2024-03-29T00:01:10Zhttp://digital.lib.washington.edu/dspace-oai/requestoai:digital.lib.washington.edu:1773/267732015-10-30T22:23:38Zcom_1773_4888col_1773_20986oai:digital.lib.washington.edu:1773/501072023-08-16T11:55:49Zcom_1773_4888col_1773_20986
Productivity loss by cancer stage in patients newly diagnosed with hepatocellular carcinoma
Cheng, Spencer Jane
Veenstra, David
Bansal, Aasthaa
Oncology
To Be Assigned
Thesis (Master's)--University of Washington, 2023
Background: New cancer diagnosis is associated with employment decrease, workplace absenteeism, and attributable costs to employers. To date, no studies have summarized the productivity loss experienced by patients newly diagnosed with hepatocellular carcinoma (HCC) by disease stage. Objective: The objective of this study was to estimate the workplace productivity loss in the year following diagnosis among patients newly diagnosed with early, intermediate, and advanced HCC in a commercially insured US population.
Methods: We conducted a retrospective cohort study using commercial claims from the Merative® Marketscan® database to identify incident diagnoses of primary HCC between January 1, 2010, and December 31, 2020. Patients with primary HCC were stratified into early-, intermediate-, or advanced-stage cohorts based on the presence of secondary malignancy codes, or first treatment received after index diagnosis. The mean workdays lost and cost attributable to workdays lost in the year following a new diagnosis were calculated using the Kaplan-Meier sample averages (KMSA) to account for censoring in each cohort. An exploratory analysis was conducted on two subgroups in the early and advanced cohorts to assess productivity loss in patients with and without treatment.
Results: Mean workdays lost in the year following a new HCC diagnosis among the early, intermediate, and advanced cohorts was 22.6 days (95% CI: 16.0, 29.8), 17.4 days (95% CI: 11.9, 23.2), and 19.5 days (95% CI: 15.6, 23.6), respectively. Corresponding indirect costs were $6,031(95% CI: 4,270, 7,953), $4,644 (95% CI: 3,176, 6,192), and $5,204 (95% CI: 4,163, 6,298) in the early, intermediate, and advanced cohorts. Early-stage patients without a liver transplant and advanced-stage patients who received systemic therapy had 19.7 (95% CI: 12.7, 27.4) and 22.0 (95% CI: 16.6, 27.7) mean annual workdays lost, respectively.
Conclusion: Productivity loss varies by stage and appears to be higher in early-stage patients who receive more intensive treatments in the first 12 months following a new HCC diagnosis. Further research to explore productivity loss by type of treatment received within patients of the same cancer stage is necessary to understand the impact of treatment on workplace productivity loss in patients newly diagnosed with HCC.
2023-08-14T17:00:52Z
2023
Thesis
Cheng_washington_0250O_25653.pdf
http://hdl.handle.net/1773/50107
en_US
none
application/pdf
oai:digital.lib.washington.edu:1773/501402023-08-16T11:56:24Zcom_1773_4888col_1773_20986
OUR GE(NE)OLOGICAL RECORD – Stratigraphy and Storytelling in Akron, Ohio
Christopher, Henry Elizabeth
Crouse, David N
Akron
Essay
Family
Geneology
Nonfiction
Ohio
Creative writing
LGBTQ studies
History
To Be Assigned
Thesis (Master's)--University of Washington, 2023
Methodology: split into pieces. Go around the family gathering with cupped hands. What can you tell me about where I come from and why? The answers you receive will allow you to rebuild yourself, but not in a pattern anyone in attendance is familiar with. They’ll move to corners when you enter a room. That’s not what we told you about ourselves, they’ll say. It was never about yourselves, but about your self, my self, the singular I I I ascending like a scared cardinal through the screen door of the sunroom. You can say: this is what you told me, and I am the truth coming through the cracking pavement of disparate accounts, and I am he on the wing, who sticks in the screen door and tatters the cloth, who does not run from the party when his cloak has been stolen, and I have patched together your remnants to cover my nakedness. Your story was never going to be something they’d recognize as their own. Each new outfit fits you different. They don’t even have to tell you they like it.
