there is proven risk to the fetus and it is not a safe option for managing the illness during pregnancy. As a result, the mother and fetus still face potentially severe consequences from uncontrolled disease whether or not the risk of the disease’s medications is established. It is essential that ethical research is conducted on drug use in pregnant women in order to eliminate a dangerous and harmful gap of knowledge and provide safe and effective treatments for illness during pregnancy. SECTION 3: PREGNANCY, MEDICATIONS AND CYSTIC FIBROSIS Introduction Cystic fibrosis (CF) is the most common life-shortening Mendelian recessive genetic disorder, especially prevalent among Caucasians in North America, Europe, and Australia. The source of the disease is a gene mutation that codes for the CF transmembrane conductance regulator. This transmembrane channel is responsible for chloride anion and bicarbonate transportation and airway mucociliary clearance. CFTR dysfunction largely affects epithelial cells, resulting in airway mucus retention, persistent infection, and airway inflammation, all detrimental to lung function43. In 1950, shortly after the disease was identified, patients with CF had a life expectancy of mere months. However, over the course of the last sixty years, the median life expectancy has increased dramatically and is now greater than forty years in developed nations44, 45. This increase in age has created the potential for women with CF to be mothers, and it is reasonable to believe many women will elect to do so. Multiple studies have found that the disease itself has no effect on maternal pregnancy survival, with similar clinical outcomes for non-pregnant CF counterparts46, 47. However, smaller single-center studies have shown that despite aggressive modern pre- and post-natal care’s sufficient support for CF women, unusual negative circumstances surrounded those births, including lower birth weight, nutritional failure at conception, and increased rates of early gestational births48, 49. These negative effects were proportional to the severity of the CF, and healthier women with CF consistently had healthier pregnancies47. Furthermore, there is some concern that the mother’s lung function may be negatively affected by pregnancy49. Medications are vital for the management of CF, even when pregnant. Bacterial infections, particularly chronic cases, are one of the most common problems present in CF patients. These infections are normally treated with antibiotics, and such management is essential for good health. If an infection isn’t treated properly or is especially severe, it is possible that a CF patient’s lung function may never return to previous levels. For CF the drugs of choice are often aminoglycosides, penicillins, fluoroquinolones, cephalosporins, and tetracyclines. Because of the large amount of antibiotics required to manage the disease, antibiotic resistance is a significant concern in CF that physicians must consider when prescribing. Understanding dosage and prescribing patterns are primary treatment concerns for drugs with potentially significant side effects and are important for obtaining positive patient outcomes50. During pregnancy, these outcomes are also important to the fetus’ health. These antibiotics that have allowed for a longer life span for those with CF have not been sufficiently tested for safe use in pregnant women, making pregnancy management and infant care highly difficult. Prescription of antibiotics and other medications and treatments with regards to dose alteration or discontinuation is not well understood due to the current lack of pregnancy-related data in this area. Due to the lack of understanding regarding this population possibility of risk to the fetus, many pregnant women with CF may be not be obtaining optimal treatment, putting both the fetus and mother at risk. This study is a simple retrospective chart review of pregnant women with CF, which will generate a de-identified data set from the University of Utah Hospital. Necessary data regarding treatment and outcomes related to pregnancy in women with CF will be collected on these women before, during, and after pregnancy. The primary objective of this study is to describe current pregnancy trends and treatment practices in patients with CF, specifically relating to antibiotic usage, and to characterize outcomes before, during, and after pregnancy. Methods Inclusion Criteria The inclusion criteria for the study is as follows: all women who are pregnant or have had a pregnancy as reported to the University of Utah Hospital, diagnosed with CF, and 18-65 years of age (inclusive). There were no exclusion criteria. Data The data for the study comes from a retrospective chart review of pregnant patients with CF. Patients were identified by searching the University of Utah Hospital’s Electronic Data Warehouse (EDW) for patients meeting the inclusionary criteria. Participants were not contacted directly. The primary investigator, Dr. Kathleen Job, worked with the EDW at the University Hospital. The data collection included data from up to ten years before pregnancy, during pregnancy, and two years after pregnancy. Data was collected from 32 patients and included: 1. Demographics: Age (year), Sex, Weight, Height, Ethnicity, Race, BMI 2. Antibiotic Information: drug information, dosing information (frequency, route, and dose), number of doses received 3. Pulmonary Function: FVC, FEV1, FEF 25-75 Institution Review Board and Data Safety The study protocol was submitted to the University of Utah’s Institutional Review Board and is included in Appendix B. There was no patient interaction in this trial and there was no PHI disclosed. The collection of information about participants was limited to the amount necessary to achieve the aims of the research, so that no unneeded information is being collected. This research posed only minimal risk to study participants. Data collected was de-identified by the University Hospital research personnel before it was received. All data was stored on password-protected computers. The primary investigator ensured that data storage and handling was consistent with University of Utah IRB standards. Statistical Methods Numerical variables were summarized by means (+/- SD). Binary and categorical variables were summarized by frequency (in %). Transformed numerical variables were used if their original variables were found to be a departure of Gaussian distribution assumptions before formal analyses were performed. Results and Discussion The query of the University of Utah Hospital’s EDW contained 32 patients that fit the inclusion criteria. 7 of these patients had multiple pregnancies on record for a total of 44 pregnancies that were examined in this study. A total of 39 medications were found as treatment options for at least one of the 44 pregnancies, and dosages for each patient were separated into those prescribed during pregnancy and those prescribed outside of pregnancy. Analysis revealed that some medications were never prescribed during pregnancy and others were only used when the patient was pregnant. This information is tabulated in Table 1 and Table 2 on the following pages. Total Treatment Options Never Used During Pregnancy Used Only in Pregnancy Number of Antibiotics 39 14 2 Percentage of Total 35.9% 5.12% Table 1. Medications never used during pregnancy and those used only during pregnancy as percentages of the total number of antibiotics, 39. Slightly more than a third of the total number of antibiotics prescribed were given to CF patients only if they were not pregnant. Conversely, a very small portion of the total medications were used exclusively when the patient was pregnant. A future study could examine the reason for this selectivity in order to determine if the 14 antibiotics never used during pregnancy are especially harmful, if the 2 used only in pregnancy are somewhat safer but not as effective for infection treatment, and if there are guidelines established for either care scenario. Aminoglycosides Gentamicin Tobramycin Beta-lactam Aztreonam Carbapenem Meropenem Ertapenem** Imipenem-Cilastatin* Cephalosporin Cefazolin Cefepime Cefoxitin Ceftazidime Ceftriaxone Cephalexin Cefdinir* Fluoroquinolone Ciprofloxacin Levofloxacin Glycopeptide Vancomycin Lincomycin Clindamycin Macrolide Azithromycin Erythromycin** Antibiotic Treatment Options Nitrofuran Nitrofurantoin Nitromidazole Metronidazole Oxazolidinone Linezolid* Tedizolid* Penicillin Amoxicillin Ampicillin Penicillin Piperacillin Dicloxacillin* Ticarcillin* Zosyn (Piperacillin + Tazobactam)* Polymixin Colistimethate* Quinolone Moxifloxacin* Sulfonamide Bactrim (Sulfamethoxzole + Trimethoprim) Sulfamethoxazole* Tetracycline Doxycycline Minocycline* Tigecycline* Table 2. Antibiotics that were prescribed for at least one of the 39 pregnancy cases listed by antibiotic class. * Drug was never prescribed during pregnancy. ** Drug was used exclusively during pregnancy. The treatment options used at the University of Utah Hospital are a diverse collection of aminoglycosides, penicillins, fluoroquinolones, cephalosporins, and tetracyclines among others, as are the smaller segment that were never used during pregnancy. The two medications that were used exclusively during pregnancy are a carbapenem and a macrolide, respectively. In order to understand how each medication was used for treatment during and outside of pregnancy, the number of dosages prescribed was compared to the total number of dosages received for each pregnancy case. Next, this number was averaged across all pregnancy cases to describe treatment of pregnant CF patients at the University of Utah Hospital as a whole. This number was computed separately for treatment during pregnancy and before and after pregnancy in order to understand difference in prescription patterns. These average frequencies for antibiotics prescribed during pregnancy are illustrated in Figure 7. By visual inspection, it is obvious that azithromycin, cefazolin, nitrofurantoin, and penicillin are the most frequently used antibiotic options prescribed during pregnancy. Together, those four options are 45.97% of the prescribed options. Other notable options include aztreonam, ceftriaxone, and vancomycin. There are obvious gaps in treatment options left by medications that were never prescribed during any patient’s pregnancy, showing more limited treatment options. Antibiotic Average Frequency of Antibiotics Prescribed During Pregnancy Cefazolin Azithromycin Nitrofurantoin Penicillin Ceftriaxone Aztreonam Meropenem Vancomycin Cefoxitin Clindamycin Amoxicillin Doxycycline Ceftazidime Tobramycin Gentamicin Ciprofloxacin Piperacillin Sulfamethoxazole Cephalexin Metronidazole Ampicillin Ertapenem Levofloxacin Bactrim Amikacin Cefdinir Cefepime Colistimethate Dicloxacillin Erythromycin Imipenem-Cilastatin Levaquin Linezolid Minocycline Moxifloxacin Tedizolid Ticarcillin Tigecycline Zosyn (Piperacillin + Tazobactam) 0 2 4 6 8 10 12 14 16 Frequency Figure 7. The frequency of usage of each antibiotic during pregnancy care averaged across all pregnancy cases. See Appendix C for numerical table. These frequencies during pregnancy are also valuable when compared to those for nonpregnant care, which are illustrated in Figure 8. Antibiotic Average Frequency of Antibiotics Prescribed Outside of Pregnancy Azithromycin Doxycycline Tobramycin Sulfamethoxazole Nitrofurantoin Meropenem Penicillin Cefazolin Amoxicillin Ciprofloxacin Gentamicin Ceftriaxone Levofloxacin Ceftazidime Clindamycin Piperacillin Aztreonam Minocycline Levaquin Ticarcillin Metronidazole Amikacin Cephalexin Ampicillin Dicloxacillin Vancomycin Cefdinir Bactrim Linezolid Zosyn (Piperacillin + Tazobactam) Cefoxitin Colistimethate Cefepime Imipenem-Cilastatin Moxifloxacin Tigecycline Tedizolid Ertapenem Erythromycin 0 2 4 6 8 10 12 14 Frequency Figure 8. The frequency of usage of each antibiotic during non-pregnancy care averaged across all pregnancy cases. See Appendix C for numerical table. In the case of non-pregnancy prescriptions, there is only one option that clearly dominates-azithromycin. A dosage of the next six antibiotics-doxycycline, meropenem, nitrofurantoin, penicillin, sulfamethoxazole, and tobramycin-are prescribed approximately 7-8% of the time. These options compose 55.59% of the total treatment options during non-pregnant care. By visual inspection, it is obvious that many of the antibiotics which had low frequency usage during pregnancy are more frequently prescribed to non-pregnant patients. This is observed for amikacin, ampicillin, cefedinir, cefepime, levaquin, levofloxacin, linezolid, moxifloxacin, tedizolid, ticarcillin, tigecycline, and Zosyn. These trends raise questions of why azithromycin, cefazolin, nitrofurantoin, and penicillin are the most frequently prescribed antibiotics during pregnancy, while most others are used approximately 4% of the time or less. Similarly, the increase in the usage of these medications when the patient is not should be investigated in order to elucidate a reason for such prescription patterns. It is also illuminating to compare the diversity of treatment options prescribed in pregnant and non-pregnant care. The number of different antibiotics prescribed during pregnancy was compared to the number of different antibiotics prescribed when the patient was not pregnant. The histogram in Figure 9 shows the percent difference of these values as the bins and the frequency describes the number of pregnancy cases out of 44 for which that percent difference was observed. Percent Difference of Antibiotic Types Prescribed During Pregnancy and Non-Pregnancy Care Number of Pregnancies 30 25 20 15 10 5 0 199 399 599 799 999 Percent Difference 1200 More Figure 9. The number of pregnancies with a certain percent difference between the number of different antibiotics prescribed during pregnancy and the different antibiotics prescribed outside of pregnancy. All but three pregnancy cases had more types of antibiotics prescribed during nonpregnancy care than during pregnancy. Even the smallest percent difference between antibiotic types prescribed during pregnancy and the types prescribed outside of pregnancy is still as great as 199%. 43% of pregnancy cases had a percent difference between pregnant and non-pregnant care of 200% or greater. Overall, 93% of pregnancy cases had a more diverse range of antibiotics prescribed when the patient was not pregnant. This may be indicative of physicians and patients alike choosing less aggressive treatment options or prescribing guidelines when the patient is pregnant, which is grounds for future research. It is revealing to examine the simple raw number of antibiotic dosages prescribed during pregnancy, as all were prescribed during same amount of time. Because the data from the University of Utah Hospital included the date of prescription dosages as well as the start and end dates of the pregnancy, it was possible to identify significant prescriptions that were given on the day of the birth and the days immediately prior and after. Table 3 includes these values. Pregnancy Case Patient # of Antibiotic Dosages Prescribed During the Pregnancy # of Prescribed Antibiotic Dosages on Day of Birth Percentage Prescribed on Day of Birth 1 A 11 11 100 2 B 9 1 11 3 C 0 0 N/A 4 D 4 4 100 5 E 7 4 57 6 F 33 6 18 7 G 26 2 8 8 G 20 1 5 9 H 0 0 N/A 10 I 15 5 33 11 J 16 12 75 12 K 14 3 21 13 L 0 0 N/A 14 L 0 0 N/A 15 L 0 0 N/A 16 L 18 17 94 17 L 1 1 100 18 M 39 2 5 19 N 6 3 50 20 O 1 0 0 21 P 5 2 40 22 Q 8 4 50 23 R 31 11 35 24 R 25 9 36 25 S 6 3 50 26 T 6 0 0 27 U 0 0 N/A 28 U 2 0 0 29 U 0 0 N/A 30 V 1 1 100 Pregnancy Case (cont’d.) Patient (cont’d.) # of Antibiotic Dosages Prescribed During the Pregnancy (cont’d.) # of Prescribed Antibiotic Dosages on Day of Birth (cont’d.) Percentage Prescribed on Day of Birth (cont’d.) 31 W 5 5 100 32 X 1 1 100 34 Z 2 2 100 35 Z 1 0 0 36 AA 1 0 0 37 AB 6 2 33 38 AB 0 0 N/A 39 AB 2 0 0 40 AC 2 2 100 41 AC 1 1 100 42 AD 1 1 100 43 AE 5 2 40 44 AF 3 2 67 5.63 (± 5.93) 2.46 (± 3.79) 50.61% (±19.5%) Average: Table 3. The number of antibiotic dosages prescribed during the pregnancy, the number of dosages prescribed on the day of birth, and the percentage of those medications prescribed on the day of birth listed per each pregnancy and patient. Grouped shading helps indicate multiple pregnancies from the same patient. Notably, there were 8 pregnancies (18.18%) examined which did not receive any prescribed antibiotics during the entire gestational period. Two women account for five of these pregnancies-three and two, respectively. This indicates that such prescribing patterns are due to the individual patient’s health. The largest number of dosages prescribed during a pregnancy was 39, and there were others with similarly high values of 25, 26, 31, and 33. These strikingly different values may be indicative of the relative health of the mothers and their medicinal needs. In 10 of the pregnancies, 100% of the dosages prescribed were prescribed on the day of the birth. On average, half of the medications prescribed during pregnancy were prescribed on that final day of pregnancy. These spikes in prescription rates raise questions of the mother’s health throughout the duration of the pregnancy, which may have been impacted by lower or less frequent than normal dosages and required immediate therapeutic attention after a successful birth. Generally, the results are what one may expect for medication usage during a pregnancy: lower usage rates during pregnancy than non-pregnancy, a wider variety of treatment options when the patient is not pregnant. There are notable trends, including a sharp increase in prescription rates immediately after the pregnancy ends, several core treatment options when the patient was pregnant, and several pregnancies without any antibiotic usage at all. Ultimately, these trends raise questions of whether these patterns arise from informal guidelines or prescribing practice or at the physician’s discretion. Antibiotic dosages and measures of the mother’s health by trimester could provide insight into the number and timing of dosages as they correspond to the mother’s need. Ultimately, this thesis illuminates the overwhelming lack of knowledge about medication usage during pregnancy and the challenge physicians face prescribing a dose that is neither so low that it’s ineffective or so high that it’s harmful to the mother and fetus, should there be a prescription at all. The basic treatments for common morbidities are generally not viable during pregnancy due to lack of knowledge of the teratogenic risk of most medications, but the consequences of uncontrolled disease to mother and fetus are severe and often fatal. For CF, some mediations are vital for good health, particularly antibiotics, and are often the reason the women live long enough to reach childbearing age. It is clear that the disease is managed with much less medication during pregnancy than the non-pregnant counterpart, but reasons for the elucidated prescribing patterns remain unclear. Conclusion It is alarming how much medication is prescribed to pregnant women, especially when the lack of knowledge surrounding its risk is considered. More attention and resources must be dedicated to understanding available, viable, and safe treatment options for the millions of women who become pregnant each year, as well as establishing outcome-based and researchdriven guidelines to serve as the basis for prescribing practices. Section 1 describes general future research that would benefit all pregnant women and investigate medication usage in a wide variety of pregnancies. However, this CF research would also benefit from investigation into themes observed in Section 3. For pregnancy in CF patients, future research is comprised of pairing these antibiotic prescription patters with maternal outcomes and health during pregnancy as described by pulmonary function, specifically FVC, FEV1, and FEF 25-75. In this way, trends seen in Section 3 may be better understood in terms of outcomes as they are related to specific dug usage and prescribing patterns. References 1. AA Mitchell, S. G.-D. (2011). Medication use during pregnancy, with particular focus on prescription drugs. Journal of Obstetrics and Gynecology, 51-58. 2. Lupattelli A, S. O. (2014). Medication use in pregnancy: a cross-sectional, multinational web-based study. British Medical Journal, 43-65. 3. Ventura SJ, C. S. (2012). Estimated pregnancy rates and rates of pregnancy outcomes for the United States, 1990-2008. National Vital Statistics Report. Atlanta: Center for Disease Control and Prevention. 4. Andrade SE, R. M. (2006). Use of prescription medications among women. Pharmacoepidemiology and Drug Safety , 546-554. 5. Li-Ting Kao, Y.-H. C.-C.-D. (2014, February 28). Prescriptions for category D and X drugs during pregnancy in Taiwan: a population based study. Pharmaxoepidemiology and Drug Safety, 23(10), 1029-1034. 6. Bell R, B. K.-B. (2008). Trends in prevalence and outcomes of pregnancy in women with pre-existing type I and type II diabetes. British Journal of Gynecology, 445-452. 7. Center for Disease Control and Prevention. (2018, July 2). Diabetes During Pregnancy. Retrieved from Reproductive Health: https://www.cdc.gov/reproductivehealth/maternalinfanthealth/diabetes-duringpregnancy.htm 8. Andrade SE, R. M. (2008). Outpatient use of cardiovascular drugs during pregnancy. Pharmacoepidemiology and Drug Safety, 240-247. 9. Andrade SE, R. M. (2008). Use of antidepressant medications during pregnancy: a multisite study. . American Journal of Obstetrics and Gynecology, 194. 10. van den Bosch AE, R. T.-H. (2015). Use and impact of cardiac medication during pregnancy. Future Cardiology, 89-100. 11. Andrade SE, G. J. (2004). Prescription drug use in pregnancy. American Journal of Obstetrics and Gynecology, 398-407. 12. Soriano LC, B. B.-D. (2014). Prescription of antihypertensive medications during pregnacy in the UK. Pharmacoepidemiology and Drug Safety, 1051-1058. 13. Hanley GE, M. B. (2014). Patterns of psychotropic medicine use in pregnancy in the United States from 2006 to 2011 among women with private insurance. BMC Pregnancy and Childbirth, 242. 14. Pasternak B, H. A. (2010). Use of proton-pump inhibitors in early pregnancy and the risk of birth defects. New England Journal of Medicine, 2114-2123. 15. George, J. (2011). Optimising medication use during pregnancy: the potential role of pharmacists. International Journal of Pharmacy Practice, 81-83. 16. McCormack, S. A., & Best, B. M. (2014). Obstetric pharmacokinetic dosing studies are urgently needed. Frontiers in Pediatrics, 9. 17. Adam, M., Polifka, J. E., & Friedman, J. M. (2011). Evolving knowledge of the teratogenicity of medications in human pregnancy. American Journal of Medical Genetics, 175-82. 18. Thomas, S., & Yates, L. (2012). Prescribing without evidence-pregnancy. British Journal of Clinical Pharmacology, 691-697. 19. Blehar, M. C., Spong, C., Grady, C., Goldkind, S. F., Sahin, L., & Clayton, J. A. (2013). Enrolling Pregnant Women: Issues in Clinical Research. Women's Health Issues, 39-45. 20. Food and Drug Administration. (2018). Pregnant Women: Scientific and Ethical Considerations for Inclusion in Clinical Trials. White Oak: U.S. Department of Health and Human Services. 21. FDA Center for Drug Evaluation and Research. (2018). Pregnant Women: Scientific and Ethical Considerations for Inclusion in Clinical Trials. U.S. Department of Health and Human Services. 22. Wyszynski, D., & Shields, K. (2016). Frequency and type of medications and vaccines used during pregnancy. Obstetric Medicine, 21-27. 23. Knight, M., Kenyon, S., Brocklehurst, P., Neilson, J., Shakespeare, J., & Kurinczuk, J. (2012). Saving live, improving mothers' care: lessons learned to inform future maternity care from the UK and Ireland confidential enquiries I to maternal deaths and morbidity 2009-2012. Oxford: National Perinatal Epidemiology Unit, University of Oxford. 24. Koren, G., & Norden, H. (2012). Antidepressant use during pregnancy: the benefit-risk ratio. American Journal of Obstetrics and Gynecology, 157-163. 25. Centers for Disease Control and Prevention. (2018). Diabetes during Pregnancy. Centers for Disease Control and Prevention. 26. Grzeskowiak, L. E. (2015). Role of pharmacists in optimizing medication management during pregnancy and lactation. Journal of Pharmacy Practice and Research, 64-71. 27. Andrew, M., Easterling, T., Carr, D., Shen, D., Buchanan, M., Rutherford, T., . . . Herbert, M. (2007). Amoxicillin pharmacokinetics in pregnant women: modeling and simulations of dosage strategies. Clinical Pharmacology and Therapeutics, 547-556. 28. Lim, A., Stewart, K., Abramson, M., & George, J. (2011). Management of asthma in pregnant women by general practitioners: a cross sectional survey. BMC Family Practice, 121. 29. Rodriguez, W., & Roberts, R. M. (2003). Current regulatory policies regarding pediartric indications and exclusivity. . Journal of Pediatrics, Gastroenterology, and Nutrition. 30. Ward, R., & Kauffman, R. (2007). Future of pediatric therapeutics: reauthorization of BPCA and PREA. Clinical Pharmacology and Therapeutics, 477-479. 31. Lyerly, M., Little, M., & Faden, R. (2009). The second wave: toward responsible inclusion of pregnant women in clinical research. International Journal of Feminist Approaches to Bioethics, 5-22. 32. Food and Drug Administration (FDA). (2015). Pregnancy and lactation labeling (drugs) final rule. FDA. 33. European Medicines Agency (EMA). (2005). Guideline on the exposure to medicinal products during pregnancy: need for post-authorization data. European Medicines Agency. 34. Saint-Raymond, A., & de Vries, C. (2016). Medicine safety in pregnancy and ambitions for the EU medicine regulatory framework. Clinical Pharmacology and Therapeutics, 21-23. 35. Mastroianna AC, F. R. (1994). Women and health research: ethical and legal issues of including women in clinical studies: volume I. Washington DC: National Academies Press. 36. Wiley, K., Cooper, S., Wood, N., & Leask, J. (2015). Understanding pregnant women's attitudes and behavior toward influenza and pertussis vaccination. Qualitative Health Research, 360-370. 37. Sawicki, K., K, S., S, W., Leung, L., & George, J. (2009). Adherence to prescribed medicines during pregnancy: a survey of outpatients. International Journal of Pharmacy Practice, 78-79. 38. Matsui, D. (2012). Adherence with drug therapy in pregnancy. Obstetrics and Gynecology International . 39. Sawicki, E., Stewart, K., Wong, S., Paul, E., Leung, I., & George, J. (2012). Managment of asthma in pregnant women attending an Australian maternity hospital. Australia and New Zealand Journal of Obstetrics and Gynecology, 183-188. 40. Nordeng, H., Ystrom, E., & Finarson, A. (2010). Perception of risk regarding the use of medications and other exposures during pregnancy. European Journal of Clinical Pharmacology, 207-214. 41. McCullough, L., Coverdale, J., & Chervenak, F. (2005). A comprehensive ethical framework for responsibly designing and conducting pharmacologic research that involves pregnant women. American Journal of Obstetrics and Gynecology, 901-907. 42. David, A., Thornton, S., & Sutcliffe, A. (2017). Developing New Pharmaceutical Treatments for Obstetric Conditions. London: Royal College of Obstetricians and Gynecologists. 43. 43. Elborn, J. (2016). Cystic fibrosis. The Lancet, 2519-2531. 44. PR Burgel, G. (2015). Future trends in cystic fibrosis demography in 34 European countries. European Respiratory Journal, 133-141. 45. Elborn, J. (1991). Cystic fibrosis: current survival and population estimated to the year 2000. Thorax, 881-885. 46. Gilljam, A. M. (2000). Pregnancy in cystic fibrosis-fetal and maternal outcome. Chest, 85-91. 47. Goss, C. (2003). The Effect of Pregnancy on Survival in Women with Cystic Fibrosis. Chest, 1460-1468. 48. Cheng, E. (2006). Aggressive prenatal care results in successful fetal outcomes in CF women. Journal of Cystic Fibrosis, 85-91. 49. Thorpe-Beeston, J. (2013). The outcome of pregnancies in women iwth custic fibrosis- single centre experience 1998-2011. British Journal of Obstetrics and Gynaecology, 35461. 50. Edmonson, C., & J.C., D. (2016). Current and future treatment options for cystic fibrosis lung disease: latest evidence and clinical mplications. Therapeutic Advances in Chronic Disease, 170-183 51. Centers for Disease Control and Prevention. (2018, June 1). Pregnancy. Retrieved from Problems of Diabetes in Pregnancy: https://www.cdc.gov/pregnancy/diabetes-types.html 52. Centers for Disease Control and Prevention. (2018, June 12). Maternal Infant Health: Reproductive Health. Retrieved from Diabetes During Pregnancy: https://www.cdc.gov/reproductivehealth/maternalinfanthealth/diabetes-duringpregnancy.htm 53. Mayo Clinic. (2017, April 28). Patient Care and Health Information. Retrieved from Gestational Diabetes: https://www.mayoclinic.org/diseases-conditions/gestationaldiabetes/symptoms-causes/syc-20355339 54. Stanford Children's Health. (n.d.). Infant of Diabetic Mother. Retrieved from Infant of Diabetic Mother: https://www.stanfordchildrens.org/en/topic/default?id=infant-ofdiabetic-mother-90-P02354 55. Bennett, H. A., Einarson, A., Taddio, A., Koren, G., & Einarson, T. R. (2004). Prevalence of depression during pregnancy: systematic review. Obstetrics and Gynecology, 698-709. 56. Food and Drug Administration. (2017, April 28). Consumer Updates. Retrieved from Depression: FDA-approved medications may help: https://www.fda.gov/forconsumers/consumerupdates/ucm095980.htm 57. Stein, A., Pearson, R. M., Goodman, S. H., Rapa, E., Rahman, A., McCallum, M., . . . Pariante, C. M. (2014). Effect of perinatal mental disorders on the fetus and child . The Lancet, 1800-1819. 58. Bennett, H. A., Einarson, A., Taddio, A., Koren, G., & Einarson, T. R. (2004). Depression during pregnancy: overview of clinical factors. Clinical Drug Investigation, 157-179. 59. Andersson, L., Sundstrom-Poromaa, I., Wulff, M., Astrom, M., & Bixo, M. (2004). Implication of antenatal depression and anxiety for obstetric outcome. Obstetrics and Gynecology, 467-476. 60. Andersson, L., Sundstrom-Poromaa, I., Wulff, M., Astrom, M., & Bixo, M. (2004). Neonatal outcome following maternal antenatal depression and anxiety; a populationbased study. American Journal of Epidemiology, 872-881. 61. Bonari, L., Pinto, N., Einarson, A., Steiner, M., & Koren, G. (2004). Perinatal risks of untreated depression during prenancy. Canadian Journal of Psychiatry, 726-735. 62. Chan, J., Natekar, A., Einarson, A., & Koren, G. (2014). Risks of untreated depression in pregnancy. Canadian Family Physician, 242-243. 63. Dayan, J., Creveuil, C., Herlicoviez, M., Herbel, C., Baranger, E., Savoye, C., & Thouin, A. (2002). Role of anxiety and depression in the onset of spontaneous preterm labor. American Journal of Epidemiology, 293-301. 64. Kwon, H., Triche, E. W., Belanger, K., & Bracken, M. (2006). The epidemiology of asthma during pregnancy: prevalence, diagnosis, and symptoms. Immunology and Allergy Clinics of North America, 29-62. 65. Informed Health Online. (2008, Jan 14). Cologne, Germany: Institue for Quality and Efficiency in Health Care. Retrieved from Asthma in pregnancy : https://www.ncbi.nlm.nih.gov/books/NBK492985/ 66. Howard, L., Molyneaux, E., Dennis, C., Rochat, T., Stein, A., & Milgrom, J. (2014). Non-psychotic mental disorders in the perinatal period. Lancet, 1276-1279. 67. Anxiety and Depression Association of America. (2009, December). ADAA. Retrieved from Medications: https://adaa.org/sites/default/files/Medications-Chart_updated1209.pdf 68. Glover, V. (2014). Maternal depression, anxiety, and stress durin gpregnancy and child outcome; what needs to be done. Best Practice and Research Clinical Obstetrics and Gynaecology, 25-35. 69. Ding, X., Wu, Y., Xu, S., Zhu, R., Jia, X., Zhang, S., . . . Tao, F. (2014). Maternal anxiety during pregnancy and adverse birth outcomes: a systematic review and meta-analyis of prospective cohort studies. Journal of Affective Disorders, 103-110. 70. Tarabulsy, G., Pearson, J., Vaillancourt-Morel, M., Bussieres, E., Madigan, S., Lemelin, J., . . . Royer, F. (2014). Meta-analytic findings of the relation between maternal prenatal stress and anxiety and child cognitive outcome. Journal of Developmental and Behavioral Pediatrics, 38-43. 71. Tomson, T., & Vilho, H. (2007). Epilepsy in Pregnancy. BMJ, 769-773. 72. Goldenberg, M. M. (2010). Overview of drugs used for epilepsy and seizures. Pharmacy and Therapeutics, 932-415. 73. Vajda, F., Graham, J., O'Brien, T., Lander, C., & Eadie, M. (2015). The outcomes of pregnancy in women with untreated epilepsy. Seizure, 77-81. 74. Mayo Clinic. (2017, July 13). Pregnancy week by week. Retrieved from Epilepsy and pregnancy: what you need to know: https://www.mayoclinic.org/healthylifestyle/pregnancy-week-by-week/in-depth/pregnancy/art-20048417 75. Centers for Disease Control and Prevention. (2018, May 16). High blood pressure. Retrieved from High blood pressure during pregnancy fact sheet: https://www.cdc.gov/bloodpressure/pregnancy.htm 76. Food and Drug Administration. (2011, May). Medcines to Help You. Retrieved from High Blood Pressure: https://www.fda.gov/downloads/forconsumers/byaudience/forwomen/freepublications/uc m282311.pdf 77. Mayo Clinic. (2018, February 14). Pregnancy week by week. Retrieved from High blood pressure and pregnancy: know the facts: https://www.mayoclinic.org/healthylifestyle/pregnancy-week-by-week/in-depth/pregnancy/art-20046098 78. Anthony, J., Damasceno, A., & Ojjii, D. (2016). Hypertensive disorders of pregnancy: what the physician needs to know. Cardiovascular Journal of Africa, 104-110. 79. Bookstaver, P., Bland, C., Griffin, B., Stover, K., Eiland, L., & McLaughlin, M. (2015). A review of anitbiotic use in pregnancy. Pharmacotherapy, 1052-1062. 80. Anderson, L. (2016, August 23). Drugs. Retrieved from Antibiotics Guide: https://www.drugs.com/article/antibiotics.html 81. National Institue of Child Health and Human Development. (2017, January 31). Health. Retrieved from What infections can affect pregnancy?: https://www.nichd.nih.gov/health/topics/pregnancy/conditioninfo/infections 82. Shah, S., Banh, E., Koury, K., Bhatia, G., Nandi, R., & Gulur, P. (2015). Pain management in pregnancy: multimodal approaches. Pain Research and Treatment. 83. Kennedy, D. (2011). Analgesics and pain relief in pregnancy and breastfeeding. Australian Prescriber, 8-10. 84. Food and Drug Administration. (2015, July 9). Drugs. Retrieved from FDA drug safety communication: FDA strengthens warning that non-aspirin nonsteroidal antiinflammatory drugs (NSAIDs) can cause heart attacks or strokes: https://www.fda.gov/drugs/drugsafety/ucm451800.htm 85. Food and Drug Administration. (2018, December 20). For Consumers. Retrieved from A Guide to Safe Use of Pain Medicine: https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm095673.htm 86. Shah, L. (2017). Can opioids be used for pain relief during pregnancy? London: UK Medicines Information. 87. Duenas, M., Ojeda, B., Salazar, A., Mico, J., & Failde, I. (2016). A review of chronic pain impact on patients, their social environment and health care system. Journal of Pain Research, 457-467. 88. UK Teratology Information Service. (2016). Pain relief in pregnancy. London: UK Teratology Information Service. 89. Oykhman, P., Kim, H. L., & Ellis, A. K. (2015). Allergen Immunoherapy in pregnancy. Allergy, Asthma, and Clinical Immunology, 11-31. 90. Mayo Clinic. (2017, June 6). Patient Care and Health Information. Retrieved from Allergy medications: know your options: https://www.mayoclinic.org/diseasesconditions/allergies/in-depth/allergy-medications/art-20047403 91. American College of Allergy, Asthma, and Immunotherapy. (2018, April 17). Who Has Allergies and Why. Retrieved from Pregnancy and Allergies: https://acaai.org/allergies/who-has-allergies-and-why/pregnancy-and-allergies 92. Pongdee, T. (n.d.). American Academy of Allergy, Asthma & Immunology. Retrieved from Asthma, Allergies and Pregnancy: https://www.aaaai.org/conditions-andtreatments/library/asthma-library/asthma-allergies-and-pregnancy 93. Henry, A., & Crowther, C. (2000). Patterns of medication use during and prior to pregnancy: the MAP study. Australian and New Zealand Journal of Obstetrics and Gynaecology, 165-172. 94. Drugs.com Staff. (n.d.). Medications for Cold Symptoms. Retrieved from Drugs used to treat cold symptoms: https://www.drugs.com/condition/coldsymptoms.html?category_id=&only_generics=true&submitted=true 95. Food and Drug Administration. (September , 11 2018). Drugs. Retrieved from Influenza (flu) antiviral drugs and related information: https://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm100228.htm 96. de Bellefonds, C. (2018, May 10). Your Health. Retrieved from Flu during pregnancy: what you need to know to stay safe: https://www.whattoexpect.com/pregnancy/pregnancy-health/flu-during-pregnancy/ 97. Jasni, F. (n.d.). Pregnancy. Retrieved from Flu & fever during pregnancy: complications and treatment: https://www.healthxchange.sg/women/pregnancy/flu-fever-pregnancycomplications-treatment 98. Khashan, A., Kenny, L., Lauresen, T., Mahmood, U., Moretensen, P., Henriksen, T. B., & O'Donoghue, K. (2011). Pregnancy and the risk of autoimmune disease. PLos One, 17. 99. Li, P., Cheng, Y., & Chen, X. (2017). Drugs for autoimmune inflammatory diseases: from small molecule compounds to anti-TNF. Frontiers in Pharmacology, 1-12. NYU Lagone Health. (n.d.). Types of Autoimmune Diseases. Retrieved from Types of Autoimmune Diseases in Pregnancy: https://nyulangone.org/conditions/autoimmune-diseases-in-pregnancy/types 100. NYU Langone Health. (n.d.). Medications. Retrieved from Medications for pregnancy complications of autoimmune diseases: https://nyulangone.org/conditions/autoimmune-diseases-inpregnancy/treatments/medications-for-pregnancy-complications-of-autoimmune-diseases 101. Waldorf, K., & Nelson, J. L. (2008). Autoimmune disease during pregnancy and the microcimerism legacy of pregnancy. Immunological Investigations, 631-644. 102. Regitz-Zagrosek, V., Lundquist, C. B., Borghi, C., Cifkova, R., Ferreira, R., Foidart, J., . . . Presbitero, P. (2011). ESC guidelines on the management of cardiovacular diseases during pregnancy. European Heart Journal, 3147-3197. 103. CenterWatch. (n.d.). Drug Information. Retrieved from FDA approved drugs for cardiology/vascular diseases: https://www.centerwatch.com/drug-information/fdaapproved-drugs/therapeutic-area/1/cardiology-vascular-diseases 104. Franklin, W., Benton, M. K., & Parekh, D. (2011). Cardiac disease in pregnancy. Texas Heart Institute Journal, 151-153. 105. Silversides, C. K., Grewal, J., Mason, J., Sermer, M., Kiess, M., Rychel, V., . . . Siu, S. (2018). Pregnancy outcomes in women with heart diseases. Journal of the American College of Cardiology, 2419-2430. 106. Horn, J., Tanz, L., Markovitz, A., Skurnik, G., Rimm, E., Missmer, S., & RichEdwards, J. (2018). Early or late pregnancy loss and development of clinical cardiovascular disease risk factors: a prospective cohort study. BJOG, 33-42. 107. Vesga-Lopez, O. B., Keyes, K., Olfson, M., Grant, B., & Hasin, D. (2008). Psychiatric disorders in pregnant and postpartum women in the United States. Archives of General Psychiatry, 805-815. 108. McIntyre, R., Cha, D., Kim, R., & Mansur, R. (2013). A review of FDA-approved treatment options in bipolar depression. CNS Spectrum, 4-20. 109. Scrandis, D. (2017). Bipolar disorder in pregnancy: a review of pregnancy outcomes. Journal of Midwifery & Women's Health, 673-683. 110. Nguyen, N., Gorman, M., Kent III, E., & Caughey, A. (2014). Pregnancy outcomes in women with bipolar disorder: a retrospective cohort study. American Journal of Obstetrics, S323. 111. Edipidis, K. (2011). Pregnancy in women with renal disease. Yes or no? Hippokratia, 8-12. 112. CenterWatch. (n.d.). Drug Information. Retrieved from FDA approved drugs for nephrology: https://www.centerwatch.com/drug-information/fda-approveddrugs/therapeutic-area/9/nephrology 113. 114. Williams, D., & Davison, J. (2008). Chronic kidney disease in pregnancy. BMJ, 211-215. APPENDIX A: SECTION 2 MEDICATIONS CHART Disease/Condition: % of Pregnant Women with Condition *Type of Drug Drug FDA Classification Consequences to Mother if Left Untreated Diabetes, Type 1: 1-2% 51 *insulin insulin regular B insulin aspart B insulin detemir B life threatening low blood glucose, ketoacidosis, high blood pressure and preeclampsia, future type 2 diabetes51, 53, 54 insulin lispro52 B Consequences to Fetus if Left Untreated birth defects, some resulting in fetal death, that affect the heart and connecting blood vessels, brain, spine, urinary and kidney systems, and the digestive tract; stillbirth; macrosomia; birth injury; hypoglycemia; respiratory distress; higher risk of type 2 diabetes and obesity later in life51, 53, 54 Diabetes, Type 2: 1-2% 51 *Alpha-glucosidase inhibitors acarbose B miglitol B *Biguanide metformin B *DPP-4 inhibitors alogliptin B linagliptin B saxagliptin B sitagliptin B dapagliflozin C canagliflozin C empagliflozin C glimepiride C glipizide C glyburide C chlorpropamide C olazamide C tolbutamide C rosiglitazone C Pioglitazone 52 C *SLGT 2 inhibitors * Sulfonylureas *Thiazolidinediones life threatening low blood glucose, ketoacidosis, high blood pressure and preeclampsia, future type 2 diabetes51, 53, 54 birth defects, some resulting in fetal death, that affect the heart and connecting blood vessels, brain, spine, urinary and kidney systems, and the digestive tract; stillbirth; macrosomia; birth injury; hypoglycemia; respiratory distress; higher risk of type 2 diabetes and obesity later in life 51, 53, 54 Depression: 12% 55 * selective serotonin reuptake inhibitors (SSRIs) *serotonin norepinephrine reuptake inhibitors (SNRIs) *tricyclic antidepressants monoamine oxidase inhibitors *others fluoxetine C citalopram C escitalopram C fluvoxamine C sertraline C paroxetine D venlafaxine C desvenlafaxine C duloxetine C amitriptyline C imipramine C doxepin C clomiprimine C maprotiline B desipramine C trimipramine C protriptyline C nortriptyline C phenelzine C isocarboxazid tranylcypromine C NOT ASSIGNED mirtazapine C bupropion B venlafaxine C duloxetine C trazodone 56 C Asthma: 8% *bronchodilator *corticosteroid postpartum depression; suicidality; pregnancy complications including preeclampsia; tendency toward high-risk behaviors, including smoking, substance and alcohol abuse, poor nutrition55, 5762 prematurity; low birth weight; intrauterine growth restriction; childhood development issues, including emotional, behavioral, cognitive, social, and impulse problems55. 5863 64 aclidinium bromide C albuterol sulfate C formoterol C levalbuterol sulfate C salmeterol C olodaterol C ipratropium bromide B arformoterol tartrate beclomethasone dipropionate C budesonide B ciclesonide64 C flunisolide C C severe asthma attacks65 preterm birth; preeclampsia; reduced growth and low birth weight65 fluticasone C mometasone furoate64 C Anxiety: 13% *azapirone busipirone B *benzodiazepine lorazepam D flurazepam C clonazepam D triazolam X chlordiazeperoxide D temazepam oxazepam X NOT ASSIGNED clorazepate D diazepam D alprazolam 67 Epilepsy: 0.7 % increased seizures, lack of seizure control73 A seizure during pregnancy can cause slowing of the heartrate, decreased oxygen supply to the fetus, birth injury, placental abruption, traumainduced miscarriage, preterm labor, premature birth74 D 71 valproate X lamotrigine C topiramate D carbamazepine D phenytoin D oxcarbazepine C ethosuximide C zonisamide C phenobarbital D primidone D felbamate C levetiracetam C tiagabine C zonisamide C gabapentin C eslicarbazepine C vigabatrin C lacosamide C pregabalin C rufinamide72 Hypertension: 8% *ACE inhibitors maternal psychological distress, panic symptoms depression, heightened anxiety symptoms caused by hormone changes, postnatal depression59 loss of fetus during first trimester; decrease in birth weight; increase in activity of the hypothalamushypophysisadrenal axis; decrease in adult fertility rate; social, behavioral, emotional, cognitive issues; hyperactivity disorder68-70 66 C 75 perindopril D quinapril D ramipril D captopril D benazepril D trandolapril D *Beta Blockers *calcium channel blockers *peripherally acting alpha-adrenergic blockers *vasodilators *angiotensin II antagonists fosinopril D lisinopril D moexipril D enalapril D enalaprilat nebivolol D NOT ASSIGNED timolol C carvedilol C nadolol C propranolol C betaxolol C penbutolol C metoprolol C acebutolol B atenolol D labetalol C pindolol B bisoprolol C amlodipine C clevidipine C diltiazem D felodipine C isradipine C nicardipine C nifedipine C nimodipine C nisoldipine C verapamil C doxazosin C phenoxybenzamine C prazosin C terazosin C hydralazine C minoxidil C candesartan D irbesartan D olmesartan D losartan D valsartan D azilsartan D telmisartan D eprosartan D preeclampsia; injury to major organs including brain, lungs, heart, kidneys, and liver; higher risk for cardiovascula r disease; risk of heart attacks and strokes; cerebrovascul ar hemorrhage; subcapsular hematoma77-78 placental abruption, intrauterine growth restriction, premature delivery77-78 *centrally-acting alpha adrenergics clonidine C guanfacine76 Bacterial Infections: 25% *penicillins/beta-lactams *tetracyclines *cephalosporins *quinolones *lincomycin *macrolides *sulfonamides *glycopeptides *aminoglycosides *carbapenem B 79 penicillin B amoxicillin B doxycycline D tetracycline D minocycline D cefuroxime B ceftriaxone B cefdinir B ciprofloxacin C levofloxacin C moxifloxacin C clindamycin B lincomycin C azithromycin B clarithromycin C erythromycin sulfamethoxazoletrimethoprim B sulfasalazine B sulfisoxazole C dalbavancin C oritavancin C telavancin C vancomycin C gentamicin C tobramycin D kanamycin D streptomycin D amikacin D meropenem B *OTC acetaminophen *OTC non-steroidal anti-inflammatory drugs hypertension; occurrences of fear, anxiety, and depression; injury; trauma; infection; nerve damage; exacerbation of pain by pregnancy hormones86-87 adverse effects from other conditions that the mother develops as a result of pain, especially those that affect the mother's cardiovascular system86,88 D Invanz80 Pain: 60% (analgesics)/ 6% (opiates) organ failure, difficult labor, increased demand on heart81 preterm labor, premature birth, lower birth weight, spread of infection from mother, birth abnormalities, miscarriage, pneumonia, intellectual disabilities, blindness81 B 82-83 acetaminophen C aspirin D naproxen C ibuprofen C celecoxib D diclofenac D diflunisal C etodolac C fenoprofen *opioid flurbiprofen D NOT ASSIGNED indomethacin C ketoprofen C ketorolac C mefenamic acid C meloxicam D nabumetone C oxaprozin C piroxicam C sulindac C tolmetin C NOT ASSIGNED NOT ASSIGNED morphine oxycodone codeine hydrocodone C NOT ASSIGNED Hydromorphone84-85 C Allergies: 30% *antihistamines 89 diphenhydramine B chlorpheniramine B cetirizine B desloratdaine C fexofenadine C loratadine B levocetirizine B azelastine C olopatadine C emedastine B ketotifen pseudoephedrine C NOT ASSIGNED NOT ASSIGNED oxymetazoline C tetrahydrozoline C budesonide B fluticasone furoate C fluticasone propionate C mometasone furoate C triamcinolone C beclomethasone C ciclesonide C prednisolone C pheniramine *decongestant *corticosteroids anaphylactic shock, worsened asthma, predisposition to sinusitis89 decreased oxygen supply; consequences of maternal asthma including preterm birth, preeclampsia, and low birth weight91-92 *leukotriene inhibitors methylprednisolone C hydrocortisone C montelukast90 B Flu: 8% *antivirals 93 peramivir C zanamivir C oseltamivir phosphate C NOT ASSIGNED baloxavir94-95 bronchitis, pneumonia, fever, myocarditis96 preterm labor, premature birth, miscarriage97 Autoimmune Diseases: 2.5%98 *NSAIDs *glucocorticoids *DMARDs *anti-TNF biologics aspirin D diflunisal C sulfasalazine B acetaminophen C mefenamic acid C meclofenamate C ibuprofen C naproxen C fenoprofen D ketoprofen flurbiprofen C NOT ASSIGNED oxaprozin C piroxicam C tenoxicam C prednisolone C methylprednisolone C dexamethasone C betamethasone C methotrexate X leflunomide hydroxychloroquine X NOT ASSIGNED sulfasalazine B infliximab B adalimumab B etanercept B golimumamb B certolizumab pepol99 Cardiovascular Diseases: 4% *anticoagulant *beta blocker disease flare-ups and exacerbation, preeclampsia, worsening organ function, blood clots100-102 miscarriage, low birth weight, preterm birth, still birth, birth defects, congenital heart block100101 B 103 betrixaban NOT ASSIGNED tinzaparin B nebivolol C metoprolol C heart strain, blood clotting, endocarditis, myocardial infarction, increased mortality rate, preeclampsia, increased mortality rate, miscarriage, stillbirth105,107 *angiotensin receptor blocker valsartan D sacubitril D olmesartan D azilsartan medoxomil D telmisartan D eprosartan D candesartan D *NSAID aspirin D *proton pump inhibitor omeprazole C *channel blocker ivabradine D amlodipine besylate C clevidipine C nimodipine C verapamil C procainamide C diltiazem *enzyme sebelipase alfa D NOT ASSIGNED *P2Y12 inhibitor cangrelor C ticagrelor evolocumab C NOT ASSIGNED NOT ASSIGNED perindopril arginine D enalapril lisinopril D NOT ASSIGNED trandolapril D edoxaban C apixaban B rivaroxaban selexipag C NOT ASSIGNED vorapaxar B ambrisentan X eplerenone B macitentan X omega-3-carboxylic acids C lomitapide X icosapent C *sGC stimulator riociguat X *oligonucleotide inhibitor mipomersen sodium B *statin atorvastatin X pitavastatin X fluvastatin X *PSCK9 inhibitor *ACE inhibitor *Xa inhibitor *receptor antagonist *antilipemic agent alirocumab arrhythmia, heart failure, pulmonary edema, gestational diabetes103,105-106 cerivastatin X pravastatin X lovastatin X *cholesterol absorption inhibitor ezetimibe C *sclerosing agent polidocanol C *renin inhibitor aliskiren D *diuretic hydrochlorothiazide B *thrombin inhibitor dabigatran C bivalirudin B *PDE5 inhibitor tadalafil B *anti-platelet prasugrel B clopidogrel B dronedarone X ibutilide C treprostinil B nesiritide C rosuvastatin X *fibrate fenofibric acid C *monoclonal antibody eculizumab C *anti-anginal ranolazine C *nitrate isosorbide dinitrate C nitroglycerin C *anti-hypertensive hydralazine hydrochloride C *platelet-reducing agent anagrelide C *alpha-adrenergic agonist midodrine C *thrombolytic reteplase C *radiopaque Iodixanol104 *anti-arrhythmic *vasodilator Bipolar Disorder: 2.8% *antipsychotic, atypical B 108 quetiapine C olanzapine C lurasidone *anesthetic ketamine B NOT ASSIGNED *eugeroic modafinil C armodafinil C *anticonvulsant lamotrigine C *antipsychotic, atypical + SSRI olanzapine-fluoxetine109 C Renal Disease: 0.12%112 *receptor antagonist tolvaptan *calcimimetic etelcalcetide C NOT ASSIGNED cinacalcet C cabozantinib D *tyrosine kinase inhibitor increased risk of illness episodes, preeclampsia, hypertension110-111 preterm birth, placenta previa, antepartum hemorrhage, congenital abnormalities, low birth weight, intrauterine fetal demise, infant death110111 preeclampsia, increased cesarean delivery rate, decline in renal function, hypertension, anemia112,114 preterm birth; miscarriage; growth restriction; decrease in infant survival rate, particularly *vitamin D analog lenvatinib NOT ASSIGNED pazopanib D calcifediol C doxercalciferol *monoclonal antibody *selective uric acid reabsorption inhibitor nivolumab lesinurad B NOT ASSIGNED NOT ASSIGNED *phosphate binder ferric citrate B sevelamer carbonate C eculizumab C lanthanum carbonate C ledipasvir B ombitasvir B sofosbuvir X paritaprevir B ritonavir B dasabuvir B ferric carboxymaltose C iron sucrose B ferumoxytol C *cystine depleting agent cysteamine bitartrate C *beta-3 adrenergic agonist mirabegron C *hematopoietic growth factor peginesatide C *phosphodiesterase inhibitor avanafil C *antispasmodic oxybutynin B trospium chloride C *enzyme activator carglumic acid C *muscarinic receptor antagonist C *erythropoiesis stimulating agent fesoterodine fumarate methoxy polyethylene glycol-epoetin beta *non-peptide vasopressin inhibitor conivaptan C *antimuscarinic solifenacin C *enzyme agalsidase beta B *GnRH agonist leuprolide acetate X triptorelin pamoate X *cholinergic receptor blocker tolterodine tartrate C *anticoagulant pentosan ploysulfate sodium B *vitamin B analog cyanocobalamin113 C *HCV inhibitor *iron replacement C when mother undergoes dialysis112,114 APPENDIX B: IRB PROTOCOL Protocol Summary Version: January 2, 2019 Trends in the Use of Medications and Outcomes in Pregnant Women with Cystic Fibrosis Principal Investigator Kathleen Job, PhD, FCP University of Utah Health Clinical Pharmacology 295 Chipeta Way, S100 Salt Lake City, Utah, 84108, USA 801.213.3972 [e-mail] Sub-Investigator(s) Micah Ballif Clinical Pharmacology 295 Chipeta Way, S100 801.213.3972 [e-mail] Background and Introduction Cystic fibrosis is the most common life-shortening Mendelian recessive genetic disorder, especially prevalent among Caucasians in North America, Europe, and Australia. The source of the disease is a gene mutation that codes for the cystic fibrosis transmembrane conductance regulator (CFTR). This transmembrane channel is responsible for chloride anion and bicarbonate transportation and airway mucociliary clearance. CFTR dysfunction largely affects epithelial cells, resulting in airway mucus retention, persistent infection, and airway inflammation, all detrimental to lung function1. In 1950, shortly after the disease was identified, patients with cystic fibrosis had a life expectancy of mere months. Their deaths were a result of malnutrition following pancreatic malabsorption and meconium ileus2. However, over the course of the last sixty years, the median life expectancy has increased dramatically and is now greater than forty years in developed nations3,4. This increase in age has created the potential for women with cystic fibrosis to be mothers, and it is reasonable to believe many women will elect to do so. Multiple studies have found that the disease itself has no effect on maternal pregnancy survival, with similar clinical outcomes for non-pregnant cystic fibrosis counterparts6,7. However, smaller single-center studies have shown that despite aggressive modern pre- and postnatal care’s sufficient support for cystic fibrosis women, unusual negative circumstances surrounded those births, including lower birth weight, nutritional failure at conception, and increased rates of early gestational births8, 9. These negative effects were proportional to the severity of the cystic fibrosis, and healthier women with cystic fibrosis consistently had healthier pregnancies7. Furthermore, there is some concern that lung function may be negatively affected by pregnancy8. Medications are vital for the management of cystic fibrosis, even when pregnant. Conventional cystic fibrosis treatments have focused on the symptoms of the disease, specifically mucus plugging and chronic infection, or on organs affected by cystic fibrosis, including the pancreas and liver. For example, bacterial infections are one of the most common problems present in cystic fibrosis patients. These infections are normally treated with antibiotics, and such management is vital for good health. Understanding dosage and prescribing patterns, and drug clearance is vital of drugs with potentially significant side effects, such as aminoglycosides (e.g. including amikacin, gentamicin, kanamycin, etc.), are important for obtaining positive patient outcomes.2 Prescription of antibiotics and other medications and treatments with regards to dose alteration or discontinuation is not well understood due to the current lack of pregnancy-related data in this area. These novel therapies and antibiotics that have allowed for a longer life span for those with cystic fibrosis have not been sufficiently tested for safe use in pregnant women, making pregnancy management care challenging. Due to the lack of understanding regarding this population possibility of risk to the fetus, many pregnant women with CF may be not be obtaining optimal treatment, putting both the fetus and mother at risk. Study Purpose and Objectives This study is a simple retrospective chart review of pregnant women with CF, which will generate a de-identified data set. Necessary data regarding treatment and outcomes related to pregnancy in women with CF will be collected on these women 120 days prior to conception, during pregnancy, and 60 days after estimated delivery date. Data collected will include demographics, antibiotic information, pulmonary function, and type of infection. This study aims to understand antibiotic prescribing patterns and outcomes associated with treatment of pregnant women. The primary objective of this study is to describe current pregnancy trends and treatment practices in patients with cystic fibrosis, specifically relating to antibiotic usage. The secondary objective is to characterize the changes in treatment patterns before, during, and after pregnancy. Participant Selection Criteria Expected Sample Size: 70 Inclusion: 1. All women who are pregnant or have had a pregnancy as reported to the University of Utah Hospital. 2. Diagnosed with Cystic Fibrosis 3. 18-65 years of age (inclusive) Exclusion: 1. None Design Descriptive study; retrospective review. Study Procedures This is a retrospective chart review of pregnant patients with CF. Patients will be identified by searching the University of Utah Hospital for patients meeting the inclusionary criteria. Participants will not be contacted directly. The PI will work with the data warehouse at the University Hospital. Data collection may include data from 90 days before the pregnancy reported pregnancy, during the year of pregnancy, and two years after the reported pregnancy year. Data collected will include: 1. Demographics: Age (year), Sex, Weight, Height, Ethnicity, Race, BMI. 2. Antibiotic Information: drug information, dosing information (frequency, route, and dose), number of doses received. 3. Pulmonary Function: FVC, FEV1, FEF 25-75. 4. Informed Consent-Requested Waiver This is a retrospective chart review study and we plan to review approximately 70 individual charts based on estimates available. There will be no patient interaction in this trial and there will be no PHI disclosed. The collection of information about participants is limited to the amount necessary to achieve the aims of the research, so that no unneeded information is being collected. Data Safety and Monitoring This research will pose only minimal risk to study participants. Data collected will be deidentified by the University Hospital research personnel before it is received. All data will be stored on password-protected computers. The primary investigator will ensure that data storage and handling is consistent with University of Utah IRB standards. Statistical Methods, Analyses, and Interpretation The number of participants (sample size) will depend on the number of patients that meets the inclusion criteria as opposed to a predetermined number. Based on numbers reported from an initial query of the University of Utah EDW, we hope to obtain data from 70 total individuals, but are unsure if we will reach that goal. Numerical variables will be summarized by means (+/- SD). Binary and categorical variables will be summarized by frequency (in %). Parametric models will be considered primary statistical tools for the study. Transformed numerical variables will be used if their original variables are found to be a departure of Gaussian distribution assumptions before formal analyses are performed. References (IRB Protocol) 1. Elborn JS. Cystic fibrosis. Lancet. 2016;388(10059):2519-2531. 2. Edmondson C, Davies JC. Current and future treatment options for cystic fibrosis lung disease: latest evidence and clinical implications. Ther Adv Chronic Dis. 2016;7(3):170183. 3. Burgel PR, Bellis G, Olesen HV, et al. Future trends in cystic fibrosis demography in 34 European countries. Eur Respir J. 2015;46(1):133-141. 4. Davis PB. Cystic fibrosis since 1938. Am J Respir Crit Care Med. 2006;173(5):475-482. 5. Quon BS, Rowe SM. New and emerging targeted therapies for cystic fibrosis. BMJ. 2016;352:i859. 6. Gilljam M, Antoniou M, Shin J, Dupuis A, Corey M, Tullis DE. Pregnancy in cystic fibrosis. Fetal and maternal outcome. Chest. 2000;118(1):85-91. 7. Goss CH, Rubenfeld GD, Otto K, Aitken ML. The effect of pregnancy on survival in women with cystic fibrosis. Chest. 2003;124(4):1460-1468. 8. Thorpe-Beeston JG, Madge S, Gyi K, Hodson M, Bilton D. The outcome of pregnancies in women with cystic fibrosis--single centre experience 1998-2011. BJOG : an international journal of obstetrics and gynaecology. 2013;120(3):354-361. APPENDIX C: AVERAGE FREQUENCY OF MEDICATIONS PRESCRIBED IN PREGNANCY AND NON-PREGNANCY CARE Average % of Each Med Prescribed During Pregnancy Standard Deviation ± Average % of Each Med Prescribed Outside of Pregnancy Standard Dev ± Amoxicillin Amikacin Ampicillin Azithromycin Aztreonam Bactrim Cefazolin Cefdinir Cefepime Cefoxitin Ceftazidime Ceftriaxone Cephalexin Ciprofloxacin Clindamycin Colistimethate Dicloxacillin 2.78 0.00 0.22 13.43 4.62 0.09 14.19 0.00 0.00 3.24 1.95 6.56 0.95 1.39 3.19 0.00 0.00 0.45 0.00 0.02 2.85 0.46 0.00 4.07 0.00 0.00 0.53 0.15 0.99 0.05 0.11 0.53 0.00 0.00 4.77 1.10 0.94 12.60 1.33 0.30 5.44 0.33 0.16 0.17 2.13 3.26 1.00 4.08 1.79 0.17 0.74 0.44 0.03 0.03 1.55 0.03 0.00 0.41 0.01 0.00 0.00 0.09 0.25 0.04 0.28 0.07 0.00 0.02 Doxycycline Ertapenem Erythromycin Gentamicin Imipenem-Cilastatin Levaquin Levofloxacin Linezolid Meropenem Metronidazole Minocycline Moxifloxacin Nitrofurantoin Penicillin Piperacillin Sulfamethoxazole Tedizolid Ticarcillin 2.31 0.22 0.00 1.68 0.00 0.00 0.18 0.00 4.36 0.95 0.00 0.00 9.74 8.63 1.04 1.00 0.00 0.00 0.20 0.00 0.00 0.16 0.00 0.00 0.00 0.00 0.64 0.05 0.00 0.00 2.26 1.75 0.04 0.04 0.00 0.00 8.24 0.00 0.00 3.84 0.16 1.24 2.91 0.27 6.49 1.17 1.27 0.12 7.09 6.30 1.46 7.14 0.06 1.23 1.12 0.00 0.00 0.36 0.00 0.06 0.14 0.00 0.55 0.05 0.03 0.00 0.70 1.14 0.04 0.65 0.00 0.03 Tigecycline Tobramycin Vancomycin Zosyn (Piperacillin + Tazobactam) 0.00 1.69 3.91 0.00 0.00 0.08 0.66 0.00 0.10 7.74 0.56 0.23 0.00 0.69 0.01 0.00 University of Utah UNDERGRADUATE RESEARCH JOURNAL PLASTICITY OF OFFSPRING GROWTH RATE IN WILD-DERIVED MICE IS PREDICTED BY PARENTAL SOCIAL FACTORS John A. Beaufort (Wayne K. Potts, Joseph W. Cauceglia) Department of Biology The ability of parents to influence offspring traits is an important source of adaptive phenotypic plasticity in mammals. By contrast, parental effects failing to regulate offspring phenotype to fit current environmental conditions could be deleterious. Although parental responses to single cues have been identified, we lack an understanding of how these factors interact and whether they are reversible across breeding cycles in a fluctuating environment. Social status in wild house mice periodically fluctuates, changing the high-fitness pathways available to offspring. We designed an experiment to parse how parental factors interact and subsequently whether they are reversible. We monitored wild-derived mice populating semi-natural enclosures for 11 weeks and simultaneously a non-competition, control group. In the enclosures, we identified dominant males with exclusive occupancy of optimal territories – defendable food and nesting resources – and non-dominant males without said territoriality. Afterward, we paired mice monogamously for 10 days, according to a reciprocal breeding design. A subset of competition males, entered a second round of competition against other males of their previous social status. This winnerslosers bracket design forced some males to gain or lose dominance, while other males maintained dominance or non-dominance. In total, these pairings produced over 900 offspring from 129 litters, each with various combinations of parental social experiences, litter sizes, and sex ratios. After weighing these offspring weekly, we systematically assessed which parental factors influence offspring growth and how these factors interacted. Offspring growth was analyzed with separate pre- and post-puberty linear mixed models (LMMs), because mice grow at two different, but near linear rates. The best-fit LMMs—selected by lowest Akaike Information Criterion—were structurally identical and included the fixed-factors: age, sex, litter size, litter sex ratio, maternal social experience, paternal social status, and all of their interactions. Both models also required including random-factors to control for sibling-level relatedness and repeated measures of the same individual. We found for wild-derived house mice, recently dominant males produced faster growing pre-pubescent offspring; however, subsequent offspring of those same males would grow relatively slower if-and-when dominance was lost, and vice versa. This supports status related cues, not genetic associations, as the underlying basis for the plasticity of offspring growth rates. Furthermore, these paternal-status associated body-size effects persisted beyond puberty, which would likely influence life-long reproductive success. Maternal experience modulates the timing, effect-size, and sex-specificity of this paternal effect, in part by interacting with litter size and sex ratio. Most notably, mothers with competitive experience appeared better at identifying the most recent social status of new mates—males they’ve never smelled or seen before. Specifically, competition females exhibited stronger positive growth effects on dominant-sired offspring—especially sons—compared to inexperienced mothers, while significantly slowing the growth of offspring sired by non-dominant males. Strikingly, pairing with a non-dominant male also positively predicted infanticide rates, which indirectly increased the growth rates of the surviving offspring. Taken together, we have shown the importance of considering parental social experience and their subsequent interactions to better explain variation in mouse offspring growth. Furthermore, reversible phenotypic plasticity across breeding cycles is an important and previously unappreciated possible feature of parental effects in mammals. University of Utah UNDERGRADUATE RESEARCH JOURNAL EXPLORING THE EFFECTS OF REPLICATION STRESS ON CHROMOSOME FRAGILE SITES IN DROSOPHILA MELANOGASTER Danielle Bonser (Kent Golic) Department of Biology ABSTRACT Using Drosophila as a model, chromosome breakage and "fragile sites" were studied. Fragile sites are areas on a chromosome where breaks occur with increased frequency (Laird et al., 1987). In humans, common fragile sites are more susceptible to breaking due to late replication in these areas and other factors (Glover & Durkin, 2007). To test whether dicentric chromosome breakage is affected by late replication, aphidicolin, a DNA Polymerase-α inhibitor, was used to induce replication stress throughout the entire genome. Exposure to aphidicolin throughout spermatogenesis does not significantly affect the distribution or incidence of dicentric chromosome breakage in the male germline. This suggests that the replication stress induced by aphidicolin does not contribute to fragility of chromosomes under tension. These results provide insight into the distribution and characteristics of fragile sites within chromosomes, as well as the relationship between Drosophila fragile sites and the DNA replication process. INTRODUCTION DNA must be accurately copied and efficiently distributed during each cell division to maintain a healthy organism. During the cell cycle, DNA replication and chromosome segregation processes may be subjected to a variety of endogenous and exogenous stressors, interfering with their completion and jeopardizing the integrity of these processes (Gelot, Magdalou & Lopez, 2015). When strategies to counteract or alleviate the effects of these stressors fail, chromosome breakage may result. In response to a double stranded break, a cell may fuse the broken ends. This is problematic when multiple breaks occur, creating rearrangements within and between chromosomes (McClintock, 1950). These attempts at repair can cause additional gene mutation and ongoing genetic instability. The accumulation of mutations and copy number variants that result are often seen in the beginning stages of carcinogenesis (Glover & Durkin, 2007). One source of chromosome breakage is stress that hampers normal DNA replication. For instance, conditions that delay or stall replication forks cause replication stress. A stalled fork could lead to a double stranded break when helicase continues to unwind the DNA into single strands, making these areas susceptible to breakage. The collapse of a stalled replication fork can result in a break (Zeman & Cimprich, 2014). Replication stress may occur naturally when low concentrations of necessary replication factors, including nucleotides, components of replication machinery, and histones, are encountered. Excessive replication origin firing in one area of the genome can lead to a depletion of these replication factors, causing replication stress in other areas of the genome. A deficiency of active origin sites within a stretch of the genome can also lead to stress, requiring continuous synthesis across a long stretch of DNA. Properties of the DNA can also contribute to replication stress. DNA lesions, crosslinking and the densely compacted structure of heterochromatin can all slow the progression of replication complexes through these areas. Replication stress can occur in any organism when problems arise during pre-replication, initiation, or elongation, resulting in a local delay in DNA synthesis (Gelot, Magdalou and Lopez, 2015). Replication stress can also be chemically induced. The drug aphidicolin binds DNA polymerase-α, inhibiting its ability to hydrolyze necessary ATP to incorporate dNTPs into a newly synthesized strand. At high concentrations of aphidicolin, all polymerase is completely inhibited, stopping cell cycle progression and eventually triggering apoptosis. With lower doses of aphidicolin, some polymerase remains uninhibited and free to synthesize DNA, but replication fork speed is reduced 2-10 fold, creating replication stress but allowing cell viability for investigation. Since aphidicolin delays S-phase, the cell cycle time is lengthened (Vesela et.al., 2017). Aphidicolin is a useful tool for studying replication stress and its effects on chromosome breakage. Treatment of chromosomes with low doses of aphidicolin induces non-random breaks at specific loci known as fragile sites. These sites have been identified in several eukaryotes as common areas of breakage (Helmrich et. al., 2006, Song et. al., 2014, LaFave, 2011). In humans, two types of chromosome fragile sites have been identified. Rare fragile sites are found in less than 5% of individuals, can be inherited in a Mendelian manner, and are associated with genetic disorders including Fragile X syndrome. The increased frequency of breakage at these sites has been identified as a mechanism of mutation leading to genetic disorders. The second and largest class of fragile sites are common fragile sites (CFS). These sites are a normal component of genomes and are highly conserved between individuals. CFS are frequently involved in breakage and fusion during replication stress and have been identified as sites of frequent chromosome rearrangements and deletions in cancer cells (Glover & Durkin, 2007). Using techniques to recover DNA sequences bound by the pre-replication complex, CFS are often found in areas of the genome far from origins of replication (Nordman & Orr-Weaver, 2012). This makes CFS replication reliant on polymerase working effectively over long distances (Gelot, Magdalou and Lopez, 2015). This process is slower than replicating short stretches of DNA from many origins, and when compared genome-wide these areas are ‘latereplicating’. These areas may replicate so late that synthesis is not complete before cell division. This would normally halt the cell cycle to allow time to resolve these issues. Recombination or incorrect processing of these unreplicated strands could lead to the formation of ultra-fine DNA bridges between the two segregating sister chromosomes. In efforts to resolve these bridges, these areas may be targeted by nucleases resulting in breakage (Franchitto, 2013). In human cells, late replicating areas of the genome frequently coincide with common areas of breakage, indicating a possible connection between late replication and chromosome fragility (Laird et. al., 1987). CFSs are loci where low doses of aphidicolin reproducibly cause breakage (Glover et al., 1984). These experiments suggest a connection between the type of replication stress caused by treatment with aphidicolin and breakage at common fragile sites. Chromosome breakage ‘hotspots’ have recently been identified in Drosophila melanogaster, a promising model to study fragile sites in an organism that can be genetically manipulated (Hill and Golic, 2015). To explore the relationship between the occurrence of fragile sites and replication stress, experiments were conducted to identify chromosome breakage patterns in D. melanogaster exposed to aphidicolin. These experiments examine the relationship between replication stress and chromosome fragility in the specific circumstance of chromosomes under tension in mitosis. This is an unexplored area and may lead to new insights regarding chromosome fragility and the role it plays in unchecked cell proliferation. METHODS Determining effective concentrations of aphidicolin: To induce replication stress, Drosophila were grown on food containing low doses of aphidicolin. Experiments were conducted to determine the highest concentration of aphidicolin flies could be raised on without causing sterility. Aphidicolin was added to 2mL of food to produce final concentrations spanning 0μM to 100μM. Wildtype (y w) female virgins were crossed to wildtype males and allowed to lay eggs on the aphidicolin treated food. Progeny from this cross developed from egg to adult on the treated food. Adult males from this cross were mated with untreated females to determine the effects of different concentrations of aphidicolin on male fertility (Figure 1). Lower concentrations of aphidicolin (<50μM) were shown to have no significant effect on the fertility of Drosophila. However, food containing 100μM of aphidicolin has a significantly detrimental effect on fertility (p<0.01). These results prompted the use of higher levels of aphidicolin (100μM) in subsequent experiments. This concentration has a clear detrimental effect while giving enough viability and fertility for successful experiments and substantial sample sizes. ** n=105 n=18 n=6 n=11 n=14 n=11 n=12 n=24 n=28 n=43 n=60 Figure 1: Fertility at increasing aphidicolin concentrations. Fertility is defined by number of progeny per male parent A 100μM concentration of aphidicolin was achieved by diluting 2 μmol (66.7 μL) of aphidicolin in 500 μL water and adding this to liquid fly food to give a final volume of 2mL. Controls ate food prepared the same way, but without aphidicolin. Chromosome fragility under tension: Because breakage events are rare and typically lethal, a system to efficiently and effectively break chromosomes was used. Ring chromosomes, found and studied in Drosophila, humans and other organisms, were used to facilitate breakage. The site-specific recombinase, FLP, catalyzes recombination between the sister chromatids of this ring, creating a single chromosome with two centromeres (Figure 2). These dicentric chromosomes break during anaphase when each centromere is pulled to opposite poles of the cell. Figure 2: Dicentric chromosome formation and breakage If this chromosome break does not result in lethality, the cell may heal the damage via de novo telomere addition to protect the DNA at the new ends from degradation. These broken, linearized chromosomes can be made in the male germline and recovered to generate stocks, allowing for further examinations (Hill & Golic, 2015). Theoretically, dicentric chromosomes have the potential to break at any point between centromeres. The double bridge made by sister chromatid exchange in a ring chromosome includes 2 copies of the entire X chromosome (Figure 3). If the arms break in similar sites, each cell may receive a complete X chromosome. After healing, such chromosomes may be recovered in viable sons. Breaks that do not precisely correspond on both arms of the dicentric chromosome will result in duplications and deletions. A duplication of euchromatin may be recovered, but a deletion is likely to be lethal. On the other hand, breaks in heterochromatin are not limited in this way, since it carries no vital genes. Figure 3: Breakage at various loci giving viable chromosomes and minor duplications and deletions Fragile sites were identified by this system of inducing breakage of a ring chromosome. It was shown that the dicentrics do not break randomly, and hotspots of breakage are, by definition, regions of chromosome fragility. Microscopic analysis of the new chromosomal termini in mitotic chromosomes of neuroblasts and polytene chromosomes of salivary gland cells enables the identification of breakage sites. A cluster or ‘hotspot’ of breaks is indicative of a fragile site. Structurally unique Ring-X chromosomes: With established effective concentrations of aphidicolin and genetic methods to induce chromosome breakage, fragile sites can be examined under induced replication stress. Two structurally distinct Ring-X chromosomes, R(1;Y) 11Ax2-8c and R(1)2-75B, were used to study the role of replication stress in the sites of dicentric chromosome breakage. The two ring chromosomes used in these experiments contain the entire euchromatic X chromosome, with variable amounts of pericentric heterochromatin. Approximately half of R(1;Y)11Ax2-8c is heterochromatin, while R(1)2-75B has significantly less. This design allows for a more comprehensive study of the chromosomal structure in which breaks preferentially occur. Genetic screen to recover opened Ring-X chromosomes: Females carrying the Ring-X chromosome were crossed to males that express FLP and Hiphop in their germline with the transgenes nosGal4, UASFLP, and UAShiphop. FLP catalyzes the exchange that makes dicentric chromosomes and Hiphop promotes healing of the broken ends. This cross was allowed to lay eggs on aphidicolin treated food or control food. The offspring developed and males with these transgenes and the ring chromosome were crossed to females expressing eyFLP. The eyFLP gene expresses FLP recombinase in the eye throughout larval development. If the ring chromosome is present, recombination between FRTs forms dicentric chromosomes in the developing eye. The resulting breakage and cell death give males with unopened ring chromosomes an easily recognized phenotype: small, rough eyes. Linearized X chromosomes are not detrimentally affected by FLP because recombination between linear chromosomes does not result in dicentric formation. Therefore, males with opened rings and expressing FLP have wildtype eyes (Figure 4). Males carrying the opened Ring-X chromosome were singly mated to C(1)DX females to produce stocks of each individual chromosome breakage event. Figure 4: Genetic screen for unopened ring chromosomes using eyFLP As a control for comparing incidence and distribution of chromosome breakage, flies were raised on food without aphidicolin and tested as described. All crosses and conditions were held constant within these two experiments with the exception of aphidicolin treatment. Determination of breakpoints: After a linearized ring was recovered, cytological analysis was used to determine the breakpoint location of each new end. First, mitotic squashes were produced by dissecting and staining a larval brain with the fluorescent DNA binding dye DAPI. Analysis on a fluorescent microscope allows visualization of metaphase chromosomes. The karyotypes of these nuclei confirmed that the ring had become linear and allowed determination of whether the breaks were in heterochromatin or euchromatin. Resolution of the euchromatic breakpoints can be specified further to a cytogenic band by polytene chromosome cytology. Salivary glands from third instar larvae were stained with Lacto Aceto-Orcein and imaged on a phase contrast microscope. This technique allows for resolution of the breakpoint to around 50kbp. This resolution is restricted by the resolution of polytene banding and light microscopy. Heterochromatin does not replicate in polytene cells so it cannot be effectively visualized in polytene cytology. Thus, chromosomes broken within heterochromatin were further studied using a genetic recombination screen. The results from this screen indicate on which side of the centromere the breaks lie. R(1)2-75B has mutations in the X-linked genes yellow and forked (y - f ), so wildtype female (w1118) flies marked with y+ f+ were crossed to males carrying the opened ring, R(1)2-75B. Breaks occurring on the side of the centromere closest to polytene band #1 will result in a linear X chromosome with the normal, wild-type orientation, with band #20 closest to the centromere. Breakage on the opposite side yields an inverted linear X (Figure 5). When a normally oriented opened ring is crossed to w1118 flies, the incidence of recombinant offspring will be almost equivalent to non-recombinants because the yellow and forked genes are relatively far apart (~50 mu). However, crossovers between an inverted opened X and the w1118 chromosome do not give viable offspring because the resulting inversion loop will prevent recombinants. The recombination frequency was determined for each fly stock with an opened Ring-X chromosomes opened in heterochromatin. Recombination frequencies allowed a determination of which side of the centromere the breakpoint was on. A high recombination frequency indicates normal orientation, while a low frequency indicated a resulting inverted orientation. Inverted orientation Normal orientation Figure 5: Breakage of a Ring-X chromosome produces a normally oriented or inverted linearized X depending on which side of the centromere it breaks Effects of late replication on ring opening rates: Previous work in the Golic lab identified R(1)2-75B as a Ring-X chromosome that is particularly hard to break. Linearized chromosomes are produced from R(1)2-75B at extremely low frequencies. However, due to the effects of aphidicolin on replication, more breaks may be produced when the entire genome is subjected to replication stress, increasing the rate of ring openings. The number of males yielding opened rings was compared to the total of all males with the potential for breakage. This ratio gives the frequency of ring opening. Rates of breakage in chromosomes with and without exposure to aphidicolin are compared to investigate the effect of late replication on ring breakage rates. Cytology: To observe mitotic chromosomes, the brains of third instar larvae were dissected in 0.7% NaCl, swelled in 0.5% sodium citrate, and fixed in a 5.5:5.5:0.5 solution of HOAc: MeOH: H2O. After fixation, the brain was squashed in 45% HOAc under a siliconized coverslip with bibulous paper and frozen on dry ice. The coverslip was flipped off with a razor blade and the slide was air dried. These squashes were stained with DAPI and viewed under UV fluorescence. For polytene analysis of euchromatic breaks, third instar larvae were dissected in 45% acetic acid. Salivary glands were moved onto a coverslip with Lacto Aceto Orcein and a slide placed on top. The salivary glands were squashed by tapping the coverslip with a wooden stick and squashing with bibulous paper. These spreads were analyzed on a Zeiss phase-contrast microscope. RESULTS Rates of Ring Chromosome Opening: To determine if replication stress has an effect on dicentric chromosome breakage, we compared rates of ring chromosome breakage in the presence and absence of aphidicolin. We chose the ring chromosome R(1)2-75B because it is notoriously difficult to open, so if replication stress does promote chromosome breakage, we expect to see more linearized chromosomes when flies are exposed to aphidicolin. Higher rates of chromosome opening would additionally allow for further characterization and observation of fragile sites. Rates of chromosome breakage in flies carrying the R(1)2 chromosome were determined (Figure 6). Rates of Ring Opening Males Yielding Opened Rings 3 ns 2 1 1.17% 0.64% 0 Without aphidicolin With aphidicolin Figure 6: Rates of ring chromosome breakage with and without exposure to aphidicolin Of the males that were screened for opened rings, only 0.64% and 1.17% were broken and recovered with and without aphidicolin, respectively. These ring opening rates are not significantly different from each other (p= 1.0, Fisher’s exact test). Surprisingly, treatment with aphidicolin did not change ring breakage frequencies. Replication stress induced by aphidicolin does not affect the fragility of Drosophila chromosomes. Distribution of chromosome breakage sites: Linearized ring chromosomes with and without exposure to aphidicolin were compared to determine the effect of replication stress on breakpoint distribution. The analysis of two structurally distinct rings allowed for the comparison of breakpoint distribution between the chromosomes to determine if common sites of breakage are present. R(1;Y)11Ax2-8c: Previous work from the Golic laboratory determined that different chromosomes exhibit different arrays of breakage hotspots (Hill and Golic, 2015). In particular, this work identified one chromosome, R(1;Y)11Ax2-8c, with almost all breakage sites clustered in a single block of heterochromatin. We suspect that this region represents an extreme fragile site, perhaps owing to very late replication. Breakage at this specific fragile site may preclude less frequent breakage at the common fragile sites identified in other chromosomes. We theorized that if these flies are treated with a low dose of aphidicolin, the replication stress may make other regions fragile enough to break, potentially revealing novel fragile sites previously unstudied due to the high rate of breakage at the extreme fragile site. Linearized R(1;Y)11Ax2-8c chromosomes were recovered and analyzed with mitotic microscopy technique described in Methods. Flies exposed to aphidicolin throughout development and the controls exhibited a strong preference for breakage within heterochromatin. The resulting linear chromosomes have heterochromatin at each end and can be recognized because sister chromatid cohesion is maintained in heterochromatin until the onset of anaphase, so in metaphase these breaks are easily distinguished from those in euchromatin because the sisters remain connected at the ends. A B Figure 7: Mitotic squashes A: an unopened ring chromosome (red arrow) B: a R(1;Y) chromosome broken in heterochromatin. Heterochromatic regions represented by blue arrows. The purple arrow shows the euchromatic region. Resolution from mitotic squashes was sufficient for identifying break sites in these crosses. No aphidicolin + 100 μM aphidicolin Figure 8: R(1:Y)11Ax2-8c breakpoints with and without exposure to aphidicolin. Arrows represent newly added telomeres on ends of breakpoints The R(1;Y)11Ax2-8c chromosome is notable for its extreme fragile site in the heterochromatic block most distal from the centromere. 59 breakage events without exposure to aphidicolin were recovered by Kent Golic (unpublished). Breakpoint distribution was not affected by treatment with aphidicolin (p<0.01). 15 independent, aphidicolin-treated R(1;Y)11Ax2-8c openings were produced, all with breaks in the extreme fragile site. No novel breakpoints were observed after treatment with aphidicolin. R(1)2-75B: Breakage of a second Ring-X chromosome, R(1)2-75B, was also examined in the presence of aphidicolin. It has been established that this chromosome has a particularly low rate of breakage and healing (unpublished). Although aphidicolin did not have an effect on the rate of opening, it may affect the breakpoint distribution. A B C Figure 9: Mitotic spreads a R(1)2-75B chromosome A: an unbroken ring B: a ring broken in euchromatin and C: a ring broken in heterochromatin When flies were treated with aphidicolin during gamete formation, one candidate male was recovered through our screen with a breakpoint in euchromatin. This chromosome was further investigated using polytene microscopy techniques. Euchromatin can be viewed in polytene spreads while heterochromatin aggregates to the non-replicating chromocenter. Analysis of this chromosome revealed breakpoints at polytene band #10B and #11C with a small duplication between these two breakpoints. Figure 10: A: an image of a polytene chromosome with labeled breakpoints B: a diagram representing the broken X with a small duplication The control (no aphidicolin) R(1)2-75B that I obtained all broke within heterochromatin and were further investigated using a recombination assay. Recombination frequencies provide insight into areas of the chromosome breakage with respect to the centromere (Table 1). Chromosome Recombination Frequency D1 40.39% D2 36.49% D4 37.77% D6 40.31% D9 40.24% D10 26.14% D12 34.65% D13 37.93% Table 1: Recombination Frequencies of Chromosomes with Heterochromatic Breaks All lines produced essentially normal frequencies of crossover events indicating that all of these chromosomes broke to give normally oriented linearized X chromosomes. These breaks are grouped within the heterochromatin on R(1)2-75B on the side closest cytology band 1. The heterochromatic breaks recovered in this experiment are a subset of all the control openings found in Figure 11, the rest of the data for this figure was contributed by Hunter Hill. Using these refined breakpoint locations, a map depicting these sites of breakage was generated: Figure 11: R(1)2-75B breakpoints with and without exposure to aphidicolin. Arrows represent newly added telomeres on ends of breakpoints In the absence of aphidicolin, 21 breaks occurred in euchromatin and 20 in heterochromatin. When exposed to aphidicolin, 27 males that should have had broken rings were recovered. Only one chromosome was linearized, the rest retained a ring chromosome and somehow evaded the screen. When dicentric chromosomes are induced using R(1)2-75B, a high level of lethality is observed. This lethality, paired with the low availability of aphidicolin, severely limits the sample size of this experiment. Due to these limitations, there is not enough data to determine a significant correlation between breakpoints in R(1)2-75B chromosomes with and without treatment with aphidicolin. DISCUSSION The replication stress induced by aphidicolin did not have a substantial effect on the fragility of chromosomes. The Ring-X chromosome R(1)2-75B yields linearized chromosomes at a very low frequency (unpublished). It is difficult to open and recover using dicentric bridge creating techniques. Treatment with aphidicolin might have allowed for the visualization and classification of more fragile sites. However, comparing ring opening frequencies showed that the rate of chromosome breakage was not altered by treatment with aphidicolin. Even though the entire genome was subjected to replication stress, the incidence of chromosome breakage was not increased. Additionally, treatment with aphidicolin did not change breakpoint distributions in ring chromosomes. Previous studies determined that the Ring-X chromosome R(1;Y)11Ax2-8c breaks almost exclusively in a block of heterochromatin that is normally found at the tip of the long arm of the Y chromosome (unpublished). Alteration of this pattern of breakage after exposure to aphidicolin would provide strong evidence for a connection between replication stress and fragile sites in this system. However, treatment with aphidicolin did not significantly change the breakpoint distribution, with nearly all identified fragile sites on this chromosome clustered in the previously identified single heterochromatic locus. The structurally distinct ring chromosome R(1)2-75B was also analyzed, but the effects of treatment with aphidicolin on the location of breakage in this Ring-X were inconclusive due to low sample size. These analyses suggest that the fragile sites revealed by dicentric chromosome breakage are not the same as Common Fragile Sites in humans. Conservation of fragile site locations, as seen in humans, does not occur between the two Drosophila Ring-X chromosomes studied. R(1;Y)11Ax2-8c and R(1)2-75B exhibit different patterns of breakpoints. Fragility during chromosome stretching likely has an underlying mechanism that is unique from breakage at human common fragile sites. Replication stress may still play a role in some forms of chromosome breakage in Drosophila, but dicentric breakage is not affected by the late replication induced by aphidicolin, indicating a fundamental difference between these two phenomena. REFERENCES Franchitto A. (2013). Genome instability at common fragile sites: searching for the cause of their instability. BioMed research international, 2013, 730714. Gelot, C., Magdalou, I., & Lopez, B. S. (2015). Replication Stress in Mammalian Cells and Its Consequences for Mitosis. Genes, 6(2), 267–298. Glover TW , Berger C , Coyle J , Echo B . 1984 . DNA polymerase a inhibition by aphidicolin induces gaps and breaks at common fragile sites in human chromosomes . Hum. Genet. 67 : 136 – 42 Glover, T., & Durkin, S. G. (2007). Chromosome Fragile Sites. Annual Review of Genetics, 41(1), 169-192. Golic M. M., Golic K. G. (2010). A simple and rapid method for constructing ring-X chromosomes in Drosophila melanogaster. Chromosoma 120: 159–164. Helmrich, A., Stout-Weider, K., Hermann, K., Schrock, E., & Heiden, T. (2006). Common fragile sites are conserved features of human and mouse chromosomes and relate to large active genes. Genome research, 16(10), 1222–1230. Hill, H., & Golic, K. G. (2015). Preferential breakpoints in the recovery of broken dicentric chromosomes in Drosophila melanogaster. Genetics, 201(2), 563–572. LaFave M. PhD thesis. 2011. Detection and analysis of common fragile sites in Drosophila melanogaster Laird, C., Jaffe, E., Karpen, G., Lamb, M., Nelson, R. (1987). Fragile sites in human chromosomes as regions of late-replicating DNA. Trends in Genetics, 10(3), 274-281. McClintock, B. (1950). The origin and behavior of mutable loci in maize. Proceedings of the National Academy of Sciences of the United States of America, 36(6), 344-355. Nordman, J., & Orr-Weaver, T. L. (2012). Regulation of DNA replication during development. Development (Cambridge, England), 139(3), 455–464. Song, W., Dominska, M., Greenwell, P.W., & Petes, T.D. (2014). Genome-wide high-resolution mapping of chromosome fragile sites in Saccharomyces cerevisiae. Proceedings of the National Academy of Sciences of the United States of America, 111 21, E2210-8. Vesela, E., Chroma, K., Turi, Z., & Mistrik, M. (2017). Common Chemical Inductors of Replication Stress: Focus on CellBased Studies. Biomolecules, 7(1), 19. Zeman, M. K., & Cimprich, K. A. (2014). Causes and consequences of replication stress. Nature cell biology, 16(1), 2–9. University of Utah UNDERGRADUATE RESEARCH JOURNAL MATHEMATICAL MODELING OF ADAPTIVE THERAPY IN PROSTATE CANCER Cassidy K. Buhler (Kathryn G. Link, Rebecca S. Terry, & Frederick R. Adler, Ph.D.) Department of Mathematics Prostate cancer is a hormonally driven cancer. These cancer cells need androgen, a class of male sex hormone, to survive and grow. Standard treatments for prostate cancer target androgens. This type of therapy is denoted as hormone therapy. Yet, for patients with recurring cancer, hormone therapy is not effective because cancer cells become testosterone independent over time, and consequently, the cells gain resistance and do not respond to therapy. There are studies that suggest therapy administered in intervals [1], as opposed to continuous treatments, could prevent this occurrence. We have analyzed mathematical models of dynamic biological systems for prostate cancer progression [1][2] in order to explore the effect of treatment timing to find the most effective therapy in delaying the inevitable emergence of testosterone resistant cells. We investigated two interval treatments: adaptive therapy and metronomic therapy. Metronomic therapy is solely based on time. Prior to treatment, time intervals are chosen and the drug is only administered during specified time intervals. Adaptive therapy is dependent on the individual patient’s PSA levels. There are predefined upper and lower bounds that are created using the patient’s pre-treatment PSA levels. If the PSA levels exceed the upper bounds, the drug is administered. Then, once the PSA drops back to the lower bound, treatment will subside. This happens relatively quickly. In this aspect, it minimizes the patient’s exposure to the drug and only given “as needed”. It appears that less treatment would give longer time to resistance, and literature has shown that adaptive therapy is the most optimal treatment method in prolonging testosterone immunity. However, we explored these claims and found different variations of metronomic therapy to perform better than variations of adaptive therapy. By manipulating the treatment window to be as short and frequent as needed, we were able to show metronomic therapy can mimic the brevity of adaptive therapy. In addition, we were able to find more optimal PSA bounds that would deliver a longer time to resistance than the initial bounds in the pre-existing models. Figure 1: Scatter plot of both therapies showing the relationship of time to resistance with the average cancer cell population before emergence of resistance. As shown, adaptive therapy is not always the most effective at prolonging resistance. There are some cases where metronomic therapy outperforms adaptive therapy. In the process of this research, we have found that the current model lacks the flexibility to include realistic mechanisms. We have also developed another mathematical model to give more insight. This will be used to push for an explanation of our current findings and answer the new question posed: Does adaptive therapy succeed only through brevity? References [1] Kam, Y., Das, T., Minton, S., & Gatenby, R. A. (2014). Evolutionary strategy for systemic therapy of metastatic breast cancer: balancing response with suppression of resistance. Women’s Health, 10(4), 423-430. [3] Jain, H. V., Clinton, S. K., Bhinder, A., & Friedman, A. (2011). Mathematical modeling of prostate cancer progression in response to androgen ablation therapy. Proceedings of the National Academy of Sciences, 108(49), 19701-19706. [3] Zhang, J., Cunningham, J. J., Brown, J. S., & Gatenby, R. A. (2017). Integrating evolutionary dynamics into treatment of metastatic castrate-resistant prostate cancer. Nature communications, 8(1), 1816. University of Utah UNDERGRADUATE RESEARCH JOURNAL PLASMONIC PROPERIES AND SENSING APPLICATONS OF ALUMINUM NANOANTENNAS Caitlin Denise Coplan (Jennifer Shumaker-Parry) Department of Chemistry Plasmonics, the phenomena resulting from light interactions with nanoscale structures, is an active field for a wide variety of applications and has been used for centuries. By varying the plasmonic metal, size, and shape, the nanostructures can be tuned to interact with various wavelengths of light. Commonly used plasmonic materials are the noble metals gold and silver, however can be costly to fabricate. Aluminum is a cost-effective alternative to the noble metals. However, aluminum does present a challenge as it readily forms a native oxide layer, which can both protect structures and complicate fabrication. Here we fabricate aluminum nanocrescents using an inexpensive, scalable technique to investigate their utility as substrates for a variety of surface enhanced spectroscopies. We show that aluminum is an affordable alternative to gold and silver and performs at the same level as gold and silver at IR wavelengths, a region that aluminum is not typically used in. We also investigate the differences in line shapes of alkyl stretches between aluminum and gold substrates. Aluminum also shows great promise in other applications due to its high tunability potential and functionality across a broad region of the spectrum of light. This allows for a wide variety of applications, such as refractive index sensing for biological macromolecules, various surface enhanced spectroscopies, photocatalysis, and photovoltaics. University of Utah UNDERGRADUATE RESEARCH JOURNAL THE IMPORTANCE OF COENZYME A IN MITOCHONDRIAL FATTY ACID SYNTHESIS PATHWAY Malika Kadirova (Jared Rutter, Katja Dove) Department of Biochemistry Mitochondrial biogenesis is a complex process, as it is composed of many pathways that communicate in coordination and are interdependent. The highly conserved mitochondrial pathway for fatty acid synthesis (mtFAS), has recently been shown to regulate late-stage assembly of the electron transport chain and how this pathway is regulated is the major question of this proposal (Nowinski et al, 2018.) The canonical fatty acid synthesis pathway (FAS I) occurs in the cytoplasm and generates fatty acids for membrane biosynthesis, hormones, and energy sources (Nowinski et al, 2018.) Interestingly, eukaryotes have maintained a second fatty acid synthesis pathway that occurs in mitochondria (mtFAS). Unlike FAS I, mtFAS does not contribute to the cellular fatty acid pool, but instead produces lipoic acid which is a cofactor for several dehydrogenase and more importantly, it has also been shown to be a major regulator for the assembly of the electron transport chain (ETC) (Nowinski et al, 2018.) Mitochondrial fatty acid synthesis involves many enzymes, substrates and cofactors, mitochondrial acetyl-CoA being the essential substrate for fatty acid synthesis. Acyl chains are synthesized by stepwise addition of carbon units. During the elongation process, the acyl carrier protein (ACP) acts as a main component upon which the growing chain is attached to the distal end of a 4’phosphopantetheine moiety (4’PP) of ACP (Nowinski et al, 2018.) Therefore, the modification of ACP with its cofactor 4’PP is a crucial, early step that precedes acyl chain formation. Coenzyme A is utilized in order to attach 4’PP to the apo form of the acyl carrier protein, and the resulting complex (holo-ACP) is utilized as scaffold, where fatty acids attach as they elongate (Nowinski et al, 2018.) Collaborators of the Rutter Lab performed a genome wide genetic screen called SATAY (saturated transposon analysis in yeast) under various nutrient-limiting conditions to identify genes that cluster with components of the mtFAS pathway. This unbiased screen identified that LEU5 clusters with the mtFAS genes. LEU5 is proposed to be a Coenzyme A transporter (Prohl et al, 2001.) This suggests that Coenzyme A (CoA) provided by LEU5 might play a role in regulating mtFAS. CoA is important in fatty acid synthesis, and therefore, plays an essential role in electron transport chain (ETC) biogenesis via the physical interaction of ETC complexes and the acyl-chain attached to 4’PP of ACP (Nowinski et al, 2018.) Data reports that when ACP is not bound to 4’PP, and as a result ACP is not acylated the mitochondrial fatty acid synthesis pathway is deactivated, and the ETC complexes are destabilized (Nowinski et al, 2018.) Hence, we hypothesize that mitochondrial CoA levels are at times limiting, which in turn regulates the mtFAS pathway by limiting the amounts of holo-ACP that is available to build acyl chains. The purpose of this research project is to investigate whether CoA levels are important in regulation of MtFAS pathway. Based on the data obtained from the collaborators of the Rutter Lab, we think that the CoA transporter LEU5 plays a crucial role in regulating mtFAS. In order to test the hypothesis, we generated LEU5 KO strain. Future goals include spot testing to confirm the genotype, cloning leu5 with endogenous promoter, testing whether pLEU5 can rescue glycerol phenotype, cloning leu5 into different plasmids contain different strength promoters and testing expression levels. References: Nowinski, SM., Vranken, J.G., Dove, KK., Rutter, J. (2018). Impact of Mitochondrial Fatty Acid Synthesis on Mitochondrial Biogenesis. Current Biology, 28, 1212–1219. Prohl, C., Pelzer, W., Diekert, K., Kmita, H., Bedekovics, T., Kispal, G., Lill, R. (2001).The yeast mitochondrial carrier Leu5p and its human homologue Graves' disease protein are required for accumulation of coenzyme A in the matrix. Mol Cel Biol, 4, 1089-97. University of Utah UNDERGRADUATE RESEARCH JOURNAL GENETIC MODIFIERS OF SEVERITY IN COLLAGEN VI-RELATED MUSCULAR DYSTROPHY Amy Loret (Russell J. Butterfield, MD, PhD) Department of Biology Collagen VI-related muscular dystrophies (COL6-RD) display phenotypic heterogeneity that includes mild Bethlem myopathy (BM), intermediate (INT), and severe Ullrich congenital muscular dystrophy (UCMD) phenotypes. COL6-RD are characterized by mutations within the collagen VI genes (COL6A1, COL6A2, and COL6A3) that lead to improper formation of collagen VI protein. Resulting symptoms may include progressive muscle weakness, joint contractures, loss of ambulation, and premature death. Variation in phenotypic severity is not fully explained by primary collagen VI gene mutations alone, suggesting the presence of genetic modifier loci that control the level of pathogenic response. Previous studies have shown that the gene encoding latent transforming growth factor β binding protein 4 (LTBP4) plays a role in genetically modifying the severity of phenotypes in other muscular dystrophies including sarcoglycanopathy in mice and Duchenne muscular dystrophy (DMD) in humans. We sought to test the hypothesis that LTBP4, a regulator of TGF-β signaling, is a modifier of clinical severity of COL6-RD. Genotyping of one of the four single nucleotide polymorphisms (SNPs) that define the IAAM haplotype of the LTBP4 gene was performed in a cohort of comprehensively phenotyped COL6-RD patients. The LTBP4 haplotype was determined in 45 individuals with COL6-RD and associated with clinical severity outcomes using chi-squared (χ2) tests. We did not find a statistically significant association between the LTBP4 genotypes and observed phenotypic classes. Our results do not support the initial hypothesis that LTPB4 is a genetic modifier of clinical severity in patients with COL6-RD. Although results did not support the initial hypothesis, our research outcomes still provide important insights into the phenotypic heterogeneity seen in patients with COL6-RD. While our findings indicate that LTBP4 may not act as a broadly applicable genetic modifier to target in the treatment of all existing forms of muscular dystrophy, COL6-RD remain an important group of muscle diseases to study. These results exemplify the need to consider the influence of genetic factors outside of LTBP4 and primary COL6A genes in the pursuit of understanding variations in clinical severity. University of Utah UNDERGRADUATE RESEARCH JOURNAL IMMOBILIZATION OF NITROGENASE FOR BIOELECTROCHEMICAL AMMONIA SYNTHESIS Janki H. Patel, Rong Cai, Shelley D. Minteer* Department of Chemistry Abstract Ammonia has a variety of uses from cleaning products to fertilizer. Most commonly, ammonia is produced from hydrogen and nitrogen through the Haber-Bosch process, an energy-intensive process requiring high temperature and high pressure. In nature, N2 is reduced by an enzyme called nitrogenase, at room temperature and ambient pressure. Nitrogenase the energy efficient reducing N2 enzyme occurs using electrochemistry. Electrochemistry serves as a powerful tool to promote redox transformation by supplying or accepting electrons. Real-time observation of the 8-electron transfer and consumption of ATP allows insight to the nitrogenase mechanism. Limitations of this process arises with enzyme turnover, which occurs between the diffusional contact of the enzyme and electrode. Efficient electrons transfer can be achieved by immobilizing catalytic enzyme on the electrode surface. Here we apply a polypeptide (KDDD) modified pyrene as an anchor to immobilize nitrogenase on the electrode surface. The polypeptide segment is capable of coordinating with Ni ion, which could further bind with the His-tag region of nitrogenase. On the other end of the molecule, pyrene has been known to absorb on multiwall carbon nanotubes through pi-pi interactions. Successful immobilization of nitrogenase onto the electrode surface using the polypeptide (KDDD) modified pyrene allows the evaluation of the nitrogenase pathway for ammonia reduction. This mechanistic approach for nitrogenase could contribute to enhance electrocatalytic efficiency for ammonia production. University of Utah UNDERGRADUATE RESEARCH JOURNAL ORDINARY DIFFERENTIAL EQUATIONS MODEL OF THE EPITHELIAL TO MESENCHYMAL TRANSITION IN HUMAN MAMMARY EPITHELIAL CELLS Katelyn Queen, Professor Frederick Adler, Dr. Jason Griffiths Department of Mathematics, Department of Biology Cellular resistance to chemotherapy treatments usually develop via genetic changes, including mutations and acquisitions of new resistance genes. However, when resistance develops without this genetic component, it is called phenotypic plasticity. Phenotypic plasticity is the idea that one genotype can produce multiple phenotypes dependent on the environmental conditions. As a result, chemo agents are stimulating cancer cells in a way that modifies their gene regulatory network (GRN). These changes to the GRN decrease the effectiveness of the chemo agents in killing the cancer cells. There are multiple processes which fall under phenotypic plasticity, but we are specifically interested in the epithelial to mesenchymal transition (EMT). EMT promotes cellular resistance by reducing therapy efficiency. When cells undergo EMT, they are said to gain ‘stem cell-like’ properties. These properties make specific targeted drug therapy difficult by creating a dichotomy where the drugs kill cancer cells but induce EMT. For example, this process can down-regulate apoptotic pathways or reduce the amount of drug in a cell, both leading to a decrease in cancer cell death. The EMT pathway is complex and not well understood. However, we believe that the pathway includes transcription factors snail family transcriptional repressor 1 (SNAIL1), twist family BHLH transcription factor 1 (TWIST1), and zinc finger E-box binding homeobox 1 (ZEB1), as well as their respective mRNAs and micro RNAs. Together, the transcription factor, mRNA, and microRNA form a positive feedback loop. All of these transcription factors upregulate the forward direction of EMT, repressing expression of E-cadherin (CDH1) and promoting expression of N-cadherin (CHD2). We use TGF-𝛽 to force the system into EMT. To model the EMT pathway, we use a system of ordinary differential equations (ODEs), where each equation models a different component of the gene regulatory network shown in Figure 1. Using X. Tian et al’s model as a jumping off point, we began by adding in TWIST1. We make an assumption that SNAIL1 and TWIST1 have the same function in the EMT pathway, and thus we model them with the same equation and parameters. Additionally, the fastest terms, as determined by their basal production rates, are the transcription factors SNAIL1, TWIST1, and ZEB1. We put these terms into quasi-steady state. Tian’s model includes a differential equation for TFG-𝛽, but we omitted that term. The final change we made was to modify the functional form of E-cadherin from a sum of effects to a multiplication of effects. To study EMT, we will be using data collected from an experiment done by Jeff Chang’s group where EMT was induced in human mammary epithelial (HMLE) cells. For 18 days, the cells were treated with tamoxifen, during which time the cells underwent EMT. The tamoxifen was then stopped, and the cells were allowed to go through the reverse process, the mesenchymal to epithelial transition (MET), for an additional 18 days. During this 36-day period, samples were collected every three days. The population of the cells that went back into the experiment, i.e. the ones that were not sent for sampling, was kept track of, and we used this to test the accuracy of our model. Using our population ODE, 𝑑𝑃 1 − 0.004𝑃 = 0.04𝑃 + 5 𝑑𝑡 𝑍 4 1+/ 3 𝐽2 we were able to plot the model predictions against the cell population from the experiment. As seen above, our model has the general shape of the population curve correct, but the parameter values need some fine tuning. Additionally, the major jump in the blue, model prediction line between days 0 and 3 can be corrected by changing our initial conditions. In general, we see the same pattern in the differences between the model predictions and experimental data. References 1. Garg M. (2013). Epithelial-mesenchymal transition - activating transcription factors multifunctional regulators in cancer. World journal of stem cells, 5(4), 188–195. doi:10.4252/wjsc.v5.i4.188 2. Jia, D., Jolly, M. K., Kulkarni, P., & Levine, H. (2017). Phenotypic Plasticity and Cell Fate Decisions in Cancer: Insights from Dynamical Systems Theory. Cancers, 9(7), 70. doi:10.3390/cancers9070070 3. Lee JM, Dedhar S, Kalluri R, Thompson EW. (2006) The epithelial-mesenchymal transition: new insights in signaling, development, and disease. J Cell Biol, 172, 973–981. doi:10.1083/jcb.200601018 4. Nurwidya, F., Takahashi, F., Murakami, A., & Takahashi, K. (2012). Epithelial mesenchymal transition in drug resistance and metastasis of lung cancer. Cancer research and treatment : official journal of Korean Cancer Association, 44(3), 151-6. doi:10.4143/crt.2012.44.3.151. 5. Qin, Q., Xu, Y., He, T., Qin, C., & Xu, J. (2011). Normal and disease-related biological functions of Twist1 and underlying molecular mechanisms. Cell research, 22(1), 90–106. doi:10.1038/cr.2011.144 6. Tian, M., & Schiemann, W. P. (2017). TGF-β Stimulation of EMT Programs Elicits Nongenomic ER-α Activity and Anti-estrogen Resistance in Breast Cancer Cells. Journal of cancer metastasis and treatment, 3, 150–160. doi:10.20517/2394-4722.2017.38 7. Tian, X., Zhang, H., & Xing, J. (2013). Coupled Reversible and Irreversible Bistable Switches Underlying TGFβ-induced Epithelial to Mesenchymal Transition. Biophysical Journal,105(4), 1079-1089. doi:10.1016/j.bpj.2013.07.011 8. Wang Q, Cheng Y, Wang Y, Fan YB, Li C, Zhang Y, Wang YD, Dong Q, Ma YJ, Teng YE, Qu XJ, Liu YP. (2017) Tamoxifen reverses epithelial-mesenchymal transition by demethylating miR-200c in triple-negative breast cancer cells. BMC Cancer, 17, 492. doi:0.1186/s12885-017-3457-4. 9. Yang, F., Sun, L., Li, Q., Han, X., Lei, L., Zhang, H., & Shang, Y. (2011). SET8 promotes epithelial-mesenchymal transition and confers TWIST dual transcriptional activities. The EMBO journal, 31(1), 110–123. doi:10.1038/emboj.2011.364 University of Utah UNDERGRADUATE RESEARCH JOURNAL SUPPLEMENTATION WITH MACULAR CAROTENOIDS IMPROVES VISUAL PERFROMANCE OF TRANSGENIC MICE by Gregory T. Rognon Paul S. Bernstein, M.D., PhD. The School of Biological Sciences ABSTRACT Previous work has shown that carotenoid supplementation can improve visual acuity in humans. However, there is yet to be a viable rodent model to verify the effects of carotenoids on the visual performance of laboratory animals. The Bernstein Lab at the Moran Eye Center recently demonstrated that mice deficient in β-carotene oxygenase 2 (BCO2) and/or β-carotene oxygenase 1 (BCO1) enzymes are able to accumulate carotenoids in their retinas. This allows an investigation into the effects of carotenoids on visual function of mice. Using OptoMotry, a device used to measure visual function in rodents, we examined the effect of zeaxanthin, lutein, and β- carotene on visual performance of various BCO knockout mice. To further investigate the potential positive effects of supplementation, we transgenically expressed the human zeaxanthin-binding protein GSTP1 (hGSTP1) in the rods of bco2−/− mice to investigate if accumulating more zeaxanthin in the retina would improve visual performance further. In summary, the visual function of bco2−/− mice supplemented with lutein or zeaxanthin improved significantly over control mice fed with placebo chow. β-Carotene has no significant effect on the visual performance of bco2−/− mice, but slightly improved visual function of bco1−/− mice. Additionally, with expression of the hGSTP1 in the rods of bco2−/− mice, 40% more zeaxanthin was found in the retina which resulted in even greater improvements of visual acuity. The presented research verifies that “macular pigment ii mice” are a viable laboratory model to study the effects of carotenoids on visual systems. TABLE OF CONTENTS ABSTRACT ii INTRODUCTION 4 METHODS 8 RESULTS 11 DISCUSSION 19 REFERENCES 26 PUBLISHED WORK 30 (22) iii INTRODUCTION Carotenoids are one of the major groups of phytochemicals, molecules which are produced by plants. Carotenoids are characterized as carotenes if they consist only of hydrogen and carbon. If they are oxidized to any degree, they are referred to as xanthophylls. Three carotenoids used in this paper are β-carotene, and xanthophyll carotenoids lutein and zeaxanthin. These molecules consist of large, conjugated polyene chain backbones with a beta-ionone ring at each end. These conjugated backbones allow the carotenoid molecule to be very efficient antioxidants, diffusing the energy in toxic reactive oxygen species (ROS) and absorbing harmful blue light (Bernstein et al., 2016). ROS are highly reactive radicals and formal charge bearing oxygens that can react with a long list of biomolecules. For example, if any protein undergoes a chemical reaction, it has a large probability of changing the shape, and therefore changing or losing the function of that protein. Additionally, these ROS can alter DNA structures leading to higher likelihoods of cancers and other mutations. In summary, having unregulated reactions in a cell can be detrimental to the health of that cell. Interestingly, carotenoids are found in nearly all organisms in varying locations and varying concentrations, following the idea that having an effective radical-scavenging molecule is evolutionarily advantageous (Maoka, 2011). Humans are rather unique in their utilization of carotenoids in that they distribute them in high concentrations to the macula lutea, creating the yellow spot that is centered at the fovea (Bone et al., 1992; Handelman et al., 1992). The carotenoid species that are used in the macula of humans are lutein, zeaxanthin, and mesozeaxanthin, and are referred to as macular pigments (MP). Lutein and zeaxanthin are obtained 4 by diet, and meso-zeaxanthin is an isomerization of zeaxanthin. The optimal wavelength that MP absorb light is at 455 nm, with a range between 400-550 nm (Bernstein et al., 2016). This is interesting because blue and violet light (390-495 nm) have been found to create ROS (Godley et al., 2005). Carotenoids act both as an effective mechanism of quenching these high energy ROS, and absorbing the light that would make more of these species. As investigative research focuses more and more on MP, an increasingly large consensus suggests that MP are crucial for high visual acuity due to its blue light-filtering properties, reduction in chromatic aberration, veiling luminance, and blue haze. (Hammond et al., 2014; Loughman et al., 2012). Additionally, MP may protect against AMD because of these optical characteristics in connection with the antioxidant capacity of the three carotenoids (SabourPickett et al., 2012). In an almost elegant manner, the human eye has selected for distribution of a particular molecule that prevents and extinguishes ROS. Not only do they reduce oxidative damage and help prevent ROS from being created in the first place, MP also increase visual acuity. In most animals, carotenoids are distributed in many tissues, including liver, serum, adipose tissue, and brain (Bernstein et al., 2016). Distribution of carotenoids to the ocular tissues is a relatively rare occurrence. This phenomenon is only observed in avian and primate species (Bernstein et. al, 2016). However, carotenoids are a rather common biomolecule in nature. The reason that so few species have retinal carotenoids is still under debate. Furthermore, one theory revolves around the story of carotenoid cleavage enzymes and carotenoid-binding proteins. When carotenoids are consumed, most are cleaved by BCO1 and/or BCO2, carotenoid 5 oxygenase enzymes (Bernstein et al., 2016). These cleavage enzymes break down the carotenoids, resulting in several products used throughout the body. Of the 700 different variants of carotenoids known to exist, only 15-30 make it into the human blood stream, and only two of these make it to the human retina (Bernstein et al., 2016). There, the carotenoids are taken up and accumulated in the retina of the eye by GSTP1 and STARD3 proteins (Bhosale et al., 2004; Li et al., 2011). Interestingly, humans have a very inactive form of BCO2 enzyme in the retina. The binding affinity between carotenoid and human retinal BCO2 is around 10-40 times weaker than the same enzyme in other species, causing human retinal BCO2 to be an inactive carotenoid cleavage enzyme (Li et al., 2014). We have previously confirmed that mice deficient in the BCO2 gene can accumulate lutein and zeaxanthin in ocular tissues. Though this paints a very clear picture as it relates to humans, the pathway of ocular carotenoid accumulation for avian and other species is not well understood. The Age-Related Eye Disease Study 2 (AREDS 2) conducted by the National Eye Institute (NEI) in 2006 has concluded that supplementation of lutein and zeaxanthin has been found to reduce the risk of Age-Related Macular Degeneration (AMD). As this is the second study by the NEI, carotenoids have been accepted as molecules that can positively affect visual acuity and longevity of vision. Related studies would be very important to conduct. However, the experimental models that accurately represent human MP are limited. Primates are excellent models for these kinds of studies. Their MP is very similar to humans, and the mechanism for distribution of these molecules is also comparable. However, there are a large amount of difficulties that can arise from using primates as clinical models. 6 We have recently found that mice lacking the BCO2 gene can accumulate carotenoids in the retina. Mice have been used as research models for centuries due to their strikingly similar anatomy to humans and ease of care, among many other desirable traits. In this thesis, we investigate the effects of zeaxanthin, lutein, and β-carotene on the spatial frequency and contrast sensitivity of rod and cone cells of the “macular pigment mice” using OptoMotry, a device to examine visual function of small animals. Furthermore, we tested if delivering more carotenoids to the retina of transgenic mice expressing the human zeaxanthin binding protein GSTP1 (hGSTP1) in their rod cells will induce further improvement of their visual function. In the following work, I will convey the extent to which I participated in this project, add my own commentary, and reflect on the results and possible future work that can be done regarding this subject matter. As an undergraduate, I have worked in a lab at the Moran Eye Center of the University of Utah for the past two years. The Principal Investigator for this work is Dr. Paul Bernstein, M.D., Ph.D. I work on a daily basis with Dr. Binxing Li, who is a postdoctoral fellow in Bernstein’s Lab. At the time that I joined the lab, Drs. Bernstein and Li had successfully created and verified “macular pigment mice” as a viable model to test the effects of carotenoids on visual systems. The next step, as explained above, was to determine the effects of such vitamins on visual performance. Over the course of roughly 18 months, Dr. Li, myself, and nine others worked together to verify our hypothesis that supplementation with carotenoids do in fact improve visual performance in macular pigment mice. The results of said work has recently been published in the Journal of 7 Archives of Biochemistry and Biophysics. I am included as second author of the work, as well as a UROP recipient for the Spring 2019 semester to continue research on this same subject matter. As stated, the purpose of this thesis is to explore my involvement, participation, and reflections of this project. Attached is a copy of the published manuscript. The original work will be referred to extensively. METHODS Much of the preliminary work regarding the husbandry and feeding of the mice was done by Dr. Li and my colleague Fu-Yen Chang. Fu-Yen specializes in genetics and worked closely with Dr. Li in the tasks of animal husbandry and Genotyping. It was necessary for me to not be involved with the feeding of the mice as to keep me blind to which groups of mice were fed the carotenoid chow. The OptoMotry System (Cerebral Mechanics, Lethbridg, AB, Canada) was used to determine the visual acuity and contrast sensitivity of the mice. Each group had 7-15 mice being 3-4 months old. Placebo chow was given to another group of mice to act as a control for each test group. Please refer to the published work under bullet number 2.4 OptoMotry for greater detail of these tasks. I must admit that I did not enjoy doing this portion of the experiment. The test required 10-15 minutes of testing for each mouse. However, the beginning stages of my learning required 3060 minutes per mouse. There were around 130 individual mice to be tested in both scotopic and photopic conditions. Only with a great amount of practice and patience was a 10-15 minute 8 test possible. As one may suspect, many experiments had to be repeated due to my inconsistency at the beginning of the experiment. As I learned, I was able to extract excellent data, but it was only after many, many hours of practice. One observation that I had during these tests was that the grounds for determining if the mouse was able to detect changes were subject to the observer. I highly suspect that if someone who was also proficient at using this system tested the same mice that I did, that we would obtain different results. However, the beauty of this system is that it allows for comparison of two groups. The hypothesis predicted an increase in visual acuity, not a specific level of sight being obtained. This differs with the Snell Eye Test which can produce consistent levels of sight among humans. Though as investigators we would like to be able to determine a consistent level of acuity that is consistent between observers, a comparison of difference is adequate to show visual performance increases. After OptoMotry experiments were conducted, the mice needed to be sacrificed and dissected. Though rather gruesome, this portion was the most enjoyable. As a team of four, three of my colleagues and I took posts each with a specific task. We collected blood, liver, brain, and eye samples from each mouse. An aspect of this work that was in contrast to the acquisition of visual acuity and contrast sensitivity of the mice was human interaction. I found very quickly that I much preferred to work with people rather than mice. After the collection of tissues was complete, we needed to extract the carotenoids from the various tissues and determine their relative levels. For each, a homogenization process had to be conducted. For liver and brain samples, that involved weighing certain amount of tissue 9 from each sample and using a tissue homogenizer to liquefy them one by one. This took an extensive amount of time including several late nights homogenizing. After tissues were homogenized, an extraction protocol was followed to separate the carotenoids from the various samples. A detailed outline of this protocol can be found in the published work under bullet number 2.4 Carotenoid extraction and analysis by HPLC. I personally did the majority of the homogenizations and many of the extractions. The process of analyzing the retina and retinal pigment epithelium (RPE) tissues of the mice required an additional step. Each eye sample had to be dissected and the RPE and retina needed to be separated. I personally did this for every mouse sample in the experiment. This was my favorite part of the work that we did. I really enjoyed the challenge of dissecting such a small eye, and it seemed very similar to surgery which is something that I am very interested in. I also have been involved with flat mounting other mouse eye samples for use in other experiments. Another aspect of the research that I was in charge of was protein analysis by Western Blot and Immunohistochemistry. Since my start at the lab I have been the person who runs these experiments in the lab. I also assisted Dr. Li in the analysis process after the data was collected. We collaborated to synthesize the data into a coherent result. 10 RESULTS To verify that carotenoid supplementation can have an effect on the visual function of bco2−/− mice, groups were fed β-carotene, lutein, or zeaxanthin for one month. The OptoMotry device was used to test the changes in visual function of the various groups. Two parameters were used to test the cone and rod systems separately, namely photopic and scotopic conditions, as well as spatial frequency and contrast sensitivity separately. Higher visual acuity corresponded with higher spatial frequency scores and lower contrast scores corresponded with better visual acuity with regards to contrast sensitivity. Fig. 1 Visual performance measured by OptoMotry in bco2−/− mice with and without zeaxanthin supplementation. Zeaxanthin supplementation significantly improves the visual function of bco2−/− mice. (a) Photopic spatial frequency; (b) Photopic contrast sensitivity; (c) Scotopic spatial frequency; (d) Scotopic contrast sensitivity. Values indicate means ± SD; 10 mice were used in each group. **, P < 0.01. 11 Fig. 1 shown above demonstrates that zeaxanthin supplementation significantly increases spatial frequency and contrast sensitivity in both photopic and scotopic conditions of bco2−/− mice. When compared to the placebo fed bco2−/− mice, spatial frequency sensitivity increased by about 15% in both cone and rod pathways, and contrast sensitivities in cone and rod systems increased between 20% and 35% respectively. Fig. 2. Visual performance measured by OptoMotry in bco2−/− mice with and without lutein supplementation. Lutein supplementation significantly improves bco2−/− mice's visual function except for the contrast sensitivity of the rod cells. (a) Photopic spatial frequency; (b) Photopic contrast sensitivity; (c) Scotopic spatial frequency; (d) Scotopic contrast sensitivity. Values indicate means ± SD; 15 mice were used in each group. *, P < 0.05; **, P < 0.01. Additionally, lutein also significantly increased visual acuity in both spatial and contrast sensitivity in cone systems, but not in contrast sensitivity in rod systems (Fig. 2). The differences between the carotenoid supplemented group and the placebo group is similar to that of 12 zeaxanthin, but only improved cone contrast sensitivity by 20%, slightly less than the impact of zeaxanthin. With respect to the large error bars associated with the contrast sensitivity, especially in scotopic conditions, I believe the problem with the data is not due to the carotenoid not having effect on the mice. I would estimate that much of the lack of agreement among the data has to do with the fact that two observer’s results of the mice were averaged. However, as I discussed before, the OptoMotry system is most useful for comparison and not consistent values across observers. Therefore, the difference between the placebo and variable groups of mice may be similar, but the actual acuity and contrast scores associated with each group can vary between observers. I would then say that if I were able to retest the lutein fed bco2−/− mice for contrast sensitivity, there is a high likelihood that I would be able to make dependable observations. As you can deduce, the line was barely crossed to label the scotopic contrast tests as insignificant. Though the fact that the OptoMotry system has difficulty reproducing actual values between observers does not deem the system any less useful. Being able to measure the difference between two groups is sufficient to conclude that a certain therapy does in fact improve function. β-Carotene is found only in trace amounts in the human retina, and therefore has very little effect on the overall health and visual capacity of our visual system. However, β-carotene is the precursor to retinal, a very important molecule to vision, and it also shares the light-absorbing character of lutein and zeaxanthin. 13 Fig. 3. Visual performance measured by OptoMotry in bco2−/− mice with and without β- carotene supplementation. βCarotene supplementation has no significant effect on the visual performance of bco2−/− mice. (a) Photopic spatial frequency; (b) Photopic contrast sensitivity; (c) Scotopic spatial frequency; (d) Scotopic contrast sensitivity. Values indicate means ± SD; 10 mice were used in each group. *, P < 0.05. Fig. 3 shows that β-carotene has no significant effect on the visual performance of bco2−/− mice. A large part of this is due to the fact that BCO1, the main cleavage enzyme that reacts with βcarotene, is still active in bco2−/− mice. In previous work done by our lab, it has been shown that β-carotene is distributed to the eye in ratios of 10-15% of the levels of lutein and zeaxanthin in the retina of bco2−/− mice. Furthermore, the levels of β-carotene in the retinas of bco1−/− mice is comparable to that of lutein and zeaxanthin in the retinas of bco2−/− mice (Li et al., 2017). 14 Fig. 4. Visual performance measured by OptoMotry in bco1−/− mice with and without β- carotene supplementation. βCarotene supple- mentation slightly improves the visual performance of bco1−/− mice. (a) Photopic spatial frequency; (b) Photopic contrast sensitivity; (c) Scotopic spatial frequency; (d) Scotopic contrast sensitivity. Values indicate means ± SD; 7 and 8 mice were used in β- carotene and placebo groups, respectively. *, P < 0.05. Fig. 4 shows that β-carotene supplementation can significantly increase the visual performance in cone systems of bco1−/− mice. However, the increase of ability over the placebo fed mice is very small, being 4% and 9% with respect to spatial and contrast sensitivity. Given an overarching view of the data, zeaxanthin improves visual performance the most, with lutein giving similar results, and β-carotene only having small improvements compared to placebo fed mice. Considering that zeaxanthin is the most effective of the three carotenoids in improving vision, we wanted to investigate the possibility of further increasing visual performance by distributing 15 more zeaxanthin to the retina. To do so we transgenically expressed the human zeaxanthinbinding protein GSTP1 (hGSTP1) in the retina of bco2−/− mice by crossing an hGSTP1 transgenic mouse line (hGSTP1- tg) with the bco2−/− mice. Fig. 5. Generation of transgenic (hGSTP1-tg) mice expressing the human zeaxanthin-binding protein GSTP1 specifically in the retina. The transgene construct (upper panel). RT-PCR reveals presence of human GSTP1 in the transgenic mouse retina. Lane 1. Amplicon size marker; 2. Wildtype C57BL/6 mice (WT); 3. hGSTP1-tg mice. Samples are normalized by GAPDH (lower left panel). Immunoblot results of antibody directed against the HA-tag versus total protein extract from pooled mouse retinas. Lane 1. Protein size marker; 2. C57BL/6 mice (WT); 3. hGSTP1-tg mice. Samples are normalized by actin (lower middle panel). Immunolocalization with antibody to HA-tag (green) in a 1-month-old hGSTP1-tg mouse retina (far right panel). OS, outer segments; ONL, outer nuclear layers; OPL, outer plexiform layers. 16 Fig. 5 shows the transgene construct and the expression of hGSTP1. cDNA encoding hGSTP1 protein was placed under the control of the mouse rhodopsin promoter, which drives hGSTP1 protein expression specifically in rods. Confocal immunolocalization of the expressed HA-tag showed robust expression of human GSTP1 throughout the rod cells, from the outer plexiform layers (OPL) to outer segments (OS). The hGSTP1-tg mice were mated to bco2−/− mice in order to generate hGSTP1-tg/bco2−/− mice. Fig. 6. Contents of zeaxanthin detected in the tissues of hGSTP1-tg, bco2−/− and hGSTP1-tg/ bco2−/− mice. The expression of zeaxanthin-binding protein GSTP1 specifically in the retina of bco2−/− mice significantly increased the retinal carotenoid contents. 8 to 10-week-old mice (n = 25/genotype) were kept on DSM zeaxanthin beadlet chow (1 g zeaxanthin/kg chow) for 4 weeks. Carotenoids were extracted from the serum and liver of each individual animal. Retina and RPE/choroid were pooled from 3 to 5 animals (5 repeats) in each mouse group. Values indicate means ± SD, N.D., not detectable. *, P < 0.05; **, P < 0.01. We then performed a zeaxanthin-feeding experiment in which ∼ 3-month-old hGSTP1- tg/bco2−/− and bco2−/− mice were fed with DSM-beadlet diets for one month. Fig. 6 shows the levels of zeaxanthin in several tissues of hGSTP1-tg, hGSTP1-tg/bco2−/− and bco2−/− mice. We determined these levels by HPLC. The difference found between the three different mice is significant. As predicted, hGSTP1-tg mice will not distribute zeaxanthin to the retina since the 17 BCO2 cleavage enzyme is still active. Additionally, bco2−/− mice were found to have appreciable amounts of zeaxanthin in the retinal tissue and hGSTP1-tg/bco2−/− mice had significantly more zeaxanthin, roughly 40% more than bco2−/− mice. There was no difference between zeaxanthin levels found in the RPE/choroid, serum, and liver of these mice. We next examined the impact of zeaxanthin on the visual performance of hGSTP1-tg/bco2−/− mice. 3-month-old hGSTP1-tg/bco2−/− mice were divided into two groups and fed with or without zeaxanthin for 4 weeks. We then examined their visual performance using OptoMotry. Fig. 7. Visual performance measured by OptoMotry in hGSTP1-tg/bco2−/− mice with or without zeaxanthin supplementation. Zeaxanthin supplementation significantly improves the visual function of hGSTP1-tg/bco2−/− mice, especially the rod contrast sensitivity. (a) Photopic spatial frequency; (b) Photopic contrast sensitivity; (c) Scotopic spatial frequency; (d) Scotopic contrast sensitivity. Values indicate means ± SD; 11 and 14 mice were used in the zeaxanthin and placebo groups, respectively. **, P < 0.01. 18 Fig. 7 shows the results of the OptoMotry experiments. As shown, the variable group showed very significant improvements over the placebo group. The improvements with the hGSTP1tg/bco2−/− mice fed with zeaxanthin are similar to those found in the bco2−/− mice fed with zeaxanthin. There is an apparent difference found in the contrast sensitivity of hGSTP1tg/bco2−/− and bco2−/− mice in scotopic conditions, suggesting that the former further improves rod system acuity when compared to the latter. The difference between is significant where hGSTP1-tg/bco2−/− mice improved vision by 35%, while the bco2−/− mice only increased by 20%. This may be attributed to the zeaxanthin binding protein GSTP1 being expressed uniquely in the rod cells. The data also demonstrates that the hGSTP1-tg/bco2−/− mice had an increase of 45% in photopic contrast sensitivity, this being about 1.3 times greater than the bco2−/− mice. There was no difference found between the visual acuity of placebo hGSTP1-tg/bco2−/− mice and placebo bco2−/− mice. DISCUSSION Carotenoids are known to be effective scavengers of reactive oxygen species. The importance of such a mechanism is apparent. However, the visual performance enhancing role that carotenoids play in ocular systems is also a primary function of these vitamins. It has been established previously that carotenoid supplementation can improve visual performance in humans (Akuffo et al., 2017; Stringham et al., 2017). Until this point a viable non-primate model for testing the effects carotenoid supplementation has on visual performance has not been found. Previous studies in the Bernstein lab have demonstrated that so-called “macular pigment mice” are effective models for distributing ocular carotenoids at appreciable levels (Li et al., 2014). In this investigation, we establish that carotenoid supplementation does in fact 19 improve visual acuity and contrast sensitivity in bco2−/− mice. This is especially clear in the area of contrast sensitivity. These results verify the viability of bco2−/− mice being used as experimental models to further research the benefits of carotenoid supplementation. Additionally, our research has shed greater light on the visual enhancing properties of ocular carotenoids. We have shown that xanthophyll carotenoids, namely lutein and zeaxanthin, can dramatically increase spatial and contrast sensitivity when distributed in appreciable amounts to the ocular tissues of mice, with zeaxanthin being the most effective of the two (Figs. 1-2). Furthermore, we have also demonstrated that β-carotene only slightly increases visual acuity when distributed to ocular tissues. β-Carotene was also shown to not accumulate in the retinas of bco2−/− mice. This can be attributed to the fact that BCO1, the cleavage enzyme responsible for degrading many carotenoids before reaching ocular tissues, is still active in these mice. This is further demonstrated by bco1−/− mice supplemented with β-carotene does accumulate the molecule in the eye (Figs. 1-4). Carotenoids are often cleaved in the digestive tract before reaching the eye, but the distribution of these vitamins to the eye can be facilitated by other binding proteins in the eye. GSTP1 and StARD3 have been identified to be the zeaxanthin-binding protein and lutein-binding proteins in the human retina, respectively. In order to further demonstrate the visual enhancing properties of zeaxanthin, we used this model to further improve the vision of mice. By expressing the human GSTP1 in bco2−/− mice, we were able to extend the amount of zeaxanthin found in the eye when fed the same amount of carotenoid. The measure of which is substantial, increasing concentrations by 40% compared to non-GSTP1 baring mice (Figs. 5-6). 