2023-08-14T17:01:01Z
2023-08-14T17:01:01Z
2023
Thesis
Christopher_washington_0250O_25630.pdf
http://hdl.handle.net/1773/50140
en_US
CC BY-NC-ND
application/pdf
oai:digital.lib.washington.edu:1773/506472023-09-29T11:26:00Zcom_1773_4888col_1773_20986
Neural Network Guided Variability Detection in Geospatial Data
Salama, Abdulrahman M
Ali, Mohamed
AI
computer vision
geospatial
machine learning
neural networks
transformers
Artificial intelligence
Computer engineering
Computer science
To Be Assigned
Thesis (Ph.D.)--University of Washington, 2023
Geospatial data refers to data associated with a specific location on the earth's surface. It plays an important role in a wide range of applications, including environmental monitoring, agriculture planning, mapping, and routing. With the increasing availability of geospatial data from various sources, there is a growing need for methods to validate and verify the accuracy and consistency of this data. Variabilities in such data can have significant impacts on the reliability of the derived information and decision-making processes. Thus, detecting these variabilities is of extreme importance for ensuring the quality of geospatial data. This PhD dissertation focuses on the development of deep neural network methods for detecting variabilities in geospatial data. Variabilities refer to differences between datasets that are otherwise expected to be consistent. Variabilities in geospatial data can occur due to various reasons such as measurement errors, misalignments between datasets, different algorithms used in processing metadata, and changes in real-world phenomena over time. The main objective of this dissertation is to present methods for evaluating the accuracy and consistency of geospatial data, detecting and reporting variabilities found in such data, and providing insights into how data is evolving over time. The effectiveness of the proposed methods will be evaluated using real-world datasets in various applications. This dissertation contributes to advancing the field of geospatial data management by providing new and innovative methods for detecting and reporting variabilities in geospatial data empowering decision-making and future planning.
2023-09-27T17:17:00Z
2023-09-27T17:17:00Z
2023
Thesis
Salama_washington_0250E_26019.pdf
http://hdl.handle.net/1773/50647
en_US
none
application/pdf
oai:digital.lib.washington.edu:1773/506482023-09-29T11:26:01Zcom_1773_4888col_1773_20986
Design and Development of an Intelligent Moderator Dashboard for an Online Support Community for Aging-Related Experiences
Wong, Sharon Hsien-Lin
Chen, Annie T
Bioinformatics
To Be Assigned
Thesis (Master's)--University of Washington, 2023
Medical conditions and other experiences related to aging can be challenging to manage for older adults and their caregivers. Virtual Online Communities for Aging Life Experiences (VOCALE) is an online community-based digital health intervention that aims to encourage problem-solving skills amongst older adults and caregivers through participation in weekly discussions. The VOCALE intervention is overseen by trained members of the VOCALE research team, known as “moderators”, whose responsibilities include monitoring the discussion platform and responding to the needs of participants. However, there are still unmet needs amongst VOCALE moderators, such as a desire to facilitate the intervention more effectively while also gaining a deeper understanding of how well participants are engaging with the study.This thesis project proposes a preliminary design for an intelligent moderator dashboard, which is a tool that can assist VOCALE moderators with their study-related duties and provide insights about participant engagement with the VOCALE intervention. To inform the design of this tool, a series of user-centered design activities, such as workshops and interviews, were conducted with current and former VOCALE moderators. Leveraging a combination of inductive coding and thematic analysis, the major themes extracted from these sessions were then used to inform the proceeding phase of the iterative design process. The final output of this project was a prototype for a proposed moderator dashboard design, alongside recommendations for further development.