20 This may be the reason why hGSTP1-tg/bco2−/− mice see significantly better than bco2−/− mice (Fig. 7). This observation also supports the proposition that increase zeaxanthin concentrations in ocular tissues can increase visual performance. Among discoveries regarding the human GSTP1 protein is the fact that hGSTP1-tg mice do not accumulate carotenoids to the retina, suggesting that BCO2 is the critical cleavage enzyme in this pathway. Taking this into consideration, it supports previous claims from our lab that BCO2 activity is responsible for preventing wild type mice from accumulating ocular carotenoids. Additionally, considering that the human BCO2 protein is 10-40 times less efficient than the mouse form, it would follow the idea that humans distribute carotenoids to the macula because the critical cleavage enzyme has very low activity levels comparatively. With regards to the OptoMotry results, the following is a list of which groups performed the best with respect to each other, listing them from greatest to least improvement: 1- hGSTP1-tg/bco2−/− (zeaxanthin-fed) 2- bco2−/− (zeaxanthin-fed) 3- bco2−/− (lutein-fed) 4- bco1−/− (β-carotene-fed) 5- bco2−/− (β-carotene-fed) 6- Any placebo mouse (significantly lower; placebo-fed) Additionally, retinal content of carotenoids are as follows, again ranking from greatest to least amount: 1- hGSTP1-tg/bco2−/− (zeaxanthin-fed) 2- bco2−/− (zeaxanthin-fed) ≈ bco2−/− (lutein-fed) ≈ bco1−/− (β-carotene-fed) 21 3- bco2−/− (β-carotene-fed) 4- Any placebo mouse (significantly lower; placebo-fed) Fig. 8. Contents of carotenoids and their yellow oxidative metabolites in the retinas of the mice used in the visual performance experiments. The yellow oxidative metabolites of carotenoids were detected in the mice fed with zeaxanthin or lutein, but not β-carotene, and their amounts were estimated using authentic standard of lutein or zeaxanthin as these metabolite compounds have not been identified yet. The number of mice in each feeding group varies from 7 to 15, and the retinas from 3 to 7 animals were pooled together for carotenoid analysis. N.D., not detectable. Interestingly, there is an inconsistency with regard to carotenoid content in the retina and visual performance, seeing that β-carotene significantly underperformed compared to zeaxanthin and lutein. This is explained by BCO knockout mice generating considerable amounts of yellow oxidative products when fed lutein or zeaxanthin which can also be deposited in the mouse retina, while β-carotene-fed BCO knockout mice do not generate these yellow metabolites (Li et al., 2017). To then correct the inconsistency, if we sum the carotenoid and yellow pigment content in the retinas we find that this then reflects the order of visual performance (Fig. 8). 22 Our investigations have produced results similar to those found in recent studies completed with human test subjects: carotenoid supplementation can significantly improve visual performance. Furthermore, we can confidently suggest the use of the so called “macular pigment mice” as a viable model to further investigate the effects and possibilities of carotenoids on visual systems. Future investigations regarding this new finding are exciting. One such would be to investigate if a dual treatment of lutein and zeaxanthin would further increase the positive effects observed on visual acuity. Additionally, we have investigated and demonstrated that expression of human GSTP1 can improve zeaxanthin accumulation at the retina and therefore improve vision, but we have not yet tested the lutein binding protein StARD3 at this time. A similar experiment of BCO knockout mice also expressing the human StARD3 gene with lutein supplementation would be interesting. This work has demonstrated the rather drastic improvements that carotenoids can have on vision. However, this is not the only use of carotenoids in the eye. As discussed, these vitamins are used as effective ROS scavengers. I hypothesize that these can act as a defense mechanism against cellular degradation, perhaps conserving visual function at a higher level for a longer amount of time. This can be seen as a preventative treatment to vision loss in general due to aging of the eye, but also due to degeneration of the macula. The National Health Institute found a correlation between carotenoid supplementation and lower morbidity of AMD. Though AMD is proliferative among humanity, little is known regarding causation of the disease. I 23 would propose that high levels of damage, among which would logically be damage due to ROS, proceed AMD and can be reduced by supplementation with carotenoids. As introduced, up until this point there has not been a viable investigative model in which carotenoid supplementation experiments could be conducted. As we have demonstrated, the “macular pigment mouse” can now fill this role. In so doing, we are now able to investigate if carotenoids can indeed prevent or perhaps even treat AMD. Furthermore, though there is substantial knowledge as to the nature and function of carotenoids in living systems, little is known about the evolutionary history of such molecules in ocular tissues. We understand that great apes and avian species accumulate these vitamins in the retina, but are there other animals that also do so? The factors for which carotenoid accumulation could occur revolve around a few simple ideas. Some may be the life-span of the animal, the exposure to high energy light rays, and dependence on visual performance. My lab has allowed me to investigate this further and preliminary work has been done to obtain eye samples from several different species to test this hypothesis. Further work would revolve around the activity of BCO cleavage enzymes and homologues of the human GSTP 1 and StARD3 binding proteins in the several species being tested. Overall, my experience with the Bernstein lab has been overwhelmingly positive. As mentioned, there were many activities that were extremely tedious and comparable to chores in my mind. However, the excitement of discovery and progress is addictive. I am now highly motivated to pursue some of my own hypotheses as a consequence of my experience. Considering the extreme rigor that is required to perform good science, I also have a new-found respect for 24 laboratorial sciences. Though I leave with a firmer conviction that working with people is more personally desirable than working with mice and protein gels, I also leave with increased curiosity. Seeing that I will likely not pursue a doctoral degree in research, this may not become part of my life for an extended period of time. However, the drive to discover will continue into my future clinical work as a physician. I am convinced that I won’t ever stop asking why. 25 REFERENCES Age-Related Eye Disease Study 2 (AREDS2): A Multi-center, Randomized Trial of Lutein, Zeaxanthin and Omega-3 Long-Chain Polyunsaturated Fatty Acids (Docosahexaenoic Acid [DHA] and Eicosapentaenoic Acid [EPA]) in Age-Related Macular Degeneration. (National Eye Institute (NEI)). (2015). Retrieved from https://clinicaltrials.gov/ct2 (Identification No. NCT00345176) Abdel-Aal, E., Akhtar, H., Zaheer, K., & Ali, R. (2013). Dietary Sources of Lutein and Zeaxanthin Carotenoids and Their Role in Eye Health. Nutrients, 5(4), 1169-1185. doi:10.3390/nu5041169 Akuffo, K. O., Beatty, S., Peto, T., Stack, J., Stringham, J., Kelly, D., . . . Nolan, J. M. (2017). The Impact of Supplemental Antioxidants on Visual Function in Nonadvanced Age-Related Macular Degeneration: A Head-to-Head Randomized Clinical Trial. Investigative Opthalmology & Visual Science, 58(12), 5347. doi:10.1167/iovs.1621192 Bernstein, P. S., Li, B., Vachali, P. P., Gorusupudi, A., Shyam, R., Henriksen, B. S., & Nolan, J. M. (2016). Lutein, zeaxanthin, and meso-zeaxanthin: The basic and clinical science underlying carotenoid-based nutritional interventions against ocular disease. Progress in Retinal and Eye Research, 50, 34-66. doi:10.1016/j.preteyeres.2015.10.003 Bhosale, P., Larson, A. J., Frederick, J. M., Southwick, K., Thulin, C. D., & Bernstein, P. S. (2004). Identification and Characterization of a Pi Isoform of GlutathioneS-Transferase (GSTP1) as a Zeaxanthin-binding Protein in the Macula of the Human Eye. Journal of Biological Chemistry ,279(47), 49447-49454. doi:10.1074/jbc.m405334200 Bone, R. A., Landrum, J. T., & Cains, A. (1992). Optical density spectra of the macular 26 pigment in vivo and in vitro. Vision Research, 32(1), 105-110. doi:10.1016/00426989(92)90118-3 García, A. L., Raila, J., Koebnick, C., Eulenberger, K. and Schweigert, F. J. (2006), Great apes show highly selective plasma carotenoids and have physiologically high plasma retinyl esters compared to humans. Am. J. Phys. Anthropol., 131: 236–242. doi:10.1002/ajpa.20428 Godley, B. F., Shamsi, F. A., Liang, F., Jarrett, S. G., Davies, S., & Boulton, M. (2005, March 29). Blue Light Induces Mitochondrial DNA Damage and Free Radical Production in Epithelial Cells. Journal of Biological Chemistry, 280(22), 21061-21066. doi:10.1074/jbc.m502194200 Goldsmith, T. H., Collins, J. S., & Licht, S. (1984). The cone oil droplets of avian retinas. Vision Research, 24(11), 1661-1671. doi:10.1016/0042-6989(84)90324-9 Hammond, B. R., Fletcher, L. M., Roos, F., Wittwer, J., & Schalch, W. (2014). A Double-Blind, Placebo-Controlled Study on the Effects of Lutein and Zeaxanthin on Photostress Recovery, Glare Disability, and Chromatic Contrast. Investigative Ophthalmology & Visual Science, 55(12), 8583-8589. doi:10.1167/iovs.14-15573 Handelman, G. J., Snodderly, D. M., Adler, A. J., Russett, M. D., & Dratz, E. A. (1992). [19] Measurement of carotenoids in human and monkey retinas. Methods in Enzymology ofCarotenoids Part A: Chemistry, Separation, Quantitation, and Antioxidation, 220-230. doi:10.1016/0076-6879(92)13123-f Lee, C. M., Boileau, A. C., Boileau, T. W., Williams, A. W., Swanson, K. S., Heintz, K. A., & Erdman, J. W. (1999). Review of Animal Models in Carotenoid Research. Journal of Nutrition, 129, 2271-2277. doi:10.1093/jn/129.12.2271 27 Li, B., Vachali, P., Frederick, J. M., & Bernstein, P. S. (2011). Identification of StARD3 as a Lutein-Binding Protein in the Macula of the Primate Retina. Biochemistry, 50(13), 2541-2549. doi:10.1021/bi101906y Li, B., Vachali, P. P., Gorusupudi, A., Shen, Z., Sharifzadeh, H., Besch, B. M., . . . Bernstein, P. S. (2014). Inactivity of human 𝛽, 𝛽-carotene-9,10-dioxygenase (BCO2) underlies retinal accumulation of the human macular carotenoid pigment. Proceedings of the National Academy of Sciences,111(28), 10173-10178. doi:10.1073/pnas.1402526111 Li, B., Vachali, P. P., Shen, Z., Gorusupudi, A., Nelson, K., Besch, B. M., . . . Bernstein, P. S. (2017). Retinal accumulation of zeaxanthin, lutein, and β-carotene in mice deficient in carotenoid cleavage enzymes. Experimental Eye Research, 159, 123-131. doi:10.1016/j.exer.2017.02.016 Li, B., Rognon, G. T., Mattinson, T., Vachali, P. P., Gorusupudi, A., Chang, F., . . . Bernstein, P. S. (2018). Supplementation with macular carotenoids improves visual performance of transgenic mice. Archives of Biochemistry and Biophysics, 649, 22-28. doi:10.1016/j.abb.2018.05.003 Loughman, J., Nolan, J. M., Howard, A. N., Connolly, E., Meagher, K., & Beatty, S. (2012). The Impact of Macular Pigment Augmentation on Visual Performance Using Different Carotenoid Formulations. Investigative Ophthalmology & Visual Science, 53(12), 7871-7880. doi:10.1167/iovs.12-10690 Maoka, T. (2011). Carotenoids in Marine Animals. Marine Drugs, 9(2), 278-293. doi:10.3390/md9020278 Sabour-Pickett, S., Nolan, J. M., Loughman, J., & Beatty, S. (2012). A review of the 28 evidence germane to the putative protective role of the macular carotenoids for agerelated macular degeneration. Molecular Nutrition & Food Research, 56(2), 270-286. doi:10.1002/mnfr.201100219 Stringham, J. M., Obrien, K. J., & Stringham, N. T. (2017). Contrast Sensitivity and Lateral Inhibition Are Enhanced With Macular Carotenoid Supplementation. Investigative Opthalmology & Visual Science, 58(4), 2291. doi:10.1167/iovs.16-21087 29 $UFKLYHV RI %LRFKHPLVWU\ DQG %LRSK\VLFV ² Contents lists available at ScienceDirect Archives of Biochemistry and Biophysics journal homepage: www.elsevier.com/locate/yabbi Supplementation with macular carotenoids improves visual performance of transgenic mice 7 Binxing Li, Gregory T. Rognon, Ty Mattinson, Preejith P. Vachali, Aruna Gorusupudi, Fu-Yen Chang, Arunkumar Ranganathan, Kelly Nelson, Evan W. George, Jeanne M. Frederick, Paul S. Bernstein∗ Department of Ophthalmology and Visual Sciences, Moran Eye Center, University of Utah School of Medicine, 65 Mario Capecchi Drive, Salt Lake City, UT 84132, USA A R T I C LE I N FO A B S T R A C T Keywords: Carotenoid Lutein Zeaxanthin Visual performance Spatial frequency Contrast sensitivity Carotenoid supplementation can improve human visual performance, but there is still no validated rodent model to test their effects on visual function in laboratory animals. We recently showed that mice deficient in βcarotene oxygenase 2 (BCO2) and/or β-carotene oxygenase 1 (BCO1) enzymes can accumulate carotenoids in their retinas, allowing us to investigate the effects of carotenoids on the visual performance of mice. Using OptoMotry, a device to measure visual function in rodents, we examined the effect of zeaxanthin, lutein, and βcarotene on visual performance of various BCO knockout mice. We then transgenically expressed the human zeaxanthin-binding protein GSTP1 (hGSTP1) in the rods of bco2−/− mice to examine if delivering more zeaxanthin to retina will improve their visual function further. The visual performance of bco2−/− mice fed with zeaxanthin or lutein was significantly improved relative to control mice fed with placebo beadlets. β-Carotene had no significant effect in bco2−/− mice but modestly improved cone visual function of bco1−/− mice. Expression of hGSTP1 in the rods of bco2−/−mice resulted in a 40% increase of retinal zeaxanthin and further improvement of visual performance. This work demonstrates that these “macular pigment mice” may serve as animal models to study carotenoid function in the retina. 1. Introduction It has been well documented that supplementation with lutein and zeaxanthin can improve visual performance of both normal subjects and patients with eye diseases [20–26]. Loughman et al. reported that significant improvements in visual acuity were found at the sixth month in normal subjects fed with a mixture of lutein, zeaxanthin, and mesozeaxanthin [27]. A randomized, double-blind, placebo-controlled, 1year interventional study in 120 Chinese drivers demonstrated that lutein supplementation can increase contrast sensitivity and decrease glare disability [28]. It was also reported that visual acuity of cataract patients supplemented with lutein improved about one line on the Snellen visual acuity chart in comparison with a placebo group [29]. Stringham and Hammond found that light scattering was greatly reduced for short wavelength monochromatic light in subjects with high levels of macular carotenoids, suggesting that macular carotenoids can mitigate glare disability [20]. The visual benefits of macular carotenoids are attributed to their optical properties, antioxidant effects, and other biological mechanisms [30,31]. Macular carotenoids are thought to be able to reduce chromatic aberration, light scatter, and Macular carotenoids are yellow xanthophyll pigments that accumulate in the human retina with extremely high concentration in the foveal area [1–3]. These carotenoids have been identified as lutein, zeaxanthin, and meso-zeaxanthin [4–7], of which lutein and zeaxanthin originate from the diet, whereas meso-zeaxanthin comes mainly from an isomerization reaction of lutein in the retinal pigment epithelium (RPE) [8,9]. The uptake of macular carotenoids has been reported to be a selective and active absorption process involving many transporter proteins and enzymes [1,10–14]. Glutathione S-transferase Pi isoform (GSTP1) and steroidogenic acute regulatory domain protein 3 (StARD3), are the two carotenoid-binding proteins responsible for the specific retinal distribution of zeaxanthin and lutein, respectively [15,16]. Many clinical trials and studies have demonstrated that carotenoid supplementation can prevent and reduce the risk of many human eye diseases such as age-related macular degeneration (AMD) [17–19]. Abbreviations: AMD, Age-related macular degeneration; BCO1, β-carotene oxygenase 1; BCO2, β-carotene oxygenase 2; GSTP1, Glutathione S-transferase Pi isoform; HA, Hemagglutinin; HPLC, High-performance liquid chromatography; RPE, Retinal pigment epithelium; StARD3, Steroidogenic acute regulatory domain protein 3 ∗ Corresponding author. E-mail address: [e-mail] (P.S. Bernstein). https://doi.org/10.1016/j.abb.2018.05.003 Received 28 January 2018; Received in revised form 19 April 2018; Accepted 4 May 2018 $YDLODEOH RQOLQH 0D\ (OVHYLHU ,QF $OO ULJKWV UHVHUYHG $UFKLYHV RI %LRFKHPLVWU\ DQG %LRSK\VLFV ² B. Li et al. promote carotenoid uptake. Then, their visual performance and carotenoid contents were examined. glare disability by absorbing blue light [1,32]. They also can quench free radicals and maintain retinal health [13,33]. Until now, however, it has been difficult to test hypothesis to examine the mechanisms underlying improvement of visual performance by carotenoid supplementation due to the lack of small mammal models capable of reproducibly accumulating substantial levels of carotenoids in their retinas [34–37]. In 2014, our group discovered that zeaxanthin can be deposited in the retina of mice deficient in the β-carotene oxygenase 2 (BCO2) enzyme, generating so-called “macular pigment mice” [38]. More recently, we were also able to deliver comparable amounts of lutein and lower levels of β-carotene to the retinas of these bco2−/− mice, while bco1−/− mice were superior for delivery of β-carotene to the retina [39]. These results have been confirmed by other research groups, and no morphological difference is detected between the retinas of wild-type mice and bco2−/− mice [40–42]. All these researchers have shown that “macular pigment mice” are likely to be good laboratory animal models to study the effects of carotenoids on visual performance. In this manuscript, we investigate the effects of zeaxanthin, lutein, and β-carotene on the spatial frequency and contrast sensitivity of rod and cone cells of the “macular pigment mice” using OptoMotry, a device to examine visual function of small animals. Furthermore, we tested if delivering more carotenoids to the retina of transgenic mice expressing the human zeaxanthin binding protein GSTP1 (hGSTP1) in their rod cells will induce further improvement of their visual function. 2.3. Carotenoid extraction and analysis by HPLC 2. Material and methods Carotenoids in liver and serum, as well as ocular tissues of the mice were extracted and analyzed as before [39]. Briefly, the ocular tissue and liver samples were extracted three times with tetrahydrofuran containing 0.1% butylated hydroxytoluene by sonication at 5 °C–10 °C for 30 min each time. Combined extracts were evaporated to dryness under vacuum at room temperature. To extract carotenoids from serum, ethanol containing 0.1% butylated hydroxytoluene was added into the samples to precipitate the proteins, and then ethyl acetate was added to extract the carotenoids. The sample was centrifuged at 2000 × g for 5 min at 4 °C, and the supernatant phase was collected. Then the sample was extracted with ethyl acetate two more times and extracted with hexane once. The collected supernatants were combined and dried down under vacuum. Finally, the dried residue was re-dissolved in HPLC mobile phase and centrifuged at 2000 × g for 10 min, and the supernatant was injected into the HPLC system. HPLC separations were performed on a silica-based nitrile bonded column (25 cm length × 4.6 mm internal diameter; 5-μm spherical particle (Regis Chemical, Morton Grove, IL)). The eluent consisted of an isocratic mixture of hexanes (75%), dichloromethane (25%), methanol (0.3%), and N, N-diisopropylethylamine (0.1%). The column flow rate was 1 mL/min. The column temperature was maintained at 25 °C, and the monitoring wavelength was 445 nm. 2.1. Animal husbandry and generation 2.4. OptoMotry Bco2−/− and bco1−/− mice were bred at the University of Utah vivarium using founders from Case Western Reserve University. To express zeaxanthin-binding protein GSTP1 specifically in the mouse retina, we generated human GSTP1 transgenic (hGSTP1-tg) mice. In brief, an XhoI site was inserted immediately upstream of the translation initiation codon and a ClaI site immediately downstream of the translation stop codon of the cDNA of human GSTP1 by PCR. The XhoI/ClaI fragment was subcloned into corresponding sites of pRho 4.4 vector to place the human GSTP1 gene under the control of the mouse opsin promoter. In order to track expression of the transgene, a hemagglutinin (HA) tag was placed contiguous with the human GSTP1 cDNA sequence. After direct DNA sequencing, the 5.6-kb trangene construct containing the rhodopsin promoter, human GSTP1 cDNA, a HA-tag, and a mouse protamine polyadenylation signal was isolated from the plasmid by digestion with KpnI and XbaI, then injected into C57BL/ 6X129 embryos. The embryos were implanted into pseudopregnant foster female mice. Founder mice with transgene integration were identified by PCR, and mated to wildtype C57BL/6 mice to produce mice used for analysis. Subsequently, the hGSTP1-tg mice were bred with the bco2−/− mice to generate hGSTP1-tg/bco2−/− mice with the expectation that they would accumulate more zeaxanthin in their retinas relative to bco2−/− mice. All the procedures were approved by appropriate institutional animal care and use committees and were carried out according to National Institutes of Health guidelines. 3- to 4-month-old mice (n = 7 to 15/group) were employed to test spatial visual acuity using the OptoMotry system (Cerebral Mechanics, Lethbridg, AB, Canada). Briefly, individual mice were placed on a platform centered in a quad-square formed by four inward facing computer screens, and their movements were monitored by an overhead video camera. Photopic measurements were conducted under illuminance of around 165 lux. Scotopic measurements were carried out in infrared light with the LCD displays masked with 5 layers of ND16 Lee299 filters. During the detection of spatial frequency threshold, the rotation speed and contrast were kept at 12°/s, and 100%, respectively, while the frequency was kept at 0.19 cycle/degree in the examination of contrast sensitivity. All experiments had concurrent control mice fed with placebo chow. 2.2. Carotenoid-feeding experiments Protein samples were separated on 4–15% gradient SDS−PAGE and transferred to 0.45 μm nitrocellulose membranes. After blocking with 5% nonfat dried milk, the membranes were incubated with primary and secondary antibodies. The dilution ratios were 1:1000 and 1:2000, respectively. The membranes were developed using ECL Plus Western blot detection reagents (GE Healthcare Bio-Sciences, Pittsburgh, PA). In the immunohistochemistry experiments, sections of perfusion-fixed monkey eyes were processed as described [43] with the addition of heating sections in a solution of 10 mM sodium citrate, pH 6, at 95 °C (5 min) prior to blocking with 10% normal donkey serum in PBS-T. Antibodies used were: Anti-GSTP1 and anti-HA-tag antibodies from 2.5. RT-PCR Total RNA was prepared from mouse retinas. cDNA was synthesized using SuperScriptIII reverse transcriptase (Invitrogen, Carlsbad, CA). PCR to detect the expression of the human GSTP1 transgene was performed with 1 μl RT reaction as template. Primers were as follows: forward, 5′-TGG TGG ACA TGG TGA ATG ACG G -3′; and reverse, 5′AGC GTA GTC TGG GAC GTC GTA TG -3′ to yield a 393 bp fragment. 2.6. Western blots and immunohistochemistry Bco2−/−, bco1−/−, hGSTP1-tg, and hGSTP1-tg/bco2−/− mice were employed in the carotenoid-feeding experiments in which bco2−/− mice were treated with lutein, zeaxanthin, or β-carotene, bco1−/− mice were treated with β-carotene, and hGSTP1-tg and hGSTP1-tg/bco2−/− mice were treated with zeaxanthin. In each experiment, 3-month-old mice were divided into two groups and fed with carotenoid beadlet chow (∼2.6 mg per mouse per day; DSM, Kaiseraugst, Switzerland) or placebo beadlet chow for 4 weeks after first receiving a vitamin A-deficient chow (AIN-93, (TestDiet, Richmond, IN)) for 4 weeks to help $UFKLYHV RI %LRFKHPLVWU\ DQG %LRSK\VLFV ² B. Li et al. Fig. 1. Visual performance measured by OptoMotry in bco2−/− mice with and without zeaxanthin supplementation. Zeaxanthin supplementation significantly improves the visual function of bco2−/− mice. (a) Photopic spatial frequency; (b) Photopic contrast sensitivity; (c) Scotopic spatial frequency; (d) Scotopic contrast sensitivity. Values indicate means ± SD; 10 mice were used in each group. **, P < 0.01. retina of supplemented bco2−/− mice [39]. Therefore, we further investigated if β-carotene can improve the visual performance of bco1−/− mice. Fig. 4 shows that β-carotene supplementation can significantly improve the spatial frequency and contrast sensitivity of the cone system but not the rod system. There were 4% and 9% improvements detected in the photopic spatial frequency and contrast sensitivity of mice fed with β-carotene relative to the control mice. All these OptoMotry data indicate that, of these three carotenoids, zeaxanthin is the best at improving the visual performance of mice, especially for cone contrast sensitivity. Next, we tested if delivering more zeaxanthin to the retina of mice will further improve their visual performance. In order to deliver more zeaxanthin to the retina of mice, we transgenically expressed the human zeaxanthin-binding protein GSTP1 (hGSTP1) in the retina of bco2−/− mice by crossing an hGSTP1 transgenic mouse line (hGSTP1tg) with the bco2−/− mice. Fig. 5 shows the transgene construct and the expression of hGSTP1. cDNA encoding hGSTP1 protein was placed under the control of the mouse rhodopsin promoter, which drives hGSTP1 protein expression specifically in rods. Confocal immunolocalization of the expressed HA-tag showed robust expression of human GSTP1 throughout rods, from the outer plexiform layers (OPL) to outer segments (OS). The hGSTP1-tg mice were mated to bco2−/− mice in order to generate hGSTP1-tg/bco2−/− mice. We then performed a zeaxanthin-feeding experiment, in which ∼ 3month-old hGSTP1-tg/bco2−/− and bco2−/− mice were fed with DSMbeadlet diets for one month. Fig. 6 shows the carotenoid contents detected by HPLC in this feeding experiment. Zeaxanthin content was ∼0.84 ng/pair of retinas in the hGSTP1-tg/bco2−/− mice, which is around 40% higher than that of bco2−/−mice. Meanwhile, there was no significant difference between the zeaxanthin contents of RPE/choroids, serum, or livers of hGSTP1-tg/bco2−/− mice and those of bco2−/− mice. In addition, we could not deliver zeaxanthin into the retina of the hGSTP1-tg mice. This is because the carotenoid cleavage enzyme BCO2 is still functional in these mice, so zeaxanthin molecules will be broken down before arrival at the retina. We next examined the impact of zeaxanthin on the visual performance of hGSTP1-tg/bco2−/− mice. 3-month-old hGSTP1-tg/bco2−/− mice were divided into two groups and fed with or without zeaxanthin for 4 weeks. We then examined their visual performance using OptoMotry (Fig. 7). Comparing with the control mice, the rod and cone spatial frequency and contrast sensitivity were significantly improved in the hGSTP1-tg/bco2−/− mice fed with zeaxanthin, and similar improvements in the rod and cone spatial frequency were seen when comparing the hGSTP1-tg/bco2−/− and the bco2−/− mice. An obvious improvement was found in the rod contrast sensitivity of hGSTP1-tg/ bco2−/− mice in contrast to the bco2−/− mice. This increase in Alpha Diagnostic International (San Antonio, TX); anti-actin antibody was purchased from Sigma-Aldrich (St. Louis, MO). 2.7. Statistical analysis Carotenoid contents of serum, liver, and the ocular tissues of the mice were analyzed using ANOVA and t-tests. Statistical analyses were performed using GraphPad Prism 6.0 (GraphPad Software, Inc., La Jolla, CA, USA) and Stata/15.1 statistical software (StataCorp, College Station, TX, USA). 3. Results To test the effects of carotenoids on visual performance of mice, bco2−/− mice were fed with zeaxanthin, lutein, or β-carotene for one month, and then their photopic and scotopic spatial frequencies and contrast sensitivities were quantified using OptoMotry. Of note, the photopic and scotopic parameters represent visual function of the cone and rod systems, respectively. Higher values of spatial frequency correspond to better visual acuity, whereas smaller contrast sensitivities are indicative of better visual function. Fig. 1 shows that zeaxanthin supplementation significantly increased the spatial frequency and contrast sensitivity of both rod and cone systems in the bco2−/− mice. In comparison with mice of the placebo group, the rod and cone spatial frequencies are increased around 15% in mice fed with zeaxanthin, while the rod and cone contrast sensitivities improved around 20% and 35%, respectively. Like zeaxanthin supplementation, lutein supplementation can significantly increase the visual performance of bco2−/− mice, except for their scotopic contrast sensitivity (Fig. 2). The extent of improvement by lutein supplementation is similar to zeaxanthin in regard to the rod and cone spatial frequency and rod contrast sensitivity. Lutein also was able to significantly improve the cone contrast sensitivity but was slightly less than zeaxanthin, around 20%. β-Carotene is not a human macular carotenoid, and only a trace amount of β-carotene is detected in the human retina overall. However, we still investigated the effects of β-carotene on visual performance as it is the precursor of retinal, a key molecule involved in vision, and it also shares the blue light filtering property of lutein and zeaxanthin. Fig. 3 demonstrates that no significant improvement in visual function was detected in bco2−/− mice fed with β-carotene relative to the control mice. This is not surprising because BCO1, the critical cleavage enzyme for β-carotene, is still present in the bco2−/− mice. Our previous study revealed that the content of β-carotene is only around 5–10% of that of lutein and zeaxanthin in the retina of bco2−/− mice, while the content of β-carotene in the retinas of bco1−/− mice supplemented with βcarotene is comparable to the contents of lutein or zeaxanthin in the $UFKLYHV RI %LRFKHPLVWU\ DQG %LRSK\VLFV ² B. Li et al. Fig. 2. Visual performance measured by OptoMotry in bco2−/− mice with and without lutein supplementation. Lutein supplementation significantly improves bco2−/− mice's visual function except for the contrast sensitivity of the rod cells. (a) Photopic spatial frequency; (b) Photopic contrast sensitivity; (c) Scotopic spatial frequency; (d) Scotopic contrast sensitivity. Values indicate means ± SD; 15 mice were used in each group. *, P < 0.05; **, P < 0.01. hGSTP1-tg/bco2−/− mice is about 35%, while it is only 20% in the bco2−/− mice. This may be ascribed to the contribution of the zeaxanthin-binding protein GSTP1 expressed specifically in the rod cells. It is also shows that zeaxanthin supplementation caused a 45% increase in the cone contrast of hGSTP1-tg/bco2−/−, which is about 1.3 times as high as the bco2−/− mice. No significant difference was found between the visual performance of hGSTP1-tg/bco2−/− control mice and bco2−/ − control mice. [44,45]. This validates that bco2−/− mice can be used to investigate the functional benefits of the macular carotenoids. Our investigations revealed several new insights into the effects of carotenoids on visual function. We found that xanthophyll carotenoids can significantly improve the visual performance of both rod and cone cells, while β-carotene just slightly enhances the visual performance of cone cells in mice (Figs. 1–4). Supplementation with lutein and zeaxanthin dramatically increased the contrast sensitivity of cone cells of bco2−/− mice, and zeaxanthin was around 1.2 ± 0.19 time stronger than lutein. (Figs. 1–2). We also examined β-carotene's effects on visual performance in bco2−/− mice, and no improvement was detected which we ascribed to the low retinal content of β-carotene in these mice. Our previously published study has shown that only trace amounts of retinal β-carotene can be detected in the bco2−/− mice because β-carotene's main cleavage enzyme, BCO1, is still active [39]. To raise β-carotene to a comparable level of lutein and zeaxanthin in the retina, we fed β-carotene to mice deficient in the BCO1 enzyme, and the OptoMotry data show that β-carotene can slightly increase the visual function of cone cells. GSTP1 and StARD3 have been identified to be the zeaxanthinbinding protein and lutein-binding proteins in the human retina, respectively. In this work, we also took advantage of this property of GSTP1 and examined if delivering more zeaxanthin to the retina of mice will further improve their visual performance. The human GSTP1 4. Discussion Besides protection against light-induced oxidative damage in the retina, improving visual performance is another primary function of the macular carotenoids. It is well known that carotenoid supplementation can improve the visual performance of both normal subjects and those with eye disease, but there is always concern that these are subjective psychophysical tests that could be influenced by subject and examiner bias. Our previous studies have established that transgenic “macular pigment mice” whose carotenoid cleavage enzymes have been selectively knocked out can serve as animal models for bioavailability and bio-efficacy of retinal carotenoids. In the present work, we demonstrate that supplementation with lutein and zeaxanthin improves the spatial frequency and contrast sensitivity of mice, especially the contrast sensitivity, mimicking the results of the recent clinical trials in humans Fig. 3. Visual performance measured by OptoMotry in bco2−/− mice with and without βcarotene supplementation. β-Carotene supplementation has no significant effect on the visual performance of bco2−/− mice. (a) Photopic spatial frequency; (b) Photopic contrast sensitivity; (c) Scotopic spatial frequency; (d) Scotopic contrast sensitivity. Values indicate means ± SD; 10 mice were used in each group. *, P < 0.05. $UFKLYHV RI %LRFKHPLVWU\ DQG %LRSK\VLFV ² B. Li et al. Fig. 4. Visual performance measured by OptoMotry in bco1−/− mice with and without βcarotene supplementation. β-Carotene supplementation slightly improves the visual performance of bco1−/− mice. (a) Photopic spatial frequency; (b) Photopic contrast sensitivity; (c) Scotopic spatial frequency; (d) Scotopic contrast sensitivity. Values indicate means ± SD; 7 and 8 mice were used in βcarotene and placebo groups, respectively. *, P < 0.05. Fig. 5. Generation of transgenic (hGSTP1-tg) mice expressing the human zeaxanthin-binding protein GSTP1 specifically in the retina. The transgene construct (upper panel). RT-PCR reveals presence of human GSTP1 in the transgenic mouse retina. Lane 1. Amplicon size marker; 2. Wildtype C57BL/6 mice (WT); 3. hGSTP1-tg mice. Samples are normalized by GAPDH (lower left panel). Immunoblot results of antibody directed against the HA-tag versus total protein extract from pooled mouse retinas. Lane 1. Protein size marker; 2. C57BL/6 mice (WT); 3. hGSTP1-tg mice. Samples are normalized by actin (lower middle panel). Immunolocalization with antibody to HA-tag (green) in a 1-month-old hGSTP1-tg mouse retina (far right panel). OS, outer segments; ONL, outer nuclear layers; OPL, outer plexiform layers. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.) protein was transgenically expressed in the retina of bco2−/− mice, causing the retinal carotenoid content to increase around 40% more than the bco2−/− mice under the same feeding conditions (Figs. 5–6). Since this specific expression is driven by the mouse rhodopsin promoter, the human GSTP1 proteins have been robustly expressed in the rod cells, and correspondingly, more zeaxanthin should be deposited there. This may be responsible for the dramatic improvement in the contrast sensitivity of rod cells in hGSTP1-tg/bco2−/− mice after zeaxanthin supplementation (Fig. 7), supporting the idea that increasing the retinal carotenoid levels can improve visual function. Of course, to study the role of macular carotenoids in visual performance further, we should selectively elevate the carotenoid level of various cone cells because, after all, the majority of the macular carotenoids are present in an area dominated by cone cells. We also found that no carotenoid was accumulated in the retina of hGSTP1-tg mice, indicating that BCO2 is a critical enzyme for the presence of carotenoid in the retina. All of these results are consistent with our previous findings that the relative inactivity of the human BCO2 enzyme is responsible for the accumulation of xanthophyll carotenoids in the human macula and that the high cleavage activity of mouse BCO2 is responsible for the failure of wild-type mice to accumulate any retinal carotenoids even after extreme systemic doses and overexpression of carotenoid-binding proteins in the retina. Of all of the possible mechanisms for carotenoid improvement of visual performance in humans and “macular pigment mice” (light filtering, antioxidant, and other neural and biochemical mechanisms), blue-light filtering by these yellow pigments is the most straightforward. Our OptoMotry results showed a rank order of visual performance of hGSTP1-tg/bco2−/− (zeaxanthin-fed) > bco2−/− (zeaxanthin-fed) ≈ bco2−/− (lutein-fed) > bco1−/− (β-carotenefed) > bco2−/− (β-carotene-fed) » any mouse (placebo-fed), yet retinal content of the intact carotenoids in our transgenic mice was hGSTP1-tg/ bco2−/− (zeaxanthin-fed) > bco2−/− (zeaxanthin-fed) ≈ bco2−/− (lutein-fed) ≈ bco1−/− (β-carotene-fed) > bco2−/− (β-carotene-fed) » any mouse (placebo-fed) (Fig. 8). This disconnect between performance and carotenoid content can be explained by the fact that transgenic BCO knockout mice generate considerable amounts of yellow oxidative products when fed lutein or zeaxanthin which can also be deposited in the mouse retina, while β-carotene-fed BCO knockout mice do not generate these yellow metabolites [39]. As can be seen in Fig. 8, if we $UFKLYHV RI %LRFKHPLVWU\ DQG %LRSK\VLFV ² B. Li et al. Fig. 6. Contents of zeaxanthin detected in the tissues of hGSTP1-tg, bco2−/− and hGSTP1-tg/ bco2−/− mice. The expression of zeaxanthin-binding protein GSTP1 specifically in the retina of bco2−/− mice significantly increased the retinal carotenoid contents. 8 to 10-week-old mice (n = 25/genotype) were kept on DSM zeaxanthin beadlet chow (1 g zeaxanthin/kg chow) for 4 weeks. Carotenoids were extracted from the serum and liver of each individual animal. Retina and RPE/choroid were pooled from 3 to 5 animals (5 repeats) in each mouse group. Values indicate means ± SD, N.D., not detectable. *, P < 0.05; **, P < 0.01. Fig. 7. Visual performance measured by OptoMotry in hGSTP1-tg/bco2−/− mice with or without zeaxanthin supplementation. Zeaxanthin supplementation significantly improves the visual function of hGSTP1-tg/bco2−/− mice, especially the rod contrast sensitivity. (a) Photopic spatial frequency; (b) Photopic contrast sensitivity; (c) Scotopic spatial frequency; (d) Scotopic contrast sensitivity. Values indicate means ± SD; 11 and 14 mice were used in the zeaxanthin and placebo groups, respectively. **, P < 0.01. Fig. 8. Contents of carotenoids and their yellow oxidative metabolites in the retinas of the mice used in the visual performance experiments. The yellow oxidative metabolites of carotenoids were detected in the mice fed with zeaxanthin or lutein but not β-carotene, and their amounts were estimated using authentic standard of lutein or zeaxanthin as these metabolite compounds have not been identified yet. The number of mice in each feeding group varies from 7 to 15, and the retinas from 3 to 7 animals were pooled together for carotenoid analysis. N.D., not detectable. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.) 20%–30% compared to WT (bco2+/+) mice of the same age. From the visual function data of bco2−/− mice fed with zeaxanthin (Fig. 1), we can see that the visual function of bco2−/− mice fed with zeaxanthin was improved 20%–35% relative to the control mice on placebo diet, sum the intact carotenoids with their yellow metabolites, the rank order of total carotenoids aligns with the visual performance results rankings. In addition, in a separate control experiment using older mice, we found that the cone visual function of bco2−/− mice was decreased $UFKLYHV RI %LRFKHPLVWU\ DQG %LRSK\VLFV ² B. Li et al. suggesting that carotenoid supplementation may improve the impaired visual function of bco2−/− mice. Our results in transgenic mice are consistent with the effect of macular carotenoids on visual performance revealed in recent human clinical trials and studies. This implies that these transgenic “macular pigment mice” may be successfully employed to further dissect the molecular mechanisms underlying the beneficial effects of the macular carotenoids on visual function. Ophthalmology 119 (11) (2012) 2282–2289. [18] S. Beatty, M. Boulton, D. Henson, H.H. Koh, I.J. Murray, Macular pigment and age related macular degeneration, British J. Ophthalmol. 83 (7) (1999) 867–877. [19] J.T. Landrum, R.A. Bone, H. Joa, M.D. Kilburn, L.L. Moore, K.E. Sprague, A one year study of the macular pigment: the effect of 140 days of a lutein supplement, Exp. Eye Res. 65 (1) (1997) 57–62. [20] J.M. Stringham, P.V. Garcia, P.A. Smith, L.N. McLin, B.K. Foutch, Macular pigment and visual performance in glare: benefits for photostress recovery, disability glare, and visual discomfort, Invest. Ophthalmol. Vis. Sci. 52 (10) (2011) 7406–7415. [21] J.M. Stringham, B.R. Hammond, Macular pigment and visual performance under glare conditions, Optom. Vis. Sci. 85 (2) (2008) 82–88. [22] B.R. Wooten, B.R. Hammond, Macular pigment: influences on visual acuity and visibility, Prog. Retin. Eye Res. 21 (2) (2002) 225–240. [23] B.R. Hammond, L.M. Fletcher, F. Roos, J. Wittwer, W. Schalch, A double-blind, placebo-controlled study on the effects of lutein and zeaxanthin on photostress recovery, glare disability, and chromatic contrast, Invest. Ophthalmol. Vis. Sci. 55 (12) (2014) 8583–8589. [24] B.R. Hammond Jr., B.R. Wooten, D.M. Snodderly, Preservation of visual sensitivity of older subjects: association with macular pigment density, Invest. Ophthalmol. Vis. Sci. 39 (2) (1998) 397–406. [25] B.R. Hammond Jr., B.R. Wooten, J. Curran-Celentano, Carotenoids in the retina and lens: possible acute and chronic effects on human visual performance, Arch. Biochem. Biophys. 385 (1) (2001) 41–46. [26] B.R. Hammond Jr., L.M. Renzi, Carotenoids, Advances in nutrition 4 (4) (2013) 474–476. [27] J. Loughman, J.M. Nolan, A.N. Howard, E. Connolly, K. Meagher, S. Beatty, The impact of macular pigment augmentation on visual performance using different carotenoid formulations, Invest. Ophthalmol. Vis. Sci. 53 (12) (2012) 7871–7880. [28] Y. Yao, Q.H. Qiu, X.W. Wu, Z.Y. Cai, S. Xu, X.Q. Liang, Lutein supplementation improves visual performance in Chinese drivers: 1-year randomized, double-blind, placebo-controlled study, Nutrition 29 (7–8) (2013) 958–964. [29] G. Age-Related Eye Disease Study 2 Research, N. Huynh, B.P. Nicholson, E. Agron, T.E. Clemons, S.B. Bressler, P.J. Rosenfeld, E.Y. Chew, Visual acuity after cataract surgery in patients with age-related macular degeneration: age-related eye disease study 2 report number 5, Ophthalmology 121 (6) (2014) 1229–1236. [30] R.A. Bone, J.M. Sparrock, Comparison of macular pigment densities in human eyes, Vis. Res. 11 (10) (1971) 1057–1064. [31] K. Kirschfeld, Carotenoid pigments: their possible role in protecting against photooxidation in eyes and photoreceptor cells, Proceedings of the Royal Society of London, Series B, Biol. Sci. 216 (1202) (1982) 71–85. [32] M. Schultze, Ueber den gelben Fleck der Retina, seinen Einfluss auf normales Sehen und auf Farbenblindheit, ohen & Sohn, 1866. [33] B. Li, F. Ahmed, P.S. Bernstein, Studies on the singlet oxygen scavenging mechanism of human macular pigment, Arch. Biochem. Biophys. 504 (1) (2010) 56–60. [34] P. Bhosale, P.S. Bernstein, Vertebrate and invertebrate carotenoid-binding proteins, Arch. Biochem. Biophys. 458 (2) (2007) 121–127. [35] P. Fernandez-Robredo, L.M. Sadaba, A. Salinas-Alaman, S. Recalde, J.A. Rodriguez, A. Garcia-Layana, Effect of lutein and antioxidant supplementation on VEGF expression, MMP-2 activity, and ultrastructural alterations in apolipoprotein E-deficient mouse, Oxid Med Cell Longev 2013 (2013) 213505. [36] S.S. Shapiro, D.J. Mott, L.J. Machlin, Kinetic characteristics of beta-carotene uptake and depletion in rat tissue, J. Nutr. 114 (10) (1984) 1924–1933. [37] A. Gorusupudi, B. Vallikannan, Glycolipids improve lutein bioavailability and accumulation in eyes in mice, Eur. J. Lipid Sci. Technol. 114 (7) (2012) 710–717. [38] B. Li, P.P. Vachali, A. Gorusupudi, Z. Shen, H. Sharifzadeh, B.M. Besch, K. Nelson, M.M. Horvath, J.M. Frederick, W. Baehr, P.S. Bernstein, Inactivity of human beta,beta-carotene-9',10'-dioxygenase (BCO2) underlies retinal accumulation of the human macular carotenoid pigment, Proc. Natl. Acad. Sci. U.S.A. 111 (28) (2014) 10173–10178. [39] B. Li, P.P. Vachali, Z. Shen, A. Gorusupudi, K. Nelson, B.M. Besch, A. Bartschi, S. Longo, T. Mattinson, S. Shihab, N.E. Polyakov, L.P. Suntsova, A.V. Dushkin, P.S. Bernstein, Retinal accumulation of zeaxanthin, lutein, and beta-carotene in mice deficient in carotenoid cleavage enzymes, Exp. Eye Res. 159 (2017) 123–131. [40] M.A.K. Widjaja-Adhi, G.P. Lobo, M. Golczak, J. Von Lintig, A genetic dissection of intestinal fat-soluble vitamin and carotenoid absorption, Hum. Mol. Genet. 24 (11) (2015) 3206–3219. [41] G. Palczewski, M.A. Widjaja-Adhi, J. Amengual, M. Golczak, J. von Lintig, Genetic dissection in a mouse model reveals interactions between carotenoids and lipid metabolism, J. Lipid Res. 57 (2016) 1684–1695. [42] L. Wu, X. Guo, Y. Lyu, S.L. Clarke, E.A. Lucas, B.J. Smith, D. Hildebrand, W. Wang, D.M. Medeiros, X. Shen, D. Lin, Targeted metabolomics reveals abnormal hepatic energy metabolism by depletion of beta-carotene oxygenase 2 in mice, Sci. Rep. 7 (1) (2017) 14624. [43] P. Bhosale, B. Li, M. Sharifzadeh, W. Gellermann, J.M. Frederick, K. Tsuchida, P.S. Bernstein, Purification and partial characterization of a lutein-binding protein from human retina, Biochemistry 48 (22) (2009) 4798–4807. [44] K.O. Akuffo, S. Beatty, T. Peto, J. Stack, J. Stringham, D. Kelly, I. Leung, L. Corcoran, J.M. Nolan, The impact of supplemental antioxidants on visual function in nonadvanced age-related macular degeneration: a head-to-head randomized clinical trial, Invest. Ophthalmol. Vis. Sci. 58 (12) (2017) 5347–5360. [45] J.M. Stringham, K.J. O'Brien, N.T. Stringham, Contrast sensitivity and lateral inhibition are enhanced with macular carotenoid supplementation, Investigative ophthalmology & visual science 58 (4) (2017) 2291–2295. Conflicts of interest The authors have no conflicts of interest. Acknowledgements We would like to thank Dr. Johannes von Lintig from Case Western Reserve University for generously providing the bco1−/− and bco2 −/− founder mice. We also thank Drs. Wolfgang Baehr (University of Utah, Moran Eye Center) and Ching-Kang Jason Chen (Baylor College of Medicine, Houston) for their assistance in the generation of hGSTP1-tg mice. This work was supported by NIH grants EY-11600, EY-14800, and by unrestricted departmental funds from Research to Prevent Blindness, New York City, NY. References [1] P.S. Bernstein, B. Li, P.P. Vachali, A. Gorusupudi, R. Shyam, B.S. Henriksen, J.M. Nolan, Lutein, zeaxanthin, and meso-zeaxanthin: the basic and clinical science underlying carotenoid-based nutritional interventions against ocular disease, Prog. Retin. Eye Res. 50 (2016) 34–66. [2] J.J. Nussbaum, R.C. Pruett, F.C. Delori, Historic perspectives. Macular yellow pigment. The first 200 years, Retina 1 (4) (1981) 296–310. [3] N.I. Krinsky, J.T. Landrum, R.A. Bone, Biologic mechanisms of the protective role of lutein and zeaxanthin in the eye, Annu. Rev. Nutr. 23 (2003) 171–201. [4] G. Wald, Human vision and the spectrum, Science 101 (2635) (1945) 653–658. [5] R.A. Bone, J.T. Landrum, S.L. Tarsis, Preliminary identification of the human macular pigment, Vis. Res. 25 (11) (1985) 1531–1535. [6] R.A. Bone, J.T. Landrum, L. Fernandez, S.L. Tarsis, Analysis of the macular pigment by HPLC: retinal distribution and age study, Invest. Ophthalmol. Vis. Sci. 29 (6) (1988) 843–849. [7] R.A. Bone, J.T. Landrum, G.W. Hime, A. Cains, J. Zamor, Stereochemistry of the human macular carotenoids, Invest. Ophthalmol. Vis. Sci. 34 (6) (1993) 2033–2040. [8] A. Gorusupudi, R. Shyam, B. Li, P. Vachali, Y.K. Subhani, K. Nelson, P.S. Bernstein, Developmentally regulated production of meso-zeaxanthin in chicken retinal pigment epithelium/choroid and retina, Invest. Ophthalmol. Vis. Sci. 57 (4) (2016) 1853–1861. [9] R. Shyam, A. Gorusupudi, K. Nelson, M.P. Horvath, P.S. Bernstein, RPE65 has an additional function as the lutein to meso-zeaxanthin isomerase in the vertebrate eye, Proc. Natl. Acad. Sci. U.S.A. 114 (41) (2017) 10882–10887. [10] B. Li, P. Vachali, P.S. Bernstein, Human ocular carotenoid-binding proteins, Photochem. Photobiol. Sci. 9 (11) (2010) 1418–1425. [11] E. Loane, J.M. Nolan, O. O'Donovan, P. Bhosale, P.S. Bernstein, S. Beatty, Transport and retinal capture of lutein and zeaxanthin with reference to age-related macular degeneration, Surv. Ophthalmol. 53 (1) (2008) 68–81. [12] K.J. Meyers, E.J. Johnson, P.S. Bernstein, S.K. Iyengar, C.D. Engelman, C.K. Karki, Z. Liu, R.P. Igo Jr., B. Truitt, M.L. Klein, D.M. Snodderly, B.A. Blodi, K.M. Gehrs, G.E. Sarto, R.B. Wallace, J. Robinson, E.S. LeBlanc, G. Hageman, L. Tinker, J.A. Mares, Genetic determinants of macular pigments in women of the carotenoids in age-related eye disease study, Invest. Ophthalmol. Vis. Sci. 54 (3) (2013) 2333–2345. [13] A.J. Whitehead, J.A. Mares, R.P. Danis, Macular pigment: a review of current knowledge, Arch. Ophthalmol. 124 (7) (2006) 1038–1045. [14] R. Shyam, P. Vachali, A. Gorusupudi, K. Nelson, P.S. Bernstein, All three human scavenger receptor class B proteins can bind and transport all three macular xanthophyll carotenoids, Arch. Biochem. Biophys. 634 (2017) 21–28. [15] P. Bhosale, A.J. Larson, J.M. Frederick, K. Southwick, C.D. Thulin, P.S. Bernstein, Identification and characterization of a Pi isoform of glutathione S-transferase (GSTP1) as a zeaxanthin-binding protein in the macula of the human eye, J. Biol. Chem. 279 (47) (2004) 49447–49454. [16] B. Li, P. Vachali, J.M. Frederick, P.S. Bernstein, Identification of StARD3 as a luteinbinding protein in the macula of the primate retina, Biochemistry 50 (13) (2011) 2541–2549. [17] A.R. Group, E.Y. Chew, T. Clemons, J.P. SanGiovanni, R. Danis, A. Domalpally, W. McBee, R. Sperduto, F.L. Ferris, The Age-Related Eye Disease Study 2 (AREDS2): study design and baseline characteristics (AREDS2 report number 1), University of Utah UNDERGRADUATE RESEARCH JOURNAL MUTAGENESIS OF THE FLGM GENE AND ITS EFFECTS ON SECRETION Ana Rosas, KT Hughes, FFV Chevance Department of Biology Background: The Salmonella flagellum is a complex molecular machine, made up of a basal body motor, a flexible hook, and a filament propeller. The formation of these structures utilizes a type three secretion system (T3SS). This system is not fully understood as the signal sequence that targets substrates for secretion has yet to be defined. FlgM is a regulatory protein, and its secretion couples the flagellar assembly process to proper gene regulation. Objective: To better understand the secretion signal of regulatory protein FlgM, which is necessary for the secretion and formation of the bacterial flagellum. Methods: Oligonucleotide mutagenesis was conducted on the coding sequences for amino acids 38 to 44 of FlgM, which was shown to be important for secretion. Mutants were screened for phenotypes characteristic of defects in secretion. Mutants with these phenotypes were characterized by DNA sequence analysis and single mutations were kept for further characterization. The expression and secretion of the mutant proteins were assayed. Results: Eleven single mutants were found from 850 colonies screened. Of these mutants, all except for one frameshift mutant were expressed. Data has indicated that certain single mutants were defective in secretion in comparison to the wild type strain. Conclusion: Certain substitution mutations in the coding region for amino acids 38 to 44 of FlgM were defective in secretion, indicating this region’s importance for FlgM secretion. Future works will focus on further characterizing important regions in FlgM for secretion. University of Utah UNDERGRADUATE RESEARCH JOURNAL Towards A Better Understanding of The Flagellar FlgM Secretion Signal Atoosa M. Samani (Kelly T. Hughes) Department of Biology The bacterial flagellum represents a remarkable evolutionary achievement in nature, which is constructed from more than thirty different protein components. Driven by an ionpowered rotary motor, the rigid flagellar filament rotates at speeds of up to 1,200 cycles per second and propels bacteria through liquid environments and across hydrated surfaces. By changing direction of filament rotation (clockwise vs counter-clockwise) a bacterium can change the direction of its movement, and swim towards nutrient sources available in the environment and away from toxic substances. The flagellum consists of three principal structures: (1) a basal body that crosses both the inner and outer membranes and acts as the rotary motor, (2) an external universal joint that connects the drive shaft of the basal body to the (3) external filament. The genes in the flagellar transcriptional hierarchy are temporarily regulated in response to assembly, and are organized into three promoter classes: I, II, and III. Class I includes the flhDC operon, also known as the flagellar master operon, and activates transcription of the class II promoters. Class II genes encode the proteins that make up the HBB, FlgM, and its chaperone σ28. Twenty percent of FlgM will be produced by class II promoter, and the rest is expressed by a class III promoter. The FlgM and σ28 interaction regulate the activation of class III gene transcription. When the HBB structure is completed, FlgM is released from σ28 and secreted outside the cell. Free σ28 will then activate transcription of the class III genes (Figure 1). Figure 1. Flagellar assembly and transcriptional hierarchy. The flagellum employs a type III secretion (T3S) system for protein export. The flagellar T3S that is located at the cytoplasmic base of the HBB facilities the export of substrates into a central channel, which then diffuse to the tip of the growing structure and self-assemble into place. Exported proteins exit the cell as unfolded polypeptides during the secretion process; however, they fold in place as they exit the t0ip of the growing organelle. By taking advantage of FlgM-bla fusion, I was able to recognize the regions on FlgM that are important for its secretion. β- Lactamase (Bla) confers ampicillin resistance to cells when it is secreted into the periplasm through the type two secretion (T2S) system where it folds into an active conformation. The fulllength FlgM protein can replace the Bla T2S signal and allow for secretion of FlgM-Bla through the flagellar T3S system into the periplasm in flk mutant strains, where it can fold and confer ampicillin resistance. Data from my experiments suggest that the Secretion signal of FlgM can be found near the N-terminal of the protein. Further targeted mutagenesis experiments are planned to investigate the T3S signal of FlgM further. University of Utah UNDERGRADUATE RESEARCH JOURNAL FOREIGN AID, DOMESTIC POLITICS, AND TIME-TO-DEVELOPMENT: AN ANALYSIS OF SUB-NATIONAL AID EFFICACY*† Minta Siripong (Dr. Tobias Hofmann) Department of Biology (Department of Political Science) When given the freedom to freely allocate aid, political leaders of recipient countries may partake in favoritism of certain regions […] or use aid to buy votes or reward government supporters Dreher et al., 2016 In spite of the large amounts of money, time, and effort spent on improving the condition of people in developing countries, most studies on the impact of foreign aid have only found modest effects in addition to significant variation between as well as within developing countries. Analyzing the causes of variation in domestic aid efficacy, this study specifically addresses the questions of why some subnational regions develop faster than other with a focus on the electoral incentives of democratic political leaders to interfere with development and the efficacy of aid. While allocation and implementation of aid projects is affected by donor governments, multilateral aid agencies, NGOs, and a wide variety of private actors, the domestic political leaders of recipient countries play a particularly important role. Based on work by Dreher et al. (2016) on aid allocation, Bueno de Mesquita et al. (2003), and others, we develop a theoretical argument for why and how electoral incentives make office-seeking leaders engineer higher levels of aid effectiveness for the specific constituencies they rely on for political survival. We claim that political leaders have incentives to affect sub-national aid effectiveness via administrative project support, matching funds, etc., to ‘buy’ the ongoing support of their electoral winning coalition. As a result, aid – controlling for initial level of development – leads to faster development in districts aligned with the national government. To test the theoretical argument’s empirical implications, we use a mixed-methods research design that combines statistical analyses with a comparative case study of Indian states. We test whether partisan alignment between the national government and state-level representatives improve the effectiveness of regional World Bank projects and attainment of the United Nations’ Millennium Development Goals (MDG), incl. the eradication of extreme poverty and hunger, achievement of universal primary education, reduction of child mortality, * † This research was supported by the Office of Undergraduate Research of the University of Utah. Keywords: foreign aid efficacy, subnational development, electoral politics, partisan alignment, Indian states, geocoded World Bank data 1 and improvement of maternal health. In other words, we check whether regional aid efficacy is mediated by partisan alignment with the help of a qualitative study of the Indian states of Kerala and Jharkhand as well as a statistical analysis of geocoded World Bank, Global Data Lab, and election data for all 36 states and union territories over a 25-year period (1991-2016). Combining the evidence from our quantitative and case study analyzes, we find strong evidence that the effects of aid on development, e.g., in terms of the time it took Indian states to attain specific MDG, are conditioned by the partisan alignment of national and state-level results in the 10th-16th Lok Sabha elections. Table 1 summarizes some of the statistical results that highlight the domestic politics of aid efficacy. The fixed-effects instrumental variable regressions provide robust evidence that World Bank projects are more effective at improving development when a state’s representatives are politically aligned with the national government. Table 1: Aid, partisan alignment, and MDG attainment MDG: Aid Alignment Aid * Alignment MDGt-1 Controls State fixed-effects Constant Observations R2 #1 -0.001* (0.001) -1.607** (0.696) -0.001** (0.000) 0.965*** (0.020) yes yes 0.246 (0.873) 525 0.952 #2 0.002** (0.001) 2.323** (1.185) 0.001** (0.001) 0.946*** (0.020) yes yes -1.250 (0.986) 525 0.926 #4 -0.005* (0.002) -4.515** (1.873) -0.002* (0.002) 0.872*** (0.055) yes yes 1.626 (2.309) 525 0.947 #5 0.000 (0.001) 0.205 (1.262) 0.000 (0.001) 0.968*** (0.023) yes yes -5.283*** (0.916) 525 0.980 Response variables (MDG): #1: % of underweight children, #2: % of children aged 6-8 attending school, #4: % of immunized children, #5: fertility rate of adolescent women. Robust standard errors in parentheses. *p < .1. **p < .05. ***p < .01. Qualitative and anecdotal evidence from Kerala and Jharkhand support our statistical findings. As Figure 1 clearly shows, both states started out shoulder-to-shoulder in terms of their level of human development in the early 1990s, but had staggeringly different experiences during the MDG period. While Kerala became a posterchild of development, Jharkhand remained an example of stagnation despite receiving similar World Bank projects. Two quotes from Amit Shah, President of the Bharatiya Janata Party (BJP), hint at partisan alignment being key to why the two states ended up at opposite ends of the development spectrum. With the BJP leading the National Democratic Alliance (NDA) coalition government, he proclaimed that “if Kerala sends BJP MPs to Lok Sabha and if the NDA retained power, we will make Kerala the number one state in India” (Times of India, 2019). He also pointed out that since the BJP/NDA came to power, the “NDA government has carried out various pro-poor schemes, uplifting the living standard of the needy” (Asian News International, 2019) in the BJP/NDA aligned state. On the other hand, he made it clear that “Development of Jharkhand is only possible when there is a BJP 2 government in the state. Jharkhand is blessed with natural resources, this land has abundant coal and iron ore, but still the people here are poor. The reason is because Jharkhand has never had a full majority government. So I urge you to vote the BJP and give us two-thirds majority in the state” (Asian News International, 2014). Only with an aligned majority would Jharkhand have development prospects. Figure 1: Human Development in Jharkhand and Kerala, 1991-2016 While this study clearly shows that subnational aid efficacy is mediated by partisan alignment, there are several opportunities for additional research into the politics of aid effectiveness within developing countries. Collecting and analyzing more and better data is an obvious starting point. Taking a closer look at the interaction between voters and political leaders in the context of local aid projects and regional development is another route worth exploring (cf. Findley et al., 2017). We plan on continuing our research into the domestic politics of aid effectiveness with lab and survey experiments that will deepen our understanding of the dynamics at work. In the lab, we intend to closely analyze the incentives of political leaders to provide differentiated development policies under different electoral institutions as well as the responses of voters to informational treatments about government behavior. The online survey experiment will provide some external validity by studying the responsiveness of Indian voters to information about government support for local aid projects. Literature Bueno de Mesquita, Bruce, Alastair Smith, Randolph M. Siverson, and James D. Morrow. 2003. The Logic of Political Survival. Cambridge, MA: MIT Press. Dreher, Axel, Andreas Fuchs, Roland Hodler, Bradley C. Parks, Paul A. Raschky, and Michael J. Tierney. 2016. Aid on Demand: African Leaders and the Geography of China’s Foreign Assistance. AidData Working Paper 3: 1-66. Findley, Michael G., Adam S. Harris, Helen V. Milner, and Daniel L. Nielson. 2017. Who Controls Foreign Aid? Elite versus Public Perceptions of Donor Influence in Aid-Dependent Uganda. International Organization 71: 633-663. 3 University of Utah UNDERGRADUATE RESEARCH JOURNAL PARASITIC SYNTHESIS OF GOLD NANO-MITE GROWTH Matthew Ticknor, Cady Lancaster, Wallis Scholl (Jennifer Shumaker-Parry) Department of Chemistry Abstract: Metal nanoparticles exhibit localized surface plasmon resonance (LSPR), the collective oscillations of surface electrons due to interactions with an electromagnetic field. When focused into sharp points and high-aspect ratio branches, LSPR produces local electric field enhancements. Branched nanoparticles synthesized to take advantage of this enhancement have issues of aggregation in solution and top down approaches are expensive and time consuming. To balance these, nano-mite structures have been synthesized onto prefabricated substrates. Substrates are formed through the evaporation of gold through a polystyrene bead mask. Previous work demonstrated the reaction viability of gold chloride to be reacted with HEPES and hydrochloric acid, silver nitrate and ethanolamine are then added simultaneously in a one-pot synthesis procedure. Current work is demonstrating that a new reaction using gold chloride, reacted with Triton-X, sodium borohydride, ascorbic acid and silver nitrate has similar promise and growth abilities. When temperature is used to control nucleation and growing conditions, limited control over the structures is achieved. Nucleation is slowed using a dry-ice and isopropanol bath. Nucleation and growth at a low temperature allows for slowed Ostwald ripening forming sharper crystalline structures. Structures are characterized using UV-visible spectroscopy, Atomic Force Microscopy (AFM), Scanning Electron Microscopy (SEM) and RAMAN. University of Utah UNDERGRADUATE RESEARCH JOURNAL RIDD IN DROSOPHILA AND MAMMALIAN CELLS Emily Tippetts (Julie Hollien) School of Biological Sciences INTRODUCTION Secretory proteins are co-translationally imported into the endoplasmic reticulum (ER) of the cell, where they will be folded, modified, and sent to the Golgi apparatus. The balance between the protein load coming into the ER and the ER’s capacity to fold incoming proteins is critical. If the balance is upset, ER stress can occur, resulting in the accumulation of unfolded and misfolded proteins inside the ER. The cell initiates the Unfolded Protein Response (UPR) to combat ER stress (Walter & Ron, 2011); however, the UPR will signal for apoptosis if the cell cannot recover (Szegezdi, Logue, Gorman, & Samali, 2006). ER stress is implicated in many physiological conditions, such as neurodegenerative diseases, Type II diabetes, and heart disease (Kaufman, 2002). Ire1, an ER transmembrane nuclease, plays an important role in the UPR. Ire1’s cytosolic nuclease domain cleaves the mRNA for X-box binding protein 1 during ER stress. Once cleaved, the mRNA end fragments are ligated together to form a spliced product (Calfon et al., 2002; Yoshida, Matsui, Yamamoto, Okada, & Mori, 2001). Spliced Xbp1 can be translated into an active transcription factor that can turn on a host of genes that increase the folding capacity of the ER and the capacity of the secretory pathway (Harding et al., 2003; Travers et al., 2000). In addition, Ire1 cleaves other mRNAs localized to the ER membrane, leading to their subsequent degradation and thereby reducing the load on the ER in a pathway termed regulated Ire1-dependent decay (RIDD; J. Hollien & Weissman, 2006; Julie Hollien et al., 2009). We have identified differences in mRNA targets in the RIDD pathway between Drosophila Ire1 and mammalian Ire1 (summarized in Table 1). Mammalian Ire1 has only a handful of RIDD targets, and sequence based requirements have to be met in order for degradation to take place (Moore & Hollien, 2015). On the other hand, Drosophila Ire1 has a broad specificity in targets, with localization to the ER membrane being both necessary and sufficient for degradation (Gaddam, Stevens, & Hollien, 2013). In my research, I have sought to answer the question of how the difference in RIDD target specificity between Drosophila and mammalian cells is mechanistically achieved. Cell Type RIDD target features RIDD specificity Mammalian Specific sequence and structural motif Only a few targets; high specificity Drosophila Localization to the ER membrane Many targets; broad specificity Table 1 Comparison of RIDD in mammalian and Drosophila cells RESULTS AND DISCUSSION We compared the Drosophila Ire1 sequence to representative mammalian Ire1 sequences, and found that while the sequence is mostly conserved, Drosophila has about 100 extra amino acids at its C terminus (Figure 1). We hypothesized that this C terminal domain is responsible for the difference in RIDD activity. Figure 1 Comparison of Ire1 sequences Alignment of C terminal ends (starting at amino acid 843) of human Ire1 (hIre1) and Drosophila Ire1 (dIre1). To test this hypothesis, we made a panel of plasmids encoding variants of Ire1 under copper-inducible promoters. The panel included wild type Drosophila Ire1 (dIre1 wt), human Ire1 (hIre1 wt), a nuclease-dead mutant of Drosophila Ire1 (dIre1 nd), and a truncated version of Drosophila Ire1 ending at amino acid 958, which removes the additional amino acids at the C terminus not found in mammalian Ire1 (dIre1 ΔCTD). We co-transfected the Ire1 variants in Drosophila S2 cells with known RIDD mRNA reporters. We then treated with copper to induce transcription of the Ire1 variant plasmids, and thereby overexpress the protein in the cell. Under these conditions, Ire1 can dimerize and activate as it would under ER stress. We purified total RNA from these cells and quantified relative RNA levels of the reporters by qPCR. mRNA levels of dSparc, a Drosophila RIDD target, are not significantly changed upon expression of dIre1 ΔCTD (Figure 2A). dAct 5C was used as a negative control, as actin should not be a RIDD target in any case. mBlos1 mRNA, both a Drosophila and mammalian target, is reduced in the presence of dIre1 ΔCTD, suggesting it is a target (Figure 2C). mBlos1S, the negative control, is a stabilized form of mBlos1 that is not targeted by RIDD (Moore & Hollien, 2015). My results suggest that without its C terminal domain, Drosophila Ire1 is no longer capable of degrading such a wide range of targets, and reverts to more specific targets similar to the mammalian version. This work sheds light on how Drosophila Ire1 may be able to have different RIDD activity than mammalian Ire1. We are currently working to corroborate these results by stably transfecting our Ire1 constructs into mammalian Ire1 knockout cells and monitoring the degradation of various RIDD targets in these cells. Figure 2 Deletion of Drosophila Ire1’s C terminal domain (CTD) results in a change in RIDD specificity A-B) Ire1 constructs were placed under a copper-inducible promoter and transiently co-transfected into Drosophila S2 cells with actin-promoted dSparc or dAct5C. We induced expression with Cu for 7 hours, collected RNA, and monitored dSparc or dAct5C mRNA levels by qPCR. Reporter mRNA levels were normalized to mRNA levels of Rpl19. Three biological replicates are shown, with matching symbols designating experiments done side by side. Bars represent average of the three replicates. * designates significant difference from dIre1 nd with p<0.05 C-D) Ire1 constructs were placed under a copper-inducible promoter and transiently co-transfected into Drosophila S2 cells with actin-promoted mBlos1 or mBlos1S. We induced expression with Cu for 7 hours, collected RNA, and monitored mBlos1 or mBlos1S mRNA levels by qPCR. Reporter mRNA levels were normalized to mRNA levels of Rpl19. Three biological replicates are shown, with matching symbols designating experiments done side by side. Bars represent average of the three replicates. * designates significant difference from dIre1 nd with p<0.05 REFERENCES Calfon, M., Zeng, H., Urano, F., Till, J. H., Hubbard, S. R., Harding, H. P., … Ron, D. (2002). IRE1 couples endoplasmic reticulum load to secretory capacity by processing the XBP-1 mRNA. Nature, 415(6867), 92–96. https://doi.org/10.1038/415092a Gaddam, D., Stevens, N., & Hollien, J. (2013). Comparison of mRNA localization and regulation during endoplasmic reticulum stress in Drosophila cells. Molecular Biology of the Cell, 24(1), 14–20. https://doi.org/10.1091/mbc.E12-06-0491 Harding, H. P., Zhang, Y., Zeng, H., Novoa, I., Lu, P. D., Calfon, M., … Ron, D. (2003). An integrated stress response regulates amino acid metabolism and resistance to oxidative stress. Molecular Cell, 11(3), 619–33. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12667446 Hollien, J., Lin, J. H., Li, H., Stevens, N., Walter, P., & Weissman, J. S. (2009). Regulated Ire1dependent decay of messenger RNAs in mammalian cells. The Journal of Cell Biology, 186(3), 323–331. https://doi.org/10.1083/jcb.200903014 Hollien, J., & Weissman, J. S. (2006). Decay of Endoplasmic Reticulum-Localized mRNAs During the Unfolded Protein Response. Science, 313(5783), 104–107. https://doi.org/10.1126/science.1129631 Kaufman, R. J. (2002). Orchestrating the unfolded protein response in health and disease. The Journal of Clinical Investigation, 110(10), 1389–98. https://doi.org/10.1172/JCI16886 Moore, K., & Hollien, J. (2015). Ire1-mediated decay in mammalian cells relies on mRNA sequence, structure, and translational status. Molecular Biology of the Cell, 26(16), 2873– 84. https://doi.org/10.1091/mbc.E15-02-0074 Szegezdi, E., Logue, S. E., Gorman, A. M., & Samali, A. (2006). Mediators of endoplasmic reticulum stress-induced apoptosis. EMBO Reports, 7(9), 880–5. https://doi.org/10.1038/sj.embor.7400779 Travers, K. J., Patil, C. K., Wodicka, L., Lockhart, D. J., Weissman, J. S., & Walter, P. (2000). Functional and genomic analyses reveal an essential coordination between the unfolded protein response and ER-associated degradation. Cell, 101(3), 249–58. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10847680 Walter, P., & Ron, D. (2011). The Unfolded Protein Response: From Stress Pathway to Homeostatic Regulation. Science, 334(6059), 1081–1086. https://doi.org/10.1126/science.1209038 Yoshida, H., Matsui, T., Yamamoto, A., Okada, T., & Mori, K. (2001). XBP1 mRNA Is Induced by ATF6 and Spliced by IRE1 in Response to ER Stress to Produce a Highly Active Transcription Factor. Cell, 107(7), 881–891. https://doi.org/10.1016/S0092-8674(01)006110 University of Utah UNDERGRADUATE RESEARCH JOURNAL RE-EXPRESSION OF PTF1A IN HUMAN PANCREATIC CANCER CELL LINES Deanne Yugawa (Dr. Charles Murtaugh, Nate Krah & Shuba Narayanan) Department of Human Genetics Pancreatic Cancer is the 3rd deadliest cancer in the U.S., despite only accounting for 3% of all cancers. The majority of malignant pancreatic cancer is in the form of Pancreatic Ductal Adenocarcinoma (PDAC), which presents itself in acinar cells of the exocrine pancreas. Over 90% of PDAC has an oncogenic Kras mutation. Kras is often considered “undruggable,” which necessitates the need for further understanding and the discovery of possible new drug targets. In previous studies, PDAC was shown to be initiated through the de-differentiation of mature acinar cells into a more duct-like phenotype. Research in our lab specifically points to the downregulation of Ptf1a, the master regulator of acinar cell differentiation, as the rate-limiting step of Kras-driven pancreatic cancer initiation. By using a Cre- and doxycycline-dependent Ptf1a gain-of-function mouse model, we saw that mice expressing transgenic Ptf1a and oncogenic Kras mutation exhibited significantly less precancerous lesions compared to that of mice expressing only oncogenic Kras. In addition, sustained expression of Ptf1a resulted in both the rescue and reversion of precancerous lesions in vivo. We sought to further investigate the mechanism of sustained Ptf1a expression in fully malignant PDAC. By infecting human pancreatic cancer cell lines with inducible lentiviral Ptf1a vectors, a model was developed through which re-expression of Ptf1a could be examined in malignant cells. Sustained Ptf1a expression in the cell lines resulted in a wide range of response. By and large, cell lines that had an upregulation of Ptf1a’s downstream genes displayed a significant growth inhibition. This indicates that Ptf1a effectively turned back on its normal cellular machinery. Future studies will attempt to elucidate the mechanism through which Ptf1a re-expression acts in cancer cells, hopefully leading to the discovery of potential new drug targets. University of Utah UNDERGRADUATE RESEARCH JOURNAL THE INFLUENCE OF MULTIPLE INFECTIONS ON INFLUENZA VIRULENCE EVOLUTION Kort James Zarbock, Rodrigo Costa, Wayne Potts Department of Biology Multiple infections occur when individual hosts are infected by more than one source of a pathogen. Theoretical models predict that multiple infections increase pathogen virulence and accelerate adaptation to the host, but very little experimental work has tested these predictions. Recent research shows that up to 66% of infections with influenza A virus (IAV) could be the result of multiple infection events. The apparent common nature of multiple IAV infections coupled with the possibility that they lead to increased viral virulence and fitness suggests a serious exploration of the subject is needed. We have designed an experiment in which we serially passaged IAV in male and female BALB/c and C57BL/6 mice while varying the number of donor hosts for ten rounds of 3-day passages. IAV was experimentally transmitted between single hosts (1X) or the virus from two or four hosts was combined before every subsequent round (2X and 4X, respectively). Once all serial passages were completed, the various viral lines were tested by infecting groups of mice and measuring their weight loss for ten days. Mice that reached 75% of their initial weight were euthanized. Other groups of test mice were euthanized at day 3 post-infection in order to collect virus for viral titration. An additional test phase experiment was performed in which the singlehost passage lines were combined at the end and used to infect groups of mice in order to simulate a single multiple infection event with independently evolving viral lineages (1XPooled). We found that multiple infections increase the average virulence of IAV and increasing amount of donors leads to higher levels of virulence and mortality (LMM; 2X p=0.025; 4X p<0.001). Furthermore, we found that a single multiple infection event with independently evolving (1XPooled) viral lineages leads to a high virulence infection, and this treatment had the highest virulence levels measured (LMM; p<0.001). Interestingly, viral fitness did not increase significantly with the multiple infection treatments, which suggests that higher virulence is not necessarily a product of increased viral fitness. Further experiments are being planned that test the mechanisms that lead to these substantial increases in virulence. This work represents the first experimental exploration of the effects of multiple infections in a vertebrate host-pathogen system. We have demonstrated that multiple infections accelerate virulence evolution and that a single multiple infection event can lead to a large increase in pathogen virulence. These observations might be applicable to many other pathogen types and have epidemiological consequences ranging from informing preventative isolation measures for infected individuals (for example in hospitals) to intensive agricultural settings, which are associated with inter-species pathogen transmission events that can lead to pandemics. University of Utah UNDERGRADUATE RESEARCH JOURNAL RELATIONSHIP BETWEEN SELF-REPORTED TIME AND OBJECTIVE ULTRAVIOLET RADIATION EXPOSURE IN FAMILIES Angela Zhu (Yelena P. Wu, Ph.D.) School of Biological Sciences ABSTRACT Objectives: One of the best ways for individuals to prevent melanoma of the skin is by minimizing their ultraviolet radiation (UVR) exposure. The objective of this study is to examine the accuracy of self-reported sun exposure measures by examining the difference between self- reported time outside and objective measures of UVR. Methods: Study participants (n=97 parent/child dyads) were asked to wear a Shade UV Sensor for 14 days and complete questionnaires reporting their outdoor activity times. Participants’ reported outdoor activity times for each day were matched with their solar UVR at those times, in standard erythema doses (SED) measured by the Shade UV Sensor. Differences between the two were calculated and linear regressions were conducted to examine whether age, gender, and/or skin type predicted accuracy of self-reporting time outside compared to objectively measured UVR exposure. Results: For both parent and child samples, device-measured SED was significantly greater than self-reported SED. For parents, neither age, gender, nor skin type significantly predicted how much better or worse parents were at reporting their UVR exposure. For children, girls had less of an SED difference between objective and self-report measures than boys (p=.006). Conclusions: The significant difference between self-reported and objective measures of SED illustrate that parents and children may underestimate their personal UVR exposure through self- reported measures alone. Objective measures of UVR exposure from personal UV dosimeters/sensors could be important tools to use for obtaining a complete understanding of one’s personal UVR exposure. College of Social & Behavioral Science University of Utah UNDERGRADUATE RESEARCH JOURNAL SOCIAL INTERACTIONS & CARDIOVASCULAR REACTIVITY: A TIME COMPARISON Elliot David Ansari (Timothy Smith, Ph.D) Department of Social and Behavioral Science According to the CDC about 610,000 people die from heart disease every year in the United States, that is 1 in every 4 deaths (CDC, 2017). Due to the high mortality rate of cardiovascular disease, there are growing concerns of how cardiovascular health can be influenced by different social interactions. Specifically, interpersonal interactions that can make cardiovascular functions more reactive. However, there has been little research into how time of day during these social interactions may lead to varying cardiovascular reactions. This study tests both dominant and hostile stimuli at the same time while also testing the effects of different types of interpersonal styles. The time of day when these interactions take place is recorded. Interpersonal styles are altered by randomizing the confederate’s affiliation and control conditions during an online social conversation. In regards to affiliation, social support is a protective factor of cardiovascular disease where conflict, social isolation, and hostility in a personality can increase the risk (Uchino, 2016). Part of the control spectrum is dominance, a person high in dominance or many social interactions with increased levels of dominance is a risk factor for cardiovascular disease (Gallo, Smith, & Cox, 2006). Cardiovascular disease is thought to be developed through cardiovascular reactivity which can be triggered by certain social interactions (Smith & Ruiz, 2002). Time of day has also been seen to influence cardiovascular reactivity in small sample sizes of research. In one study, participants who performed mental arithmetic tasks in the evening had increased heart rate and blood pressure recordings compared to participants who performed mental arithmetic tasks in the morning (Roeser, Obergfell, Meule, Vogele, Schlarb, & Kubler, 2012). This gives us some indication that stressors from the day may impact an individual's heart rate and blood pressure in the evening. Stress can be a key contributor to cardiovascular disease (Esler, Schwarz, & Alvarenga 2007) and this accumulation of stress leading up to the evening could increase systolic blood pressure (SBP) and heart rate (HR) levels. This study aims to examine the possibility of how different social interactions can change SBP and HR recordings in relation to the time that these social interactions take place. Through our research, we hope to have a better understanding of how various social interactions can influence cardiovascular reactivity and in turn, our overall cardiovascular health. References Esler, M., Schwarz, R., & Alvarenga, M. (2008). Mental stress is a cause of cardiovascular diseases: From scepticism to certainty. Stress and Health: Journal of the International Society for the Investigation of Stress, 24(3), 175–180. https://doi.org/10.1002/smi.1198 Gallo, L. C., Smith, T. W., & Cox, C. M. (2006). Socioeconomic status, psychosocial processes, and perceived health: An interpersonal perspective. Annals of Behavioral Medicine, 31(2), 109-119. Heart Disease. (2017, November 28). Retrieved June 21, 2-18, from https://www.cdc.gov/heartdisease/facts.htm Roeser, K., Obergfell, F., Meule, A., Vögele, C., Schlarb, A. A., & Kübler, A. (2012). Of larks and hearts—morningness/eveningness, heart rate variability and cardiovascular stress response at different times of day. Physiology & Behavior, 106(2), 151–157. https://doi.org/10.1016/j.physbeh.2012.01.023 Smith, T. W., & Ruiz, J. M. (2002). Psychosocial influences on the development and course of coronary heart disease: current status and implications for research and practice. Journal of consulting and clinical psychology, 70(3), 548. Uchino, B. N. (2006). Social support and health: a review of physiological processes potentially underlying links to disease outcomes. Journal of behavioral medicine, 29(4), 377387. University of Utah UNDERGRADUATE RESEARCH JOURNAL ECOMETRICS AND HUMAN EVOLUTION IN EAST AFRICA: UNGULATE DENTAL MORPHOLOGIES AS A TOOL FOR PALEOCLIMATE RECONSTRUCTION Student: Alison Bagley Faculty Mentor: Tyler J. Faith PhD. Department of Anthropology Abstract: Extensive literature exists concerning the potential role of climate change in driving hominin evolution. However, there is insufficient climate data from relevant paleontological and archaeological sites that documents our evolutionary history to provide concrete answers on such changes. Therefore, new methods of paleoclimate reconstruction are essential in filling in the gaps concerning these questions. This project applies a new paleoclimate reconstruction method in order to construct the climate context of hominin evolution over the past seven million years in East Africa. This method is based on the relationships between dental morphologies of African ungulates and climate (Zliobate et. al., 2016). This study identifies and analyses the relationship between both modern and extinct ungulate communities and their environments, and then uses those relationships to generate a reliable paleoclimate reconstruction. This method is applied regionally with the hopes of expanding it to answer questions concerning the paleoclimate reconstruction of the African continent as a whole, as well as extend to a hyper focus on South Africa and its immense bio-diverse history. Ultimately this study shows that the correlation with past precipitation levels in a region and crown height (hypsodonty) of an ungulate do strongly correlate with another, making crown height a reliable marker for an area’s past environment in East Africa. University of Utah UNDERGRADUATE RESEARCH JOURNAL PRENATAL MATERNAL CHRONIC CORTISOL CONCENTRATIONS AND THE SYMPATHETIC AND PARASYMPATHETIC NERVOUS SYSTEM ACTIVATION AS PREDICTORS OF NEWBORN NEUROBEHAVIOR Melissa Nevarez Brewster (Elisabeth Conradt, Ph.D.) Department of Psychology Stress exposure in the early years of life is a public health concern (Provencal & Binder, 2015). More specifically, previous research has emphasized the importance of understanding the impact of stress exposure on an infant (Suurland, van der Heijden, Smalling, & Huijbregts, 2017). However, there is limited research linking in utero stress exposure to newborn neurobehavior. We examined whether newborn neurobehavior was associated with prenatal maternal physiological signs of stress. Pregnant women (N=162) during their third trimester were invited to the child adaptation and neurodevelopment (CAN) laboratory to acquire hair cortisol concentrations, baseline heart rate (HR), baseline respiratory sinus arrhythmia (RSA), and baseline electrodermal activity (EDA) parameters: skin conductance response (SCR) and skin conductance levels (SCL). Newborns between twenty-four hours and two months of age were assessed using the NICU Network Neurobehavioral Scale (NNNS) which measures the dimensions of attention and arousal. The NNNS was conducted on newborns of mothers who had participated in the prenatal portion of the study. We conducted correlations and ordinary least squares regression analyses. Maternal hair cortisol levels were not significantly associated with newborn attention (r= -.026, p=.77) and arousal (r= -.077, p= .382). Baseline HR was not significantly associated with attention (r= .012, p=.879) and arousal (r= -.002, p=.979). Baseline RSA was also not significantly associated with attention (r= -.106, p=.192) and arousal (r= .071, p= .381). Lastly, baseline SCR and SCL were not significantly associated to newborn attention (r=-.094, p=.247; r=-.013, p=.874) and arousal (r=-.077, p=.342; r=-.12, p=.138), respectively. These results suggest that maternal psychophysiology at baseline may not be a risk factor in postnatal neurobehavioral development. The notion that stress reactivity, or how we respond to stress, affects postnatal infant well-being regardless of baseline parameters is confirmed in this study. References Provencal, N., & Binder, E. B. (2015). The effects of early life stress on the epigenome: From the womb to adulthood and even before. Experimental Neurology, 268, 10-20. Suurland, J., van der Heijden, K., Smaling, H., & Huijbregts, S. (2017). Infant autonomic nervous system response and recovery: Associations with maternal risk status and infant emotional regulation. Developmental and Psychopathology, 29(3), 759-773. University of Utah UNDERGRADUATE RESEARCH JOURNAL CAN MORE SENSITIVE CAREGIVING BUFFER THE EFFECTS OF MATERNAL DEPRESSION ON CHILD PROBLEM BEHAVIOR? Barbara Camara (Elisabeth Conradt, Ph.D) Department of Psychology ABSTRACT In 2012, CDC researchers found that 11.5% of women delivering a live birth that year had postpartum depressive symptoms (PDS) (Ko, Rockhill, Tong, Morrow, & Farr, 2017). Many children who have been exposed to maternal depressive symptoms in their first year of life tend to show deficits in various domains later in life. However, not all children exposed to maternal depression exhibit these deficits, suggesting the presence of a moderator. The present study examines whether exposure to maternal depression at 4 months predicts behavioral problems at 3 years. The role of maternal sensitivity, measured at 1 month, was evaluated as a moderator of this association. We analyzed data from a sample of 1,388 mother-infant dyads with prenatal substance exposure from the Maternal Lifestyle Study. Dyads were followed from 1 to 36 months of age. We found that more symptoms of maternal depression at 4 months were positively correlated with more problem behavior in preschoolers at 3 years. Mothers who had high levels of depressive symptoms and who engaged in more stimulation when interacting with their infants, had preschoolers with problem behavior scores similar to preschoolers of mothers with lower levels of depressive symptoms. The other subscales of maternal sensitivity did not significantly moderate the effects of maternal depression on preschool problem behavior. These findings support targeting maternal sensitive behaviors, particularly those within the domain of stimulation, for early intervention to provide infants with the best possible resources as they develop, despite the sometimes unavoidable circumstance of maternal depression. REFERENCES Ko, J. Y., Rockhill, K. M., Tong, V. T., Morrow, B., Farr, S. L. (2017). Trends in Postpartum Depressive Symptoms – 27 States, 2004, 2008, and 2012. Morbidity and Mortality Weekly Report, 66(6), 153-158. University of Utah UNDERGRADUATE RESEARCH JOURNAL GEOCHEMISTRY OF SEDIMENT FROM THE AKSUMITE EMPIRE ON THE TIGRAY PLATEAU, ETHIOPIA Leota Coyne (Mitchell Power) Department of Geography Abstract The horn of Africa has a long history of human-environment interactions that span the rise and fall of ancient societies. This research aims to explore the potential long-term human impacts to soils in the highlands of northern Ethiopia. Of all the physical, chemical, and biological realms of the environment, soils are most directly influenced through agricultural practices, land use activities, and intentional burning. The overall soil quality is a critical component that has been linked to the rise and fall of past civilizations, including the Aksumite Empire of approximately 2000-3000 years ago in what is now northern Ethiopia and Eritrea. This research interrogates sediment samples from early occupation sites of the pre-Aksumite and Aksumite people to explore anthropogenic impacts from millennia of dry-land agriculture. By examining the organic versus non-organic components of ancient soils, this study will test the idea that anthropogenic soils, including soils formed during the time of the Aksumite Empire, will have greater organic content and higher potential productivity (e.g. high soil carbon and nitrogen) during periods of more intense human occupation, than subsequent periods of abandonment, when soil organic content is expected to decrease. University of Utah UNDERGRADUATE RESEARCH JOURNAL Sexual Assault Kits and the Criminal Justice System’s Response Teylor Crenshaw (Heather Melton) Department of Sociology In the United States, the criminal justice system’s response to sexual assault is a contributing factor as to why sexual assault remains a prevalent and pervasive issue. Sexual Assault Kits (SAKs) provide evidence not only about a crime, but how the criminal justice system responds to sexual assault, and how the system in place treats victims of sexual assault. Up until recently, Sexual Assault Kits have been extensively backlogged and have remained untested or partially tested. The information on sexual assault and the research surrounded untested SAKs is very limited. For this research project I have assisted in creating and updating a database for the 3000+ SAKs in Utah, that have remained untested or partially tested. The database that houses all the SAK information, will be used to help predict whether SAKs get submitted, what impact SAKs have on case outcome, and how satisfied victims are with the overall criminal justice system response and process. So far, the data has shown that the criminal justice response could be updated to better equip how to handle sexual assault cases. Clearly, a lot of the cases adhere to the norms of rape culture; where the victim is blamed for the crime or people question the victim’s credibility. The question as to how to fix the backlogging problem remains unanswered, and questions as to how to implement a nationwide update on how the criminal justice system handles sexual assault remains up in the air. The importance of this research project is incredibly high, because this topic needs to be discussed and researched in order for any productive and effective changes to happen. University of Utah UNDERGRADUATE RESEARCH JOURNAL MATERNAL STRESS AND THE DEVELOPMENT OF INFANT REGULATORY PROCESES Nicolle Eldredge, Elisabeth Conradt, PhD, Jeanine Stefanucci, PhD, Lisa Aspinwall, PhD, Sylvia D. Torti, PhD Department of Psychology ABSTRACT When mother-infant dyads engage in an effective form of communication, one where mother and infant both play an active role, the infant gains an understanding for the emotions that they feel. However, acute stress exposure may challenge the dyad’s ability to effectively self-regulate prior to and following a social stressor. According to stress contagion theory, stress can be passed on from mother to infant during social interactions. Through an experimental manipulation of maternal stress, the current study examined relations between maternal stress and infant emotion regulation. The purpose of this study was to determine whether a stressed mother may “transmit” stress to her infant, thus causing infant physiological dysregulation. Forty mother-infant dyads were assessed in the laboratory, using the Still Face Paradigm (SFP), to examine this relationship. Forty motherinfant dyads participated. Infants were examined at 7 months of age, and mothers ranged from 21-38 years old. We were successful in creating a stress response in infants. However, we did not see differences in infant physiological responses between the stress group and the control group, indicating that we were not able to create two significantly different groups. We did see differences in infant heart rate during the second recovery episode of the SFP, where mothers are allowed to interact with their infants after 2 minutes of not responding. Contrary to our hypothesis, we found that mothers exposed to a stressor prior to the SFP had infants with shorter recovery times compared to unexposed mother infant dyads. TABLE OF CONTENTS ABSTRACT ii INTRODUCTION 1 METHODS 5 RESULTS 7 DISCUSSION 15 REFERENCES 18 APPENDIX 21 INTRODUCTION Caregivers act as an external source of emotion regulation for their infants until infants learn independent forms of self-regulation (Tronick, 1989). When mother-infant dyads engage in an effective form of communication, one where mother and infant both play an active role, the infant gains an understanding for the emotions they feel (Tronick, 1989). However, acute stress exposure may challenge the dyad’s ability to effectively self-regulate prior to and following a social stressor (Moore & Calkins, 2004). While researchers have examined the relationships between maternal stress and infant emotion regulation (Moore & Calkins, 2004; Conradt & Ablow, 2010), all of the studies thus far are correlational. Experimental approaches would allow us to identify a causal relationship between maternal stress and its impact on infant emotion regulation, which could in turn clarify the etiological factors involved in the expression of infant emotion regulation. Stress Contagion Infants may “catch” the emotion of their mother during times of stress. The theory of stress contagion proposes that individuals tend to capture the emotion of someone else while engaging in a social interaction (Hatfield, Cacioppo, & Rapson, 1994). In mother-infant dyads, this stress contagion can be examined by studying maternal emotional signaling, where the mother’s emotions could encourage the infant’s corresponding behavior (Sorce et al., 1985). For example, Sorce et al. (1985) found that when mothers expressed a negative emotion (e.g., fear or anger) the infant was less likely to cross a visual cliff compared to mothers that expressed a positive emotion (e.g., happiness), demonstrating that a mother’s emotions play a role in how infants behave. Another study, in support of stress contagion theory, found that the manner in which mothers interact with strangers affects the way infants interact with those same strangers (de Rosnay et al., 2006). De Rosnay et al. found that mothers who acted anxious with a stranger had infants that were more avoidant and afraid of that stranger compared to mothers who acted normally with a stranger. Furthermore, there was a greater positive covariation of mother-infant physiology after mothers met a negative stressor (e.g., fear or anger) compared to a low level stressor (de Rosnay et al., 2006). Therefore, it is possible that negative stress has a more powerful contagion effect on the infant relative to a low level stressor (Waters, West, & Mendez, 2014). In other words, as a mother experiences distress, her infant may experience this distress at behavioral and physiological levels. Infant Physiological Indices of Emotion Regulation As a method to measure infant physiological responses to interpersonal stress, the Still Face Paradigm (SFP; Tronick, Als, Adamson, Wise, & Brazelton, 1978) typically induces a stress response in both infants and mothers by breaking the natural flow of social interactions. Infant bids for communication are ignored by the mother, which increases the infant’s stress levels (e.g., often by increasing heart rate). The SFP is therefore typically used to examine infant physiological indices of emotion regulation. The SFP consists of a normal play session, a still face session (a period of time where the mother is unresponsive to her infant), and a reunion session where the mother is allowed to resume play with her distressed infant (Tronick et al., 1978). Infant cardiovascular responses to stressors like the SFP early in development may set the foundation for more complex levels of emotion regulation (Conradt & Ablow, 2010). Increases in heart rate likely reflect some kind of arousal, whether that be excitement or stress (Conradt & Ablow, 2010). Typically, infants exhibit increases in heart rate during the still face episode of the SFP (Moore & Calkins, 2004; Haley & Stansbury, 2003; Weinburg & Tronick, 1996; Bazhenova, Plonskaia, & Poges, 2001). Following the still face episode, a decrease in heart rate is usually observed during the reunion phase (Haley & Stansbury, 2003); however, reunion heart rate is still higher than baseline heart rate (Moore & Calkins, 2004). Moore and Calkins also found higher heart rates among infants during reunion than in normal play, although there are some studies that do not find this difference (Weinburg & Tronick, 1996). While an increase in heart rate in response to stress reflects a response by the sympathetic nervous system, a decrease in heart rate accompanied by an increase in respiratory sinus arrhythmia (RSA) may reflect a parasympathetic nervous system response (Moore & Calkins, 2004). RSA is an index of parasympathetic regulation and reflects the increases and decreases of heart rate as a function of respiratory activity (Beauchaine, 2001). An increase in RSA from baseline is typical during low stress interactions (Conradt & Ablow, 2010). On the other hand, a decrease in RSA is accompanied by increased sympathetic activation and movement in response to stress (Conradt & Ablow, 2010). Studies have found decreases in RSA when infants are engaging in play, but then experience the still face episode (Conradt & Ablow, 2010; Moore & Calkins, 2004; Weinburg & Tronick, 1996; Bazhenova, et al., 2001), and increases in RSA between normal play and reunion (Conradt & Ablow, 2010; Moore & Calkins, 2004). Many studies have investigated associations between maternal sensitivity and infant physiology in response to the SFP. On average, infant heart rate increases and infant RSA decreases when a mother is unresponsive (Mesman, van IJzendoorn, & Bakermans-Kranenburg, 2009). Another study found that increased maternal sensitivity is related to a lower infant heart rate during the reunion episode (Conradt & Ablow, 2010). Haley and Stansbury (2003) and Conradt and Ablow (2010) found a negative correlation between maternal sensitivity and infant heart rate during the reunion episodes, indicating that more responsive mothers had infants with a slower heart rate during these episodes. Furthermore, less responsive mothers had infants with an increased heart rate during both still face and reunion episodes compared to more responsive mothers (Haley & Stansbury, 2003). Interestingly, the correlations between maternal sensitivity and RSA were not significant for any of the still face episodes (Conradt & Ablow, 2010). However, mothers with high maternal sensitivity had infants who showed higher levels of RSA during the reunion episode (Conradt & Ablow, 2010), indicating that more sensitive mothers may have been able to soothe their infants adequately. Present study The aim of the current study is to determine, using a controlled experimental manipulation of stress in mothers, whether maternal stress exposure is related to infant physiological indices of emotion regulation. We hypothesized that mothers exposed to a stressor prior to the SFP will have infants with higher heart rates and lower RSA during still face than mothers not exposed to a stressor. We also hypothesized that stressed mother-infant dyads will have a longer infant recovery time from the still face episode compared to control dyads. These hypotheses rest on the notion, informed by stress contagion theory, that stress can distract the mother from helping her infant calm down, which would lead to the infant not being adequately soothed, thus experiencing a longer recovery time. METHOD Participants Participants were 40 mother-infant dyads who were part of a longitudinal study, beginning prenatally, that examined the impact of prenatal exposure to maternal emotion dysregulation on infant development. The caregiver-infant dyads came into the lab when infants were between 26-30 weeks old (M = 28.5 weeks, SD = 1.66). Mothers ranged from 21 to 38 years old (M = 28.9 years, SD = 4.32). Consent for the infants was given by the mother. Procedure Following consent, both mothers and infants were attached to heart rate and respiratory equipment (described below). While physiological data was collected for both mother and infant, only infant physiology data will be reported. Infants were then dressed in a gender neutral smock that covered the electrode wires. Infants were seated in a high chair while their mothers sat next to them. The dyads watched a 2 minute Baby Einstein video (© 2002, The Baby Einstein, LLC) to establish a baseline. The “Baby Einstein” assessment was used to determine the infant’s resting heart rate and RSA. Design There was one independent variable and two dependent variables. The independent variable was maternal stress exposure. Maternal stress was defined as the prompt (control or worry) that the mother was randomly assigned to before the visit. The stress prompt asked mothers to describe a parenting worry that they experienced over the last two weeks. The control prompt asked mothers to describe a quiet moment they had with their child in the past two weeks. The dependent variables were the baby’s physiological responses to the Still Face Paradigm as measured by mean heart rate and mean respiratory sinus arrhythmia (RSA). Stress assessment Following the baseline measurements for baby’s resting RSA and heart rate, mothers were asked to fill out a 10 question survey to assess their own emotions. Questions were in the format “How calm do you feel right now?” Mothers were randomly assigned to one of two writing prompts meant to illicit either a stress/worry group or a control group. The prompts and the surveys can be found in the Appendix. Lastly, after the stressor, mothers were asked to fill out the same 10-item questionnaire as before to assess mother’s emotions. This questionnaire also asked how often they thought about the writing task during the social interaction. Infants were allowed to play with toys during this task. After the writing task, the room was rearranged for the Still Face Paradigm (Tronick et al., 1978). Mother and infant were seated face-to-face with the infant in a high chair. Babies were not allowed toys for this task. Participants were told to play with their baby normally as they would at home for two minutes. Over the intercom, mothers were instructed to turn around and then turn back to face their baby with a still or neutral “poker” face for two minutes. Again, over the intercom, they were instructed to turn around, turn back, and resume normal play for two minutes. A second still face and a second reunion were instructed in the same manner. If at any point the infant grew too fussy, the still face paradigm was paused so the mother could soothe her baby. While some studies use the single still face format (play, still face, reunion), the current study utilized the double still face format (play, still face, reunion, still face, reunion) to induce greater stress compared to the single still face format (Haley & Stansbury, 2003). Video recordings were set up with one camera focused on the mother and another camera recording the infant. A split-screen generator recorded the interaction with both cameras sideby-side. Physiological assessment Infant physiology data were collected with Mindware Electrodes. Experimenters placed electrodes on the right clavicle and the bottom of the left and right ribs while infants were sitting in a high chair. Infants were covered with a smock so they could not tug on the wires, and so that coders could not make assumptions about infant sex. Infants were still able to move. During the writing task and each event of the SFP, physiological channels were continuously recorded. Individual events were recorded using an epoch file. The heart rate data were sampled at 1,000 Hz, and were checked for outliers and artifacts using MindWare Heart Rate Variability software V. 3.3.5 (© 2012, MindWare Technologies, LTD). RSA was derived using the R-R series and was determined by MindWare Heart Rate Variablity software V 3.3.5 (© 2012, MindWare Technologies, LTD). RESULTS Prior to running the primary analyses, we calculated the grand means for HR and RSA across all episodes of the still face paradigm (Tables 1-2). Manipulation checks First, we examined the differences in pre- and post- emotion assessments to determine if there were any differences in maternal self-report of emotional states between the stress and control groups. There were no differences between the experimental groups all p’s >.05, indicating that the experimental groups did not differ in self-reported emotional states and the manipulation did not work. Regardless, we continued with our analyses as planned. The purpose of our second manipulation check was to determine whether infants exhibited changes in HR or RSA across the SFP, regardless of experimental condition. A paired samples t-test was used to determine differences between the SFP episodes. As expected, infant HR was significantly higher during the still face compared to the first play episode, regardless of stress condition, t(38) = -7.04, p < .05. In addition, infant HR was significantly lower during the first recovery episode compared to the first still face episode, t(35) = 2.45, p < .05. There was also a significant increase in HR between the first recovery episode and the second still face episode t(33) = -2.45, p < .05. After the second still face episode infant HR remained high. We plotted the HR grand means across the still-face conditions in Figure 1. Figure 1. Infant heart rate across the Still Face Paradigm episodes, collapsed across experimental condition. Paired t –tests were also conducted to determine whether there were significant differences in RSA across the still-face episodes, regardless of experimental condition. As expected, infant RSA was significantly higher during the still face episode compared to the play episode, regardless of the experimental condition t(37) = 3.39, p < .05. There were no other significant differences in RSA responses (all p’s > .05). Aim 1 Results The first aim of this study was to determine whether maternal stress exposure prior to the SFP could impact infant physiological responses to stress. The hypothesis was that mothers who were stressed prior to the SFP would have infants with higher heart rates throughout the SFP. A repeated-measures analysis of variance (ANOVA), with still-face episode as the within-subjects factor and group as the between-subjects factor, revealed that there were no significant differences in infant HR or RSA between the experimental groups (Tables 3-4). Aim 2 results The second aim of the study was to determine whether there were differences in recovery times between a stressed group and a control group. The hypothesis was that mothers exposed to a stressor prior to the SFP would have infants who showed a longer time to recover, as evidenced by the theory of stress contagion, wherein an individual tends to capture the emotion of another person in a social interaction. A repeated-measures ANOVA was used to determine whether infants whose mothers were exposed to stress exhibited differences in how they recovered physiologically from the stress of the still-face episode compared to infants whose mothers were not exposed to stress. There were no significant differences between the two groups for both HR and RSA in response to the first recovery episode (N=36), F(1,34) = 0.05, p > .05. We next examined differences in HR and RSA during the second recovery episode (N=32) across all four, 30-second epochs. We found no significant differences between the two groups F(1,34) = 0.14, p > .05. Upon inspection of the graph, we noticed larger differences between the two groups during the first three epochs of the second recovery episode. We probed differences in these three epochs between infants whose mothers were exposed to a stressor prior to the still-face paradigm and those whose mothers were not exposed. There was a significant difference in HR between the two experimental groups F(1,30) = 4.01, p < .05. Figure 2 shows that the stressed group’s HR decreased more than the control group, which was contrary to our hypothesis. RSA differences in the second recovery episode were not significant F(1,30) = 0.13, p > .05. Figure 2. Differences of infant heart rate between experimental groups during the first 90 seconds of Recovery 2. Table 1 Grand Means and Standard Deviations for Infant Heart Rate Still Face Stress Control Episode M SD M SD Baseline 137.57 10.38 143.48 13.93 Writing 145.99 13.00 148.91 10.03 Play 139.95 13.28 145.50 13.17 Still Face 1 154.30 12.77 156.08 15.60 Recovery 1 148.48 17.84 149.65 12.83 Still Face 2 151.24 14.75 155.10 15.59 Recovery 2 146.72 14.71 155.04 14.79 Table 2 Grand Means and Standard Deviations for Infant Respiratory Sinus Arrhythmia Still Face Stress Control Episode M SD M SD Baseline 3.71 0.96 3.39 1.00 Writing 3.10 0.72 3.09 1.01 Play 3.70 1.06 3.49 0.8 Still Face 1 3.21 0.82 3.00 1.22 Recovery 1 3.21 1.11 3.36 1.28 Still Face 2 3.50 1.21 3.36 1.2 Recovery 2 3.33 1.12 3.47 1.15 Table 3 One Way Repeated Measures ANOVA of Infant Heart Rate During the Still Face Paradigm Sum of Mean Still Face Episodes df F Sig. Squares Square Between 348.19 1 348.19 2.27 0.14 Groups Baseline Writing Play Within Groups 5822.81 38 153.23 Between Groups 88.04 1 88.04 Within Groups 5225.83 39 134.00 Between Groups 300.04 1 300.04 Within Groups 6471.74 37 174.91 31.52 1 31.52 7719 38 203.13 12.34 1 12.34 8209.72 34 241.46 126.93 1 126.93 7369.50 32 230.30 554.57 1 554.57 6528.3 30 217.61 Between Still Face 1 Groups Within Groups Between Recovery 1 Groups Within Groups Between Still Face 2 Groups Within Groups Between Recovery 2 Groups Within Groups 0.66 0.42 1.72 0.20 0.16 0.7 0.05 0.82 0.55 0.46 2.55 0.12 Table 4 One Way Repeated Measures ANOVA of Infant Respiratory Sinus Arrhythmia Sum of df Mean Square F Sig. Still Face Episodes Squares Between 1.03 1 1.03 1.06 0.31 Groups Baseline Writing Play Still Face 1 Recovery 1 Still Face 2 Recovery 2 Within Groups 36.72 38 0.97 Between Groups 0.001 1 0.001 Within Groups 30.15 39 0.77 Between Groups 0.42 1 0.42 Within Groups 31.34 36 0.87 Between Groups 0.42 1 0.42 Within Groups 40.84 38 1.08 Between Groups 0.2 1 0.20 Within Groups 48.86 34 1.44 Between Groups 0.17 1 0.17 Within Groups 46.72 32 1.46 0.17 1 0.17 39.00 30 1.30 Between Groups Within Groups 0.001 0.98 0.48 0.49 0.39 0.53 0.14 0.71 0.12 0.74 0.13 0.72 DISCUSSION Past research investigated associations between maternal stress and infant physiological measures, but none have examined whether maternal stress may cause changes in infant physiology in response to stress. The results from this study are the first to investigate this causal relationship in mother-infant dyads using an experimental manipulation of maternal stress prior to the still-face paradigm. The results of the manipulation of maternal mood indicate that the writing task did not create any differences of emotional states between the two groups. This demonstrates that our task may not have been a sufficient manipulation of emotion to elicit a stress response in mothers. While it may be the case that the responses from our participants were not emotionally distressing to recreate a stressed response, past research may provide some other possible explanations for this result. Kross and Ayduk (2008) found that when distanced from a negative event that participants were asked to recall, negative emotions were often reduced during recall. While we asked our participants to recall an event in the past week, they may have been too distanced from the isolated event to fully experience the negativity of the event. In addition, a resolution within the recalled story reduces the negative emotions associated with the event (Pasupathi, Billitteri, & Mansfield, 2015). The stressful moment that our mothers recalled may have been resolved before they wrote about the event, a hypothesis that we will test for in future research. Thus, our insignificant results may have been due to the insufficient maternal stress manipulation. However, the infant physiological indices of emotion regulation were consistent with past research results (Moore & Calkins, 2004; Haley & Stansbury, 2003; Weinburg & Tronick, 1996; Bazhenova, Plonskaia, & Poges, 2001). In our study, we showed that infants became distressed when their mother was unavailable (i.e., did not respond to her infants’ bids for attention). We saw in increase in HR and a decrease in RSA between the play episode and the still face, which indicated that infants were activating their sympathetic nervous system, and reducing their parasympathetic nervous system in response to stress. In addition, we showed that an infant became less distressed as the mother resumed normal interactions. There was decreased HR during the first recovery episode, indicating that infants were being soothed. Lastly, we saw an increase in HR during the second still face, indicting another stress response. These findings suggest that we were able to create both a distressed state in infants and a recovery state, in which the infants effectively regulated their emotions with the aid of their mother. The results of the second aim suggest that mothers exposed to a stressor prior to the SFP have infants with shorter recovery times, which was opposite of what was hypothesized. An important caveat to these results is that we looked specifically at the first 90 seconds (out of 120 seconds) of the second recovery episode for HR only. While we did see HR differences, we did not see a corresponding RSA response between the experimental groups. A limitation to this result is that several infants did not complete the second recovery in its entirety or, in some cases, at all, thus reducing the sample size further for the second recovery episode. While the results were inconsistent with our hypothesis, these results lead us to speculate about maternal stress and infant emotion regulation. It may be the case that stress experienced by the mother may alter maternal sensitivity and affect the way infants develop their growing sense of emotion regulation. In light of this study, it is possible that stress may facilitate more sensitive parenting, rather than distract the mothers from their parenting. In addition, the prompt we use for mother’s stress manipulation asks them to think about their infant in a stressful context. This may cue the mother to her parenting worries, thus increasing her maternal sensitivity. Future research could examine behavior during the SFP in addition to the physiological measures in order to better understand how stress affects maternal sensitivity. The results of this study help to understand the effects of maternal stress on infant physiological responses. We found that stressed mothers were able to better soothe their infants than control mothers. This study provides opportunity to further investigate how maternal stress affects infants' physiological responses. A look into maternal behavioral responses as well as infant physiological responses could help pinpoint these effects. REFERENCES Ayduk, O., & Kross, E. (2009). Asking 'why' from a distance facilitates emotional processing: A reanalysis of Wimalaweera and Moulds (2008). Behaviour Research And Therapy, 47(1), 88-92. doi:10.1016/j.brat.2008.06.014 Bazhenova, O. V., Plonskaia, O., & Porges, S. W. (2001). Vagal Reactivity and Affective Adjustment in Infants During Interaction Challenges. Child Development, 72, 1314–1326. Beauchaine, T. (2001). Vagal ton, development, and Gray's motivational theory: toward an integrated model of autonomic nervous system functioning in psychopathology. Developmental and psychopathology, 13(2), 183-214. doi: 10.1017/S0954579401002012 Conradt, E., & Ablow, J. (2010). Infant physiological response to the still-face paradigm: Contributions of maternal sensitivity and infants’ early regulatory behavior. Infant Behavior & Development, 33(3), 251-265. doi:10.1016/j.infbeh.2010.01.001 de Rosnay, M., Cooper, P. J., Tsigaras, N., & Murray, L. (2006). Transmission of social anxiety from mother to infant: An experimental study using a social referencing paradigm. Behaviour Research And Therapy, 44(8), 1165-1175. doi:10.1016/j.brat.2005.09.003 Haley, D. W., & Stansbury, K. (2003). Infant Stress and Parent Responsiveness: Regulation of Physiology and Behavior During Still-Face and Reunion. Child Development, 74(5), 1534-1546. doi:10.1111/1467-8624.00621 Hatfield, E., Cacioppo, J. T., & Rapson, R. L. (1993). Emotional contagion. Current Directions In Psychological Science, 2(3), 96-99. doi:10.1111/1467-8721.ep10770953 Mesman, J., van IJzendoorn, M. H., & Bakermans-Kranenburg, M. J. (2009). The many faces of the Still-Face Paradigm: A review and meta-analysis. Developmental Review, 29(2), 120-162. doi:10.1016/j.dr.2009.02.001 Moore, G. A., & Calkins, S. D. (2004). Infants' Vagal Regulation in the Still-Face Paradigm Is Related to Dyadic Coordination of Mother-Infant Interaction. Developmental Psychology, 40(6), 1068-1080. doi:10.1037/0012-1649.40.6.1068 Pasupathi, M., Billitteri, J., Mansfield, C. D., Wainryb, C., Hanley, G. E., & Taheri, K. (2015). Regulating emotion and identity by narrating harm. Journal Of Research In Personality, 58127-136. doi:10.1016/j.jrp.2015.07.003 Sorce, J. F., Emde, R. N., Campos, J., & Klinnert, M. D. (2000). Maternal emotional signaling: Its effect on the visual cliff behavior of 1-year-olds. In D. Muir, A. Slater, D. Muir, A. Slater (Eds.) , Infant development: The essential readings (pp. 282-292). Malden: Blackwell Publishing. Tronick, E. Z. (1989). Emotions and emotional communication in infants. American Psychologist, 44(2), 112-119. doi:10.1037/0003-066X.44.2.112 Tronick E., Als H., Adamson L., Wise S., & Brazelton T. B. (1978). The infant's response to entrapment between contradictory messages in face-to-face interaction. Journal of the American Academy of Child Psychiatry, (17)1, 1-13. doi: 10.1016/S00027138(09)62273-1 Waters, S. F., West, T. V., & Mendes, W. B. (2014). Stress contagion: Physiological covariation between mothers and infants. Psychological Science, 25(4), 934-942. doi:10.1177/0956797613518352 Weinberg, K. M., & Tronick, E. Z. (1996). Infant affective reactions to the resumption of maternal interaction after the Still-Face. Child Development, 67(3), 905-914. doi:10.2307/1131869 APPENDIX Stress prompt: All new mothers worry about some aspect of their parenting. Identify the biggest worry you had as a parent in the last week. Write in detail about what it was that you were worried about, how it made you feel about yourself as a mother, how it made you feel about your baby, and how it made you feel about the future. Control prompt: All new mothers experience quiet moments with their children. Identify the quietest moment you had with your child in the last week. Write in detail about what it was that made it quiet, how it made you feel about yourself as a mother, how it made you feel about your baby, and how it made you feel about the future. Pre-prompt questions: Please rate to what degree you currently feel for each of the emotions listed using the following rating scale. Do you feel the emotion: (1) not at all (2) a little (3) moderately or (4) very strongly? Question 1. How anxious do you feel right now? 2. How worried do you feel right now? 3. How nervous do you feel right now? 4. How sad do you feel right now? 5. How happy do you feel right now? 6. How calm do you feel right now? 7. How mad do you feel right now? 8. How overwhelmed do you feel right now? 9. How scared do you feel right now? 10. How content do you feel right now? Not at all A little Moderately Very strongly Post-prompt questions-Stress: Please rate to what degree you currently feel for each of the emotions listed using the following rating scale. Do you feel the emotion: (1) not at all (2) a little (3) moderately or (4) very strongly? Question 1. How anxious do you feel right now? 2. How worried do you feel right now? 3. How nervous do you feel right now? 4. How sad do you feel right now? 5. How happy do you feel right now? 6. How calm do you feel right now? 7. How mad do you feel right now? 8. How overwhelmed do you feel right now? 9. How scared do you feel right now? 10. How content do you feel right now? 11. How much did you think about the parenting worry during the face-toface interaction? Not at all A little Moderately Very strongly Post-prompt questions - Control: Please rate to what degree you currently feel for each of the emotions listed using the following rating scale. Do you feel the emotion: (1) not at all (2) a little (3) moderately or (4) very strongly? Question 1. How anxious do you feel right now? 2. How worried do you feel right now? 3. How nervous do you feel right now? 4. How sad do you feel right now? 5. How happy do you feel right now? 6. How calm do you feel right now? 7. How mad do you feel right now? 8. How overwhelmed do you feel right now? 9. How scared do you feel right now? 10. How content do you feel right now? 11. How much did you think about the quiet moment during the face-toface interaction? Not at all A little Moderately Very strongly i University of Utah UNDERGRADUATE RESEARCH JOURNAL PUBLIC UNDERSTANDING OF POLITICAL POLLING RESULTS Isabella Fregoso, James Curry, PhD, Department of Political Science Abstract This thesis is aimed at examining possible means of improving lay understanding of political polling results, focused specifically on how text summaries of political polls can be used to increase levels of agreement with the results. To discover means of improvement, an online survey was designed and conducted among registered voters in the United States with four experimental modules, each with different text summaries of a hypothetical poll. The results indicate the clear impact of differences in coverage of political polls, indicating that more detailed descriptions do not necessarily increase trust in polling results but do decrease disbelief in polling results. Results examined by party affiliation further indicated significant differences between perceptions of polling results depending on the nature of the results summary. Table of Contents Abstract i Table of Contents ii I. Introduction 1 II. Survey Methodology and Text 3 III. Analysis Methodology 5 IV. Summary of Results and Implications 6 V. Differences by Party Affiliation 10 VI. Final Implications 13 Appendix 1: Public Poll Trust and Understanding Experiment 14 Appendix 2: Public Understanding of Political Polling Results - Topline Report 26 Works Cited 31 1 I. Introduction Prior to 1935, political polling was mainly qualitative in nature, or focused on pen-andpaper surveys processed by hand (Rothman). The prevalence of political polling and its communication began with George Gallup, the founder of Gallup Polls. In founding Gallup Polls and in an effort to communicate polling results with the average American, Gallup established a powerful precedent for the use of political polls in traditional media (Newport). He communicated closely with the public, penning a number of columns in the New York Times throughout the 1930s and 1940s that presented national polling results and explained their implications, or simply reasons to trust the results themselves. Nearly 100 years later, however, the media presentation of survey science has changed significantly, perhaps at the cost of public trust or understanding of survey and poll results. This thesis explores the reasons behind that loss, and is aimed at discovering a means to improve the trust and understanding of political polling results–hinged on the hypothesis that increased information given in polling coverage increases voter understanding and trust. Today, few pollsters communicate directly with the public, and media coverage relies on treating elections like horse races. Leading up to elections, most polling is communicated in a few sentences or less as a piece of larger work. Take, for example, an article by Matt Canham of The Salt Lake Tribune, writing on the 2018 Congressional election in Utah’s District 4. He writes, “a late August poll by Dan Jones & Associates for UtahPolicy.com...had Love at 49 percent and McAdams at 46 percent” (Canham). This is the only mention of polling in the piece, a lengthy work that relies on these numbers but does not attempt to explain or conceptualize them. Note here the lack of discussion of the sampling, the acceptance of the accuracy of the polls without questioning for biases, and the missing voice of the pollsters themselves. It is because of Gallup’s work that polling results are generally accepted, but modern readers would absolutely benefit from a closer relationship with researchers and polling methodology. George Gallup strove to understand and communicate “the will of the people” with the people themselves, but in the absence of a strong connection between laymen and pollsters, what is the general understanding of political polling? Lohr and Singer look to the so-called “polling disaster” of the 2016 American presidential election, examining the many election models that reported Clinton’s chance of victory at 70% of higher and the baffling eventual result of a Trump victory (Lohr). The authors suggest a general fallibility of political polling based on that outcome, and scrutinize the sampling, historical modeling, and the failure of local polls used to predict the election outcome (Lohr). The piece seems to suggest that polling or “big data” will never be truly accurate– that human fallibility cripples the industry in a way that deems it significantly untrustworthy if not entirely irrelevant. Nate Silver, statistician and founder of FiveThirtyEight, discusses this idea in “The Polls are All Right.” Referencing a study done by Jennings and Wlezien, Silver writes, “polling accuracy has been fairly consistent over the past several decades in a variety of democratic countries...The media narrative that polling accuracy has taken a 1 1 Horse-race election coverage, referred to throughout this paper, is defined by Broh’s writing on the subject. He writes, “A horse is judged not by its absolute speed or skill but in comparison to the speed of other horses, and especially by its wins and losses. Similarly, [in horse-race election coverage] candidates are pushed to discuss other candidates; events are understood in a context of competition; and picking the winner becomes an important topic. The race—not the winner—is the story” (Broh 515). More generally, horse-race election coverage is characterized by a focus on where candidates rank in relation to others, rather than election issues or more general concerns. 2 nosedive is mostly bullshit...Polls were never as good as the media assumed they were before 2016 — and they aren’t nearly as bad as the media seems to assume they are now” (Silver). Empirical analysis asserts that polling is as accurate as it has been since 1972 on the presidential level (Silver). Media coverage following the 2016 election, however, has toed the line between hypercriticism of polling results (especially on a national scale) and unthinking acceptance of polling results that eventually contributes to public confusion–for example, Matt Canham’s coverage of the 2018 Utah congressional race between Mia Love and Ben McAdams, which did not discuss sampling, margin of error, or methodology, and instead reported horse race predictions in the weeks leading up to election day. Lohr discusses this, writing that what contributed to the failure of the polls in 2016 as well as public distrust of the science moving forward was “a combination of the shortcomings of polling, analysis and interpretation, perhaps both in how the numbers were presented and how they were understood by the public” (Lohr). Here, an adage from columnist Jeffrey Simpson seems relevant– “just as love is wasted on the young, so polls are often wasted on the media” (Kay). Polling is not an exact science, as Silver is quick to admit– but media coverage of polling varies widely depending on the news cycle in question. He writes about a pro-Republican bias in coverage of polling results in 2012 and in early coverage of 2018 midterm elections–biases that exist while polling science has, over time, shown little preference toward either major party in the United States (Silver). These biases can influence public trust of results, and make election polling seem partisan or significantly more variable than it is. This inhibits public understanding of the science–why endeavor to understand or trust a science that is seemingly so varied and untrustworthy? Political polling provides campaigns with valuable insights on likely voters and influences campaign strategy. Moreover, we cannot relegate polling only to “experts” who can use the results–if data exists on the public, the public should have access to those results. The works referenced here point out a clear issue in media coverage of polling results: the public does not understand polls and is not given the tools to understand them. The media at times even exacerbates public misunderstanding by mischaracterizing polling results in an effort to achieve a snappier story or a catchier headline. Silver points to a story on the 2016 Irish referendum on legalizing abortion, in which The Guardian characterized the race as “close” when polling showed the “yes” vote as ahead by 11 to 29 points (Silver). If media coverage is lacking, and attempts by media outlets to outguess polling are fundamentally lacking, as Silver extensively discusses in an analysis of the 2017 French presidential election , a means to improve public understanding of political polling results is of utmost importance. Experiments to study and test methods to increase public understanding of polling, so that it is a more effective tool for campaigns, political operatives, and general understanding of the current state of affairs, is a necessary pursuit. A return to Gallup’s close 2 2 In “Conventional Wisdom May Be Contaminating Polls,” Silver discusses the mainstream media’s proclivity to “indulge the possibility” of a long shot or a statistical improbability (Silver). Specifically, he focuses on the 2017 French presidential election, in which the probability of a win by populist candidate Marine Le Pen was drastically over explored by the media. Here, media outlets, as well as financial firms, relied on “conventional wisdom,” following a Trump victory in the United States only six months earlier, to project Le Pen’s chance of winning at around 40%, when the most conservative conventional pollsters had her probability of victory resting at approximately 3% (Silver). In an attempt by media outlets to beat the pollsters, they ignored a consistent 20-25 point lead by Emmanuel Macron and eventually were proven wrong by French voters, who elected Macron with 66% of the vote (Silver). 3 relationship with the American public is not out of reach, but may not be required if public understanding of polling results can be improved. An abundance of horse race polling coverage ignores the nuances of the science as well as the nuances of the public. Failure to understand the limitations of polling inevitably leads to a distrust of polling results. Rosen in The Observer writes, “In a horse race world, polls are a baseline reality...They can tell you who’s ahead but not why. And they are mute on a favorite horse race question: how things are going to ‘play out from here,’” (Jarvis). Because media coverage relies principally on “horse race” results, media consumers lose the intricacies of results. It is possible, however, that media coverage could be improved to increase understanding of or trust in polling results. This is what this thesis intends to test and explore–lay understanding and trust of polling results as well as potential tactics to improve understanding. This is accomplished through a survey of a representative sample of 1,000 registered voters in the US, employing a survey with four experimental modules and analysis of the results. Specifically, the survey experiment tests a few hypotheses. First, that media coverage of political polling results can affect a voter’s perception of political polling by increasing or decreasing trust of coverage in both specific political races and political race coverage more broadly. Second, that different groups will respond to different types of coverage in distinct ways, specifically across party lines. Most importantly, I test the hypothesis that registered voters respond more positively to political polling results when provided with more detailed descriptions of the polling results. II. Survey Methodology and Text The survey employed is comprised of four sections from the perspective of the participant: an introductory block meant to screen out unqualified participants (those younger than 18 and those not registered to vote in the United States); a background block meant to gauge voter history, gender, and level of education; an experimental block, of which each participant viewed one of four options (explained in more detail below); and a closing block focused on party affiliation, ethnicity and race. Each participant was asked to respond to 12 or 13 questions, and the average survey response time was slightly under four minutes. Each respondent was presented with a consent letter about the nature of the research before beginning the survey, available to read in Appendix 1. The construction and ordering of the survey questions relies on widely accepted political and election survey methodology. For example, question order principles as discussed by McDermott and Frankovic in Horserace Polling and Survey Method Effects on the most effective questioning styles to construct a political public opinion poll. Specifically the idea is that respondents may need to “‘warm up’ before being asked complicated political evaluation questions” (McDermott 246). I employ this in my survey design while attempting to avoid the question order effect of “direction,” in which prior questions influence upcoming answers in the survey, especially when partisan questions are asked of the respondent (McDermott 246). In an ideal scenario, I aim to achieve similar results to Siegelman, who found in 1981 that “respondents were more willing, or more able, to give substantive answers to presidential approval questions if they had first been asked other political attitude questions. Specifically, "don't know" responses to a presidential job approval question were 8 percentage points lower when respondents were given other political attitude questions to answer first” (McDermott 246). 4 Ideally, the number of “don’t know” responses is as low as possible. In question text, the use of open questions is nearly unavoidable due to the nature of the research, though McDermott postulates that they increase “don’t know” or “unsure” responses. McDermott advises also that a survey author exclude open-ended questions (where the respondents write short responses to questions) for the same reason, though I am interested in the candid responses of the respondents (McDermott 253). The number of open-ended questions is limited, however, as the respondents are only asked to respond to two completely open-ended questions which request their opinion on beliefs on polling bias and the typical respondent of political polls. The survey instrument is included in Appendix 1 in its entirety. Respondents were randomly assigned to one of four experimental blocks to test the key hypotheses above, and are labeled in analysis Modules 1 through 4. They are differentiated by slight variations in an introductory statement on the polling results in a hypothetical congressional election. Each of the text statements, written to imitate potential media coverage of political polling results, are listed below. Module 1: “Congressional District A has two candidates running for the House of Representatives seat this year. A recently released political poll shows Candidate M. Jackson 1.9 points ahead of Candidate A. Swift two weeks before election day.” Module 2: “Congressional District A has two candidates running for the House of Representatives seat this year. A recently released political poll shows Candidate M. Jackson 1.9 percentage points ahead of Candidate A. Swift two weeks before election day.” Module 3: “Congressional District A has two candidates running for the House of Representatives seat this year. A recently released political poll shows Candidate M. Jackson ahead of Candidate A. Swift 48% to 46% two weeks before election day.” Module 4: “Congressional District A has two candidates running for the House of Representatives seat this year. A recently released political poll shows Candidate M. Jackson 1.9 percentage points ahead of Candidate A. Swift, 48% to 46%, two weeks before election day.” The statements above were constructed to exclude partisan and gender identifiers, and also to avoid any potential association with a current lawmaker or candidate that a participant would recognize. The second sentence in each includes variation in how the polling results are described in ways that may alter the reactions of respondents to the questions that follow: their level of agreement with the polling numbers, and whether they trust the polling numbers, or find them biased. Analysis focuses on the two questions that immediately follow the polling result summary, Q[Module]Points and Q[Module]Trust, shared below. Q[Module]Points: Do you agree or disagree with this statement based on the text above? "Candidate M. Jackson is leading Candidate A. Swift by 1.9 percentage points." Q[Module]Trust: Do you agree or disagree with this statement based on the text above? "I believe this political poll to be an accurate reflection of upcoming election day results." 3 3 I define “open question” as an intentionally vague question intended to draw on a respondent’s existing knowledge or opinion without prompts. For example, a question about preference for political candidates without sharing the party that the candidate is representing, with the goal of achieving results as close to eventual election day results as possible. 5 The respondents were asked to select “Strongly agree,” “Agree,” “Somewhat agree,” “Neither agree nor disagree,” “Somewhat disagree,” “Disagree,” or “Strongly disagree” in response to the statements in the questions. The full survey text is available in Appendix 1. The survey experiment was approved by the University of Utah Institutional Review Board (IRB) on March 4, 2019 and was fielded March 6-7 2019, through an established panel of US residents on Amazon Mechanical Turk (mTurk). Each respondent was compensated $0.20 for a completed survey response, judged by the respondents adherence to the screening criteria and completed answer to each question. Overall, there were 1,000 accepted survey responses leveraged in analysis. A brief note about the use of Amazon Mechanical Turk (mTurk) as a means to procure sample. After exploring the options to obtain sample, mTurk was deemed to be the most successful, cost effective, and efficient way to gather sample. However, mTurk cannot be considered a perfect representation of the general population. Paolacci et al., cautioning against relying too heavily on sample from mTurk, write that “workers tend to be younger (about 30 years old), overeducated, underemployed, less religious, and more liberal than the general population…Within the United States, Asians are overrepresented and Blacks and Hispanics are underrepresented relative to the population as a whole...It should not be treated as representative of the general population” (Paolacci). While not a perfect match to the general population, mTurk has been found to be at least as diverse as the typical internet sample. Buhrmeister writes, following analysis of 3,006 mTurk workers, that “MTurk participants are at least as diverse and more representative of noncollege populations than those of typical Internet and traditional samples” (Buhrmeister 5). Thus, for the purposes of this experiment, reliance on sample from mTurk is not only necessary but probably the best means of obtaining sample within the constraints of this project. A detailed topline report sharing the demographic information of the sampled participants can be found in Appendix 2. III. Analysis Methodology The findings were exported to R and analyzed through the creation of a set of frequencies tables summarizing the response results, once incomplete or unqualified respondents (those under 18 or those not registered to vote) were removed from the results. Potential shortcomings of this analysis lie mainly in the way the experiment was conducted. Principally, the population sampled on Amazon Mechanical Turk cannot be considered truly representative of the larger population because of its left-leaning bias, higher education level, and lower level of ethnic and racial diversity, as Paolacci writes. Further, it is possible that respondents could have been influenced by social desirability bias, or the influence to choose a societally-deemed “acceptable” answer rather than an honest personal answer (Phillips 923). While possible, this is unlikely due to the neutral nature of the survey questions and the anonymous nature of the survey. Finally, a level of self-selection bias may have skewed the results as well. Because the survey experiment was labeled as a “Political Polling Opinion” survey on both mTurk and the Qualtrics platform, it is possible that respondents self-selected to respond because of an existing interest in politics or an existing opinion about political polling (Bethlehem). Despite these possible sample biases, it was assumed that the survey sample accurately represented the population of registered voters in the United States. Using an experimental 6 approach, the representativeness of the sample is less important than it would be in an observational study. The experimental treatment used here allows for significant conclusions about how changes in wording causes change in responses. Weights were not applied to respondents based on demographic breakdowns of the voting population. Further, the margin of error assumed in this analysis is ±3.1 and the confidence interval selected was 95%. IV. Summary of Results and Implications A number of conclusions can be drawn based on the results of the survey experiment. The remainder of the paper focuses on the results and their implications in two chief subject areas. First, the overall trust or distrust of the polling results conveyed by respondents across the different modules (without consideration for demographic breaks of the participants). Second, noticeable differences based on self-identified party affiliation. Other results and conclusions, while relevant, can be drawn based on the frequencies shared in the appendix but are not explored in the text. The experiment revealed differences in trust of polling results based on how those results were presented in the text, though not on a significant macro level. Each of the four modules, which can be found in Section II, yielded between 52% and 53% agreement with the statement “I believe this political poll to be an accurate reflection of upcoming election day results,” as seen in Table 1.1. 4 4 The percentage of “agreement” or “belief in accuracy” referenced here originates from a sum of the respondents who selected “Somewhat agree,” “Agree,” or “Strongly Agree.” Similarly, a percentage of “disbelief” or “distrust” would originate from a sum of the respondents who selected “Somewhat disagree,” “Disagree,” or “Strongly Disagree.” 7 Table 1.1 Comparison of Agreement and Disagreement Scores by Module - Trust in Future Accuracy Experimental Module Score Type Score Module 1 Agreement score 54% Neutral 18% Disagreement score 28% Agreement score 52% Neutral 26% Disagreement score 22% Agreement score 53% Neutral 22% Disagreement score 25% Agreement score 55% Neutral 24% Disagreement score 21% Module 2 Module 3 Module 4 In contrast, the level of disagreement with accuracy of the polling results varies much more widely between modules. 28% of respondents expressed disagreement with the poll’s future accuracy when presented with the text prompt from Module 1, while only 21% of respondents expressed disagreement with the statement when presented with Module 4, which synthesizes the reporting components of the other three modules, and is the most holistic of the text statements. This suggests that while variations in text such as the phrase “percentage” or an inclusion of the vote share proportions of each candidate are not significantly impactful in improving belief that a poll is an accurate reflection of election day results, more concrete information along those lines in political polling coverage decreases overt disbelief in or disagreement with polling accuracy. Examined further, respondents are less likely to have a concrete belief about accuracy or inaccuracy of polling results when presented with more information, as demonstrated in the variance between frequencies of “Neither agree nor disagree” responses. “Neither agree nor disagree” selection increases when a respondent is presented with more information–modules with the phrase “percentage points” (Modules 2 and 4) have a higher share of these “neutral” responses by between 6% and 8% when compared to Module 1, which has no mention of 8 “percentage points” or a note on candidate vote share, as Module 3 does. Those who viewed Module 3 selected “Neither agree nor disagree” 4% more than those who viewed Module 1, which, though a smaller difference, is still significant. This, when paired with the findings on response levels of agreement or disagreement suggests that respondents who are presented with concrete and quantitative information about political polling results at least do not disagree as openly with their accuracy as when presented with less information. Information about candidate vote share and the arithmetic difference between the vote shares does not necessarily improve belief in results, but does decrease disbelief. This is supported by scores quantifying the agreement with the current accuracy of the polls. Respondents were asked if they agreed or disagreed with the statement “Candidate M. Jackson is leading Candidate A. Swift by 1.9 percentage points” after being prompted by text. 9 Table 1.2 Comparison of Agreement and Disagreement Scores by Module - Trust in Current Accuracy Experimental Module Score Type Score Module 1 Agreement Score 81% Neutral 14% Disagreement Score 6% Agreement Score 84% Neutral 9% Disagreement Score 8% Agreement Score 68% Neutral 15% Disagreement Score 17% Agreement Score 86% Neutral 10% Disagreement Score 3% Module 2 Module 3 Module 4 86% of respondents from Module 4 and 84% of respondents from Module 2 agreed with this statement, while only 81% of respondents who viewed Module 1 agreed with this statement. The differences between Module 2 and Module 1 are exceptionally interesting here, as the only variations between the two modules is the word “percentage,” and yet there is a difference of 3% in the frequency of agreement with the given statement. Of course, this difference cannot be found to be extremely statistically significant, especially with a margin of error of ±3.1, but still the difference stands. Again, the module that provides the respondent with the most information overall (Module 4) inspires the most agreement amongst respondents, and the lowest frequency of disagreement, at only 3% when compared to a relative high of 8% in Module 2 (setting Module 3 aside, for reasons explained below). The analysis of this question among respondents who viewed Module 3 confounds these results. Only 68% of respondents in Module 3 indicated agreement with the statement, and 17% expressed disagreement with the statement, a significant departure from the results of the other 3 texts. This may be because the text in Module 3 can be thought to be at odds with the statement the respondent was asked to evaluate. Specifically, the text in Module 3 reads “A...political poll shows Candidate M. Jackson ahead of Candidate A. Swift 48% to 46%.” The differences in vote 10 share when extrapolated from the text prompt were 2%, while the evaluation statement implied a difference of 1.9%. Based on the stark differences in the question results when compared to the other modules, it is clear that respondents were aware of the disparity and that it significantly decreased their trust in the results. Because this effect was not seen in analysis of the other Modules, the evaluation of the current accuracy of the poll by Module 3 respondents is necessarily removed from the other analysis in this question. Looking to the differences between current accuracy agreement scores and future accuracy agreement scores overall, frequencies suggest that respondents are generally comfortable with political poll results as an accurate measure of the current state of affairs, but are less comfortable with making predictions about the future based on the results of a political poll. Agreement scores are significantly lower when respondents are asked to evaluate the statement “I believe this political poll to be an accurate reflection of upcoming election day results” than when respondents are asked to evaluate the statement “Candidate M. Jackson is leading Candidate A. Swift by 1.9 percentage points.” This is clearly seen in the table below (Table 1.3). The disparity between the average agreement score between the two statements is approximately 26%, without accounting for demographic differences. Table 1.3 Comparison of Agreement by Experimental Module and Agreement Type Module 1 Module 2 Module 3 Module 4 Average Agreement Score Current Accuracy Agreement 81% 84% 68% 86% 80% Future Accuracy Agreement 54% 52% 53% 55% 54% V. Differences by Party Affiliation When agreement with future accuracy and current accuracy are examined by the party of the respondent, it becomes clear that trust and opinion of political polling results is influenced significantly by political party. When averaged between modules, it can be clearly stated that those who identify as members of the Democratic Party trust and believe polling results more than any other group, followed by those who identify as Republicans and distantly by selfidentified Independents. On average, Democrats agree with the statements “I believe this political poll to be an accurate reflection of upcoming election day results” and “Candidate M. Jackson is leading Candidate A. Swift by 1.9 percentage points” 60% and 66% of the time respectively, as seen in Table 1.3. Republicans, in contrast, agree 52% of the time with the future accuracy of the poll and 63% of the time with the current accuracy of the poll, and Independents fall even lower at 41% and 55% respectively. 5 5 This score is made by averaging the “Agreement” score (the sum of the frequency of “Somewhat agree,” “Agree,” and “Strongly agree”) in each module by party. 11 Table 1.4 - Agreement Score by Experimental Module and Party Affiliation Module 1 Module 2 Module 3 Module 4 Overall Democrat Current Agreement Score 77% 75% 41% 74% 66% Democrat Future Agreement Score 57% 62% 57% 64% 60% Independent Current Agreement Score 48% 67% 28% 77% 55% Independent Future Agreement Score 37% 34% 41% 52% 41% Republican Current Agreement Score 61% 73% 48% 70% 63% Republican Future Agreement Score 62% 51% 56% 42% 52% A note on self-identified Independents before moving into analysis. An abundance of polls suggest that “true” Independents are fewer in number than those who identify as Independents. Data from Pew Research Center suggests that most Independents are simply “partisans who are disillusioned with the two major parties” and that only 7 percent of the 38 percent of Americans who identify as Independents truly have no party affiliation (Bump). In my sample, 37% of respondents identified as “true” independents. While this proportion of “true” independents to moderate partisans does not reflect the proportions of Pew’s research, it is important to remember the nature of Independent responses in this experiment, especially in drawing broad conclusions. Looking more closely at differences between responses by module and party, a few interesting data points emerge. The measure of both Independent and Democratic agreement with the statements given increases when respondents are given more information. Democrats respond positively to “percentage points” phrasing, looking to agreement with the future accuracy of the poll–expressing agreement with the statement “I believe this political poll to be an accurate reflection of upcoming election day results” between 5% and 7% more frequently when the phrase is included in the political poll summary. Without the “percentage points” phrasing, self-identified Democrats trust the summary about equally, 57% of the time after exposure to either Modules 1 and 3. The most trusting group overall, Democrats show a clear preference for “percentage points” phrasing when compared to other groups. Independents, the group most dubious of future accuracy of the poll, are most willing to agree under circumstances where they are presented with the most information possible. The summary most trusted by this group is Module 4, which includes the phrase “percentage points,” as well as the vote share comparison of the candidates. 52% of self-identified Independents 12 expressed agreement with this statement after exposure to Module 4, an 11% increase from the next most trusted module, Module 3, which 41% of Independents expressed agreement with. Both Module 1 and 2 were greeted with much more suspicion, earning only 37% and 34% agreement respectively. Looking to the phrasing of the respective summaries, the most notable difference is the inclusion of the hypothetical vote share of the candidates “48% to 46%.” Given the significant increase in Independent support with the inclusion of this phrase, we can conclude that Independents are more likely to agree that polling results will be reflective of election-day results when a phrase on proportion of the supposed vote is included. More generally, Independents respond positively to an increase in information, as Module 4 contains notes on both vote share and the phrase “percentage points” and stands apart from the modules with an agreement score of 52%, 11% higher than the next-closest agreement score in Module 3. Self-identified Republicans, while generally more trusting than the Independent group (referring to the “Agreement averages” of the groups), contradict the trends of the other two groups. Republicans do not respond well to an abundance of information given, and seem more willing to agree with the future accuracy of the poll when the political poll summary is sparse and does not include the phrase “percentage points” or estimated vote share between candidates. By far, Republicans prefer Module 1, with 62% agreement. The next preferred summary is Module 3, with 56% agreement. Republican agreement with the phrase “I believe this political poll to be an accurate reflection of upcoming election day results” falls to just 42% in Module 4, which the two other groups support the most overall. In analysis of agreement with current accuracy of the poll, this finding is the opposite, as Republicans express more agreement with the statement "Candidate M. Jackson is leading Candidate A. Swift by 1.9 percentage points" after being exposed to poll summaries or results that contain the phrase “percentage points” or offer additional information. Republicans express the highest level of agreement with Modules 2 and 4 when posed with a question on the current accuracy of the poll–between 73% and 70% respectively. The other two modules, though most trusted to be an accurate prediction of election results in reference to future accuracy, have low agreement scores comparatively (Module 1 with 61% and Module 3 with just 48%). The low agreement score of Module 3 can be partially explained by the issue mentioned in Section IV, in which respondents noted the disparity between 1.9% and 2% and therefore disagreed with the statement given about current accuracy of the poll. Democratic trust also drops off for Module 3 significantly, with 41% agreement for Module 3 and 74% agreement for Module 4, the module with the next-lowest Democratic agreement score. An already generallylow level of Independent trust for the statement drops to 28% when a respondent is exposed to Module 3. Notable, however, is the fact that of the three groups exposed to Module 3, Republicans trust it the most of the political parties (48% agreement among Republicans, 41% among Democrats, and 28% among Republicans). It is unclear why this disparity in trends exists between belief in current poll accuracy and future poll accuracy results amongst Republicans. One possible theory is that while Republicans are more dubious of phrases like “percentage points” and vote share information in predicting future outcomes, they are comfortable with those phrases in expressing a current measurement of how a given political race stands. More generally, an explanation for this trend could be articulated as an avoidance by Republicans to make definitive statements about future election outcomes, paired with a general trust of political polls to accurately measure current election standing. 13 Independent and Democratic responses reflect this theory, though not on the same scale. The average level of agreement with the statement “I believe this political poll to be an accurate reflection of upcoming election day results,” a measure of future accuracy, is lower than the average level of agreement of all parties with the statement "Candidate M. Jackson is leading Candidate A. Swift by 1.9 percentage points," a measure of current accuracy, as seen in Table 1.3. Respondents are less willing to make statements about the future than they are about the current state of a race, but Republicans display this proclivity the most strongly, and it is paired with a general distrust for information about political polls. VI. Final Implications After a review of the results, a few conclusions emerge. First, that an increase in information about political polling results generally increases trust in the results at the current moment and trust that the results will reflect the outcome on election day. The most effective way to improve trust in political polling, however marginally, is to include the phrase “percentage points,” or that phrase in conjunction with the current vote share of each of the candidates. Further, small inconsistencies in reporting of poll results significantly affects perception of the political poll’s accuracy, as seen in respondent unwillingness to agree with the statement of current accuracy after respondent exposure to Module 3. A significant conclusion that the data reveals is the varied response to political poll summaries or reports based on political party. Self-identified Democrats are the most trusting of political polling results overall, with a clear preference for summaries that include the phrase “percentage points,” or that phrase and a note on vote share of the candidates. Independents, while on-average the least trusting or willing to agree of all three groups, follow the same trend. Republicans stand out in this data, displaying a preference for the most simple summary of polling results available, and a secondary preference for summaries that include the vote share of the candidates. Reviewing the results, it is clear that coverage of a political poll does affect how readers view the accuracy of the poll and its implications. To improve understanding amongst readers, journalists should at the very least provide their readers with a strong summary of the results when they are mentioned, which improves trust in results and could be as simple as adding the word “percentage” to a sentence. It is not necessary for polling to be inaccessible, or difficult to understand. While it may not be realistic to re-establish a close relationship between pollsters and the American reader, as George Gallup once maintained, it is possible to significantly improve agreement with polling results through the adjustment of discussions surrounding those results. Rather than relying principally on horse-race coverage, it is important to reexamine the rhetoric used in political coverage moving forward. 14 Appendix 1: Public Poll Trust and Understanding Experiment Start of Block: Intro block QINTRO Page Break QAGE How old are you? o Under 18 (1) o 18 - 24 (2) o 25 - 34 (3) 15 o 35 - 44 (4) o 45 - 54 (5) o 55 - 64 (6) o 65 - 74 (7) o 75 - 84 (8) o 85 or older (9) Page Break QREGISTERED Are you registered to vote in the United States? o Yes, registered. (1) o No, not registered. (2) Page Break End of Block: Intro block 16 Start of Block: Background block Page Break Q42 Please enter your 5-digit United States Zip Code ________________________________________________________________ Q43 What is your sex? o Male (1) o Female (2) o Trans Male (3) o Trans Female (4) o Nonbinary (5) o Other/Prefer not to respond (6) Page Break Q44 What is the highest level of education you have completed? o High school graduate (1) o Some college (2) o Associate's degree (3) o Bachelor's degree (4) o Master's degree (5) o Doctoral or professional degree (6) Page Break Q45 In most general elections, which answer best describes how you voted? o Straight Democratic (1) o Mostly Democratic (2) o A few more Democrats than Republicans (3) o About equally for both parties (4) o A few more Republicans than Democrats (5) o Mostly Republican (6) o Straight Republican (7) o Other/Unsure (8) End of Block: Background block 17 Start of Block: EXP_Control (Module 1) QCONTROLTEXT Please read the text below carefully and answer the questions that follow. “Congressional District A has two candidates running for the House of Representatives seat this year. A recently released political poll shows Candidate M. Jackson 1.9 points ahead of Candidate A. Swift two weeks before election day.” QControlPOINTS Do you agree or disagree with this statement based on the text above? "Candidate M. Jackson is leading Candidate A. Swift by 1.9 percentage points." o Strongly agree (1) o Agree (2) o Somewhat agree (3) o Neither agree nor disagree (4) o Somewhat disagree (5) o Disagree (6) o Strongly disagree (7) QControlTRUST Do you agree or disagree with this statement based on the text above? "I believe this political poll to be an accurate reflection of upcoming election day results." o Strongly agree (1) o Agree (2) o Somewhat agree (3) o Neither agree nor disagree (4) o Somewhat disagree (5) o Disagree (6) o Strongly disagree (7) Page Break Q12 These upcoming questions request a short answer response. Please be thorough. Your responses will not be associated with your name or any other identifying information. Page Break QControlSAMPLE In your opinion, who is the typical respondent of a political poll? ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ Page Break 18 QControlBIAS In your opinion, is political polling biased? If so, how? ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ End of Block: EXP_Control 19 Start of Block: EXP_Percentage (Module 2) QPERCENTAGETEXT Please read the text below carefully and answer the questions that follow. “Congressional District A has two candidates running for the House of Representatives seat this year. A recently released political poll shows Candidate M. Jackson 1.9 percentage points ahead of Candidate A. Swift two weeks before election day.” QPercentagePOINTS Do you agree or disagree with this statement based on the text above? "Candidate M. Jackson is leading Candidate A. Swift by 1.9 percentage points." o Strongly agree (1) o Agree (2) o Somewhat agree (3) o Neither agree nor disagree (4) o Somewhat disagree (5) o Disagree (6) o Strongly disagree (7) QPercentageTRUST Do you agree or disagree with this statement based on the text above? "I believe this political poll to be an accurate reflection of upcoming election day results." o Strongly agree (1) o Agree (2) o Somewhat agree (3) o Neither agree nor disagree (4) o Somewhat disagree (5) o Disagree (6) o Strongly disagree (7) Page Break Q24 These upcoming questions request a short answer response. Please be thorough. Your responses will not be associated with your name or any other identifying information. Page Break QPercentageSAMPLE In your opinion, who is the typical respondent of a political poll? ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ Page Break 20 QPercentageBIAS In your opinion, is political polling biased? If so, how? ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ End of Block: EXP_Percentage 21 Start of Block: EXP_Voteshare (Module 3) QVOTESHARETEXT Please read the text below carefully and answer the questions that follow. “Congressional District A has two candidates running for the House of Representatives seat this year. A recently released political poll shows Candidate M. Jackson ahead of Candidate A. Swift 48% to 46% two weeks before election day.” QVotesharePOINTS Do you agree or disagree with this statement based on the text above? "Candidate M. Jackson is leading Candidate A. Swift by 1.9 percentage points." o Strongly agree (1) o Agree (2) o Somewhat agree (3) o Neither agree nor disagree (4) o Somewhat disagree (5) o Disagree (6) o Strongly disagree (7) QVoteshareTRUST Do you agree or disagree with this statement based on the text above? "I believe this political poll to be an accurate reflection of upcoming election day results." o Strongly agree (1) o Agree (2) o Somewhat agree (3) o Neither agree nor disagree (4) o Somewhat disagree (5) o Disagree (6) o Strongly disagree (7) Page Break Q18 These upcoming questions request a short answer response. Please be thorough. Your responses will not be associated with your name or any other identifying information. Page Break QVoteshareSAMPLE In your opinion, who is the typical respondent of a political poll? ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ Page Break QVoteshareBIAS In your opinion, is political polling biased? If so, how? ________________________________________________________________ ________________________________________________________________ 22 ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ End of Block: EXP_Voteshare 23 Start of Block: EXP_All (Module 4) QALLTEXT Please read the text below carefully and answer the questions that follow. “Congressional District A has two candidates running for the House of Representatives seat this year. A recently released political poll shows Candidate M. Jackson 1.9 percentage points ahead of Candidate A. Swift, 48% to 46%, two weeks before election day.” QAllPOINTS Do you agree or disagree with this statement based on the text above? "Candidate M. Jackson is leading Candidate A. Swift by 1.9 percentage points." o Strongly agree (1) o Agree (2) o Somewhat agree (3) o Neither agree nor disagree (4) o Somewhat disagree (5) o Disagree (6) o Strongly disagree (7) QAllTRUST Do you agree or disagree with this statement based on the text above? "I believe this political poll to be an accurate reflection of upcoming election day results." o Strongly agree (1) o Agree (2) o Somewhat agree (3) o Neither agree nor disagree (4) o Somewhat disagree (5) o Disagree (6) o Strongly disagree (7) Page Break Q30 These upcoming questions request a short answer response. Please be thorough. Your responses will not be associated with your name or any other identifying information. Page Break QAllSAMPLE In your opinion, who is the typical respondent of a political poll? ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ Page Break QAllBIAS In your opinion, is political polling biased? If so, how? ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ 24 ________________________________________________________________ ________________________________________________________________ End of Block: EXP_All 25 Start of Block: Close block Q36 Now there are just a few more questions for background and statistical purposes only. QPARTYID Do you consider yourself a Republican, a Democrat, an Independent, or something else? o Republican (1) o Democrat (2) o Independent/something else (3) Display This Question: If Do you consider yourself a Republican, a Democrat, an Independent, or something else? = Republican And Do you consider yourself a Republican, a Democrat, an Independent, or something else? = Democrat QPARTY_INTENSITY Would you call yourself a strong ${QPARTYID/ChoiceGroup/SelectedChoices} or a not very strong ${QPARTYID/ChoiceGroup/SelectedChoices}? o Strong (1) o Not very strong (2) Display This Question: If Do you consider yourself a Republican, a Democrat, an Independent, or something else? = Independent/something else QPARTY_LEAN Do you think of yourself as closer to the Republican or Democratic Party? o Republican (1) o Democratic (2) o Neither (3) Page Break QRACE Is your racial or ethnic heritage white, Black or African American, Hispanic or Latin American, American Indian, Asian, Native Hawaiian or Pacific Islander, or something else? o American Indian or Alaska Native (1) o Asian (2) o Black or African American (3) o Hispanic or Latin American (4) o Native Hawaiian or Pacific Islander (5) o White (6) o Other (7) End of Block: Close block 26 Appendix 2: Public Understanding of Political Polling Results - Topline Report QAGE. How old are you? (n = 1000) QREGISTERED. Q43. Under 18 (TERMINATED) * 18 - 24 9% 25 - 34 39 35 - 44 22 45 - 54 15 55 - 64 9 65 - 74 5 75 - 84 <1 85 or older * Are you registered to vote in the United States? (n = 1000) Yes, registered. 100% Not, not registered. (TERMINATED) * What is your sex? (n = 1000) Male 50% Female 50 Trans Male * Trans Female * Nonbinary <1 Other/Prefer not to respond <1 27 Q44. Q45. What is the highest level of education you have completed? (n = 1000) High school graduate 8% Some college 18 Associate's degree 8 Bachelor's degree 47 Master's degree 16 Doctoral or professional degree 4 In most general elections, which answer best describes how you voted? (n = 1000) Straight Democratic 26% Most Democratic 24 A few more Democrats than Republicans 6 About equally for both parties 8 A few more Republicans than Democrats 4 Mostly Republican 15 Straight Republican 15 Other/Unsure 2 28 (RESPONDENTS RANDOMLY ASSIGNED ONE GROUP) QTEXT. Please read the text below carefully and answer the questions that follow. Control: “Congressional District A has two candidates running for the House of Representatives seat this year. A recently released political poll shows Candidate M. Jackson 1.9 points ahead of Candidate A. Swift two weeks before election day.” (n=248) Percentage: “Congressional District A has two candidates running for the House of Representatives seat this year. A recently released political poll shows Candidate M. Jackson 1.9 points ahead of Candidate A. Swift two weeks before election day.” (n=251) Voteshare: “Congressional District A has two candidates running for the House of Representatives seat this year. A recently released political poll shows Candidate M. Jackson ahead of Candidate A. Swift 48% to 46% two weeks before election day.” (n=254) All: “Congressional District A has two candidates running for the House of Representatives seat this year. A recently released political poll shows Candidate M. Jackson 1.9 percentage points ahead of Candidate A. Swift, 48% to 46%, two weeks before election day.” (n=247) QPOINTS. Do you agree or disagree with this statement based on the text above? "Candidate M. Jackson is leading Candidate A. Swift by 1.9 percentage points." Control (n=248) Percentage (n=251) Voteshare (n=254) All (n=247) Strongly agree 37% 42% 9% 45% Agree 29 31 30 28 Somewhat agree 15 11 29 13 Neither agree nor disagree 14 9 15 10 Somewhat disagree 2 3 6 1 Disagree 3 7 1 2 29 Strongly disagree QTRUST. 2 2 4 1 Do you agree or disagree with this statement based on the text above? “I believe this political poll to be an accurate reflection of upcoming election day results." Control (n=248) Percentage (n=251) Voteshare (n=254) All (n=247) Strongly agree 6% 8% 4% 8% Agree 21 14 18 14 Somewhat agree 27 30 31 33 Neither agree nor disagree 18 26 22 24 Somewhat disagree 15 12 15 11 Disagree 9 7 8 7 Strongly disagree 4 3 2 3 QSAMPLE. In your opinion, who is the typical respondent of a political poll? (OPEN-ENDED REPSONSES VERBATIM IN APPENDIX 3) QBIAS. In your opinion, is the political polling biased? If so, how? (OPEN-ENDED REPSONSES VERBATIM IN APPENDIX 3) QPARTYID. Do you consider yourself a Republican, a Democrat, an Independent, or something else? (n = 1000) Republican 31% Democrat 45 Independent/something else 24 30 (If QPARTYID = Independent/something else) QPARTY_LEAN. (n = 239) Do you think of yourself as closer to the Republican or Democratic Party? Republican 23% Democratic 40 Neither 37 QRACE. Is your racial or ethnic heritage white, Black or African American, Hispanic or Latin American, American Indian, Asian, Native Hawaiian or Pacific Islander, or something else? (n = 1000) American Indian or Alaska Native 1% Asian 6 Black or African American 7 Hispanic or Latin American 7 Native Hawaiian or Pacific Islander <1 White 76 Other 2 31 Works Cited Adams, M. (2013). Polling for Democracy. In N. Wiseman (Ed.), The public intellectual in Canada. Toronto: University of Toronto Press. Barber, M., Mann, C., Monson, J., & Patterson, K. (2014). Online Polls and Registration-Based Sampling: A New Method for Pre-Election Polling. Political Analysis, 22(3), 321-335. Retrieved from http://www.jstor.org/stable/24573073 Best, Samuel & Mcdermott, Monika. (2007). Measuring Opinions vs. Non-Opinions – The Case of the USA Patriot Act. The Forum. 5. 10.2202/1540-8884.1150. Bethlehem, J. (2010). Selection Bias in Web Surveys. International Statistical Review / Revue Internationale De Statistique, 78(2), 161-188. Retrieved from http://www.jstor.org/stable/27919830 Blumenthal, M. Toward an Open-Source Methodology: What We Can Learn from the Blogosphere, Public Opinion Quarterly, Volume 69, Issue 5, 1 January 2005, Pages 655– 669, https://doi.org/10.1093/poq/nfi059 Broh, C. A. (1980). Horse-Race Journalism: Reporting the Polls in the 1976 Presidential Election. Public Opinion Quarterly, 44(4, Polls and the News Media: A Symposium), 514. doi:10.1086/268620 Broh, C. (1983). Polls, Pols and Parties. The Journal of Politics, 45 (3), 732-744. Retrieved from http://www.jstor.org/stable/2130713 Buhrmester, M., Kwang, T., & Gosling, S. (2011). Amazon's Mechanical Turk: A New Source of Inexpensive, Yet High-Quality, Data? Perspectives on Psychological Science, 6(1), 35. Retrieved from http://www.jstor.org/stable/41613414 Bump, P., & Guskin, E. (2019, March 14). Most independents are just moderate partisans. Retrieved from https://www.washingtonpost.com/politics/2019/03/14/most-independentsare-just-moderate-partisans/?noredirect=on&utm_term=.12f0ab8572ec Canham, M. (2018, October 3). Utah's highly watched Mia Love-Ben McAdams race is now a 'toss-up'. Retrieved October 12, 2018, from https://www.sltrib.com/news/politics/2018/10/03/utahs-highly-watched-mia/ DeSoto, K. A. (2016, February 29). Under the Hood of Mechanical Turk. Retrieved from https://www.psychologicalscience.org/observer/under-the-hood-of-mechanical-turk Dr. Gallup, G. (1942, Nov 13). Dr. Gallup explains polls. New York Times (1923-Current File) Retrieved from http://ezproxy.lib.utah.edu/docview/106201090?accountid=14677 Dr. Gallup, George. Director, American Institute of, Public Opinion. (1941, Jun 08). WE, THE PEOPLE, ARE LIKE THIS --. New York Times (1923-Current File)Retrieved from http://ezproxy.lib.utah.edu/docview/106066725?accountid=14677 Dr. Gallup, George. (1938, May 17). GALLUP EXPLAINS 'OPINION SAMPLING'. New York Times (1923-Current File) Retrieved from http://ezproxy.lib.utah.edu/docview/102553610?accountid=14677 Gallup, Inc. (n.d.). George H. Gallup, Founder | 1901-1984. Retrieved November 20, 2018, from https://www.gallup.com/corporate/178136/george-gallup.aspx Jarvis, J. (2015, November 04). Gallup Decision to Drop Horse-Race Polling Is the Best Thing About This Election. Retrieved November 20, 2018, from https://observer.com/2015/11/gallup-decision-to-drop-horse-race-polling-is-the-bestthing-about-this-election/ 32 Kay, B. (2018, November 15). Polls and the Bandwagon Effect on the Electoral Process? Retrieved November 21, 2018, from http://www.revparl.ca/english/issue.asp?art=1088¶m=159 Lohr, S., & Singer, N. (2016, November 10). How Data Failed Us in Calling an Election. Retrieved November 22, 2018, from https://www.nytimes.com/2016/11/10/technology/the-data-said-clinton-would-win-whyyou-shouldnt-have-believed-it.html McDermott, M., & Frankovic, K. (2003). Review: Horserace Polling and Survey Method Effects: An Analysis of the 2000 Campaign. The Public Opinion Quarterly, 67(2), 244264. Retrieved from http://www.jstor.org/stable/3521634 Newport, F. (2004, February 18). The Pluses of Pre-Election Horse Race Polls. Retrieved December 2, 2018, from https://news.gallup.com/poll/10684/pluses-preelection-horserace-polls.aspx Paolacci, G., & Chandler, J. (2014). Inside the Turk: Understanding Mechanical Turk as a Participant Pool. Current Directions in Psychological Science, 23(3), 184–188. https://doi.org/10.1177/0963721414531598 Phillips, D., & Clancy, K. (1972). Some Effects of "Social Desirability" in Survey Studies. American Journal of Sociology,77(5), 921-940. Retrieved from http://www.jstor.org/stable/2776929 Sigelman, Lee. 1981. "Question Order Effects on Presidential Popularity." Public Opinion Quarterly 45:199-20 Silver, Nate. (2017, May 09). Conventional Wisdom May Be Contaminating Polls. Retrieved November 23, 2018, from https://fivethirtyeight.com/features/conventional-wisdom-maybe-contaminating-polls/ Silver, Nate. (2018, May 31). The Polls Are All Right. Retrieved November 22, 2018, from https://fivethirtyeight.com/features/the-polls-are-all-right/ The Gallup Poll [Transcript, Television series episode]. (2000, December). In The First Measured Century. PBS. Voss, D., Gelman, A., & King, G. (1995). A Review: Preelection Survey Methodology: Details From Eight Polling Organizations, 1988 and 1992. The Public Opinion Quarterly, 59(1), 98-132. Retrieved from http://www.jstor.org/stable/2749653 University of Utah UNDERGRADUATE RESEARCH JOURNAL CONTRACEPTIVE SWITCHING AND DISCONTINUATION BASED ON KEY DEMOGRAPHIC CHARACTERISTICS AND SIDE EFFECT REPORTING AMONG WOMEN WHO RECEIVED NO COST CONTRACEPTION Sydney Friesen (Claudia Geist) Department of Sociology Unintended pregnancies are a major issue in the United States, and they are partially due to contraceptive switching and discontinuation that cause women to have a period of time when they are not using any method to prevent pregnancy, yet they are still sexually active. This study looked at the 3704 women aged 18-45 who participated in the HER Salt Lake Contraceptive Initiative and either switched or discontinued the method of contraception they received through this program. This study found that despite receiving no cost birth control, 22.3% of women switched or discontinued their contraceptive method. This study further looked at group differences in switching and discontinuation based on language, education, and income, and how these related to side effect reporting. The study found that English speakers are more likely to report mood symptoms than Spanish speakers regardless of the contraceptive method used (p=0.044). Those with more than a high school education are more likely to report mood symptoms (p=0.009) and a positive pregnancy test (p=0.013), and less likely to report wanting to get pregnant (p=0.020) when compared to those with a high school education or less regardless of the contraceptive method used. Group differences did not exist when participants were group based on income level. These findings indicated that group differences do exist in the rates of switching and discontinuation of a person’s contraceptive method. Furthermore, there are group differences in the reported side effects and how these side effects impact a person’s decision to switch or discontinue their method. The existence of group differences suggests that cultural and social backgrounds play a role in the life experiences of patients. Providers should understand that there is a variation in the willingness and ability of individuals to report negative experiences. More research should be conducted in the field to understand how marginalization shapes experiences with medication, doctor’s visits, and contraception. University of Utah UNDERGRADUATE RESEARCH JOURNAL DETANGLING THE EFFECTS OF TEMPERATURE AND NUTRIENT AVAILABILITY ON LEAF LITTER DECOMPOSITION Jessica Gallafent (Dr. Jennifer Follstad Shah) Department of Environmental and Sustainability Studies The breakdown of organic matter, such as leaf litter, is a major contributor of carbon dioxide emitted into the atmosphere and various forms of C transported to oceans by streams and rivers (Battin et al. 2009). Litter is broken down through physical fragmentation, degradation by microbes, and feeding by detritivores (Follstad Shah et al., 2017; Woodward et al., 2012). Changes in these processes can affect the amount of terrestrial carbon that is assimilated into aquatic biomass, transported to the ocean, or respired into the atmosphere (Ferreira et al., 2014). Understanding the factors that influence litter breakdown rates, as well as those factors that influence how much carbon dioxide is lost to the atmosphere, is an important step towards better understanding the role of streams and rivers in global carbon cycling and predicting how these processes will be affected by climate change. The purpose of our project was to determine if there is a stream nutrient enrichment effect on the temperature sensitivity of leaf litter decomposition mediated by microbes and detritivores. Metabolic theory predicts an apparent temperature sensitivity of 0.65 eV for leaf litter decomposition; however, a recent study has found it to be much lower (0.34 eV) (Follstad Shah et al., 2017). Understanding how factors such as stream nutrient enrichment can influence temperature sensitivity will provide a greater understanding of how carbon cycling will be affected by rising temperatures. Using a dataset containing over 1300 observations from 57 studies, we isolated the effect of detritivore- and microbe-mediated breakdown from total breakdown using a mathematic approach developed in 2017 (Lecerf, 2017). The data were then sorted into nutrient categories (oligotrophic, mesotrophic, eutrophic) based on stream nitrogen and phosphorus concentrations. The coefficients for total breakdown (kc), microbial-mediated breakdown (𝝀M), and detritivoremediated breakdown (𝝀F) were plotted within their stream nutrient categorizations (oligotrophic, mesotrophic, eutrophic) as a function of temperature. The temperature sensitivity (Ea, eV; slope) and breakdown rate at 10 °C (intercept) were compared across breakdown coefficient types and trophic categories using linear mixed effect modeling in R. Our results showed that temperatures sensitivity did not significantly vary amongst trophic categories. This indicates that the temperature sensitivity of leaf litter breakdown does not vary with external nutrient supply. Other factors, such as leaf chemistry, may better explain the low apparent temperature sensitivity found by Follstad et al. (2017) as compared to the rate predicted by metabolic theory. Additionally, we found that breakdown rate at 10 °C did not vary with trophic category for any breakdown coefficient type, indicating that nutrient supply does not elevate rates. These results contrast with the results of a previous study by Woodward et al. (2012) which determined that moderate nutrient enrichment can stimulate leaf litter breakdown rates streams (Woodward et al., 2012). ln kC ln 𝝀M ln 𝝀F Intercept at 10° C (95% CI) Coefficient 10° C Ea, eV (95% CI) F value p value -3.85 (-3.95, -3.75) -4.22 (-4.30, -4.13) -5.22 (-5.36, -5.07) 0.0213 (0.0193, 0.0235) 0.0147 (0.0136, 0.0161) 0.0054 (0.0047, 0.0063) 0.49 (0.36, 0.62) 0.48 (0.37, 0.59) 0.56 (0.36, 0.76) 56.6 69.7 31.0 <0.001 <0.001 <0.001 Table 1. Regression coefficients from statistical modeling of the temperature sensitivity of leaf litter breakdown amongst types of breakdown coefficients (kc, λM, λF). Figure 1. Neither temperature sensitivity (Ea, eV; slopes) nor breakdown coefficients at 10 °C (intercepts) varied amongst stream trophic categories (oligotrophic = low nutrient enrichment, mesotrophic = moderate nutrient enrichment, eutrophic = high nutrient enrichment) for each type of breakdown rate (kc = total, λM = microbial, λF = detritivore). Works Cited Battin, T. J., et al. (2009). The boundless carbon cycle. Nature Geoscience, 2(9), 598-600. Ferreira, V., et al. (2014). A meta-analysis of the effects of nutrient enrichment on litter decomposition in streams. Biological Reviews, (3),669-688. Follstad Shah, J. J., et al. (2017). Global synthesis of the temperature sensitivity of leaf litter breakdown in streams and rivers. Global Change Biology, 23(8), 3064-3075. Lecerf, A. (2017). Methods for estimating the effect of litterbag mesh size on decomposition. Ecological Modelling, 362, 65-68. Woodward, G., et al. (2012). Continental-Scale effects of nutrient pollution on stream ecosystem functioning. Science, 336(6087), 1438-1440. University of Utah UNDERGRADUATE RESEARCH JOURNAL PATIENT AND PARTNER ILLNESS APPRAISAL IN TYPE 1 DIABETES: OBSERVED AND PERCEIVED BEHAVIORS IN A DIABETES-RELATED DISCUSSION TASK Rene Gilfillan, Cynthia Berg, PhD, Eunjin Lee Tracy, PhD Department of Psychology Objective: To examine how illness appraisals among individuals with type 1 diabetes and their partners and discrepancies in appraisals are associated with observed and perceived negative interactions in a diabetes-related discussion task. Methods: 199 individuals with type 1 diabetes and their romantic partners individually categorized their illness appraisal as the patient’s, mostly the patients, or shared between patient and partner and then engaged in a discussion task on a diabetes-related topic of conflict. Researchers coded negative behaviors of the person with diabetes and their partner. After the discussion, participants reported on emotional and instrumental support that they provided and received during the discussion. Hierarchical regressions examined if appraisal discrepancies were associated with negative interactions and perceptions of those interactions above and beyond patient illness appraisals. Results: Greater patient shared appraisal was significantly positively associated with observed partner negativity. It was also significantly positively associated with greater patient and partner reports of both provided and received emotional and instrumental support. More discrepancies in appraisal were significantly correlated with greater observed partner negativity and more patient report of instrumental support provided to partner. Conclusions: Possible differences between the observational and self-report data may be due to positive sentiment override in the self-report data, as well as outside observers being unfamiliar with the couple’s dyadic interaction patterns, viewing them more negatively as an outside observer. Further exploration of these differences in measures of appraisal and behavior should be conducted to inform illness appraisal and couple-based healthcare interventions for diabetes. University of Utah UNDERGRADUATE RESEARCH JOURNAL A LATE-HOLOCENE FIRE RECORD FROM THE SIERRA DE SAN PEDRO MÁRTIR NATIONAL PARK, BAJA CALIFORNIA, MEXICO Quinn Graves1,2 (Jennifer H. Watt1,2) Environmental & Sustainability Studies Program1 Geography Department2 This research investigates a fire history and environmental disturbances of a ciénega in the Sierra de San Pedro Mártir National Park in Northern Baja California, Mexico. A fire regime was reconstructed through charcoal analysis. Other environmental disturbances were reconstructed using the geochemical proxies magnetic susceptibility and loss on ignition. For this project, a sediment core was collected from a dry ciénega called the Palo Atravezado at approximately 2,750 meters (9,000 feet) in elevation. Ciénegas are wetland ecosystems that exist in arid environments and are ideal locations for sediment core recovery because they preserve information of past climates, such as charcoal particles, through deposition. Using both charcoal analysis and other proxies allowed conclusions to be drawn about past disturbance patterns of the site. The Sierra de San Pedro Mártir (SSPM) National Park was chosen as the study site because it has historically experienced less human impact than ciénega ecosystems in the southwestern United States, making the paleoecological record from the collected sediment core less altered by human activity. We hypothesize that the fire regime at this study site changed near 1800 (Figure 1). This may be due to altering land-use practices, fire suppression, livestock grazing, and other climate drivers. This project is a component of a larger body of research investigating past oscillations of the North American Monsoon (NAM) and its forcing on vegetation and fire regimes in North America. The findings will be compared with other sites on the Baja Peninsula to investigate how vegetation changes, climatic changes, and land-use changes alter ecosystems and the impacts from the NAM in the region. 0 100 200 Age (cal yr BP) 300 400 500 600 700 800 900 1000 0 20 40 60 Charcoal Influx (cm2 yr-1) 80 0 4 8 1216 0 0.4 0.8 % Organics % Carbonates 0 8 16 24 MS Figure 1: Charcoal influx, LOI, and magnetic susceptibility (MS) data plotted against the PA-18-B age model from CLAM (Blaauw, 2010). University of Utah UNDERGRADUATE RESEARCH JOURNAL ECONOMIC PATTERNING OF PARKS IN THE WASATCH FRONT: THE IMPORTANCE OF MEASURING QUALITY Brittney A. Hayesa (Dr. David Curtisb) Department of Psychologya; Department of Family and Consumer Studiesb Introduction Prior evidence has suggested that socially and economically disadvantaged neighborhoods tend to have poorer park access (Hill & Peters, 1998; Wolch et al., 2011). One reason for the mixed findings is prior failure to integrate measures of park quality and resources (Sugiyama et al., 2015). For this study, integrating measures of park quality into the research on the economic patterning of parks is key. Aims Our first aim for the Spring 2019 semester was to establish the validity of an online assessment of park quality by comparison to an established in-person assessment named the community park audit tool (Kaczynski et al., 2012). Our second aim was a preliminary analysis of the relationship between neighborhood characteristics and park quality, with the hypothesis that disadvantaged neighborhoods have poorer quality parks. Methods To complete our aims, we took a random sample of parks in Utah, Davis, & Salt Lake Counties (n=49). Parks were assessed using online and in-person standardized methods. Park subscales were broken down into activity spaces (9 items), amenities (12 items), attractiveness, and acres. Attractiveness indicators varied between online and in-person methods and included google user ratings (online) and park incivilities (in-person). Neighborhoods were defined using 2010 Census block group designations, and sociodemographic characteristics were derived from American Community Survey 2013-2017 estimates. Neighborhood sociodemographic characteristics included neighborhood deprivation (based on twelve indicators representing educational attainment, occupation, income, and housing characteristics); percent of population identifying as a non-white racial category; population density; and percent of population less than 18 years old (youth) (Kind et al., 2014). For the analysis, bivariate correlations between park subscales were examined. Next, a park quality index was computed as the average of the four standardized online assessment subscales, coded as higher scores reflecting greater quality. Finally, correlations between sociodemographic characteristics and the park quality index were tested using correlation and linear regression analyses. Results Results from park subscale bivariate correlations showed moderate to strong correlations between online and in-person assessments. Subscales for activity spaces were correlated at r = .72; amenities at r = .53; and attractiveness at r = -.58. Using standardized indicators, we averaged the four online park subscales. The Cronbach’s alpha of .61 for the park quality index is below the commonly used .70 threshold for a reliable assessment tool; however, we sought a multidimensional construct of park quality rather than an internally consistent measure, such that reliability was only one criterion to evaluate. In terms of predictive validity, we found that the park quality index was correlated with sociodemographic characteristics. These correlations with sociodemographic characteristics included economic deprivation at r = -.37; population density at r = -.33; ethnic minorities at r = -.41; and percentage of youth at r = .19. Conclusions Through our initial findings we believe that we can tentatively claim that online assessment strategies provide a valid measurement of park characteristics, allowing for greater research efficiency and time management. Assessing parks accurately online would cut down a considerable amount of time and resources that would be spent commuting to each park individually. We also were able to note that park quality is correlated with neighborhood sociodemographic characteristics. Specifically, park quality is lower in neighborhoods with greater economic deprivation, higher population density, higher percentage of ethnic minorities, and smaller percentage of youth. Consistent with findings from prior research, including measures of park quality is important when understanding the social and economic patterning of parks and the potential benefits of park access. Our next step is to complete the online assessments of all ~900 parks in the Wasatch Front to better understand the relationships between neighborhood characteristics, park presence, and quality. We plan to eventually examine how economic patterning of parks contributes to obesity risk in socially and economically disadvantaged neighborhoods. References Hill, J., & Peters, J. (1998). Environmental contributions to the obesity epidemic. Science, 280, 1371–1374. Kaczynski, A. T., Potwarka, L. R., & Saelens, B. E. (2008). Association of park size, distance, and features with physical activity in neighborhood parks. American Journal of Public Health, 98, 1451-1456. Kaczynski, A. T., Stanis, S. A. W., & Besenyi, G. M. (2012). Development and testing of a community stakeholder park audit tool. American Journal of Preventive Medicine, 42(3), 242-249. Kind, A. J., Jencks, S., Brock, J., Yu, M., Bartels, C., Ehlenbach, W., Greenberg, C., & Smith, M. (2014). Neighborhood socioeconomic disadvantage and 30-day rehospitalization: a retrospective cohort study. Annals of Internal Medicine, 161(11), 765-774. Sugiyama, T., Gunn, L. D., Christian, H., Francis, J., Foster, S., Hooper, P., Owen, N., & GilesCorti, B. (2015). Quality of public open spaces and recreational walking. American Journal of Public Health, 105(12), 2490–2495. doi:10.2105/AJPH.2015.302890. Wolch, J., Jerrett, M., reynolds, K., McConnell, R., Chang, R., Dahmann, N., Brady, k., Gilliland, F., Su, J. G., & Berhane, K. (2011). Childhood obesity and proximity to urban parks and recreational resources: A longitudinal cohort study. Health & Place, 17(1), 207–214. doi/10.1016/j.healthplac.2010.10.001. University of Utah UNDERGRADUATE RESEARCH JOURNAL AN ANALYSIS OF PHARMACEUTICAL USE AMONGST PATIENTS OF A FREE CLINIC: OPIOIDS, COMPLEMENTARY AND ALTERNATIVE MEDICINE, AND OTHER PAIN RELIEVERS Sullivan Riley Howard Akiko Kamimura, PhD, MSW, MA Department of Sociology An analysis of pharmaceutical use amongst patients of a free clinic: opioids, complementary and alternative medicine, and other pain relievers Abstract Introduction: The number of deaths from opioid overdose has been increasing since 1990’s. The purpose of this study was to describe the use of opioids and complementary and alternative medicine (CAM) among uninsured free clinic patients. Methods: A self-administered paper survey was collected to describe the use of opioids, complementary and alternative medicine, and other pain relievers from 877 free clinic patients from January to April 2018. Participants were ages 18 or older and spoke and read English or Spanish. Three groups – US born English speakers, non-US born English speakers, and Spanish speakers – were compared. Results: US born English speakers are more likely to use CAM (29.6% vs. 16.8% and 23.7%, p<0.05), nonprescription pain relievers (85.4% vs 67.0% and 65.2%, p<0.01), and prescription opioids (17.6% vs 11.5% and 7.4%), and to be more knowledgeable about opioids (3.42 vs 2.23 and 1.31, p<0.01) compared to non-US born English speakers and Spanish speakers. Second, the main source of opioids for free clinic patients is a health care facility other than a free clinic (15.1%) as well as friends. Third, while non-prescription pain relievers are commonly used among free clinic patients, CAM is less common to use for pain control (68.0% vs 23.6%). Discussion and conclusion: Due to the national increase in opioid use and misuse, it is extremely prevalent to study opioid and non-opioid pain management amongst vulnerable populations such as free clinic patients. Keywords: opioids; complementary and alternative medicine; pain relievers; free clinics; medically uninsured 1 Introduction The number of deaths from opioid overdose has been increasing since the 1990’s with a significant increase since 2013.1 Approximately 40 % of opioid deaths are caused by prescription opioids.2 Opioids are prescribed for controlling chronic pain.3 Prescription opioid abuse is predominantly found among White patients.4 The exact protective factors that keep racial minorities from being equally afflicted by the problem of opioid abuse are unknown. Due to the complexity of this issue, it is also challenging to discern how the opioid crisis affects insured versus uninsured individuals. Because health care for uninsured individuals is limited to specific settings as emergency departments and free clinics, uninsured patients may have fewer opportunities to be prescribed an opioid. Additionally, uninsured people are less likely to utilize health care services than people with insurance.5 A previous study on opioid risks among uninsured individuals using a free clinic indicated several gaps in opioid-related research.6 First, opioid abuse among Hispanic free clinic patients needs to be further examined. Second, since free clinics do not necessarily prescribe opioids, it is important to determine the possible sources of opioid obtainment among free clinic patients. Third, given that prescription opioids are primarily used for pain control, it is important to examine what non-opioid pain relievers free clinic patients are using in order to better understand free clinic patients and pain relief. In understanding factors that protect certain populations from relying on prescription opioids for pain relief, it is reasonable and necessary to study complementary and alternative medicine (CAM) utilized for pain. While CAM is not always effective, several studies found that CAM is effective to control pain in some cases.7 In fact, pain is the most common reason to use CAM in the US.7 However, whether CAM can substitute to medication requires further research.7 But little is known about uninsured individuals’ use of non-opioid pain relievers or CAM. The purpose of this study was to describe the use of opioids and complementary and alternative medicine among uninsured free clinic patients. In particular, this study focused on racial/ethnic differences, 2 information related to obtaining prescription opioids, and the use of CAM and non-opioid pain relievers. This study increases knowledge, which is currently lacking, about prescription opioid use among uninsured individuals. This study was descriptive because it aimed to gather information about the use of opioids and complementary and alternative medicine among uninsured free clinic patients to develop future research on this topic. Since opioid misuse is a significant public health issue, examining understudied populations can be worthwhile to develop effective prevention strategies. Additionally, it is of the upmost importance to examine populations who are not as heavily affected by the opioid crisis in order to better understand what protective factors are in place that keep them from being heavily affected. Methods Setting This study was approved by the Institutional Review Board (IRB). Data were collected at a free clinic in a metropolitan area of Utah. The first author has been collaborating with the free clinic since 2012 for community-based research. For un- or under- insured individuals or undocumented immigrants, a free clinic is often the only health care facility in which they are able to seek medical care, other than emergency departments.8 Free clinics take important roles in the US health system to serve underserved populations.8 The state of Utah has higher opioid-related overdose deaths, as well as opioid prescriptions than the national average.9,10 Although the free clinic does not prescribe opioids, there is an increasing concern about opioid abuse among its patients because the clinic is in the area where opioid abuse is prevalent. The clinic has been providing free primary care services to uninsured individuals living below 150 % of the federal poverty level since 2005. The clinic is run by 12 paid staff and over 400 volunteers. While patients of the clinic are from more than 50 countries, approximately half of the patients self-identify as Hispanic. The majority of the clinic’s patients are between age 19 and age 64. The primary focus areas of the clinic’s services are managing chronic conditions such as diabetes, hypertension and heart disease. 3 Compared to the results of the national survey on free clinics,11 the characteristics of the patients of this clinic have some similarities in terms of being uninsured, mostly ages 18-64 and being in poverty. However, this clinic has higher percentage of Hispanic patients than the national average (25.1%). In addition, while 41.9% of free clinic patients are homeless in the nation, the clinic does not knowingly serve homeless patients because there is another free clinic which treats only homeless people in the same city. Study participants and data collection Participants were patients of the clinic who spoke English or Spanish and were ages 18 or older. Patients who did not speak English and Spanish were not included. Since this survey was self-administered, patients with limited literacy were not included. The majority of the clinic’s patients speak English and/or Spanish. All survey materials were available in English and Spanish. A translator translated English materials into Spanish. Another translator performed back-translation from Spanish to English to ensure the accuracy of the forwardtranslation. The third translator checked the accuracy of the translation. Research assistants approached all potential participants in the waiting room. Patients who expressed interest in participating in the survey received a consent cover letter and the survey instrument. Consent was obtained from each participant. The research assistants verified each participant filled the survey only once. Participants received a small gift (e.g. reusable washcloths, 1 US$ or less value) when they completed the survey. The participants took approximately 15 minutes to complete the survey which included 37 items/questions. Because the sample was a convenient sample, a response rate was not known. In addition, the number of eligible patients who declined is unknown. The research assistants reported there were few refusals. Per the research assistants, the main reasons of the refusals were lack of time, not having reading glasses, not feeling well, and being called by a provider. Prior to the survey collection, this particular survey instrument was not tested. However, another survey on opioid use was conducted at the same clinic in summer 2017. The questions in this survey were developed based upon the previous survey’s results and areas of potential further 4 research. Furthermore, to measure the CAM use, expectation of providers’ understanding in CAM, and knowledge of opioids, the questions which had been already tested were used. The use of these questions ensured the accuracy of measuring. Measures Use of complementary and alternative medicine (CAM) There was one question about oral herbal remedy “Do you currently take or have you ever taken an oral herbal remedy (herbal medicine)?” (yes/no/don’t know).12 In addition, for each type of CAM, participants were asked whether they used the medicine/supplement/therapy in the past 12 months. The list of types of CAM were extracts from the Ho et al.’s study.13 The types of CAM asked in the survey included: Vitamins/supplements; Herbal medicine; Dietary/ nutritional therapy; Massage; Meditation/ relaxation exercises; Chiropractic; Acupuncture; Yoga; Cupping; Curanderismo (traditional healer); Tai chi; Espiritismo (Spiritism); Hypnosis; Santeria (Afro-American religion developed in Caribbean); and other. Expectation to physicians regarding CAM Sharing of CAM use with physicians was measured by a 4-item questionnaire using a 5-point Likert scale (5 = strongly agree, 1 = strongly disagree).13 Some CAM questions were developed from a study that examined CAM use and the communication of CAM practices to a health care provider.13 The 4-items were as follows: 1) “I feel comfortable telling my doctor about complementary and alternative medicine therapies I use or might use.;” 2) “I would tell my doctor if I went to a complementary and alternative medicine practitioner for treatment.;” 3) I would like my physician to have basic knowledge of complementary and alternative medicine or be able to refer me to someone with more information or skills in complementary and alternative medicine therapies.;” 4) “I would like my physician to ask me about any current complementary and alternative medicine therapies I use.” Cronbach alpha for this study population was 0.815, which indicates good reliability. 5 Knowledge about opioid overdoses Twelve items were asked (true/false/I don’t know) to measure levels of the knowledge of opioid overdoses.14 The examples of the items are “Restlessness, muscle and bone pain, and insomnia are symptoms of opioid withdrawal,” “Trouble breathing is NOT related to opioid overdose,” and “All overdose are fatal (deadly).” All items with correct answers are presented in Appendix. Scoring was based on the number of items which were correct. Other opioid or pain control related questions Additional questions regarding opioids or pain control were asked (yes/no/don’t know): “Have you ever used herbal remedy or complementary and alternative medicine such as the choices above to control pain?;” “Have you taken non-prescription pain medicine such as Tylenol in the past 12 months?;” “Have you been prescribed non-opioid pain reliever such as Naproxen in the past 12 months?;” “Have you been prescribed opioid pain reliever such as oxycodone or hydrocodone (Vicodin or Lortab) in the past 12 months?;” “Do you know anyone (e.g. your family or friend) who have abused opioids?” In addition, participants were asked in their opinion how difficult is it to obtain opioids (very easy/easy/neutral/difficult/very difficult) and whether they had over-used opioids in the past (yes/no/don’t know). If they had used opioids in the past, their source of obtaining was asked. Furthermore, participants were asked whether they had a job which is physically demanding and causes physical pain (e.g. back pain) in the past 12 months (yes/no/don’t know). General health and demographic characteristics 6 Self-rated general health was asked using a 5-point Likert scale: excellent, very good, good, fair, or poor. The following socio-demographic questions were also asked: age, gender, race/ethnicity, educational attainment, employment status, marital status, nativity, years in the US (non-US born only), and being a patient of the free clinic for two or more years (or not). Data analysis Data were analyzed using IBM SPSS ver 22. The analyses were primarily based on the comparison of the following three groups: US born English speakers; non-US born English speakers and Spanish speakers because previous studies on free clinic patients suggest the three groups reported different levels of substance use and opioid risks [6]. The three groups were compared by Pearson’s Chi-square tests for categorical variables and ANOVA tests for continuous variables. Only completed surveys were included in analysis. There were few item non-responses. Item non-responses were treated as missing in statistical analysis. Results Table 1 summarizes the socio-demographic characteristics of participants (N=887 – US born English speakers n=199, non-US born English speakers n=191, and Spanish speakers n = 497). Nearly 70% of the participants were female (n=600, 67.6%). The most common race/ethnicity among the participants was Hispanic/Latino/Latina (n=604, 68.1%) followed by non-Hispanic white (n=170, 19.2%). Slightly over 40% of the participants had some college or higher educational attainment (n=366, 41.3%). Factors such as educational obtainment, marital status, and country of origin were included. The percentage of people having had some college or higher educational attainment was much lower among Spanish speakers (n=164, 33%) than US born (n=104, 52.3%) and non-US born (n=98, 51.3%) English speakers. Less than half of the participants were employed (n=405, 45.7%). Spanish speakers (n=247, 49.7%) had a higher 7 percentage of being employed than US born (n=81, 40.7%) and non-US born (n=77, 40.3%) English speakers. Approximately 45% of the participants were married (n=396, 44.6%). US born English speakers (n=43, 21.6%) had a much lower marriage rate compared to non-US born English speakers (n=130, 53.9%) and Spanish speakers (n=250, 50.3%). Approximately one-quarter of the participants were US born (n=218, 24.6%). NonUS born participants were from 34 countries. The most common country of origin was Mexico (n=274) followed by Venezuela (n=64), Peru (n=38), El Salvador (n=26), and Tonga (n=22). Additionally, length of time as a patient was asked in order to better understand the patient population. Approximately 45% of the participants had been patients of the clinic for two years or longer (n=395, 44.5%). The percentage of being a patient of the clinic was highest among Spanish speakers (n=260, 52.3%) followed by non-US born English speakers (n=86, 45%) and US born English speakers (n=49, 24.6%). The average age of the participants was 45.73 (sd =13.86). Spanish speakers (mean=47.60, sd =13.86) were older than non-US born English speakers (mean=45.79, sd = 15.92) and US born English speakers ( mean = 41.26, sd = 13.68). The average self-rated health status was 3.18 (sd = 0.96). Table 2 presents the use of CAM and pain management among the participants. More than one-third of the participants had used oral herbal remedy (n=315, 35.5%). The percentage of having used oral herbal remedy was highest among US born English speakers (n=84, 42.2%) followed by Spanish speakers (n=182, 36.6%) and non-US born English speakers (n=49, 25.7%). The most common complementary and alternative medicine used in the past 12 months was vitamins/supplements (n=525, 59.2%) followed by herbal medicine (n=169, 19.1%). Slightly less than one-quarter of the participants had used CAM to control pain (n= 209, 23.6%). US born English speakers (n=59, 29.6%) had a higher percentage of having used CAM to control pain than Spanish speakers (n=118, 23.7%) and non-US born English speakers (n=32, 16.8%). Nearly 70% of the participants preferred non-prescription pain relievers (n=603, 68%). Pain reliever specifics were also examined. In the past 12 months, participants reported the following prevalence for each type of pain reliever: having used a non-prescription pain medicine (n=622, 70.1%); having been prescribed a non-opioid pain reliever (n=236, 26.6%); and having been prescribed an opioid pain reliever 8 (n=94, 10.6). US born English speakers reported a higher percentage of knowing anyone who have abused opioids (41.7%) than non-US born English speakers (8.4%) and Spanish speakers (2.8%). Likewise, US born English speakers reported a higher percentage of having over-used opioids (26.6%) than non-US born English speakers (7.3%) and Spanish speakers (1.6%). Furthermore, prevalence of manual labor employment was analyzed. US born English speakers reported a higher percentage of having a job which is physically demanding and causes physical pain in the past 12 months (46.2%) than non-US born English speakers (24.6%) and Spanish speakers (37.4%). Additional analyses were conducted to examine the associations between opioid or CAM use and socio demographic characteristics using logistic regression. There was no difference in being prescribed opioids in the past 12 months by socio-demographic characteristics. Participants who had some college or higher educational attainment were less likely to have used herbal medicine in the past 12 months (p<0.01). Over one-third of US born English speakers (35.6%) believed it would be easy or very easy to obtain opioids while the percentage was lower among non-US born English speakers (21.9%) and Spanish speakers (13.2%). The most common place where participants had obtained opioids was a health care facility other than the clinic of this study (n=120, 15.1%). The second most common place was the clinic of this study (n=42, 5.3%) although the clinic does not prescribe opioids. It is important to note that this contradictory finding may be due to the low levels of understanding of what is considered an opioid. US born English speakers had higher levels of expectations of providers’ understanding in CAM and of knowledge of opioids compared to non-US born English speakers and Spanish speakers. Discussion This study described the use of opioids and complementary and alternative medicine among uninsured free clinic patients. There are three main findings. First, US born English speakers are more likely to use CAM, nonprescription prescription pain relievers, and prescribed pain relievers including opioids and to be more 9 knowledgeable about opioids compared to non-US born English speakers and Spanish speakers. Second, the main source of opioids for free clinic patients is a health care facility. Third, CAM is less common to use for pain control in comparison to non-prescription pain relievers. The results of this study suggest that in comparison to non-US born English speakers and Spanish speakers, US born English speakers have a higher likelihood of utilizing CAM, non-prescription pain relievers, and prescription pain relievers including opioids. Additionally, this group was shown to be more knowledgeable about opioids. Previous studies suggest that immigrants have a lower prevalence of substance use than US born populations.17 Likewise, among free clinic patients, US born English speakers have a higher prevalence of substance use than non-US born English speakers and Spanish speakers.18 It is important to implement opioid abuse prevention programs for non-US born English speakers and Spanish speakers as well as US born English speakers. National data suggests that the primary sources to obtain prescription opioids among non-Medicaid populations are friends and relatives.4 This study, however, concluded that the main source of obtaining opioids among free clinic patients is a health care facility other than a free clinic. It is important to note that a small number of participants reported that they obtained opioids from the clinic of this study (although the clinic does not prescribe opioids). This may be due to lack of knowledge about what they were prescribed, what opioids are, or not wanting to disclose where they obtained opioids. In terms of pain control and CAM or other non-opioid use, CAM was not commonly used while nonprescription pain relief was common among participants. Higher levels of educational attainment and income are associated with greater CAM usage.21 CAM can be costly in certain areas such as the cost associated with a massage or going to a chiropractor. Because the participants in this survey were free clinic patients, there may be a correlation between socio-economic status and use of CAM. The use of non-prescription pain relievers were more common. Non-prescription pain relievers, such as Tylenol or Ibuprofen, are low cost and easy to obtain. In fact, the clinic of this study offers many over the counter pain relievers to the patients, free of charge. This issue of managing pain among free clinics needs to be further examined. 10 While this study contributes to increasing the knowledge about opioid use, CAM and non-opioid pain relievers among free clinic patients, it has limitations. This study is descriptive and does not examine causal relationships among factors. There is a possibility that some of the study participants did not understand the questions or possibly mistook an opioid for another medication that could have pain relieving qualities, such as Ibuprofen. Further research is necessary to clarify the levels of understanding of pain medicine among the free clinic population. Additionally, the over-use of opioids is a socially sensitive topic. Thus, some participants might have chosen socially desirable answers. This may be especially applicable for undocumented immigrants. However, this study did not ask immigration status. Finally, since the participants were not asked their pain levels and diagnoses, some of the participants of this study might not have chronic pain symptoms and thus might not have much to respond to opioid use or misuse. Conclusion Due to the national increase in opioid use and misuse, it is extremely prevalent to study opioid and non-opioid pain management amongst vulnerable populations such as free clinic patients. While it is known that Hispanics have a lower rate of opioid use compared to non-Hispanic Whites and non-Hispanic blacks, it is unknown exactly what factors influence this trend and what pain medications Hispanics are utilizing instead of opioids.24 It is necessary that the US directs more resources, attention, and concern towards people affected by the opioid crisis and continue researching the racial and socioeconomic factors within this epidemic. Regarding patient treatment, it is recommended for health care professionals to develop cultural competence related to CAM. This study builds knowledge and creates a platform for further research on the topic of pain management techniques and opioid use amongst free clinic patients. Future studies may examine the communication between patients and providers regarding opioids, stress relief, and lack of pain management. Furthermore, future research should consider the role of acculturation for use/non-use of CAM/pharmaceuticals because culture serves an important role in health beliefs. 11 References 1. Center for Disease Control and Prevention. Understanding the Epidemic. 2017. https://www.cdc.gov/drugoverdose/epidemic/index.html 2. Center for Disease Control and Prevention. Opioid Overdose. 2017. https://www.cdc.gov/drugoverdose/ 3. Center for Disease Control and Prevention. Improve Opioid Prescribing. 2017. https://www.cdc.gov/drugoverdose/prevention/prescribing.html 4. Netherland J, Hansen H. White opioids: Pharmaceutical race and the war on drugs that wasn't. Biosocieties. 2017;12(2):217-38. 5. Institute of Medicine (US) Spending on Health Care for Uninsured Americans: How Much, and Who Pays? Committee on the Consequences of Uninsurance. Hidden Costs, Values Lost: Uninsurance in America. Washington (DC): National Academies Press (US); 2003. Available from: https://www.ncbi.nlm.nih.gov/books/NBK221653/ 6. Kamimura A, Panahi S, Rathi N, et al. Risks of opioid abuse among uninsured primary care patients utilizing a free clinic. J Ethnicity in Substance Abuse. 2018. DOI: 10.1080/15332640.2018.1456387 7. National Institute of Health. Complementary and Alternative Medicine. 2018. https://report.nih.gov/NIHfactsheets/ViewFactSheet.aspx?csid=85 8. Gertz AM, Frank S, Blixen CE. A survey of patients and providers at free clinics across the United States. Journal of Community Health. 2018;36(1): 83–93. 9. National Institute on Drug Abuse. Utah Opioid Summary. 2018. https://www.drugabuse.gov/drugsabuse/opioids/opioid-summaries-by-state/utah-opioid-summary 10. Utah Department of Health. Opioid Abuse is a Utah Epidemic. 2018. https://www.opidemic.org/ 11. Darnell JS. Free Clinics in the United States: A Nationwide Survey. Arch Intern Med. 2010;170(11):946–953. 12. Howell L, Kochhar K, Saywell R, Zollinger T, Koehler J, Mandzuk C, et al. Use of herbal remedies by Hispanic patients: Do they inform their physician? J Am Board Fam Med. 2006;19(6):566-78. 12 13. Ho DV, Nguyen J, Liu MA, Nguyen AL, Kilgore DB. Use of and Interests in Complementary and Alternative Medicine by Hispanic Patients of a Community Health Center. J Am Board Fam Med. 2015;28(2):175-83. 14. Dunn K, Barrett FS, Yepez-Laubach C, et al. Brief opioid overdose knowledge (book): A questionnaire to assess overdose knowledge in individuals who use illicit or prescribed opioids. J Addict Med 2016;10(5): 314-323. 15. National Center for Complementary and Integrative Health. CAM Use by Race/Ethnicity Among Adults – 2007. https://nccih.nih.gov/research/statistics/2007/cam-use-by-race-among-adults 16. Harrison JM, Lagisetty P, Sites BD, Guo C, Davis MA. Trends in Prescription Pain Medication Use by Race/Ethnicity Among US Adults With Noncancer Pain, 2000-2015. Am J Public Health. 2018;108(6):788-90. 17. Ojeda VD, Patterson TL, Strathdee SA. The influence of perceived risk to health and immigrationrelated characteristics on substance use among Latino and other immigrants. Am J Public Health. 2008;98(5):862-8. 18. Kamimura A, Ashby J, Tabler J, Nourian MM, Trinh HN, Chen J, et al. The association between tobacco, alcohol, and drug use, stress, and depression among uninsured free clinic patients: US-born English speakers, non-US-born English speakers, and Spanish speakers. J Ethn Subst Abuse. 2017;16(1):122-36. 19. Ford JA, Sacra SA, Yohros A. Neighborhood characteristics and prescription drug misuse among adolescents: The importance of social disorganization and social capital. International Journal of Drug Policy. 2017;46:47-53. 20. Zoorob MJ, Salemi JL. Bowling alone, dying together: The role of social capital in mitigating the drug overdose epidemic in the United States. Drug and Alcohol Dependence. 2017;173:1-9. 21. National Center for Complementary and Integrative Health. The Use of Complementary and Alternative Medicine in the United States. https://nccih.nih.gov/research/statistics/2007/camsurvey_fs1.htm#most 13 22. Kamimura A, Christensen N, Myers K, Nourian MM, Ashby J, Greenwood JLJ, et al. Health and diabetes self-efficacy: a study of diabetic and non-diabetic free clinic patients and family members. J Community Health. 2014;39(4):783-91. 23. Kamimura A, Christensen N, Nourian MM, Myers K, Saunders A, Solis SP, et al. The relationship between diabetes attitudes and treatment among free clinic patients and volunteers. J Community Health. 2014;39(6):1186-92. 24. Rudd RA, Seth P, David F, Scholl L. Increases in Drug and Opioid-Involved Overdose Deaths — United States, 2010–2015. MMWR Morb Mortal Wkly Rep 2016;65:1445–1452. 14 Appendix. Items of knowledge of opioids and correct answers. 1 Long-acting opioids are used to treat chronic “round the clock” pain. 2 Methadone is a long-acting opioid. 3 Restlessness, muscle and bone pain, and insomnia are symptoms of opioid withdrawal. 4 Heroin, OxyContin, and fentanyl are all examples of opioids. 5 Trouble breathing is NOT related to opioid overdose. 6 Clammy and cool skin is NOT a sign of an opioid overdose. 7 All overdose are fatal (deadly). 8 Using a short-acting opioid and a long-acting opioid at the same time does NOT increase your risk of an opioid overdose. 9 If you see a person overdosing on opioids, you can begin rescue breathing until a health worker arrives. 10 A sternal rub helps you evaluate whether someone is unconscious. 11 Once you confirm an individual is breathing, you can place him/her into the recovery position. 12 Narcan (naloxone) will reverse the effect of an opioid overdose. True True True True False False False False True True True True Table 1: No. (%) or Mean (SD). N.S. – Not significant. N/A – Not applicable p-value denotes significance from Pearson’s Chi-square tests between categorical variables (for cell size ≥5 only), and ANOVA tests for continuous variables comparing US born English speakers, non-US born English speakers, and Spanish speakers. a A post hoc Tukey test indicated that US born English speakers were significantly younger than non-US born English speakers and Spanish speakers at the 0.05 level. But there was no significant difference in age between non-US born English speakers and Spanish speakers. b Higher numbers indicate worse health (range 1-5). Distribution of continuous variables: Age has a few very old participants (older than 70) but also has some skewness toward younger participants. Years in the US were skewed toward shorter years. Health was skewed toward higher number (poorer health). Table 2: No. (%) or Mean (SD). N.S. – Not significant. N/A – Not applicable p-value denotes significance from Pearson’s Chi-square tests between categorical variables (for cell size ≥5 only), and ANOVA tests for continuous variables comparing US born English speakers, non-US born English speakers, and Spanish speakers. CAM: complementary and alternative medicine a The result of a post hoc Tukey test indicates US born English speakers reported higher expectations of providers’ understanding in CAM than non-US born English Speakers and Spanish speakers. There was no significant difference between non-US born English speakers and Spanish speakers. b The result of a post hoc Tukey test indicates these three groups are different each other at the 0.05 level. # The sum is not 100% because there were participants who did not have preference or did not want to take any pain relievers. Distribution of continuous variables: Expectation of providers’ understanding in CAM is skewed to higher numbers (higher expectations). Knowledge of opioid is skewed toward lower scores (lower knowledge). 15 TABLE 1: Total US born English speakers (n=199) Non-US born English speakers (n=191) Spanish speakers (n=497) pvalue 600 (67.6) 128 (64.3) 121 (63.4) 351 (70.6) N.S. 170 (19.2) 604 (68.1) 69 (7.8) 44 (5.0) 366 (41.3) 405 (45.7) 396 (44.6) 218 (24.6) 395 (44.5) 128 (64.3) 31 (16.2) 11 (2.2) <0.01 47 (23.6) 81 (42.4) 476 (95.8) <0.01 8 (4.0) 16 (8.0) 104 (52.3) 56 (29.3) 23 (12.0) 98 (51.3) 5 (1.0) 5 (1.0) 164 (33.0) <0.01 81(40.7) 77 (40.3) 247 (49.7) <0.05 43 (21.6) 103 (53.9) 250 (50.3) <0.01 199 (100) 0 19 (3.8) 49 (24.6) 86 (45.0) 260 (52.3) (N=887) Frequency (%) Female Race/Ethnicity White – Non-Hispanic Hispanic/Latino/Latina Asian or Pacific Islander Other Some college or higher Currently employed Currently married US born Patient of the clinic – 2 years or longer Mean (SD) Age Years in the US (non-US born only n = 669) Self-rated general healthb 45.73 (13.86) 14.45 (10.02) 3.18 (0.96) <0.01 <0.01 41.26 (13.68) 45.79 (15.92) 47.60 (13.86) <0.01 3.27 (1.14) 3.13 (1.00) 3.16 (0.86) N.S. 16 a F 14.77 1.12 TABLE 2: Total Frequency (%) Have used an oral herbal remedy Vitamins/supplements in the past 12 months Herbal medicine in the past 12 months Have used CAM to control pain Preference of pain reliever: nonprescription# Preference of pain reliever: prescription# Have taken non-prescription pain medicine in the past 12 months Have been prescribed non-opioid pain reliever in the past 12 months Have been prescribed opioid pain reliever in the past 12 months Know anyone (e.g. your family or friend) who have abused opioids Have over-used opioids Had a job which is physically demanding and causes physical pain (e.g. back pain) in the past 12 months How it is difficult to obtain opioids Very easy Easy Neutral Difficult Very difficult Where obtained opioids (if obtained) (multiple answers) The clinic of this study Health care facility (other than the clinic of this study) Family Someone Mean (SD) Expectation of providers’ understanding in CAM Knowledge of opioid (range 0-12) Non-US born English speakers (n=191) Spanish speakers (n=497) p-value (N=887) US born English speakers (n=199) 315 (35.5) 525 (59.2) 84 (42.2) 129 (64.8) 49 (25.7) 103 (53.9) 182 (36.6) 293 (59.0) <0.01 N.S. 169 (19.1) 209 (23.6) 603 (68.0) 60 (30.2) 59 (29.6) 140 (70.4) 29 (15.2) 32 (16.8) 124 (64.9) 80 (16.1) 118 (23.7) 339 (68.2) <0.01 <0.05 N.S. 204 (23.0) 622 (70.1) 47 (23.6) 170 (85.4) 34 (17.8) 128 (67.0) 123 (24.7) 324 (65.2) N.S. <0.01 236 (26.6) 48 (24.1) 35 (18.3) 153 (30.8) <0.01 94 (10.6) 35 (17.6) 22 (11.5) 37 (7.4) <0.01 113 (12.7) 83 (41.7) 16 (8.4) 14 (2.8) <0.01 75 (8.5) 53 (26.6) 14 (7.3) 8 (1.6) <0.01 325 (36.6) 92 (46.2) 47 (24.6) 186 (37.4) <0.01 67 (9.6) 82 (11.7) 282 (40.3) 139 (19.9) 130 (18.6) 33 (17.3) 35 (18.3) 65 (34.0) 37 (19.4) 21 (11.0) 16 (10.0) 19 (11.9) 55 (34.4) 35 (21.9) 35 (21.9) 18 (5.2) 28 (8.0) 162 (46.4) 67 (19.2) 74 (21.2) <0.01 42 (5.3) 120 (15.1) 5 (2.5) 67 (34.0) 17 (9.3) 16 (8.8) 20 (4.8) 37 (8.9) 27 (3.4) 28 (3.5) 19 (9.6) 21 (10.7) 2 (1.1) 4 (2.2) 6 (1.4) 3 (0.7) 4.22 (0.70) 4.34 (0.69) 4.30 (0.68) 4.14 (0.71) <0.01a 2.25 (2.86) 4.63 (3.42) 2.23 (2.76) 1.31 (1.96) <0.01b 17 University of Utah UNDERGRADUATE RESEARCH JOURNAL THE ENDURING EFFECTS OF EARLY INSTITUTIONALIZATION ON THE DIURNAL CORTISOL REGULATION OF INTERNATIONALLY ADOPTED CHILDREN by Jennifer Isenhour (Faculty Mentor: Dr. Lee Raby) Department of Psychology ABSTRACT Experiences during infancy and early childhood are believed to play a crucial and unique role in organizing children’s neurobiological development. Specifically, experiences within early attachment relationships are expected to assist with regulating the diurnal functioning of the hypothalamic-adrenocortical (HPA) axis. International adoption offers a powerful test of the unique effects of early experiences on later HPA functioning because many internationally adopted children experience profound adversity prior to being adopted into highly resourced families. The purpose of the present study was to examine the potential longer-term consequences of early adversity on the HPA functioning of internationally adopted children at the age of 5 years. The results indicate that longer time in institutional care resulted in lower waking cortisol levels. The results also indicate that institution care is associated with more blunted diurnal patterns. These results indicate that the consequences of early institutionalization can endure up to four years after adoption. These results suggest that early adversity has lasting implications for neurobiological development. ii TABLE OF CONTENTS ABSTRACT ii INTRODUCTION 1 METHODS 5 RESULTS 8 DISCUSSION 10 REFERENCES 15 iii 1 INTRODUCTION Experiences during infancy and early childhood are believed to play a crucial and unique role in organizing children’s neurobiological development. Specifically, experiences within early attachment relationships are expected to assist with regulating the diurnal functioning of the hypothalamic-adrenocortical (HPA) axis (Koss, Hostinar, Donzella & Gunnar, 2014). The HPA axis is an important component of the neuroendocrine system and involves communication between the hypothalamus, anterior pituitary and adrenal cortex. When a person experiences stress, the HPA axis becomes activated and beings to excrete hormones and such as cortisol, in an effort to regulate important biological systems. Cortisol therefore, becomes an important neurobiological marker of the body’s response to stress. Often, researchers struggle to identify specific predictors in dyregulated HPA functioning due to confounding variables such as genetic expression, sensitive caregiving and environmental stress. Recently, adoption models have been used to disentangle many of these confounding variables. The present study utilizes an international adoption model which offers a powerful test of the unique effects of early experiences of adversity on cortisol, which is one element of neurobiological development. As adopted children transition from institutional care into highly resourced families, predictor variables can be isolated and examined. In this way, this study has the potential to provide a deeper understanding into sensitive developmental periods and the neurobiological organization that occurs in infancy and early childhood and will examine whether the effects of early experiences of adversity during this time persist over time. With a deeper understanding of how early adversity impacts development, we can begin to intervene earlier in life and potentially influence and improve longer term mental health outcomes in vulnerable populations. 2 Function of the HPA Axis There has been a recent surge of interest in the hypothalamic-pituitary-adrenocortical (HPA) axis among developmental researchers. The HPA axis is an important neuroendocrine system that controls reactions to stress and regulates several biological processes through the excretion of neurotransmitters and hormones such as cortisol. (Jacobson, 2014). Studies on early human development have suggested that early separations from caregivers are often associated with changes in the functioning of the HPA axis (Dozier, Peloso, Lewis, Laurenceau & Levine, 2008). HPA therefore becomes a powerful litmus test of stress and aversive experiences. The present study will use HPA changes to determine the impact of early experiences of adversity. Early Adversity and Cortisol Regulation Stress is a condition caused by aversive experiences in which an individual experiences threats to physical or emotional well-being that overwhelm the body’s capacity to cope (Gunnar, Herrera, & Hostinar, 2009). When a body is overtaxed, the HPA axis becomes activated and cortisol is excreted. Cortisol regulation patters are often discussed in terms of the change in cortisol levels between wake time and bed time. This change or natural decline in cortisol throughout the day is called diurnal cortisol. In low-risk samples, cortisol levels are typically high after waking in the morning and low prior to bed time, which creates a steep downward slope from wake to bed time. While some experience with manageable stress prove to be important for healthy development, prolonged, uninterrupted and overwhelming stress can have dire effects on biological systems (Gunnar, Morison, Chisholm, and Schuder, 2001). When the HPA axis is overstimulated, the body is forced to process excessive amounts of cortisol which, over time, cause undue wear-and-tear on the body. This type of chronic stress is often associated 3 with institutionalized care (Gunnar et al., 2001). Institutionalized care within orphanage settings in international countries has been shown to be particularly stressful to infants due to adverse conditions such as over population and limited adult-to-infant ratios (Gunnar et al., 2001). As a result, these children often experience poor quality caregiving, social neglect, which can thrust these children’s bodies into overwhelming and prolonged stress responses. Cortisol Outcomes among Children Adopted Internationally One of the most valuable ways to study the effects of early adversity on development is through the use of internationally adopted children. Adoption models offer a powerful test of the unique influence of early experiences of adversity for HPA functioning because children experience profound shifts in care giving experiences post adoption by entering highly resourced homes (Koss, Hostinar, Donzella, & Gunnar, 2014). In a study conducted by Gunnar and colleagues (2001), higher cortisol levels over the daytime hours were found in populations of children adopted from Romanian orphanages. These inflated cortisol levels persisted six and a half years post adoption demonstrating the long-term effects early experiences of adversity can have on HPA functioning. In another study, HPA axis functioning was examined in internationally adopted children, biologically reared children, and children adopted during their first year from overseas foster care (Koss et al., 2014). HPA functioning was examined in all three samples during the transition to family care in the first two years post adoption. This study analyzed four time points of diurnal HPA samples taken from each child participant. Researchers discovered that post-institutionalized children with lower social care quality prior to adoption exhibited less steep cortisol slopes. In addition, blunted diurnal cortisol levels were found to be a mediator 4 between adoption status and increased behavioral problems two years post adoption. Taken together, research shows that children with early adverse experience demonstrate less strongly fluctuating levels of cortisol compared to low-risk samples of children with no early adverse experiences (Gunnar et al.2001). Vegt, Ende, Kirschbaum, Verhulst, and Tiemeier(2009) conducted a longitudinal study of internationally adopted individuals who had experienced neglect and abuse early in life. The researchers found that these individuals had decreased waking cortisol levels, resulting in an altered diurnal cortisol slope . Thus, early experiences of adversity appear to have associations with cortisol levels and the diurnal slope, even when children are raised in another environment after their early maltreatment. Enduring Effects Model Versus Revisionist Model Amongst developmental researchers, it is commonly assumed that early experiences can have relatively long-term effects that do not fade with time (Raby, Roisman, Fraley, & Simpson, 2015). This “enduring effects model” could be used to describe the associations between early relational experiences and later outcomes. If the enduring effects model is applied to the present study, we could anticipate that the contributions of early adversity for internationally adopted children’s diurnal HPA outcomes should be relatively stable and persist across periods of development. Conversely, the “revisionist model” predicts that the association between early experiences and later outcomes would become increasingly small over time, approaching zero as the temporal lag increases (Raby et al., 2015). If the “revisionist model” is applied to the present topic, the contributions of early adversity for internationally adopted children’s diurnal HPA 5 outcomes should decrease as time progresses and resemble HPA patterns more typical of individuals who have no early aversive experiences. Present Study There has been a plethora of research that has been conducted on young, internationally adopted children, yet there is a paucity of longitudinal research addressing longer-term consequences of early experiences of adversity. There appears to be limited evidence about whether post-adoptive caregiving experiences can facilitate recovery in internationally adopted children’s diurnal cortisol outcomes or whether the effects of early adversity will persist despite substantial improvements in caregiving quality. The present study will seek to fill some of the gaps in prior research by examining the impact of early experiences of adversity on diurnal cortisol outcomes 4 years post adoption. This study is part of a larger longitudinal study conducted examining the significance of early experiences on development amongst samples of internationally adopted children. For the purposes of this study, the cortisol outcomes of 78 internationally adopted children were examined at the age of 5 years. Time spent in institutional care was used as a predictor of diurnal HPA functioning. Based on the Enduring Effects model of development (Raby et al., 2015), this study predicts HPA outcomes will remain blunted at the age of 5 years. METHOD Participants This study examines 78 children adopted internationally (55% female, 45% male). The majority of children were adopted from China (42%), Russia or Eastern Europian countries (19%), South Korea (15%), or Ethiopia (10%). Families were recruited to participate shortly 6 after adoption. Adoptive parents’ reports of the time children spent in institutional care prior to adoption was used as the indicator of early adversity. This sample of internationally adopted children spent between 0 and 35 months in institutional care prior to adoption (M = 9.94, SD = 8.7). Cortisol levels were checked at several time points post adoption but for the purpose of this study, we will be looking at diurnal cortical patterns within the HPA system in the samples taken when children were approximately 5-years-old (M = 5.44, SD = 0.56). At the time of this assessment, the average time since adoption was 4.02 years (range = 1.78 to 6.38 years). It is important to notes that adoptive parents were randomized to receive one of two parent-training interventions. The first intervention was the Attachment and Biobehavioral Catch-up (ABC) intervention, and the control intervention was the Developmental Education for Families. Fifty percent of the adoptive parents received the ABC intervention while the remaining fifty percent received the control intervention. These interventions were not part of the present study and when controlled, we did not find a significant association between intervention condition and cortisol regulation. Materials and Measures Saliva Sampling Identical salivary sampling methods used in prior studies were used in this study (Dozier, Peloso, Lewis, Laurenceau & Levine, 2008). Methods included training adoptive parents how to collect the saliva samples. Parents were instructed to collect saliva samples from children at wake-up and bedtime across three consecutive days. Specifically, the researcher instructed parents to collect a wake-up sample each day immediately when the child woke up, before even getting out of bed when possible. Although the researcher emphasized the importance of 7 collecting a sample as close to wake-up as possible, parents were told that sampling within the first 30 min of wake-up was acceptable. For the bedtime collection, parents were told to collect the sample as close to bedtime as possible. Parents collected saliva samples by putting the end of a cotton swab in the child’s mouth. After adequately soaking the cotton swab in saliva, the parents placed the cotton swab into a pre-labeled vial and recorded the date and time of sampling in a saliva sample journal and on the vial. Parents stored the vials in their freezers until the research staff retrieved the samples at a later home visit. Parents reported collecting wake-up samples between 6:10 a.m. and 10:02 a.m. with a mean wake up time of 7:45 am (SD = 45.6 minutes). Parents reported collecting bedtime samples between 7:11 p.m. and 11:07 p.m. with a mean bed time of 8:40 p.m. (SD = 43.2 minutes). To ensure families followed the guidelines, researchers gave each caregiver a binder with full sampling instructions (including directions and accompanying photographs of each step of the sampling protocol). Research staff instructed parents to delay the collection of saliva if children were sick and to not have the child eat or drink anything or brush their teeth within the 30 minutes prior to sampling. After being collected by a research assistant, the saliva samples were stored in a freezer at 20°C prior to assay procedures. Samples were assayed using a high-sensitivity salivary cortisol enzyme immunoassay kit (Salimetrics, LLC, State College, Delaware). All samples from each child were assayed in duplicate on the same plate to minimize variability. Following procedures commonly used in previous studies (Dozier et al., 2008), cortisol values that were implausible (>2.0) and those that fell 3 SDs above the mean were considered outliers and excluded from analyses. Of 468 possible samples (i.e., 78 participants with up to 6 samples each), 18 outliers were removed and 53 samples were missing due to an inadequate volume of saliva or because no 8 sample was taken. RESULTS According to past research, cortisol levels may vary day-to-day (Gunnar et al., 2001). Composites were therefore created for all three cortisol measures across days within time periods (wake, bed, and the change between wake and bedtime levels (diurnal)). All available and valid samples per child were used to calculate composites. Cronbach alphas were computed to determine how closely the items cohered or reflected the composite values at each time point. The Cronbach alphas for the wakeup and evening composites were acceptable (𝛼 = 0.73 for wakeup and 𝛼 = 0.84 bedtime). These results illustrated that both morning and evening cortisol measures were stable across days and the composites for both time periods were reliable. The measure of diurnal cortisol declines was created by developing a third composite by subtracting evening from morning cortisol levels. To test the hypothesis that waking cortisol levels would remain low among children who experienced high levels of adversity prior to adversity, we ran a hierarchical linear regression with waking cortisol composites regressed onto institution time. Children’s biological sex, age at the time of cortisol assessment, and cortisol sampling time were controlled for hierarchically. We found a significant negative relationship indicating that time spent in institutions predicts waking cortisol levels above and beyond the possible effects of sex, age, and sampling time (β = -.27, p = .029). This association indicates that more time spent in institutionalization results in reduced waking cortisol levels. Bed time cortisol composites also were regressed onto institution time. Children’s biological sex, age at the time of the cortisol assessment, and cortisol sampling time were 9 controlled for in this model. We observed no significant relationship between bed time cortisol and time spent in institutions (𝛽 = -.21, p = .095). This nonsignificant association indicates that more time spent in institutionalization did not impact bed time cortisol levels. Finally, to test the hypothesis that predicted blunted (or less steep) changes (wake up to bed time) in cortisol levels throughout the day, we ran a hierarchical linear regression with diurnal cortisol regressed onto institution time. Children’s biological sex, age at the time of the cortisol assessment, and cortisol sampling time were controlled for in this model. Significant, positive associations emerged for diurnal cortisol and time spent in institutions (β = .24, p = .046) even after controlling for sex, age and sampling time. Figure 1. Children adopted internationally who experienced institutional care for long periods of time exhibited lower morning cortisol levels than children who experienced less institutional care prior to adoption. 10 Figure 2. Children adopted internationally who experienced institutional care for long periods of time exhibited more blunted diurnal cortisol levels (i.e., exhibited less declines throughout the day) than children who experienced less institutional care prior to adoption. DISCUSSION The aim of the present study was to determine whether early experiences of adversity negatively impact internationally adopted children’s neurobiological development, as measured by the regulation of diurnal cortisol patterns over time. This study predicted HPA outcomes would be blunted at the age of 5 years (approximately four years post adoption). Consistent with that prediction, the findings from this study indicate that longer time spent in institutional care prior to adoption is associated with lower cortisol levels in the morning and more blunted declines in cortisol levels throughout the 11 day. These low waking cortisol results indicate that early experiences of severe adversity can disrupt the regulation of children’s cortisol regulation and the consequences can endure up to four years post adoption. These results thus support the Enduring Effects model of development and imply that early adversity may have lasting implications for neurobiological development (Raby et al., 2015). These findings therefore could inform the design of early interventions for both children and caregivers. While many people may assume that less cortisol is good, lower waking cortisol levels are symptomatic of dysfunctional cortisol regulation pattern which can have detrimental impacts on physical health and cognitive functioning. Applying information gleaned from studies conducted by Shoal, GIancola and Kirillova (2003), blunted diurnal cortisol patterns appear to confer risk for later psychiatric disorders, most especially psychopathy and substance abuse. We can therefore infer that children experiencing extreme forms of early adversity, such as institutionalization, are at risk for developing psychopathology later in life. For example, blunted cortisol patterns are predictive of increases in aggressive behavior over time and characterize adolescent diagnoses such as conduct disorder and adults with antisocial personality disorder and substance use disorder, dependence, and addiction (van Goozen, Fairchild, Snoek, & Harold, 2007). Shirtcliff and colleagues (2009) have argued that HPA hypo-reactivity is central to the development of lack of empathy. The impaired neural circuitry of individuals with blunted or hyporeactive HPA systems leaves them under-aroused by the distress of others and thus vulnerable to behaving in indifferent ways (van Goozen, Fairchild, Snoek, & Harold, 2007). Although it is premature to suggest specific behavioral implications for the effects of children who experience early adversity, the findings are concerning. 12 One of the limitations of this study is the nature of the internationally adopted population. The extreme adverse environments these children faced prior to adoption makes it challenging to generalize these findings to other forms of less severe early experiences of adversity. Future research should use similar methodology with samples of domestic infant adoptions, which experiences far less adverse conditions prior to adoption, in order to get a clearer picture of how “typical” adversity in early childhood impacts HPA functioning longitudinally. Another limitation for this study is the nature of saliva sampling. Saliva sampling is known to produce less accurate measures of physiological reactions to adversity when compared with more invasive measures such as the cosyntropin, tetracosactide, or Synacthen test (ACTH) or Corticotropin-releasing hormone (CRH). Unfortunately, these measurements are too invasive to be used with children (Gunnar, et al., 2009). Most researchers studying early adversity must rely on samples of cortisol obtained in saliva. Some of the issues that arise with the use of saliva samples include, time of day, child age, sleep/wake cycles, and social context. This study therefore, controlled for age, and time of day when samples were taken, and used diaries to assess external variables such as food, illness and medication in an effort to minimize measurement error. Even with the limitations of salivary samples, research on this neuroendocrine system has grown tremendously popular because of the ease of salivary cortisol measures. Another critical challenge and possible limitation to the study is the complex and multifaceted nature of adversity in childhood. When researching stress and adversity, we must consider the type, severity, and duration of the adversity the child faces. Other factors such as the family and home environment, psychological mechanisms of coping and defense, individual 13 differences in reactivity and developmental status of the child must be account for when examining the effects of early adversity (Gunnar et al., 2009). When studying internationally adopted populations, it is often impossible to accurately discern the nature of the adversity these adopted children experienced in early childhood. This study relies on parent reports of observed conditions within the care institutions and many parents did not directly observe the actual institution from which their child came. We therefore relied heavily on the amount of time spent in institutional care in order to get a clear measurement early adversity. To further control for unknown environmental variables, recruitment efforts focused on institutionalized care within regions with well-reported adverse conditions such as eastern Europe and Asia. One final limitation of this study remains the inability to parse out the interaction of the environment with an individual’s unique genetic code to shape HPA functioning and brain development. Without biological samples from birth mothers, we have no way of accurately discerning what genetic factors influence HPA functioning and what is a product of the environment prior to adoption. Future studies should look longitudinally beyond 4 years post adoption to see if diurnal cortisol outcomes remain dysregulated or if these outcomes fade over time. If these outcomes persist over time, future research can begin to look at different early interventions to regulate the HPA axis. Future research should also look at how HPA functioning may mediate effects of early adversity on executive function development. Executive function deficits often account for similar psychopathology found in HPA dysregulation and therefore may be an important predictor in psychopathology. If we can identify the specific neural networks and functioning 14 responsible for psychopathology, early interventions can be developed and implemented to curve the trajectory of mental health issues. 15 REFERENCES Adam, E. K., Quinn, M. E., Tavernier, R., Mcquillan, M. T., Dahlke, K. A., & Gilbert, K. E. (2017). Diurnal cortisol slopes and mental and physical health outcomes: A systematic review and meta-analysis. Psychoneuroendocrinology, 83, 25–41. doi:10.1016/j.psyneuen.2017.05.018 Dozier, M., Peloso, E., Lewis, E., Laurenceau, J. P., & Levine, S. (2008). Effects of an attachment-based intervention on the cortisol production of infants and toddlers in foster care. Development and Psychopathology, 20, 845–859. https://doi.org/10.1017/S0954579408000400 Gunnar, M.R., Herrera, A., Hostinar, C.E. (2009). Stress and Early Brain Development. Encyclopedia on Early Childhood Development [online]. http://www.child encyclopedia.com/brain/according- experts/stress-and-early-brain-development. Gunnar, M. R., Morison, S. J., Chisholm, K., & Schuder, M. (2001). Salivary cortisol levels in children adopted from Romanian orphanages. Development and Psychopathology,13, 611–628. doi:10.1017/s095457940100311x Gunnar, M. R., & Talge, N. M. (2007). Neuroendocrine measures in developmental research. In Developmental Psychophysiology: Theory, Systems, and Methods (pp. 343-364). Cambridge University Press. DOI: 10.1017/CBO9780511499791.014 Jacobson, L. (2014). Hypothalamic-pituitary-adrenocortical axis: Neuropsychiatric aspects. Comprehensive Physiology, 715–738. doi:10.1002/cphy.c130036 Koss, K. J., Hostinar, C. E., Donzella, B., & Gunnar, M. R. (2014). Social deprivation and the HPA axis in early development. Psychoneuroendocrinology, 50, 1–13. doi:10.1016/j.psyneuen.2014.07.028 Raby, K. L., Roisman, G. I., Fraley, R. C., & Simpson, J. A. (2014). The enduring predictive significance of early maternal sensitivity: Social and academic competence through age 32 years. Child Development, 86, 695–708. doi:10.1111/cdev.12325 Ramey, C. T., McGinness, G. D., Cross, L., Collier, A. M., & Barrie-Blackley, S. (1982). The Abecedarian approach to social competence: Cognitive and linguistic intervention for disadvantaged preschoolers. The social life of children in a changing society. (pp. 14– 174). Hillsdale, NJ: Erlbaum. Shirtcliff, E.A., Vitacco, M.J., Graf, A.R., Gostisha, A.J., Merz, J.L., Zahn-Waxler, C. (2009) Neurobiology of empathy and callousness: implications for the development of antisocial behavior. Behav Sci Law. 27(2):137-171. 16 van der Vegt, E.J.M., van der Ende, J., Kirschbaum, D., Verhulst, F.C., Tiemeier, H. (2009). Early neglect and abuse predict diurnal cortisol patterns in adults: a study of international adoptees. Psychoneuroendocrinology. 34(5):660-669. van Goozen, S.H.M., Fairchild, G., Snoek, H., Harold, G.T. (2007). The evidence for a neurobiological model of childhood antisocial behavior. Psychol Bull. 133(1): 149-182. Vegt, E. J., Ende, J. V., Kirschbaum, C., Verhulst, F. C., & Tiemeier, H. (2009). Early neglect and abuse predict diurnal cortisol patterns in adults. Psychoneuroendocrinology, 34, 660– 669. doi:10.1016/j.psyneuen.2008.11.004 Watamura, S.E., Donzella, B., Kertes, D.A., Gunnar, M.R. (2004). Developmental changes in baseline cortisol activity in early childhood: relations with napping and effortful control. Dev Psychobiol. 45(3):125-133. 17 Name of Candidate: Jennifer Isenhour Birth date: February 12, 1982 Birth place: Huntington Beach, CA Address: 8613 MOUNTAIN MEADOW DRIVE West Jordan, UT 84088 University of Utah UNDERGRADUATE RESEARCH JOURNAL AN EXAMINATION OF SWITCHOVER COSTS Emad Jabini (Korkut Erturk) Department of Economics Abstract This project focuses on firm strategies that target consumer switchover costs of three industries: pharmaceuticals, information technology, and food processing. The project explores those that involve increasing customer dependency, predatory marketing, and hidden fees, which improve firms’ bottom line at the expense of their competitors, consumers, and the overall economy. Companies will divert resources and time concentrating on ways to undercut competition and force consumers into economic situations that make it exceedingly costly to alternate from one business to another. The aforementioned factors are considered across time and analyzed from an economic standpoint to determine the overall effects on the efficiency of markets. Four case studies of modern companies who employ these methods are presented, along with an analysis of the economic welfare cost created by such practices. INTRODUCTION In all market economies, commercial enterprises seek to increase their market share. One way they do so is through innovations that raise their customers’ switching costs, i.e., the costs— both existing and perceived—involved in shifting one’s consumption to some other product or service. Though business strategies that target switchover costs are not a recent phenomenon, the rise of the information technology revolution has created new opportunities for devising strategies that target raising them. Take for example the rise of the electronic book reader. The device enables its user to read the purchased book, at one’s leisure, with the caveat that it cannot be transferred across to another platform. Thus, with each purchased book, the consumer is locked-in further as she would lose all her books if she were to switchover to some other platform. The goal of this business model—from the perspective of the corporation—is to increase consumer retention and market share. Devices used can be as explicit as exit fees or built into the use of the product, such as in a loyalty membership program. The paper proposes to analyze how these new types of strategies that target ‘switchover costs’ are used in three key industries: information technologies, food manufacturing, and big pharma. Two case studies are discussed from each sector, focusing on their effectiveness on raising the said costs. In the IT sector, these are Skype and Apple—two companies with highly variable marketing structures that represent two polar opposite strategies within IT with respect to switching costs. For the pharmaceutical industry, the discussion focuses on Mylan, discussing recent exorbitant price hikes of their products; and on General Mills for the food manufacturing industry, discussing some of their recent innovations in agribusiness. The paper also discusses the economic welfare costs associated with these business practices, along with the legal remedies that can be used to protect consumers. BACKGROUND Switchover costs or switching costs are defined as the costs that result from switching from one product and/or service to another. A switching cost can also arise from a consumer’s desire for compatibility between a currently used product and a previously purchased one (Klemperer 1991). These costs do not necessarily have to be monetary; they can include physical and psychological dependencies on particular products, as will be analyzed in the section on the food industry. In modern market economies, a saturated field of sellers can leave consumers puzzled given the bewildering differentiation between varieties of products. With inadequate standardization, each product purchased carries with it temporal and psychological investments. This is particularly true in the field of information technology, analyzed in the next section. Switching costs can pose adverse effects on sellers, as well. In evermore-competitive market economies, sellers can be pressured to increase switchover costs to maintain brand loyalty and thus retain a customer base that can ensure steady profits. However, this can weaken competition among existing firms and lead to a decline in the general economy. The higher the switching costs, the less likely that a customer will switch sellers. Economic welfare costs are a significant externality associated with switchover costs. Switching costs can exist for firms, although they are more frequently applied to consumers. A firm can face switching costs when entering a new market, increasing production/output, switching suppliers, etc. This paper does not analyze switching costs retained by firms however, with attention paid solely to externalities faced by consumers. Although the definition of switching costs is rather broad, and can incorporate a wide range of practices, there are essentially six categories, in which a majority of switching costs fall under, ranging from economic and, physical ones, to those that are psychological. Each of these categories carries with it a degree of “lock-in,” indicating the effectiveness, which the consumer is prevented from switching away from the product. The first of these categories is compatible physical equipment. Companies will often sell a product at a lower price, if the product comes with a need for additional components over time (Klemperer 1991). Common examples of this include printers and ink or razorblades and razors. The different components must be compatible, thus the customer is locked-in further. This is especially true with the advent of information technology. For example, the more software programs a consumer buys for her computer, the higher her switching costs, as she would have to purchase those programs anew if she were to switch computer manufacturers. The second category concerns psychological switchover costs. Consider again information technology companies. As the rate of technological progress accelerates and new products are released to the public at a greater rate, switchover costs will rise, thus there is an incentive for the consumer to remain with the brand she knows more about. The greater the time and effort spent in acquiring knowledge about a particular product, the more the consumer is locked-in to that product. There may be no fundamental difference between the computers offered by Firm A and Firm B; however, the consumer will chose to remain with the brand they already know more about, and continue to purchase software or products released by the same brand. This is analyzed further in the case study for Apple, Inc. The third category of switching costs concerns psychological switchover costs that are related to uncertainty. In much the same way, they remain with a product they have learned more about, consumers also remain with a product, if they are wary of its seller’s competitors. A consumer is risk adverse and thus will not take a chance on a new product, if the one they use already works for them, even if the products are identical. Such situations are common among big pharmaceutical companies, who capitalize on a product’s brand recognition among consumers by raising the price exorbitantly and preventing and/or suppressing other pharmaceutical companies’ generic brands. This was especially true with the pharmaceutical company, Mylan, who raised prices on the epinephrine auto-injectors, known as EpiPen, by acquiring the patent and raising the price of the drug exorbitantly. Mylan and big pharma’s employment of the said switchover costs are analyzed in greater depth in the big pharma section. It is important to note that “brand loyalty” can be created simply to maintain consistency of choice. Psychological studies demonstrate that individuals will often alter their own preferences in order to justify products they have already chosen and that consumers may often buy different products under the same brand, because they were satisfied by an already purchased product from that brand (Klemperer 1991). This is especially true in the food industry, whereby consumers will by a varied host of products from the same company, if they have come to trust them. The benefit to corporations is the manipulation of consumers to believe that otherwise homogeneous products are in some way heterogeneous and thus to manipulate consumers’ preferences, to increase retention, at their detriment. The fourth category of switchover costs concerns transaction costs or fees. For example, an individual may find the need to close their bank account and transfer to another financial institution. If there were a fee associated in closing/opening said account, this would qualify as a transaction cost. This practice is most egregious in world of finance1, as a culture of fees has developed since the 1980s, whereby a majority of a banks’ revenue is derived through fees, and not loans, as was the case during pre-1980s. It is important to note that in this category, there is no fundamental difference between the products offered by competing firms. The switchover costs arise out of the transaction costs, as consumers will be less likely to transfer firms, if they know they will face such costs. This presents a low-level locking-in for the consumer, as the switching cost is a purely economic one and can be overridden, based on the individual consumer’s economic position (Klemperer 1991). Another economic switchover cost concerns rewards or perceived rewards given to the consumer because of their brand loyalty. This is the most common and identifiable form of switchover costs, and represents a wide-range of practices. They can include “frequent-flyer miles,” offered by airlines or “rewards points,” offered by banks, in order to incentivize return customers to stay with a particular company. This can even include coupons provided by retailers to their shoppers. The goal is to allow the customer to believe that they are getting more with every purchase; the more “points” a customer accumulates, the higher the switchover costs 1 See The Unbanking of America: How the Middle Class Survives, by Lisa Servon. and thus the greater the degree of lock-in. This switchover cost presents little difficulty on the part of the company, and research shows that consumers are more likely to increase their purchases and spend money, if they receive some minimal concessions from the company (Klemperer 1991). It should be considered that the benefits a consumer receives do not have to be tangible. For the switchover cost to work, a consumer need only believe that they are getting additional benefits by remaining brand loyal. It is important to note that reward-based switchover costs are not simply based on goodwill of corporations rewarding their customer base. They can be contractual, as well. Telecommunications companies such as AT&T or Verizon offer a discounted price on current smartphones, yet maintain that the user must remain with said carrier for a specific period of time, or risk paying a fine. It should be noted that, this is one category of switchover costs that do not produce negative externalities for the general economy. An argument can be made that a sixth category exists in switchover costs, that of the inadvertent physical switching costs. This is most prevalent in the food manufacturing industry, whereby consumers can be locked-in to a particular product because they are drawn to its taste, appeal, nutrition, etc. However, recent studies have shown that companies such as General Mills and Kraft Foods deliberately increased the amount of salt, sugar, and fat, in their varied products to increase their appeal and further consumer dependency on their food products. This category of switchover costs will be analyzed in-depth in the food industry section of the paper. Unfortunately, switchover costs have become the modern building blocks of competitive advantage and pricing power. The examples used highlight the prevalence of switchover costs. They are not industry specific, and have been around for quite some time. However, as market economies have expanded, and the rise of capitalism has led to greater competition among firms, switchover costs have increased in frequency and cost. They arrest the ability of consumers and to a certain extent other firms, from freely moving between products. This carries with it a host of economic welfare costs and negative externalities that allow for greater consumer concentration and expanded market share among a handful of firms, contrary to the tenets of free-market capitalism. Governmental institutions have not been instrumental in curbing high switchover costs through imposing legal threats of sanctions on firms. Thus, with everexpanding economies, firms have come to invest heavily in strategies for increasing consumerswitching costs, and such practices are now commonplace in marketing, officially known as, Customer Retention Management (CRM). The goal of these firms then becomes implementing switchover costs and then transitioning the costs from low lock-ins—practices such as fees or reward points—to high lock-ins, such as brand loyalty or learning/uncertainty. The greater the commitment from customers, the more the company has to gain, with greater economic welfare costs. INFORMATION TECHNOLOGY Since the dot-com bubble of the late 1990s, information technology companies have dominated mainstream economics. Over a relatively short period of time, companies such as Apple Computers, Google, and Facebook, among a host of others, have claimed massive consumer bases and large shares of their burgeoning market sector. With the rise of IT companies, came a new series of switchover costs, although the general structure—as discussed in the previous section—was retained. There are essentially two models of locking-in consumers in the IT sector that incorporate a host of the aforementioned switchover cost techniques. The first is “coexistence,” employed by Apple, Microsoft, and Amazon, among others. The principle of coexistence is the create an environment where a wide-variety of products are at play. The more products a consumer has to purchase and understand, the higher her switching costs will be. A closer examination of this principle will be analyzed with a case study Apple, Inc., the most successful IT company of the 21st century, aided in its ascent by its effective utilization of a network of switchover costs. The second model is “freemium,” a portmanteau of the words free and premium, used by companies such as Skype, Google, and Angry Birds, just to name a few. The concept of freemium is to initially offer a product free of charge, but charge money for additional features or services. Freemium started as a pricing strategy, however has molded to practice of customer retention. Freemium companies such as Google are interested in building greater user bases than their competitors, thus establishing both market share and brand recognition. The greater the number of users, the greater the possibility of revenue further down the line. The freemium model will be analyzed closely in the case study on Skype, which has come to dominate the telecommunications software industry by employing freemium switchover costs. Apple, Inc. Apple, Inc. was started in 1976 as a consumer electronics company. What is especially noteworthy about Apple, as compared to its competitors, Microsoft, Lenovo, etc., is that it manufactures both software systems and hardware components. As mentioned, Apple engages in a practice known as coexistence. There are four components to the coexistence model, with the first being compatibility. Part of Apple’s success in today’s market, as opposed to its struggles in the 1980s and 90s, is the wide-range of consumer electronics that can be offered to the public, none of them in isolation. Each product informs and cooperates with another. An individual who owns an Apple computer and stores their music on iTunes is more likely to purchase an iPhone than the leading competitor’s smartphone. The value of a product is thus determined in relation to its complements (Hyun & Pae 2005). This is the first switchover cost discussed in the previous section, and its effectiveness derives from its relationality. In the same way that printers need ink or video game consoles need video games, so to do computers need compatible software. What is interesting about the method of coexistence is the belief among consumers that the full system is greater than its components. Thus, once customers make an initial investment, such as purchasing the latest Apple computer, they are more likely to capitalize on their investment by purchasing a host of software systems, such as Final Cut Pro, iTunes, Safari, etc. Consumers are more likely, therefore, to purchase products that are compatible with their current systems, and the more they invest, the less likely they are to change suppliers. Furthermore, this switchover cost strategy induces a high degree of lock-in, ensuring that once customers are fully integrated with a particular series of products, they are unlikely to transition to alternative ones. It is important to note that corporations induce lack of compatibility. Apple software systems are not designed to work on PC computers and vice versa. The goal once again is to ensure that customers remain locked-in, not necessarily ‘brand loyal.’ Therefore, it can be deduced that system benefits and compatibility amongst products is positively associated with higher switchover costs (Hyun & Pae 2005). What sets Apple apart in this field, as compared to say Microsoft, is its manufacture of both its own software and hardware. This allows the company to increase its switchover costs by regulating which software systems can operate on its hardware. It prevents consumers from mixing and matching from a wide range of suppliers and once again arrests compatibility in the market. Once an individual buys an Apple computer, they are relegated to the Apple operating system and any other software systems they might desire must come from Apple. Although compatibility and system benefits are under the direct control of individual corporations, the second strategy employed by Apple is a common byproduct of the IT sector as a whole. In a high-technology environment such as the United States, the pace of technological change is rather rapid. This plays upon two psychological switchover costs discussed in the previous section: learning costs and uncertainty costs. As the pace of technological change continues to accelerate, consumers can often feel overwhelmed and uncertain about the degree of heterogeneity that exists between different products. In market economics, when such a wide disparity exists between public understanding and technology, there is often an intermediary. For example, with the advent of commercial flight, the Federal Aviation Administration (FAA) was setup to govern safety and procedure for commercial aircraft, so that consumers could be protected and would not have to learn the complexities of aerospace engineering before they got on a plane. No such regulating body exists for consumer electronics, and thus the burden of differentiation is placed on consumers. Rapid technological change, such as the yearly release of new smartphones, can make it difficult for consumers to evaluate new information and ultimately differentiate between seemingly similar products. This encourages consumers to stay with the product they already have or adopt herd behavior—being attracted to certain products, for the simple reason that they are used by others around them. Furthermore, returning to the issue of compatibility, technologies such as iPhones interface better with other iPhones, thus in a strategy appropriated from the ‘freemium’ model, individuals are incentivized to stay with their incumbent technology, or risk losing compatibility with their friends and family. Because information does not stay relevant for long, a consumer is not likely to shift to an unknown technology for fear of it becoming outmoded (Eisenhardt 1989). Thus, it can be inferred that the faster is technological progress, the higher will be consumer. Additionally, the pace of technological change is related to technological knowledge. When the pace of technological change becomes faster than individuals are capable of understanding it, then the effort that people are willing to put in diminishes. If there is a lack of understanding about technologies, then consumers can be more easily herded under one brand. Lack of information leaves consumers to choose the brands they already know. It is also important to note the rise of ‘apps,’ in today’s economy. Technological fads do not stay pertinent for long and are in a state of constant flux. As they change, consumers have a desire to remain up-to-date and will constantly swap their existing technologies for new ones. However, when combined with a relative lack of understanding about the technology they are consuming, most customers will choose to remain with their current brand. Apple paved the way for this very trend and still maintains a competitive advantage over its rivals because of it. Apple’s marketing strategy is likewise based on the notion of fads and capitalizes on their customer’s lack of knowledge on emerging technologies. Apple enjoys considerable brand loyalty from a combination of these switchover cost mechanisms. As Apple continues to increase switchover costs, consumers will become more entrenched in their current technology, which decreases time and effort to research into other brands and limits competition (Hyun & Pae 2005). People can also shift their preferences to match incumbent technologies, encouraging greater loyalty for Apple. All this serves to bolster Apple’s standing among information technology companies, as its high degree of customer retention acts as a barrier for new entrants into the IT market. Higher switching costs of its customers bolsters Apple’s standing among its competitors, thus, unless a fundamental shift occurs in the technology sector, companies such as Apple will continue to accumulate market share, at the expense of its competitors. This tends to monopolize the IT industry and disincentives innovation. Since switching costs have become the primary mode of customer retention, companies shift their focus from product development to marketing. Since consumers will not be able to tell the particular nuances of one product over another, a company’s incentive is to prevent customer switching. Although this might be beneficial for the company in question, it carries with it high economic welfare costs, as competition becomes centered on who “markets” best rather than who can produce the best product. Society pays a price, since companies are no longer as not innovative as before and technological change may stagnate. Furthermore, companies outside the IT realm, such as software developers, manufacturers, telecommunications companies, will tailor their products to be compatible with what the market deems as standard (Hyun & Pae 2005). This was the case with the introduction of the iPhone, as a majority of application developers designed their products to be compatible with Apple products and not its competitors, primarily Android. A majority of such applications are still only compatible with Apple products. This serves to cement Apple’s rule, but is highly detrimental to companies looking to enter the sector. As the economy morphs, the success of a product will not be judged by its merits alone, but by its relation to a network of products. Consumers looking to purchase products must be better informed of that product’s connection to a host of others, in order to make sound judgements on what they are investing money, time, and resources into. Skype Skype is a peer-to-peer telecommunications application software that specializes in video chat and conferencing. The application was founded in 2003, and in the past fifteen years has amassed a user base of over 650 million people, roughly 40% of the international call market (Worstall 2014). As opposed to Apple, Skype’s goal is not to limit compatibility, but to encourage it, and thus its application works on all major operating systems, including Windows, iOS, and Linux. Skype’s rise has been explosive, in part because its motive was not to generate revenue, but to generate more users. It has employed a different switchover cost model than Apple. Skype employs the “freemium” pricing strategy. As discussed, the freemium strategy is to offer the initial product free, in the hopes of generating a larger user base, and then introduce extensions to the service for a fee. This is prevalent with mobile games such as Angry Birds or CandyCrush, that allow the user to play the game free, but add-ons within the game come at a price. Other incarnations of this model can be seen with companies such as Google or Facebook, where a majority of revenue is generated through ad sales or consumer data sales that increase with the size of user base. The success of a freemium company such as Skype is based on Metcalfe’s Law, which states that the value of a telecommunications network is proportional to the square of the number of users of the system. In other words, the greater the number of users within a network, the greater the number of connections, and thus the more successful is the provider. However, the drawback of Metcalfe’s Law is that the larger the telecommunications company becomes, the higher is customer switching costs. What made Skype far more successful than its competitors was its creation of intrapersonal participant-driven networks (Hammar 2007). If an individual joins Skype, and gets her friends to join, and her friends convince their friends to join, then the switching costs and the value of Skype rise with the size of their network. An individual is far less likely to leave a service, if their friends and family are members of the service as well. Because Skype is a closed network, leaving the service would mean losing access to all of one’s friends and family who use Skype. The value of the product to an individual is thus linked to how many of their friends are using the same network. In this way, consumers perpetuate their own switching costs, as they begin to do Skype’s marketing in order to improve their own experience (Hammar 2007). Skype’s use of interpersonal networks creates psychological switchover costs for its users that tie it to the software. In a recent study, 70% of all new Skype users said that they only began using Skype after hearing about it from a friend (Hammar 2007). Skype capitalizes on the viral trend discussed in the Apple section. Since consumers are more willing to try products that do not carry economic externalities and Skype is popular among their network, the uncertainty switchover costs are mitigated in Skype’s favor. Instead, consumers form psychological brand loyalty, which decreases the chances of switching products. Skype has benefited greatly by employing switchover costs that are the polar opposite of Apple’s. The service does not run into compatibility issues and is designed to be user-friendly, and thus does not run into any learning related switchover costs. As its freemium strategy contends, Skype is a mass-market product, designed to reach a wide audience. Accessibility was high, users needing only a computer and an internet connection to use the service. Other products that employ freemium strategies, but are only tailored for a particular market segment fail much more frequently than their counterparts (Hammar 2007). Skype placed its efforts into cultivating a large user base, and could survive. With a large and devoted customer base, Skype has begun to introduce premium services and add-on features that cost money. When consumers are dedicated to a particular system, and have already invested into it, they are more readily willing to accept new and/or additional charges. Because Skype had low marginal costs, it was able to focus all of its energy on building its customer base. With an expanding market share came brand recognition. Skype became associated as the primary video chat platform, which allowed it greater psychological switchover cost potential, as users are unwilling to switch from what they perceive to be the leader or standard of a particular industry. BIG PHARMA In much of the world, pharmaceuticals are among the most advanced yet relatively one markets, in part because of regulations that keep competition strong. In the United States, however, pharmaceutical companies act with a greater degree of market power and control over consumers. The Food and Drug Administration (FDA) maintains stringent rules on drug manufacturing, which allows big pharma corporations to seize on particular niche medications and raise their price exorbitantly. Such was Mylan’s strategy with the EpiPen, which will be analyzed in the following case study. Other companies, such as Turing Pharmaceuticals or global giant Pfizer have adopted similar pricing strategies when it comes to popular and necessary drugs. The switchover cost model that many U.S. pharmaceutical companies employ, particularly Mylan, is differentiation. The goal of such a practice is to introduce a product on the marketplace, which is altered in some way from the available generic brands to manufacture brand loyalty, and then raise the price unexpectedly. Since consumers of pharmaceuticals have price inelastic demand, the tactic can reliably generate massive profits for the corporation, whilst keeping the customer base intact. This strategy creates relational and psychological switchover costs for the consumers, as they identify with a particular drug, having the perception that the brand is superior to alternatives. Mylan Mylan N.V. is American global generic and specialty pharmaceuticals corporation founded in the 1960s. The company produces a wide range of medications for all manner of ailments, from oncology to euthanasia. Like most pharmaceutical companies, Mylan is relatively unknown by the general public, however, they gained significant media attention and public criticism in 2016 over price hikes for the epinephrine auto-injector, known as the EpiPen. The EpiPen is meant to counteract the allergic reaction known as anaphylaxis, and is thus required for anyone who is prone to a severe allergic reaction, particularly children, and the elderly. Mylan has had the rights to EpiPen since 2007, after acquiring it from German pharmaceutical company, Merck. According to a report by Bloomberg Media, the EpiPen dispenses roughly $1 of medication into an individual (Koons & Langreth 2015). However, since Mylan’s acquisition of the drug, they have raised the price fivefold, settling on $600 in 2016, which was only &75 in 2001. Mylan’s price hikes for the EpiPen are not the only example of price manipulation it was involved with in the last decade. Mylan has raised the price by 20 percent on 24 products and more than 100 percent on 7 other products (Mangan 2016). The chart below highlights Mylan’s aggressive price hikes for the EpiPen: (Mangan 2016) By 2015, Mylan had an 85 percent share of the epinephrine auto-injector market and sales of the EpiPen comprised roughly 40% of their revenue stream in 2015 (Koons & Langreth 2015). It is important to note that Mylan’s price hikes in 2016 are tied to two events concerning its competitors. The FDA rejected a generic competitor to the EpiPen, produced by Teva Pharmaceuticals, and a leading auto-injector pen, produced by Sanofi Pharmaceuticals, known as Auvi-Q, was recalled, although it is now back on the market. With a near monopoly, Mylan was able to reap profits from consumers, who had no other alternatives. That Mylan could retain a large customer base despite the drastic increase in price also had something to do with its customers considering the EpiPen the seminal epinephrine injector on the market. As mentioned in the previous discussion, pharmaceutical companies take advantage of a particular pricing strategy known as differentiation, in order to create psychological and relational switching costs. Concerning Mylan’s EpiPen, what made it particularly noteworthy and patentable, was its use of the auto-injector. Unlike other epinephrine pens, such as Sanofi’s Auvi-Q, the EpiPen possessed a special mechanism that injected the medication into a person’s bloodstream, without the need for a human to press a button. This allows the EpiPen to be classified as a specialty drug and marketed to the public as such. The marketing campaign made a case for the superiority of the EpiPen and raised issues of safety and efficiency about normal injector pens. Unlike the information technology industry, pharmaceutical companies suffer from the distinct disadvantage that consumers are not so much concerned with brand recognition and loyalty, as they are with the effectiveness of the drug. Thus, in order to embed psychological switching costs to its customers, big pharma companies such as Mylan slightly differentiate their products in order to market them as better for the patient. What is remarkable about the United States is that it is one of two countries that allow direct pharma marketing to consumers, with television ads being a common example. All this serves to solidify Mylan’s position, because once consumers can identify Mylan’s EpiPen and associate it with a particular ailment, they can self-diagnose demanding that particular medication from their healthcare provider. This creates both a relational and psychological switchover cost. Consumers identify with a particular brand and differentiate it from other, regardless of its effectiveness. Secondly, by using the product consumers form a psychological relationship with it, especially if the product is effective. Part of Mylan’s marketing campaign upon acquisition of the EpiPen patent was to lobby the FDA and the U.S. Congress to have the EpiPen stocked in public places, such as schools, much like defibrillators (Helfand 2016). Mylan’s success is evident in the colloquial use of “EpiPen” as a blanket term for all anaphylaxis remedies, much like the use of “Prozac” to denote all depressive disorder remedies. The goal of these marketing strategies is to make the consumer feel as if there is an absence in their life and in their health without their use. By highlighting a differentiated problem, companies like Mylan can offer their solution, at a price. This once again ties a particular ailment with a particular problem and encourages consumers to associate Mylan’s product with its remedy, creating yet another psychological switching cost. This is why marketing has become more important to U.S. pharma companies, as opposed to their counterparts in other regions. Once the brand has started becoming popular and more commonly used, the price hikes begin, as in 2011. Much like Apple or Skype, over time, it becomes less about building an effective product, but rather about building an effective brand. If consumers can be persuaded that Mylan’s product is superior, then Mylan’s product or the product of any pharmaceutical company will be more successful. Furthermore, unlike IT or the banking industry, consumers of pharmaceuticals generally have more price inelastic demand and are thus more likely to go along with price hikes, albeit begrudgingly. This involves high customer switching, which are often bolstered by loss aversion. The pain of giving up a benefit is much more psychologically significant than the pleasure of gaining that benefit. Thus, if consumers believe that a particular product is working for them, then they are less likely to forgo that product, despite a steep price increase. Additionally, as discussed earlier, people often change their preferences in favor of the product they are using, and becoming even less likely to switch products. After significant pressure from the media and the United States Congress, Mylan eventually produced a generic version of the EpiPen, which it marketed at 50% of its 2016 value, still far above the actual value of the drug contained in the injector. Mylan relented under public scrutiny; however, it was incredibly successful in generating profits, roughly $1.5 billion in 2016 alone (Willingham 2016). Mylan’s success is part of a trend, with many of the largest pharmaceutical companies having similar strategies for generating profits. Pfizer, Inc., another multinational pharmaceutical giant, has raised the prices on some of their most popular medications on an annual basis. The company is also known for its aggressive marketing campaigns around such products as Viagra, Zoloft, and Lyrica. In 2009, Pfizer settled a lawsuit for $2.3 billion after it was reported that the company marketed Lyrica, along with several other drugs, for non-approved uses (Harris 2009). Pfizer has been especially successful in its marketing of the erectile dysfunction drug, Viagra. The company’s successful marketing has placed the drug under Medicare coverage and adopted by popular culture as a stand-in for all dysfunction concerns. If Pfizer were to raise the price of Viagra as exorbitantly as Mylan raised the price of EpiPens, their loss of market share might remain limited on account of a series of embedded psychological switchover costs. FOOD INDUSTRY Unlike its counterparts in the information technology or pharmaceuticals sector, the food manufacturing industry is well organized and relatively homogenized. The oligopoly of food manufacturers consists of a few multinational firms: General Mills, The Kraft-Heinz Company, Nestle, Procter and Gamble, and Nabisco. Each of these companies produces a wide range of products, from all corners of the culinary palette, including cereals, sodas, ready-made meals, baked goods, etc. Michael Moss describes in his novel, Salt, Sugar, Fat, how these corporations met in 1999 in order to decide how they would divvy up the world’s “stomach share.” Their tactics involve inculcating psychological, physical, and economic customer switchover costs that have allowed them to continue dominating the food. Their most common and profitable products have three underlying attributes: convenience, cravings, and cheapness. Robert Lustig argues in his book, Fat Chance: Beating the Odds against Sugar, Processed Food, and Disease, that each product is scientifically engineered with a balance of sugar, salt, and fat, to maximize its appeal to the public and thus form a committed customer base. Combined with aggressive marketing, low prices, and a high convenience factor, consumers are locked-in to these products. What is most egregious about these switching cost mechanisms is that unlike the efforts of Apple or Mylan, consumers of these goods can become physically addicted to these substances. This physical dependency produces switching costs not seen in other industries and thus makes food industry companies such as General Mills or Kraft Foods wield large power, over both the market and their customers. These switchover costs are unlike any seen in other industries, and General Mills is used as a case study to address them. General Mills General Mills was first founded in 1928, after a merger of the Washburn-Crosby company and 28 other mills in and around Minneapolis. In its 90-year tenure, the company has transformed into one of the largest manufacturers of processed foods, sporting a brand portfolio just under a hundred, with some of the world’s most iconic cereals. General Mills’ mission statement is “Nourishing Lives,” although its history demonstrates that the company is primarily interested in what Michael Moss refers to as “stomach share.” What this term refers to is the percentage of control that certain companies can exert on the average daily consumption of an adult, particularly those living in North America. Thus, the goal of a company such as General Mills is to ensure that they are responsible for manufacturing a majority of the food Americans consume. As mentioned in previous case studies, companies such as Apple and Mylan do not have incentive in constant innovation to attract new clientele. Instead, the focus is on making sure the current base is intact, so that the company will remain profitable. The same applies to food processing companies, yet individuals can only consume so much before the point of satiation. The goal then becomes two-fold: marketing, and manufactured cravings. For companies such as General Mills and Kraft, their products, such as their cereals, are similar nutritionally, thus functionally. Taste differs from person to person, so in order to capture a larger market share than one’s competitors, a company has to induce individuals to continue to buy their products. This is where three key ingredients come into play: salt, sugar, and fat. Since the 1950s, food scientists employed by these corporations have been increasing the amounts of the three aforementioned ingredients in order to arrive at a “bliss point,” or the right amount of ingredients to generate the highest amount of appeal among consumers to leave them craving for more (Moss 2013). This is not simply about taste. Every concoction is measured for the right texture, color, smell, feel, etc. The term “processed food” may be a part of our lexicon now, but it is derived from this process, whereby every element of a particular product is meticulously controlled. This process does not simply apply to companies such as General Mills, Kraft, and Nabisco. Practices such as these can be found among even the meat industry, where companies such as Tyson Foods feed their livestock steroids, such as Zilmax, and antibiotics, in order to get larger, safer meat (Leonard 2014). The goal of these practices is to increase the allure of their foods, whilst minimizing the costs incurred by the corporation. Salt, sugar, and fat are relatively cheap products, and once the bliss point is reached then, consumers will continue buying products, without needing to invest in innovation. All three of these ingredients have adverse effects on the brain, with sugar shown to work on neural pathways in much the same way as cocaine. Sugar can be addictive and consumers are impervious to how much they are consuming in their daily meals. All this serves to increase physical and psychological customer switchover costs. A consumer can have a craving for a particular product, and yet not know why they are craving. Food additives are a recurring phenomenon in the food processing industry. If a corporation wants to add an additive to their foods, they do not have to consult the FDA, but can hire a consulting firm to employ what is known as the Generally Recognized as Safe or GRAS procedure. This is voluntary, and a Pew Research Center study concluded that there could be as much as 1,000 ingredients in common foods that the FDA is unaware of (Bellatti 2013). By enhancing addictive substances, General Mills can reliably ensure that consumers return to their products, as they will develop psychological and physical dependencies. However, what is most egregious about this process is that the largest food processing companies take part in this exercise. Thus, the American consumer is caught in a cycle of additives, with very little recourse. By presenting a united front, companies like General Mills can ensure that consumers stay dependent on their processed foods, regardless of which company it originated from. It is a switchover cost for society as a whole. This process is started early on with the advent of children’s cereals. In the 1960s, General Mills began two marketing campaigns targeted at children. They placed toys in cereals and began sponsoring children’s programs (Heintjes 2013). The goal of such an enterprise was to have children be weaned on sugary products early on, in order to develop a palette for the taste and craving for additional products later on. Today, General Mills is the number one producer of adult and children’s cereals, its products are just as sugary and addictive as they were in the 1960s (Moss 2013). Targeted advertising to children creates a culture of dependency on these foods and increases the lock-in power of psychological switchover costs. The role that the colorful cartoon mascot found on most cereal boxes plays is psychological association. Children can identify with the positive character and associate it with the food they are consuming. General Mills’ goal is to start the process of high switchover costs at an early age to maintain the customer base into adulthood. Other food processing companies such as Kellogg’s, Nabisco, and Nestle have incorporated this tactic as well. Consider for a moment the role of the grocery store. The grocery store is, today, an almost exact equivalent of the amusement park: a sensory-charged labyrinth wrapped in a particular theme, meticulously designed to promote “gluttony,” which the population is too desensitivized to treat the phenomenon as ordinary. Much of the design of grocery stores and supermarkets is centered on the transformation of nature into the material; each product is not so much defined by its accessibility or nutritional merits, instead by an aesthetic palette: taste, shape, color, size, etc. Even the shelf-space is designed in a way to draw the eye to the most colorful and attractive products on display. By turning food into an “experience,” you increase the possibility that customers will return. Every detail is designed carefully to appeal to individuals’ aesthetic triggers in order to encourage them to return. As previously mentioned, corporations like General Mills do not only control the taste and health content of their varied products, but also seek to maximize its aesthetic appeal, including its texture and color (Moss 2013). All this serves to create psychological triggers for the consumers who will be satisfied by all aspects of the product and drawn to it again in the future through cravings. There are also the issues of convenience and cheapness. In a modern world, consumers demand convenience from their foods. In response to this, General Mills advertises its food as easy to prepare. Such is the case with their ready-made meal brands like Pillsbury. These are all marketed at low prices to appeal to a large audience. As seen in the case studies for Apple and Mylan, individuals will often change their preferences over time to match the product they begin consuming. If one of General Mills’ products aesthetically satisfies an individual, then she is more likely to try other products from the company. This establishes relational switchover costs for the consumer, whereby she is trapped in a cycle of consuming products from the same corporation. Unsurprisingly, General Mills has found a way to benefit from recent health trends. There has been a societal trend to reject processed foods and stray toward healthier options. General Mills and other food processing companies have incorporated this into their marketing strategies as well. They now create products that are designed with certain words, such as organic, protein, supplements, etc. meant to elicit particular emotional responses—“fat” is inherently bad and “organic” is equated with health. Nestlé’s Lean Cuisine brand is one such example of this practice. However, there is no demonstration that these products contain ingredients that are healthier than the other options. The goal here is to once again create psychological triggers between certain words and images and foods, whilst making the foods themselves as addictive as possible to encourage consumers to return for more. The uniformity of these practices in the food processing industry makes their strategies to raise customer switchover costs particularly malicious and much more difficult for consumers to escape. ECONOMIC WELFARE COSTS The case studies presented on Apple, Skype, Mylan, and General Mills highlight a consistent pattern among corporations of finding methods to raise their customers’ switchover costs. Although this is detrimental to consumers, there are implications for the general economy as well. Economic welfare costs are defined as those that decrease social welfare because of various market failures. Switchover costs also give rise to welfare costs, including, but not limited to monopolization, lack of innovation, price hikes, network externalities, and stifled economic growth rates. Allowing corporations to employ strategies to raise customer switchover costs is detrimental to the whole of society and the values of competitive capitalism. Governmental institutions must find legal remedies to curb such business strategies, to not only protect consumers or mitigate welfare costs, but also to ensure a fair and equal economic process for all corporations. Consider for example the case of Mylan. After the EpiPen debacle of 2016, the company settled a suit brought by the U.S. Department of Justice for $435 million over the misclassification of the EpiPen as a generic, rather than a proprietary product under the Medicaid Drug Rebate Program. The same year, an analysis performed by the U.S. Department of Health and Human Services found that the U.S. Government had overpaid by as much as $1.2 billion to Mylan for the EpiPen, since the company’s acquisition of the product in 2007 (Thomas 2016). Mylan’s profits from the U.S. government alone are roughly three times the amount it paid in its settlement. The only other stipulation of the agreement was the Mylan sign an integrity agreement, stating that they would refrain from such activities in the future. This lax enforcement by the U.S. government only encourages corporations such as Mylan to continue their unlawful practices, as they can reap far greater profits than the fines they might be forced to pay. Thus, there are minimal deterrents against such practices. Treatment of corporations like Mylan demonstrate that there are minimal repercussions and it is more beneficial for corporations to employ strategies that raise customer switchover costs in order to gain additional market share and retain their customer base. The banking industry experienced similarly lax repercussions after the recession of 2007-08, which has encouraged additional speculative behavior in the years following the economic downturn. A company such as Apple has more to gain from raising switchover costs compared to what it stands to lose from government fines. This situation then encourages other corporations to follow suit, since they expect to face minimal punishment from the government and cannot risk losing additional market power to their rivals, as was the case with General Mills. Thus, a business culture that targets customer switchover costs is created, with corporations constantly outmaneuvering each other, to the detriment of the consumer and the economy. The economic welfare costs associated with these practices is the monopolization of major industries. The allure of monopoly profits draws corporations to these practices. In a market economy, a corporation with a locked-in customer base can exploit its customers by charging monopoly prices, as was the case with Mylan and the EpiPen (McSorley, et. al. 2003). As corporations lock-in customers, competition among firms is stifled. Once corporations gain monopoly power, they set high entry barriers that make it increasingly difficult for new institutions to emerge and compete (Farrell & Shapiro 1988). This would only motivate existing corporations to continue price manipulation in order to maintain their market share. This can be seen with the case studies on Apple and General Mills. A lack of competition stifles market growth, and the general economy suffers as a result. Furthermore, as was the case with Apple and Skype, monopolization diminished innovation. Rather than product development, corporations instead place their efforts into marketing. Companies risk valuable R&D funds in order to improve profit-seeking strategies. Additionally, if only a handful of firms exist, then the opportunities of wide-ranging innovation by new corporations are minimized. In all fairness to the government, some of the switchover costs, particularly the psychological switching costs employed by General Mills or Skype are hard to identify and regulate. Part of the responsibility must lie on the consumers, who can be educated in how corporations can behave in ways that reduce their welfare. The government can help educate consumers on the various products and foods they are consuming. This is particularly relevant in information technology. Companies such as Skype can create network externalities, where the value of their product increases for the consumer with each additional user, entrenching them in its use. As technology continues to become an integral part of the everyday experience, it is paramount that consumers know the particulars of the system they are adopting. Once the network is in place, switchover cost methodology stipulates that it will be difficult to undo. CONCLUSION Switchover costs have become a fundamental part of business strategy and they can be found in industries as wide-ranging as information technology, pharmaceuticals, and food processing. A pattern has emerged, whereby leading corporations are seeking profits more through expanding market share than through innovation and product development. The examples from Apple, Skype, Mylan, and General Mills demonstrate the different ways in which firms strategize to raise customer switchover costs at the expense of their wellbeing. These strategies include not only engineering products to inculcate physical and psychological dependencies, and relational triggers, but also those that involve imposing explicit fees and monetary penalties on consumers who move to another product. Corporations have mastered tactics that lock-in consumers to their s products and services. IT companies, such as Apple or Skype employ business models that focus on customer learning and other psychological costs to retain their customer base. Big Pharma companies like Mylan and Pfizer encourage brand loyalty through relational and psychological connections between their products and various medical conditions. Finally, food-processing giants like General Mills, Nestle, and Kraft Foods tinker with their product ingredients to make consumers physically dependent on their products, and target children in advertising to inculcate dependency early on. All these mechanisms and maneuvers are only a small fraction of the various business strategies that target raising customer switchover costs that exist in the general economy. Corporations from the banking industry to telecommunications adopt switchover cost mechanisms to lock-in their customers and expand their profit and market share. All these tactics however damage the social welfare of society, adversely affecting innovation and product development, and of course market competition. Legislation, governmental oversight, and consumer behaviors have done little to curb these corporate practices, if not made them worse. But, both governmental institutions and consumers must take a stronger stand in combating them for the health and continued vitality of our market economy. REFERENCES Bartolotta, D. (2016, August 18). Cost Jumps Nearly 500-Percent For Life-Saving EpiPens. Retrieved from https://baltimore.cbslocal.com/2016/08/18/cost-jumps-nearly500-percent-for-life-saving-epipens/ Bellatti, A. (2013, February 26). Opening Pandora's Lunchbox: Processed foods are even scarier than you thought. Retrieved from https://grist.org/food/opening-pandoraslunchbox-processed-foods-are-even-scarier-than-you-thought/ Eisenhardt, K. (1989). Making fast strategic decisions in high-velocity environments. Academy of Management Journal, 33 (September), 543-579. Farrell, J., & Shapiro, C. (1988). Dynamic Competition with Switching Costs. RAND Journal of Economics, 19(1), 123-137. Retrieved from https://www.jstor.org. Hammar, N. (2007, March). Skype - Reasons for Growth. Retrieved from http://arc.hhs.se/download.aspx?MediumId Harris, G. (2009, September 02). Pfizer Pays $2.3 Billion to Settle Marketing Case. Retrieved from https://www.nytimes.com/2009/09/03/business/03health.html Heintjes, T. (2013, March 05). Whatever Happened to Total TeleVision productions? Retrieved from http://cartoonician.com/whatever-happened-to-total-televisionproductions/ Helfand, C. (2016, March 01). FDA swats down Teva's EpiPen copy, putting Mylan in cruise control. Retrieved from https://www.fiercepharma.com/sales-and-marketing/fdaswats-down-teva-s-epipen-copy-putting-mylan-cruise-control Hyun, J., & Pae, J. (2005). The Role of Switching Costs in Technology Commitment: The Case of High Technology Market. Retrieved from http://acrwebsite.org/volumes/11918/volumes/ap06/AP-06 Klemperer, P. (1995). Competition when Consumers have Switching Costs: An Overview with Applications to Industrial Organization, Macroeconomics, and International Trade. Review of Economic Studies, 62, 515-520. Retrieved from https://www.nuffield.ox.ac.uk/ Koons, C., & Langreth, R. (2015, September 23). How Marketing Turned the EpiPen Into a Billion-Dollar Business. Retrieved from https://www.bloomberg.com/news/articles/2015-09-23/how-marketing-turned-theepipen-into-a-billion-dollar-business Leonard, C. (2015). The Meat Racket: The Secret Takeover of America's Food Business. New York City, NY: Simon & Schuster. Lustig, R. (2012). Fat Chance: Beating the Odds Against Sugar, Processed Food, Obesity, and Disease. New York City, NY: Avery. Mangan, D. (2016, August 24). How Mylan hiked prices of many other drugs besides lifesaving EpiPen. Retrieved from https://www.cnbc.com/2016/08/23/how-mylan-hikedprices-of-lots-of-other-products-besides-life-saving-epipen.html McLean, B. (2014, February 28). Book Review: 'The Meat Racket' by Christopher Leonard Retrieved from https://www.washingtonpost.com/opinions/book-review-themeat-racket-by-christopher-leonard/2014/02/28/3000c400-934c-11e3-84e127626c5ef5fb_story.html?noredirect=on&utm_term=.a30832ef7910 McSorley, C., Padilla, A. J., Williams, M., Fernandez, D., & Reyes, T. (2003). Switching Costs. National Economic Research Associates, 10-15. Retrieved from http://webarchive.nationalarchives.gov.uk/ Moss, M. (2014). Salt Sugar Fat: How the Food Giants Hooked Us. New York City, NY: Random House. Schmitz, A. (2012). Switching Costs are Everywhere. Retrieved from https://saylordotorg.github.io/text_developing-new-products-and-services/s13-02switching-costs-are-everywhere.html Thomas, K. (2016, October 07). Mylan to Settle EpiPen Overpricing Case for $465 Million. Retrieved from https://www.nytimes.com/2016/10/08/business/epipen-mylanjustice-department-settlement.html?ref=topics&_r=0 Warner, M. (2014). Pandora's Lunchbox: How Processed Food Took Over the American Meal. New York City, NY: Scribner. Willingham, E. (2016, August 25). Why Did Mylan Hike EpiPen Prices 400%? Because They Could. Retrieved from https://www.forbes.com/sites/emilywillingham/2016/08/21/why-did-mylan-hike-epipenprices-400-because-they-could/#2f40a051280c Worstall, T. (2014, January 17). Skype Is Now 40% Of The Entire International Telephone Market. Retrieved from http://www.anorak.co.uk/383464/money/skype-isnow-40-of-the-entire-international-telephone-market.html Jenkins 1 University of Utah UNDERGRADUATE RESEARCH JOURNAL ASSESSING SNOW DEPTH FROM PASSIVE MICROWAVE David G. Jenkins, S. McKenzie Skiles Department of Geography Introduction Water is one of the most precious natural resources on Earth. Global climate changes to the Earth system are altering the distribution of water resources in part through the rapid melting of snow and glaciers, which act as fresh water reserves. “One-sixth of Earth’s population depends on snow- or glacier- melt for water resources, and people in these areas generate onefourth of the global domestic product” (Barnett et al., 2005). For example, downstream of the Himalayas there are 1.3 billion people, many who depend on the water reserves held in the Himalayan snowpack and glacial ice. Although there is a general understanding of how much water come from snow in these regions, there is limited knowledge regarding snow cover dynamics and snowmelt timing. This region of the world has limited infrastructure, which can buffer the water supply, and therefore is more susceptible to climate change. To prepare for the foreseeable changes an adequate assessment of downstream water resources is needed to support the managerial decision-making process from local to regional scales. Being able to use satellite imagery is the most plausible method for quantifying the water resources in the Himalayas, especially for snow water resources, because snowfall tends to be concentrated the greatest in regions where direct observations are logistically unrealistic (ICIMOD et al, 2016). Remote sensing technology and tools are advancing, and the information acquired could better prepare resource managers for variability and long terms Figure 1: Insert Map changes associated with climate change in a highly susceptible region of the world. This project contributes to a NASA SERVIR project (https://www.nasa.gov/mission_pages/servir/himalaya.html), a capacity building effort between NASA and USAID, that transfers remote sensing knowledge to regional stakeholders. The project is developing remote sensing tools to improve water management south of the Himalayas, and one of the final aims of the project is to provide more accurate estimates of the contribution of snow water melt to total runoff over time, and the likely impacts of climate change on this value. This research contributes to the broader project goals by carrying out a validation of spaceborne snow remote sensing products, over a study region within the Sierra Nevada mountains, to determine their validity for potential future usage in the Himalayas. This region has more observations than the Himalaya, and my project will focus on a comparison between known snow depth values derived from the high-resolution Airborne Snow Observatory (ASO) Jenkins 2 to the newly developed spaceborne Advanced Microwave Scanning Radiometer (AMSR2) over the study region of Tuolumne basin, California (Figure 1). Methods Spaceborne Advanced Microwave Scanning Radiometer, a passive method based on emission of microwaves from the earth, and the Airborne Snow Observatory, which uses lidar to take the difference in snow free and snow on surface elevations, are two ways to map snow depth values. Passive microwave is very coarse spatial resolution, 25 km, whereas lidar is very high resolution, 3m. To address the limitations of the coarse resolution in mountainous terrain we downscaled the AMRS2 data to 500 m using snow covered area from the Moderate Resolution Imaging Spectrometer (MODIS). To facilitate comparison, we upscaled the ASO data to the same 500m resolution. By comparing the more accurate values of ASO to the unknown validity of AMSR2, a metric of accuracy is derived. This determines whether downscaled AMSR2 values are viable for future usage in water resource management. Much of the work conducted resided in the acquisition and processing of the AMSR2 data. Given that the data Figure 2: Raster Preparation are only available through an FTP server and the information being accessed needed to overlap with the days that ASO had flown over the study region, it required to download, query, convert and visually analyze the ASMR2 raster data (± 50GB) in order to prep the data for a difference calculation (Figure 2). Once the raster data corelated to the same day, resampled to the same spatial resolution, and encompassed the same areal coverage a difference calculation was conducted to determine the difference in accuracy between ASO and AMSR2 values. Results The flight days for ASO exist across a series of days ranging from 2016-2018, and difference maps were created based on the availability of data with corresponding days of ASO and AMSR2 data (Figure 3). This resulted in the opportunity to analyze snow depth for only seven days, due to the time of year ASO gathered data and inability of AMSR2 to image low snowcovered area. The reported AMSR2 mean snow depth is off by a magnitude of two or even three times the ASO mean recorded snow depths (Figure 4). Thus, it has been determined that AMSR2 snow depth values are unfeasible for future use in quantifying snow depth over mountainous terrain, given its lack of available data, coarse resolution, and inconsistent magnitudes of error. Additional advancements to spaceborne remote sensing of snow, that do not rely on passive microwave, are recommended in order to be used in snow water estimations. Jenkins 3 Figure 3: Difference Map Figure 4: Statistical Comparative References Barnett, T. P., J. C. Adam, and D. P. Lettenmaier (2005), Potential impacts of a warming climate on water availability in snow-dominated regions, Nature, 438, doi:10.1038/nature04141. ICIMOD. "Measuring and Modeling Snow Cover and Melt in a Himalayan Catchment." International Centre for Integrated Mountain Development (ICIMOD), 2016, pp. 1-26. Painter, Thomas H. "The Airborne Snow Observatory: Fusion of Scanning Lidar, Imaging Spectrometer, and Physically-based Modeling for Mapping Snow Water Equivalent and Snow Albedo." Remote Sensing of Environment, vol. 184, Oct. 2016, pp. 139-52. Science Direct, doi.org/10.1016/j.rse.2016.06.018. Accessed 20 June 2018. ---. "Retrieval of Subpixel Snow Covered Area, Grain Size, and Albedo from MODIS." Remote Sensing of Environment, vol. 113, 15 Apr. 2009, pp. 868-79. Science Direct, www.sciencedirect.com/science/article/pii/S0034425709000029. Accessed 20 June 2018. University of Utah UNDERGRADUATE RESEARCH JOURNAL DENDROECOLOGY OF PINUS PONDEROSA IN THE UINTA MOUNTAINS, UTAH Joshua Krahulec (Mitchell Power) Department of Geography Introduction: Western conifer trees can contain detailed histories of the climatic conditions they have experienced during their lifetimes. Understanding past climate changes and ecological responses broadens our knowledge of natural variability and allows better predictions of how future changes may affect these ecosystems. In order to improve our understanding of the climate history of northeastern Utah, dendrochronological (tree-ring) records from the Uinta Mountains were developed for this project. The study area was located in the Moon Lake basin on the southern slope of the Uinta Mountains. The watershed contains a natural lake was artificially expanded to a large reservoir (49,500 acre-feet) by the construction of a dam in the mid-20th century. Moon lake is surrounded by montane forest composed of mixed conifer species, including Pinus ponderosa (ponderosa pine). Ponderosa occur in mixed conifer stands of Douglas fir, juniper, aspen, manzanita, and giant sagebrush, among other species on the eastern side of the basin. On the western side of Moon Lake, they occur in both pure and mixed stands, leading to my two hypothesis; that 1) ponderosa pine can provide a tree-ring based climate record, and 2) that the construction of the dam created a barrier that isolated the two communities and has resulted in different ecological impacts over the past several decades. Ponderosa was selected for sampling as it is a climatesensitive tree that provides clear annual separation in its rings. Methods: Field surveys of the Moon Lake basin were conducted April-July 2018. General floral assemblages were recorded, and mature and/or fire-scarred Ponderosa were targeted for sampling. A series of 32 tree cores were taken from 20 individuals using a standard increment borer. Ring widths on the processed cores were measured using a Velmex system and MeasureJ2X software. Disconnected segments of the cores (floating chronologies) were eliminated from the analysis. Several cores with uncertain sequences due to cracking or resin obscuring were also omitted. A time series was constructed from decadal growth averages and compared with PRISM climate data6 and a charcoal analysis from lake sediments3. Difference of means tests were conducted to determine there was statistically significant variation in population characteristics between the tree stands on either side of the lake basin. Results: • Population: The majority of mature Ponderosa observed during field survey were firescarred, not unusual for burn-damage-resistant trees often found in areas with frequent fire2,4. Many of the trees sampled also exhibited heart rot, indicating ecological stress. The growth rate time series (figure I) developed from samples revealed several significant growth spikes (likely caused by changes in seasonal precipitation), a general gradual decline in growth from the late 18th century through the end of the 19th century, and an abrupt decline in the early-to-mid 1900s, followed by stabilization into a lower growth rate. This rapid decline may have been caused by drought implicated in the midwestern dust bowl phenomenon. An age depth model (figure II) demonstrated that a major recruitment pulse of Ponderosa occurred in the mid-to-late 1800s, during which moisture and fire conditions were favorable to the trees. • Precipitation: When the growth rate time series was compared with an assortment of seasonal precipitation records for the area, wintertime precipitation showed the strongest match. This aligns with previous research suggesting that snow accumulation is the primary moisture source in many western montane forests5. A precipitation peak in the early 1900s correlates with a growth spike in the Ponderosa, also identified in other western forests4. A later precipitation peak ca. 1980 corresponds with only a minor growth spike, but the peak was brief, and the 20th century decline in growth rates may have minimized its impact. Precipitation data does not reach back far enough to capture the mid-1800s growth spike, but that phenomenon has been noted in other research conducted both locally and regionally1,4. • Intra-basin variation: Statistical analysis determined that there is less than 70% confidence (p=0.337) that there is significant growth rate or age depth variation between the stands of Ponderosa on either side of the lake basin, inadequate to conclude that there is true divergence between the two stands. However, the sample size of this study was relatively small for statistical analysis, further field survey will be necessary to test if this hypothesis is plausible. • Fire: A charcoal analysis from lake sediments3 did not show significant time overlap with the tree growth series, but several notable associations are apparent. Charcoal peaks (evidence of fire in the basin) follow periods of high precipitation shown in the growth time series (late 1700s, mid 1800s), as the proliferation of plant growth during wet periods provides a fuel source for fires in subsequent years2. These charcoal peaks are also aligned with recruitment pulses of the Ponderosa, indicating that these burn-resistant trees benefit from fire removing other competitive plants, as has been suggested in other research2,4. Finally, the area experiences a regular fire regime2,3, which is conducive to maintaining Ponderosa populations2,4. Conclusions: The field and laboratory findings depict a once-flourishing population of trees exhibiting symptoms of ecological stress. Gradual reductions in growth rate observed in the time series may be explained as natural slowing of growth as trees mature, but the abrupt decline and depressed growth of the 20th century remains unexplained. It is possible these trees are living at the edge of their ecological niche, and the shifting conditions of the past century are pushing them towards population collapse. Modern fire suppression may also be implicit by allowing competitive species to gain a foothold, as well as accumulating plant matter that may fuel large enough fires to kill the Ponderosa. Further research may provide insight on the climatic factors influencing this forest, as well as the impact of human activity in the area. AVERAGE GROWTH RATE 1.6 AVERAGE GROWTH (IN MM) 1.4 1.2 1 0.8 0.6 0.4 0.2 DECADE Figure I: Average Growth Rate Series: Decadal growth averages across all samples. Figure II: Age Depth: Histogram of tree ages, divided into age brackets. References 1. Bekker, M.F., DeRose, R.J., Buckley, B.M., Kjelgren, R.K., & Gill, N.S. (2014). A 576-year Weber River streamflow reconstruction from tree rings for water resource risk assessment in the Wasatch Front, Utah. Journal of the American Water Resources Association. 2. Brown, P.M., Heyerdahl, E.K., Kitchen, S.G., & Weber, M.H. (2008). Climate effects on historical fires (1630–1900) in Utah. International Journal of Wildland Fire, 17, 28-39. 3. Kennedy, Andrew. (2019). Unpublished thesis. 4. Savage, M. (1991). Structural Dynamics of a Southwestern Pine Forest Under Chronic Human Influence. Annals of the Association of American Geographers, 81 (2), 271-289. 5. Szejner, P., Wright, W.E., Belmecheri, S., Meko, D., Leavitt, S.W., Ehleringer, J.R., Monson, R.K. (2018). Disentangling seasonal and interannual legacies from inferred patterns of forest water and carbon cycling using tree‐ring stable isotopes. Global Change Biology. 6. Westmap Climate Analysis Tool. PRISM Group/Western Regional Climate Center. Retrieved from https://cefa.dri.edu/Westmap/Westmap_home.php?page=timeseries.php University of Utah UNDERGRADUATE RESEARCH JOURNAL GPS Reliance and its Effect on Working Memory and Spatial Ability Alexis Kunz (Dr. Kristina Rand, Dr. Ian Ruginski) Department of Psychology As cell phone usage and technology is increasing in prevalence and its capabilities to the everyday user, the usage of tech-based navigational aids has also increased exponentially (specifically, the use of GPS maps on cellular devices). On the surface, this looks like a positive – electronic navigational assistance is faster than making a detailed plan from a physical map, requires less attention, and can be used on devices that are usually within reach of that individual most of each day. However, there are tradeoffs in effectiveness of physical compared to electronic navigational aids. While a physical map takes more time to plan out directions, it does not require battery life and allows users to remember cardinal information of an environment. Electronic navigational aids, while they are significantly faster, are constrained by requiring some sort of battery and service reception in order to function, and may not require learning cardinal information. Several prior studies have investigated the trade-offs associated with GPS use on spatial learning. When comparing traditional GPS directions to a physical map or direct experience, those traveling with GPS performed more poorly when asked to sketch a map of a route previously learned, were slower in traveling, and made larger errors when asked to recall directions (Ishikawa, Fujiwara, Imai, & Okabe, 2008). While this study measured more shortterm effects of the two aids, potential problems in acquisition of spatial knowledge (e.g. sense of direction, position in space, cardinal directions) can arise for users in long-term settings as well (Ishikawa, 2018). As relying on GPS to navigate throughout environments increases, the user’s ability to actively encode the environment through a visual search (i.e. paying attention to surrounding buildings, street signs, or markers) consequently decreases, which can in turn hurt incidental learning of an environment (Munzer, Zimmer, Schwalm, Baus, & Aslan, 2006). As such, problems in learning environments in potential emergencies can occur (Steele, 2018), such as instances where the medium for the GPS is dead or there is no service in an area a user is unfamiliar with. In addition to the spatial skills discussed above, potential problems can occur through reliance on GPS related to visuo-spatial working memory (VSWM) as well. Known initially as the visuo-spatial sketch pad (VSSP) by Baddeley (1981), this form of working memory relies on spatial and visual cues in encoding information, and differs from the more extensively-known articulatory loop (which relies on auditory cues). VSWM capacity has an influence on how people form spatial mental models (Gyselinck, De Beni, Pazzaglia, Meneghetti, & Mondoloni, 2007), which can in turn affect the way in which we create cognitive maps, as coined by Tolman (1948). Weisberg and Newcombe (2016) partially confirmed this, and found a relation between those who did poorly as a whole on a large-scale spatial ability task and low working memory capacity (there was no relation for any other group that did well in any other aspect of the task). Known sex differences exist (e.g. Padilla, Creem-Regehr, Stefanucci, & Cashdan, 2017; Vashro, Padilla, & Cashdan, 2016), as females traditionally perform worse on spatial tasks than men, creating more of a barrier for problems to arise in these areas. As such, there may be a disparity in how GPS is utilized and to what extent, which may have an effect on certain aspects of the population (i.e. women). Studies have been done that tested GPS and its overall effect on spatial ability (e.g. Ishikawa, 2018; Steele, 2018; Gramann, Hoepner, & Karrer-Gauss, 2017; Bakdash, 2011; Leshed, Velden, Rieger, Kot, & Sengers, 2008); however, there has been a lack of research that examined the relationship among spatial ability, VSWM, and extensive GPS reliance rather than general usage (as users can utilize GPS for tasks other than navigation, e.g. traffic and time estimates). The purpose of this study is to determine if there is a relationship between a user’s level of GPS reliance and their overall level of spatial ability, as well as VSWM capacity. As GPS devices are now fully integrated into society, measuring the long-term effects of reliance on current generations (i.e. those who have had access to GPS from a young age) will be useful in determining potential modifications to allow subsequent generations a better, more spatiallyimmersive device that will encourage better utilization of VSWM capacity. It is predicted that as participants’ levels of GPS reliance become more extensive, overall spatial ability is going to show a decrease in performance, as well as VSWM capacity (i.e. a predicted inverse relation). Method Participants Participants were primarily recruited through the University of Utah’s participant pool, and voluntarily selected a timeslot out of several available. Participants were required to be at least 18 years of age, but there was no age limit past its minimum requirement. 43 participants were recruited in this experiment. 39.5% of participants were male, and 60.5% were female. Most participants were 18-24 years of age (88.4%), with only four being over the age of 30 (9.2%). The vast majority of participants were of Caucasian descent (72.1%), with a small minority being Asian/Pacific Islander (9.3%), Latino/Hispanic (14%), and Native American (2.3%). Materials Large-Scale Spatial Task. In order to test large scale spatial ability, the Virtual Spatial Intelligence and Learning Center Test of Navigation, or Virtual SILCton task (Weisberg, Schinazi, Newcombe, Shipley, & Epstein, 2014) was implemented, and participants were asked to do a within-route and between-routes pointing task post-navigating through a virtual environment of a college campus. In this task, participants learned the environment through a total of 4 paths. The first 2 routes contain 4 buildings each (8 total) that are separate of each other in both routes and buildings themselves. The last 2 routes are connecting routes between the original 2. Participants self-navigate, using a mouse to look around and arrow keys (or corresponding WASD keys) to move along the routes. After navigating through the routes, participants are asked to use the mouse to point to a particular building in relation to another previously learned building. This trial is given seven times for each building. Unity WebPlayer is required in order to load the virtual environment. Small-Scale Spatial Tasks. In order to test small-scale spatial ability, a mental rotation and perspective taking task were implemented. The mental rotation task (MRT) is completed in SILCton, while the perspective-taking task is done by hand. In the MRT, there are two sections asking participants to identify the two blocks that are identical to the original block given, but rotated to some extent. Each section consists of ten questions, and participants have three minutes to complete each individual section. The perspective taking task, specifically the Spatial Orientation Test (Kozhevnikov & Hegarty, 2001) requires participants to look at a variety of objects on a piece of paper, and determine the angle by drawing a line where a chosen object is believed to be located when asked to imagine standing on another object’s point, facing some other object (e.g. standing on a cat, facing a tree, and asked to identify where a stop sign is). Working Memory. Working memory capacity was assessed through a dual N-Back task through the Psychology Experiment Building Language (PEBL) software (Mueller & Piper, 2014). In this task, participants are asked to identify when a match occurs, either for identical letters that come up or a square that flashes in the same location on a 3X3 grid. A match is identified after it is determined how many trials back a participant is required to remember. Asking a participant to identify a match based on a 1-back means that a letter or square position is a match when an identical letter or square position occurs 1 trial back. In a 2-back, a match occurs when a letter or square position is identical to one that occurs 2 trials back, and so on. Surveys. Several different questionnaires were also used to assess self-reported spatial ability. The survey platform Qualtrics was used in order to incorporate the questionnaires into one setting. SBSOD. The Santa Barbara Sense of Direction (SBSOD) scale (Hegarty et. al, 2002) is used as a way to assess general spatial ability through self-report, and consists of 15 questions that participants identify on a scale of 1 to 7 their agreement with a statement, with 1 being strongly disagree and 7 being strongly agree. This questionnaire has maintained consistency, reliability, and validity when measuring a participant’s spatial ability through direct experience, and is a standardized questionnaire that is commonly referred to when measuring spatial ability. Travel. Navigation and travel history were also assessed in order to get a better sense of how often participants have the opportunity to utilize GPS on a normal basis. Questions included asking participants how many new places they go to in a normal day, how often they go off-trail, how many different places were traveled to in both timeframes where participants traveled the most and the least, and the primary mode of travel utilized when going out. GPS Reliance and Usage. Overall GPS use and reliance was also assessed, with questions asking how often participants use GPS for traffic estimates, a general sense of direction, and how much GPS is used for actual reliance (i.e. the actual need to use GPS to get to a specific location). These questions are used to measure if there is a difference in spatial ability among participants who use GPS for actual reliance, those who use it mainly for tasks other than actual reliance, and those who do not use GPS at all (refer to Appendix). Extracurricular Activities. Participants were also asked two questions regarding extracurricular activities that may mediate spatial ability. The first one asks how often a participant plays firstperson shooter games per week, and the second one asks the participant how many years they have participated in physical sports or dance. Demographics. General demographics were asked in order to account for general mediating factors for spatial ability (e.g. sex differences, age as a restrictor for travel or GPS usage, etc.) and to be more thorough when accounting for and interpreting results. Procedure After filling out a consent form, participants completed the within- and between-objects pointing task that the SILCton (Weisberg et. al, 2014) provided. After completion of the SILCton task, the same program provided a mental rotation task that the participants completed. Once the participant finished with the mental rotation task, they then moved onto the perspective-taking task (Kozhevnikov & Hegarty, 2001). After, the dual N-Back task (Piper & Mueller, 2014) was taken to test the participant’s working memory capacity. Once participants completed all these tasks, they filled out a survey containing the SBSOD, demographics, travel history, and GPS usage and reliance questions. Upon completion, the participant was debriefed and received credit in the University of Utah’s participant pool. Results The primary hypothesis was that VSWM capacity (as indicated by spatial dual N-back performance) would be inversely related to levels of GPS usage and reliance. To test this, a linear regression was calculated to predict VSWM capacity based on GPS usage and reliance levels, for which there was significance (F(1,36)=5.421, p=.026, see Figure 1). Linear regressions were also calculated to predict large-scale spatial ability based on GPS usage and reliance levels, where significance was present for within-route pointing (F(1,36)=6.816, p=.013, see Figure 2), but not for between-route pointing (F(1,36)=.024, p=.878). In the data, a correlation existed between within-route pointing and VSWM capacity (r(37)=-.350, p=.034), but no correlation existed with between-route pointing and VSWM capacity (r(37)=-.284, p=.089). A linear regression was calculated to predict VSWM capacity based on within-route spatial ability and GPS usage/reliance levels, for which there was significance (F(2,34)=3.578, p=.039). Linear regressions were also calculated to predict different levels of small-scale spatial ability based on GPS usage/reliance. There was significance when predicting SBSOD scores based on GPS usage/reliance (F(1,41)=6.965, p=.012) as well as predicting scores on the perspective taking task based on GPS usage/reliance (F(1,38)=7.695, p=.009), but there was no significance when predicting MRT scores on these same metrics (F(1,38)=3.532, p=.068). Discussion Findings suggest that there does seem to be an inverse relationship between GPS usage/reliance levels and VSWM capacity, as well as GPS usage/reliance levels and most forms of spatial ability (except for the MRT, where GPS reliance may not affect general object rotation abilities). These results lead to suggest that GPS navigation may play a role in the development and maintenance of both spatial ability and VSWM, which has further implications as to the long-term effects GPS may have on future societies (e.g. mass loss of spatial awareness, extreme dependence on aids in navigation).This study helps to maintain conclusions of previous experiments done that would lead to the suggestion that GPS hurts spatial knowledge acquisition and VSWM capacities (e.g. Ishikawa, 2018; Steele, 2018; Gramann, Hoepner, & Karrer-Gauss, 2017; Bakdash, 2011; Leshed et. al, 2008; Ishikawa et. al, 2008; Munzer et. al, 2006). As for the experiment itself, there are implications that may affect the study’s results. The questions related to GPS usage and reliance were broad in scope, and did not address how long participants had been using GPS prior to participating in the study. In future studies, looking at the length of time spent using GPS in years will hold greater significance as to determining the effect long-term usage of this technology has on VSWM and spatial ability. Participants were also primarily from the University of Utah, making demographics of participants non-representative (most were between the ages of 18-25, had no children, and vastly dominated as being of Caucasian descent). More extensive studies would need to be done to determine any potential effects outside of Utah, especially when accounting for the potential for more polarized levels of spatial ability in participants due to the grid system. Significance may be weak due to the low number of participants, and will need more extensive data collection to determine true significance. Figures Figure 1 Regression scatterplot for GPS reliance and VSWM capacity scores on dual N-back task Figure 2 Regression scatterplot for GPS reliance and within-route pointing spatial ability Appendix GPS Questionnaire 1. How often do you use GPS when going out? a. Never b. Rarely – 1-24% of the time c. Sometimes – 25-49% of the time d. Often – 50-74% of the time e. Very often/Always – 75-100% of the time 2. How often do you rely on GPS to navigate in a new or unfamiliar territory (this does NOT include using it for the sole purpose of time and/or traffic estimates)? a. Never – 0% b. Rarely – 1-24% c. Sometimes – 25-49% d. Often – 50-74% e. Very often/Always – 75-100% 3. How often do you rely on GPS to navigate in an area you have a lot of experience with, such as a hometown, work area, or school you attend (this does NOT include using it for the sole purpose of time and/or traffic estimates)? a. Never – 0% b. Rarely – 1-24% c. Sometimes – 25-49% d. Often – 50-74% e. Very often/Always – 75-100% 4. How often do you use GPS for the sole purpose of time and/or traffic estimates (i.e. you know where the place is and could find it without needing a navigational aid)? a. Never – 0% b. Rarely – 1-24% c. Sometimes – 25-49% d. Often – 50-74% e. Very often/Always – 75-100% 5. How often do you utilize GPS for a minimal sense of navigation (i.e. to know the general direction or a couple of steps for a trip, but could otherwise find the destination on your own – this does NOT include using it for the sole purpose of time and/or traffic estimates)? a. Never – 0% b. Rarely – 1-24% c. Sometimes – 25-49% d. Often – 50-74% e. Very often/Always – 75-100% Works Cited Baddeley, A. (1981). The concept of working memory: A view of its current state and probable future development. Cognition, 10(1–3), 17–23. Bakdash, J. Z. (2011). Guided navigation impairs spatial knowledge: Using aids to improve spatial representations. Dissertation Abstracts International, 72, 3745. Gramann, K., Hoepner, P., & Karrer-Gauss, K. (2017). Modified navigation instructions for spatial navigation assistance systems lead to incidental spatial learning. Frontiers In Psychology, 8. Gyselinck, V., De Beni, R., Pazzaglia, F., Meneghetti, C., & Mondoloni, A. (2007). Working memory components and imagery instructions in the elaboration of a spatial mental model. Psychological Research, 71(3), 373–382. Hegarty, M., Richardson, A. E., Montello, D. R., Lovelace, K., & Subbiah, I. (2002). Development of a self-report measure of environmental spatial ability. Intelligence, 30(5), 425–448. Hegarty, M., & Waller, D. (2004). A dissociation between mental rotation and perspectivetaking spatial abilities. Intelligence, 32, 175-191. Ishikawa, T., Fujiwara, H., Imai, O., & Okabe, A. (2008). Wayfinding with a GPS-based mobile navigation system: A comparison with maps and direct experience. Journal Of Environmental Psychology, 28(1), 74-82. Ishikawa, T. (2018). Satellite navigation and geospatial awareness: long-term effects of using navigation tools on wayfinding and spatial orientation. The Professional Geographer. Kozhevnikov, M., & Hegarty, M. (2001). A dissociation between object-manipulation and perspective-taking spatial abilities. Memory & Cognition, 29, 745-756. Leshed, G., Velden, T., Rieger, O., Kot, B., & Sengers, P. (2008). In-car gps navigation: Engagement with and disengagement from the environment. Proceeding of the Twenty-Sixth Annual SIGCHI Conference on Human Factors in Computing System, 1675-1684. Mueller, S. T., & Piper, B. J. (2014). The Psychology Experiment Building Language (PEBL) and PEBL Test Battery. Journal of Neuroscience Methods, 222, 250-259. Münzer, S., Zimmer, H. D., Schwalm, M., Baus, J., & Aslan, I. (2006). Computer-assisted navigation and the acquisition of route and survey knowledge. Journal of Environmental Psychology, 26(4), 300–308. Padilla, L. M., Creem-Regehr, S. H., Stefanucci, J. K., & Cashdan, E. A. (2017). Sex differences in virtual navigation influenced by scale and navigation experience. Psychonomic Bulletin & Review, 24(2), 582–590. Steele, S. J. (2018). Predicting GPS usage: The relative importance of wayfinding ability, objectbased spatial ability, working memory capacity, anxiety, and overall technology usage. Dissertation Abstracts International, 78. Tolman, E. C. (1948). Cognitive maps in rats and men. Psychological Review, 55(4), 189-208. Vashro, L., Padilla, L., & Cashdan, E. (2016). Sex differences in mobility and spatial cognition: A test of the fertility and parental care hypothesis in Northwestern Namibia. Human Nature, 27(1), 16–34. Weisberg, S. M., & Newcombe, N. S. (2016). How do (some) people make a cognitive map? Routes, places, and working memory. Journal of Experimental Psychology: Learning, Memory, and Cognition, 42(5), 768-785. Weisberg, S. M., Schinazi, V. R., Newcombe, N. S., Shipley, T. F., & Epstein, R. A. (2014). Variations in cognitive maps: understanding individual differences in navigation. Journal of Experimental Psychology: Learning, Memory, and Cognition, 40(3), 669-682. University of Utah UNDERGRADUATE RESEARCH JOURNAL PACKRAT MIDDENS AND PAST ENVIRONMENTS Erika Kusakabe (Professor Larry Coats) Geography Department The purpose of our research was to find preserved remains of the Colorado piñon (Pinus edulis) in packrat middens from the Crawford Mountains of northern Utah. The vegetation remains help determine the timing of the arrival in the farthest northern distribution of this important species. Radiocarbon dating is then used to supplement the dendrochronological data by extending the time depth of data. This project is contributing to research already being done by Professor Larry Coats mapping piñon migration across the Colorado Plateau. We found that the Crawford Mountains is the farthest that the Colorado piñon has been found. A sample also pushed the arrival timing to be around 100 years earlier than the current record. This has helped with expanding the dendrochronological data. It could alter our understandings of the past climates in relation to tree distributions, and help us to better understand the impacts of current and future climate changes on plant migrations. University of Utah UNDERGRADUATE RESEARCH JOURNAL USING THE GINI COEFFICIENT TO DETECT SOCIAL INEQUALITY IN PREHISTORIC BASIN-PLATEAU POPULATIONS Roxanne Lois F. Lamson (Brian F. Codding) Department of Anthropology The factors that allow social inequality to emerge remain poorly understood. This is partially due to the limited ability of archaeologists to quantify variation in past inequality. Recently, Kohler and colleagues introduced a proxy for household wealth using house size to calculate the Gini coefficient, a common measure of inequality. In this research, I build on their approach by testing the validity of the method and evaluating prehistoric inequality across formative period sites, from Basketmaker to Pueblo III (500 BC – 1290 AD), in the Bears Ears National Monument. The area is characterized by well-preserved architectural archeology due to the dry climate. This research yielded results displaying a fluctuation in the Gini coefficient through time in an inter-site analysis. A preliminary correlational test showed a positive relationship between mean annual precipitation and the Gini coefficient. This could suggest that as the landscape became more productive, inequality increased. The next steps are to obtain a larger data set in order to produce Gini coefficients for an inter-site and intra-site analysis and to run more correlational tests with environmental variables. Further testing on the relationship between environment and inequality will be conducted to comprehensively explore the ways environmental change can impact social inequality. University of Utah UNDERGRADUATE RESEARCH JOURNAL HUMAN RIGHTS IN RUSSIA: THE IMPACT OF ECONOMIC SANCTIONS AND GLOBALIZATION Kathryn Loden Howards Lehman, Ph.D. Department of Political Science Abstract The Sergei Magnitsky Rule of Law Accountability Act of 2012 was designed as a means of punishing individuals and entities who violate human rights, participate in systematic corruption, and fail to uphold the rule of law in Russia. In theory, the Magnitsky Act should improve human rights yet in practice, the economic sanctions and travel bans imposed by the act have done nothing of the sort. Human rights, systematic corruption, and the relationship between the U.S. and Russia have not improved in the years since the implementation of the Magnitsky Act. Instead, all three of these phenomena have declined to unacceptable levels. While it may be too hasty to imply direct causation between the Magnitsky Act of 2012 and the troubling RussoAmerican relationship that exists today, it is more than fair to suggest that the act has served as one of the dominoes in the line leading to today’s volatile international conflict. The overarching phenomenon that has led to both the Magnitsky Act and the deteriorating Russo-American relationship is globalization; a process that has favored the spread of Western practices and ideologies at the cost of those more traditional to Eastern nations. Analyzing the RussoAmerican relationship from the context of globalization helps to explain why U.S. efforts have been unsuccessful in improving human rights conditions in Russia. Keywords: Human rights, Russia, United States, Globalization, Economic sanctions ii Table of Contents ABSTRACT ii BACKGROUND 1 HISTORICAL CONTEXT 3 GLOBALIZATION 4 EFFECTIVENESS OF SANCTIONS 7 POLITICAL IMPACT 15 INTERNATIONAL RELATIONS 21 HUMAN RIGHTS REPORTS 25 a. Unlawful deprivation of life 25 b. Freedom of expression 30 c. Political freedom 34 d. Official corruption 36 e. NGOs and International Investigative Organizations 37 f. Discrimination and societal abuses 41 g. Workers’ rights 46 SOLUTIONS 49 CONCLUSION 53 REFERENCES 55 iii 1 BACKGROUND In 2008, a Russian lawyer named Sergei Magnitsky uncovered one of the largest corruption schemes in Russian history. According to testimony from Bill Browder, CEO of Hermitage Capital Management where Magnitsky worked, officers from Russia’s Interior Ministry conducted a raid of Hermitage in 2007, taking boxes full of documents and records. Shortly thereafter, members of the Ministry as well as tax-officials, police officers, and other professional criminals reinstated closed companies with forged contracts allegedly proving that Hermitage was owed a $230 million tax refund. Russian tax officials immediately approved the request, distributing the refund not to Hermitage itself, but to the conspirators (The Magnitsky Act at Five Years, 2017). Upon discovering this operation, Magnitsky reported his findings and was asked to testify in front of Russian State Investigators. He was then arrested and accused of having committed the fraud himself. Magnitsky spent over a year in the Matrosskaya Tishina pretrial detention facility in Moscow, where he was subjected to torturous and neglectful conditions and where he later died after being denied medical treatment for more than an hour after being beaten with rubber batons by prison guards. After learning of the unlawful arrest and detention of Sergei Magnitsky, Bill Browder began to lobby for U.S legislative action against those responsible for the arrest, detention, abuse, and false accusations against the deceased. Browder brought the case before Senators Benjamin Cardin and John McCain who initiated the policy proposal. In April 2012, the House Committee on Foreign Affairs unanimously passed the bill entitled the Sergei Magnitsky Rule of Law Accountability Act (2012) (H.R. 4405). The purpose of this act was “to impose sanctions on persons responsible for the detention, abuse, or death of Sergei Magnitsky, and for other gross 2 violations of human rights in the Russian Federation” (Sergei Magnitsky Rule of Law Accountability Act, 2012). In November 2012, the bill moved to the Senate (H.R. 6156) and was amended to include the addition of “…for the conspiracy to defraud the Russian federation of taxes on corporate profits through fraudulent transactions and lawsuits against Hermitage…” to the original language (Sergei Magnitsky Rule of Law Accountability Act 2012). This edition of the bill passed on December 6th by a 92-4 vote. Senators Bernie Sanders, Carl Levin, John Reed and Sheldon Whitehouse voted against the bill on the grounds that it should be applied globally rather than targeted only to Russia. In passing this bill, Congress also repealed the Jackson-Vanik Amendment of 1973 which pressured the then Soviet Union to comply with free emigration policies (Ginsberg 2009). This amendment, like the Magnitsky Act, was intended to improve human rights conditions in Russia. Also like the Magnitsky Act, it was not received favorably by the Russian government. Since President Obama signed the bill into law, a total of 49 individuals have been sanctioned by the Department of the Treasury’s Office of Foreign Assets Control (OFAC) and have had their visas revoked or denied by the Department of State. The U.S. has regularly justified this action which many have criticized as an overreach of power by claiming that as a member of the United Nations, the Organizations for Security and Co-operation in Europe, the Council of Europe, and the International Monetary Fund; Russia is obligated to protect and encourage human rights and punish acts of corruption. However, as the case of Magnitsky and many other similar breaches of these responsibilities prove, the Russian government and society elites have not taken the necessary steps to improve their human rights record or end systematic corruption. Rather, they have engaged in criminal behaviors while disregarding the rule of law. Because of this, it is both necessary and proper for the U.S. government to take action against those responsible for these activities. 3 However, the justifiability of this act may not be as black and white as it appears. Several arguments against the act and its implementation have arisen in the six years since the passage. The arguments against the act itself are based on the idea that the U.S. has overstepped its authority by interfering in Russia’s domestic affairs and by denying due process of law to those deemed responsible for the violation of human rights or participating in corruption. Other arguments against the implementation of the act question the effectiveness of targeted economic sanctions in improving human rights as well as the effectiveness of targeting individuals rather than the administration at large. In the following sections, I shall argue that not only are targeted economic sanctions ineffective, but the punitive action taken by the U.S. has worsened human rights in Russia and threatens the international relationship. HISTORICAL CONTEXT To understand the Magnitsky Act of 2012 and assess its effects, it is crucial to first understand the political climate between the U.S. and the Russian Federation during this period and how it developed. Providing such a context allows for a comprehensive analysis of both positions in this conflict as well as an opportunity to generate potential solutions that appease both parties while recognizing the importance of protecting human rights and preventing acts of corruption. After the fall of the Soviet Union and the subsequent collapse of communism in Eastern Europe, relations between the U.S. and Russia appeared to be stabilizing. During the presidency of Boris Yeltsin (1991-1999), an advocate of democracy, the years of division between the two countries were finally beginning to reverse with a series of cooperative measures. This period witnessed joint collaboration regarding space exploration and reductions in nuclear weapons (Nunn-Lugar bill 1991). Economically, this period also brought the inclusion of Russia into the 4 World Bank (1992), the International Monetary Fund (1992) and the G7 (1997) with support from the U.S. Further legislation and treaties passed between President Yeltsin and Presidents Bush (H.W) and Clinton include the Cooperative Threat Reduction Agreement (1992), the Freedom Support ACT (1992), START I and II (1993), the Comprehensive Test Ban Treaty (1996), and the NATO-Russia Cooperation Pact (1997) (Harvard Kennedy School for Science and International Affairs). Between 2000 and 2009, the relationship between the countries was mixed, with both friendly and unfriendly interactions. During this time the Roadmap for Middle East Peace (2003) and the Global Initiative to Combat Global Terrorism (2005) were introduced as joint efforts to maintain support for one another and their interests. However, the U.S. invasion of Iraq in 2003 was met with Russian opposition. Then in March of 2007, Russia again opposed the U.S., this time over the decision to build a missile defense shield in Poland. Fearing NATO expansion to Georgia, Ukraine, and other former Soviet states, Russia began to withdraw from agreements and treaties. Finally, during the five-day Russo-Georgian war and the sixth wave of NATO expansions during 2008 and 2009, the U.S-Russian relationship had reached dangerous levels. After that, in a period intended to “reset” Russo-American relations, it was discovered that Sergei Magnitsky had been unlawfully detained, where he faced months of torture resulting in his death. This event sparked what has continued to be the most counterproductive and aggressive relationship since the Cold War (Harvard Kennedy School for Science and International Affairs). GLOBALIZATION An important factor to consider with regards to the Magnitsky Act and the current RussoAmerican relationship is globalization. In the simplest terms, globalization is the process of 5 interaction and integration among individuals, organizations, and governments driven by international trade and investment. It includes the spread of goods, services, money, people, information, and culture across borders (Guillen, 2001). This process has occurred for thousands of years but has reached new levels of intensity since the mid-20th century with the advancement of technology and the two World Wars that forced international interdependence like never before. While some nations like the U.S. have profited socially, politically, and economically from the process of globalization, other nations, such as Russia, have suffered rather negative consequences as a result of the developing global marketplace. During the early 1990s, Russia was in transition to becoming a democratic state and mending relationships with other democracies like the U.S. and Western European nations. However, the economic fallout from the Cold War left Russia on an uneven level of competition with the rest of the developed world. Between 1991 and 2000, the portion of Russia in the world’s Gross Domestic Product (GDP) reduced from 5.57% to 2.1%, and the portion of Russia in world industry reduced from 10.3% to 4.5% (Dobrenkov, 2005). This led to a massive deindustrialization of the country as Russia found itself on the brink of economic disaster. Because of this decline, many of Russia’s most educated and qualified individuals—doctors, scientists, graduates from the top universities—left the nation in search of greater financial security and prosperity. As the economy fell, the amount of people working in the technological and scientific fields decreased from 2.5 million to 800 thousand. Without the necessary funding for research and development along with the sheer lack of capable individuals, Russia ceased to be an economic and scientific force in the world. At a time when science and technology were booming, this event was a disastrous blow to Russia. With very few markets 6 left to compete in, Russia became a main producer of raw materials such as oil, gas, metals, and woods. Between 1991 and 2000 Russia increased its mining industry from 18% to 24.4% and oil accounted for 40% of the national exports (Dobrenkov 2005). Basing an economy on the production and exportation of raw materials is a high-risk strategy. Especially considering the limited quantity and fluctuating prices of the resources as well the recent movement towards more sustainable and renewable energy. In addition to the negative economic events caused by globalization, Russia also faced many changes in the social and political spheres of society. In general, globalization is not an equalizing or unifying phenomenon but rather a cause for deepening divides between rich and poor nations and between the rich and poor populations within each nation, “liberal reforms split Russia into a small group of billionaires and multimillionaires on the one hand and the majority living in poverty on the other hand” (Dobrenkov, 2005). As stated by Nikos Passas in 2001, “enormous populations have become more vulnerable to exploitation, criminal victimization, and recruitment in illicit enterprises or rebel and fundamentalist groups”. Following that line of reasoning, this massive discrepancy in wealth led to a sharp rise in crime and corruption as many individuals turned to illegal methods of maintaining or improving their quality of life. In 1990 there were 14,300 recorded murders in Russia, a little more than a decade later in 2002, there were more than 32,000 recorded murders. Life expectancy also dropped from 69.2 years in 1991 to 65.3 years in 2001 (Dobrenkov 2005). With an underwhelming economy and overwhelming crime rate, many Russians, including elected officials, took a page from the Soviet doctrine and began to blame and criticize globalization and pro-western ideologies for being what they perceived as a threat to Russian sovereignty and overall wellbeing. The process of globalization quickly developed a negative 7 connotation of “westernization” associated with economic failures and deteriorating social structures. When President Putin took office in 2000 it became clear that this would take precedent in his dealings with the U.S. as well as the repressive policies implemented in the nation. Understanding the incongruity in success rates for globalization as well as how this great divide has led to deeply set anti-American and nationalistic sentiments not only in the Russian government but the population as a whole, explains in part why Russia has not been receptive to further extensions of U.S. power in the global community. EFFECTIVENESS OF SANCTIONS Since World War II, the U.S. and other traditional powers—such as some European states and China—have utilized a method of coercion known as economic sanctions. This practice is hardly new; there is documented evidence of Athens imposing trade sanctions on Megara in 432 BC (Fabre, 2018). However, the use of economic sanctions gained the most influence after the U.S. and allied countries used this power as a preventative measure against Nazi forces during the Holocaust (Erbelding, 2018). While the use of economic sanctions has become increasingly common among economically powerful nations, the effectiveness of this method has been widely debated and contested. To gauge the effectiveness of the targeted economic sanctions against individuals and entities in Russia, it is necessary to first identify their purpose and intended consequences. Bryan Early offers this definition of economic sanctions in his book, Busted Sanctions, “Economic sanctions specifically refer to restrictions that policy makers place on their target’s commerce with foreign states, firms or individuals to compel a change in their behavior. They tend to be used in response to objectionable foreign behaviors that require a more assertive response than diplomacy alone but in which the use of military force is undesirable”. 8 In the case of the Magnitsky sanctions, this definition fits quite well. The U.S., acting as an enforcer of international human rights agreements in accordance with the International Emergency Economic Powers Act (1977), has placed restrictions on targeted individual’s assets within U.S. borders and banks. This means that once a person is added to the Magnitsky List—a list compiled by OFAC that also sanctions individuals like ISIS and al-Qaeda terrorists and Mexican and Columbian drug lords—they will not be able to access any resources that they previously placed or purchased in the U.S. There is also an international component to this act in that the list published every year by OFAC is cross referenced by World-Check, an international database that every bank in the world subscribes to. Meaning that when a person is sanctioned by the U.S., other banks and organizations around the world may refrain from doing business with that person in order to protect their relations with the U.S. Additionally, the individuals lose the privilege of obtaining or using U.S. visas to further restrict their ability to benefit from U.S. assistance. The Magnitsky list and the sanctions associated with the legislation are an attempt to change the negative behaviors of individuals, and more broadly to change the policies within Russia that allow these behaviors to persist with impunity. The type of sanction utilized under the Magnitsky Act has been referred to as a “smart” or “targeted” sanction because it affects only the individuals or entities directly involved in the objectionable behaviors (Hofer, 2018). These sanctions are allegedly not directed at the nation of Russia or its government. For this reason, targeted sanctions are typically the preferable method of financial restriction for they do not actively engage with Russian authorities. While this was supposedly the goal of the Magnitsky Act sanctions, it is evident that the Russian government has deemed the legislation to be an attack on Russian sovereignty and therefore feels targeted by the U.S. and these sanctions. In 2017, Gary Kasaparov, chairman of the Human Rights 9 Foundation said during a hearing before the Commission on Security and Cooperation in Europe, “the best way to target Putin’s power is to take aim at his agents and cronies and their money to pursue the mafia that hold the lever of power and who benefit the most from Putin’s rule. The individuals who can influence Putin must be targeted or there can be no effective deterrence…Putin and his gang must understand that if he continues on this path, their fortunes, their families’ comfortable lives abroad will be at risk” (The Magnitsky Act at Five Years, 2017). Despite what authorities claim, it is quite clear from those sentiments that the Magnitsky Act is at least in part directed towards the Putin administration and its role in the objectionable behaviors. From this perspective, it is fair to qualify Russia as a targeted nation The U.S. has historically employed economic sanctions at substantially higher rates than any other nation (Early, 2015). This is due to the fact that the U.S. maintains a large amount of economic power that it can use as leverage in dealings with less wealthy nations. This exploitative process is based on the knowledge that many nations rely heavily on U.S. markets, capital, financial systems, and aid. Losing these benefits can be very problematic for struggling nations so it is therefore seen to be within their best interests to bend to the will of the U.S. Economic sanctions are also a preferable alternative to military action for several reasons. It is less costly both in human lives and resources for the U.S. to engage in economic rather than military warfare. And the U.S. is able to maintain a symbolic position of opposition to the objectionable behaviors of others while remaining far-enough detached from any actual conflict. Sanctions are also believed to achieve their intended policy changes faster than military engagement. Despite the apparent advantages of sanctions, there is strong evidence showing the overall ineffectiveness and harmful results from this form of coercion. 10 Economic sanctions have only proven to be successful in achieving their goals about 23 to 34 percent of the time (Early, 2015). This poor track record is the result of several important factors that both limit the effectiveness of the actual sanction and create other problems for both the sending (sanctioning) and receiving (targeted) parties. These limiting factors: so-called sanction busters described by Early, the growing problem of cryptocurrency, and extralegal methods of getting around sanctions, have been quite productive in reducing the overall impact that a sanction could have inflicted. Additionally, a few unintended consequences of economic sanctions, such as their use in propaganda for the Russian government and the negative effect on the human rights and economic state of Russia, illustrate the dangers and perhaps deterrents against imposing sanctions. In his book, Bryan Early describes a phenomenon called “sanction busting” where a target nation—or in the case of Russia via Magnitsky, target individual—is financially aided by third parties, ultimately decreasing the effect of the sanction. These third parties can be countries, organizations or individuals who seek to benefit from the situation by developing alternative trade relationships with the targeted party at increased rates. This relationship allows the targeted party to maintain their economic standing and even replace lost revenue while the third party also gains a profit. In regard to the Magnitsky sanctions, the process of sanction busting enables those who have been cut off from resources in the U.S. to rebuild or repair their finances through other relationships. This is particularly relevant given the strong relationship between Russia and China, a nation rivaling the economic prowess of the U.S. It is also increasingly likely that those individuals involved in corruption and or human rights violations have heard of the Magnitsky Act and are no longer keeping large amounts of money or assets in U.S. run enterprises. 11 Next arises the relatively new phenomenon of cryptocurrency, which although still in its early stages has proven to be a force worth noting. For clarity, cryptocurrency is a form of digital currency based on code that is secure, anonymous and unregulated by a central bank or country (Shin 2017). It is used like any other currency, but it is entirely electronic and essentially untraceable which is why it has been used in many criminal settings such as human trafficking and the trade of illegal drugs and weapons. Earlier this year, the New York Times published an article about the ability of nations like Russia and Venezuela to side-step sanctions using digital currency (Popper, Matsnev & Herrero, 2018). Although the likelihood of such a large endeavor actually succeeding is minimal, the use of cryptocurrencies like Bitcoin (2009) and Litecoin (2011) on a much smaller scale does threaten the reach of targeted economic sanctions. Since cryptocurrency is anonymous and not backed by any sort of bank, it is very easy for an individual to trade and use without interference from the U.S. government. This also means that the U.S. cannot regulate the movement of money, goods, or services in or out of its borders as the need for a bank or physical money has been minimized. Cryptocurrency also allows individuals to participate in criminal activities without necessarily needing to fear any consequences. If nations like Russia, Venezuela, and Iran are able to create nationally based cryptocurrencies, the effectiveness of economic sanctions will be greatly reduced. Even the lowlevel uses that occur today have made sanctions a much less powerful tool. Also relevant to the effectiveness of economic sanctions is the presumption that those who are sanctioned will be motivated to change their behavior and to follow the rules of the sanction. It is naïve to assume that individuals who have been suspected to be responsible for heinous acts will suddenly become law-abiding citizens. Considering the various ways one can get around an economic sanction both legally and otherwise (illegally obtained visas, concealing 12 money, transferring money before sanction takes effect), there is hardly any reason for an individual to cease their objectionable behaviors. Thus, it appears that targeted economic sanctions are not nearly as effective in reducing human rights violations and corruption in Russia as U.S. policymakers would like to believe. Rather than an actual consequence or a legitimately deterring factor, economic sanctions are received as a hostile measure from an unfriendly nation and used to further anti-American and nationalist propaganda within Russian borders. To summarize the ineffectiveness of the Magnitsky sanctions, the Library of Congress issued a report from the Congressional Research Service in 2018 that addresses some of the reasons that the objectionable behaviors in Russia will not change. As the authors state, “Russian policy makers may be willing to incur the cost of sanctions in furtherance of Russia’s foreign policy goals. Sanctions also might have the unintended effect of boosting internal support for the Russian government and sanctions may be targeting individuals that have less influence on Russian policymaking than the United States assumes. Furthermore, the economic impact of sanctions may not be consequential enough to affect Russian policy”. The report goes on to say that the effect of sanctions in changing behavior is difficult to determine. However, it seems immensely clear that targeted economic sanctions like those implemented under the Magnitsky Act will have little chance at obtaining their intended consequences because of the minimal effects on either the sanctioned individual or the Russian government at large. Beyond noting the overall inability of the sanctions to change behaviors in a positive direction, it is important to address the fact that these sanctions have directly impacted human rights and corruption in Russia in a negative way. In an article published in the Journal of Peace Research, Dursun Peksen claims that economic sanctions unintentionally worsen human rights in the nations they target. Based on one theory of economic sanctions, economic coercion is 13 designed to weaken the target regime by denying them necessary physical and monetary resources that are crucial for political elites to maintain stability and order (Pesken, 2009). It is believed that economic sanctions are expected to improve human rights conditions by undermining target governments’ coercive power and political support from elites as well as support from the public. However, this is not often the result. As Pesken states, “foreign economic pressure unintendedly permits the targeted leadership to enhance their coercive capacity and create more opportunities to violate the basic rights of average citizens…economic coercion enhances the repressive capacity of the regime” (Pesken, 2009. pg. 61-62). One of the largest human rights issues in Russia is the repressive nature of the regime, targeting the freedom of speech and expression of any who voice dissent against the policies and leaders of the nation. This has only increased in the years since Magnitsky was implemented. Another way that economic sanctions have worsened the condition of human rights in Russia has been the broadening legitimacy and justification of repressive tactics by the Russian government. The government and elites have used the Magnitsky Act sanctions to strengthen their hold on the country under the justification of maintaining domestic cohesion to fight external threats. The anti-western and nationalist ideologies that were created as a result of the sanctions, fueled the implementation of legislation designed as a retaliatory measure against the U.S. The Dima Yakovlev Law (2012), issued as what many have described as a direct response to the Magnitsky Act, created an identical list of U.S. citizens who are banned from entering Russia and whose assets and investments inside Russia have been frozen based on human rights violation in Guantanamo Bay. As more names are added to the Magnitsky list, more names are added to the Yakovlev list. Additionally, this law suspended the activity of politically active nonprofit organizations that receive aid from American organizations or individuals. This clause 14 limits the ability of human rights and corruption watch groups to investigate and report on issues inside Russia. The Dima Yakovlev Law also banned U.S. citizens from adopting children from Russia, including children who were already in the process of being adopted. The law is named after a Russian orphan who died from heat stroke after being left in a hot car by his adoptive parents in Virginia. However, as subsequent sections of this paper demonstrate, the welfare of Russian children is not an actual concern of Russian authorities. Instead, this law seeks to punish U.S. citizens for the actions of their government. There are also those who argue that economic sanctions are themselves a violation of human rights (Marks, 1999). This argument stems from the fact that by implementing a sanction against an individual, the sending nation is denying them their rights to material assistance and property. Other rights that have been denied to those who have been sanctioned are the freedom of movement and the right to due process of law. All of these rights are clearly outlined in articles 10, 11, 13, and 17 of the Universal Declaration of Human Rights (UDHR) authored by the United Nations General Assembly in 1948. However, the language and implementation style used in the Magnitsky sanctions and UDHR appear to negate this claim. With regards to due process, “programs are effectively devoid of the procedural and substantive due process protections that would be associated with similar actions if they were taken pursuant to civil or criminal law” (Hofer, 2018), because the targeted individual is not actually being charged with any wrong doing in a court of law, they are not entitled the same protections. Similarly, the declaration guarantees every human with the right to leave their country of origin, it does not however give them the right to enter another country. The U.S. Department of State is also allowed by Congress to deny any person access to the country meaning that the freedom of movement clause is not applicable either. The rights to property and material assistance are more 15 substantial in terms of this argument. However, they are not enough to prove that the U.S. is deliberately violating the rights of the individuals it sanctions. While sanctions themselves may not be fully considered a violation of human rights, there remains considerable evidence that sanctions contribute to a reduction in human rights in the nations they target. Thus, not only are the economic sanctions implemented under the Magnitsky Act unsuccessful in changing or deterring the behaviors they sought to alter, they have also had a negative impact on human rights. In the six years since the Magnitsky Act was passed, very few if any policies have been changed to protect human rights or punish corruption in Russia. Rather, as following sections of this paper will demonstrate, policies intended to reduce the rights of individuals and increase the repressive power of the government have been introduced. The overall quality of human rights in Russia has declined in the years following the implementation of Magnitsky, as has the relationship between the U.S. and Russia. POLITICAL IMPACT When word reached the Putin administration about the potential adoption of the Magnitsky Act, the reaction from all levels of the government was one of clear objection and agitation. At the annual press conference in 2012, President Putin referred to the policy as an “undoubtedly unfriendly act towards the Russian Federation,” he goes on to say, “It (the act) is a matter of one anti-Soviet, anti-Russian law being replaced with another…This is very bad and has had a negative impact on our relations” (Santos, 2012). Sergei Ryabkov, the Russian Deputy Foreign Minister at the time, mirrored the President with his statement about the act, “owing to certain sentiments that prevail in the U.S., including on Capitol Hill, our relations with the U.S. seriously lack what we call the three basic principles-mutual respect, equal rights and noninterference in internal affairs…difficulties appear if attempts are made to impose one’s opinion 16 of how things should be done in a sovereign state on someone else” (Englund, 2012). Resentment towards the act and U.S. interference in Russian affairs, triggered a symmetrical reaction from the Russian government in the adoption of the Dima Yakovlev Law. This reaction as well as subsequent retaliatory measures can be understood in the context of globalization. For over a decade the Russian economy, industry, and social sector suffered at the hands of globalization while the U.S. prospered and grew. This created deeply rooted indignation towards any western foreign policy directives that aimed to influence Russian policies or ideologies. When confronted with their failing human rights and corruption records, the Russian government could have, but did not, perceive it as an opportunity to improve important aspects of their nation. Instead, they took the legislation as an opportunity to increase anti-American sentiments and hostilities. As further denial of any responsibility in the illegal arrest and detention of Sergei Magnitsky, the Russian government maintains that the Magnitsky himself was culpable for the fraud operation; even going as far as to posthumously charge Magnitsky with tax evasion in 2013, the first case of its kind in Russian history (The Magnitsky Act at five Years). During this time, the Russian courts additionally tried Bill Browder, a British citizen and Magnitsky’s activist, in absentia and found him guilty, sentencing him to 9 years in Russian prison colony. British authorities have repeatedly denied Russia’s request for extradition (Tsvetkova & Gutterman, 2013). Setting the tone for all future bilateral relations, Russia has made clear that the Magnitsky Act was an anathema. In the years since the passage of the Magnitsky Act, the political relationship between the U.S. and Russia has been a volatile battle of wills with neither side prepared to relent. In an effort to demonstrate their power, the Russian government has participated in various political interference schemes targeted towards undermining U.S domestic affairs. The most notable cases 17 of these nefarious tactics are those of Edward Snowden and Natalia Veselnitskaya two individuals who have attempted and arguably succeeded in disrupting U.S. politics and procedures. Edward Snowden gained infamy in 2013 after downloading and leaking over 200,000 classified government documents that show the NSA’s “bulk collection of phone and internet metadata from U.S. users, spying on the personal communications of foreign leaders including U.S. allies and the NSA’s ability to tap undersea fiber optic cables and siphon of data” according to Reuters in 2014. Additionally, the documents Snowden exposed revealed a program piloted by British cyber spies that was able to monitor YouTube in real time and collect addresses and user information. This program was also capable of spying on individuals through Facebook and Twitter. Many in the U.S. criticize Snowden of committing treason and some even accuse him of being a Russian spy. Snowden defended himself by claiming that the documents he exposed show violations of the U.S. Constitution. After being charged with violating the Espionage Act of 1917, Snowden sought and was granted asylum in Russia where he remains today. Many in Washington were upset by Russia’s decision to harbor a criminal and felt that the decision was meant to send a message of boastful noncompliance to the States. More recently, the case of Natalia Veselnitskaya has created unrest not only in the U.S. but internationally. In June of 2016, Natalia, a Russian lawyer with strong ties to the Russian government, met at the Trump Tower in New York City with Donald Trump Jr.—and several others including Paul Manafort and Jared Kushner—while his father was campaigning for the presidency. While the actual events of that day remain widely speculated, it has been alleged that Natalia offered the Trump campaign destructive and incriminating information about Hillary Clinton in exchange for Trump’s support in amending the Magnitsky Act once elected. The 18 Trump campaign has vehemently denied having accepted Russian help in the election process yet the fact that Donald Trump Jr. was both willing and eager to take the meeting implies otherwise. There is very little doubt that Russia interfered in the 2016 Presidential Election and this meeting reveals that the Magnitsky Act may be one of the reasons (Sheth, 2017). By targeting the presidential elections, Russian authorities are taking strategic shots at the foundation of democracy: free and fair elections. This may seem like an overreach in what has previously been a symmetrical tit-for-tat bilateral relationship but recalling the key problem of globalization, Russia is only evening the playing field. The U.S. is responsible for forcing democracy upon Russia in the 1990s, now they are taking aim at the principle Americans hold so closely. Other examples of the straining political relationship between Russia and the U.S. include the military conflicts with Syria and Iran as well as the controversial annexation of Crimea, Ukraine in 2014. These events have each played an important role in and contributing to the growing rivalry of nations. To summarize, the Syrian Civil War began in 2011 when demonstrators took to the streets to protest for political and economic reforms. They were met with intense violence at the hands of regime led security forces which fueled the uprising and gained the attention of other nations in the world. Sides were quickly established, the U.S. offering weapons and military training to the moderate rebels while Russia and Iran backed President Bashar al-Assad and his regime. From the context of globalization, the lines drawn in this conflict follow a wellestablished pattern of Russo-American dealings in international affairs. The uprising in Syria followed shortly after similar uprisings in Tunisia and Egypt where the U.S. again supported the overthrowing of authoritarian regimes in favor of democracy. In both of these conflicts, Russia 19 has supported the authoritarian regimes. The overall themes in all three of these uprising has been the U.S. attempting to promote and expand democracy while Russia attempts to halt this movement because of the negative consequences democracy—a factor of western lead globalization—inflicted on the country in the 1990s. The Syrian Civil War and tensions between Russia and the U.S. predate the adoption of the Magnitsky Act but it is clear that the underlying divisions caused by globalization have carried through in both events. Another consistent factor to consider when analyzing the U.S. and Russia’s roles in political uprisings is that of the protection of human rights. One of the predominant reasons why the U.S. has supported rebel forces in these conflicts has been the record of abuse by the authoritarian regimes. Since the advancement of technology, the media has been bombarded almost daily with graphic images and videos from inside Syria where attacks and bombings occur all too frequently. Even before the conflict began, the Assad regime was notorious for repressive policies that drastically restricted citizen’s individual rights. This is also true of the regimes that led Egypt and Tunisia before their political uprisings. The U.S. has created a pattern of using human rights violations as justification for intervening in the domestic affairs of other nations and backing moderate to extreme revolutions in various countries while Russia has stuck to their pattern of defending such violations and supporting the regimes responsible in the name of sovereignty. This pattern of human rights and political interference or intervention follows Russia and the U.S. into the annexation of the Crimean Peninsula in 2014. Officially, the UN and many individual nations continue to recognize Crimea as a part of Ukraine. Conversely President Putin and his administration justify and validate the annexation by claiming that ethnic Russians living in Crimea were being persecuted and were vulnerable to NATO expansion if Ukraine ever joined 20 the union. Russian immigration policies also changed dramatically during this time to favor Ukrainian immigrants and ethnic Russians living in in Ukraine over every other population of migrants. This appears to the U.S and the UN as an attempt to regain soviet territory that was stripped away after the cold war. As with most conflicts involving military action, the annexation of Crimea resulted in massive violations of human rights. According to the Organization for Security and CoOperation in Europe (OSCE), Russian authorities have attempted to silence any dissent from individuals residing in Crimea who are opposed to the annexation. In doing so, Russian authorities have conducted “murders, torture, harassment, illegal detentions, disappearances, and the persecution of journalists, human rights defenders and activists” which mirrors the unjust treatment of citizens in Russia. In this scenario, Russia has used the alleged violation of human rights in regard to ethnic Russians in Ukraine as justification for occupying and annexing the territory which only led to increased human rights concerns including the recent attack on Ukrainian ships and the abduction of crew members. An important distinction to note in relation to the Russo-American conflict is the difference between interference and intervention. Russia has accused the U.S. of interfering in not only their but other sovereign nations such as Syria, Egypt and Tunisia’s domestic affairs in an effort to promote Western ideology. From the U.S. perspective, the government is intervening in the domestic affairs of other nations to protect human lives and internationally recognized rights. Depending on the lens one chooses to look through, both sides could appear to have a compelling argument in maintaining the battle of wills. 21 INTERNATIONAL RELATIONS To further demonstrate the deterioration of the relationship between Russia and the U.S., it is important to look at the international organizations and agreements that have been signed and abandoned or ignored in the last few decades as well as what this trend implies for the future. Most notably, the Parliamentary Assembly of the Council of Europe (PACE), the Group of Seven (G7), the North Atlantic Treaty Organization (NATO), the United Nations (UN), and most recently the Intermediate-Range Nuclear Forces Treaty (INFT). These organizations and treaties have undoubtedly brought strife to the nations they encompass, but their abolition rightfully terrifies much of the world. Established in 1949, PACE and its current 49-member states are dedicated to upholding the “shared values of human rights, democracy and the rule of law that are the ‘common heritage’ of the peoples of Europe” (PACE). In 2014, Russia’s right to vote in PACE, their right to be represented in its ruling bodies and to participate in election observation missions were suspended following the Crimean annexation. The goal of this political sanction was to change the behavior of the Russian government by compelling it to withdraw from Crimea. In retaliation against this political sanction, Russia completely pulled out of the council in 2017 and ceased payments of membership fees which negatively impacted the other member states who depended upon these funds to operate. By leaving the organization, Russia signaled that it is not committed to the protection of human rights nor is it interested in maintaining relationships with other European nations. In a similar fashion to the reaction against the Magnitsky sanctions, Russia has used the political sanctions imposed by PACE to strengthen isolationist rhetoric in the nation. According to their logic, the world—led by the U.S. and Europe—is targeting the sovereignty of Russia by imposing their western political ideology on the nation. 22 Between 1998 and 2014, Russia also belonged to the organization then known as the G8. The now G7 is a coalition of industrialized democracies that work together on issues of “global economic governance, international security, and energy policy” (Laub & McBride, 2017). Russia’s initial inclusion in the group was a controversial decision of President Clinton’s given the fact that at the time Russia had accrued large amounts of debt with a relatively small economy. For the entire period of inclusion, Russia was consistently in opposition with the other member states over issues of foreign policy including the Syrian civil war. Then in 2014, just as PACE had done, the leaders of G7 imposed their own set of sanctions against Russia following the Crimean conflict as well as the Russian attack on the Malaysia Airlines Flight that killed all 298 passengers aboard. In a joint statement issued by the leaders, “We believe it is essential to demonstrate to the Russian leadership that it must stop its support for the separatists in eastern Ukraine”. The G7 credits itself with the implementation of the Minsk accords, a plan that called for the withdrawal of heavy weaponry in addition to a ceasefire in Eastern Ukraine. This accord was made possible only after the group lifted their sanctions on Russia. Another particularly sore-spot for the Putin administration is NATO. While Russia has never been a fully-fledged member of the organization, there have been numerous attempts to increase dialogue and cooperation between NATO and Russia (NATO Relations with Russia, 2018). In 1997, the NATO-Russia Founding Act initiated the process that was strengthened by the establishment of the NATO-Russia Council in 2002. This council served as a forum for discussion of security concerns and policy initiatives. The Russo-Georgian war in 2008 damaged this relationship and the council was suspended for the year. In 2014, the council was indefinitely suspended, again in reaction to the aggressive actions against Crimea. Channels of political communication remained open between Russia and NATO, but the civilian and military 23 cooperation efforts are no longer in practice. NATO continues to condemn the actions of Russia in Ukraine and refuses to recognize the annexation as a legitimate merging. The organization has refrained from sanctioned the Russian government in hopes of retaining some semblance of diplomacy. However, many of the member nations including the U.S. and the U.K. have implemented their own sanctions, creating a tense climate that seems counterproductive for communication. Over the past year, the UN Human Rights Council (UNHRC) has faced a new set of problems stemming from the U.S. decision to withdraw from the position. In June of this year, the former U.S. Ambassador to the UN Nikki Haley said, “for too long the Human Rights Council has been a protector of human rights abusers and a cesspool of political bias” in reference to the UNHRC’s stance on the Israel-Palestine conflict (U.S. State Department, 2018). Russia welcomed the U.S. withdrawal because it gave the nation another chance to be elected onto the council. The Russian ambassador criticized the U.S. by saying that the U.S. does not understand how the UNHRC operates, alluding to the idea that President Trump withdrew because the council didn’t take his side with regards to Israel. Russia has served one term on the council but lost the reelection in 2016 due to its support of the Assad regime in the Syrian Civil War. In July, Iceland was elected for a period of a year to replace the U.S. but the upcoming election leaves 7 spots that Russia could run for. However, this seems unlikely given Russia’s stance on the recent sanctions against North Korea that and the nation’s record of human rights violations that have not improved in recent years. Finally, and most recently, a new wave of Russo-American conflict has arisen with talks of withdrawing from the INF accord. For years Russia has been accused by the U.S. of not complying with the accord that bans the two nations from testing, producing, or possessing 24 ground-launched ballistic or cruise missiles (Gordon, 2016). In 2014, the Obama administration first voiced concern that Russia was in violation of the accord by testing missiles. Then in 2016, more concerns were issued that Russia was producing more missiles than necessary for a flight which could mean that the government was attempting to build a stockpile. In the following year, the U.S. again accused Russia of testing and deploying prohibited intermediate-range missiles. Russia has consistently denied these claims, saying that the missiles they test are in full compliance with the treaty because they aren’t able to travel long distances (Pifer, 2018). The U.S rejects this argument and is getting closer to abandoning the treaty, an action that many in the international community are opposed to. 1 If the U.S. does abandon the accord, many fear that Russia will have more leeway to create a sophisticated stockpile of weaponry endangering more than just the U.S. In summary, the past few decades of international relations between Russia and the U.S. have become increasingly hostile and dangerous owning to legislative actions, failed agreements as well as a lack of trust and commitment from both sides. The unfavorable relationship between these nations at the time of Magnitsky’s implementation as well as the relationship that has transpired since, demonstrate the importance of international relations in foreign policy. Negative international relations foster a problematic environment for any legislative act between the states. Even an act like Magnitsky, an intervention in human rights, which has been advertised as a means of punishing individuals not the administration at large, has minimal chances for success. The relationship that existed in 2011 is arguably an improvement from the relationship that exists in 2018 given the events that have occurred during the years. Considering the further decline in international relationship, in part due to the act itself, it is reasonable to 1 Since the initial writing of this paper, the U.S. has withdrawn from the IMF Treaty effective February 1, 2019. 25 predict that the Magnitsky Act could not have had its intended effect at improving human rights nor will it be able to succeed until relations improve or other measures are introduced. To illustrate the validity of this prediction, the Human Rights Reports for Russia during the period of 2011-2017 2 will serve as the data section of this paper. HUMAN RIGHTS REPORTS Every year the U.S. Department of State issues country level reports on the human rights practices of specific nations. This information is gathered using a network of NGOs and other non-profit organizations located inside the nation that observe and report on human rights violations. The Department of State separates these issues into the following categories: arbitrary or unlawful deprivation of life; freedom of expression; political freedom; official corruption; governmental attitudes regarding NGOs investigation of human rights and corruption; discrimination and other societal abuses, trafficking in persons; and workers’ rights. To demonstrate the lack of progress and overall deterioration in regard to human rights protection, the following pages summarize the findings from these reports for the period of 2011-2017. Unlawful Deprivation of Life Between 2011 and 2017, an alarming number of events took place regarding the arbitrary or unlawful deprivation of life. The reported number of incidents is unlikely to be representative of every situation given the well-known fact that many cases go unreported and many are covered up in some form or another. In 2011, the Committee of Soldier’ Mothers received over 25,000 complaints of hazing from the military yet only 1,500 cases were ever registered. This is because many soldiers refused to report hazing to their unit officers for fear of reprisal and 2 The human rights report from 2017 was the last published report at the time this paper was created. 26 because cases that were reported very rarely resulted in punishment for those responsible. If the hazing resulted in death, courts frequently found the cause of death to be suicide despite substantial evidence of foul play. This lack of justice carries through all seven years of reports. Several instances of suspicious deaths occurred during these years including prominent journalists opposed to Russian policies and behaviors as well as political dissidents such as Boris Nemtsov who was the Deputy Prime Minister under President Yeltsin. Suspicious disappearances also took place in large numbers during this time period. These disappearances are believed to be enforced by authorities for political and financial reasons. In 2015 there were 476 outstanding cases of enforced or involuntary disappearances; by 2017 there were 480 cases. From December 2016 through March 2017, over 100 male residents of Chechnya were kidnapped by local security services, held prisoner and tortured for their suspected homosexuality. The Russian government denies this anti-gay purge, yet several survivors have come forward with their personal testimonies to local newspapers and human rights watch groups. In Russia there is no legal definition of torture meaning that the only criminal charges that can be brought against the perpetrators are simple assault or exceeding authority. During those seven years, there were increased amounts of illegal psychiatric detentions, beatings, extortion and manipulation of prison inmates to enact confessions as well as the use of racial profiling by police officers. Very few cases involving torture were ever brought before a court of law and even fewer were ever prosecuted even when the torture resulted in death. Conditions in prisons and detention centers were often life threatening and disregarded fundamental human rights. In 2011 it was reported that the standard space per person was on average 43 feet which ignores the 75 square-foot standard outlined by ECHR. Also during this 27 year, it was reported that 50 individuals had died in pretrial facilities and 4,432 died in correctional facilities. In 2012, 285 deaths occurred in pretrial facilities and in 2013—the year the Magnitsky Act went into effect—over 4,120 people had died in pretrial detention centers. Medical services were often limited or denied to patients resulting in 4 percent of the prison population being infected with tuberculosis by 2014 (17 times higher than the national average) and HIV rates that increased nearly 6 percent every year reaching 62,000 detainees in 2016. In 2017 it was reported that 87 percent of deaths in detention facilities were caused by poor medical care. One problem that contributes to the rapid spread of disease is overcrowding. By 2015, every detention facility in Russia was crowded beyond capacity, some by more than 27 percent. This is a substantial increase from 2014 when prisons were operating at 95 percent capacity and from 2013 when levels were at 90 percent capacity. As a result of repressive legislation from the Putin administration, by 2016 there were no independent bodies to investigate allegations of inhumane treatments in prison. Consequently, many violations remain unreported. There are several laws pertaining to arrest procedures and treatment of inmates while in detention, yet they are rarely enforced with any real effort by the prison guards. In many cases, prison officials held individuals in custody longer than acceptable, subjected inmates to unfair and illegal interrogation techniques, and withheld important information regarding the arrest and detention from detainees. Additionally, there were numerous cases of “pocket” defense attorneys who acted in ways that benefited the prosecution rather than their client as well as judges who were easily influenced to rule a certain way. While the law prohibits arbitrary arrests, the practice continued with impunity during the 7 recorded years. Oftentimes, individuals involved in demonstrations against the government were arrested and held to silence the opposition. 28 Beyond the problems occurring during the initial arrest and detention, many issues occurred during the trial procedures that were blatant denials of human rights. Between 2011 and 2017 complaints sent to the human rights ombudsman regarding alleged violations of the right to a fair trial consistently accounted for more than 60 percent of complaints related to violations of civil rights. Human rights watch groups noted in 2017 that many court hearings appeared to be predetermined through behind-the-scenes interactions with police, judges and lawyers. Due to the high cost of attorney fees, the poorest defendants often received inadequate legal advice and representation. Other illegal procedures that occurred during this time include the illegal detention and prosecution of political prisoners. In 2011, the number of recorded political prisoners was 39, in 2017 that number tripled to 117 individuals. The charges these individuals faced fall under the general term of extremism which is broadly defined in Russian law. The ECHR frequently opposed the actions taking place in Russia and attempted to issue rulings on especially egregious human rights violations. However, in 2015 the Russian government passed a law enabling the Constitutional Court to declare these rulings “nonexecutable” meaning that Russia does not have to obey decisions they deem contradictory to their constitution. This law vastly restricted the ability of outside forces to intervene in Russian affairs. Russian law also forbids officials from entering a private residence, prohibits the collection, storage, utilization and dissemination of information about a person’s life without their consent and until 2015, prohibited government monitoring of correspondence, telephone conversations and other means of communication. However, in 2016 under the broad antiterrorism initiative, Russian authorities required telecommunication providers to store all electronic and telecommunication data including phone calls, texts, images, and videos. This group of amendments called the “Yarovaya package” allows authorities to monitor phone calls in 29 real time with an easily obtained warrant. Human rights groups claim that authorities regularly use this tool to intimidate citizens. Prior to these amendments, there were numerous claims of Russian officials monitoring telecommunication of regular citizens and more commonly, those who were actively opposed to the regime. In 2013, another objectionable law went into play that requires relatives of terrorists to pay the cost of damages caused by an attack. Many human rights groups criticize this policy as a form of collective punishment. The final subcategory listed under arbitrary and unlawful deprivation of life is abuses in internal conflict. The North Caucasus republics, which reside on the southwest border of the nation, specifically Dagestan and Chechnya, experienced extreme violence driven by jihadist movements, interethnic conflict, personal and clan-based vendettas and the use of excessive force by security. During the recorded seven years, the number of missing persons grew to 20,000 according the Caucasian Knot, a local news source. A majority of those missing are believed to have been detained or abducted by government forces or law enforcement and were either imprisoned or killed. Over those seven years, at least 2,611 individuals died as a result of armed conflict in the region. Many of the deaths and disappearances went uninvestigated and unprosecuted. Section four, subsection (a) of the Sergei Magnitsky Rule of Law Accountability Act states that those persons responsible for “extrajudicial killings, torture, or other gross violations of internationally recognized human rights” shall be determined in violation of the act and subjected to the outlined financial and travel restrictions. However, considering that the rates of these offenses did not decline but rather increased in the time since the act was introduced, it is clear that the intended deterring element of the act has not been successful. 30 Freedom of Expression One of the best examples of the deterioration of human rights in Russia is the freedom of expression including speech and press. Between 2011 and 2017, these rights were severely limited to the point of complete authoritarian censorship. In 2013, several new laws were instituted that started the process of restricting speech. These laws prohibited the distribution of material that promoted nontraditional sexual relationships to minors; criminalized the intentional offending of religious sentiments; and criminalized calls for separatism. Then in 2014, more laws went into action that broadened the definition of extremist speech; prohibited profanity in books, films, music, theater, and blogs; toughened punishments for advocacy of separatism, and banned symbols associated with fascism. In 2015, the list of “extremist” materials that were banned from the country totaled 3,072 items, by 2017 this list had reached 4,294 books, videos, websites, social media pages, and other items. Among the organizations that were banned for being “extremist” were Jehovah’s Witnesses for their translation of the bible. The press in Russia has never truly been free but during this period it became nearly impossible to publish anything that opposed the regime’s authority. Those who did were labeled as “traitors” or “foreign agents” and effectively shut down. Beyond losing their jobs, many journalists, radio hosts and television news reporters became the targets of violence as a result of their new labels. Over the years there were hundreds of incidents including murders, attacks, detention, threats, and harassment against journalists in all forms of the press. From 2012 to 2015, the number of attacks on journalists tripled. Those who reported on human rights violations and corruption inside Russia or Crimea were especially vulnerable to retaliation. To further censor journalists, libel and slander laws were broadened and heavily enforced. 31 The internet also became increasingly restricted during these years. The NGO Agora stated that in 2014 there were 1,832 cases where the rights of internet users were infringed upon, by 2017 there were 116,103 cases of this nature. This dramatic increase is the result of several laws implemented in 2013 and onwards that attempted to crack down on internet freedom. The first oppressive law of this period was introduced in 2012 as a federal blacklist of internet sites. This list was allegedly created to protect children from offensive information yet that hardly explains why over 600,000 sites had been blocked in the country by 2016. The Pirate Party of Russia who monitored the blacklist reported that between 96 and 99 percent of the blocked sites in any given year did not contain illegal content. Other problematic laws that went into place during these years include the new ability of the Prosecutor General to demand websites promoting extremist information of mass public events to be blocked; a law requiring bloggers who received more than 3,000 views per day to register as mass media outlets; a law requiring data servers for email and social networking sites be kept on the country’s territory; a law requiring owners of internet search engines to be accountable of the truthfulness of information before it is published; and a law prohibiting anonymous users from using online messaging applications. Beginning in 2014, the government took steps to restrict academic and cultural freedoms inside Russia. These steps include opening criminal investigations against university professors who criticized government policies; censoring and shutting down cultural events or displays that authorities considered offensive or that expression opposition views; closing museums and universities that depicted unfavorable materials; and canceling ballets and essay contests due to the topic of sexual orientation. 32 The law provides for freedom of assembly and association but over the years local authorities continued to restrict the practice of these rights. Protestors and organizers of demonstrations were often attacked or arrested for their participation. In 2012, a law that increased the penalties for engaging in unsanctioned protests was enacted. In 2013, Putin signed a law banning demonstrations in Sochi leading up the Winter Olympics. Also in 2012, the “foreign agents” law that forced NGOs that receive foreign funding to register as foreign agents went into action (Machalek). Shortly thereafter the Dima Yakovlev Act banned these NGOs from receiving material or financial assistance from the U.S. Additionally foreign agent NGOs faced stigmatization and were forced to report their activities every six months. Being labeled as a foreign agent was essentially a death sentence for NGOs as they could no longer participate in political activities due to heavy fines and they lost a majority of their funding and support from Russia. In 2014, the government toughened the punishment for mass rioting and increased fines for violating these policies. By the end of 2016, over 150 NGOs had been designated as foreign agents, with or without their consent. In May of 2015, Putin created the new “undesirable” foreign organizations list that meant any organization found to be “dangerous to the foundations of the constitutional order of the Russian Federation” would have to cease all activities. Many of the new “undesirable” organizations were involved with protecting and reporting on issues of human rights and corruption in the country. In 2017, the term foreign agent was expanded to include foreign media working in Russia and Russian news publications that received funding from abroad. Undesirable organizations were prohibited from establishing physical entities in the country, essentially shutting down their operations. The final subcategory under the protection of civil liberties is the freedom of movement including internally displaced persons (IDPs), refugees, and stateless persons. These three 33 populations were particularly restricted in movement and were often denied services based on their status. While the number of IDP decreased from 75,980 in 2011 to 22,600 individuals in 2016, the number of stateless people increased from 21,443 to 178,000 individuals during the same period of time. This discrepancy is understandable given the definitions and circumstances of these groups. IDPs are the result of internal conflict like that in Chechnya whereas stateless people are identified as illegal migrants or noncitizens. Because of this, IDPs were able to resettle in Russia while stateless people were denied the right to citizenship, legal work, land and the right to register as residents. Like refugees, stateless people were often housed in decrepit facilities that were unsuitable and unsustainable. There were many reports of police and progovernment groups targeting and harassing these people, occasionally detaining and deporting them involuntarily. Certain nationalities, like Ukrainian, were preferred among stateless persons and refugees. Those of Ukrainian decent were readily integrated into society while those from Central Asia and Africa where repeatedly denied asylum or had to pay fees for equal service. After the annexation of Crimea, non-Ukrainian persons were denied many of the services given to those from Ukraine including food, shelter, medical care, and job-placement assistance. This clear-cut racism was an effort to reestablish soviet influence while keeping out populations that could threaten the homogenous nationalistic order. It is overwhelmingly evident that neither the government nor the societal elites are determined or invested in protecting internationally established human rights or the rule of law in many cases. Because of this defiant strategy and the lasting influence of globalization, the Magnitsky Act—as well as the subsequent sanctions and travel bans—has predictably not been able to alter the state of human rights in Russia. 