Beyond its primary purpose of providing a framework for a dashboard that can be used for future iterations of the VOCALE intervention, this work illuminates key insights about the operation of VOCALE itself, identifying the needs of various stakeholders while also highlighting areas in which the VOCALE intervention could be improved. Furthermore, the work from this project contributes to a broader understanding of how to design tools to aid with the management of online health-related discussion-based communities, with consideration placed on how individual user needs interact with overarching objectives to inform the experience of those who moderate online digital health interventions.
2023-09-27T17:17:00Z
2023-09-27T17:17:00Z
2023
Thesis
Wong_washington_0250O_26190.pdf
http://hdl.handle.net/1773/50648
en_US
none
application/pdf
oai:digital.lib.washington.edu:1773/506492023-09-29T11:26:01Zcom_1773_4888col_1773_20986
Efficient Transfer Learning using Pre-trained Models on CT/MRI
Guobadia, Nicole
Hu, Juhua
computer vision
ct scans
feature extraction
fine-tuning
mri
Computer science
To Be Assigned
Thesis (Master's)--University of Washington, 2023
The medical imaging field has unique obstacles to face when performing computer vision classification tasks. The retrieval of the data, be it CT scans or MRI, is not only expensive but also limited due to the lack of publicly available labeled data. In spite of this, clinicians often need this medical imaging data to perform diagnosis and recommendations for treatment. This motivates the use of efficient transfer learning techniques to not only condense the complexity of the data as it is often volumetric, but also to achieve better results faster through the use of established machine learning techniques like transfer learning, fine-tuning, and shallow deep learning. In this paper, we introduce a three-step process to perform classification using CT scans and MRI data. The process makes use of fine-tuning to align the pretrained model with the target class, feature extraction to preserve learned information for downstream classification tasks, and shallow deep learning to perform subsequent training. Experiments are done to compare the performance of the proposed methodology as well as the time cost trade offs for using our technique compared to other baseline methods. Through these experiments we find that our proposed method outperforms all other baselines while achieving a substantial speed up in overall training time.
2023-09-27T17:17:00Z
2023-09-27T17:17:00Z
2023
Thesis
Guobadia_washington_0250O_25896.pdf
http://hdl.handle.net/1773/50649
en_US
CC BY
application/pdf
oai:digital.lib.washington.edu:1773/506502023-09-29T11:26:02Zcom_1773_4888col_1773_20986
Explainable query generation for cohort discovery and biomedical reasoning using natural language
Dobbins, Nicholas J
Yetisgen, Meliha
clinical trials
cohort discovery
database
natural language processing
user interface
Computer science
Bioinformatics
To Be Assigned
Thesis (Ph.D.)--University of Washington, 2023
Clinical trials serve a critical role in the generation of medical evidence and enablingbiomedical research. In order to identify potential participants, investigators publish eligibility
criteria, such as past history of certain conditions, treatments, or laboratory tests.
Patients meeting a trial’s eligibility criteria are considered potential candidates for recruitment.
Recruitment of participants remains, however, a major barrier to successful trial
completion, and manual chart review of hundreds or thousands of patients to determine a
candidate pool can be prohibitively labor- and time-intensive. At the same time, the amount and variety of data contained in Electronic Health Records(EHRs) is increasing dramatically, creating both challenges and opportunities for patient
recruitment. While more granular and potentially useful data are captured and stored in
EHRs now than in the past, the process of accessing and leveraging these data often requires
technical expertise and extensive knowledge of biomedical terminologies and data models.
This thesis focuses on the development of an integrated system for identifying patients in
clinical databases using a natural language interface. Humans use natural language nearly
effortlessly, and thus automated means of leveraging natural language to identify patients
in databases hold great potential in time and cost savings. The primary contributions of
this work include a novel database schema annotation and mapping method enabling data
model agnostic query generation, a method for generating intermediate logical representations
of eligibility criteria, exploration of dynamic reasoning upon non-specific criteria, and
development of an integrated graph-based knowledge base of biomedical concepts.