34 Respect for Political Freedom To further enhance the nationalistic and isolationist principles that define the Putin administration, the government has taken several steps to restrict the political freedom of its people. Both State and Presidential elections between 2011 and 2017 were marked with accusations of governmental interference and manipulation of the electoral process. This includes: fraudulent use of absentee ballots, ballot-box stuffing, manipulation of protocols, busing in voters from other regions, “carousel” schemes in which citizens voted multiple times at different locations, distribution of gifts to voters, allowing unregistered voters to vote, and preventing registered voters from voting. These undemocratic practices were widely and frequently used throughout the country. In a 2011 election for State Duma, Chechnya reported a 99 percent voter turnout rate with 99.5 percent of those votes in favor of United Russia (the Party of President Putin). Despite only having 608,797 registered voters at the time of election, Chechnya reported that 611,099 ballots had been cast. During the 2012 Presidential election, Putin allegedly won 99.82 percent of the vote in Chechnya. Contradictory to his apparently favorable standing among Russian voters, over 30,000 protestors rallied in Moscow after the election. As more citizens gained access to the media, government officials used this mode of communication to build up certain campaigns and candidates while silencing others. Pro-regime candidates received more coverage from television and print media and the coverage that minority candidates did receive was often negative and inaccurate. These candidates also faced other obstacles including disqualification for menial reasons, denial of applications for rallies, and restricted access to media of any type. 35 Over the years, the political rights of citizens were increasingly limited due to a series of legislative actions from the Putin administration. In 2013, the Justice Ministry suspended independent election monitor GOLOS’ registration as an NGO and evicted the group from their offices. Human rights watch groups suspect that this was an effort to distract the group from election monitoring. In 2014, the President abolished mayoral elections in many major cities in an effort to streamline the government and accumulate more influence. Also during this year, the “foreign agents” policy banned those organizations from taking part in the election process. Since many of these organizations were created to monitor corruption and human rights abuses, they were no longer able to oversee and report on violations that took place during the election cycles. Additionally, the Central Election Commission eliminated the use of video monitoring at polling stations claiming that it was an unnecessary expense. Observer groups claim that this decision was actually made to prevent the detection of fraud at polling places. As a result, by 2016 over 1,800 reports of alleged election-day violations were received by observer groups. Concerns also began to rise over the treatment of organizations and opposition figures by progovernment individuals and groups. Physical and economic threats were made against these groups in attempt to intimidate them and in several cases, authorities went as far as to conduct raids of campaign offices where they planted incriminating materials or seized materials and important equipment to hinder campaign progress and operations. The Russian government’s role in interfering with the sanctity of the democratic process is one of many examples of how deeply and systematically corruption runs within the nation. The criminal acts and behaviors outline in the Magnitsky Act are not being perpetrated by a select few persons in Russia but are rather occurring at all levels of society and to all degrees of extremity. Therefore, the targeted economic sanctions and travel bans of the Magnitsky Act are 36 unlikely to exact mass change since they are not targeted towards the largest proponents of corruption and human rights violations. Official Corruption In regard to official corruption and the lack of transparency within Russia, the nation experienced a rather pervasive problem involving all levels of government. The State Department lists several manifestations of corruption in Russia such as bribery of officials, misuse of budgetary resources, theft of government property, kickbacks in the procurement process, extortion, and improper use of official position to secure personal profit. While the law provides criminal penalties for corruption, there is a general lack of enforcement from officials. In 2011 the Ministry of Internal Affairs estimated the average amount for commercial bribes in Russia to be 61,000 rubles which tripled the previous year’s figure. In 2016, that number grew to over 654,000 rubles proving that the economic sanctions have had little effect on the systematic corruption taking place in this nation. Every year the Global Competitiveness Report compiled by the World Economic Forum cites corruption as the most problematic, high-risk factor for doing business in Russia. In the years 2014 and 2015 alone there were over 57,000 reported cases of corruption registered by the Prosecutor General’s Office. Due to inconsistent enforcement of anticorruption polices as well as the adoption of liberal legislation during the years, systematic corruption has increased dramatically. For example, there is currently no specific anticorruption agency assigned to investigate and prosecute corruption. Instead, when a whistleblower such as Sergei Magnitsky complains about official corruption, the government official who is the subject of the complaint is often asked to investigate the claim. This practice frequently leads to retaliation against the whistleblower, including criminal prosecution, and no charges pressed against the actual culprit. 37 There also remains to be no legal procedure in place to protect whistleblowers who report on corruption. Adding to the problem, in 2015 the government passed a law that reduced fines for receiving a bribe from 25 times the size of the bribe down to 10 times and reduced fines for providing a bribe from 15 times the size of the bribe down to five times. By reducing these fines, the government is essentially encouraging individuals to participate in acts of corruption. This law specifically aids government officials who, in the unlikely event that they are caught, will face less retribution for their crimes. Government officials are frequently given a free pass when it comes to corruption. According to Russian law, the public must have access to government information such as the financial activities of federal executive agencies. However, several watch groups noted that only 40 percent of the required information was ever published in a given year. While acts of corruption are a fairly regular occurrence in Russia, when large scale events like the Winter Olympics in Sochi take place, the practice drastically increases. According to Boris Nemtsov, in 2014 between $25 billion and $30 billion of public money was pocketed by government officials. The initial estimated cost of the Olympics was $12 billion but this number was quadrupled by officials in the construction industry through false or misleading reports. It is estimated that a third of the final $50 billion budget was lost to corruption. While the government and society’s elites reaped the benefits from this operation, the most vulnerable populations in Russia were further exploited with increased violations of workers’ rights. The act of corruption, both on individual and systematic levels is perhaps the forefront principle of the Magnitsky Act. In the act as well as in the congressional hearings about the act, it was determined that the human rights abuses experienced by Sergei Magnitsky while in prison were a result of corruption, not only regarding the scheme he discovered but also the tactics used to cover up Sergei’s death and detention. It is also noted throughout the Human Rights Reports 38 that corruption is one of the most prominent issues in Russia at all levels of society. Therefore, rate of corruption can be rationally used as a measurable indicator of whether or not the Magnitsky Act has fulfilled its purpose. As illustrated by this section, the rate of corruption has increased substantially leading to the conclusion that the efforts to quell the practices and behaviors have not sufficed. NGOs and International Investigative Organizations One strategy used by the Russian government to suppress oppositional opinions in the public and to prevent international interference is the restriction of nongovernmental organizations (NGOs) and international investigative groups’ abilities to operate in the country. Before the implementation of the Magnitsky Act, human rights organizations faced harassment in the form of investigations and raids. These groups acted very cautiously about accepting foreign aid but for the most part they were able to conduct business with only moderate amounts of resistance from government authorities and civilian groups. This disdainful attitude against NGOs and other outside groups began to change once the U.S. government began publicizing work on the Magnitsky Act. In 2012, the “foreign agents” law and the Dima Yakovlev Act went into effect, drastically effecting the abilities of NGOs, especially those concerned with human rights issues and corruption schemes. Nearly all political activity was banned under these laws for groups that received foreign funding and support as well as for those with dual U.S. citizen members. Additionally, laws on extremism and libel were employed more heavily, further limiting the influence NGOs had had. Government authorized harassment increased, and many authorities refused to cooperate with NGOs that were critical of their activities. Groups dedicated to work in the North Caucus regions reported numerous threats and intimidation by law enforcement. 39 The term “foreign agent” quickly became associated with espionage and therefore stigmatized any group burdened with the label. Starting in 2013, authorities used the law to justify increased amounts of inspections of NGOs as well as threats, prosecution, convictions, or closure of certain groups. On September 9th, President Putin referred to human rights groups and their activities as “anti-Russian” claiming that their work was unpatriotic and detrimental to national security. When groups refused to register themselves as “foreign agents”, the government began to change the status themselves. By the end of 2014, 28 NGOS were listed in the national registry and at the end of 2016 over 150 NGOs had been added. Also during 2014 in an effort to cut back on foreign interference, the government increased the amount of governmental aid for NGOs by 250 million rubles. Many rightfully worried that accepting this funding would limit the operational independence and ability to voice concerns and criticism. A year later, many NGOs on the foreign agent list reported that the government had denied them federal funding due to the sensitive matters they investigated. In fact, only 3 of the 112 NGOs with the label were given federal assistance during the year. In 2015, President Putin implemented the Russian Undesirable Organizations Law that gave prosecutors the power to extrajudicially declare foreign and international organizations “undesirable” and to shut them down. The NGO Committee against Torture was one of the first groups to be affected by this law as they were forced to shut down after accusations of “undermining the constitutional order of the Russian Federation, calling for the overthrow of the current government, a change of political regime in the country” by the Ministry of Justice. Those organizations that were allowed to remain open were constantly harassed by government officials and pro-government civilian groups. Terms such as “foreign agent” “political agent” and “fifth column” were used regularly in official speeches and publications from the 40 government to increase the stigmatization of opposition politicians, human rights activists and their so-called “destructive purposes”. The effect of this propaganda and the legislation it sparked was widely felt throughout the nation. Many organizations closed during the years due to mounting pressure or direct action from the government and even more were rendered useless in the protection of human rights. Equally detrimental was the decline in quality of human rights defenders within the Russian government. In 2016 Ella Pamfilova resigned from her position as Human Rights Ombudsman and was replaced by Tatyana Moskalkova who made a statement that “human rights issues have been actively used by Western and American bodies as a weapon of blackmail, speculations, threats, attempts to destabilize and exert pressure on Russia”. After this speech it became very clear that this office was merely a pawn of the regime rather than an office legitimately dedicated to its citizen’s rights. Before resigning, Pamfilova released a report noting that during 2015 the Ombudsman’s Office had received 64,189 complaints from citizens and state organizations regarding the state of human rights in the country. This is an alarming increase from 2013 when there were only 23,640 complaints of this nature. Without independent organizations to report of the human rights violations and acts of official corruption, these crimes were allowed to continue and those responsible were only emboldened. In addition to identifying persons responsible for extrajudicial killings or torture, section four, subsection (a) of the Magnitsky Act also seeks to identify those responsible for violating the human rights of those seeking “to obtain, exercise, defend, or promote internationally recognized human rights and freedoms such as the freedoms of religion, expression, association, and assembly and the right to a free and fair trail and democratic elections”. The foreign agent and undesirable laws that went into effect after the act provide evidence that the Russian 41 government and societal elites are unwilling and uncommitted to uphold fundamental human rights. In fact, the act has made the Russian government more determined than ever to silence whistle-blowers and protectionist groups alike. Discrimination and Societal Abuses The sixth section of the yearly report by the U.S. State Department relates to the discrimination against numerous populations in Russia such as women, children, minorities, persons with disabilities, and members of the Lesbian, Gay, Bisexual, Transgender, Queer community (LGBTQ). Russian law prohibits discrimination based on race, religion, language, social status, and other circumstances yet the government very rarely enforced these prohibitions. Instead, several policies and events took place between 2011 and 2017 to restrict the rights of these marginalized individuals. Statistics from 2013 show that while women were the victims of only 43 percent of all crimes, they were the victims of 63 percent of crimes committed in the home, 73 percent of the victims of crimes committed by family members and victims of 91 percent of crimes committed by a spouse. According to the same Internal Affair report, over 70 percent of these victims did not seek help and 97 percent of domestic violence cases never researched a court. The cases that were reported were frequently dismissed or transferred to a reconciliation process conducted by a “justice of the peace” who focuses on preserving the family. Domestic violence in particular is a major problem for Russia. It has been reported that one third of women in the country were subject to physical spousal abuse during these years. In 2011 there were 21,400 reported cases of domestic violence and in 2016 there were over 31,000. At least 14,000 women die each year in Russia to due violence in their homes as of 2014 which is a 2,000 person increase from 2012. There are several reasons that women in Russia do not report the abuse they experience at home. 42 Firstly, law enforcement officials regularly advise them against making claims and often don’t investigate unless they believe the woman’s life is directly in danger. Secondly, there is no legal definition of domestic violence in the criminal code so unless there is physical assault involved, many courts will not prosecute. Thirdly, there are very few services available to women who chose to leave their husbands. According to the ANNA Center, there were only 23 women’s shelters across the country totaling less than 200 beds for women at any given time. Additionally, it is common practice for the husbands to gain full custody of children in divorce cases so many mothers stay to protect their families. In 2017, president Putin signed a law that made beatings by close relatives an administrative rather than criminal offence. The sponsor of the law said “[women] don’t take offence when they see a man beat his wife…a man beating his wife is less offensive than when a woman humiliates a man”. This same law allows parents to beat their children so long as the beating does not cause hospitalization. Other crimes against women that were not only allowed but approved by the government during these years were female genital mutilation (the law does not prohibit), sexual harassment (the law does not prohibit), honor killings where men are permitted to kill their wives or female relatives for disobeying, bride kidnappings, limited access to birth control, and discrimination in the workforce. As of 2014, there was a list of 456 occupations where employers could legally exclude women. As in the U.S. a widespread gender pay gap exists forcing women to depend on a spouse for financial aid. Crimes against children were also widespread and increased significantly during the time period. Although education was free through grade 11, authorities often denied school access to children of refugees, asylum seekers and migrants as well as minorities like Roma. In 2015 there were over 102,608 minors recognized as victims of a crime which is a 10 percent increase from 43 the previous year. These crimes include sexual abuse which increased 20 percent in the year, negligence by parents (440,000 cases), enabling alcohol or drug abuse (1,400 cases), and physical abuse of a child (11,900 cases—2,500 fatalities). According to the NGO Foundation of Assistance of Children in Difficult Life Situations, between 2,000 and 2,500 children die every year from domestic abuse and 2000 children commit suicide. Children, especially homeless children and orphans were often sexually exploited. Russian law prohibits the manufacture, distribution, and procession with intent to distribute child pornography, yet no legal definition of the term existed until June of 2016. Despite the newly established definition, authorities consider child pornography to be a serious concern in the country. Approximately 15 percent of the 45,700 links shut down by Roskomnadzor in 2014 (an internet monitoring group) were related to child pornography. Despite this unnervingly high number of websites, in 2014 the Russian government had only opened 247 cases related to child pornography. Overall, injustices against children increased during these years. In 2011 there were 120,000 orphaned children, 200 children on average were taken away from neglectful parents each day and over 600,000 children were located in various types of institutional and foster care systems. The NGO Children’s Rights estimated that in 2011 40,000 children ran away from home to escape neglect and abuse and 20,000 orphans fled for similar reasons. In 2013, as a result of the Yakovlev Law, there were 198,000 orphans in the country. In 2014, over 53,000 children had run away from their homes, a 22 percent increase from the previous year. In some cases, (652 reported cases as of 2014) children who misbehaved in orphanages or foster homes were sent to psychiatric facilities. Homeless children and orphans often engaged in criminal activities, received no education or health care, and were especially vulnerable to substance 44 abuse and abuse from other civilians. There were numerous reports of law enforcement officials abusing street children, blaming them for unsolved criminal cases and committing illegal acts against them such as extortion, detention and psychological violence. Minority populations were also especially vulnerable to abuse and harassment from law enforcement, civilians and other groups in the nation. Every year, racially motivated violence took the lives of at least 20 people and injured at least 150. The most targeted groups were Central Asian, African, Romani and Muslims. Anti-Islam and Skinhead groups terrorized communities and individuals through acts of vandalism, verbal and physical abuse, and racist rallies with very little if any punishment from law enforcement. In 2011 it was estimated that 200,000 individuals nationwide belonged to some type of neo-fascist, radical nationalist group. Even the administration targeted minority groups during the years. In 2015 there was a violent clash between police and residents of a Romani settlement in Tula over access to a gas pipeline running through their community. Then in 2016, 118 Romani homes in Tula were demolished as a result of the protests. The abuse continued into 2017 when troops bulldozed 22 more homes in the community while local civilians and news outlets used anti-Romani rhetoric. Another targeted group of people in Russia are those with physical or mental disabilities. These citizens faced discrimination and denial of equal access to education, employment and social institutions. Authorities did not enforce laws requiring building and public services to be accessible to people with disabilities. Only 19 of the 189 train stations had elevators in 2013, only 54 percent of public buildings were accessible, as were only 40 percent of busses and 25 percent of trolleys. Because of these restrictions, many people with disabilities were confined to their homes or hospital care. Only 9 percent of persons with disabilities held a permanent job. Also alarming is the treatment of children with disabilities. 45 Since only 3 percent of schools in the country could accommodate these children, of approximately 450,000 school aged children with disabilities only 250,000 received an education. Of those who did, 140,000 attended “regular” schools, 40,000 were taught at home and 70,000 attended special schools. While children with disabilities only account for 2 to 3 percent of the population, 45 percent of these children were institutionalized. These children were often abused or neglected, and several reports indicate that the treatment resulted in the deaths of many children. Once a person with a disability enters the system, they are branded with the label “idiot” or “imbecile” that follows them through life often making it difficult to gain employment, housing or benefits. These labels are typically designated during early childhood and are irrevocable. This was made worse in 2016 when President Putin created a federal register for disabled persons. The last marginalized group to be included in the State Department reports is the LGBTQ community. In most nations, individuals from this group suffer from societal stigma and discrimination. In Russia, abuses against LGBTQ members were especially rampant and harmful. A majority of these individuals hid their orientation due to fear of losing their jobs, their families and even their lives. Those who were actively open about their sexuality were frequent targets of skinhead aggression that was never punished by law enforcement. Rather, many law enforcement officials targeted and harassed openly gay or suspected gay individuals. Every year Moscow refused to allow gay pride parades despite the ECHR rulings that say this type of ban violated the freedom of assembly. One website GayRussia.eu claims that instead of allowing these parades, Russian authorities grant permission for anti-gay rallies calling for the criminalization of homosexuality. In 2013, President Putin signed the law criminalizing the “propaganda of nontraditional sexual relations” to minors limiting the rights of free expression 46 and assembly. The banned “propaganda” includes materials that “directly or indirectly approve of people who are in nontraditional sexual relationships”. After this law, many LGBTQ individuals as well as allies were arrested and targeted for their statements. Violent attacks happened often including the 2016 abduction and torture of over 100 gay men in Chechnya. Transgender individuals also faced severe discrimination in nearly every aspect of life. Even though the law allows for a person to change their gender on government documents, very few civil registry offices allowed the requests. Transgender individuals were often held in prisons with members of their biological sex rather than the gender they identify with causing mass amounts of abuse. These individuals were also targeted at the same or higher rates by skinhead groups and law enforcement. As further evidence that the Magnitsky Act has not improved the human right conditions in Russia, this section—as well the previous sections analyzing the Human Rights Reports— proves that the most vulnerable populations in society have faced increased rates of abuse while their abuses are emboldened through legislation and actions of their government. Despite the efforts of the U.S. the Russian government has yet to take notable steps towards improving the welfare of its citizens and has instead repeatedly oppressed, degraded, and dehumanized them. Workers’ Rights The seventh and final way in which the U.S. State Department measures the human rights of a nation is by the rights enjoyed by workers including: the freedom of association, prohibition of forced labor, prohibition of child labor, freedom from discrimination with respect to employment, and the right to acceptable working conditions. These rights are considered to be a fundamental aspect of any industrialized society especially one with such a large working class 47 as Russia. However, just as in the previous six categories of human rights, Russia failed to protect and promote the rights of its citizens and actively contributed to their deterioration. Russian law provides workers the right to join and form independent unions, conduct strikes and to bargain collectively; however, several policies have several restricted these rights. Active members of the military, civil servants, customs workers, judges and prosecutors, and persons working under civil contracts are excluded from the right to organize. Strikes in the emergency response services and essential public-service sectors such as transportation are also outlawed. Additionally, strikes on issues relating to state policies and solidarity strikes are not allowed. In the small percentage of strikes that are allowed by federal law, many are denied due to extensive legal requirements that infringe upon worker’s abilities to organize. The legal process involved in authorizing a strike takes at least 40 days to complete. Furthermore, individuals who join in or organize strikes are often pressured by employers not to participate at the risk of losing their jobs. Several labor groups have also noted that police forces regularly interfere with citizens’ rights to strike through means of intimidation. Of the issues that compel citizen groups and labor unions to go on strike or to protest, forced labor and child labor rank high on the list. The industries that were most likely to use forced or child labor were construction, textile, and agriculture. In each of these sectors, men, women and children—typically from foreign countries—faced poor conditions with insufficient meals and housing, improper instruction, abusive and exploitative employers, and unacceptable wages. In 2012, it was estimated that between 8 and 12 million migrant workers were in the country. Since these individuals were not citizens of Russia, the only work they could acquire involved the previously mentioned sectors. Under a state-to-state agreement, approximately 20,000 North Korean citizens were sent to Russia each year under conditions of forced labor. 48 Many of these individuals ended up working in construction projects for the Winter Olympics of 2014 and the 2018 World Cup. In the first half of 2016, the Ministry of Internal Affairs registered 262 cases of human trafficking or use of slave labor. In general, children were more protected in regard to working conditions than adults were. However, between 2011 and 2016, there were 11,898 reports of child labor violations. In urban populations, children were typically employed in construction and informal sectors such as retail services, washing cars, delivering items, and selling goods on the streets. Children in rural areas more commonly worked in agriculture. The most common violations of rights included the absence of written labor agreements, use of minors in harmful and unsafe work, and excessive hours. The Federal Labor and Employment Service (RosTrud) often classified violations of child labor laws as administrative offenses that were punished by insufficient fines. Between 2012 and 2014 RosTrud inspectors found 1,757,200 labor violations with a large portion coming from 2014 due to construction on projects for the Winter Olympics. Russian labor codes provide regulations for standard work hours, overtime, and annual leave as well as minimum wage and standard conditions for work, yet the government was ineffective in enforcing these laws in either the formal or informal sectors. The most vulnerable populations of workers were undoubtedly migrants who were more likely to be subjected to forced labor, discrimination, and hazardous or exploitative working conditions. While there were some improvements in the overall quality of working conditions, during the time period, Russia consistently failed to protect and promote the rights of its people and the rights of workers from other countries. In regard to the Magnitsky Act, it is apparent that the legislation is not enough to prevent human rights violations. When it comes to workers’ rights, the U.S. appears to have a 49 contradictory interpretation of how best to prevent abuses and violations. It is a widely-known phenomenon that when a city is chosen to hold a large-scale sporting event, the rate of human rights abuses in said city will undoubtedly rise as a result of various factors including displacement, restriction of the freedoms of speech and assembly as well as questionable and dangerous guidelines for workers. This is illustrated by the 2016 Olympics in Rio de Janeiro, Brazil. Despite this information, the U.S. as a member of both the International Olympic Committee and FIFA Council, approved Russia’s bid for the 2014 Olympics and 2018 World Cup. Had these events not taken place in Russia, it is likely that the increase in worker’s rights violations during these years would not have been as great. SOLUTIONS The purpose of the previous pages of analysis was to illustrate how human rights in Russia have changed since the implementation of the Magnitsky Act. It is evident that in nearly every category under the umbrella of human rights, conditions have worsened—in some cases substantially—since the first round of targeted economic sanctions. Given the complexity of the situation and the multitude of factors that impact human rights, it is impractical to conclude that the Magnitsky Act in itself is the only cause of this phenomenon. However, it is more than fair to conclude that the Magnitsky Act has been unsuccessful in its intended purpose of promoting human rights and ending systematic corruption. Supporters of the act argue that the sanctions have not been given enough time or been used against enough people to know whether or not they have made a positive impact. In the six years since the act was passed, hundreds of thousands of people have been abused, degraded, exploited and even killed at increasing rates without a change in legislation from the Russian government. These six years have been enough time for President Putin to retaliate against the 50 U.S. and to implement more repressive and restrictive laws. If a positive change were going to happen as a result of the Magnitsky Act, it would have happened already. Another argument in support of the act is that the greatest indication of success has been the effect the legislation has had on President Putin. It is true that the President and his administration have been greatly angered by the passage of the Magnitsky Act. This is evident the Dima Yakovlev Law as well as by their interference in the 2016 U.S. Presidential Election. However, what has made President Putin so upset is not the effect the act has had or could have but the message behind the act. From the perspective of Russia, the Magnitsky Act is yet another way for the U.S. to exert power and influence over the domestic affairs in Russia. Russia has long been resentful of U.S. efforts to interfere in the sovereignty of the nation and the Magnitsky Act is a continuation of this problem. President Putin will not bend to the will of Washington and be pressured into adopting pro-western standards. While it is justified and appropriate for the U.S. to attempt to better the conditions of human rights and to eliminate systematic corruption in Russia, the solution Washington has utilized has been tried and failed for many years with a very low success rates. Instead of relying on an outdated method to combat a modern problem, the U.S. should investigate alternative solutions to protecting human rights and punishing those who violate them. From the U.S. State Department reports, it is clear that the majority of human rights violations are being executed by government and other officials at the local, state, and national levels rather than the few individuals that the U.S. government has thus far sanctioned. One alternative to solve the menial amounts of sanctions that have actually been issued would be to sanction the Russian government rather than go after target individuals. However, as the most recent economic research shows, sanctioning countries with the intention of improving their 51 human rights actually worsens them in the long run (Pesken, 2009). Therefore, a sanction on Russia as a whole is not an efficient option. Instead, law makers in the U.S., as well as the Treasury Department and the State Department, should focus on simplifying the sanctioning process to allow for more immediate action and a large scope of influence. One of the greatest weaknesses of the act is the lack of follow through in regard to actually issuing sanctions. This is because the process of getting an individual on the Magnitsky list is incredibly cumbersome. According to Bill Browder, in order to sanction an individual, there must be overwhelming evidence that they did in fact violate human rights or participate in acts of corruption (How to Get Human Rights Abusers and Kleptocrats Sanctioned Under the Global Magnitsky Act, 2018). This is difficult to prove considering that most of these events are not documented or verifiable. Even bringing a name to the investigative committee requires a certain burden of proof that is often just not there. Documents that do exist, such as police records, typically do not reflect the truth of the events. These documents can also be changed or forged to cover up criminal activity. Another administrative issue with the act is that there are not enough resources allocated to the investigative process, reducing the potential effect the sanctions could have if they were more widely executed. These flaws help explain why in the six years the act has been in effect, only 49 individuals have been sanctioned. Part of the appeal of the Magnitsky Act was that the amount of sanctions issued would be a sort of deterring factor against further objectionable behaviors. However, this has not been the effect and the behaviors have continued in spite of the act. Simplifying the investigative process by allocating more resources and providing more opportunities for individuals and groups to report on abuses could make the act more impactful in the long run. 52 Another solution that could be used in conjuncture to the Magnitsky Act to increase the impact is to limit the opportunities for Russia to increase human rights violations. During the seven years of reports by the State Department, several events triggered increased the amount of violations that took place. These events were the annexation of Crimea as well as the 2014 Winter Olympics in Sochi and the 2018 FIFA World Cup. While the human rights report for 2018 has not yet been released, the years leading up to the event were marked by an increase in workers’ rights violations related to construction as well reduced freedoms of speech and expression relating to protests and rallies. In order to prevent these increases, Russia should not be allowed to host such large-scale events. The international community should not be celebrating or encouraging a nation with such poor human rights and enabling the government to commit even more atrocities against vulnerable populations in the nation. A third solution to the problem of the effectiveness of economic sanctions is to change the method of sanctioning from negative to positive. David Baldwin defines positive sanctions as, “actual or promised rewards” in context this means that the U.S. would offer Russia certain benefits as an incentive for improving its human rights record rather than take away benefits as with a negative sanction (Baldwin, 1971). Historically, this method has not been utilized as a form of coercion and there is little research done on the effectiveness in comparison to negative sanctions. In an article about criminality, Arie Freiberg says, “the strength of the modern state now seems to depend less on the state’s powers of coercion than upon its ability to satisfy the material demands of its citizens” (Freiberg 1987). It can also be said that the strength of a modern country depends upon its ability to satisfy the material demands of its enemies. From that interpretation, positive sanctions which are individualized to satisfy the targeted nation’s needs, are a more effective method of exacting change from a problematic regime. 53 CONCLUSION The Magnitsky Act of 2012 was created to punish individuals who had violated human rights or were involved in systematic corruption in Russia. The act is named after Sergei Magnitsky, a Russian tax attorney who uncovered a large-scale corruption operation and was subsequently arrested, neglected, beaten, and left to die inside a pretrial detention facility. Under this act, anyone directly involved in the crime Magnitsky uncovered or involved in his unlawful arrest, detention and death would have their assets frozen by the U.S. Department of the Treasury and have their visas denied or revoked by the U.S. State Department. The act was amended prior to becoming a law to more broadly effect any human rights abuser or participant in mass corruption in Russia. In the six years since the Magnitsky Act was implemented, there has been relatively little economic impact on the targeted parties. This is due to the fact that in the modern world there are numerous ways to side-step economic sanctions including sanction-busters, cryptocurrencies and illegal methods of obtaining money and visas. These sanctions have also been ineffective because the difficult process of sanctioning individuals has resulted in only 49 sanctions/travel bans. One way in which these asset freezes and travel bans have had an effect has been in aggravating the relationship between Russia and the U.S. This is caused by the Russian government’s resentment of the U.S. interfering in the sovereignty and domestic affairs of the nation. This issue stems from the rather disastrous effects that globalization had on the economy, politics and social structures of the country during the 1990s. Globalization has since become associated with Westernization and the extension of U.S. influence in the global community. To 54 combat this perceived threat, the Russian government has adopted a strikingly anti-Western attitude that effects both foreign and domestic policies. While President Putin and his administration continue to promote nationalistic and antiWestern propaganda in Russia, the conditions of human rights are crumbling under the repressive regime. These rights, separated into the categories of freedom from unlawful deprivation of life, freedom of expression, political freedom, freedom from corruption, freedom for nongovernmental organizations to investigate and report, freedom from discrimination and societal abuses, and workers’ rights, have been infringed upon in alarming ways and at increasing rates since the adoption of the Magnitsky Act. From the yearly reports conducted by the U.S. Department of State through NGOs and other human rights watch groups it is evident that the U.S. legislation has not improved human rights in any meaningful way. Protecting these rights and preventing corruption at all levels is of the highest concern for U.S. policy makers. Since the current solution has proven inefficient, it is time to research and implement alternative solutions such as positive sanctions, addressing administrative issues within the legislation and taking active steps to prevent further abuses from occurring. With human lives and the rule of law at risk, policy makers and government officials in both nations should be doing everything within their power to make substantial and lasting improvements. To change the harmful policies in Russia, it is first crucial to change the message of Magnitsky from punitive to proactive. By improving the Russo-American relationship, the U.S. will have a more conducive foundation of diplomacy, rather than hostile tension, to open communication on human rights. This action should not be interpreted as an act of submission to the Russian regime but rather an opportunity to protect U.S. interests and foreign policies with Russia. 55 REFERENCES Baldwin, David. (1971). The Power of Positive Sanctions. Cambridge University Press: World Politics 24(1), 19-38. Congressional Research Service. (2018). U.S. Sanctions on Russia. Library of Congress, R45415, Version 1. Dobrenkov, V.I. (2005). Globalization and Russia. The 37th World Congress of the International Institute of Sociology. http://www.swedishcollegium.se/IIS2005/total_webb/tot_html/papers/globalization_and_ russia.pdf Early, Bryan. (2015) Busted sanctions: Explaining why economic sanctions fail. Stanford, CA. Stanford University Press. Encyclopedia Britannica. Leaders of Muscovy, Russia, the Russian Empire and the Soviet Union. Retrieved from https://www.britannica.com/topic/Leaders-of-Muscovy-Russia-theRussian-Empire-and-the-Soviet-Union-1832695 Englund, Will. (2012). Russia Chafes as House Passes Magnitsky Act. The Washington Post. Retrieved from https://www.washingtonpost.com/world/europe/russia-chafes-as-housepasses-magnitsky-bill/2012/11/16/b589e544-300f-11e2-a30e5ca76eeec857_story.html?utm_term=.660d928d35c6 Erbelding, Rebecca. (2018). Rescue board: The untold story of America’s efforts to save the Jews of Europe. New York, NY. Penguin Random House LLC Fabre, Cecile. (2018). Economic statecraft: Human rights, sanctions, and conditionality. Cambridge, MA. Harvard University Press. Freiberg, Arie. (1987). Reconceptualizing Sanctions. Criminology 25(2), 223-256. Ginsberg, Julie. (2009). Reassessing the Jackson-Vanik Amendment. Council on Foreign Relations. Retrieved from https://www.cfr.org/backgrounder/reassessing-jackson-vanikamendment Gordon, Michael. (2016). Russia is Moving Ahead with Missile Program That Violates Treaty, U.S. Officials Say. The New York Times. Retrieved from https://www.nytimes.com/2016/10/20/world/europe/russia-missiles-inf-treaty.html Guillen, Mauro F. (2001). Is Globalization Civilizing, Destructive or Feeble? A Critique of Five Key Debates in the Social Sciences Literature. The Wharton School and department of Sociology, University of Pennsylvania. 27, 235-260 Harvard Kennedy School for Science and International Affairs. Russia Matters: Timeline of U.S Russia Relations (1983-Feb. 2018). Retrieved from https://www.russiamatters.org/facts/timeline-us-russia-relations-1983-feb-2018 Hofer, Alexandra. (2018). The ‘Curiouser and Curiouser’ Legal Nature of Non-UN Sanctions: The Case of the US Sanctions against Russia. J Conflict Security Law. 23 (1): 75, 1-42. 56 How to Get Human Rights Abusers and Kleptocrats Sanctioned Under the Global Magnitsky Act: Briefing of the Commission on Security and Cooperation in Europe. Senate, 115th Cong, 2 nd Session (2018). International Emergency Economic Powers Act (IEEPA) of 1977. Pub. L. No. 95-223, 91 Stat. 1626, 50 U.S.C. 1701 (1977). Laub, Zachary & McBride, James. (2017). The Group of Seven (G7). Council on Foreign Relations. Retrieved from https://www.cfr.org/backgrounder/group-seven-g7 Machalek, Katherin. Factsheet: Russia’s NGO Laws. Freedom House. Retrieved from https://freedomhouse.org/sites/default/files/Fact%20Sheet_0.pdf Marks, Stephen P. (1999). Economic Sanctions as Human Rights Violations: Reconciling Political and Public Health Imperatives. American Journal of Public Health 89 (10), 1509-1513. North Atlantic Treaty Organization. Relations with Russia. (2018). Retrieved from https://www.nato.int/cps/en/natolive/topics_50090.htm Parliamentary Assembly of the Council of Europe. In Brief: The democratic conscience of Greater Europe. Retrieved from http://website-pace.net/en_GB/web/apce/in-brief Passas, Nikos. (2001). Global Anomie, Dysnomie, and Economic Crime: Hidden Consequences of Neoliberalism and Globalization in Russia and around the World. Social Justice. 27, 2, 16-44 Peksen, Dursun. (2009). Better or Worse? The effect of Economic Sanction on Human Rights. Journal of Peace Research. 46 (1), 59-77. Pifer, Steven. (2018). Russia Denies it violates the INF Treaty. Ok, show it. The Brookings Institution. Retrieved from https://www.brookings.edu/blog/order-fromchaos/2018/01/22/russia-denies-it-violates-the-inf-treaty-ok-show-it/ Popper, Nathaniel., Matsnev, Oleg., Herrero, Vanessa Ana. (2018, January 4th) Russia and Venezuela’s Plan to Sidestep Sanctions: Virtual Currencies. The New York Times. pp. A1. Reuters, 2014. “Edward Snowden says he was trained ‘as a spy’”. Retrieved from https://www.reuters.com/article/us-usa-snowden/edward-snowden-says-he-was-trainedas-a-spy-idUSKBN0E81O820140528 Russia and Moldova Jackson-Vanik Repeal and Sergei Magnitsky Rule of Law Accountability Act of 2012. Pub. L. No. 112-208, 126 Stat. 1496, 19 U.S.C (2012) Santos, Lady MJ. (2012). President Putin’s Complete News Conference: 2012 Highlights, U.S Magnitsky Act & Human Rights, etc. TSR News Agency. Retrieved from https://thesantosrepublic.com/2012/12/22/president-putins-complete-news-conferenceon-2012-highlights-u-s-magnitsky-act-human-rights-etc-full-text-and-video/ Sergei Magnitsky Rule of Law Accountability Act of 2012. 112th Cong. (2012) 57 Sheth, Sonam., Bertrand, Natasha. (2017) Trump Jr.’s meeting with a Russian lawyer sheds new light on the extent of Russia’s election interference. Business Insider. Retrieved from https://www.businessinsider.com/evidence-russia-meddled-in-us-election-2017-6 Shin, Laura. (2017). How to Explain Cryptocurrencies and Blockchains to the Average Person. Forbes Magazine. Retrieved from https://www.forbes.com/sites/laurashin/2017/10/03/how-to-explain-cryptocurrencies-andblockchains-to-the-average-person/#1bbc4bdf324d The Magnitsky Act at Five Years: Assessing Accomplishments and Challenges: Hearing Before the Commission on Security and Cooperation in Europe, Senate, 115th Cong. (2017) Tsvetkova, Maria., Gutterman, Steve. (2013). Russia Convicts Lawyer Magnitsky in Posthumous Trial. Reuters. Retrieved from https://www.reuters.com/article/us-russiamagnitsky/russia-convicts-lawyer-magnitsky-in-posthumous-trialidUSBRE96A09V20130711?feedType=RSS&feedName=topNews&utm_source=dlvr.it &utm_medium=twitter&dlvrit=992637 United Nations General Assembly. (1948). General Assembly resolution 217 A: Universal Declaration of Human Rights. Retrieved from http://www.un.org/en/universaldeclaration-human-rights/ United Nations Human Rights Council (2018). 39th Session of the Human Rights Council. U.S. Department of State (2018). Remarks on the UN Human Rights Council. Nikki Haley, U.S. Permanent Representative to the United Nations United State Department of State; Bureau of Democracy, Human Rights and Labor; Country Reports on Human Rights Practices. Russia 2011 Human Rights Report United State Department of State; Bureau of Democracy, Human Rights and Labor; Country Reports on Human Rights Practices. Russia 2012 Human Rights Report United State Department of State; Bureau of Democracy, Human Rights and Labor; Country Reports on Human Rights Practices. Russia 2013 Human Rights Report United State Department of State; Bureau of Democracy, Human Rights and Labor; Country Reports on Human Rights Practices. Russia 2014 Human Rights Report United State Department of State; Bureau of Democracy, Human Rights and Labor; Country Reports on Human Rights Practices. Russia 2015 Human Rights Report United State Department of State; Bureau of Democracy, Human Rights and Labor; Country Reports on Human Rights Practices. Russia 2016 Human Rights Report United State Department of State; Bureau of Democracy, Human Rights and Labor; Country Reports on Human Rights Practices. Russia 2017 Human Rights Report University of Utah UNDERGRADUATE RESEARCH JOURNAL MAPPING VITALITY IN UTAH’S SALT LAKE COUNTY Savannah Mailloux (Monisha Pasupathi, Timothy Collins) Department of Geography The term vitality within the field of psychology is related to someone’s energy or spirit as they move through different experiences in life. Most often, the term is associated with a sense of liveliness if someone were to possess high vitality, or a sense of dullness if someone were to possess low vitality. Geographic information science affords the opportunity to visualize where high and low vitality experiences occur. The goals of this research into vitality are to use geographic information science in order to spatially determine high and low vitality areas identified by residents in Utah’s Salt Lake County as well as determine if spatial clustering exists based on responses from participants in a survey administered online through Amazon Mechanical Turk. Analysis of the survey data utilizing the hot spot analysis tool in ArcGIS Pro showed that there are areas of statistical significance, known as hot spots, in the downtown area of Salt Lake City as well as on the eastern canyons of Salt Lake County. Understanding where participants experience high and low vitality can aid local policymakers and key stakeholders in addressing potential barriers in terms of access to high vitality locations. University of Utah UNDERGRADUATE RESEARCH JOURNAL TECHNOLOGICAL ADVANCEMENTS IN THE OBSERVATIONAL ASSESSMENT OF COMMUNICATIVE BEHAVIOR Brandon Moncur, Julia Moncur, (Dr. Nick Perry, Dr. Brian Baucom) Department of Social and Behavioral Sciences Historically, the vast majority of what we know about how couples handle conflict has been based on white, heterosexual, middle-to-upper-class, and well-educated study subjects. Efforts are currently underway to broaden the diversity of couples studied to include same-sex couples, rural dwelling couples, and couples of lower socioeconomic statuses. Typical barriers to participation in these research studies have included time commitment, distance to travel to assessment sites, and a lack of resources for child care and transportation. Furthermore, recruiting participants outside major metropolitan areas is also a significant challenge. Researchers in the Couple Laboratory for Observational Studies (CLOSE) lab are using novel technologies, such as Adobe Connect, a web-based conferencing software, to more efficiently recruit and study these harder to reach study cohorts. Recently, the CLOSE lab has focused on how same-sex couples handle conflict. Utilizing Adobe Connect, researchers now have the ability to observe and measure communicative behavior directly in study subjects located remotely. Communication styles during conflict among same-sex couples may be observed in their own homes, scheduled at their convenience, and free of extra costs for transportation or for childcare. With Adobe Connect, the CLOSE lab has successfully recruited 60 same-sex couples and recorded ten-minute conversations, in real time, discussing a relationship conflict. Advantages to this method include a more user-friendly platform for assessment of couples which significantly reduces study burden for participants and facilitates recruitment of larger and more diverse study cohorts. Generalizability of results from these data will further advance knowledge on the study of conflict among couples. University of Utah UNDERGRADUATE RESEARCH JOURNAL SECURITIZING CLIMATE CHANGE: EXAMINING THE IMPACT OF THE NATIONAL SECURITY FRAME ON UTAH POLITICAL ELITES Connor Morgan (Tabitha Benney, PhD) Department of Political Science The partisan divide over climate change in the United States has led to long-term inaction in creating policies aimed at mitigating and adapting to the changing climate. This study explores one option for bridging the gap: reframing the discussion of climate change to better appeal to those who do not view addressing the issue as a priority. Democrats tend to consider climate change as a much more urgent concern compared to Republicans (Norman, 2017). Republicans, on the other hand, tend to be particularly concerned with national security issues, among other topics (Winter, 2010). Thus, this study examines whether framing climate change as a national security issue will cause Republicans to be more concerned with climate change and more willing to take action to address it. Because the general public tends to take cues from political elites on highly partisan issues (such as climate change-related issues), the study was focused on political elites in Utah (Druckman, Peterson, & Slothuus, 2013). Members of the Utah House of Representatives were used to represent Utah’s political elite. Through a two-stage interview of both Republican and Democratic representatives, the efficacy of framing climate change as a national security issue was tested. It is unlikely, however, that framing climate change as a national security issue (or at least as framed in this study) was effective at elevating Republican representatives’ concerns about climate change. It does seem likely, though, that more closely linking climate change to air quality and to the economy would more effectively increase Republican representatives’ willingness to substantively address climate change through policies aimed at mitigation and adaptation. University of Utah UNDERGRADUATE RESEARCH JOURNAL RECONSTRUCTING PALEOCLIMATE IN THE GREAT BASIN USING SIZE CLINES IN THE FAUNAL REMAINS FROM HOMESTEAD CAVE Christopher O’Connor-Coates (Tyler Faith, Ph.D) Department of Anthropology Size clines in contemporary mammalian species are well known to track environmental gradients (e.g., in temperature, precipitation, productivity). Such relationships can be used to determine the nature of paleoclimatic change using the fossil record. The faunal remains collected from Homestead Cave serve as the best documented faunal record for the Great Basin, and include an abundance of small mammal remains spanning the last 12 thousand years. These remains can be measured and compared to their modern counterparts in order to track and understand paleoclimate in the region. Previous paleoenvironmental research in the Great Basin indicates a transition from a cool and humid terminal Pleistocene to a warmer and more arid Holocene, with peak aridity occurring during the middle Holocene. For this study two species of squirrel were used: the white-tailed antelope squirrel (Ammospermophilus leucurus) and Townsend’s ground squirrel (Spermophilus townsendii). Specifically, mandibles from all available contexts were measured for comparison against each other and their modern counterparts. The primary data collected from the Homestead Cave fauna have shown that there is variation occurring between stratigraphic contexts, indicating that climate may have been driving some morphological variation within species. These variations include increased width and thickness of mandible body, and an increased length in the mandibles. Using the predefined relationships between small mammal morphology and climate, the variations in robusticity allow for paleoclimatic inference. University of Utah UNDERGRADUATE RESEARCH JOURNAL MULTIPROXY PALEOENVIRONMENTAL ANALYSIS IN RANGE CREEK CANYON Olivia Olsen, Andrea Brunelle & Benjamin Marconi Department of Geography Range Creek Canyon is considered one of the nation’s best-preserved regions of ancient Ancestral Puebloan occupation due to the high density of undisturbed historic sites that have been found in the canyon. Current research being conducted in Range Creek Canyon supports the notion that Fremont who inhabited the area between BCE 200-CE 1350 applied labor intensive methods to grow maize in this arid region. To successfully farm, the Fremont were likely to have performed annual maintenance to their croplands by burning surface vegetation for land management and excavate irrigation trenches to water their crops. Cherry Meadows in Range Creek has been identified as a focus of agriculture in the canyon because of its central location, the amount of contiguous arable land and its proximity to the perennial creek. Thirteen sediment cores were collected in Cherry Meadows in the summer of 2018 along a 100-meter trench running east to west. Analysis of these cores will likely show a charcoal peak stratigraphically above and below the period of Fremont occupation. Charcoal peaks indicate that more organics are burning than what is normal for the region and can be construed as the Fremont using annual maintenance burning for agricultural management. Analyzing charcoal morphologies can allow inferences about the nature of the vegetation that was burned. The most recent laboratory analyses on charcoal in the sediment core samples indicate that the most ubiquitous charcoal morphologies are lattice and dark within all cores being studied. Magnetic susceptibility and x-ray fluorescence on the sediment cores have been completed. Preliminary results from Principle Component Analysis (PCA) plots indicate the variables driving sediment geochemistry to be fluvial deposition and diagenesis. The geochemical data are supporting our initial hypothesis that the Fremont used Cherry Meadows to irrigate maize during the period of occupation. University of Utah UNDERGRADUATE RESEARCH JOURNAL THE UNIVERSITY OF UTAH’S INTERPROFESSIONAL STUDENT HOTSPOTTING COLLABORATIVE: AN INFORMAL PROGRAM ANALYSIS Stormy Foster-Palmer (Faculty Mentor: Susan Hall, College of Nursing) Department of Health Society and Policy ABSTRACT Hotspotting is a nationwide data-driven intervention that aims to reduce health care costs and improve health outcomes for vulnerable patient populations by addressing social determinants of health (Gawande, 2011). The Hotspotting model was implemented at the University of Utah in the year 2016. Previously the program recruited patients from one location, a housing facility, but in 2018, the program expanded to involve individuals from the Salt Lake City community. The present two-pronged study is an informal analysis of the University of Utah’s 2018-2019 Hotspotting cohort. First, logbook entries completed weekly by each of the eight Hotspotting teams were used to extract common challenges, goals, and successes experienced by the participants. The second component of this study is an analysis of Hotspotting participant interviews conducted by a nurse practitioner graduate student, to analyze what participants found useful in the program, as well as what may have hindered progress on their health goals. A total of eleven patients participated in the 2019 Hotspotting cohort. These analyses will be used to highlight the current strengths and weaknesses of the program, and provide a basis for recommendations on how the program can develop moving forward. The most significant finding was that about 46% of the challenges faced by this cohort were social, mental, and emotional, rather than clinical in nature. Strengths of the program include the ability of the teams to build rapport with the participants and motivate them to reach their goals, and ultimately feel cared for. Barriers to optimal functioning of the program included delay in consenting, stress about the limited timeline of the program, and major communication barriers between caseworkers and patients. TABLE OF CONTENTS ABSTRACT ii INTRODUCTION 1 LITERATURE REVIEW 3 METHODS 8 RESULTS 10 DISCUSSION 16 CONCLUSION 19 APPENDIX 20 REFERENCES 23 INTRODUCTION Male. Mid-50’s. Overweight, pre-diabetes, high blood pressure. He’s a smoker and has emphysema. Seizures. Struggles climbing stairs or walking long distances. Not monitoring diabetes, and blood sugar is wildly uncontrolled. Isn’t sure how to manage prescriptions or diet, and needs assistance securing necessary durable medical equipment. 35 medications listed. Unemployed. No car. He lives alone. Limited family contact, few friends. But his dog, Diamond, is with him at all times. He loves his dog. In the last six months, he had visited the emergency room (ER) one to two times a month. (McLean, personal communication, 2018). Surprisingly or not, this type story is common, especially for those termed “superutilizers,” or frequent fliers of the ER who also endure many inpatient hospital visits. These individuals tend to face a diverse spectrum of complex health and social problems in their dayto-day lives (Moe, et. al). This sector of the population contributes significantly to the cost of healthcare (Ostermeyer, et al., 2018). But even more concerning, with all of their contact with the healthcare industry, this population’s health outcomes aren’t improving. Their care lacks coordination, continuity, and most importantly someone to listen to their story. “Super-utilizers” are individuals with chronic and complex health and social issues, who also over-utilize the ER, which contributes significantly to high healthcare costs. The Center for Healthcare Strategies (2013) offers a well-encompassing definition of super-utilizer as, “individuals whose complex physical, behavioral, and social needs are not well met through the current fragmented health system.” Many of the individuals in this population experience complex social issues including lack of transportation, “a higher prevalence of chronic illness, psychiatric comorbidity, and lower socioeconomic status” (Moe, et. al, 2017). In addition, many experience addiction, are or have been homeless and sometimes have criminal histories (Hasselman, 2013). All of these can make continuity of care particularly challenging. High cost and poor health outcomes currently characterize the U.S. health system (cite). Hotspotting is a data-driven intervention, which aims to reduce health care costs and improve health for vulnerable patient populations by addressing social determinants of health for these “super-utilizers”. Social determinants of health are defined as “conditions of the places where people live, learn, work, and play.” (See Figure 1 and 2 in Appendix) This paper introduces the Hotspotting model and its recent implementation at the University of Utah. The overarching goal of this paper is to evaluate the effectiveness of this program using existing qualitative data. The Hotspotting logbooks and results of the guided participant interviews, will offer insight as to how a Hotspotting team working with complex patients to improve the quality of health and life can also affect the social determinants of health. This research provides insight into how Hotspotting could be a mechanism to improve the quality of health, and life, for complex patients in Utah, as well as the United States. LITERATURE REVIEW The cost of healthcare in the United States is higher than ever with healthcare expenditures reaching 17.9% of GDP in 2016 (“National Center for Health Statistics,” 2017). Over half of U.S. healthcare costs are attributable to only five percent of the population (Brenner, Doyle, Finkelstein, Taubman, & Zhou, 2014). Compared to other high-income nations, the U.S. spends nearly double that of other nations on healthcare (Papanicolas, Woskie, & Jha, 2018). Given this extravagant investment, shouldn’t Americans be the healthiest as well? Existing literature asserts otherwise. In a 2018 study, Papanicolas et. al found that out of eleven OECD (Organization for Economic Co-operation and Development) countries, the United States scores lowest on significant measures of health including life expectancy and scored highest in overweight and obesity percentage, and infant mortality. This study also found that although the U.S. spends about the same amount on social services as other states, it allocates much of its social spending budget on healthcare, instead of other social services. One argument that attempts to explain this disparity is that spending on healthcare services, administration, expensive equipment and higher doctor salaries isn’t going to improve health outcomes, but investing in the social determinants of health will (“For the Public’s Health,” 2015). Perhaps directing this attention to social determinants of health can alleviate these adverse health outcomes in the US, while reducing the costs associated with frequent ER visits. The importance of targeting and focusing on social determinants of health is growing (Butler, 2017; Adler, Glymour & Fielding, 2016). Social determinants of health are factors that profoundly affect health status and can produce health disparities, including education, employment, socioeconomic status, living environment, social support systems, access to healthy food, and access to health services (Artiga & Hinton, 2018). Evidence is growing indicating how these kinds of social factors can adversely impact health. For example, chronic stress can produce negative health outcomes for all ages (Artiga & Hinton, 2018). Health is much more than just physical health and being sick. In fact, the World Health Organization (1948) defines health as, “a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity.” An additional barrier for this population is the difficulty associated with not having a “usual source of care” (USC) (Liaw, 2014). In a cross-sectional study conducted by Liaw et al., the findings revealed an association between insurance type and ER use. For nearly 22% of individuals enrolled in Medicaid and over 24% of uninsured individuals more than half of their medical visits took place at the ER (Liaw). The ER is required to treat individuals whether they are insured or not, creating a major financial burden, that could be prevented (All, 2010). Repeated visits to the ER, and repeated inpatient stays reflect an inept health system that is not adequately tending to the health of these vulnerable patients. Research on interventions to address social determinants of health and reduce healthcare costs is ample, but finding the most effective and efficient strategies is more difficult. According to a review of 31 studies on interventions used to address frequent use of the ER, it is well established that frequent ER users utilize more healthcare than others (Moe, Kirkland, Rawe, Ospina, Vandermeer, Campbelle, & Rowe, 2017). In addition, this review revealed that there are interventions that can successfully reduce the number of ER visits by super-utilizers. Over half of the studies reported a decrease in ER visits, and several studies reported that some interventions helped patients find stable housing, indicating program effectiveness at addressing social determinants of health. It is estimated that approximately one-third of ER visits are preventable (Riley, Golde, & Kayam, 2017), making interventions diverting use of the ER to primary care especially valuable. Interventions that address both utilization and the underlying social determinants of health may be effective at driving down costs and improving quality of life. It is important to resolve unanswered questions regarding this patient population. For example, why are patients going to the ER? Why do they keep going to the ER? Questions like these require listening to individual patient stories and cannot only be analyzed quantitatively. Implementing a framework that puts the patient at the center, and prioritizes their unique story, has the potential to not only improve patient care and quality of life, but also may improve/impact how physicians care for their patients. The benefits of improving the quality of life for these complex patients, while simultaneously lowering healthcare expenditures, are enormous. Background on Hotspotting The Government Sustainability Office (2015) reports that about 5% of Medicaid patients consume half the costs of the program. According to the Agency for Healthcare Research and Quality, “the top 1 percent of persons ranked by their health care expenditures accounted for 22.8 percent of total health care expenditures” (Mitchell, 2014). In an effort to address the disorganized, inefficient and even “passive” use of the healthcare system, Dr. Jeffrey Brenner developed Hotspotting. His objective was to target this 20% of patients, called super-utilizers, and improve their quality of care. Dr. Brenner discovered these discrepancies in Camden, New Jersey’s healthcare system while working with a database he prepared for the Camden police department that detailed visits to the ER by crime victims (“A Revolutionary Approach,” 2014). In working extensively with this data, Dr. Brenner mapped insurance claims to understand more about Camden’s healthcare utilization. Dr. Brenner found that, “20% of the population were 90% of the costs,” (“A Revolutionary Approach,” 2014). This database was later adapted to incorporate data sharing from other healthcare institutions in the Camden region, and is now called the Camden Coalition Health Information Exchange. Hotspotting Criteria For a patient to qualify for the Hotspotting program, they must be a super-utilizer, as defined above, and have the following criteria (Brenner, Doyle, Finkelstein, Taubman, & Zhou, 2014): 1. At least two hospital admissions in the last six months 2. Have at least two chronic conditions (e.g., diabetes, heart disease) 3. Have at least five prescribed medications In addition, the Camden Coalition’s model of Hotspotting has three main components (“A Revolutionary Approach”, 2014): (1) Database. Access to data regarding emergency room visits, inpatient stays, and frequent utilizers is a necessary component of this model. This allows practitioners to identify those who have the highest need of the Hotspotting intervention as well as those will receive the most benefit from it as well. (2) Care Management Team. In the context of Camden’s original care management teams, they were designed to include health professionals from a variety of different backgrounds. This interprofessional team traditionally consists of a nurse, social worker, health coach or volunteer, and a community health worker. The team is trained with a curriculum created by the Camden Coalition. (3) Coordination of Care. After a patient has been identified and consented to participate, the interprofessional care team makes frequent home visits to assist in coordinating the patient’s care. The purpose of this team is to work with the patient on navigating the health system, help coordinate their care, communicate with their healthcare team, and establish continuity of care with a primary care physician. To graduate from the Hotspotting program, the end goal is that the team has successfully coached them on how to manage their health independently. Along with these three components, Hotspotting utilizes a specific curriculum designed to equip health workers in the program with a strong skill set for interacting with Hotspotting participants. The curriculum is organized by the following themes: Motivational Interviewing, Programmatic Operations, Trauma Informed Care, “COACH”, Harm Reduction, Safety, and Leadership. COACH is an acronym standing for (“Camden Coalition Hotspotting Curriculum,” 2018): C: Connect tasks with vision and priorities O: Observe the normal routine A: Assume a coaching style C: Create a backwards plan H: Highlight progress with data The purposes of the COACH model are to aid Hotspotters in cultivating a genuine partnership with their participant and help them to set and meet their goals. Motivational interviewing, another component of the Hotspotting curriculum, is effective in guiding patient visits and avoiding “Yes/No” answers to questions. Another component implemented in the 2018-2019 Hotspotting program at the University of Utah, is the use of the Connect2Health database. This database contains hundreds of local resources that patients can be connected with. For example, this database can help participants of the Hotspotting program find resources for consistent transportation, access to needed health equipment, etc. METHODS This study examined the Logbook entries of the eight teams participating in the University of Utah’s Interprofessional Hotspotting Student Collaborative from September 2018 to April 2019. Most teams work with a single patient; a few teams were assigned to work with two patients. The logbooks are filled out by the students participating in the Hotspotting program about their experiences with their patient. The Logbooks utilize a specific framework asking the students to respond to the following prompts: • Encounter dates, locations, and team members present • Engagement with health or social services providers • Progress toward patient goals and/or change in patient goals • Hotspotting Curriculum Utilization: how are you applying your learning? • Planning: what's next? • Challenges: where are you stuck? This year the program included a team from Arizona in the program. However, this analysis will only include the eight Utah teams, and their respective ten patients. A total of 112 logbooks were analyzed and information was extracted regarding challenges, successes, goals, and goals of the participants. In addition, mentions of features about the program that were effective or ineffective were also taken note of. The extracted data were organized into four spreadsheets, one for each of the following: challenges, successes, goals, and Hotspotting program functioning. The categories included in the first three spreadsheets are: Emotional/Mental, Social, Environmental, Physical Health, Medications, Appointments, Attitude toward healthcare system/ providers, Healthcare, and “Related to Hotspotting.” In addition, since the original intention for Hotspotting was to reduce hospitalizations and ER visits, the number of ER visits/ hospitalizations that were recorded in the logbooks was also noted. The fourth spreadsheet details the Hotspotters’ perspectives on their patient/ patient interactions, and the program challenges and successes that they identify. For the patient interview components of this study, a graduate student in the nurse practitioner program conducted semi-structured interviews with the participants of Hotspotting. The aim of his research differs from the aim of this study. However, the questions are direct and ask the participants about their opinion of their Hotspotting experience. His questions include: 1. How would you describe your overall physical and mental health in the past 30 days? What is your expected level of health at this time? Ultimately, what is your preferred level of overall health? 2. What interactions have you had with the Hotspotting team in the previous 30 days? How did the interactions go? 3. How does the Hotspotting team help you in achieving your overall health goals? 4. How does the Hotspotting team hinder you in achieving your overall health goals? 5. What are your expectations for the Hotspotting team in participating with your healthcare and personal needs? Cochrane’s research is ongoing and will include more interviews, however for the purposes of this study, the interviews of eight patients will be analyzed. RESULTS The Logbooks Logbook results reflect the categorical separation used for analysis. After reviewing 112 logbooks from eight teams, several themes have been identified. “Frequency” indicates number of teams that mentioned a particular challenge, success, or goal related to their participant. (See Appendix Figures 3-6) Challenges. The overarching challenges experienced by patients include anxiety, depression, lack of hobbies/ friends, lack of transportation, unhealthy diet (high in fat and sugar), and feeling mistreated by their healthcare team. Thirteen different issues were reported falling under the Emotional/Mental category. Of these, anxiety and depression were the most common. However, loneliness and shame were the next most frequently reported as being participant challenges. Grief and “trouble caring for self,” were issues for two participants in the program. (See Appendix Figure 3) In the “Social” category, lack of hobbies and friends, was the most commonly mentioned issue, with separation from loved ones, caregiver burnout and “condition inhibiting participant from doing activities,” following. Drug/tobacco use, communication, and not leaving their home (due to social isolation or social anxiety), were challenges experienced by two participants. While air quality, “living in an unsafe neighborhood,” and insanitary living environment were some of the challenges listed in the Environmental category, the most significant challenge for this population was transportation- whether it be an explicit lack of transportation, or other issues regarding transportation. “Physical health” is difficult to analyze without having access to participant electronic health records. However, based solely off the logbook entries, the most common physical health issue was diet, specifically a diet high in fat and sugar. Close behind this were weight and pain. Daily oxygen therapy, diabetes, and asthma are also common in at least two participants. Challenges related to prescriptions included that participants are either taking numerous medications, or they aren’t taking their medications at all. A couple of teams reported that participants had been missing and canceling their appointments. In the “Attitude toward healthcare system/ health workers,” four logbooks mentioned that the participant feels they are being mistreated or treated unfairly by the health workers they have interacted with. Another trend is that many participants experienced challenges with their caseworkers - either the caseworker stopped communicating with them or left the job entirely. Goals. According to the logbooks, a total of six patients expressed the goal of wanting to go back to school or get a job. As far as Social goals, five patients wanted to cultivate friendships and participate in or find new hobbies. Several patients wanted the Hotspotting team’s help with organizing all of their health-related information into a central place. (See Appendix Figure 5) The most common “Environmental” goals were moving into a different home and getting transportation. Creating a better diet and exercising more often were common goals in this cohort for ways they wanted to improve their physical health. As in the challenges section, anxiety and depression have resurfaced in the goals section: participants want to improve their anxiety and depression symptoms to improve their emotional and mental health. The number one healthcare-related goal was establishing care with a new primary care physician, caseworker, and therapist. Getting help in making appointments was also a common goal. Successes. Categories for this section included: Related to the Hotspotting Team, Emotional/Mental, Educational/Occupational, Social, Environmental, Physical Health, Medications, Appointments, and Attitude toward healthcare system/ providers. (See Appendix Figure 4) The most prevalent success specifically noted in five logbooks was “building rapport with patient,” with “good listening and communication skills,” second. Transportation posed a huge barrier for many participants, however transportation is also cited as a success. Seven logbooks mentioned successful scheduling of appointments with participants’ healthcare teams. Among other successes, gaining confidence, finding a job, and engaging in hobbies/social activities were some of the many small victories this cohort of Hotspotting participants experienced. Hotspotting Program. This section details the Hotspotters’ perspectives shared (sparsely) throughout the logbooks. There were many mentions of patient interactions from the students’ perspective that are worth mentioning. Most frequently, students reported in their logbooks that their patients simply wanted someone to listen to their story. Other mentions related to patient interactions included the challenge of patients wanting to leave the program, as well as finding boundaries with the patients. (See Appendix Figure 6) Program features that the Hotspotters found effective include the “COACH” curriculum, motivational interviewing, and use of the Connect2Health database. Additionally, using data to highlight patients’ progress with their goals, a component of the “COACH” model, was deemed effective at empowering patients and improving their self-esteem. Participant Interviews The interviews with the participants that the teams interacted with help provide an understanding of what is working in the program and what isn’t working- from the patients’ perspective. This perspective is incredibly important moving forward in efforts to improve the program. The patient experience. Overall, Hotspotting participants report nothing but great reviews of the Hotspotting teams themselves. The most common themes shared by participants about their experiences with the Hotspotting teams included that the teams were attentive and listened to the participant, had a nonjudgmental attitude, the teams were very supportive and did not in any way hinder them from reaching their goals. Several participants specifically noted that the Hotspotting team successfully helped the participants better navigate the healthcare system. Participants valued that each team member was from a different specialty and could offer a slightly different perspective. In addition, a couple participants felt that their interactions with the Hotspotting team offered the structure of accountability, empowerment and confidence. Participants especially valued the fact that the teams had high energy and motivation, and that this program is mutually beneficial. Lastly, being surrounded by highly motivated individuals that genuinely wanted to help had a lasting impact on these individuals. Barriers and challenges. The most common barrier experienced for the participants in the program (and the students) was difficulty with communication, especially when incorporating the caseworkers. Several participants also reported that they felt they needed to make progress on their goals so that they wouldn’t disappoint the team, or that the Hotspotters wanted them to succeed more than the participants themselves wanted to succeed on their own behalf. “Bad timing” was also mentioned. Several patients expressed frustration in the delay in consenting causing them to have less time with their team. Confusion about what the Hotspotting team is for also surfaced as a challenge. Lastly, scheduling visits and aligning schedules with the teams also posed a challenge for this cohort of patients. Room for improvement and recommendations. One participant made the recommendation of providing participants with a Hotspotting team “roster” with the names, programs, and a photo of the Hotspotting team member. This recommendation is echoed by several of the patients mentioning that they had a difficult time remembering names as well as what each individual “specialized” in. Caregiver burnout surfaced as an issue twice in this cohort, and one participant recommended that the Hotspotting teams could also help to connect caregivers to resources for dealing with burnout. Participants also expressed that they would like the Hotspotting teams to know more about the participants’ medical histories. This is thought to better assist the teams in assisting the participants. A few participants wished that they could have taught the team something new in return for all of the help they received. Nearly all of the participants mentioned that communicating through case workers was ineffective and frustrating. Direct communication between the Hotspotting team and the participant was recommended. Limitations The small data set included in this study limits the generalizability of this data. All data used to analyze was extracted from the logbooks so this analysis is limited by the completion of the logbooks and how much information was provided in the logbooks. The logbook analysis is also limited in that students may not be as forthcoming about challenges they experienced in an assignment setting and they would be in something more informal that does not count for their grade. In addition, other challenges, goals, and successes may have occurred in this cohort of the program that were not represented in the logbooks, therefore further limiting this analysis. Though participant perspectives are essential to include in a program analysis, there are a few limitations to this study’s examination of the participants’ interviews. First, due to recall bias, and second, this study is not longitudinal, so any changes in patient perspectives over time are not captured. Evidence for Hotspotting’s efficacy in reducing healthcare costs is not yet available as several effectiveness studies are still underway (“Camden Coalition hits enrollment,” 2017). The fact that there is lacking research in this area of health care interventions reveals the importance of this study. Regardless of the aforementioned limitations, this research is crucial as this is the first year that logbooks have been utilized in the program and this study will provide insight into the pragmatism of the logbook entries. Additionally, this research provides invaluable insight into the participant and Hotspotter experiences and constitutes a case study to be utilized as a guide for future programs. DISCUSSION Though originally designed as a methodology for reducing costs and creating better health outcomes, Hotspotting could be one of many ways to bring back the human component of health by addressing the social determinants of health, and focusing on the patient’s experience. Analyzing how this intervention can do just that was the goal of this research. One major theme in the Logbook data set is that the most pressing goals and challenges that the Hotspotting particpants faced had less to do with their health, and more to do with all other aspects of their lives: the social determinants of health. About 46% of the challenges experienced by this cohort were not clinical and instead involved social, environmental, and emotional/mental challenges further emphasizing the importance of social determinants of health. This was the first year that Logbooks were implemented, and this research proves that the entries can be useful in extracting the challenges that the super-utilizer population faces. Clearly, the logbook entries can provide invaluable information into the Hotspotting experience on behalf of both of the teams and the participants. From the logbooks, we can analyze the most common challenges experienced by this Hotspotting cohort, as well as extract recommendations for improvement. The participant interviews add another layer to the logbook analysis with the direct perspectives of the participants being presented. Several themes revealed themselves in this analysis. In reference to the Hotspotting program itself, the COACH model, motivational interviewing, and the newly implemented Connect2Health database access all proved to improve the Hotspotting experience for the teams in effectively facilitating meaningful discussions with the participants, establishing goals, and connecting them to needed resources. A significant challenge experienced by two teams in this program was retaining their patient’s participation. Reasons for participant resignation could include delay in time between consenting and meeting the team, or “bad timing,” meaning that the team cannot effectively assist a participant who isn’t ready to make changes yet. The ability for the Hotspotting teams to build strong rapport with their participants is both important and one of the most common outcomes from the teams of this cohort. Instituting the Hotspotting curriculum into the program for any caregiving role could improve the patienthealth worker relationship, and enhance both the caregiving and the care-receiving experiences. This study has implications beyond the Hotspotting program. For example, several participants mention that they feel mistrust toward the healthcare system and their own healthcare team. This is a detail that cannot go unnoticed. For patients to heed the advice of their health practitioners, the need to maintain some kind of trust in them- this issue calls for more attention and care in cultivating a healthy physician-patient relationship. Another trend was burnout among caregivers and caseworkers implicating the need to improve support services for caseworkers and provide resources for caregivers. Recommendations for next year’s program include: 1. Beginning the consenting process early and ensuring it is thorough and the participants are aware of what the program entails. 2. Distributing a “team roster” to each participant including the names, pictures, and specialties of each member on their team. 3. Streamlining the communication process, by supporting direct patient-team communication without having to rely on a caseworker to relay information back and forth. In addition, incorporating participant interviews as a routine part of the program could allow for continual program improvement. Future Research Future research should entail effectiveness studies of the University of Utah’s Interprofessional Hotspotting Program, as well as the programs at the Camden Coalition’s other hubs. In addition, though it is well established that Hotspotting can help health practitioners and students, future qualitative research reflecting the patients’ experiences in the Hotspotting program would be valuable. One question remains: Is our healthcare system prepared to make this intervention widespread? This prospect looks unlikely, unless the U.S. health system can undergo a holistic shift in its delivery of care model. From one primarily focused on treatment, rather than prevention. One that is reactive, not proactive. But perhaps Hotspotting can be a mechanism to connect the elements of our fragmented, disorganized, and ineffective health system. Perhaps the Hotspotting program can reshape how prospective medical and healthcare professionals are trained by revealing an area in health that should be looked into further as a mechanism for teaching the significance of the social determinants of health and compassion. And perhaps Hotspotting has the possibility to bring the importance of patient’s stories to the forefront of caregiving. CONCLUSION Remember the anonymous patient information shared at the beginning of this paper? With help from this Hotspotting team at the University of Utah last year, he lost weight and lowered his hemoglobin A1C (a measurement of glucose in the plasma of blood). He obtained medical equipment he needed and learned how to better control his seizures with medication, which were two of his goals. But since the intervention, more is known about who he is and what he’s like. He’s lonely and quiet. Shy at first. But once he warms up, he’s quite vivacious. Turns out he has a great sense of humor. He’s very open about his “sugar addiction,” and he loves chocolate. He loved to banter with his Hotspotting team. And of course, now he is more able to play with his dog, Rudy (McClean, personal communication, 2018). APPENDIX Figure 1. University of Wisconsin Population Health Institute. (2014). County Health Rankings Model [Describes the social determinants of health]. Retrieved April 2, 2019, from http://www.countyhealthrankings.org/explore-health-rankings/measures-data-sources/countyhealth-rankings-model Figure 2. Henry J. Kaiser Family Foundation. (2018, May 10). Social Determinants of Health [Chart detailing what comprise social determinants of health]. Retrieved April 2, 2019, from https://www.kff.org/disparities-policy/issue-brief/beyond-health-care-the-role-of-socialdeterminants-in-promoting-health-and-health-equity/ Challenge Scheduling conflicts Anxiety Depression Lack of friends and hobbies Lack of transportation Diet Mistreated by health care team Confusion about what Hotspotting is Shame/ Discomfort in public Lonliness/ Isolation Separation from loved ones Family caregiver burnout Condition prevents participation in activities Pain Caseworker communication issues Weight Taking multiple medications Canceling appointments High cost of healthcare Complex healthcare system Frequency 4 4 4 4 4 4 4 3 3 3 3 3 3 3 3 3 2 2 2 2 Figure 3. Table listing the most commonly reported challenges in the Hotspotting logbooks. Successes Building good rapport with patient Coordinated transportation Helped patient set up appointment Good listening and communication Patient engaged in hobbies Patient established care with new PCP or therapist Frequency 5 3 7 2 2 2 Figure 4. Table listing the most commonly reported successes in the Hotspotting logbooks. Goals Be more social, get friendships and hobbies Get a job/ return to work Improve diet Exercise more frequently Improve anxiety Improve depression "Fix" relationship with PCP Organize all health-related information into central location Go back to school Move into different housing Establish transportation Find new PCP Establish care with a therapist Help making appointments Frequency 5 4 4 4 4 4 3 3 2 2 2 2 2 2 Figure 5. Table listing the most commonly reported goals in the Hotspotting logbooks. Hotspotter Perspectives Patient "Just wanted to tell their story" Patient left program/ did not respond to communication Creating boundaries with patient Program Challenges Concerns about length of program Scheduling difficulties Program Successes Use of curriculum "Highlighting progress with data" Use of Connect2Health Frequency (teams) 4 2 2 4 2 3 3 3 Figure 6. Table listing common themes from the Hotspotters’ point of view as expressed in the logbooks. REFERENCES Adler, N. E., Glymour, M. M., & Fielding, J. (2016). Addressing Social Determinants of Health and Health Inequalities. JAMA, 316(16), 1641. doi:10.1001/jama.2016.14058 All, A. (2010). Addressing the Inadequacies of the Current Healthcare Model with a Universal Healthcare System in the United States. World Medical & Health Policy, 2(1), 353-364. A Revolutionary Approach to Improving Health Care Delivery. (2014, February 1). Retrieved September 30, 2018, from https://www.rwjf.org/en/library/articles-andnews/2014/02/improving-management-of-health-care-superutilizers.html Artiga, S., & Hinton, E. (2018, May 11). Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity. Retrieved November 12, 2018, from https://www.kff.org/disparities-policy/issue-brief/beyond-health-care-the-role-of-socialdeterminants-in-promoting-health-and-health-equity/ Awdish, R. L., & Berry, L. L. (2017, October 09). Making Time to Really Listen to Your Patients. Retrieved November 14, 2018, from https://hbr.org/2017/10/making-time-toreally-listen-to-your-patients Bedoya, P. W., Neuhausen, K. M., Dow, A. S., Brooks, E., Mautner, D., & Etz, R. (2018). Student Hotspotting: Teaching the Interprofessional Care of Complex Patients. Academic Medicine, 93(1), 56-59. Brenner, J., Doyle, J., Finkelstein, A., Taubman, S., & Zhou, A. (2014). Health Care Hotspotting in the United States. Retrieved November 11, 2018, from https://www.povertyactionlab.org/evaluation/health-care-hotspotting-united-states Butler, S. M. (2017). Building Blocks for Addressing Social Determinants of Health. JAMA, 318(19), 1855. doi:10.1001/jama.2017.16493 Camden Coalition hits enrollment mark in randomized controlled trial. (2017, October 11). Retrieved November 18, 2018, from https://www.camdenhealth.org/camden-coalitionhits-enrollment-mark-randomized-controlled-trial/ Camden Coalition Hotspotting Curriculum. (2018, April 26). Retrieved from https://www.camdenhealth.org/curriculum/ Davis, P. (2007, February 08). Listening to patients' stories. Retrieved November 14, 2018, from https://www.sciencedirect.com/science/article/pii/S1361311107000088#! For the Public's Health: Investing in a Healthier Future. (2015, August 19). Retrieved October 7, 2018, from http://www.nationalacademies.org/hmd/Reports/2012/For-the-PublicsHealth-Investing-in-a-Healthier-Future.aspx Gawande, A. (2011, January 24). The Hot Spotters. The New Yorker. Retrieved from https://www.newyorker.com/magazine/2011/01/24/the-hot-spotters Gidman, J. (2013). Listening to stories: Valuing knowledge from patient experience. Nurse Education in Practice, 13(3), 192-196. doi:10.1016/j.nepr.2012.09.006 Glied, S. (1998). Chronic condition: Why health reform fails. Cambridge: Harvard University Press. Hasselman, D. (2013, October). Super-Utilizer Summit Common Themes from Innovative Complex Care Management Programs (Rep.). Retrieved November 12, 2018, from Center for Health Care Strategies Inc., website: https://www.chcs.org/media/FINAL_Super-Utilizer_Report.pdf Henry J. Kaiser Family Foundation. (2018, May 10). Social Determinants of Health [Chart detailing what comprise social determinants of health]. Retrieved April 2, 2019, from https://www.kff.org/disparities-policy/issue-brief/beyond-health-care-the-role-of-socialdeterminants-in-promoting-health-and-health-equity/ Liaw, W., Petterson, S., Rabin, D. L., & Bazemore, A. (2014). The impact of insurance and a usual source of care on emergency department use in the United States. International Journal of Family Medicine, 2014, 842847. doi:10.1155/2014/842847 McClean, H. (2018, October 30). Personal interview. Mitchell, E. (2016, November) Concentration of Health Expenditures in the U.S. Noninstitutionalized Population, 2014. Statistical Brief #497. Agency for Healthcare Research and Quality, Rockville, MD. http://www.meps.ahrq.gov/mepsweb/data_files/publications/st497/stat497.pdf Moe, J., Kirkland, S. W., Rawe, E., Ospina, M. B., Vandermeer, B., Campbell, S., & Rowe, B. H. (2017). Effectiveness of Interventions to Decrease Emergency Department Visits by Adult Frequent Users: A Systematic Review. Academic Emergency Medicine, 24(1), 4052. doi:10.1111/acem.13060 National Center for Health Statistics. (2017, May 03). Retrieved from https://www.cdc.gov/nchs/fastats/health-expenditures.htm National Health Expenditure Data: Historical. (2018, January 08). Retrieved October 7, 2018, from https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-andReports/NationalHealthExpendData/NationalHealthAccountsHistorical.html Ostermeyer, B., Baweja, N. U., Schanzer, B., Han, J., & Shah, A. A. (2018). Frequent Utilizers of Emergency Departments: Characteristics and Intervention Opportunities. Psychiatric Annals, 48(1), 42-50. doi:10.3928/00485713-20171206-02 Overview. (2018, August 02). Retrieved November 14, 2018, from https://uofuhealth.utah.edu/ipe/hotspotting/ Papanicolas, I., Woskie, L. R., & Jha, A. K. (2018). Health Care Spending in the United States and Other High-Income Countries. JAMA, 319(10), 1024. doi:10.1001/jama.2018.1150 Parekh, R., & Childs, E. W. (Eds.). (2016). Stigma and prejudice: touchstones in understanding diversity in healthcare. Retrieved from https://ebookcentral.proquest.com Preamble to the Constitution of WHO as adopted by the International Health Conference, New York, 19 June - 22 July 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of WHO, no. 2, p. 100) and entered into force on 7 April 1948. The definition has not been amended since 1948. Randomized Controlled Trial. (2018, July 09). Retrieved from https://www.camdenhealth.org/randomized-controlled-trial/ Riley, C. B., Golde, M., & Kayam, T. (2017). Emergency Department Care Coordination: Targeted Strategies to Improve Health Outcomes and Decrease Costs (Rep.). Washington, DC: National Association of Community Health Centers. University of Wisconsin Population Health Institute. (2014). County Health Rankings Model [Describes the social determinants of health]. Retrieved April 2, 2019, from http://www.countyhealthrankings.org/explore-health-rankings/measures-datasources/county-health-rankings-model University of Utah UNDERGRADUATE RESEARCH JOURNAL THE ROLES OF EMOTION DYREGULATION AND HOPELESSNESS IN THE DELINQUENT AND AGGRESSIVE BEHAVIOR OF JUSTICE-INVOLVED YOUTH Yasmin Peralta, Michaela Mozley M.S., Patricia Kerig Ph.D. Department of Psychology Poor emotion regulation strategies have been associated with a host of negative outcomes for youth. Research suggests that emotion dysregulation is associated with committing delinquent and aggressive acts. Additionally, poor emotion regulation may be associated with feelings of hopelessness, which in turn has also been shown to be related to delinquency and aggression. However, whether the relation between emotion dysregulation and aggression or delinquency may be strengthened by feelings of hopelessness remains ambiguous. A sample of 278 justiceinvolved youth (boys = 221, girls = 57) completed self-report measures of emotion dysregulation, hopelessness, delinquent acts, and aggression. Multiple regressions were run to examine the association between these factors. While no results were significant, the findings have numerous implications for future research. Poor emotion regulation has long been associated with an assortment of negative outcomes. Although its definition and conceptualization vary, emotion regulation can be generally defined as the process of evaluating the emotions one has, and then responding to or modifying how one expresses them (Gross, 2014, p.6). Consequently, emotion dysregulation refers to dysfunctions in this process (Gross, 2014, p. 59), resulting in a person’s overcontrol or undercontrol of their emotional responses. A growing body of literature has found that two negative outcomes associated with emotion dysregulation include delinquency and aggression (Roberton, Daffern, & Bucks, 2014; Rodriguez, Tucker, & Palmer, 2016; Marsee, Lau, & Lapré, 2014; Garofalo, Holden, Zeigler-Hill, & Velotti, 2016). For example, Garofalo et al. (2016) found that incarcerated offenders reported higher levels of emotion dysregulation compared to a community sample, suggesting that limited emotion regulation strategies may be associated with higher rates of delinquency or aggressive acts. Additionally, previous research has found emotion dysregulation to be a predictor of juvenile arrests (Kemp et al., 2017), consistent with the hypothesis that problems regulating emotions can lead to poorly regulated behavior and impulsivity, leading to subsequent involvement with the justice system. In addition to delinquent behavior, emotion dysregulation has been implicated in aggression (Marsee, Lau, & Lapré, 2014). Specifically, prior research found that maladaptive emotion regulation strategies are associated with aggression (Scott, DiLillo, Maldonado, & Watkins, 2015) and that difficulties in emotion regulation may lead to both proactive and reactive aggression (Skripkauskaite et al., 2015). Ultimately, emotion dysregulation has the potential to lead to a host of negative behavioral and psychological outcomes (Rajappa, Gallagher, & Miranda, 2012). Although emotional dysregulation has clear implications for youth involvement of delinquent and aggressive behavior, other research has pointed to a different emotional reaction, that of hopelessness. Hopelessness reflects one’s negative expectations of the future (Abramson, Metalsky, & Alloy, 1989) and may result from diminished access to effective strategies to regulate emotions (Vatan et al., 2014; Miranda et al., 2014; Rajappa et al., 2012; Palmier-Claus, Taylor, Gooding, Dunn, & Lewis, 2012). Therefore, hopelessness may be related to emotion dysregulation (Vatan, Lester, & Gun III, 2014; Miranda, Tsypes, Gallagher, & Rajappa, 2013). In one sample of young incarcerated offenders, Biggam and Power (1997) found that nearly 40% of the youth in their sample reported high levels of hopelessness. Similarly, Biggam and Power (2002) also found high levels of hopelessness in a sample of young offenders aged 16-21 years. Moreover, youth with moderate to high levels of hopelessness have been shown to be 1.5 to 13 times more likely to perpetrate delinquent or violent behavior (Duke, Borowsky, Pettingell, & McMorris, 2011). Additionally, hopelessness has been linked to aggression. In one sample of inner-city youth, high levels of hopelessness were significantly correlated with both aggressive and violent acts (Bolland, 2003). Hopelessness may be related to increased aggressive and delinquent behavior because youth with high levels of hopelessness may tend to operate with a negative cognitive framework that diminishes and impairs healthy decision-making and coping abilities, leading to delinquency and aggression (Duke, Borowsky, Pettingell, & McMorris, 2011). Taken together, previous research suggests that emotion dysregulation may interact with hopelessness to predict youth aggressive and delinquent behavior. Past literature concerning the impact of emotion dysregulation on delinquency does not provide a complete picture of how this construct may interact with feelings of hopelessness to explain youths’ delinquent and aggressive behavior. To further extend past research on the related topics, the current study sought to examine the associations between emotion dysregulation, aggression, and delinquent behavior in a sample of justice-involved youth. Based upon previous research, we hypothesized that hopelessness will strengthen the relation between emotion dysregulation and both delinquency and aggression. The results from this study may be able to provide us with a better understanding of the underlying mechanisms that contribute to youths’ involvement in delinquent and aggressive behavior, which may ultimately help to inform and develop intervention and prevention programs aimed at reducing youth justice-involvement and recidivism. Method Participants Participants consisted of 278 youth (221 boys, 57 girls) recruited from a juvenile detention center located in the Western United States. The participants were between the ages of 12 and 18 years old (M = 16.02, SD = 1.26). As for ethnicity, 39.6% of the youth in the sample identified as White, 38.1% as Latino(a)/Hispanic, 8.6% as Biracial/Multiracial, 5.8% as Black/African American, 2.5% as Native American, 2.5% as Pacific Islander/Native Hawaiian, 1.8% as Asian/Asian American, and 1.1% as other. Procedure Study procedures were approved by the institutional review boards of the University of Utah as well as the Utah Department of Human Services. During visiting hours at the detention center, research assistants approached youths’ legal guardian to obtain informed consent to talk to their child. If consent was obtained, the youth, if interested in participating in the study, provided informed assent. Following assent, an interview was conducted in a private visiting room at the detention center and self-report measures were administered on a laptop. Legal guardians and youth were not offered compensation. Measures Emotion dysregulation. Developed by Gratz & Roemer (2004), the Difficulties in Emotion Regulation Scale (DERS) is a brief, well-validated 36-item, self-report questionnaire designed to assess multiple aspects of emotion dysregulation. The DERS includes six scales: (1) nonacceptance of emotional responses, (2) difficulties engaging in goal direction behavior, (3) impulse control, (4) lack of emotional awareness, (5) limited access to emotion regulation strategies, and (6) lack of emotion clarity. The measure yields a total score as well as scores on each of the six scales derived through factor analysis. Each item on each of the six scales is rated on a 5-point Likert scale that ranges from 1 (almost never) to 5 (almost always). Higher scores are indicative of greater dysregulation. This project used the total scale. The internal consistency of the current sample, the alpha, of the DERS was .85. Hopelessness. The Kazdin Hopelessness Scale for Children (KHSC; Kazdin, Rodgers, & Colbus, 1986) was modeled after the scale developed with adults (Beck, Weissman, Lester, & Trexler, 1974) to assess perceptions of hopelessness. The shortened version used in the current study consists of 8 items such as, “I might as well give up because I can’t make things better for myself” and “I don’t think I will get what I really want” which reflect negative expectations of the future. Youth responded “yes” or “no” to each item and the scale was scored so that higher scores indicated greater levels of hopelessness or negative expectations for the future. Scores could range from 0 to 8, and in the current sample, the alpha for the KHSC was .67. Aggressive behavior. How Friends Treat Each Other (HFTEO; Bennett, Guran, Ramos, & Margolin, 2011) is a measure of aggression against peers and focuses on four types of aggressive behavior: electronic aggression, psychological aggression, physical aggression, and coerced intimacy. For each item, participants were asked in the past year “Have you done any of the following things to any of the following people?” Youth indicated on a 5-point Likert scale the number of times they participated in each event and responses ranged from 1 - never happened to 5 - happened more than 10 times. Electronic aggression includes 4 items such as, “Sent mean or hurtful message via e-mail, text message, Facebook, Myspace, or Twitter.” Psychological Aggression includes 15 items such as, “Said things just to make someone angry or hurt someone’s feelings.” Physical Aggression includes seven items such as, “Kicked, hit, or punched someone.” Coerced Intimacy includes four items such as, “Touched someone sexually when they didn’t want it.” The responses were summed to produce a total perpetration score. In the current sample, the alpha for HFTEO was .93. Delinquent behavior. An adapted version of the Self-Report of Delinquency scale (SRD; Elliot, Huizinga, & Ageton, 1985) was used to assess youths’ involvement in delinquent activities. The adapted scale was developed by Feiring, Miller-Johnson, and Cleland (2007) to include additional items related to lower-level status offenses that are commonly seen among certain subsets of youth, including girls. The scale used in the current study included 48 items that inquire as to whether the youth has participated in specific activities (e.g., truancy, theft, property destruction, aggression against others, substance use) within the last year (0= no, 1= yes). A total score of SRD was obtained by summing all of the items, and responses could range from 0 to 48. In the current sample, the alpha for SRD was .92. Data Analysis All variables of interest were checked for potential outliers and normality prior to conducting data analyses. After examining diagnostic test results, histograms, and scatterplots, no indication was found of outliers, but there was indication of skewness in our aggression variable. Therefore, the variable for aggressive behavior was log transformed prior to analysis. The emotion regulation variable had 0.4% missing data, the delinquency variable had 18% missing data, the aggression variable had 18.7% missing data, and the hopelessness variable had 18.3% missing data. All missing data were assumed to be missing at random and were managed using multiple imputation in SPSS. Before conducting analyses, our predictor variables, emotion dysregulation and hopelessness, were mean-centered. In order to investigate the relation between emotion dysregulation and aggressive and delinquent behavior and whether hopelessness moderated these effects, an interaction variable was created (emotion dysregulation x hopelessness) and we ran two interaction regressions. If the results were significant, two moderation models using the Hayes (2018) PROCESS macro, which tests for moderation on direct effects with bootstrapped estimates of the confidence interval, would be run in order to decompose the interactive effects. All analyses were conducted using SPSS version 25. Results Descriptives In the current sample, 83.2% of youth reported engagement in 6 or more delinquent activities. With regards to aggressive behavior, 50.2% of youth reported participating in physical aggression, 76.4% psychological aggression, 11.6% sexual aggression, and 69.5% electronic aggression. Means, standard deviations, and correlations can be found in Table 1. Regressions To investigate whether hopelessness would act as a moderator between emotion dysregulation and delinquency, we ran a linear regression. Results indicated that there was no significant relationship between emotion dysregulation and delinquency (B = .058, p = .300) and no significant relationship between hopelessness and delinquency (B = .857, p = .537). There was also no significant interactive effect between emotion dysregulation and hopelessness on self-reported delinquency (B = -.009, p = .739). These results did not support the hypothesis that emotional dysregulation would interact with hopelessness to predict delinquent behavior. To investigate whether hopelessness would moderate the relation between hopelessness and aggression, a linear regression was run. Results showed no significant relationship between emotion dysregulation and aggression (B = .002, p = .508), such that emotion dysregulation was not a significant predictor of aggression. There was also no significant relationship between hopelessness and aggression (B = -.004, p = .961). Additionally, we found no significant interactive effect between emotion dysregulation and hopelessness on aggression (B = .000, p = .886). Therefore, the results from our second linear regression also did not support our prediction. Discussion Research to date has not investigated the underlying mechanisms among emotion dysregulation, delinquency, and aggressive behavior. Therefore, the current study investigated the impact of youths’ feelings of hopelessness on the link between emotion dysregulation and delinquency and aggression in a sample of justice-involved adolescents. The first aim of the study was to examine whether hopelessness strengthened the relation between emotion dysregulation and delinquent behavior. Neither emotion dysregulation nor hopelessness was significantly related to delinquent behavior. Along with this, there was no significant interactive effect between hopelessness and emotion dysregulation and delinquent behavior. This was unexpected given the findings of previous research done by Garfolo et al. (2016), which suggested that limited emotion regulation strategies are associated with higher rates of delinquency, as well as other research that has supported the finding of emotion dysregulation being a predictor of juvenile arrests (Kemp et al., 2017). The low correlation between hopelessness and delinquent behavior was also unexpected, given the multitude of past studies linking the two variables (Vatan, Lester, & Gun III, 2014; Miranda, Tsypes, Gallagher, & Rajappa, 2013; Biggam and Power, 1997, 2002; Duke, Borowsky, Pettingell, & McMorris, 2011). This finding suggests that within our sample, neither emotion dysregulation nor hopelessness may have been considerable factors in the commitment of delinquent acts. The second aim of the study was to evaluate whether hopelessness strengthened the relationship between emotion dysregulation and aggressive behavior. Neither emotion dysregulation nor hopelessness were significantly related to aggressive behavior. Additionally, there was no significant interactive effect between hopelessness and emotion dysregulation on aggression. This finding was also unexpected given that past findings have found that poor emotion regulation strategies are associated with aggressive behavior (Marsee, Lau, & Lapré, 2014; Scott, DiLillo, Maldonado, & Watkins, 2015) and additional research has suggested that emotion dysregulation is a predictor for both proactive and reactive aggression (Skripkauskaite et al., 2015). Taken together, these findings suggest that neither emotion dysregulation nor hopelessness may have been substantial factors in the participation in aggressive behavior within our sample. Though the hypotheses were not supported by the data, our results suggest that some other underlying mechanism other than hopelessness may contribute to the relation between emotion dysregulation and both aggression and delinquency. It is possible that hopelessness and emotion dysregulation are two separate constructs that do not interact in the way expected for this study. However, contrary to past findings, no significant association between either emotion dysregulation and delinquency or aggression were found. This study used a similarly size sample and measures as that in previous research, therefore, our specific sample may have simply failed to capture both the main effects supported by previous research, as well as the interaction effect that was being explored in this study. Future research should replicate the relation between emotion dysregulation and both delinquency and aggression. Since it is unclear whether our insignificant interaction effect is due to our sample or due to the lack of an effect, future efforts may also find it beneficial to investigate hopelessness, as well as other variables that may reasonably moderate the relation between emotion dysregulation and other negative outcomes relevant to the juvenile justice system. It may also be beneficial to investigate whether specific types of emotion dysregulation, such as difficulty with controlling behavior or difficulty with goal directed activity, are related to hopelessness, delinquent behavior, and aggression. Given that the current study used a measure of overall emotion dysregulation, it is possible that the effects of specific types of emotion dysregulation on delinquent and aggressive behavior were missed. Future research may also benefit by examining different types of aggression within a sample, such as looking at the specific effect of emotion dysregulation on physical electronic, sexual and psychological aggression separately . For example, it is possible that emotion dysregulation and hopelessness may be more strongly related to physical aggression. Future directions may also be taken to investigate how emotional dysregulation and hopelessness relate to delinquency, as well as whether a strong relation between these two factors relate to the participation of specific types of delinquent acts over others due to the negative future outlook that characterizes hopelessness. Finally, this study relied exclusively on self-report measures, which come with limitations. Future research may also benefit by investigating emotion dysregulation and aggression using behavioral or physiological measures rather than just self-report measures. Although the results of the current study were not consistent with hypotheses or previous research, the current study had a number of strengths. First, this study sought to address a gap in the current literature that has not investigated possible mechanisms underlying the link between emotion dysregulation and youths’ behavioral outcomes. Additionally, this study sought to test unique associated between aggression and delinquency. This study also used an appropriate sample size given the large range of sample sizes used in previous research investigating emotion dysregulation and delinquency (Garofalo et al., 2016; Kemp et al., 2017), emotion dysregulation and aggression (Skripkauskaite et al, 2015; Scott, DiLillo, Maldonado, & Watkins, 2015) and emotion dysregulation and hopelessness (Vatan et al., 2014; Miranda et al., 2014; Rajappa et al., 2012; Palmier-Claus, Taylor, Gooding, Dunn, & Lewis, 2012). However, in light of these strengths, the findings of this study should be interpreted in the context of some relevant limitations. First, our sample was limited to the individuals found in a single juvenile detention facility, which increases the variability of the sample and limits the generalizability of our results. Another limitation is that all data used for this study came from self-reports. As a result, the data could have been biased given that individuals prefer to portray themselves more positively rather than realistically due to social expectations or demands. Additionally, our data was cross-sectional, therefore we were unable to capture reported feelings and behaviors over time. Future studies using longitudinal data may find differing results than those of this study, such that increased hopelessness and emotion dysregulation leads to increased delinquent and aggressive behavior over time. Lastly, this study was limited in its use of only one measure per variable, instead of using multiple measures to capture emotion dysregulation, hopelessness, aggression, and delinquent behavior. In conclusion, within a sample of justice-involved youth, the current study did not find hopelessness to be a moderator between emotion dysregulation and delinquent and aggressive behavior within a sample of justice-involved youth. Inconsistent with hypotheses, emotional dysregulation did not interact with hopelessness to predict youths’ aggression or delinquent behavior, which is in contrast to previous literature. Further investigation into how emotion dysregulation and other constructs may interact to explain youths’ delinquent and aggressive behavior could have significant implications for intervention efforts and prevention programs. This will ultimately contribute to efforts in reducing youth recidivism and negative behavioral outcomes. References Abramson, L. Y., Metalsky, G. I., & Alloy, L. B. (1989). Hopelessness depression: A theorybased subtype of depression. Psychological Review, 96, 358. doi:10.1037//0033295x.96.2.358 Beck, A. T., Weissman, A., Lester, D., & Trexler, L. (1974). The measurement of pessimism: The hopelessness scale. Journal of Consulting and Clinical Psychology, 42, 861. doi: 10.1037/h0037562 Bennett, D. C., Guran, E. L., Ramos, M. C., & Margolin, G. (2011). College students' electronic victimization in friendships and dating relationships: Anticipated distress and associations with risky behaviors. Violence and Victims, 26, 410-429. doi: 10.1891/08866708.26.4.410 Biggam, F. H., & Power, K. G. (1997). Social support and psychological distress in a group of incarcerated young offenders. International Journal of Offender Therapy and Comparative Criminology, 41, 213-230. doi: 10.1177/0306624x97413002 Biggam, F. H., & Power, K. G. (2002). A controlled, problem-solving, group-based intervention with vulnerable incarcerated young offenders. International Journal of Offender Therapy and Comparative Criminology, 46, 678-698. doi:10.1177/0306624x02238162 Bolland, J. M. (2003). Hopelessness and risk behaviour among adolescents living in highpoverty inner-city neighbourhoods. Journal of Adolescence, 26, 145-158. doi: 10.1016/S0140-1971(02)00136-7 Duke, N. N., Borowsky, I. W., Pettingell, S. L., & McMorris, B. J. (2011). Examining youth hopelessness as an independent risk correlate for adolescent delinquency and violence. Maternal and Child Health Journal, 15, 87-97. doi:10.1007/s10995-009-0550-6 Elliott, D. S., Huizinga, D., & Ageton, S. S. (1985). Explaining delinquency and drug use. Sage Publications. Feiring, C., Miller-Johnson, S., & Cleland, C. M. (2007). Potential pathways from stigmatization and internalizing symptoms to delinquency in sexually abused youth. Child Maltreatment, 12, 220-232. doi: 10.1177/1077559507301840 Garofalo, C., Holden, C. J., Zeigler-Hill, V., & Velotti, P. (2016). Understanding the connection between self-esteem and aggression: The mediating role of emotion dysregulation. Aggressive Behavior, 42, 3-15. doi: 10.1002/ab.21601 Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment, 26, 41-54. doi: 10.1007/s10862-008-9102-4 Gross, J. J. (2014). Emotion regulation: Conceptual and empirical foundations. In J. J. Gross (Ed.), Handbook of Emotion Regulation (pp. 3-20). New York, NY, US: Guilford Press. Hayes, A. F. (2018). Introduction to mediation, moderation, and conditional process analysis: A regression based approach. New York, NY: Guilford Press. Kazdin, A. E., Rodgers, A., & Colbus, D. (1986). The Hopelessness Scale for Children: Psychometric characteristics and concurrent validity. Journal of Consulting and Clinical Psychology, 54, 241. doi: 10.1037/0022-006X.54.2.241 Kemp, K., Thamotharan, S., Poindexter, B., Barker, D., Tolou-Shams, M., & Houck, C. D. (2017). Emotion regulation as a predictor of juvenile arrest. Criminal Justice and Behavior, 44, 912-926. doi: 10.1177/0093854817695842 Marsee, M. A., Lau, K. S., & Lapré, G. E. (2014). Parent and adolescent report of the forms and functions of aggression: Associations with delinquency, CU traits, and dysregulation. Child & Youth Care Forum, 43, 27-39. doi: 10.1007/s10566-013-92230 Miranda, R., Tsypes, A., Gallagher, M., & Rajappa, K. (2013). Rumination and hopelessness as mediators of the relation between perceived emotion dysregulation and suicidal ideation. Cognitive Therapy and Research, 37, 786- 795. doi:10.1007/s10608-013-9524-5 Palmier-Claus, J. E., Taylor, P. J., Gooding, P., Dunn, G., & Lewis, S. W. (2012). Affective variability predicts suicidal ideation in individuals at ultra-high risk of developing psychosis: An experience sampling study. British Journal of Clinical Psychology, 51, 7283. doi: 10.1111/j.2044-8260.2011.02013.x Rajappa, K., Gallagher, M., & Miranda, R. (2012). Emotion dysregulation and vulnerability to suicidal ideation and attempts. Cognitive Therapy and Research, 36, 833-839. doi: 10.1007/s10608-011-9419-2 Roberton, T., Daffern, M., & Bucks, R. S. (2014). Maladaptive emotion regulation and aggression in adult offenders. Psychology, Crime & Law, 20, 933-954. doi: 10.1080/1068316x.2014.893333 Rodriguez, C. M., Tucker, M. C., & Palmer, K. (2016). Emotion regulation in relation to emerging adults’ mental health and delinquency: A multi-informant approach. Journal of Child and Family Studies, 25, 1916-1925. doi: 10.1007/s10826-015-0349-6 Scott, J. P., DiLillo, D., Maldonado, R. C., & Watkins, L. E. (2015). Negative urgency and emotion regulation strategy use: Associations with displaced aggression. Aggressive Behavior, 41, 502-512. doi: 10.1002/ab.21588 Skripkauskaite, S., Hawk, S. T., Branje, S. J., Koot, H. M., van Lier, P. A., & Meeus, W. (2015). Reactive and proactive aggression: Differential links with emotion regulation difficulties, maternal criticism in adolescence. Aggressive Behavior, 41, 214-226. doi: 10.1002/ab.21583 Thompson, R. A. (1994). Emotion regulation: A theme in search of definition. Monographs of the Society for Research in Child Development, 59, 25-52. doi: 10.1111/j.15405834.1994.tb01276.x Vatan, S., Lester, D., & Gunn III, J. F. (2014). Emotion dysregulation, problem-solving, and hopelessness. Psychological Reports, 114, 647-651. doi: 10.2466/20.02.PR0. 114k23w3 Table 1. Means, Standard Deviations, and Bivariate Correlations Variable Aggression Delinquency Hopelessness ED Aggression - - - - Delinquency 0.38** - - - Hopelessness 0.12* 0.10 - - ED 0.14* 0.09 0.25** - M 10.73 13.48 1.73 45.06 SD 14.19 7.83 1.63 12.81 Range 0 - 109 0 - 35 0 -8 3 - 76 Note. *p < .05. **p < .01; ED = Emotion dysregulation. University of Utah UNDERGRADUATE RESEARCH JOURNAL EXAMINING THE COMBINED EFFECTS OF SOCIAL SUPPORT AND MATERNAL PRENATAL MOOD ON NEWBORN NEUROBEHAVIOR Luciana P. Salmi (Elisabeth Conradt, Ph.D.) Department of Psychology ABSTRACT A large body of research shows that exposure to maternal prenatal anxiety may be linked to adverse birth outcomes and impaired psychophysiological functioning in infancy (Barker, Jaffee, Uher, & Maughan, 2011). The majority of research has been focused on birth outcomes leaving a gap in the literature of the effects on newborn neurobehavior. It is important to understand what influences neurodevelopmental outcomes because short term (e.g. birth outcomes) and long-term effects (e.g. maladaptive behavior) on the infant could be prevented through the development of reliable measures to detect such influences. There is also supportive evidence that social interactions are protective against the health consequences of life stress (Ozbay, Johnson, Dimoulas, Morgan, Charney, & Southwick, 2007) particularly during pregnancy (Barker et al., 2011). Such findings warrant further exploration of the interaction between prenatal anxiety and social support effects combined in order to identify pathways to reduce the effects of maternal adversity and ensure better developmental outcomes for the offspring. We examined whether the effect of prenatal maternal mood operationalized as pregnancy specific anxiety on newborn neurobehavior would be moderated by social support during pregnancy. Participants included 100 mothers and 96 infants from diverse ethnic backgrounds. Mothers were recruited during the last trimester of their pregnancy and measured for pregnancy specific anxiety (PSA), and social support (SS). Infants were assessed within the first 48 hours of life by certified examiners with the NICU Network Neurobehavioral Scale (NNNS). We hypothesized that pregnancy specific anxiety would be positively correlated to physical and neurological signs of stress on the infant. We found there was a significant association between pregnancy specific anxiety and hypotonicity; as maternal pregnancy specific anxiety increased, infant’s muscle tone or tension decreased. We also predicted that as social support increased, the negative effects of pregnancy specific anxiety on newborn outcomes would decrease in intensity. There was a significant negative correlation between pregnancy specific anxiety and social support scores. We did not find, however, any significant results that suggest that social support would act as a buffer of the effects of pregnancy specific anxiety on newborn neurobehavior. Our findings indicate that pregnancy specific anxiety has some influence on newborn developmental outcomes although further exploration is required. Consistent with previous studies, social support has an effect on the levels of anxiety perceived by the mother during pregnancy. Key Words: Social support, pregnancy specific anxiety, newborn neurobehavior University of Utah UNDERGRADUATE RESEARCH JOURNAL NEEDS OF YOUTH WITH AUTISM SPECTURM DISORDER (ASD) IN THE HEALTH CARE SETTING Carly Shields (Marissa Diener Ph.D.) Department of Family & Consumer Studies Introduction: Autism spectrum disorder (ASD) is a developmental disability characterized by difficulties with social communication and repetitive and restrictive behaviors patterns (American Psychiatric Association, 2013). According to the Center for Disease Control and Prevention, 1 in 59 8-year-old children were diagnosed with Autism Spectrum Disorder (ASD) in the United States in 2014 (Baio et. al., 2018). These rates constitute a 150% increase in the prevalence of ASD from 2000 to 2014 (Baio et al., 2018). As the prevalence of ASD continues to increase, interactions of children with autism with the medical environment also increase. Further, children with Autism have a higher rate of comorbidities compared to typically developing children, making them more likely to have frequent contact with the medical environment (Kohane et al., 2012). Thus, the awareness of ASD among professionals in healthcare settings is essential for the successful experience and accessibility to healthcare for youth with ASD. The purpose of this study is to identify the needs, challenges, and accommodations youth with ASD face during health care visits from the perspective of health care professionals. Method: For this research study, Health Care Professional’s (HCP’s) in Utah were surveyed. A total of 184 surveys were completed by a variety of HCP’s (including physicians, nurses and medical assistants). Participants were recruited through distribution of online survey links to newsletters and groups of Utah Health Care Professionals. Participants were asked demographic questions in addition to being surveyed regarding their experience, exposure, facility policies and training with patients with ASD. Results: Data analysis showed that 94% of HCPs reported having treated a patient with ASD, however, only 55% of providers had received training specific to the care of this patient population (see Figure 1). Despite the prevalence of ASD, 85% of health care providers indicated that their facility did not have policies in place for treating patients with Autism (see Figure 2). In addition, only 44% of medical professionals surveyed reported being extremely or very confident in interactions with this patient population (see Figure 3). With training, medical professionals were significantly more confident when treating with patients with autism (F(1,175) = 46.47, p. < .001, η2 = .21) (see figure 4). Conclusions: The majority of Utah medical professionals surveyed reported having treated patients with ASD, but frequently lacked training and confidence treating this population. These results expand previous findings that with more training, medical professionals feel more confident treating patients with Autism in health care environments. Figure 1: Medical Professionals' Exposure and Training on Treating Pediatric Patients with Autism 100% 80% 60% Have Treated a Patient With Autism 94% 40% Have Received Training on Autistic Patients 55% 20% 0% Figure 2: Health Care Facilities Policies in Place for Patients with Autism 15% No Policies in Place Policies in Place 85% Figure 3: Medical Professionals' Confidence When Working with Patients with ASD 25% 44% Extremeley or Very Confident Moderatley confident Slightly or not at all Confident 31% Figure 4: Confidence Level of Medical Professionals Mean Confidence Levels 5 4 3 2 1 0 Received Training No Training University of Utah UNDERGRADUATE RESEARCH JOURNAL CONTRIBUTING FACTORS FOR SHELTER RETURN OF HOMELESS VETERANS Claire Elizabeth Smith (Richard Fowles PhD, Tamara Calzado Real, Logan McGlamery) Department of Economics Abstract This paper seeks to identify factors within the population of homeless veterans that indicate a higher likelihood of return stays at shelters. The study uses information from the Road Home Shelter collected from July 2011 to December 2015. The data, which was collected at intake, excludes those who returned to the shelter following this time period as well as those who were entering the shelter at a time prior to July 2011. This data was assessed using correlation matrices, Bayesian model averaging (BMA), logistic regressions, classification and regression trees. Software used for analysis was R and Tableau. The federal definition of chronic homelessness being “either (1) an unaccompanied homeless individual with a disabling condition who has been continuously homeless for a year or more, OR (2) an unaccompanied individual with a disabling condition who has had at least four episodes of homelessness in the past three years.”. There are questions on the means of collection given that data was obtained in a highpressure situation where even though it was stressed to respondents that factors such as drug use or mental illness will not lead to refusal of service, responses may have been influenced by a fear to disclose sensitive information. Smith, Calzado Real, McGlamery Purpose This study was done with the intent to determine factors that lead to return stays of Veterans at homeless shelters. Previous literature has examined factors that lead to veterans becoming homeless, but there is a lack of focus on those returning to shelters more than once. Understanding these factors is crucial to ending homelessness among Veterans, who have been heavily represented in the homeless population for decades. Background Background literature was examined at on both statewide and national levels. The literature was used to contextualize the general composition of homeless veteran populations and to gain a further understanding of state-wide actions that may have changed the makeup of the sample. Veteran homelessness has been a national public health concern since the 1980s when veterans were overrepresented in the homeless population. This substantial growth in homeless veterans had to do with the high inflation and recession of the 1980’s, when even low paying jobs became hard to find (The New York Times). The National Coalition for Homeless Veterans stated that roughly 11% of the homeless adult population are veterans and about 20% of the male homeless population are veterans. The nation’s homeless veteran population is comprised primarily of single men, and approximately 50% suffer from a mental illness. Also, around 70% suffer from substance abuse problems. Homeless veterans also tend to be older, with about half over the age of fifty-one. Approximately 57% are white, and roughly 45% of homeless veterans African American or Hispanic. Veterans are already more likely to experience mental health problems because of their exposure to combat, which may cause trauma, and also because of Smith, Calzado Real, McGlamery being far away from home for military deployment. Therefore, it is concerning that veterans are underrepresented among the homeless population because homelessness is also associated with serious medical problems including mental health and substance abuse. In 2009, the then US Secretary of Veterans Affairs, Eric Shinseki, introduced a five-year plan to end homelessness among veterans. Some of the actions taken included discharge planning for incarcerated veterans re-entering society, more services for low-income veterans and their families, financial assistance for those who are qualified and wanted to pursue a college degree at a state university, collaboration with the Small Business Administration to certify veteran-owned small businesses for listing on the Federal Supply Register-making their businesses more competitive and creating more jobs for veterans, spending more money on housing for Veterans, and more (U.S. Department of Veterans Affairs). However, three years into the plan, Shinseki resigned as Secretary of the VA after a scandal in which VA hospital systems employees were hiding months-long wait times that veterans faced when seeking care. Shinseki’s former aids claim that the long wait times for Veterans to receive care were caused by the use of outdated technology in the VA hospitals, poor leadership and the hospitals, and a large number of veterans using the health care system at once that they could not handle (Washington Post, 2014). If a large number of veterans are waiting for care when there are a significant number of them that need care, as noted earlier, it’s important that this is communicated and reflected accurately for funding purposes. Up until Shinseki’s resignation, homelessness among veterans had decreased and the VA had helped tens of thousands of veterans secure housing and access more support services. Pushes for permanent housing, financial assistance, and everything else that the plan included, proved to be successful. Smith, Calzado Real, McGlamery Unfortunately, with Shinseki’s resignation, the five-year plan slowed down and as we’ve seen in recent years, veteran homelessness hasn’t had any significant reduction. Literature Review Previous studies have found consistent risk factors for homelessness among veterans. A metaanalysis of seven studies looking at risk factors for homelessness among veterans found that substance abuse problems was the risk factor with the greatest magnitude of effect (Tsai & Rosenheck, 2014). The meta-analysis also found that six of the seven studies identified low income/poverty and income-related variables including military pay grade and unemployment as high-risk factors for homelessness. A less common factor that has been proven significant is lack of social support. Three of the seven articles found that social isolation after discharge had a direct effect on homelessness. Van den Berk-Clark and McGuire, 2013, reported that lack of social support was associated with a longer duration of homelessness. Similar to lack of social support, Blackstock, Haskell, Brandt, and Desai, 2012, found that males who identified as unmarried were at higher risk for being homeless. A unique variable that proved to be significant in determining factors for homelessness among veterans was personal money management issues (Elbogen, Sullivan, Wolfe, Wagner, Beckham, 2013). In their study, personal money management issues represented a bigger risk factor than low income and mental health problems. However, there has not been a lot of research to analyze what factors cause veterans to return to a shelter more than once. One study compared three different groups of homeless veterans; one being participants that had ever been a part of HUD-VASH, another with participants who had intensive case management, and a third group with participants who received standard care. Out of these three groups, the HUD-VASH group was at lower risk for Smith, Calzado Real, McGlamery returning to homelessness over a five-year period, even after the analysis controlled for significant differences between the groups. In identifying variables that significantly predicted loss of housing, the greatest risk factor was drug abuse and the next most significant factor was post-traumatic stress disorder (PTSD). Variables that they found to be significant in lowering the risk of discontinuing housing included having a psychiatric problem or mood disorder at time of intake for housing (O’Connel et al, 2008). A second study that specifically looked at chronic homelessness among veterans found that poor employment history and diminished social support appeared to be an important indicator of chronic homelessness (Wenzel, Gelberg, Bakhtiar, Caskey, Hardie, Redford, & Sadler, 1993). It was difficult to find more studies that focused on finding predicting factors for chronic homelessness among Veterans. Most focused-on factors that put veterans at risk for homelessness yet we found a significant gap in the literature of explaining why veterans return to shelters more than once. Ten-year plan Started in 2003 and implemented in 2005; Utah had a ten-year plan to eradicate chronic and veteran homelessness by the end of 2015. The ten-year plan utilized the housing first approach, which aimed to have quick access to permanent housing resources. The recipients of housing first services agree to regular visits by case managers and are given the opportunity to access addiction and mental health services. The ten-year plan had four steps: prevention, rapid rehousing, support and data collection. Utah made national headlines for having a 91 percent decrease in chronic homelessness, but this figure was a misrepresentation of data as the 2015 figure was the raw HUD data while the years prior was annualized. In other words, the HUD count was annualized, or multiplied by a factor (legislator auditor general of Utah). Additionally, Smith, Calzado Real, McGlamery the state stopped counting individuals in transitional housing as chronically homeless and more verification was used for determining who counted as chronically homeless by Continuum of Care regions. The population of chronic homeless stated to be assisted by the ten-year plan included chronically homeless veterans. Housing and Urban Development has designated that regional boards allocate resources to best suit homeless communities. The regional Continuum of Care board administers the Point-inTime count. The state of Utah has three Continuums of Care. There are 13 regional Local Homeless Coordinating Committees. There is a HUD requirement for Continuums of Care to work with local communities in the creation, implementation and monitoring of strategic plans. Smith, Calzado Real, McGlamery There are issues with the Point-in-Time count given that it occurs during winter, and that the definitions used by state agencies vary. The Utah homeless population for the years 20112015 based on the HUD Point-in-Time count during the time of the study are visualized above. Operation Rio Grande Following the time of the data collection, Salt Lake City, Salt Lake County and the state of Utah implemented Operation Rio Grande, which sought to relocate homeless populations and increased the amount of policing on Rio Grande Street. This was done with the long-term goal of having shelters on the street close in July of 2019. Operation Rio Grande is a three-phase approach: “public safety and restoration of order,” “assessment and treatment,” and “dignity of work.” The stated goals of this action were reduction of crime, and reduction of criminals on the street. Operation Rio Grande has had a drastic impact on the homeless population of Utah and will have the end goal of having less concentrated populations of homeless in the State of Utah. Study This study utilized data analysis and visualization methods to explore the homeless veteran data and find determining factors to repeat stays at the Road Home shelter by veterans. The goal of the study was to create a model the Road Home could use to predict which veterans are at a higher risk of returning to the shelter. This process can be broken down into three main components: data preparation and cleaning, data analysis and determining the most relevant variables, and data visualization. These three tasks were repeated throughout the research to refine the data and models and gain understanding of trends in the data. Means of collection Smith, Calzado Real, McGlamery The data collected by the Road Home included veterans that were in shelter from July 2011- the end of 2014. It was collected at the veteran’s intake to the shelter, before they received a bed. Data Preparation and Cleaning The original homeless veteran data provided by The Road Home needed to be cleaned for data analysis. Variables with zero variance were deleted from the data set, as were variables that provided no useful information for the purpose of this study, such as dates and identification numbers. All categorical variables such as gender and race where turned into binary variables so that the data set contained only numeric values to make the data analysis simpler. The original dataset was brought down from 88 to 26 usable variables. Data Analysis and Variable Relevancy We used correlation matrices, Bayesian model averaging (BMA), logistic regressions, and classification and regression trees (CART) to determine which variables were the most important indicators of veteran returns to shelter. Most data analysis was done using R. These methods where selected to best accommodate the data based on its structure and the dependent variable. The independent variable, if an individual has stayed in the shelter multiple times (StayedInShelterMoreThanOnce), is a binary variable, as are most of the dependent variables. Some variables, such as age and income variables, are continuous. To avoid overfitting data while creating classification trees, random forests were used to test different models on training groups. Cross validation was used with the logistic regression models for the same purpose. In order to get an understanding of the relationship between the 26 possible dependent variables and the independent variable a correlation matrix was created This shows the correlation between variables. The darker the color, the stronger the correlation is. The visual shows highly correlated Smith, Calzado Real, McGlamery variables that are likely giving the same information and would lead to redundancy in the final model. For example, the Barriers Sum and Disabling Conditions have high correlations so they shouldn’t both be included in a final model. The variables with the highest correlation to multiple stays at the shelter can be seen in the following table: Chronic Homelessness (EverExperiencedChronicHomeless) has the highest correlation coefficient, 0.377. The next highest correlation was AGE with a negative correlation of 0.126. Smith, Calzado Real, McGlamery Bayesian Model averaging is more helpful in selecting which variables to use for maximization of the accuracy for the final models without overfitting with too many variables. The BMA generated from the 27 possible dependent shows that experiencing chronic homelessness and age are the top two predictor variables. A closer look at the relationship between these two variables and veteran return is necessary. Smith, Calzado Real, McGlamery Experienced Chronic Homelessness Of the eighty-two veterans that had experienced chronic homelessness, sixty-eight or around 82% returned to the shelter more than once within the three years that the data was recorded. There were 368 veterans that had not experienced chronic homelessness and 127, or 35%, returned to the shelter more than once. Using EverExperiencedChronicHomeless in a classification tree means that if they have ever experienced chronic homelessness they would be predicted to return to the shelter, and if they haven’t they would be predicted not to return to the shelter. The majority of the veterans that returned to the shelter more than once had not previously experienced chronic homelessness. Experiencing chronic homelessness is only helpful to predict about one-third of the veterans that stayed in the shelter more than once for this data set. Smith, Calzado Real, McGlamery Age Age is the next best predictor, as indicated by the models. It is not a very strong indicator with a negative correlation of 0.126 and a high degree of variance. The visual below shows the average number of veterans returning to shelter more than once sectioned by age. If the population of veterans who had previously experienced homelessness is omitted, the correlation with age increases slightly. There are some general patterns that are visible between age and whether the veteran returned to the shelter more than once. However, the correlation isn’t strong enough to seriously consider in a model. The best predictor, if they’ve previously experienced chronic homelessness, is fairly obvious since being chronically homeless means that you have either been homeless for over a year or have had multiple episodes of homelessness. As for the population that has not experienced chronic homelessness, it is far more challenging to predict whether they will return to the shelter. Veteran age is also a weak predictor. We did not find that most predictive factors for recidivism to homeless shelters in the Smith, Calzado Real, McGlamery literature applied to this data. This could be attributable to issues with the data collection methods since much of it is self-reported. There may be a reluctance for veterans to candidly disclose their health conditions as a result of their perception that it could affect their eligibility for different programs. Recommendations In summary, the few articles that also examined factors that predicted returns to a shelter had four variables that proved to be significant: drug abuse, Posttraumatic Stress Disorder (PTSD), poor employment history, and lack of social support. Unfortunately, our data only included information on drug abuse problems. We are unable to compare information from The Road Home with previous similar studies on any variables found to be significant other than drug abuse problems. Below are recommendations and connections with previous chronic Veteran homelessness broken down into the four variables mentioned: Posttraumatic Stress Disorder (PTSD) In our study, we did not find mental illness to be a significant determinant for return to the shelter. However, only 28% of our participants identified as having a mental illness, which may not be reliable considering that nationally, about 50% of all Veterans suffer from a mental illness. The literature that specifically examined factors that cause returns to shelter more than once included a variable to measure PTSD which proved significant in predicting that a veteran would return. Therefore, it would be beneficial to include a variable that helps us look at PTSD alone instead of using an umbrella term for all mental illnesses. Afterward, we can see if our findings on PTSD are consistent with others that found it to be significant in predicting veteran return to shelters. Smith, Calzado Real, McGlamery Drug Abuse Previous literature suggested that drug abuse was an important factor when looking at homelessness among veterans, while only 7% in our study reported having drug abuse problems. We didn’t find this variable to be significant in predicting returns to shelter, however, we assume that at the time of collecting the data, many answered inaccurately to this question. National data suggests that around 70% of all Veterans have some sort of substance abuse problem. We predict that the reason for few veterans reporting mental illnesses and substance abuse problems is that their information is collected at intake when they are first entering the shelter. We suggest that The Road Home be more transparent about their policy of not discriminating against those who disclose drug or alcohol problems and make it clear that they still have the same opportunity to receive a bed at the shelter so that more clients can answer truthfully. Poor Employment History The few studies that included previous employment history found that veterans were more likely to return to a shelter after successful housing if they had a history of poor employment. Especially if veterans were deployed for a long time, it can be very difficult to feel confident in job search and interviewing, writing a resume, and filling out applications. We believe it would be beneficial to implement new strategies and efforts to focus on career services. For clients seeking employment, having a designated place or person to prepare them and conduct mock interviews would help them build interviewing skills and feel more confident and supported. Additionally, teaching clients how to format a resume to look more professional could increase their chances of being recognized by employers and motivate them to keep applying Smith, Calzado Real, McGlamery since they know they have the support. With improved career services, veterans who had a poor employment history will likely be more resilient and persistent. Lack of Social Support Previous literature on chronic homelessness among veterans has shown that diminished social support is relevant in determining why Veterans return to shelters more than once. They included questions about marital status, if they had family around, and about how much time they spent with family and friends. Our data didn’t include this information. It would be beneficial to include similar questions to see if this finding is relevant for The Road Home clients as well. Finally, the Road Home should reconsider its measures of success. While it may seem like a good thing that a veteran hasn’t returned to the shelter more than once, many of those individuals stayed more than 100 nights on their first stay. If The Road Home is trying to prioritize their resources, return to shelter shouldn’t be the only parameter. Conclusion Overall, there have not been many efforts to determine why veterans return to a shelter more than once. This study, along with few others that have been done, is important considering that veteran homelessness has been a national public health concern for decades. We did not find variables of large significance in this data to explain what causes veterans to return more than once. Age and prior experience of homelessness were the most relevant variables, but were not strong predictors of returns, and also were not aligned with any of the previous literature. Recommendations for future study include adding more specific questions that relate to social Smith, Calzado Real, McGlamery support and PTSD, more transparency from The Road Home towards their clients on nondiscrimination policies, and more efforts on career preparation. The Road Home has been an active leader and innovator in ending Veteran Homelessness as shown by their previous actions. However, stronger cooperation and support from the State would tremendously help their actions. Smith, Calzado Real, McGlamery Works Cited Blackstock O.J., Haskell S.G., Brandt C.A., Desai R.A., Gender and the use of Veterans Health Administration homeless services programs among Iraq/Afghanistan veterans. Med Care. 2012 Apr; 50(4):347-52. Elbogen E.B., Sullivan C.P., Wolfe J, Wagner H.R., Beckham J.C.. Homelessness and money mismanagement in Iraq and Afghanistan veterans. Am J Public Health. 2013 Dec; 103 Suppl 2(): S248-54 Housing and Urban Development, “2007-2018 PIT Counts by State” HUD Exchange. Web. 1 Apr 2019. https://www.hudexchange.info/resource/3031/pit-and-hic-data-since-2007/ Jack Tsai, Robert A. Rosenheck, Risk Factors for Homelessness Among US Veterans, Epidemiologic Reviews, Volume 37, Issue 1, 2015, Pages 177–195, https://doi.org/10.1093/epirev/mxu004 Jaffe, G. and O’Keefe, Ed., Obama accepts resignation of VA Secretary Shinseki. The Washington Post. May 30, 2014. https://www.washingtonpost.com/politics/shinseki-apologizes-for-va-health-carescandal/2014/05/30/e605885a-e7f0-11e3-8f9073e071f3d637_story.html?utm_term=.ec8a14f32b3e McKinney-Vento Homeless Assistance Act as amended by S.896 The Homeless Emergency Assistance and Rapid Transition to Housing (HEARTH) Act of 2009, 42 USC 11302 §103. 2009. O'Connell M.J., Kasprow W, Rosenheck R.A. Rates and risk factors for homelessness after successful housing in a sample of formerly homeless veterans. Psychiatr Serv. 2008 Mar; 59(3):268-75. Office of the Legislative Auditor General, Utah. A Performance Audit of Utah’s Homeless Services. 2018 Wenzel, S.L., Gelberg, L., Bakhtiar, Caskey, N. Hardie, E., Redford, C. Sadler, N. “Indicators of Chronic Homelessness Among Veterans.” Hospital and Community Psychiatry. 1993 Dec. Vol.44. van den Berk-Clark C, McGuire J. Elderly homeless veterans in Los Angeles: chronicity and precipitants of homelessness. Am J Public Health. 2013;103(suppl 2):S232–S238. [PMC free article][PubMed] [Google Scholar] [Ref list] Lewin T. New York Times. Nation's homeless veterans battle a new foe: defeatism; p. A10. Dec 30, 1987. https://www.nytimes.com/1987/12/30/us/nation-s-homeless-veterans-battle-a-new-foe-defeatism.html Smith, Calzado Real, McGlamery University of Utah UNDERGRADUATE RESEARCH JOURNAL THE EFFECTS OF TEXT CAPTIONING ON NON-NATIVE ENGLISH SPEAKERS’ IMMEDIATE RECALL AND DELAYED RECOGNITION OF SPEECH Vanessa Srivastava (Brennan Payne) Department of Psychology Studies based on Rabbitt’s Effortfulness Hypothesis suggest that speech perceived in challenging perceptual situations comes with a cost of speech memory and comprehension because more cognitive resources are being allocated to speech perception. However, research shows that cognitive losses can be offset by text captioning in monolingual English speakers. Research also suggests that non-native speakers have more difficulty with speech perception. The purpose of this study is to determine whether or not text captioning effects immediate recall and delayed recognition of speech stimuli presented to non-native English speakers in varying levels of background noise. The participants were non-native English speaking young adults. Participants were presented with complex sentences in varying levels of background noise. In one condition, these auditory stimuli were paired with text captioning, and in the other condition, no text captioning was present. Immediate recall of these sentences was measured immediately after stimuli were presented, and delayed recall was tested after a block of forty-five trials. Text captioning was found to have a significant effect on both immediate recall and delayed recognition of speech stimuli in every background noise condition. Background noise was found to have an effect on immediate recall of speech stimuli. Correlation between language proficiency and immediate recall was found to be extremely high in every captioning X background condition. Moderate correlations were found between language proficiency and delayed recognition in most captioning X background noise condition. Such results imply that text captioning helps non-native English speakers with immediate recall and delayed recognition of speech ii stimuli and that background noise decreases immediate recall of speech stimuli in nonnative English speakers. ACKNOWLEDGEMENTS This work was supported by funding from the Undergraduate Research Opportunities Program at the University of Utah awarded to Vanessa Srivastava. iii TABLE OF CONTENTS ABSTRACT ii ACKNOWLEDGEMENTS iii INTRODUCTION 1 METHODS 5 RESULTS 8 DISCUSSION 16 REFERENCES 22 iiii INTRODUCTION The world we live in is changing in significant ways due to globalization. According to the Associated Press, at least two-thirds of children in the world are raised speaking more than one language (Marian and Shook, 2012). Therefore, it is essential that we think about the effects of learning multiple languages on our cognitive abilities. The majority of research in psychology is conducted on American university students (Heinrich, Heine, & Norenzayan, 2010). There is a lot of research being conducted in other Western countries as well (Heinrich, Heine, & Norenzayan, 2010). However, much of the literature on non-native language speakers is research into bilingualism, not L2 language learning, which is the time during which people are acquiring a non-native language. There is some evidence that language comprehension in an L2 language is more difficult than a native language (Song and Iverson, 2018). One obvious but important component of language is listening comprehension, which is relatively understudied in the context of second language abilities. Therefore, it is important to study listening comprehension in L2 language learners and identify potential ways to increase comprehension. In the following study, we examined whether text captioning affects immediate recall and delayed recognition of auditory stimuli presented to non-native speakers in varying background noise conditions. The task of speech comprehension for a non-native language is cognitively demanding for several reasons, and background noise non-surprisingly impairs performance. Mayo et al. (1997) and Rogers et al. (2006) conclude that non-native speakers never match the abilities of native speakers when there is background noise 1 (Lecumberri et al., 2010). Non-native language listeners have been found to be at a disadvantage when compared to native listeners in a few aspects. Several studies find that non-native listeners struggle more with word or sentence processing than do native listeners in the presence of noise, whether it be in fixed or variable noise levels (Lecumberri et al., 2010). Furthermore, as described in more detail later in the paper, noise increases the cognitive load required to attend to and comprehend stimuli. Nonnative speech adds another layer of unintelligibility, thus further increasing the cognitive load (Lecumberri et al., 2010). There are many potential reasons for this additional unintelligibility. For example, non-native speech could be harder to comprehend because non-native speakers may be less familiar with the phonemes associated with the stimuli language. Because of the relatively small number of phonemes and large number of words seen in every language, many words are phonemically similar. There are different phonemes associated with different languages, and due to familiarity, it is more difficult to distinguish between phonemes that are not as common in a native language (Lecumberri et. al, 2010). Additional explanations can come from limitations in vocabulary and multiple characteristics of one’s native language (Lecumberri et. al, 2010). Finally, non-native listeners have a harder time attending to one stimuli in the presence of multiple stimuli than native listeners when those stimuli interfere with lowlevel processing information, such as consonant sounds that aid in word predictability, which it seems that non-native speakers rely upon more heavily than their native speaking counterparts (Lecumberri et al., 2010). Taken together, research suggests that non-native English speakers have a more difficult time with the perception of auditory stimuli. 2 The comprehension of auditory stimuli is a complex process. It requires the detection of sound, the separation of the background noise from the meaningful information, understanding that the input is language, and processing the speech. Such a process requires significant cognitive demand, which is affected by effortfulness. Rabbitt’s (1968) effortfulness hypothesis proposes that an increase in the effort required to perceive sensory input, such as speech, leads to depletion in cognitive processing resources, which, in turn, causes a decline in stimulus memory (Wingfield, Tun, & McCoy, 2005). Rabbitt conducted an experiment on young adults in which he confirmed this hypothesis. In the experiment, Rabbitt presented verbal information to participants in clear speech, then in background noise. He found that participants’ memory for the first list of clear speech was worse when followed by unclear noise stimuli (Wingfield, Tun, & McCoy, 2005). This suggests that background noise interfered with the participant’s ability to encode memory of the vocal stimuli. A number of studies have since found that increased effort in the perception of stimuli leads to weaker memory, including in adults with hearing loss (Wingfield, Tun, & McCoy, 2005). These studies show that, even if speech can be perceived in challenging perceptual situations, the perception comes with a cost of speech memory and comprehension because those cognitive resources are being allocated to speech perception. However, several studies have shown that text captioning, written words on a screen that accompany speech, can improve the recognition of speech in background noise and hearing loss. Krull and Humes (2016) measured the effects of text captioning on speech recognition in monolingual, English speaking younger and older adults. They found that participants were best able to comprehend the stimuli when presented with 3 both speech and text information (Krull & Hulmes, 2016). This implies that text captioning can help to offset the cognitive load caused by more effortful speech perception. In a study of monolingual adults, Payne et al. (2018) found that as signal-tonoise ratio declines (meaning that there is more background noise in relationship to the speech stimuli), so does immediate recall and delayed recognition of speech. However, text captioning was revealed to offset these declines (Payne et. al, 2018). These results suggest that text captioning alleviates the cognitive load of noisy speech comprehension even in relatively simple speech perception tasks (i.e., listening to one’s own primary language). Additionally, the effects of SNR and text captioning were found to vary as a function of individual differences in adults with hearing loss (Payne et. al, 2018). Hearing loss would increase effortfulness in speech processing, as would non-native listening, suggesting that these effects may also vary along the lines of language proficiency. The effects of text-captioning on understanding speech in noise have only been tested in monolingual adults, and these effects are not understood in terms of second language captioning. Research suggests that when non-native speakers use one language, the other language is simultaneously active (Marian and Shook, 2012), which could mean that bilingual speakers are applying a higher cognitive effort than their monolingual counterparts when using either language. More recent research further implies that speakers must work harder to listen to speech in a non-native language. This suggests that encoding speech in a non-native language is more effortful (Song and Iverson, 2018). This information led to the following hypotheses: First, I hypothesized that immediate recall and delayed recognition would decline with lower signal to noise ratios 4 (SNR) in non-native English speakers. There were two potential effects that text captioning may have had on this decline. It was possible that text-captioning would improve speech memory in non-native English speakers, as seen in monolingual English speakers (Krull & Hulmes, 2016). If this was the case, we would expect the textcaptioning to offset the declines caused by the lower SNR. It was also possible that the cognitive effort required to both listen and read in a non-native language would be too overwhelming for non-native English speakers, in which case captioning would not help to offset the decline. Finally, I hypothesized a positive correlation between language proficiency and recall accuracy, as well as language proficiency and recognition accuracy. METHODS Participants Nineteen non-native English speaking participants were recruited for this study. Of those nineteen, eighteen participants completed the study, with one stopping midway due to frustration with the difficulty of the study. The average age of the participants was twenty-two years old, with the youngest participant being eighteen years of age and the oldest participant being twenty-seven years of age. All of the participants identified as male or female gender (8 male, 11 female). Participants varied significantly in the number of years they had been speaking English (M = 13.63 years, range = 4-27 years). The majority of participants were students at the University of Utah and therefore spoke English at a college level. Participants were recruited both through the University of Utah psychology participant pool and by word of mouth. Participants recruited through the participant pool were given class credit for their time spent participating in 5 the study. Those participants who were not enrolled in psychology courses were compensated at $10.00 per hour for their time spent in the study. Materials and Design: Participants were presented with two blocks of forty-five trials of speech stimuli in background noise conditions. In one block, they were presented with only auditory stimuli, and in the other they were presented with auditory stimuli and text captioning. Speech stimuli were complex, propositionally dense eighteen word sentences taken from National Geographic and similar magazines. Speech stimuli were taken from previous experiments conducted by Payne and Stine-Morrow (StineMorrow et al., 2001; Payne & Stine-Morrow, 2017). The sentences were recorded by a female native English speaker using a cardioid USB microphone (frequency response: 20Hz - 20kHz; sample rate 48 kHz, Max SPL: 120 dB) in a quiet environment. The auditory stimuli were recorded and digitized at a sampling rate of 44.1 kHz. The silent periods preceding and following the target sentence were removed from the recordings. Auditory stimuli were equated on root mean square amplitude. The noise masker was a stationary speech-shaped noise with the long-term frequency spectrum of the speech. There were three different noise conditions: Quiet, 7 dB SNR (mild background noise), and 3 dB SNR (moderate background noise). These noise levels were chosen because they were determined to increase listening effort while maintaining intelligibility during pilot studies. The noise conditions were randomly assigned to an even number of trials in each block, so that there were six categories of caption/no caption X Quiet/7 dB SNR/3 dB SNR for a two by three within-subjects design. Procedures, Measures, and Apparatus: Before beginning the main experiment, participants gave informed consent and filled out a demographics sheet asking about their 6 age, ethnicity, vision and hearing problems, language background, and mental health history. Participants were administered two language tests. The first was the Extended Range Vocabulary test created by the United States Educational Test Services (ETS), which takes up to six minutes. The second is the Michigan English Language Institute College English Test (MELICET), which is untimed. In order to quantify language proficiency for the correlational models, we calculated participants’ z-scores on each the MELICET grammar, MELICET cloze (semantics), and ETS Extended Range Vocabulary test, and we averaged them together. Additionally, eye tracking data was collected from the participant, but we did not use it in this study, so we will not discuss it further. Auditory stimuli were presented to participants at 60 dB through a MA-41 audiometer via the auxiliary input. The participants heard the stimuli through IP-30 insert air-conduction earphones. During the text captioning condition, captions were presented in segments designed to simulate the experience of Internet Protocol Captioned Telephone Service users. In order to keep this consistent, speech was presented in three word chunks with all text remaining on the screen until 1000 ms after the end of the spoken sentence. The rate of each block was based on the timing of the auditory stimuli so that the text could not precede the auditory stimuli. After that 1000 ms, a cross appeared on the screen for 5000 ms, after which a recall cue was presented. This recall cue prompted participants to recall as much of the sentence as they could remember out loud. The accuracy of this response was considered the immediate recall task. Their response was recorded with a microphone and saved for future transcription. At the end of the forty-five trial block, the participant was given a survey to determine their memory for the sentences and a survey indicating the difficulty of the task. The accuracy of this 7 response was considered the delayed recall task. After an optional break, the computer task and the following surveys were repeated in a second block, varying only in that the sentences were different and whether or not text captioning appeared with the speech stimuli. RESULTS In order to analyze the effects of text captioning on immediate recall and delayed recognition of auditory stimuli, we conducted two 2x3 repeated measures factorial Analyses of Variance (ANOVAs). The first ANOVA was designed to determine the effects of text captioning on immediate recall of auditory stimuli in three different noise conditions; no background noise, mild background noise (7 dB SNR), and severe background noise (3 dB SNR). The second ANOVA was designed to determine the effects of text captioning on delayed recognition of stimuli in those same three noise conditions. For each of the two ANOVAs, we looked at the effect of captions, the effect of SNR, and the interaction effect between the two variables. We used a significance level of p=0.05. The first ANOVA determined the effects of text captioning and SNR on immediate recall of speech stimuli. Captioning was found to have a significant main effect on immediate recall with F(1, 17) = 28.78, p < .05, partial η = .63. Posthoc 2 pairwise comparisons allowed us to determine that the mean difference between the caption and no caption condition was t (17) =5.79, p<.05. SNR was also found to have a significant main effect on immediate recall with F(2,17) = 10.63, p <.05, partial η = 2 .57. Posthoc pairwise comparisons allowed us to identify significant differences between each of the noise conditions. The mean difference between the Quiet and the 7 dB SNR 8 was t (17) =4.35, p<.05. The mean difference between the Quiet and the 3 dB SNR was t (17)=1.89, p<.05. The mean difference between the 7dB SNR and the 3dB SNR conditions was t (17) =-2.46, p<.05. The interaction between captioning and SNR was not found to have a significant effect on immediate recall with F(5,17) = 1.43, p>.05, partial η = .15. 2 Figure 1: Immediate Recall Accuracy as a function of captioning and SNR The second ANOVA determined the effects of text captioning and SNR on delayed recognition of speech stimuli. Captioning was found to have a significant effect 9 on delayed recognition of stimuli with F(1,17) = 10.36, p <.05, partial η = .38. Posthoc 2 pairwise comparisons allowed us to determine that the mean difference between the caption and no caption condition was t (17) = 4.1, p<.05. SNR was not found to have a significant effect on delayed recognition of stimuli with F(2,17) = 2.21, p>.05, partial η 2 =.22. Additionally, the interaction between captioning and SNR was not found to have a significant effect of delayed recognition of stimuli with F(5,17) = .08, p>.05, partial η = 2 .01. 10 Figure 2: Delayed Recognition Accuracy as a function of captioning and SNR In order to analyze the effects of language proficiency on immediate recall and delayed recognition of auditory stimuli, we have looked at the Pearson’s two-tailed correlations of the average z-score score of the three language tests with each immediate recall scores and delayed recognition scores in each of the six captioning X SNR categories. 11 Table 1 Correlation between Language Proficiency and Immediate Recall Captioning X SNR r p Cap X Quiet .83 <.05 Cap X 7dB SNR .85 <.05 Cap X 3dB SNR .80 <.05 No Cap X Quiet .87 <.05 No Cap X 7dB SNR .88 <.05 No Cap X 3 dB SNR .86 <.05 Table 1 There is a significant strong correlation between language proficiency and immediate recall in all six of the captioning X SNR conditions tested in this study. 12 Figure 3: Correlation between Language Proficiency and Immediate Recall of Speech with Captions Figure 4: Correlation between Language Proficiency and Immediate Recall of Speech with No Captions 13 Table 2 Correlation between Language Proficiency and Delayed Recognition Captioning X SNR r p Cap X Quiet .65 <.05 Cap X 7dB SNR .42 >.05 Cap X 3dB SNR .28 >.05 No Cap X Quiet .48 <.05 No Cap X 7dB SNR .66 <.05 No Cap X 3 dB SNR .54 <.05 Table 2 There are significant moderate correlations in the Caption X Quiet condition, No Caption X Quiet condition, No Caption X 7dB SNR, and No Caption X 3dB SNR. There are no significant correlations between language proficiency and delayed recognition of speech stimuli in the categories that have both captions and background noise. 14 Figure 5: Correlation between Language Proficiency and Delayed Recognition of Speech with Captions SNR Figure 6: Correlation between Language Proficiency and Delayed Recognition of Speech with No Captions 15 DISCUSSION Much of the underlying research for this study was based on Rabbitt’s (1968) effortfulness hypothesis, which suggests that the more difficult it is to perceive sensory input, such as speech, the fewer cognitive resources there are available to process the sensory input, leading to a decline in stimulus memory (Wingfield, Tun, & McCoy, 2005). Based on this effortfulness hypothesis and results from former studies, we hypothesized that non-native English speakers’ immediate recall and delayed recognition would both decline with lower SNRs. We know, based on former research, that speech perception is already more difficult for participants who are non-native language speakers (Song & Iverson, 2018; Lecumberri et. al, 2010). Prior research conducted on monolingual adults also suggests that background noise makes auditory perception more difficult (Wingfield, Tun, & McCoy, 2005). In fact, we even know that background noise makes speech perception more difficult in non-native English speakers (Lecumberri 1. et. al, 2010). A similar study conducted on monolingual adults yielded results in line with this; in Payne’s study, participants’ immediate recall and delayed recognition of auditory stimuli was hindered in background noise (Payne et. al, 2018). The results in this study, however, did not fall in line with the results of former research. Background noise was found to affect immediate recall as predicted, but was not found to have a significant effect on delayed recognition. This result was unexpected and was possibly due to the relatively small sample size of our study. However, it is possible that the effects of background noise are more detrimental to immediate recall than delayed recognition in non-native English speakers. This could be due to the levels of difficulty 16 for each task. As described in the methods of this study, immediate recall was calculated by the percentage of words participants replicated correctly when asked to repeat each sentence verbatim almost immediately after the target sentence was presented. The delayed recognition task only required participants to distinguish between old sentences and semantically similar new sentences. Such a task would require less resources from working memory, and therefore could be less impacted by increased effortfulness. We also hypothesized that text captioning could either attenuate the difficulties associated with the presence of background noise or that the cognitive effort associated with both reading and listening in a non-native language would be overwhelming for participants, which would lead to a decline in performance. The results suggested that text captioning had a positive effect on speech perception. In this case, we expected that text captioning would improve both immediate recall and delayed recognition accuracy because such results were seen in former studies conducted on monolingual adults (Krull & Holmes, 2016; Payne et. al, 2018). Text captioning was found to have a statistically significant positive effect on both immediate recall and delayed recognition of speech stimuli. However, there was not a statistically significant interaction effect between text captioning and SNR as observed in monolingual samples. This could be due to the fact that non-native speakers benefitted significantly from text captioning, even in the quiet background noise condition. We decided to test for correlation between language proficiency and performance in both immediate recall and delayed recognition of speech stimuli because of the wide range of language proficiency scores found amongst participants. There were some interesting trends in the correlations between language proficiency and recall of speech 17 stimuli, as well as language proficiency and recognition memory. It is interesting to note how high the correlation between language proficiency and immediate recall accuracy is regardless of SNR or text captioning. Prior research has shown a positive correlation between both L2 language proficiency and L2 language comprehension and between L2 language proficiency and working memory (Jeon and Yamashita 2014). The nature of the immediate recall task, described earlier in the paper, clearly relates strongly to both language comprehension and to working memory. These relationships could explain the high correlation between language proficiency and working memory seen in our results. In both immediate recall and delayed recognition, we see a trend of lower correlations between language proficiency and accuracy with text captioning than without it. This could suggest that language proficiency is less important when captioning is present for the recall and recognition of speech stimuli. This very clearly supports our hypothesis that text captioning could help with the perception of auditory stimuli and refutes our hypothesis that text captioning could overwhelm non-native speakers and detriment their perception of auditory stimuli. It is possible that text captioning helps to relieve the difficulties of speech perception in non-native speakers because some of the added difficulties of non-native speech perception come from auditory difficulties, such as accent or phonemic similarities, and the ability to read the same stimuli reduces that confusion. It is important to note that the target sentences used for both immediate recall and recognition memory may have been culturally biased in favor of those individuals who had been in the United States for the longest amount of time. I noticed often when coding the data that those participants who did not do as well overall would also struggle 18 to remember popular historical figures like George Washington, Teddy Roosevelt, or Jane Goodall. It would likely be significantly harder for an individual to remember a name he or she had not grown up hearing than one they knew very well. Although only six of the sentences have names of famous figures discussed in the American school system, it is possible that there are additional cultural biases that are less obvious. Despite the many positive results, there are important limitations to this study that must be considered. There were considerable individual differences in language proficiency amongst our sample that contributed to our results in significant ways. However, with a larger sample size, it would be possible to get a clearer understanding of how L2 language learners process auditory stimuli as a more collective group. It is possible that the differences between our results and the expected results based on prior research could be due to the relatively small sample size of this study. Additionally, every participant in the study was either a student, an employee or a former student of the University of Utah. This likely limited the diversity of the participants based on their education level, and therefore could impact the generalizability of the study. Some of the participants in this study were personal friends of the experimenter. This could have made participants either more nervous (because they were performing the study in front of someone they knew) or more comfortable for the same reason. This could also have affected some of the participants’ scores in positive ways (feeling comfortable) or negative ways (feeling nervous). There are many directions in which this research may extend in the future. Future research could benefit by examining a larger section of the population in this study. A larger sample size could allow researchers to separate the effects of individual differences 19 from the ways in which SNR and text captioning affect L2 English speakers overall. Along similar lines, it could be interesting to conduct a similar experiment on groups of individuals in different periods of the language learning process. For example, L2 language learners could be separated from balanced bilingual speakers and non-balanced bilingual speakers who are even stronger in their non-native language. Finally, it could be fascinating to directly compare the ways in which non-native English speakers’ perception of speech stimuli differ from the ways in which native English speakers perceive the same stimuli in various background noise conditions, as well as with and without text captioning. The results of this study suggest that text captioning improves immediate recall and delayed recognition of speech regardless of whether or not background noise is present. Additionally, results suggest that the presence of background noise decreases immediate recall of speech stimuli. Finally, language proficiency correlates extremely highly with immediate recall of speech stimuli and can have moderate correlation with delayed recognition of speech stimuli depending on the captioning X SNR condition. These results have important real world applications. In a classroom setting, for example, it may be helpful for non-native English speaking students to have word-heavy PowerPoint presentations to help them follow along with a lecture. Additionally, it would be helpful to minimize background noise as much as possible in classroom and workplace settings. In a shared cultural setting, such as a movie theater, it could be beneficial for L2 language learners to have the option of seeing a movie with text captioning. We have seen the use of text captioning help monolingual English speakers with hearing loss in both research and in real world settings (Payne et.al, 2018; Hoffman 20 & Warner, 2016). The results of this study may encourage us to expand text captioning to non-native English speaking populations as well in an attempt to improve L2 learning outcomes. 21 REFERENCES Heinrich, J., Heine, S. J., & Norenzayan, A. (2010). The weirdest people in the world? Behavioral and Brain Sciences, 61-135. Hoffman, C., Warner, M. (2016) United States Patent No. USD775653S1 Jeon, Eun Hee, and Junko Yamashita (2014). L2 Reading Comprehension and Its Correlates: A Meta-Analysis. Language Learning 64(1), 160–212. Krull, V., & Hulmes, L. E. (2016). Text as a Supplement to Speech in Young and Older Adults. Ear and Hearing, 164-176. Lecumberri, Maria, Garcia, Luisa, Cooke, Martin, & Cutler, Anne (2010). Non-Native Speech Perception in Adverse Conditions: A Review. Speech Communication 52(11). Non-Native Speech Perception in Adverse Conditions, 864–886. Marian, V., & Shook, A. (2012, September-October). The cognitive benefits of being bilingual. Cerebrum. Payne, B.R., Silcox, J., Lash, A., Ferguson, S.H., & Lohani, M. (2018). Assistive text captioning offsets the effects of background noise on speech memory. Academy of Rehabilitative Audiology Institute. Payne, B.R., Stine-Morrow, E. A. L., (2017) The Effects of Home-Based Cognitive Training on Verbal Working Memory and Language Comprehension in Older Adults. Frontiers in Aging Neroscience (9), 1-20. Song, Jieun & Iverson, Paul (2018) Listening Effort during Speech Perception Enhances Auditory and Lexical Processing for Non-Native Listeners and Accents. Cognition 179, 163–170. Wingfield, A., Tun, P. A., & McCoy, S. L. (2005). Hearing Loss in Older Adulthood: What it is and How it Interacts with Cognitive Performance. American Psychological Society, 144-148. 22 23 University of Utah UNDERGRADUATE RESEARCH JOURNAL FIRE HISTORY OF PYRAMID LAKE, UINTA MOUNTAINS, U.S.A., THROUGH CHARCOAL ANALYSIS Hannah Stevens (Dr. Mitchell Power) Department of Geography ABSTRACT Wildfire plays a significant role in all forest ecosystems. Fire regimes are heavily influenced by the climate and topography of an area. The Uinta Mountain range in Northeastern Utah is unique in the intermountain west for its topography, east-west orientation, and its consistent high elevation. Fire regimes are dynamic and change over time. This project focuses on the past 500 years of fire history in the Uinta Mountains and aims to discover the role that temperature and precipitation play in fire regimes. The research examines historical fire records using charcoal analysis from a sediment core obtained from Pyramid Lake. The results from charcoal analysis will be compared with historical climate data to understand the links of these variables over time. The results gathered from this research show that as temperatures warm and precipitation changes, fires are likely going to increase in severity and frequency. Understanding the link between fire and climate will help inform managers how to prepare for changing fire regimes and how to manage forests appropriately. University of Utah UNDERGRADUATE RESEARCH JOURNAL THE INFLUENCE OF VISUAL AND BODY-BASED CUES ON PATH INTERGRATION IN A VIRTUAL ENVIRONMENT: A COMPARISON OF CHILDREN AND ADULTS Jessica Stoker Faculty Advisor: Dr. Sarah Creem-Regehr Graduate Student Advisor: Erica Barhorst-Cates Department of Psychology Advances in virtual reality technology and the reduced size of head mounted displays (HMDs) introduces new possibilities for exploring more age ranges in virtual environments. This study was designed to examine which different types of locomotion methods are optimal for navigating a virtual environment in varying age groups. Data were collected from a group of children, aged 9 to 12 years, in a large-scale spatial task in virtual reality. This was compared with data collected from a group of young adults performing the same task. Methods We used an HTC Vive HMD to immerse the participant in the virtual environment. This allowed for manipulation of the types of locomotion the participant used to navigate the virtual world, limiting the sensory information they received during the task. Participants completed a virtual triangular completion task (Figure 1). They were asked to remember a starting location and locomote around two sides of a triangle, and with no visual input, face back to the starting location (Figure 2). This task was completed in three different conditions. In all conditions, participants used real rotations, or body turns to locate the next target, but the method of translation, or distance traveled from point A to point B, varied. The first condition, physically Walking through the virtual environment, provided the participant with both body-based and visual cues as they completed the task. The Joystick condition provided the participant with dynamic visual cues as they pulled a trigger to translate along the path of the task. Finally, in Teleportation condition, participant pointed and clicked a controller to automatically transport themselves to the target locations, eliminating body-based and visual input. The difference between the angle that the participant turned and the correct response was calculated as a measure of accuracy for each experimental trial. We expected that participants from both age groups to be most accurate in the Walking condition, less accurate in the joystick condition, and least accurate in the teleporting condition. Our prediction was that the less sensory information the participant was exposed to, the less accurate the participant would be during the experiment. Results For young adults, the accuracy in both the Walking and Joystick conditions did not significantly differ, however, participants were more accurate in these conditions than in the Teleporting condition. Children showed a different pattern of accuracy. Children overall were significantly more accurate in the Joystick condition than the Walking condition, and more accurate in the Walking condition than the Teleportation condition. We found a relationship between age and accuracy within the experiment in all three conditions, such that error decreased with increasing age. There were significant improvements in accuracy in the child sample from age 9 to 12. There were also significant improvements in accuracy in the combined child-adult sample from age 9 to 40. This suggests that there are significant developmental improvements in this task. Implications The results of this experiment suggest that children rely on different types of sensory information compared to adults when keeping track of their changing position in the virtual environment. Adults appear to be more flexible in which types of information they are able to employ when learning spaces, in that in this experiment they displayed similar accuracy with the dynamic-only visual information and the visual and body-based information. Contrastingly, children were more impaired when faced with integrating body-based information and visual information. It could be the case that with their rapidly changing body size the information that children are receiving from body-based cues is unreliable; this could lead to lessened accuracy in the walking condition. These results also suggest that children are more visually dependent than adults while keeping track of their location. These results bring into question the importance of body-based information in keeping track of where one is in a virtual environment. This could be explored further by eliminating the visual cues built into the virtual room. Eliminating visual cues could force participants to rely more on body-based information during the task. Changing the virtual environment to an open field would test whether the participant is relying on visual cues that were inadvertently provided (Figure 2). Future experiments will also test an adolescent age group to fill in the age gap between the child and young adult age groups. These future studies will provide a better picture of the development of these spatial skills across the lifespan. Figure 1 Figure 2 Triangular completion task: Participants are asked to remember a starting location (1) Locomote to point A (2) Locomote to point B (3) Visual input is taken away and participants are asked to face back to the starting location The error in angle is recorded Participants were asked to take one step forward, position is recorded again University of Utah UNDERGRADUATE RESEARCH JOURNAL LATE HOLOCENE FIRE HISTORY IN NORTHERN ETHIOPIA: A POTENTIAL LINK TO THE RISE AND FALL OF THE AKSUMITE EMPIRE Rachel Struhs (Mitchell J. Power) Department of Geography Over 2000 years ago, in the northern highlands of modern-day Ethiopia, the Aksumite Empire flourished using dry-land agricultural practices, extensive trade and domesticated animals during a time of wetter-than-present average climate conditions. However, the precise reasons for the rise and fall of the Aksumite Empire has been a topic of speculation by scholars for decades (Terwilliger et al. 2011). One approach to contribute evidence toward understanding this complex history is through the analysis of charred plant fossils preserved in ancient sediments. The Aksumite Empire existed during the 1st millennium AD in the northern highlands of Ethiopia (French et al. 2009). Our specific study site was in a location called the Mezber Valley (14.438112°, 39.410551°). These early dry-land farming societies were heavily dependent on seasonal rain. Fire was likely a primary tool for clearing forests and preparing fields for agriculture, particularly during the period of Aksumite ascendance (3000-2000 cal yr BP). However, previous research on the fire history within the Ethiopian highlands has been limited. The critical role of fire, either natural or human-caused, as a response to the changing environmental conditions of the Afromontane forests is explored in this research through sediment core analysis. Fossil fragments of charcoal were quantified and assigned to five different potential fuel types (e.g. grass fuel versus woody fuel) to understand more about fuel types and burning practices. Figure 1a. shows these fuel types in relation to fire events during the Aksumite empire. In addition to fuel type, this research explores the timing and frequency of past fire events before, during and after the Aksumite empire. Loss-on-ignition was also compared with charcoal results to explore changes in organics and carbonates in ancient soils (see Shapley et al. 2005). I hypothesize that most of the fire activity occurring during the Aksumite period, approximately 2000 to 1000 years ago, was predominately for burning grassland/farmland systems, and most of the charcoal evidence during the occupation should reflect these morphological types, including fibrous and/or lattice-type charcoal, indicative of fine grassy fuel types. As the Pre-Aksumite peoples came to rise around 2850 cal yr BP, fire events began to rise and remained consistent throughout the reign of the Aksumite. A minor dip in fire events occurred around 1600 cal yr BP but rose again soon after. Ultimately, the Aksumite fell by 1000 cal yr BP. However, charcoal counts continued to increase after they disappeared. Figure 1b. shows charcoal influx data during this time period. From the LOI data, increased burning coincides with increases in soil organics and fire events. Perhaps charcoal was used as fertilizer which would increase soil organic matter from the burned biomass. Carbonates were on the rise then fell in the middle of the Aksumite empire (1000-2800 cal yr BP). Soil carbonates tend to rise and fall with dry/wet climate patterns, respectively. The possibility of drought as cause for the decline of the empire is probable as charcoal count rises as do carbonates which suggest a potential for extended dry periods. We assume wetter climates would decrease soil carbonates. Figure 2. Depicts the varying levels of carbonates and organics in the soil throughout the Aksumite period. Overall the data shows that fire increased after the fall of the Aksumite Empire around 1,000 cal yr. BP (or around 940 AD). We assume the fall was likely linked to extreme climate variability. The presence of lattice charcoal during the rise and fall suggests an emphasis on dry-land farming and potential limitations during extreme climate variability. Figure 1a. Figure 2. Figure 1b. French, C., Sulas, F., & Madella, M. (2009). New geoarchaeological investigations of the valley systems in the Aksum area of northern Ethiopia. Catena, 78(3), 218-233. doi:10.1016/j.catena.2009.02.010 Shapley, Ito, & Donovan. (2005). Authigenic calcium carbonate flux in groundwater-controlled lakes: Implications for lacustrine paleoclimate records. Geochimica Et Cosmochimica Acta, 69(10), 2517-2533. Terwilliger, V. J., Eshetu, Z., Huang, Y., Alexandre, M., Umer, M., & Gebru, T. (2011). Local variation in climate and land use during the time of the major kingdoms of the Tigray Plateau in Ethiopia and Eritrea. Catena, 85(2), 130-143. doi:10.1016/j.catena.2010.08.003 University of Utah UNDERGRADUATE RESEARCH JOURNAL QUANTIFYING THE COST OF INTERRUPTIONS ON VISUAL SEARCH Aydin Tasevac (Trafton Drew) Department of Psychology Introduction Recent estimates have placed medical errors as the third leading cause of death in America (Makary & Daniel, 2016). Each year, medical errors are responsible for approximately 100,000 deaths and an additional 1 million injuries in the United States alone (Kohn, Corrigan, & Donaldson, 2000). The field of diagnostic radiology plays a central role in disease management mainly through various medical imagining procedures (e.g., searching for cancer nodules in CT scans). During the difficult process of analyzing and interpreting medical images through visual search, radiologists experience interruptions on a frequent basis. These interruptions have been identified as a prevalent and potentially harmful occurrence in radiology reading rooms. Recent studies have linked interruptions to increased discrepancies between residents and attending physicians (Balint et al., 2014). Interruptions have also been tied to an increased error rate in other medical tasks, such as dispensing of medication (Westbrook et al., 2010). We define visual search as a type of perceptual task that requires attention and typically involves an active scan of the visual environment for a particular object or feature (the target) amongst other objects or features (the distractors) (Treisman, Gelade, 1980). The purpose of this study was to quantify the cost of interruptions on visual search in terms of error rate and search time. Effects of interruptions on foraging in human visual search were also computed. Methods To simulate visual search performed by radiologists, participants were asked to conduct a task in which they were instructed to search for multiple targets amongst an array of distractors. In this experiment, targets were Landolt C’s positioned in a specific orientation and the distractors were additional Landolt C’s turned in different fashions (A Landolt C is a standardized symbol used for testing vision. It consists of a ring that has a gap, thus looking similar to the letter C. The gap can be oriented in various positions). Throughout the experiment, the participants primary visual search task was interrupted by a secondary task involving either a set of math problems, or a mental rotation problem. In order to determine an interruption’s effect on visual search we computed trial duration, accuracy of target detection and the observers average click-rate. In addition, two versions of the experiment were conducted; version one contained an average of 7 targets, and version two contained an average of 41 targets. Results Search time experiment 1 Our data revealed that participants spent a significantly longer time searching interrupted cases (Math Interruption: M=100.04 s, SD=53.57 s; Mental Rotation: M=94.22 s, SD= 43.48 s) than control cases (M=89.87 s, SD=52.31 s). Math interruption + control trials mean comparison: t(19)=3.66, p=.001, Cohen’s d=0.20 Mental rotation + control trials mean comparison: t(19)=2.23, p=.03, Cohen’s d=0.09 The average time cost for math interruptions was 10.17 s (median: 11.43 s, range:-20 to 30s), an 11% increase in search time when compared to control cases. Average time cost for mental rotation interruption was 4.34 s (median: 5.86 s, range: -41 to 18s), a 4% increase in search time when compared to control cases. Interruption type comparisons show math interruptions (M=100.04 s, SD=53.57 s) as leading to a slightly longer search time than mental rotation interruptions (M=94.22 s, SD= 43.48 s), t(19)=1.97, p=.06, Cohen’s d=0.09. Search time experiment 2 In experiment two, results indicated that participants spent significantly more time searching math interruption cases (M=122.32s, SD=38.66 s) than control cases (M=115.75 s, SD=32.02 s), t(20)=2.29, p=.03, Cohen’s d=0.19. However, search time for trials involving a mental rotation task (M=118.17 s, SD=35.42 s) did not vary significantly from control cases (M=115.75 s, SD=32.02 s), t(20)=1.02, p=0.3, Cohen’s d=0.07. The average time cost for math interruption was 6.56 s (median: 4.58 s, range: -25 to 37 s), a 6% increase in search time when compared to control cases. Average time cost for mental rotation interruption was 2.42 s (median: 5.25 s, range: -39 to 29 s) a 2.09% increase in search time when compared to control cases. Interruption type comparisons show math interruptions (M=122.32s, SD=38.66 s) lead to a slightly longer search time than mental rotation interruptions (M=118.17 s, SD=35.42 s), t(20)=1.60, p=0.12, Cohen’s d=0.11. Accuracy experiment 1 Approximately 78.5% of all targets were detected with no significant differences in the amount of targets missed between interrupted (Math Interruption: M=1.44, SD= 1.92; Mental Rotation Interruption: M=1.64, SD=1.03) and control cases (M=1.51, SD=1.55). Math interruption + control case mean of target misses comparison: t(19)=.93, p=.3, Cohen’s d=0.04 Mental rotation + control case mean of target misses comparison: t(20)=.1.09, p=.2, Cohen’s d=0.09 Accuracy experiment 2 Approximately 90% of targets were detected with no significant differences in amount of targets missed between interrupted (Math Interruption: M=3.31, SD= 3.55; Mental Rotation Interruption: M=3.51, SD=3.59) and control cases (M=3.72, SD=3.57). Math interruption + control case mean of target misses comparison: t(20)=1.69, p=.10, Cohen’s d=0.11 Mental rotation + control case mean of target misses comparison: t(20)=.83, p=.41, Cohen’s d=0.05 Foraging Pre-interruption click-rates indicated that participants averaged at approximately 1.8 clicks every 5 seconds. In the 5 seconds following an interruption, click-rates dropped to an average of 0.5 clicks, and took an additional 5 seconds to return to their pre-interruption average. Discussion After accounting for the amount of time spent on the secondary task, the primary effect of interruptions on visual search tasks was a slower completion time. Although both types of interruptions led to longer search duration, there were no significant differences in regards to accuracy of target detection between the conditions. Similar to previous studies, we speculate that interruptions lead to an impaired memory for previously searched areas. This impaired memory consequently leads to slower task completion (Williams & Drew, 2017). An additional explanation for our results is that there is a speed/accuracy tradeoff caused by the interruption. When an interruption occurs, the observer sacrifices time in order to prevent errors from occurring. Interruptions are thought to impact foraging in visual search by either prompting an early task termination or educing a prolonged search time (Wolfe, 2013). Either outcome can negatively impact task performance in the real world. Early task termination may cause radiologists to miss cancer nodules due to the search being ended too soon. In the contrary, a prolonged search can results in radiologists falling behind on work as a result of spending too much time on each case. However, very little research has been done regarding interruption-foraging interactions. Our data suggest interruptions lead to a significant time delay in resumption of baseline task functioning. This provides nuance for the speed/accuracy tradeoff assumption for interrupted cases: perhaps observers sacrifice time in order to make up for what was potentially compromised by the interruption. By quantifying the cost of interruptions on visual search, we can deepen our understanding of how visual attention and memory are affected by these disturbances. Ultimately, we hope this research will lower the rate of medical errors by shining light on the costs associated with interruptions. References: Balint, B.J., Steenburg, S.D., Lin, H., Shen, C., Steele, J.L., & Gunderman, R.B. (2014). Do Telephone call interruptions have an impact on radiology resident diagnostic accuracy? Academic Radiology, 21(12), 1623-1228. Doi: 10.1016/j.acra.2014.08.001 Kohn, L.T., Corrigan, J., & Donaldson, M.S. (2000). To Err is Human: Building a Safer Health System. Washington, DC: National Academy Press. Makary, M.A., & Daniel, M. (2016). Medical error-the third leading cause of death in the US. BMJ, 353, i2139 Treisman, A.M., Gelade, G. (1980). A feature-integration theory of attention. Cogn Psychol. 12(1):97-136. Westbrook, J. I., Woods, A., Rob, M. I., Dunsmuir, W. T., & Day, R. O. (2010). Association of interruptions with an increased risk and severity of medication administration errors. Archives of Internal Medicine, 170(8), 683–690. Williams, L. H., & Drew, T. (n.d.). Distraction in diagnostic radiology: How is search through volumetric medical images affected by interruptions? Cognitive Research: Principles and Implications. Wolfe, J. (2013). When is it time to move to the next raspberry bush? Foraging rules in human visual search. Journal of Vision. University of Utah UNDERGRADUATE RESEARCH JOURNAL KNOWLEDGE, BELIEFS, AND EXPERIENCES ABOUT IMMUNIZATION AMONG REFUGEES RESETTLED IN THE UNITED STATES FROM THE THAILANDMYANMAR BORDER 1,2 Tessa Truman (Akiko Kamimura1, Alla Chernenko1, Rebecca Higham1,2, Zobayer Ahmmad1, Mu Pye3, Kai Sin3, Adrienne Griffiths1) 1 Department of Sociology, University of Utah, Salt Lake City, UT, USA; 2Health Society and Policy, University of Utah, Salt Lake City, UT, USA; 3Department of Health, Kinesiology and Recreation, University of Utah, Salt Lake City, UT, USA Corresponding author: Akiko Kamimura, PhD Department of Sociology, University of Utah, 380 S 1530 E, Salt Lake City, UT 84112, USA E-mail: [e-mail] RUNNING TITLE Immunization- Refugees in the United States ACKNOWLEDGEMENTS We thank participants of this study and Soe Meh and Naveen Rathi for their assistance with this study. ORCID Akiko Kamimura https://orcid.org/0000-0001-6528-5770   1   Knowledge, Beliefs, and Experiences about Immunization Among Refugees Resettled in the United States from the Thailand-Myanmar (Burma) Border Abstract Objectives: The purpose of this study was to investigate immunization-related experiences among Karen refugees from the Thai-Myanmar border currently living in the U.S. Understanding of how Karen refugees perceive immunization programs in the U.S. is seriously lacking. Exploration of knowledge, beliefs, and experiences of immunization among Karen refugees will help strategize education programs to enhance immunization among Karen refugees. Methods: Karen refugees resettled in the United States from the Thai-Myanmar (Burma) border (n=120) completed a survey on their perceptions and experiences related to immunizations. Results: Older age was associated with higher levels of perceptions that immunizations were safe and longer-term residence in the US was associated with lower levels of perceptions that immunizations were safe. While long-term side effects of immunizations are not commonly perceived, perceived short-term side effects are prevalent. Conclusions: With improved understanding on demographic factors related to immunization belief and perception, the healthcare system in the United States can strategize culturally fit intervention programs that alleviate potential concerns Karen refugees might have regarding vaccination. Future research should expand to study more Karen refugee populations across the nation and develop vaccination health education programs specifically aimed at these refugee populations. Keywords: immunizations, perceptions, refugees, resettlement, Myanmar, USA   2   INTRODUCTION A number of refugees worldwide has been growing since 2010 [1]. Resettlement is one of the ways to protect refugees from a number of urgent risks [1]. The United States (U.S.) is currently experiencing an influx of refugees seeking an asylum from their homeland due to persecution, war, or violence [2]. Over three million refugees have resettled in the U.S. since 1975 [3]. Refugees entering into a new nation have complex medical needs and are a vulnerable population in a new environment [4]. Not only have refugees often faced conflicts in their home country, but many continue poor health, and issues with the migration process by way of finding access to resources or services in their new country [4]. Oftentimes, before coming to the U.S., these refugees have spent time living in refugee camps where they may be especially susceptible to communicable diseases and hunger [5]. When refugees are resettled in the U.S., they are required to have a medical examination, which includes screening for specific diseases, and evaluation of immunization status to find out which vaccinations the refugee might still need [6]. Unlike most other immigrant populations, refugees are not required to receive any vaccines before entering the U.S. due to lack of availability vaccines [7]. However, regardless of the vaccination requirements, immigrants should undergo vaccination as a necessity for public health management [4]. Even though refugee vaccinations upon arrival into the U.S. are recommended but not required, refugees who apply for legal permanent residency after living in the U.S. for a year are required to be fully vaccinated [6]. In 2013, the Center for Disease Control and Preventions (CDC) developed a Vaccination Program for U.S.-Bound Refugees [6]. This program helps improve the overall health of refugees before and during their resettlement, reduces the risk of vaccine-preventable disease outbreaks upon arrival into the U.S., and helps refugee children enter school quicker upon arrival [6]. Despite the importance of vaccination and immunization, very little is known about how refugees perceive existing immunization program. Perceptions of immunization are important predictors of whether people will obtain a vaccine [8]. Perceptions of immunizations can serve as barriers to refugee immunization; therefore, it is important to address these concerns to promote health of refugees resettled in the U.S. or another country. This study focused on resettled refugees from the Thailand-Myanmar (Burma) border to the U.S. Since 1975, more than three million refugees have been resettled in the U.S. [9]. Among these 3 million refugees, more than 75,000 Karen refugees arrived in the U.S. since 2006, coming from camps and urban settings along the Thai-Myanmar (Burma) border [10]. The Karen are one of the many ethnic groups within the large Burmese population that has relocated to the United States during this time [11]. In 1948, civil war erupted across the country of Burma (Myanmar) leading to the displacement of the Karen to refugee camps along the Thai-Myanmar (Burma) border [12]. As Karen refugees have been resettled in the U.S. throughout the past decade, research has been conducted primarily focusing on the mental health of these Karen refugees [10,13]. Ongoing civil war and human rights violations in Myanmar (Burma) place Karen population at a higher risk for experiencing chronic mental health disorders, such as posttraumatic stress disorder (PTSD) and depression [10,13]. In addition to mental health issues, this population is susceptible to a variety of other health risks, including infectious diseases, malnutrition, Type 2 diabetes, anemia, and hypertension [14]. Relatively little is known about Karen refugees’ perceptions of immunizations or their past immunization-related experiences. A greater understanding of these perceptions will provide insight into past and current experiences and attitudes surrounding vaccinations of the Karen refugee populations resettled in the U.S. In a study of post-arrival screening among Karen Refugees in Australia, it was found that Karen refugees had inadequate immunity to vaccine-preventable diseases, increasing the need for accessible immunization programs in early stages of resettlement [4]. Another study conducted   3   in England aimed to understand the reasons parents in general decide against vaccinating their children against influenza [15]. After reviewing the surveys of 1,001 participants, it was found that the most common reason parents chose not to vaccinate their child was that they believed their child was generally healthy and they were not worried about them catching influenza [15]. The second most common reason was the perception that the vaccination causes negative side effects [15]. This study shows that beliefs and perceptions regarding immunizations can greatly influence whether or not parents choose to vaccinate their children and can also influence the rate at which adults choose to vaccinate themselves. Studying Karen refugees’ perceptions will help to gain a greater understanding of how this refugee population perceives the process of receiving immunizations after becoming residents of the United States, since most Karen refugees will end up residing in the U.S. permanently due to continued violence in their home nation [12]. Karen refugees, among other refugees, may face barriers or hesitations to receiving immunizations after being resettled in the United States [16,17]. In a systematic review of barriers, it was found that cultural norms, knowledge gaps, insufficient access to healthcare, and anti-vaccination beliefs all affected a refugee’s perception of immunizations [17]. Refugees’ perceptions of immunizations resulting in vaccination hesitancy upon arrival in the U.S. include belief in low risk of infection, concern about side-effects, belief that the vaccinations are unnecessary or optional, perceived low effectiveness of vaccines, mistrust, and concern about newness of a vaccine [17]. These perceptions could be a result of past, childhood experiences or a general lack of knowledge about immunizations [17]. The purpose of this study was investigate immunization-related beliefs, experiences and perceptions among Karen refugees from the Thai-Myanmar border currently living in the U.S. Knowledge about the perceptions of immunizations among Karen refugees is lacking. Such knowledge is important to develop health education programs that provide accurate knowledge about immunizations with the goal to increase immunization uptake among Karen refugees. Similarly, the results of this study can assist in developing strategies to address issues surrounding immunization attitudes immunizations early on in resettlement of Karen refugees and other refugee populations. METHODS Data Collection and Participants This study was approved by the Institutional Review Board (IRB). Data was collected using self- or interviewer-administered surveys in Salt Lake City, Utah where there are approximately 1,000 Karen refugees. Participants were recruited through flyers, in-person contacts, snowball sampling, networking within the refugee community, and through organizations that serve Karen refugees. The survey instrument and consent cover letter were written in English. Three student research assistants who were fluent in the languages spoken by the Karen refugees collected the survey. The languages used in survey collection included English, Karen, Poe Karen, Burmese, and Karenni. Participants who were fluent in English took the surveys as self-administered. If participants were not fluent in English, they were given interviewer-administered surveys. Consent was obtained from all participants. No personal information was collected from the participants. Measures Perceptions about safety of immunizations Beliefs regarding general safety of childhood vaccinations and fear of vaccine side effects were found to be associated with vaccine hesitancy and vaccine refusal among parents [18-20]. In this study, we assessed the extent to which Karen refugees believed in the safety of vaccines for   4   children using a three-item scale: 1) “Vaccines (shots) are very safe for children;” 2) “A lot of research is done to make sure vaccines (shots) for children are safe;” and 3) “Side effects from vaccines (shots) for children are usually not very severe”). A 5-point Likert scale (1= Strongly disagree, 5 = Strongly agree) was used to measure perceptions about the safety of immunization. Scoring was based on mean. Higher scores indicate higher levels of perceptions that immunization is safe. Cronbach alpha for the study participants was 0.612. Immunization related experiences Another factor associated with childhood vaccination decisions is parents’ own experience with vaccines or their perception or knowledge about experiences of others. Parents who recall having adverse reaction to childhood vaccines or cases of adverse outcomes among friends or family members may be reluctant to follow the vaccination guidelines for their children [21,22]. To gain an understanding of adult Karen refugees’ immunization experiences, we included the following questions in the survey instrument: “Did you receive vaccines (for example, Chickenpox, Diphtheria, Hepatitis B, Measles, Mumps, Polio, Rubella, Tetanus) as a child (before age 6)?;” “Did you receive vaccines (for example, Flu, HPV, MMR, Chickenpox, Hepatitis B) as a child (between age 7 and 18)?;” “Did you or anyone you know experience short-term side effects of childhood vaccination (for example, fever, rash or pain during and after injection)?;” “Did you or anyone you know experience severe or long-term side effects of childhood vaccination (lifethreatening side effects or side effects that lasted for many years)?; ” and “If you have children, did they receive vaccinations recommended for their age?” Socio-demographic characteristics This study asked participants to disclose several socio-demographic characteristics: age, sex, highest level of educational attainment, marital status, current employment, a number of children living in their household, and how many years they have lived in the US. The socio-demographic characteristics allowed us to understand basic information on the Karen refugee population and how each participant fits within the larger United States population. Data Analysis The data from this study was analyzed using SPSS version 22 (IBM Corp., Armonk, NY, USA). Multiple linear regression was used to examine associations between perceptions towards immunizations and demographic characteristics, past experiences, and perceived side-effects. Variables were tested for skewness and collinearity prior to performing the regression analysis. RESULTS Table 1 summarizes the characteristics of the 120 participants. Approximately 40% of the participants were female (n=50, 41.7%). The average age of participants was 29.59 (SD=13.95). About 38% of the Karen refugees did not graduate from high school (n=45, 37.5%). One-third of participants were married (n=40, 33.3%) and about half worked full-time (n=54, 45%). The average length of residence in the US was 8.03 years (SD=3.00). On average, the Karen refugees had 2.43 children in each household (SD=2.23). Table 1 also describes immunization attainment among the participants. Approximately 30% of the participants had received vaccines before the age of 6 (n=34, 28.3%). More than half of the participants (n=66, 55.0%) had received them between the age of 7 and 18. Participants perceived short-term side effects in self (n=29, 24.2%), family (n=23, 19.2%), friends or neighbors (n=12, 10.0%), or other person(s) (n=13, 10.8%). Over half of all participants (n=66, 55%) did not report being exposed to short-term side effects of vaccination in self or others. Participants perceived long-term side effects in self (n=9, 7.5%), family (n=5, 4.2%), friend or neighbors (n=2, 1.7%), other person(s) (n=9, 7.5%), and over 80% did not have direct or indirect   5   experience with long term side-effects of vaccinations (n=98, 81.7%). Only half of participants reported that their child received recommended vaccines (n=60, 50.0%). Table 2 presents the results of regression analysis that indicated the predictors of beliefs regarding the safety of immunization. Older age was associated with higher levels of perceptions that immunizations were safe (p<0.01). Longer-term residence in the US was associated with lower levels of perceptions that immunizations were safe. (p<0.01). DISCUSSION This study examined and described immunization-related perceptions and experiences among Karen refugees from the Thai-Myanmar border currently living in the U.S. The results indicated three main findings. First, older age among the participants whose average age of 29.59 years were associated with higher levels of perceptions that immunizations were safe. Second, long-term residence in the U.S. was associated with lower levels of perceptions that immunizations were safe. Third, while long-term side effects are not commonly perceived, perceived short-term side effects are prevalent. It has been reported that increased age is strongly associated with increased vaccination uptake, specifically with the influenza and pneumococcal polysaccharide vaccine (PPV) vaccines [23,24]. In a study that focused on adult PPV vaccination disparities among foreign-born populations residing in the United States, while 13.7% of immigrants between 18-64 were vaccinated, while 40.5% of immigrants 65 or older were vaccinated [24]. This shows a dramatic increase in vaccination coverage that could be due to different factors including increased immunization education or fear of getting ill from various vaccine-preventable diseases due to older age [24]. In this current study, possible factors for the strong association between age and increased perception of immunization safety might be due to increased education to older Karen populations. Future research should examine these factors and other factors that may affect their perceptions of immunizations. The results of this study suggest that longer-term residence in the U.S. by the Karen refugees is found to lead to mistrust of immunizations and the perception that they are less safe. When studying potential barriers to immunizations in the Hmong immigrant population living in California, it was determined that nativity, or years living in the U.S., did not predict perceived barriers [16]. Reasons why longer-term residency and acculturation in the U.S. may lead Karen refugees to believe that immunizations are unsafe are barriers within our healthcare system, low socioeconomic status, anti-vaccination rhetoric through media, language constraints, and/or increased difficulty for accessing immunizations the longer a refugee resides in the U.S. [25]. When first arriving to the U.S., health care workers may take extra time informing Karen refugees of the vaccinations they need to receive [6]. However, after living in the U.S. for an increased period of time, health care workers may cease to properly educate refugees of the importance of receiving vaccines [26]. The lack of information may make these Karen refugees feel as though the initial push to receive vaccinations was part of a marketing practice, which can lead to distrust in the health care workers and the overall health care system. Future research should attempt to determine these reasons for feeling as though vaccinations are increasingly unsafe the longer they live in the U.S. in order to properly educate this particular population. Lastly, the results showed that long-term side effects were not generally perceived, whereas short-term side effects were commonly perceived to come as a result of receiving an immunization. This aligns with research that shows short-term or minor side effects, including pain at the injection site, low-grade fever, chills, headache, and/or fatigue, as the most common side effects after receiving an immunization [27]. Long-term and more serious side effects are   6   rare [27]. Therefore, the most commonly reported side effects from vaccinations will most likely be short-term side effects that generally go away within a day [27]. While this study provides insightful information about the Karen refugee’s perceptions on immunizations in the United States, there are some limitations to this study. First, the sample population size was relatively small (n=120). However, this small sample size should be considered in context of the relatively small number of Karen refugees residing in the greater Salt Lake area. The second limitation is that the sample included in the study may not be fully representative of all the Karen refugees that are currently residing in the U.S. because the survey was collected only in one county. However, because refugees are considered a vulnerable population, it is often difficult to obtain a “fully” representative sample. Future studies should aim to study other Karen refugee groups in varying U.S. locations to provide a richer representation of Karen refugees. Another limitation of this study might be due to its crossdesign that does not help determine causal directions among variables. A longitudinal study could be beneficial for future research on perceptions of immunizations to see how perceptions might shift, morph, or remain the same over time. Furthermore, the reliability of the scale measured the perceptions of immunization safety was somewhat low. It is necessary to develop a scale with higher reliability for future research, which will allow comparisons across different refugee groups. This study has important implications for addressing refugee health and cultivates ways of limiting poor perceptions of immunizations among Karen and potentially other refugee populations. With improved understanding on demographic factors related to perceptions of immunization, the healthcare system in the U.S. can strategize culturally fit intervention programs that alleviate potential concerns Karen refugees might have regarding vaccination. This research can also potentially be applied to other minority refugee populations. Future research should expand to study a larger number of Karen refugee populations across the nation and the globe and develop vaccination health education programs specifically aimed at these refugee populations. CONFLICT OF INTEREST The authors have no conflicts of interest associated with the material presented in this paper. REFERENCES 1. UNHCR. Mid-Year Report: 2018 [cited 2019 Apr 4] Available from: https://www.unhcr.org/statistics/unhcrstats/5c52ea084/mid-year-trends-2018.html 2. UNHCR. What is a Refugee?: 2019 [cited 2019 Apr 4] Available from: https://www.unrefugees.org/refugee-facts/what-is-a-refugee/ 3. U.S. Department of State. Refugee Admissions: 2019 [cited 2019 Apr 4] Available from: https://www.state.gov/j/prm/ra/ 4. Paxton G, Sangster K, Maxwell E, McBride C, Drewe R, Karunajeewa H. (2012). Postarrival health screening in Karen refugees in Australia. PLoS ONE 2012; 7(5):E38194. 5. Toole MJ, Waldman RJ. The public health aspects of complex emergencies and refugee situations. Annual Review of Public Health 1997;18(1): 283-312. 6. Center for Disease Control and Preventions. Vaccine Information for Adults: 2016 [cited 2019 Apr 4] Available from: https://www.cdc.gov/vaccines/adults/rec-vac/immigrantsrefugees.html 7. Center for Disease Control and Preventions. Domestic Immunizations Guidelines: 2016 [cited 2019 Apr 4] Available from: https://www.cdc.gov/immigrantrefugeehealth/guidelines/domestic   7   /immunizations-guidelines.html 8. Bish A, Yardley L, Nicoll A, Michie S. Factors associated with uptake of vaccination against pandemic influenza: a systematic review. Vaccine 2011;29(38):6472-6484. 9. U.S. Department of Health. Cumulative Summary of Refugee Admissions: 2015 [cited 2019 Apr 4] Available from: https://20092017.state.gov/j/prm/releases/statistics/251288.htm 10. Brink DR, Shannon PJ, Vinson GA. Validation of a brief mental health screener for Karen refugees in primary care. Family Practice 2015;33(1): 107-111. 11. Center for Disease Control and Preventions. Population Movements | Burmese | Immigrant and Refugee Health: 2016 [cited 2019 Apr 4] Available from: https://www.cdc.gov/immigrantrefugeehealth/profiles/burmese/populationmovements/index.html 12. Kenny P, Lockwood-Kenny K. A mixed blessing: Karen resettlement to the United States. Journal of Refugee Studies 2011;24(2):217-238. 13. Shannon PJ, Vinson GA, Wieling E, Cook T, Letts J. (2015). Torture, war trauma, and mental health symptoms of newly arrived Karen refugees. Journal of Loss and Trauma 2015;20(6):577-590. 14. Stratis Health. Karen People in Minnesota: 2019 [cited 2019 Apr 4] Available from: http://www.culturecareconnection.org/matters/diversity/karen.html 15. Smith LE, Webster RK, Weinman J, Amlôt R, Yiend J, Rubin GJ. Psychological factors associated with uptake of the childhood influenza vaccine and perception of postvaccination side-effects: A cross-sectional survey in England. Vaccine 2017;35(15):1936-1945. 16. Baker DL, Dang MT, Ly MY, Diaz R. Perception of barriers to immunization among parents of Hmong origin in California. American Journal of Public Health 2010;100(5);839-45. 17. Wilson L, Rubens-Augustson T, Murphy M, Jardine C, Crowcroft N, Hui C, Wilson K. Barriers to immunization among newcomers: A systematic review. Vaccine 2018;36(8):1055-1062. 18. Brown KF, Kroll JS, Hudson MJ, Ramsay M, Green J, Long SJ, Vincent CA, Fraser G, Sevdalis N. Factors underlying parental decisions about combination childhood vaccinations including MMR: a systematic review. Vaccine 2010;28(26): 4235-4248. 19. Mills E, Jadad AR, Ross C, Wilson K. Systematic review of qualitative studies exploring parental beliefs and attitudes toward childhood vaccination identifies common barriers to vaccination. Journal of Clinical Epidemiology 2005;58(11):1081-1088. 20. Yaqub O, Castle-Clarke S, Sevdalis N, Chataway J. Attitudes to vaccination: a critical review. Social Science & Medicine 2014;112:1-11. 21. Marshall S, Swerissen H. A qualitative analysis of parental decision making for childhood immunisation. Aust N Z J Public Health 1999;23:543–5. 22. Wilson T. Factors influencing the immunization status of children in a rural setting. J Pediatr Health Care 2000;14:117–21. 23. Yeung MP, Lam FL, Cooker R. Factors associated with the uptake of seasonal influenza vaccination in adults: A systematic review. Journal of Public Health 2016: 38(4); 746753. 24. Lu PJ, Rodriguez-Lainz A, O’Halloran A, Greby S, Williams WW. Adult vaccination disparities among foreign-born populations in the U.S., 2012. American Journal of Preventive Medicine 2014: 47(6); 722-733.   8   25. Hacker K, Anies M, Folb BL, Zallman L. Barriers to health care for undocumented immigrants: a literature review. Risk Management Health Policy 2015:8; 175-183. 26. Ventola CL. Immunization in the United States: Recommendations, barriers, and measures to improve compliance: Part 1: Childhood Vaccinations. P T 2016;41(7):426– 436. 27. U.S. Department of Health and Human Services. Vaccine Side Effects: 2019 [cited 2019 Apr 4] Available from: https://www.vaccines.gov/basics/safety/side_effects/index.html   9   University of Utah UNDERGRADUATE RESEARCH JOURNAL The Effect of Stereotype Threat on Stereotype Activation Kate Warnock (Paul H. White ) Department of Psychology ABSTRACT Stereotypes form due to repeated associations between concepts, thus allowing for less effortful processing of information. However, stereotypes must be activated before they can be applied to judgments or actions. The activation of stereotypes is automatic, requiring no conscious effort, and occurs in the presence of a stereotype object, but application of stereotypes is a separate process that can be interrupted. The current study evaluated whether stereotype threat—the anticipation that one could be stereotyped against by others—could act as a stereotype activator, and subsequently if cognitive busyness could interfere with the application of those stereotypes. Specifically, we investigated whether stereotype threat paired with cognitive busyness leads to increased activation of stereotypes regarding an outgroup. In order to activate stereotype threat for women regarding math performance when compared to men, participants were told either that prior test results did show sex differences, or that the results did not show sex differences, and then asked to complete a math exam. Following the math test, participants completed a set of word fragments that could either be completed to be racially-significant words or neutral words to examine stereotype activation. Additionally, cognitive load was activated in half the participants during this portion by asking participants to remember an eight-digit number while they completed the word fragments. We predicted that cognitive busyness paired with stereotype threat will lead to more stereotype activation than the other three conditions, namely stereotype threat/no cognitive load, no stereotype threat/no cognitive load, and no stereotype threat/cognitive load. Our results did not show any significant differences between conditions regarding the amount of stereotypic word completions. These results are inconclusive, however, due to the fact that our manipulation of stereotype threat in the first part of the study was unsuccessful. Further iterations of the study will be required to determine the true effects of stereotype threat on stereotype activation. Keywords: Stereotype, stereotype threat, stereotype activation, cognitive load, exam. 2 INTRODUCTION Psychological research has given much attention to the formation and usage of stereotypes. Stereotypes arise from the repeated association of two ideas and frequent recall from memory, just like any other automatically activated association. For instance, just as one can come to associate colder weather with warm soup and sweaters, one can also learn to associate types of people with traits, such as Asian individuals with math abilities. The associated ideas will be activated in the presence of a member of the target group. The activation of stereotypes is thought to be an automatic process, thus requiring little conscious effort. Further, activation of the stereotypes must take place before perception, judgement, or actions can be influenced by them (Devine, 1989). Additionally, Kunda and Spencer (2003) proposed that stereotype activation and application depend on the strength of one’s self-enhancement goals and one’s motivation to avoid prejudice. Kunda and Sinclair (2009) showed that the activation and application of stereotypes may be influenced by one’s motivation to align information with preconceived impression of the individual. As stereotypes are an automatic process, they are considered a cognitive shortcut that allows judgments to be made with little cognitive effort (Rosch, 1978). Thus, it appears that the activation and application of stereotypes may be impacted by the amount of cognitive busyness an individual is experiencing. In their work evaluating this question, Gilbert and Hixon (1991) found that when participants were made cognitively busy by being asked to rehearse an eight-digit number, stereotype activation was inhibited. However, when the researchers first allowed stereotype activation to occur by priming the participant with the stereotype object (i.e., by showing a picture of an Asian individual), the addition of cognitive busyness then led to an increase in application of stereotypes to perception and judgment. Thus, cognitive busyness can have differing effects on stereotyping depending on when it occurs during the task and which processes come first. Additionally, Spencer, Fein, Wolfe, Fong, and Dunn (1998) examined another potential factor—negative feedback. Consistent with Gilbert and Hixon’s (1991) findings, they found that cognitive busyness alone inhibited stereotype activation. However, stereotype activation emerged when cognitive busyness was paired with negative feedback. It was contended (Fein & Spencer, 1997) that negative feedback leads to self-image threat, which motivated participants to maintain their self-image, and they did this by stereotyping others. Thus, when paired with cognitive busyness, the impact of self-image threat overcame the impact on stereotype activation that cognitive busyness has alone. This led to an increase in stereotype application. Many decades of research dedicated to evaluating another way in which stereotypes affect our daily lives began with the coining of the term “stereotype threat” by Steele and Aronson (1995). According to the authors, “stereotype threat is the risk of confirming, as selfcharacteristic, a negative stereotype about one’s group (p.797).” Such a risk can inflict distraction, anxiety, narrowed attention, withdrawal of effort, self-consciousness, and over-effort, which can all negatively impact performance (Steel & Aronson, 1995). Stereotype threat has been shown to influence performance on various tasks for several groups of people, including African Americans with their test performance (Steele & Aronson, 1995), women and their math performance (Spencer, Steele, & Quinn, 1998), White men in math compared to Asians (Smith & White, 2002) and older adults and cognitive abilities (Barber, 2017). This negative effect on performance of stereotype threat can have disastrous consequences in high-stakes areas such as medicine or engineering. In such situations, mistakes such as incorrect dosage of medication, inaccurate diagnosis, or inattention to details in constructing tools or architecture, can hugely 3 impact the safety and health of individuals and thus any factors that may increase mistakes should be taken seriously and eradicated. After various replications with different groups and situations made it clear that stereotype threat is a potentially serious and rampant problem, researchers began to examine conditions and nuances in its activation. Steele (1997) found that individuals were more vulnerable to stereotype threat when they identified more strongly with the domain in question. For example, women whose identity includes an association with math, such as an engineer, will be more susceptible to stereotype threat in math settings than women whose identity does not include math. Additionally, findings from Spencer, Steele, and Quinn (1998) found a conditional emergence of gender differences in math performance due to stereotype threat. When participants were told that there had been gender differences in math performance previously, gender differences emerged. Further, gender differences emerged when previous gender differences in performance were not mentioned at all, thus exposing participants to the natural stereotype threat of the situation. However, no gender differences in math performance emerged when participants were explicitly told there had been no gender differences in the past. Thus, when stereotype threat was eliminated, gender differences in performance disappeared. Taken together, prior research shows that stereotype threat is prevalent among many groups, has negative impacts on performance, and can be eliminated with explicit instruction. On an individual level, it has large implications for task performance. Less is known, however, about how stereotype threat may influence an individual’s perceptions of others. In the current study, we investigated whether stereotype threat can have the same effect on stereotype application as negative feedback when paired with cognitive busyness. In particular, prior research has mostly focused on examining the effects of stereotype threat on an individual’s performance, but less research has focused on how stereotype threat might affect a person’s perception of another individual or group of individuals. The current study investigated the relation between stereotype threat and activation of stereotypes regarding an outgroup, defined as a group that is different from the group with which an individual identifies (Tajfel, 1970). We examined whether stereotype threat can act as a primer for stereotype activation, and thus interact with cognitive load to increase stereotype application. We attempted to induce stereotype threat in individuals, then expose them to a situation in which stereotypes can be applied while they are cognitively busy, thus measuring the impact of stereotype threat and cognitive busyness on the application of stereotypes about others. The experiment used a 2 (threat vs. no threat) x 2 (high cognitive load vs. low cognitive load) factorial, between-subjects design, utilizing the stereotype threat felt by women in math settings. We expected that high cognitive busyness paired with stereotype threat will show an increased application of stereotypes toward an outgroup. However, it is also possible that the group which experienced nullification of stereotype threat could also still show increased stereotype application when experiencing cognitive busyness. This could occur if the discussion of stereotypes, regardless of whether they are supported or nullified, could act as a primer for stereotype activation. We hypothesize that the high cognitive load/stereotype threat condition will show higher application of stereotypes than the low cognitive load/stereotype threat condition. If it is the case that nullification of the stereotype threat still acts as a primer for stereotype activation, we expect the high cognitive load/no stereotype threat condition be show similar levels of stereotype application as the high cognitive load/stereotype threat condition, and the low cognitive load/no stereotype threat conditions to be similar to the low cognitive load/stereotype threat condition. If it is the case that nullification prevents stereotype activation, we expect the two no stereotype threat conditions to both be lower than the two stereotype threat conditions. 4 Method Participants One-hundred and fifty-nine undergraduate students were recruited using the University of Utah’s undergraduate psychology participant pool and were given course credit for participation in our study. Our sample consisted of 38 men, 120 women, and 1 gender non-conforming participant, with 74.21% identified as White, 16.35% as Hispanic, 13.21% as Asian, 2.52% as Other, 1.89% as African American, 1.26% as Native American, and 1.26% as Pacific Islander. Ages ranged from 18-45, with an average age of 20 years. All participants provided written informed consent with procedures approved by the University of Utah Institutional Review Board. No exclusions were applied for race or gender despite the content of the stereotype threat and stereotype activation measures. We included men in our sample, despite the target of the stereotype threat being women, because men could potentially feel stereotype threat compared to Asians in a math setting, which would manifest separately from the gender stereotype in the math setting (Smith & White, 2002). We included Asians in the sample, although Asian stereotypes are included in the stereotype activation portion, because Asian women have been shown to perform better in math when their racial identity is highlighted, and worse when their gender identity is highlighted. Thus, we expected Asian women to still feel the effect of stereotype threat in our math condition due to the highlighting of gender differences rather than racial differences (Shih, 1999). Asian men, however, can act as an interesting pseudo-control group as they potentially will not feel any stereotype threat in the math setting. Materials Stereotype Threat Measure. We chose to activate the stereotype threat experienced in math settings for women when compared to men, as has been studied over the years (e.g., Smith & White, 2002; Spencer, Steele, & Quinn, 1998). Stereotype threat was manipulated using the design proposed by Spencer, Steele, and Quinn (1998). A general math exam was modeled after the general quantitative Graduate Record Exam (GRE; Educational Testing Service, 2017). A copy of the math test can be found in Appendix A. In the stereotype threat condition, participants were told that the test had previously shown gender differences in performance, and in the nonstereotype threat condition they were told that the test had not shown any gender differences. The method of explicitly nullifying the stereotype was chosen based on work by Smith and White (2002), which found that in a stereotype threat-inducing situation, the explicit stereotype threat condition (stereotype explicitly addressed and affirmed) and the implicit stereotype condition (no mention of stereotype) both showed test scores lower than the nullified stereotype condition (stereotype addressed but refuted). Thus, it appears the stereotype must be explicitly negated, rather than just not addressed, in order to create a non-stereotype threat condition. Cognitive Load Measure. Cognitive load was manipulated by employing the technique created by Gilbert and Hixon (1991), involving the recall of an eight-digit number while completing word stems (the high-cognitive load condition). The low-cognitive load condition involved being asked to recall a two-digit number while completing the word stems, as two digits is well below the range of typical working memory capacity (Miller, 1956). Thus, participants would still be experiencing cognitive load, as opposed to none if not asked to recall a number at all, but the load was considerably less than that in the high-cognitive load condition. The 8- and 2-digit numbers were randomly generated and consistent for all participants. Stereotype Application Measure. Participants completed a word completion task, which entails adding letters to a word fragment to create complete words. The blank spaces could be filled with letters to make the word stereotype-consistent or with different letters to make it a neutral word. For example, from the Black stems, participants would be presented with the letters “LA_ _” and asked to fill in the additional letters. Completing the word to be “LAZY” 5 would reflect a stereotype-consistent response whereas completing the word to be anything else (e.g. LAMP, LAND) would reflect a stereotype-inconsistent response. We employed the word stems used by Gilbert and Hixon (1991) reflecting Asian stereotypes (e.g., polite, short) and the word stems used by Spencer, Fein, Wolfe, Fong, and Dunn (1998) reflecting Black stereotypes (e.g., lazy, poor). We also included stems used by Steele & Aronson (1995) that reflect selfdoubt (e.g. weak, shame). These were included to act as an extra manipulation check. The completion of these stems with self-doubt words will allude to the proper application of stereotype threat with the math exam. The Black, Asian, and self-doubt stems were mixed so that no two consecutive stems were of the same group, and interspersed with additional filler stems, which can only be filled with letters to create a neutral word. A copy of the list of word stems can be found in Appendix B. Domain Identification. Prior research has suggested that individuals who are most identified with the domain are more vulnerable and most strongly affected by stereotype threat in that domain (e.g., Steele, 1997). We employed the Domain Identification Measure (DIM) (Smith & White, 2001) to determine how strongly the participants identified with and care about the domain measured (i.e. math). Items included questions such as, “How much is Math to the sense of who you are?” and “How important is it to you to be good at Math?” A copy of the Domain Identification Measure used can be found in Appendix C. Manipulation Checks. For stereotype threat exposure, participants were asked to recall what information was told to them regarding gender differences in math performance. For cognitive load, participants were asked to recall the eight-digit number (if in the “high cognitive load” condition) or the two-digit number (if in the “low cognitive load condition) given to them before the verbal task. Procedures Participants completed the experiment on a desktop computer. They were seated and given a consent form. They provided written informed consent before beginning the study. They began by answering the DIM and demographic survey. Participants were told that they would be completing two components; a math test meant to determine their math ability, followed by a verbal activity. Participants were then asked to read a false article claiming gender differences in math performance. Individuals in the “stereotype threat” condition were then told that the math test they were about to take had also shown gender differences in performance in the past in favor of men. In the “no stereotype threat” condition participants were told that the current test had not shown gender differences in the past. Participants were then given scratch paper and a pencil and completed two practice problems before beginning the real test. The participants were given 10 minutes to complete the 10 questions of the real test. After completing the math test, participants were told they would then complete a verbal component. Participants in the “high cognitive load” condition were shown an eight-digit number to remember as they completed the word stems. Participants in the “low cognitive load” condition were shown a 2-digit number to recall while they perform the verbal test. Participants in both conditions were given one minute to rehearse the number in their head. Participants then began the word completion task. They were given 10 minutes to complete 50 word stems. Following the word completion task, the participants were asked to recall the eight- or two-digit number to the best of their ability. They were then given a post-exam questionnaire, debriefed, and excused. Results The stereotype threat we attempted to activate was that of females performing worse than males in math. Thus, we analyzed the results for the female participants only (N=120). The data were analyzed using a 2(stereotype threat: present vs. absent) x 2(cognitive load: high vs. low) 6 Analysis of Variance (ANOVA) with post-hoc test (Tukey HSD) to check for any significant differences, unless noted otherwise. For the manipulation check of stereotype threat exposure, participants were asked, “What were you told regarding factors related to math ability during the study?” with the options of “No gender differences”, “Males are “better” at math”, and “Females are “better” at math.” Responses were observed to determine whether participants accurately recalled what they were told regarding gender differences in math. The Threat conditions were told that men had shown reliably superior ability to women in math. The No Threat conditions were told that no differences in math ability between genders had been observed. Using a one-way Analysis of Variance (ANOVA), we observed a significant difference between in the groups in the rate of correct responses (F(3, 167) = 65.924, p = .000). As can be seen in Table 1, while we were successful in getting participants to remember the stereotype information in the threat conditions (i.e., responding that “Males are ‘better’”), more than 70% of the participants in the No Threat conditions selected this response, even though they were told there were no gender differences on our exam. Threat + High Load Threat + Low Load No Threat + High Load No gender differences Males are “better” Females are “better” 2.44% 16.67% 25.00% 97.56% 83.33% 70.45% 0.00% 0.00% 4.55% 11.36% 86.36% Table 1: Accurate recall of the stereotype information presented No Threat + Low Load 2.27% For the manipulation check of cognitive load, we calculated the percentage who recalled their number correctly at the end of the study. The percentage of participants in the high load conditions that successfully remembered the full 8-digit number they were given was 65.88%. This can be compared to the 97.67% of participants in the low load conditions who successfully recalled the two-digit number given to them (see Table 2 for the breakdown of each condition). High Load Low Load Threat 70.73% 95.24% No Threat 61.36% 100.00% Table 2: Successful recall of cognitive load number To assess performance on the math test, we looked at the total number correct on the exam out of the ten problems (68.55% of participants attempted all ten problems). We expected a main effect of stereotype threat only, given that the cognitive load manipulation was not given until after the math test. However, there were no significant differences between the threat and no threat conditions in the number of math questions answered correctly F(1, 116) = 1.004, ηp2 = .009, p = .318 . We found a trend toward a significant main effect of cognitive load on math performance (F(1, 116) = 3.766 ηp2 = .031, p = .055). This is surprising as the cognitive load manipulation was not introduced until after the math exam had been completed. Participants in low cognitive load condition tended to perform better (M = 4.90) than those in the high cognitive load condition (M = 4.29) on the math test. There was no significant interaction of threat and cognitive load F(1, 116) = .171, ηp2 = .001, p = .680). Differences in average math performance between groups can be observed in Graph 1. 7 Average Math Performance Questions answered correctly 6 5 4 3 2 1 0 Threat No Threat High Load Low Load Graph 1: Average math performance as a function of cognitive load. Error bars represent standard error of the mean. To assess stereotype activation, we counted the number of stereotypic words used to complete the word stems for Black and for Asian related word fragments. We predicted a main effect of stereotype threat, a main effect of cognitive load, and an interaction between stereotype threat and cognitive load, such that the effect of stereotype threat will be stronger in the high cognitive load condition. For the Black stems, there were 11 possible words to complete. There was no significant main effect of threat for completion of Black stereotypic words F(1, 116) = .301, ηp2 = .003, p = .585. There was also no main effect of cognitive load F(1, 116) = .000, ηp2 = .000, p = .987. Finally, there was no interaction effect of threat and cognitive load F(1, 116) = .240, ηp2 = .002, p = .625. The differences between averages can be observed in Graph 2. Black stems filled with stereotype word Average Stereotypical Completion of Black Stems 2 1.8 1.6 1.4 1.2 1 0.8 0.6 0.4 0.2 0 Threat No Threat High Load Low Load 8 Graph 2: Average stereotypic completion of Black stems. Error bars represent standard error of the mean. For the Asian stems, there were 5 possible words to complete. There was a marginal main effect of threat on the completion of the Asian stems F(1, 116) = 3.031, ηp2 = .025, p = .084. Participants in the Threat condition tended to put more Asian stereotypic words (M = 1.34) than participants in the No Threat condition (M = 1.05). There was no main effect for cognitive load F(1, 116) = .050, ηp2 = .000, p = .823, nor a significant interaction for threat and cognitive load F(1,116) = .003, ηp2 = .000, p = .957. Average differences in completion of Asian stems with stereotype words can be observed in Graph 3. Asian stems flled with stereotype word Average Stereotypical Completion of Asian Stems 1.8 1.6 1.4 1.2 1 0.8 0.6 0.4 0.2 0 Threat No Threat High Load Low Load Graph 3: Average stereotypic completion of Asian stems. Error bars represent standard error of the mean. Discussion Past research on stereotype activation and application has shown that stereotype activation and application are separate but sequential processes that can be affected cognitive resources and motivation (Devine, 1989; Gilbert & Hixon, 1991; Kunda & Sinclair, 2009; Kunda & Spencer, 2003; Spencer et al., 1998). The primary goal of this project was to investigate whether exposure to stereotypes through stereotype threat situations could lead to a similar application of general stereotypes about other groups. This would be stronger especially under circumstances when cognitive resources may be reduced (e.g., Gilbert & Hixon, 1991). In particular, we expected that participants who were under a stereotype threat of not performing well in math would underperform on a math quiz, and this same group would demonstrate stereotype application by completing word fragments with words associated with Asian (Gilbert & Hixon, 1991) and Black (Spencer et al., 1998) stereotypes. However, on the math performance, our results did not show significant effects for threat. There may be two explanations for this finding. First, the results of our manipulation check for threat exposure points to the issue that the participants who should have not felt threatened may have still been affected by the negative stereotype. That is, 90.36% of participants in the threat 9 conditions recalled what they were told about gender differences in math performance, but only 18.18% of participants in the no threat conditions accurately recalled what they were told during the study. This suggests that the nullify manipulation of stereotype threat was ineffective. This could be due to either the natural stereotype threat felt in this math setting or the information from the fabricated article superseding the nullification presented to them by the researchers. Additionally, our results showed a significant main effect of cognitive load on performance on the math exam. However, this suggests a randomization failure as cognitive load was not introduced until the word completion task, which occurred after the math exam. This suggests that our samples may not have been equal and representative. Second, it appears that we may have gotten a floor effect for the math test, such that the average amount of correctly answered math questions was around five out of ten for all conditions. This may be due to the lack of the nullification manipulation working for those participants, but also may suggest that the math test was too difficult (perhaps also due to the time restraint of ten minutes to complete ten questions) to show differences between groups for the presence of stereotype threat. Due to these issues with stereotype exposure, accurate results regarding stereotype activation and application may be hard to ascertain in that portion of the experiment. We expected the high load/stereotype threat condition to have the largest amount of stereotypic word completions. However, we observed mixed results in the amount of Black and Asian stems that were completed with stereotypic words. While we found no effects of threat, cognitive load, or the expected interaction of them for Black stems, along with no cognitive load or interaction effects for the Asian stems, there was a marginal effect of threat for Asian stems. Given the possibility that most participants felt under threat, and the domain was mathematics, in which there are stereotypes of Asian and Asian Americans performing well (e.g. Shih et al., 1999) we cannot rule out that there was an application of the stereotype as a result of stereotype threat exposure. In addition, this activation may have been sufficient enough to play a role in participants’ responses, regardless of the cognitive load. Future directions in this work could test these possibilities. We also noticed a potential issue with the inclusion of both the Asian and Black stems in the same completion task. One of the Asian stems, POLI_E, which was meant to be filled in as “polite” for the Asian stereotypic word, was consistently completed as “police” instead. Given the current climate of the police force and the Black Lives Matter movement, it is possible that this completion of the stem could be considered a Black stereotypic word. However, we did not count these completions as such, as the stem was presented as an Asian stem, and thus these potentially stereotypic completions were considered non-stereotypic for the Asian stem. As our manipulation of stereotype threat was unsuccessful in this attempt, future directions of this study should first establish a sound manipulation of stereotype threat in order to accurately assess the effect of stereotype threat and cognitive load on stereotype activation. It would also be informative to evaluate whether the effect differs depending on whether the stereotypes activated in the activation portion are in the same domain as the stereotypes implied in the stereotype threat portion. That is, for example, whether the results would have been different if the word completion task contained gender-stereotypic stems rather than race stems. Alternatively, it is an open question whether the Black and Asian stems would be filled with stereotypic words more often if the stereotype threat condition highlighted Black or Asian stereotypes regarding math performance rather than gender stereotypes. It would also be illuminating to replicate the results of Gilbert and Hixon (1991) in that cognitive load had differing effects on stereotype activation depending on when it was presented during the process. Specifically, future studies could evaluate whether stereotype activation is 10 inhibited rather than amplified, as it was in Gilbert and Hixon (1991), when cognitive load is instilled before the stereotype object is presented, namely before stereotype threat is activated. The findings of the current study and other related works can help to build a broad picture of how stereotyping may or may not affect performance on different tasks based on different types of parameters. Understanding these nuances is important for informing ways in which society can hope to ameliorate the negative effects of stereotyping. While stereotypes in general are considered shortcuts for the brain to process large amounts of information, and are thus not in and of themselves a negative occurrence, more complicated issues can arise when such shortcuts are applied perceptions of human persons. Overuse of stereotypes regarding different groups can lead to prejudice, discrimination, and self-fulfilling prophecies (Fiske, 1998). The undertaking of the current study was prompted by the presence of societal costs of stereotyping, and the drive to reduce the negative effects of such processes. If it is the case that being stereotyped against makes one more likely to stereotype others, dismantling stereotypes will be very difficult as they will follow a circular pattern. It will take a conscious effort to break the cycle in order to hinder the negative effects of stereotypes in varying domains. Knowing the impact of stereotype threat and cognitive load on stereotype activation can help focus our efforts on reducing stereotype threat in order to reduce the greater presence of stereotypes. The data from the current study suggested that there was no relation between stereotype threat and cognitive load in the application of stereotypes with this particular sample. However, the failure of the manipulation checks—both on performance on the math exam and the recall of what stereotype information was presented—suggest inconclusive results. The marginal impact of threat on the stereotypic completion of the Asian stems hint at a potential significant effect. However, correction of the study design to produce a successful manipulation of stereotype threat would be required to accurately evaluate the interaction of stereotype threat and cognitive load in stereotype application. This work was supported by funding from the Undergraduate Research Opportunities Program at the University of Utah awarded to Kate Warnock 11 References Barber, S. J. (2017). An examination of age-based stereotype threat about cognitive decline: Implications for stereotype-threat research and theory development. Perspectives On Psychological Science, 12(1), 62-90. doi:10.1177/1745691616656345 Educational Testing Service. (2017). Overview of the quantitative reasoning measure. Retrieved October 27, 2017 from https://www.ets.org/gre/revised_general/prepare/quantitative_reasoning/ Fein, S., & Spencer, S. J. (1997). Prejudice as self-image maintenance: Affirming the self through negative evaluations of others. Journal of Personality and Social Psychology, 73, 31-44. Fiske, S.T. "Stereotyping, Prejudice, and Discrimination," in Daniel T. Gilbert, Susan T. Fiske, and Gardner Lindzey, eds., The handbook of social psychology, 4th Ed., Vol. 1. New York: McGraw-Hill, 1998, pp. 357- 411. Gilbert, D. T., & Hixon, J. G. (1991). The trouble of thinking: Activation and application of stereotypic beliefs. Journal of Personality and Social Psychology, 60(4), 509 517. doi:10.1037/0022-3514.60.4.509 Kunda, Z., & Sinclair, L. (1999). Motivated reasoning with stereotypes: Activation, application, and inhibition. Psychological Inquiry, 10(1), 12–22. https://doi.org/10.1207/s15327965pli1001pass:[_]2 Kunda, Z., & Spencer, S. J. (2003). When do stereotypes come to mind and when do they color judgment? A goal-based theoretical framework for stereotype activation and application. Psychological Bulletin, 129(4), 522 544. http://dx.doi.org/10.1037/00332909.129.4.522 Miller, G.A. (March 1956). "The magical number seven plus or minus two: some limits on our capacity for processing information". Psychological Review. 63 (2):81 97. doi:10.1037/h0043158. Rosch, E. (1978). Principles of categorization. In E. Rosch & B. B. Lloyd (Eds.), Cognition and categorization (pp. 27-48). Hillsdale, NJ: Erlbaum. Shih, M., Pittinsky, T. L., & Ambady, N. (1999). Stereotype susceptibility: Identity salience and shifts in quantitative performance. Psychological Science, 10(1), 80 83. https://doi.org/10.1111/1467-9280.00111 Smith, J. L., & White, P. H. (2001). Development of the Domain Identification Measure: A tool for investigating stereotype threat effects. Sage Publications. 61(6), 1040 1057. Smith, J. L., & White, P. H. (2002). An examination of implicitly activated, explicitly activated, and nullified stereotypes on mathematical performance: It's not just a woman's issue. Sex Roles, 47(3-4), 179-191. doi:10.1023/A:1021051223441 Spencer, S. J., Steele, C. M., Quinn, D. M. (1998). Stereotype threat and women’s math performance. Journal of Experimental Social Psychology. 35(1), 4-28. Spencer, S. J., Fein, S., Wolfe, C. T., Fong, C., & Dunn, M. A. (1998). Automatic activation of stereotypes: The role of self-image threat. Personality and Social Psychology Bulletin, 24(11), 1139-1152. doi:10.1177/01461672982411001 Steele, C. M. (1997). A threat in the air: How stereotypes shape intellectual identity and performance. American Psychologist, 52, 613-629. Steele, C. M., Aronson, J. (1995). Stereotype threat and the intellectual test performance of African Americans. Journal of Personality and Social Psychology, 69 (5), 797 811. 12 Tajfel, H. (1970). "Experiments in intergroup discrimination". Scientific American. Springer Nature. 223 (5): 96 102. doi:10.1038/scientificamerican117096. JSTOR 24927662. PMID 5482577. 13 Appendix A Directions: Each of the Questions 1-10 has five answer choices. For each of these questions, select the best of the answer choices given. 2 1. 3 x = 2 1 1 (A) (B) 1 (C) 3 (D) 6 (E) 6 3 2 2. If k = 15, then (A) 156 (k-2)180 = k (B) 23 (C) –23 (D) –204 (E) -360 3. In the figure above, the area of square PQRS is 64. What is the area of (A) 48 (B) 32 (C) 24 (D) 16 QRT? (E) 8 4. If x equals 25 percent of a number, then 125 percent of the number is (A) x 1.25 (B) x 4 (C) 1.25x (D) 4x (E) 5x 2 c cents for each 3 additional minute, what is the cost, in cents, of a 10-minute call of this type? 5. If the cost of a collect phone call is c cents for the first minute and 5 (A) c 3 (B) 6c (C) 20 c 3 (D) 7c (E) 6. In a certain apartment building exactly 23 c 3 1 of the apartments have two bedrooms and 3 1 of the two bedroom apartments are front apartments. Which of the 7 following could be the total number of apartments in the building exactly (A) 42 (B) 50 (C) 51 (D) 56 (E) 57 14 7. Which of the following could be the area of an isosceles triangle with perimeter 18 and one side of length 8? (A) 6 (B) 12 (C) 14 (D) 16 (E) 18 8. When a certain number is divided by 7, the remainder is 0. If the remainder is not 0 when the number is divided by 14, then the remainder must be (A) 1 (B) 2 (C) 4 (D) 6 (E) 7 9. If x > 0 and 2x-1 = (A) 1 , then x = 2x+1 1 2 √" (B) " (C) 1 (D) 2 (E) 2 +1 10. If the radius of a circle is decreased by 30 percent, by what percent will the area of the circular region be decreased? (A) 15% (B) 49% (C) 51% (D) 60% (E) 90% 15 Appendix B 1. R _ SH 2. _ _ IDE 3. RI_ E (RICE) 4. _ IS _ 5. _ _ O R (POOR) 6. _ EA _ 7. W _ _ T 8. N_ P (NIP) 9. C L _ S _ (CLASS) 10. UP_ _ _ 11. T O _ _ _ (TOKEN) 12. POLI_ E (POLITE) 13. _ _ FE 14. _ _ O _ P 15. L A _ _ (LAZY) 16. _ _NG 17. _ ONE 18. _ _ AR 19. C O _ _ _ (COLOR) 20. MO _ _ 21. _ EAM 22. _ _ USE 23. M I _ _ _ _ _ _ (MINORITY) 24. JO _ 25. S _ _ L 26. S _ ORT (SHORT) 27. L_ _ K 28. W E L _ _ _ _ (WELFARE) 29. _ _ P 30. QU _ _ E 31. DE _ _ 32. _ _ _ T E (WHITE) 33. S _ _ _ _ ISED 34. S_ Y (SHY, SOY) 35. SCH _ _ _ 36. B R _ _ _ _ _ (BROTHER) 37. COM_ _ _ _ 38. V _ _ E 39. _ _ A C K (BLACK) 40. _ _ TION 41. TH_ _ _ 42. _ _ C E (RACE) 43. NE_ _ 16 Appendix C PLEASE COMPLETE THE FOLLOWING INFORMATION ABOUT YOURSELF (For statistical use only): AGE: GENDER: ETHNICITY: o African American o Asian or Asian American o Hispanic/Latinx o Native American/Indigenous o Pacific Islander o White (non-Hispanic/Latinx origin) o Other HOME STATE (COUNTRY): ACADEMIC MAJOR: Academic Background Your current or anticipate major: How certain are you that you will keep this major until graduation (circle one)? 1 2 3 4 5 Not at all Somewhat Very much How many years of math did you take in high school? Were there advanced classes available? YES NO (circle one) If yes, how many advanced classes did you take? How many years of English did you take in high school? Were there advanced classes available? YES NO (circle one) If yes, how many advanced classes did you take? How many years of science did you take in high school? Were there advanced classes available? YES NO (circle one) If yes, how many advanced classes did you take? How many math classes have you taken in college? When did you last take a math class? How likely is it that you will take any additional classes in math? (circle one) 1 2 3 4 5 Not at all Somewhat Very much How many English classes have you taken in college? When did you last take an English class? How likely is it that you will take any additional classes in English? (circle one) 1 2 3 4 5 Not at all Somewhat Very much 17 How many science classes have you taken in college? When did you last take a science class? How likely is it that you will take any additional classes in science? (circle one) 1 2 3 4 5 Not at all Somewhat Very much Using the following scale, please indicate the number that best describes how much you agree with each of the statements below. 1 = Strongly Disagree 2 = Moderately Disagree 3 = Neither disagree or agree 4 = Moderately Agree 5 = Strongly Agree ______ Math is one of my best subjects ______ I have always done well in Math ______ I get good grades in Math ______ I do badly in tests of Math ______ English is one of my best subjects ______ I have always done well in English ______ I get good grades in English ______ I do badly in tests of English Please indicate the number that best describes you for each of the statements below: 1 Not at all 2 3 Somewhat 4 5 Very much ______ How much do you enjoy Math-related subjects? ______ How likely would you be to take a job in a Math-related field? ______ How much is Math to the sense of who you are? ______ How important is it to you to be good at Math? Compared to other students, how good are you at Math? 1. Very Poor 2. Poor 3. About the same 4. Better than average 5. Excellent ______ How much do you enjoy English-related subjects? ______ How likely would you be to take a job in a English-related field? ______ How much is English to the sense of who you are? ______ How important is it to you to be good at English? Compared to other students, how good are you at English? 