This work also introduces two new annotated corpora, the Leaf Clinical Trials (LCT)
corpus and Leaf Logical Forms (LLF) corpus. The LCT corpus is unique in the granularity
with which it represents complex eligibility criteria, while the LLF corpus is the most extensive
annotated corpus of eligibility criteria logical representations at the time of this writing.
Both corpora are valuable contributions to the biomedical informatics and natural language
processing communities. To evaluate the viability of our methods, both our system and a human database programmergenerated queries to identify patients eligible for 8 past clinical trials at our institution.
We then compared actual participant enrollments to those found eligible. We demonstrate
that our system rivals and sometimes surpasses an experienced human programmer in finding
eligible patients. We finally developed a novel user interface for enabling real-time interactive
cohort discovery.
2023-09-27T17:17:01Z
2023-09-27T17:17:01Z
2023
Thesis
Dobbins_washington_0250E_26010.pdf
http://hdl.handle.net/1773/50650
en_US
CC BY-SA
application/pdf
oai:digital.lib.washington.edu:1773/506512023-09-29T11:26:04Zcom_1773_4888col_1773_20986
Mothering at the Margins: Place, Memory and Migration in Circum-Caribbean Women's Writing
Rubinsky, Leah
Handwerk, Gary
Caribbean Literature
Colombian Literature
Gender Studies
Mothering
Comparative literature
Caribbean literature
Latin American literature
To Be Assigned
Thesis (Ph.D.)--University of Washington, 2023
My dissertation investigates how contemporary circum-Caribbean women’s literary fiction is shifting ideas of motherhood by narrating mothering in ways that complicate traditional notions of place and nation. I examine place, memory and migration across the novels of three circum-Caribbean women writers, including Haitian-American writer Edwidge Danticat, Colombian-American Patricia Engel and Colombian Pilar Quintana. Although each writes from a specific linguistic and cultural context, they all imagine fragmented, transtemporal, deterritorialized and deeply subversive mothering that contrasts starkly with the “good mother,” trope circulated in popular state and religious narratives. My textual analysis focuses on key literary moments in which subversive mothering unfolds within marginal and liminal spaces: in memories, across borders, at the edges of a forest, on transient coasts, in the womb and beyond death. Taken together, these authors articulate mothering as processes that occur not in or for nations but across them, unsettling and expanding our understandings of place and motherhood, and ultimately, opening up spaces in the literary imagination for grappling with histories of colonialism and displacement while offering the possibility of reconnection and healing.
2023-09-27T17:17:08Z
2023-09-27T17:17:08Z
2023
Thesis
Rubinsky_washington_0250E_26066.pdf
http://hdl.handle.net/1773/50651
en_US
Cuentame Mama Motherhood and Migration.wav; audio; .
CC BY-NC-ND
application/pdf
oai:digital.lib.washington.edu:1773/506522023-09-29T11:26:05Zcom_1773_4888col_1773_20986
Instruments of Truth: The Opioid Risk Tool, Foucault, and the Values Assessment Approach
Buckner, Francine
Bustillos, Dan
Clinical Practice
Ethics
Foucault
Ethics
Nursing
Medical ethics
To Be Assigned
Thesis (Ph.D.)--University of Washington, 2023
The clinical encounter between the clinician and the patient is the central, pivotal node ofthe healthcare domain. As such, there is a significant ethical onus on the clinician to assure that
the practices they use during this encounter are in alignment with their ethical commitments to
their patients. Most practices undergo either a formal or an informal validation procedure, and
sometimes those validation procedures neglect or under-emphasize the role of ethics and of
potential unintended consequences (Messick, 1989). Even practices that were validated in good
faith and according to accepted standards may cause patient harm. Samuel Messick has stated
that the validity of a practice depends as much on its ethical impact and the potential negative
consequences it may incur as it does on its quantification and that these aspects are often
neglected (Messick, 1989). This project is underpinned methodologically by Michel Foucault’s
problematization approach (Foucault, 1990, 1995) and applies it to a widely accepted clinical
practice called the Opioid Risk Tool (ORT) (Webster & Webster, 2005). The ORT is used as a
critical case (Flyvbjerg, 2006; Yin, 2011) to show how problematization can critically interrogate
a practice in ways that reveal some of its tacit biases and possibilities for causing patient harm
that thus may pose potential ethical conflicts for the clinician. Problematizing the ORT then
leads to the creation of the Values Assessment Approach (VAA) as a way to problematize other proposed clinical practices. The VAA is a novel approach that can offer clinical communities theopportunity to critically assess any proposed practice in a democratic and deliberative way in
order to determine whether that practice is in alignment with the ethical commitments of the
clinician community and what to do if ethical misalignments are revealed through applying this
process.