18 1. Very Poor 2. Poor 3. About the same 4. Better than average 5. Excellent University of Utah UNDERGRADUATE RESEARCH JOURNAL RECONSTRUCTING FIRE HISTORY FROM SOIL SEDIMENT SAMPLES NEAR A FREMONT SITE CONCENTRATION IN CHERRY MEADOWS, RANGE CREEK CANYON, UTAH. Stefania Wilks, Undergraduate student Department of Anthropology, University of Utah Andrea Brunelle, PhD. Director, Records of Environment and Disturbance Lab Department of Geography, University of Utah Ben Marconi, PhD. Candidate Department of Geography, University of Utah Range Creek Canyon, Utah is a unique research field station because of its well preserved Ancient Puebloan and Fremont archaeological sites; over five-hundred have been located and recorded so far. Cherry Meadows is a significant location within the canyon because of the high concentration of surrounding archaeological sites. It is level land adjacent to a year-round water source and may have been used for agricultural purposes during the Fremont occupation of the canyon between 900 - 1100 A.D. In the summer of 2018, a 100 meter trench, 2 meters in depth, was dug in an east/west trajectory, perpendicular to the creek. Sediment cores were extracted at intervals along the southern edge of the trench. The sediment core for this research was taken at 95 meters. Additional cores taken at 22.5m, 50m, and 75m were also examined and tested. While of interest individually, data collected from each sample combined to provide a macroscopic charcoal analysis of fire history in the sediment in Cherry Meadows. Sediment cores serve as proxy for paleoclimate conditions and prehistoric agricultural land management practices. Additional multi-proxy analysis of each core includes Magnetic Susceptibility, X-Ray Fluorescence, and Loss on Ignition. Preliminary results show consistent charcoal stratification and morphology across the cores. The geochemical data supports the initial hypothesis that the Fremont used Cherry Meadows to irrigate maize during the period of occupation. This research contributes to the overarching data collection in Range Creek Canyon. University of Utah UNDERGRADUATE RESEARCH JOURNAL DOES SOCIOECONOMIC STATUS AFFECT DECISION MAKING? AN EYETRACKING APPROACH TO UNDERSTANDING CONSUMER CHOICE Victoria Wilson1 (David Alonso1, Dr. Eric VanEpps2, Dr. Trafton Drew1) Department of Psychology1, Department of Marketing2 In an attempt to combat increasing obesity rates, the FDA began requiring most chain restaurants to disclose caloric information on food menus (Center for Food Safety and Applied Nutrition, 2018). However, previous research suggests broad neglect of this information, the result being that this intervention may have little effect on calories consumed by patrons in fast food settings. The neglect of calorie information is not merely because these individuals do not care about the health information being presented. Rather, it has been hypothesized that individuals of low socioeconomic status may neglect this helpful information as a result of the burden financial constraints have on attention. Financial restraint may compel attention to the most relevant information, specifically to price. As a result, calorie labeling may have little impact on obesity which is higher in incidence amongst those of lower socioeconomic status (VanEpps et al., working paper). Economic principles would suggest that a scarcity effect is at play here. Due to the fact that poor people have less money, they are more likely to be concerned with choosing an option with a lower price than an option with a healthier caloric index. This concept may be used to explain commonly seen indices of poverty such as over-borrowing, under-saving, or the underutilization of assistance programs. From this perspective, individuals experiencing poverty are more likely to deploy attentional resources on price because money is a scarce resource (Shah, Mullainathan, & Shafir, 2012). Previous findings suggest this difference in attentional focus in impoverished populations may account for the apparent disregard for caloric information presented on food menus. This is suggested by findings in many past real-world studies of calorie labeling policies as reported in a recent systematic review (Bleich et al. 2017), particularly those investigating the impact of calorie labeling among low-income populations. This line of research suggests that the introduction of calories labeling did not influence calories purchased by low-income people in New York City (Elbel et al. 2009). Additionally, error detection studies indicate that low-income individuals are more likely to notice discrepancies regarding price information on a menu than discrepancies in calorie information (VanEpps et al., working paper). Detecting more errors in price may indicate that these individuals pay more attention to information regarding price than information regarding calories. However, we infrequently evaluate food menus for errors in real life. To improve upon the design of this prior study, we placed individuals in a realistic decision-making situation and monitored their eyes using eye-tracking technology. The use of eye-tracking technology provides a well-recognized and robust measure of attention. In this experiment we hold specific interest in measuring where participants look first, in addition to the time spent looking at each item. For this pilot study we constructed 20 different mock food menus. Each menu counterbalances price and calorie information for each food option, with half presenting price on the right and calories on the left, and half presenting the two elements in the reverse order. Participants were instructed to regard each menu exactly how they would if they were actually at the prompted restaurant about to purchase a meal. Eye-tracking data was gathered during this task. Analysis of time to first fixation provides vital information on the guidance of attention as opposed to time spent merely evaluating information. As participants for the pilot study were college students and probably of higher socioeconomic status, we did not expect a significant difference in attention deployment between calories and price for individual menu items. In accordance with this, participants looked at price (6.5 seconds) more quickly on average than calories (7.5 seconds), but this effect did not reach statistical significance. Time to First Fixation 9000 Milliseconds 8000 7000 6000 5000 4000 Calories Price By recruiting participants of low and high socioeconomic status in future directions for this study, we hope to gain a better understanding of the influence of attention on choice, and whether socioeconomic status is a significant predictor of decision-making. We propose that socioeconomic status is a relevant predictor for how individuals allocate attention and ultimately make purchasing decisions about food. Specifically, we predict that those of lower socioeconomic status attend to information about price for a longer period of time than calorie information, and that those of higher socioeconomic status will attend to calorie information for a longer period of time than price. This information has clear implications for the effectiveness of information provided on food menus, presenting a unique opportunity to ensure such public health measures are maximally impactful. . References Bleich, S. N., Vercammen, K. A., Zats, L. Y., Frelier, J. M., Ebbeling, C. B., & Peeters, A. A. (2017). Interventions to prevent global childhood overweight and obesity: A systematic review. The Lancet,6(4). doi:https://doi.org/10.1016/S2213-8587(17)30358-3 Center for Food Safety and Applied Nutrition. (n.d.). Labeling & Nutrition - Menu Labeling Requirements. Retrieved from https://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformati on/LabelingNutrition/ucm515020.htm Elbel, B., Kersh, R., Brescoll, V. L., & Dixon, L. B. (2009). Calorie Labeling And Food Choices: A First Look At The Effects On Low-Income People In New York City. Health Affairs,28(6). doi:10.1377/hlthaff.28.6.w1110 Shah, A. K., Mullainathan, S., & Shafir, E. (2012). Some Consequences of Having Too Little. Science,338(6107), 682-685. doi:10.1126/science.1222426 VanEpps, E. M., Downs, J. S., Loewenstein, G., & Olivola, C. Y. Low-income individuals prioritize attention to price over calorie information. Working paper. Acknowledgments: This work was funded by the University of Utah Undergraduate Research Opportunities Program and the Department of Marketing University of Utah UNDERGRADUATE RESEARCH JOURNAL TELEHEALTH UTILIZATION IN RURAL UTAH Beth Wineke (John G. Francis) Department of Political Science ABSTRACT Rural communities often are disadvantaged in accessing healthcare resources. The absence of nearby health facilities can significantly affect health outcomes. In recent decades, telehealth has been explored as a solution to disparities in health access, particularly for those living in rural settings. Telehealth resources utilize virtual communications in order to improve healthcare provision. Telehealth has the capability to improve healthcare provision and access to healthcare for rural residents if it is supported by adequate policy and infrastructure. This research assesses the availability of health resources throughout Utah and explores the current state of telehealth use in Utah. The locations of health facilities throughout the state correlate with population density across Utah, though there are thousands of people living in rural areas of the state without access to any nearby health resources. Telehealth operations performed by University of Utah Health and Intermountain Healthcare have improved access to healthcare for rural Utahns, and demonstrate a commitment to improved healthcare access for residents in all areas. The state is in an excellent position to pursue telehealth further, though telehealth alone cannot remedy health access disparities. Cost and quality of care are important concerns within the domain of telehealth that can be addressed through appropriate targeting and monitoring strategies. Additionally, reimbursement strategies that support telehealth more broadly would greatly contribute to improved implementation in both urban and rural settings. Policy supporting telehealth must catch up to available technologies in order for the impact of telehealth to be expanded. INTRODUCTION Pam lives in Stevensville, Montana, about 40 miles south of Missoula. Pam is a white woman in her mid-seventies, and she has spent her retirement volunteering in her community. She has beaten lung cancer twice and lives with COPD and atrial fibrillation. Her husband Ben is a white man in his mid-seventies who spent much of his career in the Air Force, and he now volunteers his time for the Innocence Project. Ben also has atrial fibrillation and suffered a minor stroke in 2016. Their small hometown of Stevensville does not have adequate health resources to treat these issues, but Ben and Pam have been able to travel to Missoula for health care. As they age, however, those 40 miles become longer, their ability to travel diminishes, and new strategies for managing their health must emerge. While Ben and Pam are only one couple in a small town in Montana, their story is representative of much of rural America. Healthcare resources for Americans living in rural areas are scarce, and when the ability to travel for care diminishes, how can they get the care they need? One of the most significant inequities of the urban-rural divide is healthcare. Rural communities are fundamentally disconnected from many health resources that exist in abundance in urban spaces. Despite rural communities being home to a minority of Utahns, their health status is critical for the wellbeing of rural residents. Telehealth resources have existed for decades and have been supported by improved technology, but their full potential has not yet been realized. Telehealth consists of resources and systems that utilize the internet and other computer technologies to connect patients with healthcare providers. This research will explore telehealth resources in Utah and assess the capacity of telehealth to make a difference in rural healthcare provision. It identifies gaps in health access for rural Utahns and evaluates current telehealth resources. Finally, this research addresses reimbursement practices for telehealth services in order to determine how to widen access to these resources in the future. SURVEY OF UTAH’S HEALTH RESOURCES Background Significant research has been conducted on health disparities between urban and rural populations. Rural populations tend to experience worse health outcomes than their urban counterparts, and primary care providers are in higher demand and shorter supply in rural spaces (Richards, Saloner, Kenney, Rhodes, & Polsky, 2015). The depleting supply of health care workers extends beyond primary care physicians as well. The population of rural nurses throughout the country is aging, and fewer young adults are entering the profession than in previous years (Pfeifer, 2011). Additionally, rural Americans are less likely than their urban counterparts to work for employers that offer private insurance and a high proportion of veterans live in America’s rural spaces (Pfeifer, 2011). As Murphy, Hughes, and Conway (2018) write, “rural hospitals frequently lack the financial and human resources to offer complex, highly specialized inpatient care that is required for most admissions today,” which poses a threat to the sustainability of rural healthcare and rural communities in general. Telehealth services may help to reduce cost to payers while improving health outcomes if supported by adequate personnel. Health professional shortages One important indicator of an area’s access to healthcare is the size of its population of health professionals. Across the country, rural areas tend to be home to fewer health professionals than urban centers and suburban areas. Shortages of health professionals greatly reduce communities’ access to care and may hinder the long-term sustainability of an area. The Health Resources & Services Administration designates Health Professional Shortage Areas (HPSAs) based on federal standards, and these areas are eligible for certain federal resources (Health Resources & Services Administration [HRSA], 2019). Clinics in rural areas that are designated as HSPAs are eligible for Rural Health Clinic (RHC) designation. RHCs are provided enhanced reimbursement from the Health Resources & Services Administration, supporting their continued financial health (HRSA, 2019). As of January 2019, Utah is home to 14 federally recognized Rural Health Clinics (Rural Health Information Hub [RHI], 2018). In 2017, 36 states had more Rural Health Clinics than Utah, with Missouri topping the list at 367 clinics (Kaiser Family Foundation, 2017). Utah has a much smaller population than many states, however, and the large majority of Utah’s population is concentrated in urban and suburban areas. Richards et al. (2012) found that rural primary care providers tend to be burdened with heavier workloads than those serving in urban areas due to the scarcity of rural providers and the types of services required by rural residents. Richards et al. (2012) also found that federallyrecognized Rural Health Clinics grant Medicaid appointments roughly on par with their rates of privately insured appointments, and that the “supply of new patient appointments appears influenced by the presence of RHCs.” This suggests that cost-based reimbursement positively affects provider availability for Medicaid beneficiaries in rural spaces, and opens the question of how telehealth resources may be further utilized within the RHC system. In Utah, Davis and Sevier Counties are the only counties that are not classified as HPSAs. Twenty counties contain areas that are classified as HPSAs. The remaining seven counties (Beaver, Daggett, Emery, Kane, Piute, Rich, and Tooele) are classified entirely as shortage areas (RHI, 2017). All of these seven counties are primarily rural, though parts of Tooele County act as a bedroom community of Salt Lake County. The wide prevalence of HPSAs throughout the state demonstrates a federally-recognized shortage of health professionals in Utah, particularly in the state’s rural communities. Utah’s counties vary widely in the size of their populations of health professionals. In 2014, only six counties out of 29 reported greater than 15 physicians per 10,000 people. All of these counties center around urban areas with the exception of Grand County, which has a large tourism industry that warrants more health resources. The economic character of Utah communities is a significant factor in determining demand for health services, as exemplified by Grand County’s relatively large population of health professionals. Every other county in Utah reported fewer than 15 physicians per 10,000 people in 2014, and Daggett, Piute, and Wayne Counties reported zero physicians (RHI, 2015). These data indicate a wide disparity in access to physicians across the state, with urban areas having the greatest concentration of doctors and some rural counties having no physicians at all. Some rural residents may be able to access care in nearby counties, but barriers to access remain for those who are unable to visit the next county over. The shortage of health professionals in Utah’s rural communities may be supplemented by direct-to-consumer telehealth services, but these services cannot replace health professionals entirely. Clinic and hospital locations Comparing locations of hospitals and clinics with population data allows for assessment of access to healthcare facilities. The map below displays Utah’s population, organized by census block group. Population data from the 2010 Census demonstrates population density across the state. Additionally, data from 2017 displays the locations of various health resources throughout Utah. This map displays locations of assisted living facilities, clinics, hospitals, mental health facilities, nursing homes, Rural Health Clinics, and urgent care clinics. Figure 1. Utah Health Facility Locations. Development aided by Warren Scott, University of Utah Department of Geography. The map above displays a strong correlation between population density and health resource availability, as expected. Areas of Utah with greater population density tend to be home to more health facilities, and more sparsely populated areas have fewer resources. In itself this is not necessarily negative, as resources should be scaled to the communities in which they are located. These data do indicate, however, that there are many census block groups in Utah that do not have any health resources of these types at all. The western part of the state is particularly barren, and while the population of this area is relatively small, the few thousand people living in this part of the state live without access to any health facilities and are required to travel for care. Additionally, many census block groups house only one type of health facility, reducing the kinds of care available to its residents. In areas in which hospitals are the only available health resource, patients must seek care for non-emergency conditions at the hospital, which drives up the cost of care. These data indicate disparities in access for those living in rural areas as compared to urban residents. Telehealth services may help fill this gap by increasing access to various kinds of health resources, including mental health care, long-term care, and acute treatment. INSTITUTIONAL TELEHEALTH RESOURCES Background Virtual communications between doctors are gaining prominence in the telehealth sphere and have the capacity to significantly improve the efficacy of healthcare provision in rural spaces. Health professionals who do not have experience in a specialty area can communicate virtually with specialists in a different city in order to improve their provision of care and keep patients in their hometowns. These communications require written contracts within and among health networks in order to organize payment, liability, and health records, among other factors. Telehealth communications between health professionals can significantly complicate payment for care, as the use of a specialist is costly and insurance plans have varied reimbursement practices for both specialists and telehealth use. Reexamination of reimbursement practices and policy supporting investment in telehealth would improve the provision of these communications and increase their availability for patients located in both urban and rural spaces. Telehealth use between health professionals can improve healthcare provision for many different kinds of patients. Persons located in rural areas without access to specialists in their hometowns are one of the largest and most obvious target populations. Keeping patients in their hometowns for treatment improves healing, saves transportation costs, and helps to keep urban hospitals from over-filling. Another target population for virtual communication between doctors is nursing home residents. In a study of eleven nursing homes, Grabowski and O’Malley (2014) found that “off-hours telemedicine coverage in a chain of nursing homes generated cost savings for Medicare through fewer hospitalizations of residents of the facilities that were more engaged in the telemedicine intervention.” Though these findings may not be generalizable to other nursing homes, they indicate that with proper training and utilization, virtual communications between doctors may be able to improve health and reduce patient transfers for nursing home residents. Rural nursing homes in particular may benefit from these technologies, as transfers to urban hospitals are costly. Another potential service population for telehealth communications between health professionals is persons who are incarcerated. Transporting prisoners to health facilities is expensive because of the required personnel, and getting doctors to visit jails and prisons can prove complicated. Improving telehealth communications between in-house clinics and doctors in other health networks can improve access to care for those who are incarcerated while also reducing costs. Telehealth adoption has been relatively slow in most communities, regardless of their place along the urban-rural continuum. Martin, Probst, Shah, Chen, and Garr (2012) found that between rural hospitals and rural primary care providers, hospitals demonstrate a greater level of financial and institutional readiness for telehealth service utilization than primary care providers. Hospitals and primary care providers both could benefit greatly from telehealth implementation, as it would allow them to retain more patients and provide specialized care (Martin et al., 2012). Telehealth service implementation is expensive, however, due to infrastructure costs and requisite training. Hospitals may be at an advantage in this area due to their greater concentration of resources. Pursuing improved telehealth communications through adjusted reimbursement practices and clear contracting will help improve telehealth adoption and readiness in rural communities. University of Utah Health: Specialist Communications University of Utah Health is one of the state’s largest healthcare providers. The University is in a position to offer excellent telehealth services because of its large financial and personnel endowments. By working with other hospitals throughout the state, University of Utah Health extends its reach and provides care to patients needing specialty services. University of Utah Health runs a program called Project ECHO (Extension for Community Health Care Outcomes), a free partnership program to connect rural health providers with specialists in Salt Lake City. Through this program, rural health providers gain free access to specialist consultation and a broad network of providers (University of Utah Health, 2018). The University’s three main telehealth contracting programs center on intensive care, burns, and strokes. Additionally, the University operates a tele-hub which rural facilities can call in order to get connected with a specialist. This service has existed for about 20 years, and University of Utah Health pioneered this kind of communication. This service is utilized by hospitals outside of Utah as well as those within the state. In 2018, University of Utah telehealth services aided 508 stroke patients, 66 ICU patients, and 1,134 burn victims. Additionally, the University contracted with about 60 sites throughout the intermountain West for burn services. Because University of Utah Health is one of few burn centers in the western states, its services are in high demand, as illustrated by the large number of patients that it served virtually in 2018. All follow-up visits for burn victims are conducted virtually, allowing patients to stay in their hometowns while recovering. The University’s teleICU program is primarily driven by consulting between doctors about how to treat patients with specific needs that may not be met within their home settings. The goal of this program is to keep patients in their home communities in order to promote healing, reduce costs, and keep the University’s urban hospitals from overfilling. Project ECHO and University of Utah Health’s other telehealth programs indicate commitment to healthcare access for all Utahns. The low barriers to participation in these programs allow for high levels of participation by rural providers, and the programs’ successes thus far indicate a promising future for University of Utah telehealth. The desire to maintain autonomy in care provision may prevent participation for rural providers, and careful contracting is required to preserve the integrity and autonomy of rural clinics and hospitals. Additionally, financial support for technology and infrastructure in rural health facilities is important in improving these communications, as rural providers are limited by the tools they have regardless of their ability to communicate with specialists in Salt Lake City. DIRECT-TO-CONSUMER TELEHEALTH Background The advent of the internet and cell phones has created the opportunity for individuals to access healthcare in their own homes and beyond. Direct-to-consumer telehealth improves patients’ ability to access providers from any location, and is intended to increase access to healthcare in both urban and rural spaces. For those living far away from a primary care clinic or urgent care, direct-to-consumer telehealth may help fill this gap in access. Additionally, these resources may help to expedite healthcare provision for certain conditions requiring little intervention. Direct-to-consumer telehealth comes in many forms, though real-time communications are dominant. Store-and-forward communications are another form of direct-toconsumer telehealth in which a patient shares information with a provider and receives feedback at a later date. Accessing providers through direct-to-consumer telehealth services may be more time-efficient than seeing a provider in person, and in many cases is a viable alternative to inperson care. Direct-to-consumer telehealth is provided to patients in a number of ways. Some healthcare providers utilize these services as a supplement to the in-person care that is already being provided to patients. The majority of the direct-to-consumer telehealth market, however, is dominated by for-profit companies that are separate from a patient’s normal provider (Mehrotra, Uscher-Pines, & Lee, 2018). The relatively wide market for direct-to-consumer telehealth improves patients’ access to telehealth services, but the use of telehealth companies outside a patient’s normal health network can lead to difficulties in coordination of care, particularly for those with long-term conditions. The efficacy and benefits of direct-to-consumer telehealth are heavily dependent on both the medical condition and the population being treated (Ashwood, Mehrotra, Cowling, & Uscher-Pines, 2017). Patients experiencing single-episode conditions with relatively low risk are more likely to reap the greatest benefits from direct-to-consumer telehealth providers. These “simple acute” conditions appear to represent the greatest share of direct-to-consumer telehealth interactions, though behavioral health services are also gaining traction in the provision of directto-consumer telehealth (Mehrotra et al., 2018). Longer-term conditions requiring continuous care are better treated using telehealth services as a supplement to in-person care, though telehealth services can help patients stay in contact with their providers and reduce travel costs associated with care. Responsiveness to virtual visits In delivering healthcare, patient comfort is of utmost importance. Direct-to-consumer telehealth visits are effective and useful only if patients are responsive to the service and feel comfortable sharing their information via the internet. A Cisco survey of over 1,500 people across ten countries concluded that 74% of participants were open to virtual doctor visits, while only 40% of those in the United States were open to this kind of visit (Cisco, 2013). Additionally, while the majority of midsize and large American companies offered telehealth services to their employees in 2017, only 8% of eligible employees utilized the service (Murphy, 2019). A primary concern for potential patients is the quality of care associated with telehealth visits, particularly for parents seeking treatment when a child is sick. Additionally, personal preferences influence the patient’s decision to seek care in person or virtually (Murphy, 2019). Unfamiliarity with technology and concerns about data safety may also be important in determining whether a patient feels comfortable seeking treatment online. Martin et al. (2012) describe fears of increased risk arising from telehealth use due to misdiagnosis, mistreatment, or other unfortunate possibilities. These apprehensions may be especially pertinent at the rural level where traditional values tend to be particularly salient. Many of these barriers to telehealth use can be addressed through proper marketing and targeting strategies. Quality assurance policies and communication strategies may help patients feel safer using direct-to-consumer services. Provision of clear instructions to patients interested in the service is necessary to bolster patient agency with the technology. Additionally, secure internet connections and smartphone-based communications are essential in order to ensure safe transmission of medical information and improve patient responsiveness to the service. Ultimately, proper communication strategies would help reduce patient reluctance to telehealth services, but personal preferences are still paramount in determining how someone may choose to access care. The goal for telehealth services should not be 100% utilization, as personal preferences affect patients’ responses to care and not every condition should be treated using direct-to-consumer telehealth. Cost of care One of the most promising aspects of direct-to-consumer telehealth is its potential to generate significant cost savings. The two main goals of rural health care sustainability are financial stability for providers and reduced cost to payers (Murphy et al., 2018), which are difficult to reconcile with each other, though telehealth may play a promising role in bridging this gap. Telehealth visits with a health professional may be less expensive than in-person visits for a variety of reasons. First, telehealth visits may be supported by fewer staff than in-person visits, and reducing the number of people that the patient is in contact with may generate cost savings. Telehealth visits may also be shorter than in-person visits depending on the technology and software that are used to conduct the interaction. Direct-to-consumer telehealth also may reduce costs by keeping patients from seeking care at the emergency room as a last resort (Ashwood et al., 2017). Additionally, while transportation costs may be separate from the cost of care itself, the savings in transportation made possible by direct-to-consumer telehealth present a significant benefit to patients. Transportation costs include both the cost of travel and the opportunity costs associated with taking time off of work or away from home. Particularly for those living in rural areas, transportation time and costs can be a limiting factor to the patient’s access to care. It is also possible, however, for direct-to-consumer telehealth to generate greater costs than in-person visits in the long run. If a telehealth visit is inconclusive or leads to misdirection of care, the patient may have to seek additional services that would nullify the savings generated by the direct-to-consumer telehealth interaction. Direct-to-consumer services may lead to more follow-up appointments, testing, or prescriptions compared to other methods of care, which increases spending in the long run (Ashwood et al., 2017). These complications could be remedied by targeting telehealth services to those with relatively simple conditions or using them as a supplement to in-person care. Studies of the costs of direct-to-consumer telehealth have produced mixed results. In a study of 40,000 Minnesota telehealth visits, Courneya, Palattao, and Gallagher (2013) estimated cost savings of $88 per episode compared to traditional channels of care. Patients also reported high levels of satisfaction with the service (Courneya et al., 2013). These findings present a compelling and promising case for the use of direct-to-consumer telehealth as a substitute for inperson care. Per-episode cost savings certainly benefit patients and providers alike, but doctorpatient interactions and initial visits represent only one component in the greater sphere of healthcare. In a study of about 300,000 patients over three years, Ashwood et al. (2017) found that direct-to-consumer telehealth visits did not decrease spending overall. While per-episode spending was reduced via direct-to-consumer telehealth, the convenience of the service led to greater use of care and an increase in overall spending (Ashwood et al., 2017). In this study, well over half of the telehealth visits represented new utilization, rather than use of the service as a substitute for an in-person appointment, and “telehealth services could save money if greater shares of visits represented substitutions for visits to other settings” (Ashwood et al., 2017). High levels of new utilization of health services is not necessarily negative in itself, as this represents greater inclusion of patients and increased access to care generally. It does, however, potentially negate the per-episode cost savings associated with telehealth use by increasing expenditures in the long-run, implying that other cost solutions are necessary in order to address rising costs. While direct-to-consumer telehealth may not currently present cost savings on a large scale, targeting strategies and education may help to direct resources efficiently and usher in greater cost savings in the future. The potential for cost savings is one of the most attractive features of direct-to-consumer telehealth. While these kinds of services may not reduce health spending overall, evidence of per-episode savings still presents a compelling case for direct-to-consumer telehealth. Appropriate targeting strategies are crucial in directing care as a substitute for in-person visits. Overuse of care can be addressed through targeted marketing and education, though the forprofit nature of most telehealth vendors complicates this relationship. Basic economic relationships suggest that in order to address overuse of the service, one solution would be to raise the cost of the telehealth visits. This is not an ideal solution, as it reduces the possible cost savings associated with telehealth and reduces access to care. Because many direct-to-consumer telehealth vendors are for-profit firms, balancing the price of the service has implications beyond the level of utilization of telehealth visits. Targeting and education strategies by both private firms and governmental resources are most promising in addressing overuse of care. While the cost of healthcare is an ever-growing concern with monumental implications, cost of care is only one of a series of metrics that should be used to evaluate telehealth services. Greater inclusion in healthcare and improved access are benefits of the service that should not be limited by costs, though over-use of telehealth services and increases in follow-up appointments are one area in which cost can be addressed. Direct-to-consumer telehealth resources clearly benefit patients by increasing access to care and providing meaningful companionship and reassurance in the provision of healthcare, and the costs associated with this kind of service are only one of many considerations in assessing care. Quality of care Paramount in evaluating healthcare is assessment of the quality of care that is delivered. While cost and convenience are also significant factors in assessing healthcare delivery, quality of care is the most significant measure of health system success. Quality is of particular concern with direct-to-consumer telehealth because patients often have telehealth visits with professionals that are not their normal care providers, which can complicate the patient’s interactions and record of care. Physicians that are hired by the telehealth service company “may not offer care that meets the standards of patients, insurers, or other stakeholders in a given health network” (Baird, 2017). The speed at which direct-to-consumer telehealth visits are often conducted can undermine the quality of care that is delivered, as many telehealth vendors attempt to keep visits to about 5 minutes in order to reduce costs (Baird, 2017). Hierarchical monitoring structures within telehealth companies and monitoring of interactions may help to address these factors. Coordination of care is one of the most commonly discussed concerns in assessing directto-consumer telehealth. For patients utilizing private telehealth vendors outside their normal network, merging medical records and coordinating care with other physicians tends to be complicated. Records from telehealth visits may be lost or unfiled, and most electronic health record systems aren’t currently compatible with telehealth software and records (Baird, 2017). This presents important complications for patients requiring follow-up care or new prescriptions. Additionally, the physician conducting the virtual visit may not have access to a patient’s full record, which can result in miscommunication, misinformation, and poor prescription choices. In a study of over 38,000 direct-to-consumer telehealth visits and 942,000 primary care visits, Shi et al. (2018) found that virtual visits had less appropriate testing and resulted in more follow-up appointments than in-person visits. This suggests problems for both quality and cost of care, as misdiagnosis, inappropriate testing, and follow-up appointments can complicate patient health status and health records and increase the cost of care. In order to improve the quality of direct-to-consumer telehealth interactions, health organizations must coordinate to ensure that health records can be appropriately and securely shared with telehealth vendors. Additionally, health insurance providers and employers must play an active role in monitoring quality of care and implementing appropriate mechanisms for improvement (Shi et al., 2018). The promises of direct-to-consumer telehealth must not overshadow the importance of monitoring quality of care, as some care is not always preferable to no care at all. Intermountain Healthcare: Connect Care Intermountain Healthcare provides direct-to-consumer telehealth to those living in all states where telehealth services are legal. Connect Care is Intermountain Healthcare’s direct-toconsumer telehealth service that can be accessed 24 hours a day for those experiencing common conditions. Visits are conducted through video communication. For patients already within Intermountain Healthcare’s network, their medical records are available to the clinician conducting the telehealth visit, and the record of the virtual visit is integrated into the patient’s general medical record. For those outside the Intermountain network, however, medical records are supplied to clinicians by the patient herself, which can lead to complications in quality of care if the patient does not supply adequate background information or have access to the details of her health status. Visits cost $49 and may be covered by the patient’s insurance, depending on the policy. Additionally, if a patient’s condition is not diagnosable by video communication and requires an in-person visit, the patient is not charged for the Connect Care visit (Intermountain Healthcare, 2019). Concern about over-prescription of pain medicine and abuse of pain medicine has been renewed in recent years in the wake of the opioid epidemic. Rural spaces have been especially plagued by this issue, and the prescribing power of physicians through direct-to-consumer telehealth is a warranted concern. Physicians who see patients through Connect Care are able to prescribe medicine through virtual visits, however it is illegal to prescribe opiates virtually. The ability to write prescriptions based on virtual visits is helpful for improving access to medicine and treating patients appropriately, but telehealth visits could also lead to over-prescription of medicines such as antibiotics. Additionally, the Department of Health and Human Services is currently developing policy that allows physicians to prescribe buprenorphine virtually in order to combat opioid abuse and overdose (U.S. Department of Health & Human Services, 2018). Treatment for substance abuse through real-time video communication is also covered by Utah Medicaid (Center for Connected Health Policy [CCHP], 2019). Medically-assisted treatment for drug abuse is one area in which direct-to-consumer telehealth services can play an important role in the future, particularly for persons living in rural areas without access to other clinics. Connect Care exemplifies telehealth services that are well-coordinated by a health organization which also provide in-person care. Intermountain Healthcare should continue to pursue Connect Care for the treatment of simple acute conditions, as the program provides a streamlined channel of care for those in both urban and rural settings. In the future, Intermountain Healthcare could further integrate direct-to-consumer telehealth into its existing patient network by implementing long-term care and monitoring services virtually. University of Utah Health: Tele-Prenatal and Behavioral Health University of Utah Health conducts direct-to-consumer telehealth operations in addition to their consulting programs. One of the University’s newest programs is targeted toward expectant mothers. The tele-prenatal program combines direct-to-consumer telehealth with inperson visits in order to maximize efficacy. Every three to four appointments, the patient makes an in-person visit with their doctor, and this care is supplemented by virtual visits that direct the patient to specific products that will aid her pregnancy and help the doctor monitor the patient. This program model aids both rural and urban residents by reducing the number of in-person appointments required of the expectant mother and reducing travel stress. Additionally, University of Utah Health has begun implementing behavioral health services virtually. The telecrisis program aids those in need of immediate assistance, and licensed social workers conduct visits with patients remotely in order to reduce costs and improve accessibility to care. Patients may also feel more comfortable participating in virtual visits since they do not have to experience a new environment and can stay in the comfort of their own homes. Appropriate targeting strategies and reimbursement practices can help to widen the use of these services in order to increase access to both prenatal and behavioral care. REIMBURSEMENT FOR TELEHEALTH SERVICES As telehealth services grow in their availability, marketability, and recognizability, health insurance policies must be shaped to support appropriate uses of telehealth. Reimbursement for telehealth services is critical in shaping patients’ decisions to seek virtual communications, as well as medical facilities’ decisions about contracting with specialists virtually or implementing direct-to-consumer telehealth. One significant complication in this area is the wide variety of insurance policies that exist in the private market, as well as the variance between state Medicaid policies. This variance may decrease access to telehealth services by creating inconsistencies in cost of care to patients and by compromising patients’ understanding of what their insurance covers. The Center for Medicare and Medicaid Services should serve as a leader in writing telehealth reimbursement policies because of its large patient base, legal authority, and relative consistency as compared to private insurers. Medicaid in particular has been studied as an important channel for resources in rural health systems. The program is a key source of funding for hospitals and primary care providers, and it contributes significantly to keeping rural economies afloat (Mueller et al., 2012). Medicaid is a vital source of health coverage for many rural Americans that allows physicians and hospitals to serve patients that may otherwise not be able to pay for their services. Additionally, Mueller et al. (2012) have described Medicaid as the “largest single payer for long-term services and support.” Those with long-term conditions may be supported by telehealth as a supplement to in-person care, and Medicaid can play a meaningful role in supporting these services. This research has established the critical role that Medicaid plays in supporting rural American health systems, and suggests that its importance will only grow in future years. Medicaid also presents complex bureaucratic and financial impediments to providers, however, and variance across the states further complicates reimbursement for these transactions. Martin et al. (2012) found that reimbursement practices are a major barrier to implementation of these resources, and that states with low telemedicine adoption also have low rates of coverage for these kinds of services by private insurers. This presents a problem for both urban and rural populations that could benefit from telehealth implementation, and suggests that Medicare and Medicaid might act as leaders in promoting consistent reimbursement practices in order to support the growing role of technology and the internet in health care. One success in this area was the 2006 implementation of Medicare Part B coverage of medical nutrition therapy via telehealth use. The implementation of this reimbursement practice in 2006 signals a step in a positive direction for those living in rural areas with chronic conditions such as diabetes. Medicare employs a particularly rural-focused policy in reimbursing telehealth. Medicare beneficiaries must live in a federally-classified rural Health Professional Shortage Area, or otherwise in a county outside of a Metropolitan Statistical Area in order for their telehealth interactions to be covered (Center for Medicare & Medicaid Services [CMS], 2019). Additionally, telehealth is defined as two-way, real-time communications between parties, so store-and-forward interactions are not covered by Medicare. Eligible visits include those addressing behavioral health, substance abuse, end-stage renal disease, consultations, and followup visits (CMS, 2019), and Medicare reimburses for a wide variety of visit types. In 2015, the Medicare Telehealth Parity Act was introduced with the goal to incrementally expand telehealth coverage for Medicare beneficiaries, but this bill died in committee (GovTrack, 2015). Medicare reimbursement for telehealth services currently is off to a good start, but expansion of the number of eligible geographic areas would greatly improve access to telehealth services for those living in urban and suburban areas that may use telehealth for reasons other than locational challenges. Within Utah Medicaid, telehealth is defined as “two-way, real-time interactive communication between the member and the physician or authorized provider at the distant site” (CCHP, 2019). This definition limits the use of telehealth to real-time communications and does not include the use of store-and-forward communications between parties. Expanding legal definitions of telehealth within both Medicare and Medicaid would greatly improve these services’ support of telehealth by widening the number of eligible interactions. Two-way, realtime communications may not always be viable for beneficiaries, and expanding legal definitions of telehealth to include store-and-forward communications and other interactions would increase access to telehealth communications greatly. Consultations, evaluations, and mental health services are included in Utah Medicaid’s collection of eligible services. Only specific long-term cardiac conditions may be monitored remotely according to Utah Medicaid. This is a significant barrier to widening the service population of telehealth, as long-term monitoring could be of great service to many people living in areas without regular access to clinic locations. An expansion of the list of eligible services for reimbursement by Utah Medicaid would signal a commitment to supporting both acute and longterm patients remotely while increasing access to care. CONCLUSION The role of telehealth in supporting rural healthcare has shifted greatly over the last decade. The use of technological services for communications within healthcare is not new, but the goals and types of these communications have expanded significantly. The prevalence of smartphones and accessibility of video communications has brought direct-to-consumer telehealth into the mainstream market and expanded access to care generally. Additionally, improved communications technologies have reduced barriers to institutional use of telehealth. These resources have improved access to healthcare in rural communities, and they also carry significant promise for those living in urban spaces. Telehealth is not a singular solution to address issues in healthcare accessibility, but it has the capacity to make improvements in this area if supported by adequate infrastructure and policy. Within Utah, access to health facilities is highly limited for those in the state’s most remote areas. While it is expected and reasonable for the concentration of health resources to scale with population density, thousands of Utahns remain outside of this equation entirely. Direct-to-consumer telehealth may support these residents by providing access to care for acute conditions, but emergency and specialty services remain limited. Telehealth services that support emergency and ambulatory communications could have a meaningful impact on the state’s most remote communities. Communication between providers is one area in which telehealth interactions can greatly improve care. The ability of medical professionals to communicate with each other securely and quickly improves access to specialty care for those living outside of major cities while maintaining professionalism and quality of care. In this area of telehealth, the greatest barriers to use have to do with available infrastructure for rural providers. Rural facilities are limited by the tools at their disposal, and specialist communications can be prohibitively expensive for patients and providers. While University of Utah Health supports rural providers through offering free specialist contracting, this is only one example of a well-nurtured relationship between urban and rural providers. Additionally, in contracting with specialists across health networks, rural hospitals must work to maintain their autonomy in service provision while adequately utilizing the advice received through the specialist communication. Direct-to-consumer telehealth is a growing field that must be monitored and assessed closely in order to maintain quality of care and limit the cost of healthcare. These resources are an important way for patients to receive care when they are not able to access an in-person visit to a hospital or clinic, and can also serve companionship and reassurance functions for patients. Direct-to-consumer healthcare provision can improve access to care and the provision of longterm services, but it must be met with careful cost and quality regulations of telehealth vendors. In order to address overuse of direct-to-consumer telehealth services, pointed marketing strategies should be pursued by both private telehealth firms and governmental agencies. Additionally, integrating telehealth records with other medical records is important for ensuring quality of care both during and after the virtual visit. Integrating medical records also can help to address overuse of care and expansion of costs through telehealth use, as the availability of a patient’s full medical history can help physicians make more accurate diagnoses and prescriptions and lead to less follow-up care and fewer complications. Direct-to-consumer telehealth communications through a patient’s normal health network can also support long-term care for patients in both rural and urban areas if it is supported with appropriate reimbursement practices. The successes and shortcomings of telehealth use thus far demonstrate that it is a promising supplement to in-person care in its current form. Institutional telehealth resources should continue to be utilized in order to expand access to specialty care and aide communications between doctors and hospitals. Direct-to-consumer telehealth can offer support and care to those in both urban and rural areas, and it may help rural residents in particular access care that is unavailable near their hometowns. Telehealth resources are more diverse than they appear at first glance, and are becoming increasingly varied as technologies expand. Expansion into preventive and long-term care is a promising area for telehealth to grow in future years if supported by adequate policy and financing. Expanding service areas, legal definitions of telehealth, and eligible conditions for reimbursement would greatly improve the ability of Medicaid and Medicare to support telehealth and serve as leaders in the field. Policy in this area must catch up to available technologies and infrastructure in order for telehealth to continue impacting rural communities positively. REFERENCES Ashwood, J. S., Mehrotra, A., Cowling, D., & Uscher-Pines, L. (2017). Direct-to-consumer telehealth may increase access to care but does not decrease spending. Health Affairs, 36(3), 485–491. https://doi.org/10.1377/hlthaff.2016.1130. Baird, M. (2017). The case for a hybrid approach to direct-to-consumer telehealth. Becker’s Hospital Review. Retrieved from https://www.beckershospitalreview.com/telehealth/thecase-for-a-hybrid-approach-to-direct-to-consumer-telehealth.html. Center for Connected Health Policy. (2019). Current State Laws & Reimbursement Policies. Retrieved from https://www.cchpca.org/telehealth-policy/current-state-laws-andreimbursement-policies?jurisdiction=73&category=128&topic=All. Center for Medicare & Medicaid Services. (2019). Telehealth Services. Medicare Learning Network. Cisco. (2013). Cisco Study Reveals 74 Percent of Consumers Open to Virtual Doctor Visit. Retrieved from https://newsroom.cisco.com/press-releasecontent?type=webcontent&articleId=1148539. Courneya, P. T., Palattao, K. J., & Gallagher, J. M. (2013). HealthPartners’ Online Clinic For Simple Conditions Delivers Savings Of $88 Per Episode And High Patient Approval. Health Affairs, 32(2), 385-392. https://doi.org/10.1377/hlthaff.2012.1157. Grabowski, D. C. & O’Malley, A. J. (2014). Use Of Telemedicine Can Reduce Hospitalizations Of Nursing Home Residents And Generate Savings For Medicare. Health Affairs, 33(2), 244-250. https://doi.org/10.1377/hlthaff.2013.0922. GovTrack. (2015). “H.R. 2948 — 114th Congress: Medicare Telehealth Parity Act of 2015.” www.GovTrack.us. Health Resources & Services Administration. (2019). What is Shortage Designation? Retrieved from https://bhw.hrsa.gov/shortage-designation/what-is-shortage-designation. Intermountain Healthcare. (2019). Connect Care: FAQs. Retrieved from https://intermountainhealthcare.org/services/urgent-care/connect-care/faqs/. Kaiser Family Foundation. (2017). Number of Medicare Certified Rural Health Clinics. Retrieved from https://www.kff.org/other/state-indicator/total-rural-healthclinics/?activeTab=map&currentTimeframe=0&selectedDistributions=total-rural-healthclinics&sortModel=%7B%22colId%22:%22Total%20Rural%20Health%20Clinics%22, %22sort%22:%22desc%22%7D. Martin, A. B., Probst, J. C., Shah, K., Chen, Z., & Garr, D. (2012). Differences in Readiness Between Rural Hospitals and Primary Care Providers for Telemedicine Adoption and Implementation: Findings From a Statewide Telemedicine Survey. The Journal of Rural Health, 28(1), 8-15. Mehrotra, A., Uscher-Pines, L., & Lee, M. S. (2018). The Dawn of Direct-to-Consumer Telehealth. In: Rheuban, K., & Krupinski, E. A. eds. Understanding Telehealth. New York, NY: McGraw-Hill. Mueller, K. J., Coburn, A. F., Lundblad, J. P., MacKinney, A. C., McBride, T. D., & Watson, S. D. (2012). The current and future role and impact of Medicaid in rural health: Columbia, MO: RUPRI Rural Health Panel. Murphy, K. M., Hughes, L. S., & Conway, P. (2018). A Path to Sustain Rural Hospitals. JAMA, 319(12), 1193. doi: 10.1001/jama.2018.2967. Murphy, T. (2019, February 8). Patients reluctant to make virtual visits to a doctor. The Seattle Times, pp. A10-A11. Pfeifer, M. G. (2011). Finding Solutions to Advance Rural Health. AJN, American Journal of Nursing, 111(9), 15-15. doi: 10.1097/01.NAJ.0000405044.77582.6e. Richards, M. R., Saloner, B., Kenney, G. M., Rhodes, K. V., & Polsky, D. (2016). Availability of New Medicaid Patient Appointments and the Role of Rural Health Clinics. Health Services Research, 51(2), 570-591. doi: 10.1111/1475-6773.12334. Rural Health Information Hub. (2018). Retrieved from https://www.ruralhealthinfo.org/states/utah. Rural Health Information Hub. (2015). Retrieved from https://www.ruralhealthinfo.org/dataexplorer?id=205&state=UT. Rural Health Information Hub. (2017). Retrieved from https://www.ruralhealthinfo.org/dataexplorer?id=210&state=UT. Shi, Z., Mehrotra, A., Gidengil, C. A., Poon, S. J., Uscher-Pines, L., & Ray, K. N. (2018). Quality Of Care For Acute Respiratory Infections During Direct-To-Consumer Telemedicine Visits For Adults. Health Affairs, 37(12), 2014-2023. doi: 10.1377/hlthaff.2018.05091. University of Utah Health. (2018). Project ECHO. Retrieved from https://physicians.utah.edu/echo/. U.S. Department of Health and Human Services. (2018). Telemedicine and Prescribing Buprenorphine for the Treatment of Opioid Use Disorder. University of Utah UNDERGRADUATE RESEARCH JOURNAL ANOTHER BIG FOOT STUDY: GAP WIDTH PERCEPTION WITH VIRTUAL FOOT SCALING IN CHILDREN Serena Yang Faculty Advisor: Dr. Sarah Creem-Regehr Department of Psychology The purpose of this study was to explore our understanding of spatial cognitive abilities in children versus adults; investigating how one may use their perceived body sizes to make decisions about what they can do in an environment. Gibson, and his theory of affordance (1979) theorizes that one’s perception of the environment is related to one’s capability of available action in the specific environment. Action-scaled affordances and our judgments of such may be based off of our understood perceptions of our own body dimensions and the environment itself. Our goal in this study is to replicate the effects of a past study on adults to analyze the effects of virtual body size on children, and specifically investigate the effects of foot size on gap width perception and affordance judgments for stepping. Methods. We use an HMD Vive, a virtual reality device, to investigate our questions. The environment, an Italian plaza (see Figure 1), was created using a computer generated program called WorldViz. Participants are asked to wear a head mounted display headset, and foot trackers. Our data collection consisted of 36 kids ages ranged from 8 to 12 (mean age 10 years), and 40 adults ages 18 to 48 (mean age 21 years). The participants were placed into two conditions, the big foot condition where the participants’ virtual foot was enlarged by 150% but of their actual foot size, or the small foot condition where their virtual foot was scaled to 75% of actual foot size (see Figure 2). The participants were asked to perform two tasks: the first, affordance judgment task where they were presented eight different size gaps which were shown three times each and randomized across 24 trials, and then were asked whether or not they could step over the gaps with a yes or a no response. They did not actually step over these gaps. The second task involved size estimation of four width gaps presented three times each, and also randomized across 12 trials. Lastly, the participants were asked to whether or not they felt shorter or taller, or their actual height. Questionnaires were also taken to collect their perception of their virtual foot, and their perception of ownership, agency, and self-localization of their avatar feet. Results. Our findings showed a significant interaction of foot condition (e.g. big vs small) and age group (e.g. adult vs children). A replicated effect of big foot condition was seen in the adult population which showed adults overestimated their stepability of gaps with big compared to small feet, however this was not the case for children. With children, there was a significant foot condition effect, but reversed, showing kids overestimated their stepability of gaps with the small foot condition compared to the big foot condition. There was no effect of foot condition in the gap size estimation tasks. Implications. Thus, our findings suggest a need for further exploration of spatial cognitive abilities in children. Possible explanations for the reversed effect could be the instability in the continuous growth of children, which may affect their ability to judge their action-scaled affordances in accordance to their body dimensions. Another possible explanation could be due to the kids’ logic in how their perception of height relates to feet size. For example one may perceive their smaller feet to mean they are taller as an individual because they are farther away from the ground (e.g. longer legs), or big feet to mean they are a shorter individual because they are closer to the ground (e.g. shorter legs). Future work will assess perception of virtual body size across age and different body dimensions. Figure 1. The plaza virtual environment with virtual feet. Figure 2. Big (1.5x) and Small (.75x) virtual feet used in the experiment. University of Utah UNDERGRADUATE RESEARCH JOURNAL THE USE OF “WOMEN’S SAFETY” IN CRIMINALIZATION VS. DECRIMINALIZATION ARGUMENTS ABOUT PROSTITUTION IN THE U.S. Anne Marie Bitter (Ella Myers, PhD) Department of Political Science i ABSTRACT This thesis analyzes academic discourse arguing for and against the criminalization of prostitution within the U.S. It specifically investigates how claims about women’s safety are used by both sides in this debate, examining four common frameworks that shape appeals to women’s safety: physical harm, sexual exploitation, STIs, and the patriarchy. Reflecting on these claims, the thesis argues that advocates of both criminalization and decriminalization mobilize ideas about “women’s safety” which cast women as violable and in need of protection. These protectionist arguments are rooted in patriarchal beliefs and are used to control women’s behavior, silence women’s voices, and reinforce sexist assumptions about women. The project concludes by offering suggestions as to how future research might resist patriarchal standards by normalizing and accepting women’s power within prostitution and avoiding the portrayal of women as victims. ii TABLE OF CONTENTS ABSTRACT ii INTRODUCTION 1 ‘WOM EN’S SAFETY’ IN ARGUMENTS ABOUT PROSTITUTION 2 PATRIARCHAL IM PLICATIONS 13 SUGGESTIONS FOR IM PROVEM ENT 25 REFERENCES 28 iii INTRODUCTION Academic discourse on the legality of prostitution within the contemporary United States can be organized into two broad categories: abolitionists and decriminalization proponents. Advocates of continued criminalization, also known as abolitionists, hope to abolish prostitution by imposing negative legal ramifications on individuals who engage in prostitution. Proponents of decriminalization believe the proper way to address prostitution is to legalize and regulate it. Both positions use a variety of reasons to support their claims, but they both utilize ideas of female safety. Furthermore, both sides use similar definitions and concepts of women’s safety as a cornerstone of their arguments—this reflects protectionist attitudes. These attitudes deserve scrutiny because they reinforce patriarchal views that women are weak, passive, and in need of protection through behavioral control. This project uses the term prostitute to define an individual who sells sexual intercours e; prostitution is used to define this practice overall. While often used interchangeably, sex work and prostitution are not necessarily the same thing. Sex work includes the commercialization of any sex act. This includes pornography, cam girls, exotic dancing, and prostitution. The term “prostitution” as it is used here, is not meant to carry a derogatory connotation, but to provide specificity. Additionally, while prostitution expands across all genders, sexual interactions, time, and space, this analysis will be limited to heterosexual interactions in which a man purchases sexual intercourse from a woman in the contemporary United States. 1 This thesis demonstrates that “women’s safety” serves as a common vocabulary that unites otherwise opposed contemporary academic discourses concerning the legality of 1 There are a few counties in Nevada that have legalized prostitution; these counties are not included in this analysis. 4 prostitution; both sides believe women’s safety is of primary importance. Furthermore, claims about women’s safety in arguments for both criminalization and decriminalization rely on core patriarchal beliefs and assumptions: women need protection, women are inherently victimizable, and women can be protected through control. In addition, the shared emphasis on women’s safety reinforces specific patriarchal gender norms which cast women as weak, vulnerable, submissive, and harmed by sexual interactions and men as aggressive, violent, exploitative, and virile. This pattern suggests that even those initiatives which claim to empower women may also reinforce patriarchal expectations. Part One makes direct comparisons between the arguments presented by advocates of continued criminalization and decriminalization to demonstrate their shared use of female safety arguments. Part Two identifies a patriarchal lens that shapes these arguments about women’s safety. Part Three includes recommendations about how to remove or lessen the patriarchal connotations of these arguments. ‘WOM EN’S SAFETY’ IN ARGUMENTS ABOUT PROSTITUTION Women’s safety is utilized to further arguments for the continued criminalization and for the decriminalization of prostitution in the US. Despite the seemingly disparate trajectories of these opposing arguments, they both rely on claims about protecting women. This section examines how arguments about women’s safety are presented through four prevalent frameworks: physical violence, sexual exploitation, sexual health, and the patriarchy.2 Physical Violence Since 45-75% of prostitutes have experienced violence in association with their work, both advocates of decriminalization and abolitionists seek to protect prostitutes from physical 2 While these are not meant to represent every single poss ible argument, they represent the most commonly argued. 5 violence (Deering, 2014). Physical violence, as it is used here, is the intentional use of physical force to cause a prostitute physical injury or trauma as a direct result of her work (Deering, 2014). Despite their differing solutions, proponents of criminalization and decriminalization rely on the protection of women from physical violence as a basis for their argument. Abolitionists argue that women can be protected from physical violence by eliminating the vulnerability accompanying prostitution. They seek to disallow men from objectifying and harming prostitutes and claim that there is a causal relationship between engaging in prostitution and violence (Vicente, 2016). Abolitionists assert that commercial sexual intercourse places prostitutes in an unsafe position; this vulnerability allows for violence to ensue without set procedures to end or prevent it (Vicente, 2016). Subsequently, abolitionists declare that prostitution should be kept illegal to prevent women from being subject to unavoidable danger and coinciding violence. Abolitionists argue that allowing prostitution to be legal is like allowing an individual to drive a car without a seatbelt or ride a bike without a helmet (Vicente, 2016). Since the constant threat of harm is so immediate and apparent, legal ramifications must be employed. Abolitionists insist that women and men will choose to engage in prostitution less frequently when legal consequences are enforced (Vicente, 2016). In effect, this reduces the number of women engaging in prostitution and protects a greater number of women from being placed in a vulnerable position. In addition, abolitionists argue that prostitution is intertwined with violence because men view prostitutes as objects for their personal consumption (Davison and Geravis, 2015). This objectification emboldens men to view these women as subhuman, thereby justifying violent inhumane treatment.3 Subsequently, in order to end the objectification of women and connected violence, women must disallow men from objectifying them by not 3 This is based on liminality theory. For a more in depth read, view: Kira Hall, Intertextual Sexuality: Parodies of Class, Identity, and Desire in Liminal Delhi, (Journal of Linguistic Anthropology, 2005), 6 participating in prostitution. Abolitionists argue that the most effective way to encourage this is to continually criminalize prostitution because consequences are provided for those that engage in the objectifying dynamics of prostitution. Proponents of decriminalization also acknowledge the physical dangers that arise when engaging in prostitution. However, they argue that protecting prostitutes from physical violence is possible through decriminalization because it removes systematic barriers that endanger women and fosters community building. Decriminalization activists believe that criminalizing prostitution perpetuates violence because of the lack of implemented legal procedure and protection—this endangers prostitutes because they cannot utilize law enforcement in situations of violence without confessing to their engagement (Chateauvert, 2014). Prostitutes’ clients and other associated men actively exploit this vulnerability by abusing prostitutes without suffering major social or legal consequences (Chateauvert, 2014). Subsequently, decriminalization would enable women to utilize formalized legal protections from these dangers to reduce physical violence. Furthermore, decriminalization advocates seek to implement “harm reduction” and “harm minimization” techniques. Drug rehabilitation programs have successfully employed similar techniques for years. These include prostitute peer education, tips to prevent physical violence with clients, and safety guidelines for brothels (Rekart, 2006). This would allow prostitutes to create a community in which knowledge and experiences could be shared—these measures could increase prostitutes’ resilience. Through these approaches, proponents of decriminalization envision a society in which women are protected by being enabled to press charges against violent clients/pimps and to empower one another through their shared knowledge and experiences. Although the two solutions discussed for protecting women from physical violence differ, abolitionists and decriminalization proponents both use the protection of women from male7 violence as a center point for their argument. Abolitionists argue that physical violence happens due to the intrinsically vulnerable nature of prostitution and the active objectification of women by men. M eanwhile proponents of decriminalization believe it is the lack of structural protection from men and the absence of community-based knowledge that endangers women. However, both seek to increase women’s safety from the threat of physical violence and both rely on the assumption that men are inherently dangerous to women. Sexual Exploitation Due to the intimate nature of prostitutes’ work, each side is wary of the sexually exploitative elements of prostitution; both aim to protect women from this. This wariness can be seen in abolitionists’ belief that prostitution is permanently coercive and on par with human trafficking and in decriminalization proponents’ criticism of punitive prostitution policy. Abolitionists argue that prostitution is the economic exploitation and sexual abuse of women (Rekart, 2006). They claim that when money is exchanged for sexual intercourse, prostitution immediately becomes coercive because money coerces sex rather than guaranteeing consent to it; they argue that this makes prostitution a practice of serial rape (M acKinnon, 2011). Furthermore, this constant coercion produces an economic sector of sexual abuse (M acKinnon, 2011). Subsequently, abolitionists argue that prostitution must be kept illegal because women will never be safe within this form of employment. Abolitionists equate prostitution to human trafficking because it entraps women. Human trafficking is defined as any situation of prostitution in which an individual cannot leave (Barry, 1995). Some abolitionists examine the choice ability within prostitution and reason that if a woman is trapped in prostitution due to socioeconomic or societal forces, her work is human trafficking (Barry, 1995). In addition, many abolitionists identify the similarities between pimping and trafficking (M acKinnon, 2011). In both scenarios men transport, transfer, harbor, 8 and receive women for purposes of sexual exploitation (M acKinnon, 2011). Subsequently, pimping and trafficking are often viewed as the same entity within the abolitionist movement (M acKinnon, 2011). Abolitionists’ perceptions of prostitution cause them to seek the removal of prostitution from social life through severe legal ramifications. Proponents of decriminalization believe that the proper way to counteract the sexual exploitation of prostitutes is through legalization. They argue that prostitutes are sexually exploited because punitive laws prevent reporting—decriminalization enables reporting (Albright and D’Adamo, 2017). Proponents of decriminalization argue that prostitution’s criminality disempowers prostitutes from seeking help and having a well-regulated workspace; meanwhile, it enables men to exploit prostitutes without legal ramifications (Albright and D’Adamo, 2017). Furthermore, since prostitutes cannot operate through proper legal channels, they often rely on pimps for protection and for arranging meetings. This reliance enables pimps to abuse their power and control women. However, proponents of decriminalization argue that decriminalization allows women to freely leave prostitution and seek the help of law enforcement if a coercive situation arises (Albright and D’Adamo, 2017). T hrough the support of law enforcement, they argue, prostitutes would not have to rely on pimps and would be able to pursue legal action against those that try to sexually exploit them. Proponents of decriminalization argue that these measures would effectively protect prostitutes from the sexual exploitation associated with their work. Abolitionists and proponents of decriminalization argue that women must be protected from the inevitable sexual exploitation of men. Abolitionists argue that men so actively exploit prostitutes that prostitution cannot be made safe and should be continually criminalized. M eanwhile, proponents of decriminalization argue that through legalization, prostitutes can be 9 protected from exploitative men and autonomy regained. While these solutions vastly differ, the protection of women from men is actively used by both sides to argue for their position. Sexually Transmitted Infections Both sides are concerned for the sexual health of prostitutes due to prostitutes’ frequent sexual contact and number of sexual partners. Prostitutes have a much higher chance of contracting a Sexually Transmitted Infection (STI) than the average population because 35-55% of prostitutes have engaged in unprotected commercial sex, and 10-35% never use condoms while engaging in commercial sex (Hong-Jing et al., 2008). This has led both sides to actively seek a reduction in the transmittal of STIs to protect the sexual health of women. Abolitionists believe that eradicating prostitution will protect the sexual health of women because it will reduce the transmission of STIs. Abolitionists argue that pimps and prostitutes encourage unprotected intercourse because of the cost of condoms and cost-benefit of not using condoms (M ackinnon, 2011). The lack of condom usage compounds with the high number of sexual partners a prostitute has and contributes to the spreading of STIs amongst other prostitutes (M ackinnon, 2011). Abolitionists therefore believe that the best way to eliminate the spread of STIs is to decrease the number of sexual partners for women by disallowing them from engaging in prostitution. This would decrease the likelihood of contracting an ST I. Abolitionists argue that criminalization protects the sexual health of women. Advocates of decriminalization also acknowledge the health risks associated with prostitution—the chance of contracting an STI while working as a prostitute is high.4 However, decriminalization proponents argue that prostitution has not ended due to this danger and will not end because of it. Subsequently, they claim that prostitution should be legalized and regulated 4 The rates of STIs are from 5 to 60 times higher among sex workers than in general populations. 10 through regular screenings for STIs, required condom use, and easy access to health care centers (Singer, 2016). Furthermore, advocates of decriminalization argue that women’s sexual health is endangered when prostitution is criminalized because women do not seek out medical attention when needed because of the illegality surrounding prostitution—this avoidance stems from societally imposed shame, fear of discrimination, and fear of legal ramifications (Singer, 2016). Legalization would decrease medical stigmatization and rid of the discrimination prostitutes face within the medical system, according to proponents of decriminalization (Singer, 2016). Legalization would enable prostitutes to actively seek out needed medical assistance, decreasing the number of women with STIs and increasing the sexual health of those involved in prostitution. While proponents of decriminalization and continued criminalization have vastly different solutions, they both seek to increase the sexual health of women. They both agree that protecting the sexual health of women directly correlates to decreasing the transmittal of STIs. They widely differ in their solutions otherwise. Abolitionists seek to decrease STI transmission by abolishing prostitution completely, whereas decriminalization proponents believe that legalizing, regulating, and destigmatizing prostitution will lead to a decrease in STIs amongst prostitutes. While the mechanisms abolitionists and proponents of decriminalization believe are most effective for decreasing the transmission of STIs differ, they actively rely on claims about the protection of women’s health to further their arguments. The Patriarchy Protecting women from the patriarchy, or male domination, is a major aspect in conversations surrounding prostitution policy. This subsection addresses how abolitionists and decriminalization advocates claim that their preferred policy can help dismantle dominant gender 11 roles and imposed negative effects; this supposedly should protect women from repression and abuse at the hands of men. Both sides believe that protecting women from the patriarchy is vital for the safety of women. They reason that since the patriarchy creates a framework that actively represses women and encourages violence towards women, measures must be employed to protect women from the patriarchy. Both abolitionists and decriminalization advocates argue that gender roles are fundamentally detrimental to the safety of women. Gender roles are beliefs that certain traits, behaviors, and responsibilities are intrinsically tied into an individual’s gender. When individuals stray from gender roles, they are often perceived as abnormal (Haslanger, 2012). Gender roles support the patriarchy because they encourage behaviors that reinforce the idea that men are dominant and sexually virile while women are submissive, weak, and nonsexual. The acceptance of male dominance creates a foundation for men to be aggressive towards women; both sides seek to protect women from this and increase women’s overall wellbeing. Abolitionists and proponents of decriminalization seek to protect women from the patriarchy through their prostitution policy. Abolitionists firmly believe that the eradication of prostitution serves to lessen patriarchal power and therefore improves women’s wellbeing. First, abolitionists argue that prostitution is inherently gendered similar to rape, sexual assault, sexual harassment, and incest; therefore, prostitution is a component and manifestation of the patriarchal institution of heterosexuality (Overall, 1992). Second, they argue that prostitution is the public recognition of men as sexual master and women as a sexually submissive commodity (Pateman, 1983). This amounts to patriarchal oppression because women are assigned to a position of sexual vulnerability in relation to men, which reaffirms the belief that women are naturally submissive in accordance with gender roles (Pateman, 1983). Subsequently, abolitionists argue that prostitution should be eliminated to protect women from these constraining and damaging patriarchal beliefs. Third, 12 abolitionists also argue that prostitution oppresses women because its organized practice testifies to and perpetuates the belief that women’s main value is the use of their bodies for men’s sexual pleasure (Shrage, 1989). Finally, abolitionists argue that unlike other forms of labor mostly performed by women, prostitution is dependent both for its value and for its existence upon the cultural construction of gender roles in terms of men’s dominance and women’s submission (Overall, 1992). Subsequently, abolitionists believe that there is no way to legalize prostitution without furthering patriarchal beliefs that repress women and leave them vulnerable to physical abuse and coercion at the hands of men. They seek to abolish prostitution through continued criminalization in order to protect women from the most egregious expressions of patriarchal power. Decriminalization advocates believe that through decriminalization, women will be better able to actively fight against patriarchal forces that repress them. The idea of disabling the patriarchy through the legalization of prostitution is two-fold: enable women to control their capital and bodies in the marketplace and redefine gender roles. Proponents of decriminalization believe that the threat to women’s safety is not prostitution itself. The threat is the patriarchy’s way of exploiting sexual labor and commercializing the female body. Advocates suggest that decriminalization would enable women to run prostitution operations that ensure health and safety, rather than the exploitative schemes that maintain control over and exploit women currently (Carmen and M oody, 1985). They theorize that the increase of female power would rid of pimps and other male control (Carmen and M oody, 1985). Furthermore, decriminalization advocates argue that the legalization of prostitution allows women to better control their own sexuality. They often view prostitution as an expression of agency or as a model of sex equality in relationships (M ackinnon, 2011). From this perspective, women control the sexual interaction, are compensated for what is usually expected from women for free, have independent lives, and 13 anonymous sex with many partners (M ackinnon, 2011). These behaviors are stereotypically monopolized by men, and some argue that they can liberate women from the dominant constructed gender roles that limit and police women’s sexual behavior (M ackinnon, 2011). Decriminalization proponents argue that the legalization of prostitution will break gender roles, increase women’s bodily autonomy, and rid of men’s control of the commercialization of women’s bodies. Despite the extreme differences in how abolitionists and decriminalization advocates think women’s lives can be improved in relation to patriarchal power, both sides believe that women need to be liberated from male expectations and control. Both sides fight against the normalization of female submissiveness and male dominance in sexual interactions. Abolitionists argue that when women are in a state of increased vulnerability and go against expectations of being nonsexual they are in danger—men will exploit this vulnerability and society will socially punish women for being sexual (Rekart, 2006). Hence, they seek to eliminate prostitution. M eanwhile, proponents of decriminalization believe it is the commodification of women’s bodies by men and the expectation that women are nonsexual and sexually submissive that need to be combatted; decriminalization would eliminate these patriarchal effects on women. While both sides frame their solutions differently, each relies on protecting women from patriarchal effects to further their arguments. Summary From the close comparison of the arguments surrounding female safety, it should be apparent that abolitionists and decriminalization advocates both use women’s safety to further their claims. Not only does this demonstrate that these arguments are not as different as one might expect, but that there is a shared framework used by academics to call for both continued criminalization and decriminalization of prostitution. This framework, I suggest, is rooted in 14 patriarchal norms and expectations. Despite their stated aim to increase empowerment, these arguments may reinforce ideas that harm women. The following section will analyze each previously extrapolated facet of female safety to demonstrate the patriarchal influence on each of these arguments. ‘WOM EN’S SAFETY’ IN ARGUMENTS ABOUT PROSTITUTION In order to analyze the effects of the patriarchy, a concrete understanding of it is necessary. Patriarchy refers to a social system that organizes life based upon behaviors that impose male dominance and female subordination. While this system is made up of various moving parts and is actively sustained by individuals and society as a whole, in no way is any individual the patriarchy. Subsequently, while the patriarchy is often spoken of in terms of individuals and their behaviors—their behaviors “being” the patriarchy, the patriarchy is a system and cannot be reduced to the people within it (Johnson, 1988). This being said, the patriarchy is not a static entity; it cannot survive without the consistent usage, belief, and acceptance of society (Johnson, 1988). Patriarchy is a system that organizes human behaviors by normalizing certain ideas, social relationships, and actions (Johnson, 1988). The patriarchy furthers the idea that manhood and masculinity are most closely associated with being human; meanwhile, womanhood and femininity are relegated to the marginal position of other (Johnson, 1988). This furthers the valuing of masculinity and maleness and devaluing of femininity and femaleness (Johnson, 1988). The devaluation of women instills the belief that men are superior to women and by “nature” more dominant. Furthermore, it enables men to have power over women and feel culturally applauded when they use it (Johnson, 1988). In addition, the patriarchy encourages rules for social relationships shaped by the belief that men are superior to women, men are more human than women, and men can exercise control over women without ramifications. 15 Subsequently, this male-centered system helps produce and normalize male violence towards women (Johnson, 1988). M ale-dominance is also maintained by gender norms and roles. Common gender norms include women being passive, gentle, weak, and non-sexual; while men are dominant, aggressive, and sexual. Gender norms shape people’s actions, motivations, and resistance. Gender roles also define societal functions for each gender (Haslanger, 2012). Since women are “naturally” passive, gentle, and weak, they fit in the roles of mothers, subordinate staff members, and as helpmates to men. M eanwhile men’s perceived dominance makes them suitable for positions of power. These norms and roles are pervasive and significant; society uses them to evaluate an individual’s moral correctness (Haslanger, 2012). People are encouraged to behave in ways that support patriarchal norms in order to receive acceptance and when individuals do not conform, they are socially punished (Haslanger, 2012). The patriarchy encourages the objectification of women. Women are considered lesser than men within patriarchal bounds and are objectified as sexual property valued primarily for their usefulness to men (Johnson, 1988). This dynamic of objectification does not require men to be valued in terms of bodily usability during sexual intercourse—it only requires the reduction of women to objects (Haslanger, 2012). This objectification has been constructed as desirable and encourages men to treat women as objects for their personal consumption (Haslanger, 2012). When combined with men’s dominance, women are reduced to entities purposed for male pleasure that must be controlled (Walby, 1992). The integration of these factors creates a system in which women are consistently in a place of a submission and men in a place of dominance. This designated submission and dominance also encourages the use of physical force against women. 16 In the patriarchy, women are designated as desirable and legitimate objects of male control and men are encouraged to maintain this control through physical violence (Johnson, 1988). This being said, every man does not need to display physical force to gain control because women’s fear of impending physical threats keeps them in a state of submission (Chancer, 1988). Subsequently, women are kept in a place of submission and physically harmed due to behaviors encouraged by the patriarchy. The patriarchy creates a systematic path of least resistance that socially punishes those that deviate—this provides a powerful reason for people to continually behave in accordance with it (Johnson, 1988). Furthermore, when people seek to understand patriarchal mechanisms, they analyze it incorrectly. For example, they seek to understand how men could commit acts of severe violence on women. However, it is not the psychological derangement of a few men that leads to attacks on women, it is a society that creates fertile ground for men to abuse women that leads to frequent violence (Hanmer and Saunders, 1984). Since the patriarchy is pervasive in nature, it is hard to step outside its psychological bounds to examine it. This creates a society in which people passively choose to uphold patriarchal expectations and are unaware of how to actively resist it. Now that a base understanding of the patriarchy has been established the remainder of this section will demonstrate how women’s safety arguments surrounding prostitution are shaped by patriarchal expectations. Physical Violence Abolitionists and proponents of decriminalization both utilize the protection of women from physical violence to present their position on prostitution. These protectionist attitudes are built upon a shared understanding that prostitutes need to be protected from male violence. Patriarchal influence can be observed in their arguments through the normalization of the 17 objectification of women, the understanding that commercial sex acts and violence are intertwined, and the acceptance that some women may be harmed to fulfil male pleasure demands. Abolitionists’ acceptance of the objectification of women demonstrates the effect of the patriarchy on their argument. They argue that women should not be allowed to engage in prostitution because it enables men to objectify the prostitute as a lesser being or even a thing, thereby justifying physical abuse (Davison and Geravis, 2015). This rationale is patriarchal because it normalizes the objectification of women by accepting that women are fated to be the designated objects of desire for men to utilize for their personal pleasure (Johnson, 1998). There is no discussion of teaching men to view women as something other than subhuman objects for their individual consumption nor how to address societal issues that frame such male behavior as acceptable and expected (Johnson, 1998). Abolitionists do not actively condemn and critique men for viewing women as objects and accept that women that engage in prostitution are objectifiable without consequence for those that objectify them. This view inadvertently supports the patriarchal belief that women are less human than their male counterparts. Abolitionists also normalize male violence against women in the context of prostitution by arguing that commercial sexual intercourse and violence have a causal relationship (Vicente, 2016). This reflects, first, the patriarchal tenet that women are nonsexual and are “supposed” to be sexually controlled by a single man (Haslanger, 2012). The postulated “causal” relationship between prostitution and violence signals that severe social punishment is to be expected for women not following patriarchally mandated norms and roles (Haslanger, 2012). However, abolitionists’ arguments usually do not attack the patriarchal premise that women will receive physical violence when they do not follow societally constructed rules surrounding sexual 18 relations. Rather, this violence is accepted as fact and abolitionists reaffirm a patriarchal standard that legitimize male control and even physical abuse of women (Johnson 1998). Advocates of decriminalization often prioritize male pleasure—sometimes even above female safety. Decriminalization advocates employ “harm reduction” strategies —these strategies rely on prostitutes sharing their experiences and advice with other prostitutes to prevent violence, negotiate condom use, etc. (Rekart, 2005). While these strategies may reduce harm and increase condom use, it also accepts that some women will need to be physically abused or manipulated to satisfy male pleasure demands (Nussbaum, 1995). This furthers the patriarchal concept that men, and their needs, are of more importance than women (Johnson, 1998). Furthermore, by placing men’s sexual pleasure even before the physical wellbeing of women, the patriarchal understanding that women should be thought of in terms of bodily usability is furthered (Johnson, 1998). In addition, “harm reduction” strategies echo earlier attitudes from Victorian America—medical authorities sought the legalization and regulation of prostitution in 1870 under the “doctrine of necessity” which argued that men could relieve sexual and physical tension without offending their wives (Rosen, 1982). This patriarchal precedent can be observed in present day “harm reduction” strategies. In both cases, women’s main value is p roviding sexual satisfaction to men who are understood to be intrinsically violent. This demonstrates the antiquated and pervasive concept of women’s objectification and normalization of male-violence within prostitution. Decriminalization proponents tend to accept that male violence will occur within prostitution, because men are supposedly dominant and aggressive (Nussbaum, 1995). This patriarchal belief is based within staunch stereotypic gender roles. Furthermore, it supports the idea that men, especially men that are not your monogamous partner, are intrinsically dangerous. In effect, this belief normalizes the patriarchal practice that when women engage in non-stereotypical gendered 19 sexual behavior they are in danger and will be subject to violence (Haslanger, 2012). Decriminalization advocates’ argument is built upon beliefs that normalize men’s violent domination of women. In sum, arguments that use women’s protection from physical violence to further their claims are based upon the normalization of the objectification of women, an acceptance that commercialized sex acts “cause” physical violence, and a tendency to prioritize male pleasure; these are all patriarchal beliefs. Sexual Exploitation Proponents of decriminalization and continued criminalization both believe prostitutes are in need of protection from sexual exploitation. In making this case, both sides advance patriarchal beliefs. They do so by representing prostitutes as victims, relying on paternalistic perspectives, and accepting that men are abusive. Abolitionists often represent prostitutes as victims. They portray commercialized sexual intercourse as a dominant violent man abusing a submissive, relatively powerless woman. While coercion most certainly can happen in these situations, it is important to acknowledge that a woman is not necessarily weak and without power in these sexual interactions, but often structures the sexual interaction and conveys her expectations. The portrayal of prostitutes as victims relies on the false notion that women are either victims or in complete control of their agency (Schneider, 1995). This is an incorrect dichotomous relationship that is narrow, incomplete, and assumes that victimization and agency are extreme opposites which categorizes women into strict stereotypes that do not actively reflect their lived experiences (Schneider, 1995). Furthermore, victim stereotypes silence the voices of prostitutes (Schneider, 1995). This is a patriarchal move because it reduces women to children who are incapable of making 20 decisions for themselves. When abolitionists use these argumentative mechanisms they reinforce patriarchal expectations that women are weak, innocent, and need to be behaviorally controlled. Abolitionists often conflate prostitution with rape due to the possibility of coerced choice (M ackinnon, 2011). However, by removing agency from women engaging in prostitution, an adult woman participating in sexual intercourse is reduced to a minor in a situation of statutory rape. By reducing prostitutes to children, abolitionists may once again silence prostitutes’ voices and act as a parental figure determining their best interests, implying that prostitutes are incapable of adult rationality and choice (Haslanger, 2012). In addition, the belief that prostitution and serial rape are the same leads to “rescue industries” intent on pulling women from the “depths” of prostitution (Jackson, 2016). This furthers the gender norm that women are submissive and passive individuals who need to be saved. Portraying prostitutes exclusively as victims is a patriarchal gesture that effectively silences and seeks to “rehabilitate” women who have strayed from societally deemed normality. Decriminalization advocates also argue for women’s safety from sexual exploitation in ways that uphold patriarchal expectations. Similar to abolitionists, proponents of decriminalization argue that women are intrinsically vulnerable to sexual exploitation when engaging in prostitution. However, they claim that through the decriminalization and regulation of prostitution, women can in turn seek aid from law enforcement agencies. This relies on a fundamental assumption that women are victims in need of protection. In addition, they envision women seeking help from legal and police forces that are predominantly male, furthering the patriarchal notion that women need to be protected from men by other men. Furthermore, the scenarios presented by decriminalization advocates often normalize and accept that men will sexually exploit women. There is little discussion of how to remove systematic oppressive forces that train and encourage men to be sexually exploitative (Johnson, 21 1998). This silence supports oppressive gender norms by tacitly accepting that men will use force to gain sexual access and that it is primarily women’s responsibility to avoid these tactics. Furthermore, the societally imposed power imbalance between genders is not taken into account within this expectation. The oppressed group is expected to avoid the aggression of societally empowered men. Abolitionists and decriminalization advocates present arguments that not only accept, but reinforce, patriarchal arrangements. The patriarchy relies on the majority of society using it as their framework for understanding and acting in the world (Johnson, 1998). Both parties of the prostitution debate are at fault for using and thereby advancing this framework. Sexual Health Proponents of decriminalization and continued criminalization rely on the protection of women’s sexual health to support their argument. They seek a reduction in the contraction of STIs. Although the mechanisms used by the respective sides to reach this goal vary drastically, both sides rely on patriarchal norms that are paternalistic and seek the control of women’s sexual behavior. Abolitionists seek to eliminate the contraction of STIs in commercialized sexual intercourse. Since abolitionists believe that prostitution is fundamentally nonconsensual, they view the contraction of STIs through said intercourse as increased harm to women (M ackinnon, 2011). Subsequently, they argue that prostitution is intrinsically harmful to women’s sexual health and should remain criminalized. They hope that through the threat of legal ramifications, women will be discouraged from engaging in prostitution and subsequently less women will contract an STI. However, this is a paternalistic attitude that has a patriarchal foundation. Disallowing someone from engaging in an activity for their protection is an action often taken by adults to take care of children. This seems to reduce women to the status of children and suggests that women cannot 22 reliably make decisions for themselves. (Schneider, 1995). Restricting a women’s liberty in order to protect them from harm is a dangerous notion; supposed advocacy can easily be used as a means of control (M azur, 1996). Decriminalization advocates also use the protection of women’s health as a means to further their argument. They believe that through strict regulations, women’s STI contraction can be reduced; proposed regulations include requiring registration as a sex worker and requiring condom use and regular STI testing, etc. Advocates of decriminalization arguably seek control of women’s sexual behavior to protect them from contracting an STI. Yet these regulatory interventions are paternalistic. Similar to abolitionists’ arguments, they seek to restrict the freedom of women in order to protect them. Second, they specifically seek to control women’s sexual behavior, a defining feature of patriarchy (Walby, 1992). Decriminalization advocates often frame a shift in control away from pimps and toward regulated brothels as a positive development (Chateauvert, 2015), yet it is a transfer of control of the sexual behavior of women from pimps to lawmakers. Women cannot be liberated through control. Both sides aim to prevent the transmittal of STIs in the name of women’s health. However, controlling women’s sexual interactions is no more forward thinking than it ever has been. To mistakenly accept that women must be controlled to be protected reduces women to children and denies them autonomy. The Patriarchy The effects of the patriarchy upon prostitutes is widely discussed by abolitionists and decriminalization advocates. Both seek to protect women from patriarchal forces through their preferred legal regime for prostitution, however their arguments ironically may reinforce patriarchy. This tendency is evidenced by the assumption of male control and female passivity, 23 the belief that sex is intrinsically harmful to women, and the assumption that stereotypically male behavior is superior to stereotypically female behavior. Abolitionists frame sexual interactions between prostitutes and their male clientele as a situation of male control over women. However, this relies on the fundamentally patriarchal assumption that a woman cannot control sexual interactions (and that it is properly the role of men to do so). However, prostitutes often do dictate the interaction. They arrange the time and place, determine the exact services to be provided, and expect compensation at the end of the interaction. By presuming it is always a case of coercion, any power the woman had in the exchange disappears from the abolitionists’ argument. This mechanism reduces prostitutes to sexual objects used by men (Shrage, 1989). They are no longer women engaging in prostitution, but instead are “prostituted” by men. Failing to acknowledge that a woman can exercise control within a commercialized sex act supports the passive victim stereotype so often assigned to women. Abolitionists also seem to support patriarchal beliefs when they assume that nonmonogamous and commercial sex harms women. Abolitionists often compare prostitution to rape and incest (Overall, 1992). Rape and incest are both widely understood as intrinsically harmful sexual interactions. By placing consensual prostitution within this category, they are stating that prostitution is also intrinsically harmful. However, labeling all prostitution as harmful also affirms the patriarchal norm of heteronormative monogamy —the idea that proper sexual relations are only fitting between two people of the opposite sex, and that certain behaviors are appropriate or inappropriate within these parameters. So, when a woman engages in monogamous intercourse, abolitionists do not immediately deem it as harmful. However, when a woman has sexual intercourse with multiple men for money, it is likened to rape and incest. Engaging in non-monogamous sex with a prostitute is almost never deemed harmful to men—it 24 is supposedly only harmful to women. This assumption relies on the patriarchal belief that women are nonsexual and only seek the companionship of one man, rendering prostitution a state of misery. Decriminalization advocates also have their assumptions shaped by the patriarchy as they try to protect women from it. This can most easily be observed in their glorification of stereotypically male behavior. Proponents of decriminalization portray that the key to women’s liberation lies in breaking chaste/virtuous feminine gender norm and emulating men by having independent lives and engaging with many sex partners (M acKinnon, 2011). However, this relies on the patriarchal assumption that stereotypically male behavior is superior to stereotypically female behavior and that women should “aspire” to the behavior of men in order to obtain freedom (Johnson, 1998). Even as both sides attempt to protect women from the patriarchy, they are actively reinforcing its existence. This demonstrates the pervasive nature of the patriarchy and the difficulty in reframing one’s mindset from within it. Yet although the patriarchal system has shaped the behaviors, mindsets, and opinions of society at large it is also non-deterministic (Johnson, 1988). By actively working against the pervasive nature of the patriarchy and reframing one’s mindset against it, serious change and improvement can be made (Johnson, 1988). Therefore, the following section will discuss recommendations for more nuanced arguments surrounding prostitution. SUGGESTIONS FOR IM PROVEM ENT Despite arguments of decriminalization and continued criminalization seeming fundamentally opposed on the surface, they both rely on ideas of women’s safety —ideas which, as I have shown, are also patriarchal in character. Nonetheless, the desire to empower women and increase their safety is a positive one. Recommendations for how to remove the patriarchal 25 influence from arguments surrounding prostitution include redefining the path of least resistance, normalizing and accepting women’s power within prostitution, and avoiding the portrayal of women as victims. The patriarchy creates a societal path of least resistance; this path promotes behaviors and values that further the repression of women and the dominance of men (Johnson, 1988). Some examples include men using societally sanctioned force, women taking on behaviors that are submissive in nature, and the belief that gender norms apply to all people within each gender. When individuals follow the path, they tend to be accepted and rewarded by society, while varying from the path leads to societal punishment; this provides powerful incentives for people to follow the status quo (Johnson, 1988). As individuals follow the status quo, they begin to accept that it is the “factual” way of life. The path of least resistance helps explain why both sides of the debate use similar concepts and terms. They are operating within culturally created rules as they work to make their case. (Johnson, 1988). However, for each side to reframe their arguments without patriarchal influence, they must discard these rules and begin thinking beyond this framework. They should investigate patriarchal mechanisms that endanger women and create solutions that actively work against this danger. When arguments are built from this basis, both sides can create paths which allow men and women to exist and operate outside of patriarchal bounds. When these arguments disavow the path of least resistance, they must also accept and normalize women’s power within prostitution. Both sides have developed protectionist attitudes that do not consider the power prostitutes may have. The normalization of women’s weakness by both sides also encourages men engaging with prostitutes to see women as powerless and may even justify forceful behavior. Furthermore, the normalization of women’s power could decrease social stigmatization because it would rehumanize these women in the eyes of society. 26 Finally, the representation of women as victims within prostitution must end. Both sides are guilty of portraying prostitutes as victims through their protectionist language, ideals, and solutions; this actively silences the women who participate in prostitution (Chateuvert, 2015). Furthermore, this depiction dehumanizes women by denying their multi-faceted experiences and reducing them to a single stereotype. Future work should reject this extreme and explore the interrelationship between, and simultaneity of, coercion, consent, victimization, and empowerment within prostitution (Schneider, 1995). This work must seek to understand the social context of women’s oppression which shapes women’s choices, but also acknowledge women’s agency and independence in a more nuanced way (Schneider, 1995). This requires rejecting the dichotomous nature of victimization and agency and investigating the gray area in between these categories (Schneider, 1995). This rejection will allow for a more “textured and contextual analysis of the interrelationship between women's oppression and acts of resistance” in prostitutes’ experiences (Schneider, 1995). If women are no longer simply portrayed as victims, it is possible to understand and substantially improve women’s lives. In conclusion, by creating a positive path that disavows patriarchal patterns, normalizes women’s power, and no longer assigns prostitutes to the roles of victims, positive change can be made. Approaches that consider women’s complex and varied circumstances can foster better solutions which actively fight against patriarchal beliefs and practices. 27 REFERENCES Albright, E. and D’Adamo K. (2017). Decreasing Human Trafficking through Sex Work Decriminalization. AMA Journal of Ethics, 19(1), 122-126. Retrieved from: https://journalofethics.ama-assn.org/article/decreasing-human-trafficking-through-sexwork-decriminalization/2017-01 Barry, K. (1995). The Prostitution of Sexuality. New York University Press, 62. from: http://openaccessbooks.nyupress.org/details/9780814712771/ Retrieved Beechey, V. (1979). On Patriarchy. Feminist Review, 3(1), 66-82. Retrieved from: https://journals.sagepub.com/doi/full/10.1057/fr.1979.21 Carmen, A. and M oody, H. (1985) Working Women: The Subterranean World of Street Prostitution. Harper and Row, 2. Chancer, L. (1998) Reconcilable Differences: Confronting Beauty, Pornography, and the Future of Feminism, Berkeley, 42. Chateauvert, M . (2013). From Stonewall to Slut Walk. Beacon Press, 4-542. Davidson, M . and Geravis, S. (2015) Violence Against Women Through the Lens of Objectification Theory. University of Nebraska, 21(3), 331-349. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/24625169 Deering K., et al., (2014). A Systematic Review of the Correlates of Violence Against Workers. AMJ Public Health, 104(5) 42-54. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/24625169 Hanmer, J. and Saunders S. (1984) Well-Founded Fear: A Community Study of Violence to Women London: Hutchinson in association with the Explorations in Feminism Collective. Haslanger, S. (2012). Resisting Reality: Social Construction and Social Critique. Oxford University Press, 46. 28 Sex Jackson, C. (2016). Framing Sex Workers Rights: How US Sex Workers Perceive and Respond to M ainstream Anti-Sex Trafficking Advocacy. Sociological Perspectives, 59(1), 27-45. Retrieved from: https://journals.sagepub.com/doi/abs/10.1177/0731121416628553 Johnson, A. (1998). The Gender Knot: Unraveling our Patriarchal Legend, American Sociological Association, Contemporary Sociology, 77-91. M ackinnon, C. (2011). Trafficking, Prostitution, and Inequality. Harvard Civil Rights Civil Liberties Law Review, 271(46), 276. Retrieved from: https://heinonline.org/HOL/LandingPage?handle=hein.journals/hcrcl46&div=14&id=&p age= M azur, D. (1996). The Beginning of the for Women in the M ilitary. Florida College of Faculty Essays, 74(1), 452-471. Retrieved from: https://scholarship.law.nd.edu/ndlr/vol74/iss1/1/ Law Nussbaum M . (1995). Objectification. Philosophy and Public Affairs, 265-281. Retrieved from: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1088-4963.1995.tb00032.x Overall, C. (1992). What’s Wrong with Prostitution? Evaluating Sex Work. The University of Chicago Press, 17(1), 705-724. Retrieved from: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1088-4963.1995.tb00032.x Pateman, C. (1983). Defending Prostitution: Charges Against Ericsson. The University of Chicago Press, 93(3) 561-565. Retrieved from: https://www.feministes-radicales.org/wp-content/uploads/2010/11/Carole-Patemanagainst-contractarian-defense-of-prostitution.pdf Rekart, M . (2006). Sex-work Harm Reduction. The Lancet, 366(9503), 2123-2134. Retrieved from: https://www.sciencedirect.com/science/article/pii/S014067360567732X Rosen, R. (1982). The Lost Sisterhood: Prostitution in America. John Hopkins, 1900-1918. Schneider, E. (1995). Feminism and the False Dichotomy of Victimization and Agency. Brooklyn Law School, 389-414. Retrieved from: https://brooklynworks.brooklaw.edu/cgi/viewcontent.cgi?referer=&httpsredir=1&article= 1356&context=faculty Shrage, L. (1989). Should Feminists Oppose Prostitution. The University of Chicago 99(2), 347-361. Retrieved from: https://philpapers.org/rec/SHRSFO 29 Press, Singer, P. (2016). The Case for Legalizing Sex Work. Princeton University, Project Syndicate. Retrieved from: https://www.project-syndicate.org/commentary/case-for-legalizing-sex-work-by-petersinger-2016-11?barrier=accesspaylog Vicente, A. (2016). Prostitution and the Ideal State: A Defense of a Policy of Vigilance. Theory and Moral Practice, 19(2), 475-487. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/24625169 Ethical Walby, S. (1992). Theorizing Patriarchy. The British Journal of Sociology, 43(2) 224Retrieved from: https://www.jstor.org/stable/i225017 231. 30 University of Utah UNDERGRADUATE RESEARCH JOURNAL THE UNIVERSITY OF UTAH’S INTERPROFESSIONAL STUDENT HOTSPOTTING COLLABORATIVE: AN INFORMAL PROGRAM ANALYSIS Stormy Foster-Palmer (Faculty Mentor: Susan Hall, College of Nursing) Department of Health Society and Policy ABSTRACT Hotspotting is a nationwide data-driven intervention that aims to reduce health care costs and improve health outcomes for vulnerable patient populations by addressing social determinants of health (Gawande, 2011). The Hotspotting model was implemented at the University of Utah in the year 2016. Previously the program recruited patients from one location, a housing facility, but in 2018, the program expanded to involve individuals from the Salt Lake City community. The present two-pronged study is an informal analysis of the University of Utah’s 2018-2019 Hotspotting cohort. First, logbook entries completed weekly by each of the eight Hotspotting teams were used to extract common challenges, goals, and successes experienced by the participants. The second component of this study is an analysis of Hotspotting participant interviews conducted by a nurse practitioner graduate student, to analyze what participants found useful in the program, as well as what may have hindered progress on their health goals. A total of eleven patients participated in the 2019 Hotspotting cohort. These analyses will be used to highlight the current strengths and weaknesses of the program, and provide a basis for recommendations on how the program can develop moving forward. The most significant finding was that about 46% of the challenges faced by this cohort were social, mental, and emotional, rather than clinical in nature. Strengths of the program include the ability of the teams to build rapport with the participants and motivate them to reach their goals, and ultimately feel cared for. Barriers to optimal functioning of the program included delay in consenting, stress about the limited timeline of the program, and major communication barriers between caseworkers and patients. TABLE OF CONTENTS ABSTRACT ii INTRODUCTION 1 LITERATURE REVIEW 3 METHODS 8 RESULTS 10 DISCUSSION 16 CONCLUSION 19 APPENDIX 20 REFERENCES 23 INTRODUCTION Male. Mid-50’s. Overweight, pre-diabetes, high blood pressure. He’s a smoker and has emphysema. Seizures. Struggles climbing stairs or walking long distances. Not monitoring diabetes, and blood sugar is wildly uncontrolled. Isn’t sure how to manage prescriptions or diet, and needs assistance securing necessary durable medical equipment. 35 medications listed. Unemployed. No car. He lives alone. Limited family contact, few friends. But his dog, Diamond, is with him at all times. He loves his dog. In the last six months, he had visited the emergency room (ER) one to two times a month. (McLean, personal communication, 2018). Surprisingly or not, this type story is common, especially for those termed “superutilizers,” or frequent fliers of the ER who also endure many inpatient hospital visits. These individuals tend to face a diverse spectrum of complex health and social problems in their dayto-day lives (Moe, et. al). This sector of the population contributes significantly to the cost of healthcare (Ostermeyer, et al., 2018). But even more concerning, with all of their contact with the healthcare industry, this population’s health outcomes aren’t improving. Their care lacks coordination, continuity, and most importantly someone to listen to their story. “Super-utilizers” are individuals with chronic and complex health and social issues, who also over-utilize the ER, which contributes significantly to high healthcare costs. The Center for Healthcare Strategies (2013) offers a well-encompassing definition of super-utilizer as, “individuals whose complex physical, behavioral, and social needs are not well met through the current fragmented health system.” Many of the individuals in this population experience complex social issues including lack of transportation, “a higher prevalence of chronic illness, psychiatric comorbidity, and lower socioeconomic status” (Moe, et. al, 2017). In addition, many experience addiction, are or have been homeless and sometimes have criminal histories (Hasselman, 2013). All of these can make continuity of care particularly challenging. High cost and poor health outcomes currently characterize the U.S. health system (cite). Hotspotting is a data-driven intervention, which aims to reduce health care costs and improve health for vulnerable patient populations by addressing social determinants of health for these “super-utilizers”. Social determinants of health are defined as “conditions of the places where people live, learn, work, and play.” (See Figure 1 and 2 in Appendix) This paper introduces the Hotspotting model and its recent implementation at the University of Utah. The overarching goal of this paper is to evaluate the effectiveness of this program using existing qualitative data. The Hotspotting logbooks and results of the guided participant interviews, will offer insight as to how a Hotspotting team working with complex patients to improve the quality of health and life can also affect the social determinants of health. This research provides insight into how Hotspotting could be a mechanism to improve the quality of health, and life, for complex patients in Utah, as well as the United States. LITERATURE REVIEW The cost of healthcare in the United States is higher than ever with healthcare expenditures reaching 17.9% of GDP in 2016 (“National Center for Health Statistics,” 2017). Over half of U.S. healthcare costs are attributable to only five percent of the population (Brenner, Doyle, Finkelstein, Taubman, & Zhou, 2014). Compared to other high-income nations, the U.S. spends nearly double that of other nations on healthcare (Papanicolas, Woskie, & Jha, 2018). Given this extravagant investment, shouldn’t Americans be the healthiest as well? Existing literature asserts otherwise. In a 2018 study, Papanicolas et. al found that out of eleven OECD (Organization for Economic Co-operation and Development) countries, the United States scores lowest on significant measures of health including life expectancy and scored highest in overweight and obesity percentage, and infant mortality. This study also found that although the U.S. spends about the same amount on social services as other states, it allocates much of its social spending budget on healthcare, instead of other social services. One argument that attempts to explain this disparity is that spending on healthcare services, administration, expensive equipment and higher doctor salaries isn’t going to improve health outcomes, but investing in the social determinants of health will (“For the Public’s Health,” 2015). Perhaps directing this attention to social determinants of health can alleviate these adverse health outcomes in the US, while reducing the costs associated with frequent ER visits. The importance of targeting and focusing on social determinants of health is growing (Butler, 2017; Adler, Glymour & Fielding, 2016). Social determinants of health are factors that profoundly affect health status and can produce health disparities, including education, employment, socioeconomic status, living environment, social support systems, access to healthy food, and access to health services (Artiga & Hinton, 2018). Evidence is growing indicating how these kinds of social factors can adversely impact health. For example, chronic stress can produce negative health outcomes for all ages (Artiga & Hinton, 2018). Health is much more than just physical health and being sick. In fact, the World Health Organization (1948) defines health as, “a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity.” An additional barrier for this population is the difficulty associated with not having a “usual source of care” (USC) (Liaw, 2014). In a cross-sectional study conducted by Liaw et al., the findings revealed an association between insurance type and ER use. For nearly 22% of individuals enrolled in Medicaid and over 24% of uninsured individuals more than half of their medical visits took place at the ER (Liaw). The ER is required to treat individuals whether they are insured or not, creating a major financial burden, that could be prevented (All, 2010). Repeated visits to the ER, and repeated inpatient stays reflect an inept health system that is not adequately tending to the health of these vulnerable patients. Research on interventions to address social determinants of health and reduce healthcare costs is ample, but finding the most effective and efficient strategies is more difficult. According to a review of 31 studies on interventions used to address frequent use of the ER, it is well established that frequent ER users utilize more healthcare than others (Moe, Kirkland, Rawe, Ospina, Vandermeer, Campbelle, & Rowe, 2017). In addition, this review revealed that there are interventions that can successfully reduce the number of ER visits by super-utilizers. Over half of the studies reported a decrease in ER visits, and several studies reported that some interventions helped patients find stable housing, indicating program effectiveness at addressing social determinants of health. It is estimated that approximately one-third of ER visits are preventable (Riley, Golde, & Kayam, 2017), making interventions diverting use of the ER to primary care especially valuable. Interventions that address both utilization and the underlying social determinants of health may be effective at driving down costs and improving quality of life. It is important to resolve unanswered questions regarding this patient population. For example, why are patients going to the ER? Why do they keep going to the ER? Questions like these require listening to individual patient stories and cannot only be analyzed quantitatively. Implementing a framework that puts the patient at the center, and prioritizes their unique story, has the potential to not only improve patient care and quality of life, but also may improve/impact how physicians care for their patients. The benefits of improving the quality of life for these complex patients, while simultaneously lowering healthcare expenditures, are enormous. Background on Hotspotting The Government Sustainability Office (2015) reports that about 5% of Medicaid patients consume half the costs of the program. According to the Agency for Healthcare Research and Quality, “the top 1 percent of persons ranked by their health care expenditures accounted for 22.8 percent of total health care expenditures” (Mitchell, 2014). In an effort to address the disorganized, inefficient and even “passive” use of the healthcare system, Dr. Jeffrey Brenner developed Hotspotting. His objective was to target this 20% of patients, called super-utilizers, and improve their quality of care. Dr. Brenner discovered these discrepancies in Camden, New Jersey’s healthcare system while working with a database he prepared for the Camden police department that detailed visits to the ER by crime victims (“A Revolutionary Approach,” 2014). In working extensively with this data, Dr. Brenner mapped insurance claims to understand more about Camden’s healthcare utilization. Dr. Brenner found that, “20% of the population were 90% of the costs,” (“A Revolutionary Approach,” 2014). This database was later adapted to incorporate data sharing from other healthcare institutions in the Camden region, and is now called the Camden Coalition Health Information Exchange. Hotspotting Criteria For a patient to qualify for the Hotspotting program, they must be a super-utilizer, as defined above, and have the following criteria (Brenner, Doyle, Finkelstein, Taubman, & Zhou, 2014): 1. At least two hospital admissions in the last six months 2. Have at least two chronic conditions (e.g., diabetes, heart disease) 3. Have at least five prescribed medications In addition, the Camden Coalition’s model of Hotspotting has three main components (“A Revolutionary Approach”, 2014): (1) Database. Access to data regarding emergency room visits, inpatient stays, and frequent utilizers is a necessary component of this model. This allows practitioners to identify those who have the highest need of the Hotspotting intervention as well as those will receive the most benefit from it as well. (2) Care Management Team. In the context of Camden’s original care management teams, they were designed to include health professionals from a variety of different backgrounds. This interprofessional team traditionally consists of a nurse, social worker, health coach or volunteer, and a community health worker. The team is trained with a curriculum created by the Camden Coalition. (3) Coordination of Care. After a patient has been identified and consented to participate, the interprofessional care team makes frequent home visits to assist in coordinating the patient’s care. The purpose of this team is to work with the patient on navigating the health system, help coordinate their care, communicate with their healthcare team, and establish continuity of care with a primary care physician. To graduate from the Hotspotting program, the end goal is that the team has successfully coached them on how to manage their health independently. Along with these three components, Hotspotting utilizes a specific curriculum designed to equip health workers in the program with a strong skill set for interacting with Hotspotting participants. The curriculum is organized by the following themes: Motivational Interviewing, Programmatic Operations, Trauma Informed Care, “COACH”, Harm Reduction, Safety, and Leadership. COACH is an acronym standing for (“Camden Coalition Hotspotting Curriculum,” 2018): C: Connect tasks with vision and priorities O: Observe the normal routine A: Assume a coaching style C: Create a backwards plan H: Highlight progress with data The purposes of the COACH model are to aid Hotspotters in cultivating a genuine partnership with their participant and help them to set and meet their goals. Motivational interviewing, another component of the Hotspotting curriculum, is effective in guiding patient visits and avoiding “Yes/No” answers to questions. Another component implemented in the 2018-2019 Hotspotting program at the University of Utah, is the use of the Connect2Health database. This database contains hundreds of local resources that patients can be connected with. For example, this database can help participants of the Hotspotting program find resources for consistent transportation, access to needed health equipment, etc. METHODS This study examined the Logbook entries of the eight teams participating in the University of Utah’s Interprofessional Hotspotting Student Collaborative from September 2018 to April 2019. Most teams work with a single patient; a few teams were assigned to work with two patients. The logbooks are filled out by the students participating in the Hotspotting program about their experiences with their patient. The Logbooks utilize a specific framework asking the students to respond to the following prompts: • Encounter dates, locations, and team members present • Engagement with health or social services providers • Progress toward patient goals and/or change in patient goals • Hotspotting Curriculum Utilization: how are you applying your learning? • Planning: what's next? • Challenges: where are you stuck? This year the program included a team from Arizona in the program. However, this analysis will only include the eight Utah teams, and their respective ten patients. A total of 112 logbooks were analyzed and information was extracted regarding challenges, successes, goals, and goals of the participants. In addition, mentions of features about the program that were effective or ineffective were also taken note of. The extracted data were organized into four spreadsheets, one for each of the following: challenges, successes, goals, and Hotspotting program functioning. The categories included in the first three spreadsheets are: Emotional/Mental, Social, Environmental, Physical Health, Medications, Appointments, Attitude toward healthcare system/ providers, Healthcare, and “Related to Hotspotting.” In addition, since the original intention for Hotspotting was to reduce hospitalizations and ER visits, the number of ER visits/ hospitalizations that were recorded in the logbooks was also noted. The fourth spreadsheet details the Hotspotters’ perspectives on their patient/ patient interactions, and the program challenges and successes that they identify. For the patient interview components of this study, a graduate student in the nurse practitioner program conducted semi-structured interviews with the participants of Hotspotting. The aim of his research differs from the aim of this study. However, the questions are direct and ask the participants about their opinion of their Hotspotting experience. His questions include: 1. How would you describe your overall physical and mental health in the past 30 days? What is your expected level of health at this time? Ultimately, what is your preferred level of overall health? 2. What interactions have you had with the Hotspotting team in the previous 30 days? How did the interactions go? 3. How does the Hotspotting team help you in achieving your overall health goals? 4. How does the Hotspotting team hinder you in achieving your overall health goals? 5. What are your expectations for the Hotspotting team in participating with your healthcare and personal needs? Cochrane’s research is ongoing and will include more interviews, however for the purposes of this study, the interviews of eight patients will be analyzed. RESULTS The Logbooks Logbook results reflect the categorical separation used for analysis. After reviewing 112 logbooks from eight teams, several themes have been identified. “Frequency” indicates number of teams that mentioned a particular challenge, success, or goal related to their participant. (See Appendix Figures 3-6) Challenges. The overarching challenges experienced by patients include anxiety, depression, lack of hobbies/ friends, lack of transportation, unhealthy diet (high in fat and sugar), and feeling mistreated by their healthcare team. Thirteen different issues were reported falling under the Emotional/Mental category. Of these, anxiety and depression were the most common. However, loneliness and shame were the next most frequently reported as being participant challenges. Grief and “trouble caring for self,” were issues for two participants in the program. (See Appendix Figure 3) In the “Social” category, lack of hobbies and friends, was the most commonly mentioned issue, with separation from loved ones, caregiver burnout and “condition inhibiting participant from doing activities,” following. Drug/tobacco use, communication, and not leaving their home (due to social isolation or social anxiety), were challenges experienced by two participants. While air quality, “living in an unsafe neighborhood,” and insanitary living environment were some of the challenges listed in the Environmental category, the most significant challenge for this population was transportation- whether it be an explicit lack of transportation, or other issues regarding transportation. “Physical health” is difficult to analyze without having access to participant electronic health records. However, based solely off the logbook entries, the most common physical health issue was diet, specifically a diet high in fat and sugar. Close behind this were weight and pain. Daily oxygen therapy, diabetes, and asthma are also common in at least two participants. Challenges related to prescriptions included that participants are either taking numerous medications, or they aren’t taking their medications at all. A couple of teams reported that participants had been missing and canceling their appointments. In the “Attitude toward healthcare system/ health workers,” four logbooks mentioned that the participant feels they are being mistreated or treated unfairly by the health workers they have interacted with. Another trend is that many participants experienced challenges with their caseworkers - either the caseworker stopped communicating with them or left the job entirely. Goals. According to the logbooks, a total of six patients expressed the goal of wanting to go back to school or get a job. As far as Social goals, five patients wanted to cultivate friendships and participate in or find new hobbies. Several patients wanted the Hotspotting team’s help with organizing all of their health-related information into a central place. (See Appendix Figure 5) The most common “Environmental” goals were moving into a different home and getting transportation. Creating a better diet and exercising more often were common goals in this cohort for ways they wanted to improve their physical health. As in the challenges section, anxiety and depression have resurfaced in the goals section: participants want to improve their anxiety and depression symptoms to improve their emotional and mental health. The number one healthcare-related goal was establishing care with a new primary care physician, caseworker, and therapist. Getting help in making appointments was also a common goal. Successes. Categories for this section included: Related to the Hotspotting Team, Emotional/Mental, Educational/Occupational, Social, Environmental, Physical Health, Medications, Appointments, and Attitude toward healthcare system/ providers. (See Appendix Figure 4) The most prevalent success specifically noted in five logbooks was “building rapport with patient,” with “good listening and communication skills,” second. Transportation posed a huge barrier for many participants, however transportation is also cited as a success. Seven logbooks mentioned successful scheduling of appointments with participants’ healthcare teams. Among other successes, gaining confidence, finding a job, and engaging in hobbies/social activities were some of the many small victories this cohort of Hotspotting participants experienced. Hotspotting Program. This section details the Hotspotters’ perspectives shared (sparsely) throughout the logbooks. There were many mentions of patient interactions from the students’ perspective that are worth mentioning. Most frequently, students reported in their logbooks that their patients simply wanted someone to listen to their story. Other mentions related to patient interactions included the challenge of patients wanting to leave the program, as well as finding boundaries with the patients. (See Appendix Figure 6) Program features that the Hotspotters found effective include the “COACH” curriculum, motivational interviewing, and use of the Connect2Health database. Additionally, using data to highlight patients’ progress with their goals, a component of the “COACH” model, was deemed effective at empowering patients and improving their self-esteem. Participant Interviews The interviews with the participants that the teams interacted with help provide an understanding of what is working in the program and what isn’t working- from the patients’ perspective. This perspective is incredibly important moving forward in efforts to improve the program. The patient experience. Overall, Hotspotting participants report nothing but great reviews of the Hotspotting teams themselves. The most common themes shared by participants about their experiences with the Hotspotting teams included that the teams were attentive and listened to the participant, had a nonjudgmental attitude, the teams were very supportive and did not in any way hinder them from reaching their goals. Several participants specifically noted that the Hotspotting team successfully helped the participants better navigate the healthcare system. Participants valued that each team member was from a different specialty and could offer a slightly different perspective. In addition, a couple participants felt that their interactions with the Hotspotting team offered the structure of accountability, empowerment and confidence. Participants especially valued the fact that the teams had high energy and motivation, and that this program is mutually beneficial. Lastly, being surrounded by highly motivated individuals that genuinely wanted to help had a lasting impact on these individuals. Barriers and challenges. The most common barrier experienced for the participants in the program (and the students) was difficulty with communication, especially when incorporating the caseworkers. Several participants also reported that they felt they needed to make progress on their goals so that they wouldn’t disappoint the team, or that the Hotspotters wanted them to succeed more than the participants themselves wanted to succeed on their own behalf. “Bad timing” was also mentioned. Several patients expressed frustration in the delay in consenting causing them to have less time with their team. Confusion about what the Hotspotting team is for also surfaced as a challenge. Lastly, scheduling visits and aligning schedules with the teams also posed a challenge for this cohort of patients. Room for improvement and recommendations. One participant made the recommendation of providing participants with a Hotspotting team “roster” with the names, programs, and a photo of the Hotspotting team member. This recommendation is echoed by several of the patients mentioning that they had a difficult time remembering names as well as what each individual “specialized” in. Caregiver burnout surfaced as an issue twice in this cohort, and one participant recommended that the Hotspotting teams could also help to connect caregivers to resources for dealing with burnout. Participants also expressed that they would like the Hotspotting teams to know more about the participants’ medical histories. This is thought to better assist the teams in assisting the participants. A few participants wished that they could have taught the team something new in return for all of the help they received. Nearly all of the participants mentioned that communicating through case workers was ineffective and frustrating. Direct communication between the Hotspotting team and the participant was recommended. Limitations The small data set included in this study limits the generalizability of this data. All data used to analyze was extracted from the logbooks so this analysis is limited by the completion of the logbooks and how much information was provided in the logbooks. The logbook analysis is also limited in that students may not be as forthcoming about challenges they experienced in an assignment setting and they would be in something more informal that does not count for their grade. In addition, other challenges, goals, and successes may have occurred in this cohort of the program that were not represented in the logbooks, therefore further limiting this analysis. Though participant perspectives are essential to include in a program analysis, there are a few limitations to this study’s examination of the participants’ interviews. First, due to recall bias, and second, this study is not longitudinal, so any changes in patient perspectives over time are not captured. Evidence for Hotspotting’s efficacy in reducing healthcare costs is not yet available as several effectiveness studies are still underway (“Camden Coalition hits enrollment,” 2017). The fact that there is lacking research in this area of health care interventions reveals the importance of this study. Regardless of the aforementioned limitations, this research is crucial as this is the first year that logbooks have been utilized in the program and this study will provide insight into the pragmatism of the logbook entries. Additionally, this research provides invaluable insight into the participant and Hotspotter experiences and constitutes a case study to be utilized as a guide for future programs. DISCUSSION Though originally designed as a methodology for reducing costs and creating better health outcomes, Hotspotting could be one of many ways to bring back the human component of health by addressing the social determinants of health, and focusing on the patient’s experience. Analyzing how this intervention can do just that was the goal of this research. One major theme in the Logbook data set is that the most pressing goals and challenges that the Hotspotting particpants faced had less to do with their health, and more to do with all other aspects of their lives: the social determinants of health. About 46% of the challenges experienced by this cohort were not clinical and instead involved social, environmental, and emotional/mental challenges further emphasizing the importance of social determinants of health. This was the first year that Logbooks were implemented, and this research proves that the entries can be useful in extracting the challenges that the super-utilizer population faces. Clearly, the logbook entries can provide invaluable information into the Hotspotting experience on behalf of both of the teams and the participants. From the logbooks, we can analyze the most common challenges experienced by this Hotspotting cohort, as well as extract recommendations for improvement. The participant interviews add another layer to the logbook analysis with the direct perspectives of the participants being presented. Several themes revealed themselves in this analysis. In reference to the Hotspotting program itself, the COACH model, motivational interviewing, and the newly implemented Connect2Health database access all proved to improve the Hotspotting experience for the teams in effectively facilitating meaningful discussions with the participants, establishing goals, and connecting them to needed resources. A significant challenge experienced by two teams in this program was retaining their patient’s participation. Reasons for participant resignation could include delay in time between consenting and meeting the team, or “bad timing,” meaning that the team cannot effectively assist a participant who isn’t ready to make changes yet. The ability for the Hotspotting teams to build strong rapport with their participants is both important and one of the most common outcomes from the teams of this cohort. Instituting the Hotspotting curriculum into the program for any caregiving role could improve the patienthealth worker relationship, and enhance both the caregiving and the care-receiving experiences. This study has implications beyond the Hotspotting program. For example, several participants mention that they feel mistrust toward the healthcare system and their own healthcare team. This is a detail that cannot go unnoticed. For patients to heed the advice of their health practitioners, the need to maintain some kind of trust in them- this issue calls for more attention and care in cultivating a healthy physician-patient relationship. Another trend was burnout among caregivers and caseworkers implicating the need to improve support services for caseworkers and provide resources for caregivers. Recommendations for next year’s program include: 1. Beginning the consenting process early and ensuring it is thorough and the participants are aware of what the program entails. 2. Distributing a “team roster” to each participant including the names, pictures, and specialties of each member on their team. 3. Streamlining the communication process, by supporting direct patient-team communication without having to rely on a caseworker to relay information back and forth. In addition, incorporating participant interviews as a routine part of the program could allow for continual program improvement. Future Research Future research should entail effectiveness studies of the University of Utah’s Interprofessional Hotspotting Program, as well as the programs at the Camden Coalition’s other hubs. In addition, though it is well established that Hotspotting can help health practitioners and students, future qualitative research reflecting the patients’ experiences in the Hotspotting program would be valuable. One question remains: Is our healthcare system prepared to make this intervention widespread? This prospect looks unlikely, unless the U.S. health system can undergo a holistic shift in its delivery of care model. From one primarily focused on treatment, rather than prevention. One that is reactive, not proactive. But perhaps Hotspotting can be a mechanism to connect the elements of our fragmented, disorganized, and ineffective health system. Perhaps the Hotspotting program can reshape how prospective medical and healthcare professionals are trained by revealing an area in health that should be looked into further as a mechanism for teaching the significance of the social determinants of health and compassion. And perhaps Hotspotting has the possibility to bring the importance of patient’s stories to the forefront of caregiving. CONCLUSION Remember the anonymous patient information shared at the beginning of this paper? With help from this Hotspotting team at the University of Utah last year, he lost weight and lowered his hemoglobin A1C (a measurement of glucose in the plasma of blood). He obtained medical equipment he needed and learned how to better control his seizures with medication, which were two of his goals. But since the intervention, more is known about who he is and what he’s like. He’s lonely and quiet. Shy at first. But once he warms up, he’s quite vivacious. Turns out he has a great sense of humor. He’s very open about his “sugar addiction,” and he loves chocolate. He loved to banter with his Hotspotting team. And of course, now he is more able to play with his dog, Rudy (McClean, personal communication, 2018). APPENDIX Figure 1. University of Wisconsin Population Health Institute. (2014). County Health Rankings Model [Describes the social determinants of health]. Retrieved April 2, 2019, from http://www.countyhealthrankings.org/explore-health-rankings/measures-data-sources/countyhealth-rankings-model Figure 2. Henry J. Kaiser Family Foundation. (2018, May 10). Social Determinants of Health [Chart detailing what comprise social determinants of health]. Retrieved April 2, 2019, from https://www.kff.org/disparities-policy/issue-brief/beyond-health-care-the-role-of-socialdeterminants-in-promoting-health-and-health-equity/ Challenge Scheduling conflicts Anxiety Depression Lack of friends and hobbies Lack of transportation Diet Mistreated by health care team Confusion about what Hotspotting is Shame/ Discomfort in public Lonliness/ Isolation Separation from loved ones Family caregiver burnout Condition prevents participation in activities Pain Caseworker communication issues Weight Taking multiple medications Canceling appointments High cost of healthcare Complex healthcare system Frequency 4 4 4 4 4 4 4 3 3 3 3 3 3 3 3 3 2 2 2 2 Figure 3. Table listing the most commonly reported challenges in the Hotspotting logbooks. Successes Building good rapport with patient Coordinated transportation Helped patient set up appointment Good listening and communication Patient engaged in hobbies Patient established care with new PCP or therapist Frequency 5 3 7 2 2 2 Figure 4. Table listing the most commonly reported successes in the Hotspotting logbooks. Goals Be more social, get friendships and hobbies Get a job/ return to work Improve diet Exercise more frequently Improve anxiety Improve depression "Fix" relationship with PCP Organize all health-related information into central location Go back to school Move into different housing Establish transportation Find new PCP Establish care with a therapist Help making appointments Frequency 5 4 4 4 4 4 3 3 2 2 2 2 2 2 Figure 5. Table listing the most commonly reported goals in the Hotspotting logbooks. Hotspotter Perspectives Patient "Just wanted to tell their story" Patient left program/ did not respond to communication Creating boundaries with patient Program Challenges Concerns about length of program Scheduling difficulties Program Successes Use of curriculum "Highlighting progress with data" Use of Connect2Health Frequency (teams) 4 2 2 4 2 3 3 3 Figure 6. Table listing common themes from the Hotspotters’ point of view as expressed in the logbooks. REFERENCES Adler, N. E., Glymour, M. M., & Fielding, J. (2016). Addressing Social Determinants of Health and Health Inequalities. JAMA, 316(16), 1641. doi:10.1001/jama.2016.14058 All, A. (2010). Addressing the Inadequacies of the Current Healthcare Model with a Universal Healthcare System in the United States. World Medical & Health Policy, 2(1), 353-364. A Revolutionary Approach to Improving Health Care Delivery. (2014, February 1). Retrieved September 30, 2018, from https://www.rwjf.org/en/library/articles-andnews/2014/02/improving-management-of-health-care-superutilizers.html Artiga, S., & Hinton, E. (2018, May 11). Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity. Retrieved November 12, 2018, from https://www.kff.org/disparities-policy/issue-brief/beyond-health-care-the-role-of-socialdeterminants-in-promoting-health-and-health-equity/ Awdish, R. L., & Berry, L. L. (2017, October 09). Making Time to Really Listen to Your Patients. Retrieved November 14, 2018, from https://hbr.org/2017/10/making-time-toreally-listen-to-your-patients Bedoya, P. W., Neuhausen, K. M., Dow, A. S., Brooks, E., Mautner, D., & Etz, R. (2018). Student Hotspotting: Teaching the Interprofessional Care of Complex Patients. Academic Medicine, 93(1), 56-59. Brenner, J., Doyle, J., Finkelstein, A., Taubman, S., & Zhou, A. (2014). Health Care Hotspotting in the United States. Retrieved November 11, 2018, from https://www.povertyactionlab.org/evaluation/health-care-hotspotting-united-states Butler, S. M. (2017). Building Blocks for Addressing Social Determinants of Health. JAMA, 318(19), 1855. doi:10.1001/jama.2017.16493 Camden Coalition hits enrollment mark in randomized controlled trial. (2017, October 11). Retrieved November 18, 2018, from https://www.camdenhealth.org/camden-coalitionhits-enrollment-mark-randomized-controlled-trial/ Camden Coalition Hotspotting Curriculum. (2018, April 26). Retrieved from https://www.camdenhealth.org/curriculum/ Davis, P. (2007, February 08). Listening to patients' stories. Retrieved November 14, 2018, from https://www.sciencedirect.com/science/article/pii/S1361311107000088#! For the Public's Health: Investing in a Healthier Future. (2015, August 19). Retrieved October 7, 2018, from http://www.nationalacademies.org/hmd/Reports/2012/For-the-PublicsHealth-Investing-in-a-Healthier-Future.aspx Gawande, A. (2011, January 24). The Hot Spotters. The New Yorker. Retrieved from https://www.newyorker.com/magazine/2011/01/24/the-hot-spotters Gidman, J. (2013). Listening to stories: Valuing knowledge from patient experience. Nurse Education in Practice, 13(3), 192-196. doi:10.1016/j.nepr.2012.09.006 Glied, S. (1998). Chronic condition: Why health reform fails. Cambridge: Harvard University Press. Hasselman, D. (2013, October). Super-Utilizer Summit Common Themes from Innovative Complex Care Management Programs (Rep.). Retrieved November 12, 2018, from Center for Health Care Strategies Inc., website: https://www.chcs.org/media/FINAL_Super-Utilizer_Report.pdf Henry J. Kaiser Family Foundation. (2018, May 10). Social Determinants of Health [Chart detailing what comprise social determinants of health]. Retrieved April 2, 2019, from https://www.kff.org/disparities-policy/issue-brief/beyond-health-care-the-role-of-socialdeterminants-in-promoting-health-and-health-equity/ Liaw, W., Petterson, S., Rabin, D. L., & Bazemore, A. (2014). The impact of insurance and a usual source of care on emergency department use in the United States. International Journal of Family Medicine, 2014, 842847. doi:10.1155/2014/842847 McClean, H. (2018, October 30). Personal interview. Mitchell, E. (2016, November) Concentration of Health Expenditures in the U.S. Noninstitutionalized Population, 2014. Statistical Brief #497. Agency for Healthcare Research and Quality, Rockville, MD. http://www.meps.ahrq.gov/mepsweb/data_files/publications/st497/stat497.pdf Moe, J., Kirkland, S. W., Rawe, E., Ospina, M. B., Vandermeer, B., Campbell, S., & Rowe, B. H. (2017). Effectiveness of Interventions to Decrease Emergency Department Visits by Adult Frequent Users: A Systematic Review. Academic Emergency Medicine, 24(1), 4052. doi:10.1111/acem.13060 National Center for Health Statistics. (2017, May 03). Retrieved from https://www.cdc.gov/nchs/fastats/health-expenditures.htm National Health Expenditure Data: Historical. (2018, January 08). Retrieved October 7, 2018, from https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-andReports/NationalHealthExpendData/NationalHealthAccountsHistorical.html Ostermeyer, B., Baweja, N. U., Schanzer, B., Han, J., & Shah, A. A. (2018). Frequent Utilizers of Emergency Departments: Characteristics and Intervention Opportunities. Psychiatric Annals, 48(1), 42-50. doi:10.3928/00485713-20171206-02 Overview. (2018, August 02). Retrieved November 14, 2018, from https://uofuhealth.utah.edu/ipe/hotspotting/ Papanicolas, I., Woskie, L. R., & Jha, A. K. (2018). Health Care Spending in the United States and Other High-Income Countries. JAMA, 319(10), 1024. doi:10.1001/jama.2018.1150 Parekh, R., & Childs, E. W. (Eds.). (2016). Stigma and prejudice: touchstones in understanding diversity in healthcare. Retrieved from https://ebookcentral.proquest.com Preamble to the Constitution of WHO as adopted by the International Health Conference, New York, 19 June - 22 July 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of WHO, no. 2, p. 100) and entered into force on 7 April 1948. The definition has not been amended since 1948. Randomized Controlled Trial. (2018, July 09). Retrieved from https://www.camdenhealth.org/randomized-controlled-trial/ Riley, C. B., Golde, M., & Kayam, T. (2017). Emergency Department Care Coordination: Targeted Strategies to Improve Health Outcomes and Decrease Costs (Rep.). Washington, DC: National Association of Community Health Centers. University of Wisconsin Population Health Institute. (2014). County Health Rankings Model [Describes the social determinants of health]. Retrieved April 2, 2019, from http://www.countyhealthrankings.org/explore-health-rankings/measures-datasources/county-health-rankings-model 1 University of Utah UNDERGRADUATE RESEARCH JOURNAL THE DEVELOPMENT OF THE WITCH STEREOTYPE IN LORRAINE, FRANCE Chloe Evelyn Preble (Heather Melton) Department of Sociology ABSTRACT The following is a study of the witch trials that took place in the region of Lorraine, France between 1200 AD and 1700 AD. This paper performs a content analysis on 20 trial transcripts, 5 from each class those being labeled as Destitute, Poor, Comfortable, and Wealthy. Areas of interest for this paper also include gender, age, the application of torture during interrogation, as well as the mention of Satan or Satanic practices during the interrogation process. 2 TABLE OF CONTENTS ABSTRACT INTRODUCTION LITERATURE REVIEW METHODS DISCUSSION REFERENCES ii 1 6 9 13 15 3 INTRODUCTION The medieval era of Europe’s history provides a challenging view of how social change can deeply effect community standards and practices. The Protestant Reformation, a movement that moved Christianity from being in the hands of the church to creating an individualistic approach to one’s relationship with god created a time of turmoil that was not only religious but also social and political (Deane,2011). A strife between the many differing sects of Christianity began which evolved from sub groups of a Christian based faith to Christians and heretics (Deane,2011). Creating Christian unity at this time was of the utmost importance as it would ensure a central ruling body of the population rather than allowing for smaller, less powerful groups to roam the land. One method that was used to ensure unity was demonizing these subgroups and making examples of these individuals to the community at large and thus creating the “us and them” mentality of this time period. While the topic of religious persecution during this time period is vast, this paper will hone its focus to a particular group of heretics more commonly known as witches. More so this paper will focus on smaller communities in the region of Lorraine in southern France, an area well known for trials and rich with a structured view of “us and them.” Although it can be argued that the data is skewed due to the weather and wear of the documents lasting for hundreds of years “this region was in any case the center of the most intense persecution…when the number of trials is measured against the population” (Briggs, 2007, p.293). While the overarching structural and political changes of Christianity are key to setting the stage for witch trials, the focus of this paper will be on individual trials within smaller communities, seeking to better understand how victims were selected, how they were tried, and how trials contributed to maintain the community as a whole. To examine this further, the theoretical principals by which 4 Henri Trajfel built his understanding of intergroup conflict will be examined: “1. Individuals strive to achieve or to maintain positive social identity. 2. Positive social identity is based to a large extent on favorable comparisons that can be made between the in-group and some relevant out- groups: the in-group must be perceived as positively differentiated or distinct from the relevant out-groups. 3. When social identity is unsatisfactory, individuals will strive either to leave their existing group and join some more positively distinct group and/or to make their existing group more positively distinct” (Trajfel, 284). These ideals can be applied directly to the persecution of witches by viewing trials as a tool through which the in-group is starkly defined by the accusations against the out-group. In other words, we can see what white is based on knowing what black is. To being our discussion, let us first look at the social geography of the region of Lorraine at this time. Life was harsh for many during the Medieval era due in large part to a lack of scientific and technological advancement. Although agricultural techniques had “advanced significantly since Roman times… crop yields were still only a fraction of their modern equivalents, and mechanization of agricultural processes was virtually nonexistent, so that a very high proportion of the population—probably around 90 percent—was needed to raise food” (Singman, 65). Most of the population was positioned to grow the majority of their own food or raise livestock. The source of food also presented differing social structures as agricultural pursuits required more hands for physical labor and thus a great tie to community. In “less-fertile regions, where animal husbandry played a larger role, communities tended to be smaller and less collaborative, in some places consisting only of isolated homesteads” (Singman, 65). It is also important to note that many of those working in agriculture were, as expected, located in the county. In the city of Nancy, “apart from modest groups of officials, clerks, lawyers, and substantial merchants, their populations were made up of small traders, artisans, and agricultural 5 workers who frequently had relatives in the countryside” (Briggs, 294). Innovation was far more prevalent in cities which may be a key factor in why so many trials in Lorraine took place in the country rather than in cities. As Briggs shows, out of the 800,000 that made up the population in the Ducall Lorraine and Bar Lorraine regions, approximately 4,500 individuals, or .56% of that population, were executed with witchcraft in comparison to all of France which as a whole experience .06% (52). This is an indication that the communal effect of an agricultural territory had an impact on the formation of the in-group out-group dynamic which took hold of smaller villages and communities. In fact, “Nancy itself saw few witchcraft trials…at least 43 persons may have been tried for witchcraft at Nancy between 1578 and 1645, of whom no more than twelve (and probably less) came from the city itself” (Briggs, 295). Being that the majority of the trials took place in the smaller townships which were heavily agricultural and collaborative, we can quickly see the opportunity for individuals to form a group mentality to seeks to protect its self, both in resources and in faith identity. The “derogation of the black sheep might be functional in its protection of the ingroup stereotype. According to this rationale, a clear disapproval of the bad and anti-norm ingroup member by the rest of the group goes hand in hand with a strong affirmation of the fact that the ingroup as a whole is living up to its standard, say its stereotype.” (Castano 376). As mentioned earlier, Lorraine was a hotbed for trials and maintaining a solid, Christian identity was key for survival as execution was often the outcome of a trial. With the possibility of torture or execution for people within a community looming “it is reasonable to assume that they will adopt a series of strategies to establish and maintain as positive an image as possible” (Castano, 366). Having a comparison point between the majority of the community and a deviant was a protective measure not only from the authorities who perpetrated the trials but also from unexplainable tragedy that often befall communities. 6 Unexplained death, especially among infants and children, was another crucial issue facing the population at this time. The average mother in Europe “had 7-8 live births over 15 years…unidentifiable fevers, and the following list of diseases, killed perhaps 30% of… children before the age of 15- the bloody flux (dysentery), scarlatina (scarlet fever), whooping cough, influenza, smallpox, and pneumonia.” (Payne, np). Living in an era of unexplainable tragedy was the perfect breeding ground for developing myths about witches that focused on them being the overall causes of a community’s hardships. As these individuals became nearly sought after to bring justice and peace to these communities, a “set of lurid and remarkably enduring stereotypes of heretics as not only hypocritical and secretive foes but even as orgiastic, bestial, murderous baby eaters—ludicrous and baseless accusations that would nonetheless reach painfully across medieval centuries” (Deane, 9). The inclusive nature of these stereotypes came forth from the development of a centralized Christianity was well underway and the “process of establishing the Christian authority…was lengthy, controversial” (Deane, 9). To help promote this authority, the use of heresy was utilized to help people outside of the clergy, mainly peasants, understand the differences between Christian authority and the sub-groups of Christianity. Heretics were needed in order to act as a contrast for orthodoxy. Witches served as both a way to bond individuals to the burgeoning Christian authority and also to act as the explanation for pain. While we have a basic picture of the setting of these trials, that being a confusing time where survival depended on agriculture and community, we have yet to discuss who the witches themselves were. As Horsely discussed “each [of the studies he reviewed] confirms the now familiar generalization that the vast majority of witches were poor, elderly women” (Horsely 698). Part of his research focused on the distinction between the “official theory and the popular realities” of what happened at these trials as much of the previous literature focused on 7 examining the documents as though the accused were guilty based on the theory of witch craft rather than how the lifestyle and culture of those persecuting the witches affected these trials (Garrett 690). In order to explore this topic, I reviewed the published literature on the topic to gain an understanding of the time period. Religious Influence and Authority: Understanding the religious geography of the time is crucial to understanding the point of the trials. Earlier in this time period, Christianity was broken up into subsections of the faith with various groups having similar beliefs but practicing their faith in different ways. For example, the Cathars were individuals who believed there were two gods, one good and one evil. The god they worshiped was derived from the New testament and was an entity outside of our physical realm where as the other god, their version of Satan, was believed to have created all physical entities, including their flesh, and thus believed they were born of sin and to participate in basic needs was sinful (Haliczer np). This group in particular helps to highlight the struggle the Roman Catholic Church was facing at this time as they sought to become a unified power. As Jennifer Deane explains, the “process of establishing the Christian authority…was lengthy, controversial” (Deane 9). To help promote this authority, the use of heresy was utilized to help people outside of the clergy, mainly peasants, understand the differences between Christian authority and the sub-groups of Christianity. Heretics were needed in order to act as a contrast for orthodoxy. The Cathars served as an instrumental component to creating this heretic dichotomy that was needed in order to establish legitimacy. The Cathars “rejected the Roman Catholic, the entire church structure…they said they were the only true Christians…they developed an alternative religion, an alternative hierarchy, an alternative priesthood that attracted many adherents in that 8 period, which is why the Cathar heresy above all occasioned the founding of the inquisition” (Haliczer, np). From the beginning of the Christian church becoming an authority in the third and fourth centuries, the idea of witches was planted as a “set of lurid and remarkably enduring stereotypes of heretics as not only hypocritical and secretive foes but even as orgiastic, bestial, murderous baby eaters—ludicrous and baseless accusations that would nonetheless reach painfully across medieval centuries” (9). Deane’s study outlines the roots of the witch trials by examining the war on heretics as a means to gain support for the burgeoning Christian authority. Garret also explains that the stereotype of the witch was not a random occurrence. it had in fact been developed over a number of centuries and had reached its climax in the 16th and 17th centuries. The publication of the Maleficium helped to cement what a witch was for those who hunted witches (463). The book described acts such as pacts with the devil, participating in “sabbats,” sexually deviant acts such as orgies, and the consumption of human flesh, typically that of a baby (Garret 690). These key elements of the witch were deeply rooted in the fears that plagued Medieval Europe such as rebelling against organized religion through alternative worship, social and sexual deviance, and the mockery of life itself. For example, the consumption of infant flesh was particularly offensive not merely because it is considered taboo to be cannibalistic, but also because people during this time period were ravaged by disease and infertility. If one was lucky enough to have a healthy baby and then murder it, it was a slap in the face so to speak to the community. Demonizing those who did not subscribe to the Roman Catholic Church served as a swift and effective maneuver to solidify their institution. Haliczer explains that “referring to Western Europe, the world of Christendom was a world of monarchies that were developing, but were as yet poorly organized…every sovereign took upon himself the protection of the Roman Catholic Church in the twelfth and thirteenth centuries. … the sovereign and sovereign power 9 was closely identified with Roman Catholicism and the maintenance of Roman Catholicism… heretical movement therefore in seeking to undermine Roman Catholicism also could be seen as a direct threat to the State” (np). Heretic was a name that developed into “witch” in later use of the trials which focused on presumed enemies of the church and thus the state. As we will discuss later, those identified as witches may have started as individuals with differing views of religion however quickly evolved to be anyone who threatened the lifestyle of the community at hand. Community Lifestyle and its Effect on the Trials: A key aspect understanding of the witch trials would be to gain an understanding of individual and community lifestyles. Though the literature on the witch trials of Medieval Europe often examine the historical transcripts and documents that survived time through the lens of the accused being guilty based on the dominate theory of witch craft during the time period, the literature available on the topic includes insight into the lives of those both accused and accusing. Life in the Medieval era was not only harsh but often unpredictable. Famine, disease, community dispute, war; any of these issues could arise at any time. The prospect of unity and a common belief system was a survival technique that allowed for security within a village. That paired with a belief that many tragedies could be explained with magic helped to set the stage for the trials. Garrett subscribes to the theory that trials acted as a “means for explaining, and also, through counter magic and persecution, for dealing with the misfortunes of village life…it provided an outlet for the functional generation by the isolation and constriction of face-to-face village life—tensions exacerbated by the disappearance after the Protestant Reformation of the outlets formerly provided by the Roman Catholic Ritual” (Garrett 462). The major religious 10 shift from Roman Catholic traditions that were typically based on community to the transition of the protestant reformation, a movement which inspired individuality through the personal communication between man and his god without the need of a priest, created tension within communities. As someone who shares a collective consciousness with their neighbors that includes witchcraft and magic as true threats to their livelihood and survival “the community often became a focus for conflict instead of cooperation’ (Briggs, 24). This shift added yet another unknown to the daily lives of peasants. People were already living in a world of unexplainable tragedy and now their sense of community that was provided through their religion was stripped from them as well. The new-found individualism played a large role in the trials as the victims were mainly people who could not provide for themselves and had grown up during a time when community values still help true. Socioeconomic Status: Though witch persecutions effected people in varying socioeconomic statuses, we find that there is a disproportionate number of death occurring in lower classes as will be discussed in the results section. This is pertinent to understanding the witch trial victims as promises of financial gain from the devil were considered a key part of the investigations and trials. Remy’s book “The Devil’s Mark” details to witch hunters how to catch a suspected witch and what signs to look for when persecuting the accused. He writes that people are tempted by the Devil through “some large and ample promise of riches…Satan assails mankind not only through their secret and domestic affections and (if I may so express) by burrowing into their hearts, but also openly and in declared welfare” (Levack 83). Remy writes this as a way to exemplify how the devil takes hold of people but also creates a stereotype for the witch. The previous passages assume that riches and love can be key to tempting people to become witches. This is highly 11 biased for the time period and reflects on the victims heavily because during this time period marriages were still arranged to promote the most financial security possible between two families. Those who could not provide this security were typically impoverished. The issue of being tempted by riches also creates a biased against the poor as this was a time period where being poor meant fighting for one’s survival. That paired with an individualistic approach to community life created by the protestant reformation lead to the victimization of those who could not fend for themselves. Horsley writes that “each study confirms the now familiar generalization that the vast majority of witches were poor, elderly women” (698). It was typical for unmarried, elderly women to be accused of witchcraft. As will be reviewed in the results section, the number of fights occurring between individual community members and elderly women of the community are numerous and they are also more likely to confess to witchcraft prior to torture. Gender: Gender also plays a significant role in the witch trials. The previous section discusses how many of those accused where elderly, unmarried women. Even in Medieval times women were likely to outlive their husbands. Once their spouse died that typically cut off any income the women had been relaying on to survive which lead to desperate and aggressive attitudes towards other members of the community who were not as charitable as in previous years. The text written by Nicholas Remy in this time period also created a bias against women as he writes “all kinds of persons attend the nocturnal assemblies of demons in large numbers; but the majority of these are women, since that sex is the more susceptible to evil councils” (Levack 86). When looking through the transcripts of the trials, the majority of those tried and put to death were indeed women, typically those who were elderly, widowed, and impoverished. 12 As Garrett explains, the victims were “women [who] were in some fashion social deviants… they were poor, they were old and powerless, they were quarrelsome and difficult for their neighbors to deal with…in the most typical pattern of accusation, an old woman had come to a female neighbor’s door begging something, was turned away, and was heard to grumble or curse those who had refused her…then misfortune had befallen the neighbors. They blamed her” (462). This was usually what started a person’s reputation as a witch and as an elderly woman would reach out to other neighbors and would be turned down followed by the neighbor experiencing misfortune, it is not a surprise that people would associate their misfortune. METHODS: In order to explore this topic, I chose to focus on the available, translated transcripts from the trials perused in Lorrain, France. The reason for this was that the data base of transcripts I found had an ample sample of cases that crossed over classes, the transcripts were translated to English, so they could be coded, and Lorraine is famous for being a center for witch trials even as the trend for the trials began to dissipate. Lorraine is a unique place in that it offers a researcher such as myself a close look how confessions were obtained, how torture affected the interrogations, and the cases here are able to give perspective on how classes differed in the pursuit of witches during the same time periods. My sample include 20 transcripts. Most of the defendants in the transcripts are female (put in the numbers of females and males). In terms of socio-economic class, 5 would be considered extremely poor, 5 poor, 5 are what we would consider middle class, and 5 were the wealthy and elite. Class distinction turned out to be a key element in the content analysis performed as the greatest differences in the how individuals were prosecuted and whether or not they were put to death. 13 The qualitative data were analyzed using constant comparative analysis from grounded theory (Glauser & Strauss, 1967; Strauss & Corbin, 1990). This allows the findings to emerge from the data themselves rather than using the data to test already formed ideas. The author reviewed each transcript and noted common themes. The data was then coded according to those themes. Those themes are identified and reported on table 1. Results: The themes found in the content analysis of the trial transcripts included gender and socioeconomic status however the pattern of the trials was also of note. When reviewing the data presented in the Table 1, we find that 85% of those accused were women and of those women 60% were 50 years old and up noting that three transcripts did not disclose age. The majority of the transcripts did not record marital status though of the 9 recorded we do see that 5 were married and 4 of these individuals were 50 or lower in age. The second main finding was that an overwhelming number of them are not first-hand account of seeing any magical activity but rather hearing rumor in the village that the accused is a witch or quarreling with the accused at some point and then later on separate occasion having misfortune befall them such as the death of a loved one or damage to property in the form of crop failure or livestock death. While there was no distinct pattern for how many witnesses were first hand versus second hand meaning they testified based on the reputation of the accused, we do see that 80% of the cases had both first and second hand testimony. It is also important to note the occurrence of the accused mentioning Satan before interrogation versus post. While we do see instances of pre-interrogation confessions the majority is after the interrogation and closely follows what is described in the Demonolatry by Nicolas Remy, a known authority on the matter of witches and trials at the time. In the Destitute group, 60% of those tried made mention 14 of Satan before torture and after torture the number moves to 80%. The Poor group shows 20% before torture and 100% after. The Comfortable group shows 0% mentioning Satan before torture and 80% mentioning him after. And the Wealthy individuals show 20% before torture and 80% after. In all groups we see an increase on discussing Satan and witchcraft after torture had been administered. We must also look at whether or not execution took place after the trial. As shown in Table 1, execution was a common outcome. Lastly, we must address the rates of execution. In the Destitute and Poor population, we find that 100% of the individuals were sentenced to death. The Comfortable group shows a rate of 80% and the Wealthy show 60%. In all classes the rate of execution is over half however the perfect goes down as socioeconomic status increases. Socioeconomic Gender Status Accused’s Marital Status Age Number of witnesses References to Satan or witch craft before interrogation References Execution to Satan or witch craft 15 after interrogation Destitute Female 67 Widow 11 4 first hand (36%) 7 second hand (64%) no Yes Yes Destitute Female 60 Widow 1, only firsthand (100%) yes yes Yes Destitute Female 70 Married 11 6 first hand (54%) 5 second hand (48% yes yes yes Destitute Female 70 Widow 1, only firsthand (100%) yes No torture Sentenced to death but died prior to execution Destitute Female 60 Widow 12 7 first hand (58%) 5 reputations (42%) no yes yes 60% 80% 100% no yes yes Poor Female Not Disclosed Not Disclosed 7 3 first hand (42%) 16 4 reputation (58%) Poor Female Not Disclosed Not Disclosed 23 7 first hand (30%) 16 reputation (70%) 5, all firsthand (100%) no yes yes Poor Female 60 Not Disclosed no yes yes Poor Female 46 Not Disclosed 7, all firsthand (100%) no yes yes Poor Female 50 Married 19 10 first hand (52%) 9 reputation (48%) yes yes yes 20% 100% 100% no yes yes no yes yes no yes yes Comfortable Female 70 Not Disclosed Comfortable Male 46 Married Comfortable Female 50 Not Disclosed 13 11 first hand (84%) 2 reputation (16%) 12 7 first hand (58%) 5 reputation (42%) 12 6 first hand (50%) 6 reputation (50%) Comfortable Female 35 Married Comfortable Female 40 Married Wealthy Female 60 Not Disclosed Wealthy Female Not Disclosed Not Disclosed Wealthy Male Not Disclosed Not Disclosed Wealthy Female 50 Not Disclosed Wealthy Male 80 Not Disclosed 8 3 first hand (38%) 5 reputation (62%) 30 2 first hand (7%) 28 reputation (93%) 16 4 first hand (25%) 12 reputation (75%) 11 5 first hand (45%) 6 reputation (55%) 6 4 first hand (66%) 2 reputation (34%) 12 8 first hand (67%) 4 reputation (33%) 17 15 first hand (88%) 2 reputation (12%) no yes 17 yes No No torture no 0% 80% 80% no yes yes no yes yes There was not a report of nontorture interrogation yes no no yes yes no yes No 20% 80% 60% 18 During the course of my review of the 20 transcripts chosen I found that in the lower classes the interrogations were far more brutal and more methodological meaning they followed a basic pattern that eventually led to conviction. With the Destitute group, I found that in the five cases selected all of the victims were elderly, widowed women who had typically been caught begging for food or services from their neighbors or had been caught stealing. Within these cases there were far fewer witnesses to testify against the accused yet in all of these cases the women were executed with the exception of one in which she committed suicide in prison. It is apparent from these cases that the confession was brought about either in fear of torture or after having been in prison for at least a month before the interrogation began. In the case of Barbe Mallebarbe, a 60-year-old woman who was living in extreme poverty the majority of her life with her husband, had confessed to acts of witchcraft on July 8, 1596. However, on July 10, 1596 it was revealed that she “had tried to hang herself in her prison previous night, because she was afraid she would be tortured; asked to be put to death, but not to feel the fire, as she had harmed no-one.” In this and one other case in which the victim had been classified as extremely poor. There were no formal witness testimonies. Instead the interrogation was based on rumor that the victim was a witch. This differs greatly from the other classes as the “poor,” “comfortable,” and “wealthy” cases all had an abundant amount of witness testimony that was recorded. In these classes witnesses who claimed they had even heard rumor that the accused was a witch was recorded. However, in the extremely poor or “destitute” cases three of the five had witness testimony. The majority of the testimony recorded discussed the person 19 accused of witchcraft as having stolen from the witness or having quarreled over un received payment or food donation to the accused. In the case of Collatte Lorette, a 67-year-old woman who had been widowed for eight years, of the eleven witness accounts, four had reported that the victim was rumored to be a witch and seven had claimed she had stolen items from their property such as logs and food. During her initial interrogation, she had confessed to quarreling with her neighbors but mentioned nothing of witchcraft. When torture was utilized she began telling a fantastical tale about being seduced by a demon and had been promised money. It is when torture is applied that the confession, as with many of the cases reviewed, suddenly begins to follow a prescription; they accused is seduced by a demon, promised money in exchange for using a powder to commit malice only to find that the money has turned into either leaves or another valueless piece of organic matter. Discussion and Conclusion: Like prior research, the vast majority of the defendants tried in the transcripts analyzed for this paper were female and elderly (Garret, 1977; Horsley, 1979). The application of torture during interrogation increased the number of confessions admitting a relationship with Satan and many of the accused were put to death. While this is a piece based in history we cannot help but draw parallels to our own era. The victimization of individuals within a specific group continues as does physically harmful questioning. We look at this event in history as a shocking and barbaric time, something we feel detached from in our everyday lives. Yet when we look to draw comparisons between the witch trials of Medieval Europe and the current war practices we use is there truly a difference? Sociological exploration of historical events is an important way to analyze and record the 20 history of humans on this earth because without our past, how can we look to our present and future with understanding? References: 21 Briggs, Robin. The Witches of Lorraine. Oxford: Oxford UP, 2007. Print. Castano, E., Paladino, M., Coull, A., & Yzerbyt, V. Y. (2002). Protecting the ingroup stereotype: ingroup identification and the management of deviant ingroup members. The British Journal Of Social Psychology, 41(Pt 3), 365-385. Deane, Jennifer Kolpacoff. A History of Medieval Heresy and Inquisition. Lanham, MD: Rowman & Littlefield, 2011. Print. Garrett, Clarke. “Women and Witches: Patterns of Analysis”. Signs 3.2 (1977): 461–470. Web. Glauser, B.G. & Strauss, A.L. (1967) The Discovery of Grounded Theory: Strategies for Qualitative Research. New York, NY: Aldine de Gruyter. Horsley, Richard A. “Who Were the Witches? the Social Roles of the Accused in the European Witch Trials”. The Journal of Interdisciplinary History 9.4 (1979): 689–715. Web. Levack, Brian P. The Witchcraft Sourcebook. New York: Routledge, 2004. Print. Lynda Payne, "Health in England (16th–18th c.)," in Children and Youth in History, Item #166, http://chnm.gmu.edu/cyh/items/show/166 (accessed June 15, 2018). Sidanius, Jim, and John T. Jost. Political Psychology: Key Readings. Langara College, 2007. Singman, Jeffrey L. “Daily Life in Medieval Europe.” Canadian Social Science, Canadian Research & Development Center of Sciences and Cultures; Canadian Academy of Oriental and Occidental Culture, 1999, www.questia.com/library/106851232/daily-lifein-medieval-europe. Smith, Philip. “A Quantitative Evaluation of Demographic, Gender and Social Transformation Theories of the Rise of European Witch Hunting 1300-1500”. Historical Social Research / Historische Sozialforschung 17.4 (64) (1992): 99–127. Web. Strauss, A. & Corbin, J. (1990). Basics of Qualitative Research: Grounded Theory Procedures and Techniques, Newbury Park, CA: Sage Tajfel, Henri. Social Identity and Intergroup Relations. Cambridge University Press, 2010. University of Utah UNDERGRADUATE RESEARCH JOURNAL SOCIAL JUSTICE IN NOVEL WRITING: AN EXPLORATION OF SOCIAL JUSTICE ISSUES IN THE UNITED STATES TODAY Jasmine Robinson (Dr. Michael Gills) Honors College INTRODUCTION The goal of this project would be a creative work. It will comprise of writing a novel that tackles the major social justice issues in this country today including: racism, sexism, homophobia, classism, colonialism/colonization, immigration, refugees, whiteness, privilege, ahistory, colorblind policies, indigenous rights, threat of nuclear war, Christian privilege, islamophobia, heterosexism, transphobia, ableism, ageism, predatory capitalism, and the limits of a one-sided Western point of view. Through this work, I intend to build on a continuing work in showcasing instances where injustice occurs in this nation through literary fiction. The goal is to illuminate instances of privilege, show how ignorance is the true enemy of our country, and ultimately inspire people to be more educated and help enact social change. LITERATURE REVIEW For too long, ignorance has reigned over the United States, ignorance of people ravaged by the detriments of oppression, obedience, control, and power. Ferber (2012) says our society is caught in the ideology of oppression blindness knowing that “it is not only race-based privilege that we actively render invisible today, but many other systems of oppression and privilege as well, including class, gender, sexuality, nationality, ability, age, and religion.” It’s time this nation seeks to rectify this ignorance and blindness. It’s time to start working to make positive and effective change to better society for all citizens. We live in a country where some people have privilege and others do not. It’s important for all individuals to come face to face with our country’s ugly past and learn to confront privilege head on. Now, people who suffer oppression come to have a unique experience on how they interact with the world. Young (2004) says “all oppressed people suffer some inhibition of their ability to develop and exercise their capacities and express their needs, thoughts, and feelings.” Because of power structures in our society, the voices of the oppressed tend to get diminished, drowned out, and ultimately not listened to. This is why it’s important for people who have the privilege of having a voice to step up and enact change when they can. That being said, it’s important to have a firm grasp of what exactly oppression is, and what it comes to mean for marginalized communities. Young (2004) says In its traditional usage, oppression means the exercise of tyranny by a ruling group . . . In its new usage, oppression designates the disadvantage and injustice some people suffer not because a tyrannical power coerces them, but because of the everyday practices of a well-intentioned liberal society . . . Oppression in this sense is structural, rather than the result of a few people’s choices or policies. Its causes are embedded in unquestioned norms, habits, and symbols, in the assumptions underlying institutional rules and the collective consequences of following those rules. Because of this, many people go through life ignorant that they may or may not be benefiting from the structural way in which hegemonic systems operate. The many structures in our society have been carefully crafted to provide unseen advantages to some, including power, and not others. Lemert (1997) says “power is the means by which social structures do this not-exactly-fair work of sorting people according to the few or many life-chances they get. Power may simply, if incompletely, be defined as the social energy of structures. Power is the deterring force that causes some people to get less and some more of whatever is considered desirable in a social world.” A group in power is able to dictate who has opportunities, who has resources, and who has the chance to succeed. Another concept of importance is prestige. Lemert (1997) says “prestige, that is, is the remarkable and systematic consistency with which nearly everyone in a society seems to agree that some person ought to be respected highly, others less so, and some not at all.” This predicament puts many marginalized people in a tough spot. With no power, and no prestige, they have no easy way of making change and drawing attention to the needs their communities face. In addition to marginalized groups suffering from oppression, these groups also face societal factors that can affect the way others perceive them as people. Lemert (1997) says “there is considerable evidence that we often view out-groups as homogenous, while we see considerable diversity within our own group.” People like to separate into “them” and “us” categories. Often the “them” is seen as different, typically in a negative way. These negative views lead to things like stereotypes. Lemert (1997) says “the point is that our stereotypes prime us to interpret events in ways that confirm our expectations . . . not only do stereotypes affect how we store and interpret information, they guide our attitudes and behaviors. Because many stereotypes involve outgroups and we are motivated to enhance the image of our own group, many, if not most, stereotypes are relatively negative.” If we stereotype a group as lazy, dangerous, and incompetent, every action they take will be interpreted in a way for the “us” group to confirm those stereotypes and thus boost the view of their own group. There are other facets that can develop out of negative information. One of those facets is prejudice. Lemert (1997) says “prejudice is a negative attitude toward, or evaluation of, a person based on his or her membership in a group other than one’s own.” Prejudice develops not out of the actions or behaviors of a certain group, but simply because they happen to identify with and belong to a certain group. Lemert (1997) goes on to say that From this base of prejudice, discrimination is likely to follow. Discrimination is action taken to harm a group, or a member of a group, on a basis of membership in the group. In its extreme form, the combination of prejudice and discrimination can lead to delegitimization of a target group, determining that it does not deserve fair treatment according to a code of norms calling for proper and decent behavior. This view opens the door for the exploitation of the target group and even justifies resorting to violence. Many marginalized groups in The United States have faced this cycle of oppression. They have faced the injustice of what comes with preconceived notions and uneducated judgments. It has led to their mistreatment and discrimination throughout history. Yet in the face of this knowledge surrounding the realities of marginalized and minority communities, comes opposition from people of privilege in recognizing their identity. Watt (2007) explains a series of notions that people of privilege might undergo when confronted with reality, which include: denial, deflection, rationalization, intellectualization, principium, false envy, benevolence, and minimization. All of these tactics seek to ultimately refuse the acceptance of a privileged identity and seek to prevent the equity of marginalized groups in all aspects of society. My novel seeks to point out the gaps in our education surrounding history, social justice, and privilege, and highlight the positive effects that come from social change. ACTIVITIES AND TIMELINE This is a project that will occur over the course of a one-year timeline. Throughout the Fall Semester 2018, I have already been writing and researching this project. By the conclusion of the semester, I will have 150 pages written of this novel. Over the Spring Semester 2019 I will have written a total of approximately 300 pages, having a fully complete novel. About 1/3 of the time I spend working is on doing research on settings, characters, social justice issues etc. as well as mapping and planning out the structure of the novel. The other 2/3 of the time is spent writing. During the Summer of 2018, I read well-written novels from the Western Canon of literature to learn about good writing techniques and find important tips on good writing from published authors to incorporate into my own work. I plan on doing more reading during the Winter Break before the start of the Spring semester to continue to enhance my writing. Daily Activities My daily routine involves getting up at 4:30 am five days a week, and writing, researching, and planning for approximately one to two hours each day. Weekly Activities My weekly activities include turning in ten pages each Friday, which my mentor reads, and having a reading partner provide feedback on the previous week’s pages to take into account in continued writing. In addition, I meet with the Novel Writing class each week for three hours to discuss not only my own work, but other peers’ work and different writing techniques and strategies. Semester Activities This includes having a chapter of my novel manuscript workshopped by a collection of peers and my faculty mentor with heavy review and feedback twice a semester. In addition, the week after my pages are workshopped, I have a one-on-one meeting with my mentor in order to gain valuable, constructive, and in-depth feedback on how to improve my writing and the content of the story. REFERENCES Ferber, A. L. (2012). The culture of privilege: Color-blindness, post-feminism, and christonormativity. Journal of Social Issues 68(1), 63-77. Lemert, C. C. (1997). The mysterious power of social structures. In Social things: An introduction to the sociological life. Lanham: Rowman & Littlefield. Watt, S. K. (2007). Recognizing privileged identity. The College Student Affairs Journal 26(2), 120-125. Young, I. (2004). Five faces of oppression. In Oppression, privilege, & resistance. Boston: McGraw Hill. College of Social Work University of Utah UNDERGRADUATE RESEARCH JOURNAL THE WOUNDED HEALER: A DESCRIPTIVE ANALYSIS OF THE THEMATIC MATERIAL OF THE WOUNDED HEALER ARCHETYPE IN CONNECTION WITH THE THERAPEUTIC HEALING PROCESS Myranda Peterson (David Derezotes, PhD) Department of Social Work ABSTRACT The following thesis project is a critical analysis of Greek mythology, particularly the myth of Asklepios as The Wounded Healer, and why the best therapists often embody this archetypal energy in alchemical transformation. Mythology has been used to inform practice in the helping professions throughout history, and in our era still is used as a metaphor for how we think about helping and healing. Mythos is a philosophy of thought that combines not only reason, or that of logos, but the innate feelings behind them. Renowned psychoanalyst, Carl Jung, referred to myth as the expressions of the collective unconscious which are rooted in the psyche. The mythic approach is one that addresses the world in a narrative and indirect way. Subjective aspects, such as individual feelings and personal experiences, become pertinent to the mythology. There have been a number of various treatment interventions that have been used in clinical practice to help patients who have experienced trauma in their lives. Such therapeutic interventions may include art, dance, or music amongst others as a method to express oneself through creative means. Another intervention is that of literature which can be found in the practice of depth psychotherapy. The essence of catharthism is the purification or purgation of emotions through an expression of an art form. Depth psychotherapy combines the approaches of psychology and mythology to help a client that is psychologically suffering to uncover the meanings embedded in their unconscious minds to promote healing by becoming conscious of repressed traumas, thoughts, and feelings. This particular Greek myth of Asklepios examines the ideology of the wounded healer archetype. The wounded healer, after recognizing and healing from their own traumas, is compelled to help others realize that they can do the same. ii Keywords: Greek mythology, Asklepios, wounded healer, depth psychotherapy, narrative, helping professions, medicine iii ACKNOWLEDGMENTS I would like to express my sincere gratitude for Dr. David Derezotes, my mentor, for always supporting me and guiding me throughout this research journey. He has taught me many things about myself and has encouraged me to step into this role and look at my experiences as valid. It has been an honor to have him as a mentor. And I would like to thank the Director of the College of Social work and my honors faculty advisor, Jason Castillo for being willing to meet with me over the course of a year to discuss the progress of my thesis. And lastly, I would like to thank my friends and family for believing in me through the whole process. iv TABLE OF CONTENTS ABSTRACT ii ACKNOWLEDGMENTS iv INTRODUCTION 1 LITERATURE REVIEW 9 METHODS 17 FINDINGS AND PRACTICE IMPLICATIONS 18 DISCUSSION 20 APPENDIX 24 REFERENCES 28 v 1 INTRODUCTION The following thesis covers a vast amount of material and provides only what explanation is necessary to help the reader understand the research question on a very basic and fundamental level. For a paper of this length, the background information has been significantly modified and shortened to fit the parameters of this specific thesis. It is by no means a comprehensive piece. What is contained in this thesis has the potential to be further developed in the near or distant future as this is just an introduction to a prevalent issue. Before any sort of action can be taken, first a new perspective must be taken into consideration. What follows is meant to shed a new light on ancient practices and principles that we have since forgotten about or lost connection with. The time is coming when we need to rekindle the relationship with our ancestors and hear what they have to teach us about healing. There are many different types of interventions that have been used in clinical practice (i.e., dance, art, music etc.) and one that is of interest is that of literature, or mythology in particular. The myth of Asklepios examines the importance of the archetypal energy behind the wounded healer. As mentioned in the abstract of this thesis: myths are the expressions of the collective unconscious; therefore, mythology is a means to help identify traits embedded in the psyche. The mythic figures, then, are created with the purpose of bringing archetypal energy to life. It is through these archetypes that we are able to translate human experiences. This thesis will make reference to the concepts of Jungian depth psychotherapy. Carl Jung (1875-1961) was a psychiatrist from Switzerland who founded analytical psychology. 2 A few of the important concepts that will be referenced in this thesis are: psyche, collective unconscious, and archetype. Jungian theory is one that is very much driven by experience. It can be metaphorically thought of as one foot planted firmly in reality and the other in the world of myth and dreams. The psyche is defined as: The totality of all psychological processes, both conscious and unconscious...The way in which the psyche manifests is a complicated interplay of many factors, including an individual’s age, sex, hereditary disposition, psychological type and attitude, and degree of conscious control over the instincts. (Sharp, 1991, p. 107) Jung divided the psyche, or mind, into three parts: consciousness, the personal unconscious, and the collective unconscious. The collective unconscious is defined as: “A structural layer of the human psyche containing inherited elements, distinct from the personal unconscious” (Sharp, 1991, p. 35). Jung writes: The collective unconscious–so far as we can say anything about it at all– appears to consist of mythological motifs of primordial images, for which reason the myths of all nations are its real exponents. In fact, the whole of mythology could b e taken as a sort of projection of the collective unconscious…We can therefore study the collective unconscious in two ways, either in mythology or in the analysis of the individual. (Jung, 1969, para 325) Furthermore; “The more that one becomes aware of the contents of the personal unconscious, the more is revealed of the rich layer of images and motifs that comprise the collective unconscious” (Sharp, 191, p. 36). And lastly, archetypes are defined as: “Primordial, structural elements of the human psyche...Archetypes are irrepresentable in themselves but their effects are discernible in archetypal images and motifs” (Sharp, 1991, p. 27). Jung also thought of archetypes as “instinctual images”; or in other words, the forms assumed by instincts (Sharp, 1991, p. 28). Archetypes will manifest on a personal and collective level. On a personal level, archetypes will manifest through complexes (Sharp, 1991, p. 28). A complex is: “An 3 emotionally charged group of ideas or images...In the same way that atoms and molecules are the invisible components of physical objects, complexes are the building blocks of the psyche and the source of all human emotions” (Sharp, 1991, pp. 37-38). And on a collective level, archetypes will manifest as characteristics of entire cultures (Sharp, 1991, p. 28). It is the responsibility of each new generation to attempt to seek new understanding of whatever manifests itself. The archetypal image is: “The form or representation of an archetype in consciousness...Archetypal images, as universal patterns or motifs which come from the collective unconscious, are the basic content of religions, mythologies, legends and fairy tales” (Sharp. 1991, p. 29). Previously mentioned in the abstract of this thesis: the essence of catharthism is the purification or purgation of emotions through an expression of an art form. In Jungian analysis, the cathartic method is defined as: “A confessional approach to treating neurosis, involving the abreaction of emotions associated with a trauma” (Sharp, 1991, p. 33); and abreaction is defined as: “A method of becoming conscious of repressed emotional reactions through the retelling and reliving of a traumatic experience” (Sharp, 1991, p. 11). While Jung abandoned these above mentioned methods as effective tools in trauma therapy, understanding how they operate in the mythology is important to this thesis. Jung referred to neurosis as “the suffering of a soul which has not discovered its meaning” (Jung, 1932, CW 11, para. 497). He also said, “neurosis is always a substitute for legitimate suffering” (Jung, 1938, p.92). The wounded healer is someone who has experienced the burdens of pain, suffering and loss, and transcended these experiences into a vital source of wisdom and compassion. The word compassion itself originates from the Latin stem word compati 4 meaning, “to feel pity”; com meaning, “with, or together” and pati meaning, “to suffer”. Therefore, the word compassion literally translates “to suffer with, or together”. In her article, “The Wounded Healer: A Jungian Perspective”, Larisey (2012) says “The most skillful clinician, rather than being a strong and capable model of good health, is one who has suffered from all sorts of illnesses and is being transformed by those agonies” (p.12). The wounded healer is able to feel and understand the burdens and pains of their patients because they themselves have also experienced it. Carl Jung once said, “The doctor is effective only when he himself is affected. Only the wounded physician heals” (Jung & Jaffe, 1963, p. 134). Instead of sympathizing with the patient on a very one-dimensional level, the wounded healer is able to genuinely empathize in the shared experience. By “sitting in the fire” with the patient, the wounded healer fosters a relationship of vulnerability and trust. Let it be clear that the healer is not the master of the patient. Rather, the healer helps the patient become the master of their own self. The wounded healer fulfills their soul purpose or meaning by helping others to heal. However, because a wounded healer is always in a vulnerable state so as to help their patients process through their own wounds, the wounded healer needs to be mindful so as to not let their patient’s wounds infect their own. The wounded healer is always at risk when helping others because they are continuously acknowledging their own wounds for the benefit of the patient. “Our sorrows and wounds are only healed when we touch them with compassion”(Kornfield, 1994, p. 31). By looking at one’s wounds and nurturing them through a gentle and compassionate mind, the wounded healer is able to then teach their patients how to foster healing through caring for their own wounds. It is 5 when wounds are rubbed with dirt and covered with a bandaid that the trauma slips into the unconscious and manifests in unexpected and unpleasant ways in the form of complexes. When a complex is constellated it replaces the ego as the authority figure in the psyche and will remain in control until the constellation is complete. If this is an unconscious process, complex can lead an individual to act, do, or say things that they normally would not. However, if an individual attempts to understand this process and recognize it for what it is, an emotionally charged reaction, then it becomes more conscious to the ego and less potentially reactive. By interrupting the constellation with an acknowledgement of how one’s behaviors, thoughts, and feelings are simply rooted in previous experiences or traumatic events, the complex will eventually become less and less reactive. The healing process consists of reconciling with one’s symptoms of traumatic experience. Carl Jung uses a diagram to describe what he refers to as the lines of communication in a relationship1. There are six lines that make up the diagram, each contains a double set of arrows suggesting that communication between the different paradigms flows in both directions; therefore, there are twelve lines of communication that information can pass through in a therapeutic relationship (Sharp, 1991, p. 150). This diagram looks like a rectangle of arrows with another two arrows running diagonally across the shape. The top arrow of the diagram illustrates the conscious flow of information whereas the bottom illustrates the course of unconscious information. The analyst (therapist) is represented on the left side of the diagram and the analysand (client) on the right. 1 See Figure 1 6 Each of the two individuals has a relationship with the shadow parts of themselves. The shadow self is defined as, “hidden or unconscious aspects of oneself, both good and bad, which the ego has either repressed or never recognized” (Sharp, 1991, p. 123). In this case, the shadow self of the healer would be the wounded and the shadow self of the wounded would be the healer. The analyst, or healer in this situation, is relatively conscious of their wounds. However, despite an in-depth analysis of their afflictions, their wounds live a shadowy existence and have the potential to be reconstellated in certain situations (Sharp, 1991, p. 150). Especially if they are working with an individual whose wounds resemble their own, in which case they would experience some countertransference. The wounded, or the client in this situation, has a natural potential to be a healer themselves but it is temporarily unable to access that ability (Sharp, 1991, p. 150). The unconscious information is just as important as the conscious information. Bringing unconscious traumas to the surface of consciousness bridges the gap between suffering and healing. It is important to note that the analyst needs to maintain a constant relationship with their unconscious self so that they may remember that they embody a wounded healer archetype and not a savior archetype (Sharp, 1991, p. 150). The therapist is not responsible for the growth or healing of a client. The purpose of a therapist should be to help their clients to recognize the strength and healer within themselves. A therapist should never take credit for a patient’s successes. Note, that there is an inherent difference between healing someone and curing someone. Curing someone is to eliminate the symptoms of disease through the use of medicine. Medicine is rooted in a science, and science comes from rational thought of the 7 mind. The word disease can also be understood as dis-ease. The essence of the word is discomfort. Healing, on the other hand, is to make or become whole again. Healing is an art that originates from the heart. “To do ‘psychotherapy’ is to ‘attend to the soul’ which is something that is quite different to the ‘mind’” (Dargert, 2016). When we look at the etymology of the word health, we will find that it translates into wholeness. If we think about all of the things that life consists of, we would have to include all of the bad along with all of the good; for there is not one without the other. So, “we are then faced with the challenging idea that illness, and indeed death itself form an inevitable part of that whole which makes up a fully lived life” (Dargert, 2016). There is a certain kind of power in spoken words. Dr. Zahed (2014) includes a powerful quote by Yehuda Berg in his article “The Power of Spoken Words,”: Words are singularly the most powerful force available to humanity. We can choose to use this force constructively with words of encouragement, or destructively using words of despair. Words have energy and power with the ability to help, to heal, to hinder, to hurt, to harm, to humiliate and to humble. In storytelling, especially mythology, words have the power to leave an imprint on an individual’s mind and heart. It is the responsibility of the social worker clinician to use this knowledge of the power of spoken words as a tool to help their clients to heal. One must be careful with their intention behind their spoken words and practice self reflection diligently so as to do no harm. Self-reflection is an effective tool in recognizing any phenomena of transference or countertransference in the therapeutic relationship early on. According to Michael Meade (2018), there are fundamentally two ways of explaining the world; the first is mythos and the second is logos. Logos is a form of rational thought process, seeking to find objective truths. It is the most commonly used approach today in the way that we view our world. Mythos, on the other hand, is a very 8 ancient way of thinking that approaches the world in a less direct and more narrative means. The word mythology means the study of myths. The root word, being mythos, is derived from the ancient Greek word “µῦθος” (pronounced mûthos) meaning tale or story. Mythology is composed of both facts and feelings. Subjective aspects, such as an individual’s feelings or personal experiences, become relevant and pertinent information (Meade, 2018). Meade (2018) expands on this idea of mythology as a narrative means to reality by saying: A narrative method involves relating to the experience of others, a sense of feeling connected to them and feeling sympathetic to the suffering of others. Where logos would dissect and analyze in order to distinguish one thing for another to get at the truth, Mythos seeks to uncover hidden connections between things and underline patterns that shape a person and events in this world from within. Each of them, the logical way and the narrative way, can lead to meaning but each offers a truth of a different order. (Meade, 2018) In his book Myth and the Body, Keleman (1999) describes myth as “A story that grows out of the history of bodily process to orient life and give values” (Keleman, 1999, p. 5). On a fundamental level, myth communicates a perspective of the social and personal word. On a deeper level, myth “tells about the trials and tribulations in the initiation into different stages of adult life. A myth is a social order that tells about familial roles, about conflict and resolution” (Keleman, 1999, p. 5). Like all stories, the stories told by mythology suggests a sort of emotional reality. In this emotional reality, we see ourselves as a character, we relate to different aspects of the story as we are experiencing them in our waking reality. Recognizing which characters we play and at what time can help us to recognize what stories we live in and how we live our life. By becoming conscious of our unconscious thoughts, feelings, and actions we discover and learn more about ourselves. This is one of the many functions of mythology. And so we 9 will read about the myth of Asklepios and how he represents the wounded healer archetypal energy. The question that this thesis proposes to answer is: What are the thematic elemental patterns that emerge from the Myth of Asklepios and how do they translate into therapeutic characteristics in the process of healing? LITERATURE REVIEW The Myth of Asklepios2 Apollo fell in love with the princess of Thessaly. Koronis was unfaithful to Apollo after conceiving the child. Her disloyalty was brought to the attention of the god by one of his traditional messengers, the crow. The crow is supposed to have been white, but Apollo turned the crow black in a fit of rage. Apollo sent his twin sister Artemis, goddess of the hunt, to shoot down Koronis with her golden arrows. With the unborn child still inside the womb, Apollo watched his beloved burn on a funeral pyre. The sight caused Apollo to become stricken with grief and he rescued the child from the horrors of death saying: “I can no longer bear in soul to kill my seed with horror in the grasp of its own mother’s death.” the flames gave him ingress, and in a stride he pulled the child out of its mother’s corpse. The child was given the name of Asklepios and given to Chiron, one of the wisest kentaurs. Chiron was known for his heroic healing and teachings, becoming a master of the science of herbs and medicine. Chiron is another example of the wounded healer. Chiron suffered from a wound that would not heal as a result of being caught in the crossfire of one of Heracles’s arrows tainted with deadly poison belonging to the Hydra. 2 See Figure 2 10 His wound caused him eternal torment because he was immortal, and his search for his own cure led him to discover how to heal others. Asklepios learned from Chiron and eventually surpassed him as his teacher and mentor. Asklepios “also was said to have instituted psychotherapy by healing ‘with the words that can alleviate men’s tormented souls’ and by giving mortals the gift of healing dreams” (Tick, 2001, p. 18). Asklepios was gifted the traits of a healer by his divine lineage. Asklepios was granted his abilities of diagnoses, healing, and intuitive insight from his divine father, Apollo. Athena also gifted Asklepios healing abilities through two vials of blood from the legendary gorgon, Medusa. One gaze upon the head of Medusa could turn any mortal to stone. One vial contained blood from the right side of her body, which is said to have healing properties. While the second vial contained blood from the left side of her body, which slayed. Asklepios became renowned as the greatest healer in the Mediterranean world. And all who came to him for treatment Of malignancies or wounds From shining spears Or bullet stones Or ravages of summer heat or winTer’s cold he healed accordingly: Some with soothing incantations, some with Beneficial potions, some with ointments Rubbed on limbs, and some He brought to health by surgery. (Tick, 2001, p. 19) Asklepios was so well known for his abilities that it was rumored that he could awaken the dead. His life came to an end when Zeus killed Asklepios with a thunderbolt for bringing someone back to life. 11 Temples3 of Asklepios After his death, Asklepios became so reverently honored that he was eventually given the title “god of healing” and raised to walk among the immortals. His temples and healing sanctuaries became sacred places as his influences spread throughout the Mediterranean, originating from his first sanctuary located in Epidauros. In any therapeutic practice, Apollo’s gifts translate into understanding of the inner disease-and-healing process itself and the germinating and reading of dreams. Diagnosis and understanding are the healing arts derived from reason; dreaming and reading their mysteries are the arts derived from spirit. (Tick, 2001, p. 23) The sanctuaries and temples dedicated in honor of the god, brought healing through the method of dream incubation. Dream incubation can be thought of as a sort of questing. “The healing sanctuaries of ancient Greece attended to spiritual and emotional needs as much as they did to the physical needs of its patients” (Dargert, 2016). Those individuals who sought healing in the sanctuaries and temples were considered to be incurable of their severe psychological, spiritual, or physical afflictions. Patients attempting to be healed during a brush with the divine must commit to a state of cleanliness and chastity in order to be purified and worthy (Tick, 2001, p. 4). Upon being purified, the patients would then be called by an initial dream to move into the abaton of Asklepios. “The abaton was the sleeping chamber; the name literally means ‘The place not to be trodden’” (Tick, 2001, p. 4). In his book, Ancient Dream Incubation and Modern Psychotherapy, Meier (1967) translates the word abaton to mean “the place not to be entered by the unbidden” (p. 56). The etymology of the word abaton, in both ancient and modern Greek, is “βατός” (pronounced bat'-os). The word batos is interpreted as “passable, capable of passing through by foot”; therefore, abatos means exactly the 3 See Figures 3-4 12 opposite: “impassable by foot”. The word then transforms into abaton which means “an impassable place”. Thus, the sanctuaries and temples of Asklepios were not easy to access. The purpose of these sacred enclosures were to bring about healing; hence, the reason for their location being tucked away from the mundane was to intensify the spiritual and psychological powers associated with the dream questing. The seeker waits, for several hours or several days, in a narrow chamber resembling a sort of womb, awaiting a healing dream or a vision from the deity in any number of his different forms. “The god touched or treated the afflicted part of the person, or provided instruction, or advice. Thus a cure was effected. It was the epiphany, the visit of the god through a dream, that healed” (Tick, 2001, p. 5). The Rod4 of Asklepios The rod of Asklepios is an important symbol with regards to the healing process. There is a serpent that coils itself around the rod he holds. The serpent symbolizes Mother Earth and transformation simultaneously. However, in Judeo-Christian religions, the snake is traditionally thought of as a curse or the fall of man. That is not the case here. Under these circumstances, the serpent is a symbol of transformational healing. “Asklepios was an advanced practitioner of snake healing, particularly the inner transformation of poisons and identity transformations symbolized by shedding one’s old skin” (Tick, 2001, pp. 24-25). Healing practices surrounding snake worshiping were widespread throughout the Mediterranean region. Priests and priestesses practicing such traditions would permit the snake to bite them; thereby building up resistance to the poison over a period of time while propelling themselves into altered states of consciousness in sacred healing rituals (Tick, 2001, pp. 25-26). 4 See Figure 5 13 Crazywise Phil Borges and Kevin Tomlinson (2017) co-directed a documentary called Crazywise that takes a new perspective on psychosis and how to transform psychological crisis into an opportunity for growth and change. This growing conversation has shed a new light on the need for alternative treatment approaches that focus on recovery, fostering social support, and a meaningful purpose. The documentary consists of several interviews with various health professionals, incorporates the experiences and teachings of tribal and indigenous cultures, and follows the stories of two individuals who transform their psychological suffering into a new understanding and appreciation for life. A man named Adam Gentry from Seattle, Washington tells his story about struggling with depression and bipolar manic episodes shortly after his 20th birthday. His family and close friends described him as compassionate, kind, intuitive, and funny before becoming very angry. Adam spent four years taking all sorts of medications with up to 15 pills in a day; none of which helped him. Actually, Adam says that the medications did more harm than good; it changed him, and not for the better. Adam lost everything as a result of the mental health system failing him. He lost his sense of identity. His relationships with his close friends and family were severed as a result of his worsening mental state. Adam decided he wanted to change his life. He quit all of his medications at once, which is a very dangerous and risky thing to do without medical supervision. Adam described himself as “a drug addict, alcoholic that hated everyone” before making this change. And after a ten day silent meditation retreat, he returned to life as “a sober, life-loving vegan and complete health nut” (Borges et al., 2017). 14 The second testimony comes from a woman named Ekhaya Esima from NYC, New York. Ekhaya experienced extreme paranoia in her twenties, hearing voices and seeing dead people. She attempted suicide several times and tried to get help from the mental health system. Ekhaya also took various medications and she described them all as changing her, both physically and physiologically. She felt “drugged up” (Borges et al., 2017). It became too much for her to bear and she gave her children up for adoption. Ekhaya found her meaning and purpose as a wounded healer through a peer-led mental health organization and spiritual healing. She has since rekindled her relationship with her children and she is now actively engaged as a mental health and spiritual advocate (Borges et al., 2017). Crazywise teaches us that tribal and indigenous cultures think differently. Rather than view mental illness as a disease with no cure or a hopeless cause, Crazywise emphasizes the importance of a strengths-based perspective. Such cultures view, what we would call, symptoms of mental illness as signs that a person is gifted with the abilities of the wounded healer. Those who experience hearing voices or seeing visions in an indigenous culture are taken under the wings of an elder who provides them guidance with respect to their special sensitivities. These individuals transform their abilities into gifts that they then use for the benefit of their tribal community. These individuals become the most respected and honored medicine men and women and bring healing and guidance to their tribe. 15 Application of the Wounded Healer Archetype to the Therapeutic Healing Process Born to a divine father and a mortal mother, Asklepios has several resemblances of a Christ-like figure. “Like Jesus, he was a manifestation of the archetype of the wounded healer and savior who knows our suffering because he has experienced it” (Tick, 2001, p. 17). The pattern of birth origins in myth is symbolic for the wounded healer. Being born to a mortal mother, the wounded healer experiences incarnation and therefore understands the struggle of the human condition, all of which is essential to the role of a wounded healer (Tick, 2001, p. 20). The wounded healer must walk a middle path between divine and human. Born into the violent confrontation between his mother and father, Asklepios’s birth is rooted in a primal wound, of which he had to overcome (Tick, 2001, p. 21): He was saved from dying flesh by an act of god, saved from the decay of the earthly by the heavenly, the immortal. Further, like other divine figures to which his pattern is related, by being snatched from his dead mother’s womb and the devouring flames of her funeral pyre, he experienced a resurrection. (Tick, 2001, p. 21) In retrospect of this symbolism, a wounded healer is one whose “spirit” or “soul” would have died as a result of family conflict, if it wasn’t for some divine act of intervention that saved them. The archetypal energy behind the wounded healer is what makes– therapists, guides, physicians, ministers–the best healers. The archetypal mentor is another important role in the wounded healer’s journey. For Asklepios, it was the wise kentaur by the name of Chiron. Being half human and half horse, Chiron represents both the nature and the human worlds. Apollo represents the divine. And Asklepios brings all three worlds together; mastering gifts of the healing arts of the natural, human, and spiritual worlds. The wounded healer must be able to bridge the three worlds; 16 harmonizing the tensions between their mental and emotional wellbeing in the process. Like any mentor/apprentice relationship (or therapist/patient relationship) the true healer will surpass the mentor in time. If mentor does well to pass on their wisdom to the student, the student will take that wisdom and grow. When applied in a clinical profession, the patient will take what knowledge and wisdom is offered by the therapist, learn to apply it, and continue to build on it so that in time they can pass it on to others and the roles will be reversed. The archetype of the wounded healer is also central to the Christian Gospels. In the Gospel of John, Jesus says the following: If I do not wash you, you have no part with me...For I have given you an example, that you also should do as I have done to you. Most certainly I tell you, a servant is not greater than his lord, neither one who is sent greater than he who sent him. If you know these things, blessed are you if you do them. (John 13:1-15, English Standard Version) Here, Jesus is embodying the archetypal energy of the wounded healer. It was tradition in those days for the lowliest person in the room to wash the feet of those who return after a journey. By humbling himself, he reinvents what it means to be a healer in the helping profession (Larisey, 2012, p. 13). In psychotherapy, there is an alchemical foot-washing that takes place in the therapeutic relationship (Larisey, 2012, p. 13). “The primary requirement for becoming a psychotherapist is not the intellectual training. It is not the methods and techniques. It is simply the willingness to kneel and be washed” (Larisey, 2012, p. 13). Another aspect of the myth that can be translated into the therapeutic healing process is the significance of a sacred space. In this context, the use of the word sacred is meant to describe a space that is safe and possesses the qualities of the ethereal. The 17 temples of Asklepios and the sleeping chambers are kept sacred so that a human can experience a connection with the divine. This image of the bed on which the sick would lie is translated into the concept of the analytic couch in therapy. The notion of the analytic couch originates from this myth and took nearly two millennia to make an appearance in modern medicine (Dargert, 2016). Therefore, the therapy room echoes that of the temples and the couch that of the sleeping chambers. Depth psychologists attempt to understand the manifestations of the unconscious minds of their patients “through the study of dreams, images, symptoms, slips of the tongue, spontaneous humor, meaningful coincidences, as well as interpersonal engagements” (Pacifica Graduate Institute, 2018, What is Depth Psychology?). This approach to psychological suffering encourages patients to look at unconscious material in their psyches: things that have been repressed or things unknown. The process of healing begins with recognizing what has been buried in the unconscious. By exploring the importance of whatever material arises, and by integrating it into the conscious mind, an alchemical transformation of consciousness takes place. This understanding of the individual can be applied to cultures and society at large. All of these processes impact the psyche. METHODS Research Design This thesis uses descriptive analysis to evaluate the relevance of the myth of Asklepios in the therapeutic healing process and to highlight certain thematic material as it translates to the alchemical transformation of patient to wounded healer. The curiosity 18 that elicited discussion surrounding this topic was one of personal interest and fascination with Jungian psychology and how it uses mythology and dream analysis to cultivate healing in therapeutic practice. Jungian depth psychotherapy is very demanding of an individual in that it requires a lot of time and effort to work on oneself. Data Collection and Data Analysis According to Nassaji (2015), “The goal of descriptive research is to describe a phenomenon and its characteristics. This research is more concerned with what rather than how or why something has happened” (p. 129). Additionally, qualitative research “is more holistic and often involves a rich collection of data from various sources to gain a deeper understanding of individual participants, including their opinions, perspectives, and attitudes” (Nassaji, 2015, p. 129). This type of research method is common for conducting research in the social sciences (Nassaji, 2015, p. 129). This particular thesis uses descriptive analysis to examine the thematic material of the wounded healer archetype in connection with the therapeutic healing process. The analysis will be summarized to provide specific examples supporting the analysis of the material. The data gathered will then be interpreted as qualitative data. The data collected for this thesis originated out of other sources. There were several sources consisting of peer reviewed articles, books, and a documentary. In analyzing the qualitative data, there were certain parallels that connected the mythology and archetypal energy to the evidence of true experience. 19 FINDINGS AND PRACTICE IMPLICATIONS As a western culture, we commonly think of mental illness as a limitation. We label individuals with psychological struggles as “ill” that seemingly suggests that they are “less than” or “broken”. There is a culturally demeaning discernment underlining the language surrounding the conditions of a person’s mental health, such that it creates a barrier that prevents open and sincere communication regarding a person’s sense of wellbeing or wholeness. It is a good reminder that we must be careful with the language and rhetoric we use. Depending on the connotation of the language, either positive or negative, we can either promote healing and open communication or we can hinder it and terminate it where it stands before it ever has a chance. As previously illustrated by the testimonies from the Crazywise (2017) documentary, pharmacological therapy is unreliable and potentially harmful to its consumers. It’s expected that medication is supposed to alleviate the symptoms of mental illness so that a person’s life can become more manageable. However, often times the warning labels and side effects of the drugs are cautioning about the very thing the drug is supposed to help. For example, one of the more common side effects antidepressant medications are suicidal thoughts. It does not make sense why these prescription drugs would be causing the very thing they are meant to prevent. Instead, the medications generally tend to make an individual feel numb. It would only make sense that by numbing the pain of the thoughts or feelings an individual would feel somewhat dead on the inside. The unconscious is being flooded with information that is not being consciously processed, and is therefore worsening the symptoms. 20 The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a book, published by the American Psychiatric Association, containing all the various mental disorders, each associated with their own daunting descriptions, symptoms, and criteria. The number of disorders has significantly increased with each new edition. According to the National Alliance on Mental Illness (2015), 1 in 5 Americans will suffer a psychological crisis in their lifetime. Seventy-five percent of crises occur before the age of twenty-four (NAMI, 2015). According to the National Institute of Mental Health (2019), only about half of the population who need professional services actually receive it. There is a certain stigma surrounding the conversation of mental health that prevents individuals from seeking help for fear of being weak or vulnerable. According to the journal article, “The biomedical model of mental disorder: A critical analysis of its validity, utility, and effects on psychotherapy research” Deacon (2013) states: “Although neuroscience has undeniably revolutionized our understanding of the brain, it has failed to enumerate even one instance in which neurobiology alone can explain a psychological experience” (p. 851). He continues to note that, “Despite the emergence of novel technologies in recent decades...researchers have yet to discover a single biological marker with sufficient sensitivity and specificity to reliably inform the diagnosis of any mental disorder” (Deacon, 2013, p. 851). And yet, pharmaceutical sales for mental illness has risen dramatically in the last 20 years. In 1988, pharmaceutical sales were worth $500 million (Borges, et al., 2017). In 2008, pharmaceutical sales increased to $40 billion (Borges, et al., 2017). 21 DISCUSSION What this thesis has attempted to illustrate is the importance and value of recognizing archetypal energy in mythology as a guide to or representation of everyday life. As pertaining to the wounded healer archetype, mythology helps us to understand that we can transform our sufferings into something beautiful that can be shared and used to foster healing. There are key themes across all of mythology that can lead us to a better understanding of ourselves, our situations, and our purpose. In her journal article “Analytical Psychology and Literary Criticism” Marie-Louise von Franz (1980) says, “It is inevitable that psychology should deal with literature, since both spring from the same womb: the human psyche” (p. 119). The therapeutic healing process is similar to the creative process in many ways. As mentioned in the introduction section, healing is an art that lives in the heart. This work is very much applicable in many different situations. If we consider the client to be the artist by which they bring their creations or dreams to a therapist for processing, we can understand this dynamic in a much larger context. Creativity demands psychic energy. It is childish and eccentric, and it is the price one must pay to be the “instrument of spirit which reaches beyond himself” (Franz, 1980, p. 123). Just as there is a personal unconscious, there is the collective unconscious that we all share. Artists often embody the collective unconscious in their art. If it is well received by the public, then the issue or cultural trauma must be relatively conscious. However, if it is not well received, it is likely that the general population is not aware of the unconscious illness or symptoms. Unconscious illnesses sometimes take hundreds of years to become known to the general conscious (Franz, 1980, p. 123). An artist’s work, if not accepted during their 22 lifetime, will likely gain public understanding and success with time once it moves from the collective unconscious to the general conscious. As a whole society, it will take a lot of time and effort and sacrifice for us to understand and heal our collective illnesses. It must first begin with “myself”. We all have a responsibility for doing the work it takes to better understand ourselves and our purpose in life. Strengths and Limitations This thesis is a descriptive analysis of other sources of material. The human data collected by these other sources was done through a series of interviews or self-reports of experiences. Analyzing subjective data, while less scientific, can bring about a greater understanding of the complexity that makes up a person’s identity. The material analyzed in this thesis was gathered and organized accordingly to illustrate parallel themes across different sources. The patterns that emerge from the descriptive analysis seem to suggest commonalities in connection with certain trait characteristics of a person and their innate ability to help heal themselves and others in a therapeutic environment. The limitations of this research exist in the inability to determine a cause and effect correlation between different variables. Only suggestions and implications from the data could be made to support the research. Analyzing other sources of data, there was no physical research conducted by the researcher as evidence to support this thesis. There was no manipulation of variables; hence, a statistical analysis cannot be concluded. The findings of this research may be open to interpretation by the reader. The results of this research cannot be replicated because of the nature of descriptive analysis. 23 Suggestions for Further Research, Implications, and Conclusions Further research could be conducted through the use of focus groups to determine the effects of different methods of intervention on mental health and overall individuation of a patient with the purpose of analyzing the difference between the current methods of our mental health system as it is in comparison to the depth-psychotherapy. It may also include personal testimonies or statements from individuals included in the study. An IRB proposal would need to be submitted for approval before conducting any further research that would the collection of include human subjects data. Participants would need to be screened to be deemed appropriate for this study. Additionally, participants would need to fully comprehend and sign a document regarding confidentiality and patient rights. All documents would need to be successfully completed and in compliance with HIPAA law. The descriptive analysis of this research suggests that there are holes in the mental health system. It also suggests that there needs to be new methods of intervention that focus primarily on fostering social connections, recovery, and developing an individual’s purpose and overall individuation. This in-depth research provides us with a better understanding of how a person’s subjective experiences are internalized and then transformed within the unconsciousness of the psyche to become enacted upon as archetypal energy under the social and cultural conditions within which we live. Understanding how this research applies on an individual and micro level enables us to comprehend its implications on a social, cultural, and macro level. Further analysis can help to anticipate the direction in which our collective wellbeing is heading and hopefully provide insight as to how heal the collective unconscious illnesses that plague our world. 24 APPENDIX Figure 1 (Sharp, D. (1991). Jung Lexicon: A Primer of Terms & Concepts. Toronto, Canada: Inner City Books, p.150) 25 Figure 2 (Mehnert, M. F. (n.d.). Statue of Asklepios) 26 Figure 3 (Wellcome Collection. (n.d.). Facade of temple of Aesculapius at Epidaurus) Figure 4 (Wellcome Collection. (n.d.). Altar and statue of temple of Aesculapius at Epidaurus) 27 Figure 5 (Wellcome Collection. (n.d.). Coluber Long issimus Aesculapius snake coiled round staff) 28 REFERENCES Borges, P., & Tomlinson, K. (Directors). (2017). Crazywise[Motion picture on DVD]. USA: Green Planet Films. Dargert, G. (2016, July 28). The Snake in the Clinic: Psychotherapy's Role in Medicine and Healing. Retrieved September 17, 2018, from https://karnacology.com/2016/01/26/the-snake-in-the-clinic-psychotherapys-rolein-medicine-and-healing-by-guy-dargert/ Deacon, B. J. (2013). The biomedical model of mental disorder: A critical analysis of its validity, utility, and effects on psychotherapy research. Clinical Psychology Review,33(7), 846-861. Retrieved April 12, 2019, from http://jonabram.web.unc.edu/files/2013/09/Deacon_biomedical_model_2013.pdf Franz, M. (Autumn 1980). Analytical Psychology and Literary Criticism. New Literary History,12(1), 119-126. Retrieved September 17, 2018, from https://www.jstor.org/stable/468809. Graves, R. (1990). The Greek Myths(Vol. 2). New York, New York: Penguin. Jung, C. G. (1938). Psychology and Religion(The Terry Lectures Series). New Haven and London: Yale University Press. Jung, C. G. (1932) "Psychotherapists or the Clergy," Psychology and Religion, CW 11, par. 497 Jung, C. G. (1969). The structure of the psyche (R. F. C. Hull, Trans.). In H. Read et al. (Eds.), The collected works of C. G. Jung(Vol. 8, 2nd ed., pp. 139-158). Princeton, NJ: Princeton University Press. (Original work published 1931) Jung, C. G., & Jaffe, A. (1963). Memories, Dreams, Reflections(C. Winston & R. 29 Winston, Trans.). New York, NY: Random House. Keleman, S. (1999). Myth and the Body. Berkeley, CA: Center Press. Kornfield, J. (1994). Buddha's Little Instruction Book. New York, NY: Bantam Books. Larisey, K. C. (2012, Fall). The Wounded Healer: A Jungian Perspective. C.G. Jung Society of Atlanta, 12-13. Retrieved January 21, 2019, from http://www.jungatlanta.com/articles/fall12-wounded-healer.pdf Meade, M. (n.d.). Living Myth. Retrieved February 8, 2019, from https://www.livingmyth.org/contact/ Meade, M. (Producer). (2018, October 4). The Force of Truth [Audio podcast/Living Myth]. Retrieved from https://www.livingmyth.org/living-myth-podcast-91-theforce-of-truth/ Mehnert, M. F. (n.d.). Statue of Asklepios[Photograph found in The Legion of Honor, San Francisco]. Retrieved February 18, 2019, from https://upload.wikimedia.org/wikipedia/commons/9/98/Asklepios__Epidauros.jpg Meier, C. A. (1967). Ancient Dream Incubation and Modern Psychotherapy(M. Curtis, Trans.). Evanston, Illinois: Northwestern University Press. Nassaji, H. (2015). Qualitative and descriptive research: Data type versus data analysis. Language Teaching Research,19(2), 129-132. Retrieved April 10, 2019, from https://journals.sagepub.com/doi/pdf/10.1177/1362168815572747. National Alliance on Mental Illness (NAMI). (2015, October 23). Mental Health Facts: 30 Multicultural. Retrieved April 10, 2019, from https://www.nami.org/NAMI/media/NAMIMedia/Infographics/MulticulturalMHFacts10-23-15.pdf National Institute of Mental Health. (2019, February). Mental Illness. Retrieved April 11, 2019, from https://www.nimh.nih.gov/health/statistics/mentalillness.shtml#part_154787 Pacifica Graduate Institute. (n.d.). What is Depth Psychology? Retrieved March 8, 2019, from https://www.pacifica.edu/about-pacifica/what-is-depth-psychology/ Sharp, D. (1991). Jung Lexicon: A Primer of Terms & Concepts. Toronto, Canada: Inner City Books. Tick, E., PhD. (2001). The Practice of Dream Healing: Bringing Ancient Greek Mysteries into Modern Medicine. Wheaton, Illinois: Quest Books: Theosophical Publishing House. Wellcome Collection. (n.d.). Altar and statue of temple of Aesculapius at Epidaurus [Reconstruction of the interior, altar and statue of temple of Aesculapius at Epidaurus.]. Retrieved February 21, 2019, from https://wellcomecollection.org/works/asvckf75 Wellcome Collection. (n.d.). Coluber Long issimus Aesculapius snake coiled round staff [Digital image]. Retrieved February 21, 2019, from https://wellcomecollection.org/works/sx9er64w Wellcome Collection. (n.d.). Facade of temple of Aesculapius at Epidaurus [Reconstruction of the facade of temple of Aesculapius at Epidaurus]. Retrieved February 21, 2019, from https://wellcomecollection.org/works/zu22tv8f 31 Zahed, H., Dr. (2014, December 15). The Power of Spoken Words. The Huffington Post. Retrieved February 8, 2019, from https://www.huffingtonpost.com/dr-hyderzahed/the-power-of-spoken-words_b_6324786.html University of Utah UNDERGRADUATE RESEARCH JOURNAL YOUNG ADULTS, THE IMPACT AND EXPERIENCE OF COMMEMORATIVE PRACTICES Lynette Randall (Mark de St. Aubin) Department of College of Social Work ABSTRACT This study uses qualitative methodology to investigate the self-reported impact commemorative practices have on bereaved young adults. The act of commemoration is defined in the literature review with special emphasis on traditional and non-traditional methods. The difference between traditional and non-traditional as well as intentional and unintentional practices are highlighted with the research and subsequent data collection. Data has been acquired from a convenient sampling of young adults between the ages of 18-35 who have experienced a loss in the last 10 years. Data was collected via individual interviews following a question guide in which both the experience and impact of said commemorative practices was studied. There is value in examining the different ways young adults participate in commemorative practices. This understanding can hopefully emphasize the importance of diverse commemorative networks and practices which can help aid within the field of grief counseling. The results of this study highlight the influence of traditional and non-traditional commemorative practices within bereaved young adults. The definition of traditional is contextual and based on the reporter, but is likewise compared to other traditional and non-traditional practices that will also be examined. This study will also consider the effect said commemorative practices have on daily activities in the lives of the reporters as well as their relationships. Additionally, quotes from the grief interviews are utilized throughout the results section in a unique narrative format as a way to both honor the grief shared throughout this study and to better illustrate the impact of these commemorative practices. Coding and thematic analysis were used to analyze the results. It is hopeful that the results of this research ii could aid the clinical grieving process by demonstrating the importance of diverse commemorative networks. iii TABLE OF CONTENTS ABSTRACT ii INTRODUCTION 1 METHODS 6 RESULTS 9 DISCUSSION 19 REFERENCES 22 iv INTRODUCTION & LITERATURE REVIEW Bereavement is “a condition that is endemic to being human” (Balk, 2011, prelude). Experiencing and subsequently mourning or grieving the loss of a loved one can be an overwhelming and powerful experience. Grief looks differently for each individual and is accompanied by a unique set of symptoms (Hoy, 2013). “We grieve because we are attached to someone who has been taken irreparably from us” (Balk, 2011, pg. 41). Many do not know where to begin to talk about their loss, grief and trauma responses. Psychotherapist Pamela Malone says, “this stems from growing up in a death-denying society where grief and death are rarely discussed in either the home or the community, although they are a very real part of life” (Malone, 2016, pg. 75). This “death-denying” society hinders the bereaved as they intentionally or unintentionally pursue their own form of healing (Malone, 2016). An additional aspect of this “death-denying” society is how individuals often apply the concept of “normal grief” (Servaty-Seib & Fajgenbaum, 2015, pg. 82). An unhealthy cultural expectation is prevalent among those who are bereaved of what grief should look like and how it should be handled. In a study conducted by Servaty-Seib & Fajgenbaum (2015), many bereaved reported being told or assumed an expectation that their grief had a timeline and moved in specific stages. However, in spite of this dominant discourse, they described their experience of grief as “dynamic, complicated, unpredictable, and ongoing” (Servaty-Seib, et al., 2015, pg. 81). The complexity of grief is also reflected in the various commemorative practices bereaved persons utilize throughout their grieving process. Participation in commemorative practices is a personal response by mourners to individualized needs embedded in their grief (Neimeyer, Harris & Winokuer & Thornton, 2011). Grief and 2 commemoration responses are always unique to the needs of the self or the self in community with others (Servaty-Seib, et al., 2015). Research shows that acts of commemoration are both helpful and important within the bereavement experience (Balk, 2011). Commemoration is a vital and personal act within the grieving process (Hoy, 2013). Commemoration can be defined as an intentional or unintentional ritual or activity the bereaved does to remember their loved one (Hoy, 2013). Commemoration can further be categorized within traditional and nontraditional methods (Servaty-Seib, et al., 2015). It is important to consider such distinctions and their impacts as the field of grief counseling is currently undergoing a critical examination (Walter, C. A., & McCoyd, J. L., 2016). Understanding the benefit and subsequent importance of diverse commemorative networks and practices can help aid the field of grief counseling (Walter, et al., 2016). “Bereavement rituals and legacy are inextricably linked concepts as often the use of rituals by mourners assist in the consolidation of the legacy of the one mourned” (Neimeyer, et al., 2011). Hoy also stated that commemoration “in the face of death can clearly be numbered among the important, adaptive activities in which bereaved families and communities participate” (2013). Commemoration can take on a variety of forms. Within the standard traditional definition, commemoration is often viewed as funerals, grave visits and symbols tied back to the deceased (Hoy, 2013; Gross, 1992; Neimeyer, et al., 2011). In spite of the variation that can exist among funerals themselves, the traditional funeral procession is “a highly ritualized metaphor for [commemoration’s] transitional bridge” (Hoy, 2013, pg.10). Symbols or “observable objects referring to ideas or emotions outside the 3 symbols themselves” are also categorized under the section of traditional commemorative practices (Gross, 1992, pg. 70). These symbols can include photo collages, memorabilia display and video tributes; all of which assist in recasting the life of the deceased (Hoy, 2013). These symbols are utilized by mourners to “make sense of the deceased person’s life by recasting the events shared and the relationships enjoyed into a tribute” (Hoy, 2013, pg.91). Symbols encompass a diverse array of possibilities for mourners to connect and find meaning with their loss. Such connection can also enhance present relationships and experiences, both of which will be viewed later in this study (Walter, et al., 2016; Neimeyer, et al., 2011). It is important to note that what is traditional for a person in one culture may not be traditional for a person of another (Hoy, 2013). Non-traditional commemorative practices could then be described as anything outside of these traditional common practices (Hoy, 2013). As has been expressed, grief and subsequent grief practices are dynamic and complex experiences for each individual. Literature shows a wide array of noted commemoration rituals and activities that all fall within a non-traditional category (Hoy, 2013; Walter, et al., 2016). However, there is less concrete research on strictly non-traditional bereavement practices as traditional and nontraditional are rarely separated for research purposes and often share intersectionalities. A commonality shared between both traditional and non-traditional categories is that of shared space (Cobb, 1976; Hoy, 2013, Servaty-Seib, et al., 2015). Support from others who are grieving is important for many grievers and the need to “gather with caring others is intrinsic” to the grieving process (Servaty-Seib, et al., 2015; Hoy, 2013, pg. 61). Honoring the life of the deceased in community format facilitates connection among grieving people to each other and provides support to co-mourners (Hoy, 2013). 4 This social support is vital as it “leads an individual to believe that they are cared for and loved, esteemed and valued, and belong to a larger network involving communication and mutual obligation” (Cobb, 1976, pg. 300). While grief obviously affects persons of all ages, this study focuses specifically on the impact and experience of grief and commemorative practices within young adults. In Grief and loss across the lifespan: A biopsychosocial perspective, Walter and McCoyd highlight the unique experience grief can have on emerging and young adults (Walter, et al., 2016). Young adults are in an impressionable time between adolescence and adulthood and the loss of a loved one can be traumatic and jarring (Servaty-Seib, et al., 2015). A significant percentage of young adults experience bereavement (Balk, 2011). For example, research has shown “between 22% and 30% of college students are in the first 12 months of grieving the death of a family member or a friend” (Balk, 2011). Servaty-Seib and Fajgenbaum’s research studied college students exclusively, featuring the diverse networks the bereaved reported in their grief process as well as the wide array of their commemorative practices (2015). Additionally, Water and McCoyd highlight the importance of programs that facilitate grieving especially for young adults as constructive steps towards being present and processing their grief (Walter, et al., 2016). This study aims to prove that non-traditional means of commemoration are just as effective, if not more beneficial, than traditional commemoration. Personal Narrative The beginnings of this research and subsequent thesis originate from the devastating loss of the author’s mother. Parental loss at any age is a specific form of bereavement, however, parental loss within young or emerging adulthood is particularly 5 unique (Servaty-Seib, Fajgenbaum, 2015). I began this project as a way to understand my own loss-- to identify what I do specifically to commemorate the memory of my mother and what I have found that affect (if any) to be. Curiosity peaked as I contemplated the commemorative practices of my similarly bereaved peers. I wondered what they did to remember their loved one and how they felt that impacted them, specifically their continued relationships and their day-today life and perspectives. I choose these categories of self-reported impact to examine simply because it is where I have experienced the largest shift within my own grief. As mere curiosity transitioned into genuine contemplation and inquisition, I sculpted the framework of an independent research project highlighting a specific population (18-35 years old) with inclusion criteria of having experienced a loss in the past 10 years. I highlighted the context of both relationship and time since loss of loved one, as well as age of the bereaved upon time of death. I speculated differences in commemoration based on length of time and age as well as types of commemoration (i.e. self-defined traditional vs. non-traditional, and intentional vs. unintentional). I examined 22 young adults over the course of three months, all of whom had experienced the loss of a loved one. These losses included parents, siblings, grandparents and friends. While conducting “grief interviews,” I acquired data regarding their personal commemoration practices and the subsequent self-reported impacts. The entire process was beautifully insightful and incredibly genuine. I was honored to share vulnerable space with these young adults as they bravely recounted their loss and allowed me to take an inner look into their rituals. METHODS Participants The participants within this study were selected via convenience sampling. They feature bereaved young adults between the ages of 18-35 who have lost a loved one within the last 10 years. Participants do not include anyone unable to give consent, nor those who are incarcerated or pregnant. Recruitment took place within the University of Utah chapter of “Actively Moving Forward,” a bereavement support group for college students and young adults. This recruitment was simply an extended invitation in person within these settings. Recruitment also involved reaching out in person to other individuals known by “Actively Moving Forward” participants who have also experienced a loss. Instruments The influences of traditional vs. non-traditional commemorative practices were self-reported by this convenient sampling of young adults who experienced a loss in the last ten years. The data collection took the form of individual interviews responding to a question guide. These interviews utilized open-ended questions to facilitate a conversation to collect qualitative data. The data collected provided evidence regarding how traditional and non-traditional methods of commemoration are experienced by the bereaved, as well as how they were impacted by said methods. Procedure Following recruitment, individual interviews were scheduled with each participant. These interviews took place at a location most convenient for the participant (usually on the University of Utah campus). The interviews were recorded and followed 6 7 the question guide (Appendix A). All responses were captured into a password protected online platform (google drive) and were later transcribed by the primary investigator. Following the completion of the questions, a short “check-in” was facilitated by the primary investigator. This check-in, a simple question of “how are you?” followed a potentially triggering or emotional conversation. If needed, the participant was then directed to additional resources (counseling, self-care suggestions, etc.) by the primary investigator. The individual interview process took no longer than 30 minutes. The entirety of this research study was conducted under the supervision and approval of the University of Utah’s Institutional Review Board (IRB). This included confidentiality requirements as well as an IRB approved consent letter (Appendix B). Safety of participants in this research study as well as subsequent data integrity was a high priority. Outreach and later individual interviews took place in a safe environment and check-ins also took place post-interview to assess emotional well-being/safety of participant. Discussing bereavement and grief could have involved triggers for a participant and a closing emotional check-in helped said participant identify or process further steps needed to stabilize emotional safety. These factors were specifically pointed out during the consent process, via the consent letter. Data integrity was implemented via storing all transcribed interviews on a password protected online site (google drive) and omitting participants name and other identifying information from their answers. Upon completion of study, data will be subsequently deleted. The resources available to conduct this research included a close mentor and faculty advisor within the College of Social Work at the University of Utah who specializes in grief & loss counseling, as well as additional research mentors. The space the research took place in varied depending on individual interviews, as there was 8 no set aside place for these to occur. Additionally, equipment (i.e. laptop and recording device) was owned by the researcher. Confidentiality of the study data mirrored the measures taken to ensure data integrity. Data integrity was implemented via storing all transcribed interviews on password-protected online site (google drive) and by omitting participants name and other identifying information from their answers. Additionally, the principal investigator complied with the confidentiality requirements of gathered data as required by the IRB. Data Analysis Method Interviews were analyzed using theme analysis (Dudley, 2011, pg. 258). Theme analysis was developed specifically for interview-formed methodology, with the goal of identifying common themes or patterns that are prevalent in several cases. This approach was chosen given the open-ended and personal nature of the expected answers regarding commemorative practices. In order to understand how these practices are experienced and their subsequent influence, theme analysis will be utilized to identify common themes reported in the answers. These responses were grouped together by a theme and a clearly articulated name was labeled for each theme. This method of coding or labeling enabled a succinct overview for the array of experience and impact within commemorative practices. Consistent with recommendations for this approach, this analysis process took place upon completion of data collection. Interviews were transcribed and coded after the primary investigator become thoroughly acquainted with the entire narrative. Themes were then identified and subsueqnetly coded. Qualitative data saturation can be achieved via a relatively low sample size. Data saturation is a term used in qualitative data methods to describe data satisfaction, meaning enough data has been collected to identify themes 9 as well as no new data emerging (Dudley, 2011). The sample size within this study was 22 participants. RESULTS Sample Description Of the 22 interviews that were conducted, the mean age a participant experienced a loss was 22 years old, with a range between 10-26 years old. The mean length of time since the passing of the loved one was 5 years, with a range between 1-10 years. Based on the evidence reported herein, the majority of relationships reported were between children and their parents (36.4%, n=8), followed closely by grandparents (31.8%, n=7), friends (27.3%, n=6) and siblings (4.5%, n=1). Above is a graph depicting the range in age at time of death for the loved one of the participants. The graph below depicts the categories of reported relationships with the deceased. 10 According to the findings, there was no direct correlation between time passed since death and frequency of engagement in commemorative practices the participant engaged in. Some participants reported an increase in frequency of engagement in commemorative activities the longer it had been since the passing of their loved one, while some reported a decrease, and others reported a consistent amount entirely. One participant described the increase in her commemoration as time since the death of her father increased: o “From the beginning, I didn’t listen too much. I was grieving. But after I had a grasp on the memories, I would listen to the song every day and then to every other day and now a couple times a day.” Commemoration 11 Within the reported findings a wide array of diverse commemorative practices was reported. Before delving into the categories of traditional and non-traditional as well as the self-reported impact, a comprehensive list of the various commemorations will be provided. Some participants reported multiple commemoration activities. Commemorative Practices wake book snowboarding collegiate athletics visiting gravesite hiked the AT kayaking walking on beaches listen to grandfather’s record player go to her grave drive past her home, play the piano Beyoncé song Instagram meme camping hexagon tattoo ash spreading photo album necklace made from his belongings celebrate his birthday playing basketball, listen to Journey, eating tacos going into her room praying internal conversations with him imagine what he would be like now mimic her clothing style re-read birthday cards she wrote me snuggle in the quilt she made me picking wildflowers going to the desert with our group of friends birdwatching hear her voice in my head throughout the day teddy bear made from his shirts necklaces worn at funeral, sharing stories dinner with his parents once a month similar tattoo going to his favorite spot fixing up his dollhouse wear his clothing conversations with family influencing my wedding planning physically be in places he has been to talk to him out loud while driving visit her house, celebrate her birthday listen to her song, go to her favorite restaurant order her normal order, talk in her native language 12 Below are a few explanations behind these practices from the participants: o “Being outside every day is his memory living on through me.” o “He and I had a dream that we would both be playing sports at a collegiate level. I’ve done my best to reach the standard and play at a collegiate level.” o “My dad was cremated, I would bring a little bit of his ashes and spread them where I loved. It was special to take him with me to places where I found meaningful and leave him.” o “Playing the piano is an ode to my grandmother as she encouraged me to play my whole life.” o “I grew up playing basketball with my dad. I’m not super athletic now, but I still keep my toes in basketball because my dad liked him so much.” o “I dig through my thoughts and memories and I am drawn back to certain memories that are really meaningful to me. Or I’ll be reminded of cool characteristics of him.” o “I always think about how good of friends we could have been.” o I hear her voice throughout the day, little sentence long lessons that I remember for some reason… they work their way into my head. It is just a part of who I am.” Of the 22 interviews that were conducted, participants reported on a number of traditional commemorative practices, ranging from going to a place of connection, doing an activity, celebrating a certain event or holiday. A majority of participants, (50%, n=11) commemorated the loss through traditional practices. 36.4% (n=8) reported non-traditional practices, while 13.6% (n=3) reported both traditional and non-traditional. Additionally, a majority of participants (86.4%, n=19) reported that their commemoration was intentional, while 9.1% (n=2) reported unintentional commemoration, and 4.5% (n=1) reported doing both. The graphs below portray both the reported traditional vs. non-traditional and intentional vs. unintentional reporting in commemorative practices. 13 When asked why they self-defined their commemorative practices as traditional, participants listed a number of explanations: o “I visit their graves and where they last were. It makes me feel like I am a little bit closer to them.” o “This is traditional because I’ll do this with my kids someday. o “I am doing things he loved.” o “On her birthday I pick wild flowers and put them in a jar as I did as a kid for her.” Additionally, “tradition” emerged when participants felt they were complying with a traditional practice of grief processing: o “There are definitely times when I felt like I should be sad or be happy and I couldn’t get ahold of myself…I envision that to be pretty traditional in the grieving process.” Consequently, when asked why they self-defined their commemoration as non- 14 traditional, participants listed a number of explanations, one of which being the lack of a set routine or ritual such as commemorating on a certain day or time: o “I would want them to be traditional, I struggle with anniversaries. I would enjoy some sort of tradition. I initially wanted to right after he passed away, but it became more challenging as time from his death increased.” o “I wouldn’t say that I have frequent rituals that I do, but I more often do things sporadically with him in mind and in his memory.” o “I do these things whenever I feel I need my mom… not at a set time.” Others related their non-traditionalism to the uniqueness of their commemorative practices in relation to their perception of societal norms: o “His grave is a tree in the desert instead of a grave in a cemetery.” o “I don’t think most people get to partake in this kind of ceremony where all of his friends got to participate in spreading his ashes. I feel very lucky to have done that. It was a huge part in my healing process.” o “When he passed away initially, I spent a lot of time trying to do things that I thought would make him really proud, but now it has developed into doing what I love.” And other participants spoke to the authenticity the claimed non-traditional commemoration provided: o “I don’t think it is traditional because it is much more personal than any traditions.” Impact Of the 22 interviews that were conducted, participants reported on various impacts commemorative practices have had on their relationships, ranging from strengthening to weakening. The majority of participants (72.8%, n=16) reported positive impacts such as helping them feel closer to their significant other, family, friends, or helping them to prioritize and be more open and accepting. 22.7% (n=5) reported negative impact of their commemorative practices resulting in straining current or past relationships. And 4.5% (n=1) reported no impact upon their current or past relationships. Many participants referenced the impact it has had on their relationships with their 15 significant other: o “If it is somebody I really want to bring into my life, they need to know this part about me.” o “I have a fiancé and he didn’t get to meet my mom, but he can tell that she was a good person through me because of the way she raised me. That brings us closer together.” o “When he first passed, I was dating somebody and he was not supportive at all and that is what helped end that relationship. It helped identify a red flag for me in that relationship.” o “It makes me look for someone like my dad to marry. Puts a new perspective and emphasis on meeting the standard of my dad and I try share him with whomever I am with so they can understand that part of me.” Other participants referenced the impact commemorative practices have had on their relationships with family members: o “I am closer with my immediate family because it something that all of us are experiencing. We all mourn differently, but we are so connected so we understand and empathize a little better.” o “Her influence has helped me to have a better relationship with my brother and sister.” And other participants referenced the overall mentality shift which their commemorative practices have helped to facilitate, affecting all of their relationships: o “I take the time and energy to spend those moments with those you love. My perspective has totally changed.” o “When I do remember my mom, it helps me want to be more like her.” o “It has helped me to see people for who they really are and what they could become. He saw me for the person that I was going to become and helped me in that way.” Negative impact was also experienced by participants including: o “I was not letting myself use my family as a resource and it put quite the strain on our relationship.” o “I find it healing when I do commemorate... If I dwell too much on it, it can be hard on my relationships, even with my stepmom and with my husband. “ o “Makes me more private sometimes. I feel awkward that they don’t know this big part of me and I don’t know how to communicate that sometimes.” 16 Of the 22 interviews that were conducted, participants reported on various impacts commemorative practices have had on their day-to-day experiences and/or functioning. 45.5% (n=10) reported no impact on their day-to-day functioning as a result of commemorating and 54.5% (n=12) reported impact on their day to day activities. Interestingly, within this impact, 33.3% (n=4) reported negative impact such as difficulties in school and consistent negative feelings, while 66.7% (n=8) reported positive impacts such as an increase in positivity and appreciation, as well as strengthened spirituality. Additional narrative on the impact includes: o “It is a gamble when I wake up, is this going to be a draining day or a good day?” o “I almost dropped out of grad school. I have had a very difficult time focusing.” o “I started antidepressants for the first time in my life. And that took a lot to process.” o “Makes me jealous of others who have their parents.” o “Helps me reframe a bad day into a good day… It has been healing for me.” o “Her lessons impact me every day. I mean, how important to you consider a parent’s lessons after they are gone?” o “Fairly often I try to self-evaluate to see if my decisions would make him proud of not. He still has a pretty big influence on what I do.” 17 The final component of the grief interviews assessed overall self-reported mood of the participants following commemoration. The overwhelming majority of participants reported positive affect post-commemoration with 72.7% (n=16), while 27.3% (n=6) reported negative. The specific moods described are listed in the pie chart below. Furthermore, there was higher reporting for positive emotions following participants’ use of non-traditional commemorative practices vs. traditional commemorative practices. In contrast, there was higher reporting for negative feelings following traditional commemoration rather than non-traditional. However, when engaging in both types of commemoration, positive feelings 18 were unanimously experienced. Below are narrative reports from participants when prompted to describe what they feel following a commemorative act: o “It is just weird to have that person gone. I’m figuring out what works best for me still. It feels good to remember.” o “I feel like I am respecting what he did, respecting my family name and my heritage and connections I have with my family.” o “There are times when it is more painful, there are moments I would want to share with him. It just feels good that he is still a part of my life.” o “I am more motivated by thinking about people who have passed on and be more involved and engaged in honor of them.” o “I feel motivated to stay positive. And have goals to be a cool mom like her someday.” o “It has caused me to question my beliefs and want to believe in a form of an afterlife.” o “There is a sense of feeling very, very lucky that he was brought into my life. I do sometimes get upset, because I wish I would have had the rest of my life to learn and grow with him. That is upsetting for me. I just let those emotions in as they come. This is bigger than anything I’ve dealt with and I have actively tried to take it as it comes.” o “It is daunting to realize that this is my new normal.” o “The hardest thing for me to sit with was realizing that no one will ever occupy the space that he filled in my life.” o “I feel confidence because I feel he approves of my choices.” 19 o “It is still kind of painful, but it is still warm and makes him feel closer. [Commemoration] is something that I am not afraid to do and look back on him now. It is not something that I dread or avoid. It happens randomly and when it does, I don’t get distraught over it anymore.” o “He is a song that I’ve forgotten how it goes and then when I play it again, it is ‘Oh, that is how it goes!’ It is bright colors and hopeful, not necessarily happy. It is refreshing.” o “That emptiness helps me realize how important she is to me.” o “It has made me a person that understands loss.” o “I am acutely reminded of her absence.” DISCUSSION Limitations While there is a substantive amount of qualitative research derived from these grief interviews, there are many areas that could be bolstered by acquiring additional data. The sample size (n=22) was more than enough to reach saturation, however, additional data would have been helpful to acquire from the participants. Such additional data could include added demographics, i.e. race, ethnicity, gender, education, etc. Identification of additional demographic fields could have assisted in supporting a generalization of this data as it relates to a collective clinical framework. Additionally, understanding the context of these grief practices via demographic information could provide insight into cultural traditions and pressures within groups using varied commemorative practices. The limited demographic characteristics of the sample also feeds into another limitation that results from the selection procedure of convenient sampling. There was little effort put into procuring a diverse sample population, instead aiming for a larger sampling pool. Subsequently, most participants came from similar backgrounds (young adults primarily college students within the Salt Lake City area) as they were involved in the sampling process similarly. That being said, the results of valuing all forms of grief commemoration can be beneficial to any person (Hoy, 2013). An additional limitation is the inability to identify correlation verses causation. This 20 study aims to prove that non-traditional means of commemoration are just as effective, if not more beneficial, than traditional commemoration. Yet, it is almost impossible to isolate the reported positive affect of said commemoration as a cause of changes in mood. A reported increase in positive affect may be attributed to other reasons entirely unrelated to grief. Thus, limitations exist within the bounds of isolating factors and proving responses. Implications In terms of implications of this study for actual practice, grief counselors can hopefully implement varied suggestions into clinical practice of introducing and encouraging the client to participate in whatever form of commemorative practices which resonate best for them. The results of this study should provide fellow peers as well as the clinical community with increased awareness of diverse commemorative practices, including ample support for the bereaved to carry out these practices as they need. This could take the form of continuing to support and advocate for bereavement leave policies for students on college campuses, implementing peer led community grief support groups, and providing professionals with additional understanding of the uses of varied forms of commemorative practices. A primary aim of this study was to understand grief responses and subsequent commemorative practices within young adults. Thus, the hope is to spread this research among other young adults and hopefully reduce the stigma of a “death-denying” society. As one of the participants reflected on her self-defined non-traditional commemoration, she said, “I don’t think most people get to partake in this kind of ceremony where all of [the deceased’s] friends got to participate in spreading his ashes. I feel very lucky to have done that. It was a huge part in my 21 healing process.” Conclusion Commemoration is deeply personal and vitally important to the grieving process (Balk, 2011). The act of commemorating can range from a funeral to a series of letters written from the bereaved to their loved one (Hoy, 2013). The importance and benefit of commemoration can be enhanced by a diverse availability of options for various commemorative practices. Traditional (i.e. funerals, religious services, etc.) and nontraditional (i.e. websites, art projects, etc.) commemorative practices are both beneficial to the bereaved. “Human beings seek meaning in mourning and do so by struggling to construct a coherent account of their bereavement that preserves a sense of continuity with who they have been while also integrating the reality of the changed world into their conception of who they must be now” (Neimeyer et al., 2011, pg. 331). Results from this study show a higher reporting for positive emotions following participants’ use of non-traditional commemorative practices vs. traditional commemorative practices. This illustrates the significant benefit in encouraging and participating in diverse methods of commemoration. In contrast, there was higher reporting for negative feelings following traditional commemoration rather than non-traditional. Yet, when engaging in both types of commemoration, positive feelings were unanimously experienced. This study has effectively shown that all forms of commemorative practices are beneficial long-term, however, the methods originally viewed as “non-traditional” appear to make a great impact on young adults. 22 REFERENCES Balk, D. E. (2011). Helping the Bereaved College Student. New York City, NY: Springer Publishing Company. Brimberry, T. (2015). The impact of engagement with social networking on the grieving process in bereaved emerging adults. Adler School of Professional Psychology, ProQuest Dissertations Publishing. Dudley, J. R. (2011). Research methods for social work: Being producers and consumers of research (2nd ed.). Boston: Allyn and Bacon. Gross, D. (1992). Discovering anthropology. Mountain View, CA: Mayfield. Hoy, W. G. (2013). Do Funerals Matter? New York City, NY: Routledge. Malone, P. A. (2016). Counseling adolescents through loss, grief, and trauma. New Routledge, Taylor & Francis Group. Mearns, S. J. (2014). The impact of loss on adolescents: developing appropriate support. International Journal of Palliative Nursing, Volume 6, Issue 1. Neimeyer, R., Prigerson, H., & Davies, B. (2002). Mourning and meaning. American Behavioral approach 46(2), 235-251 Neimeyer, R. A., Harris, D. L., Winokuer, H. R., & Thornton, G. F. (2011). Grief and bereavement in contemporary society: Bridging research and practice. New York: Routledge. Sanders, J. (2011). Bereavement websites for children and young people. Bereavement Care, Volume 30, Issue 2. Servaty-Seib, H. L., & Fajgenbaum, D. C. (2015). We Get It. London, UK: Jessica Kingsley Publications. York: Walter, C. A., & McCoyd, J. L. (2016). Grief and loss across the lifespan: A biopsychosocial perspective. New York: Springer Publishing Company. 23 APPENDIX A- Interview Question Guide o Relationship to loved one o Age candidate was upon death of loved one o How long it has been since death of loved one? o What intentional practices/activities do you engage in to remember this person (by yourself or with family)? o Would you describe these practices as traditional or non-traditional? o How often do you commemorate? o Has this amount changed over time? o How does your commemoration affect your relationships? o How does your commemoration affect your day-to-day activities? o How do you feel after your commemoration? 24 APPENDIX B, Consent Cover Letter Young Adults, The Experience and Impact of Commemorative Practices 25 The purpose of this research study is to identify the differences between traditional and nontraditional commemorative practices in young adults ages 18-35 who have lost a loved one in the past 10 years. This study will also examine how these commemorative practices are experienced, as well as the subsequent impact of these practices upon young adults. Your participation in this study includes answering an interview-style question guide in which you will be asked questions regarded your relationship to your loved one and what you have done/do to grieve your loss. You will also be asked how you feel these practices have affected you. There are no physical risks associated with this study, however, answering questions and talking about your deceased loved one might initiate some emotional triggers or feelings of sadness. Additionally, there are no direct benefits to you as a result of participating in this study. However, the results of this research could aid the clinical grieving process by demonstrating the importance of diverse commemorative networks. Subsequently, traditional grief psychotherapy could be encouraged to include an array of commemorative practices. Your answers will be kept confidential and protected as they will be stored on an online password protected platform. Additionally, your responses will contain no identifying information. Upon completion of this study, all of your responses will be deleted. If you have any questions complaints or if you feel you have been harmed by this research please contact Lynette Randall, Primary Investigator, BSW (May 2019), College of Social Work, University of Utah. Contact the Institutional Review Board (IRB) if you have questions regarding your rights as a research participant. Also, contact the IRB if you have questions, complaints or concerns which you do not feel you can discuss with the investigator. The University of Utah IRB may be reached by phone at [phone] or by e-mail at [e-mail]. It should take approximately 30 minutes to complete the questionnaire. Participation in this study is voluntary. You can choose not to take part. You can choose not to finish the questionnaire or omit any question you prefer not to answer without penalty or loss of benefits. By returning this questionnaire, you are giving your consent to participate. Thank you for your willingness to participate in this study. And please know that you are not alone in your grieving process.