2023-09-27T17:17:08Z
2023-09-27T17:17:08Z
2023
Thesis
Buckner_washington_0250E_25981.pdf
http://hdl.handle.net/1773/50652
en_US
none
application/pdf
oai:digital.lib.washington.edu:1773/506532023-09-29T11:26:06Zcom_1773_4888col_1773_20986
Text-Supervised Local Feature Mixup Towards Long-Tailed Image Categorization
Franklin, Richard Samuel
Hu, Juhua
computer vision
deep learning
long-tailed
mixup
multimodal
vision-language
Computer science
To Be Assigned
Thesis (Master's)--University of Washington, 2023
In many real-world applications, the frequency distribution of class labels for training deep visual models can exhibit a long-tailed distribution that challenges traditional approaches of training deep neural networks, which require heavy amounts of balanced data. Gathering and labeling data to balance out the class label distribution can be both costly and time-consuming. Many existing solutions that enable ensemble learning, re-balancing strategies, and fine-tuning applied to deep neural networks are limited by the inert problem of few class samples across a subset of classes. Recently, vision-language models like CLIP have been observed as effective solutions to zero-shot or few-shot learning by grasping a similarity between vision and language features for image and text pairs. Considering that large pre-trained vision-language models may contain valuable side textual information for minor classes, in this work, we propose to leverage text supervision to tackle the challenge of long-tailed learning for visual recognition. Furthermore, we propose a novel local feature mixup technique that takes advantage of the semantic relations between classes recognized by the pre-trained text encoder to further help alleviate the long-tailed problem. Our empirical study on several benchmark long-tailed tasks demonstrates the effectiveness of our proposal with a theoretical guarantee.
2023-09-27T17:17:09Z
2023
Thesis
Franklin_washington_0250O_26138.pdf
http://hdl.handle.net/1773/50653
en_US
none
application/pdf
oai:digital.lib.washington.edu:1773/506542023-09-29T11:26:07Zcom_1773_4888col_1773_20986
“Anglo-Saxons of the East”: Redefining Armenians in Early Twentieth Century America
Daglian, Ara
Halperin, Liora
Armenian Americans
Armenians
Jewish Americans
Jews
Middle Eastern history
History
American history
To Be Assigned
Thesis (Master's)--University of Washington, 2023
This thesis focuses on an important work of Armenian American identity––The Armenians in America by M. Vartan Malcom. While previously known as a source of statistical and quantitative information on early Armenian American history, the text also provided a voice to Armenian Americans in an era where the American public knew them only through paternalistic aid campaigns and fundraiser slogans in the aftermath of the Armenian Genocide. To analyze The Armenians in America as a work to redefine the Armenian American identity, this paper turns to Jewish studies for inspiration. Jewish studies historiography boasts a highly developed framework for understanding how Jewish Americans redefined themselves in the late nineteenth and early twentieth centuries, offering a useful tool for studying Armenian Americans as well.
2023-09-27T17:17:09Z
2023-09-27T17:17:09Z
2023
Thesis
Daglian_washington_0250O_25853.pdf
http://hdl.handle.net/1773/50654
en_US
CC BY
application/pdf
oai:digital.lib.washington.edu:1773/506552023-09-29T11:26:07Zcom_1773_4888col_1773_20986
An Examination of the Minority Stress Model and Cigarette Smoking among Lesbian, Gay, and Bisexual (LGB) United States Military Veterans: Implications for Smoking Cessation Intervention Development
Ruiz, Raymond Allen
Ornelas, India J
cigarette smoking
LGB health
minority stress
Veterans health
Public health
To Be Assigned
Thesis (Ph.D.)--University of Washington, 2023
Lesbian, gay, and bisexual (LGB) individuals and United States military Veterans are more likely to report current cigarette smoking compared to the general adult population. The intersection between a LGB identity and Veteran status places LGB Veterans at increased risk for smoking. The purpose of this study is to assess whether past-year cigarette smoking among LGB Veterans is explained by constructs within the Minority Stress Model, a conceptual framework, developed to understand how sexual orientation-related stressors as well as coping and social support influence health behaviors. In addition to minority stress, this study assessed differences in cigarette smoking motives and stages of change in smoking cessation, which may partially explain the high prevalence of cigarette smoking among LGB Veterans. We used cross-sectional baseline data from the Health for Every Veteran Study, which used a prospective cohort design to understand mental health problems and health risk behaviors among heterosexual and lesbian, gay, bisexual, and transgender (LGBT) Veterans. In Aim 1, we tested whether interpersonal minority stressors (discrimination, harassment, victimization, trauma, social exclusion, and family rejection), intrapersonal minority stressors (identity concealment and internalized homophobia), and LGB-specific military stressors were associated with past-year smoking versus no past-year smoking. In Aim 2, we tested whether coping and three types of social support (general, Veteran-specific, and LGBT-specific) moderated the associations between interpersonal minority stressors, intrapersonal minority stressors, and/or LGB-specific military stressors and past-year smoking. In Aim 3, we examined differences in cigarette smoking motives and stages of change in smoking cessation among Veterans with past-year smoking by gender and sexual orientation. In Aim 1, we found that several interpersonal stressors, including harassment, victimization, and family rejection were associated past-year smoking. In Aim 2, we found that coping and social support buffered the associations between minority stressors and LGB-specific military stressors with past-year smoking, but also exacerbated the association between social exclusion and past-year smoking. In Aim 3, we found that gay men reported higher social smoking motives compared to heterosexual men and higher boredom relief smoking motives compared to bisexual men in age-adjusted models. Findings among women Veterans indicate that lesbian women were more likely to be in more advanced stages of quitting or had already quit in the past year. Future smoking cessation interventions should consider focusing on interpersonal minority stressors, social and boredom relief smoking motives, and teaching positive coping skills while leveraging social support to aid LGB Veterans in smoking cessation.
2023-09-27T17:17:09Z
2023
Thesis
Ruiz_washington_0250E_26016.pdf
http://hdl.handle.net/1773/50655
en_US
none
application/pdf
oai:digital.lib.washington.edu:1773/506562023-09-29T11:26:08Zcom_1773_4888col_1773_20986
Characterizing the role of informal payments in the delivery of pathology and clinical laboratory services
Glynn, Emily H.
Soge, Olusegun
capacity building
clinical laboratory services
corruption
global health
informal payments
pathology services
Public health
Pathology
Public policy
To Be Assigned
Thesis (Master's)--University of Washington, 2023
OBJECTIVES: Stronger pathology and laboratory medicine (PALM) services are needed in low- and lower-middle income countries (LMICs), though the impact of informal payments (IPs) on PALM remains unclear. IPs are a common, but regressive method of financing health care in LMICs. This study aims to characterize the prevalence and impact of IPs on PALM services. METHODS: PALM staff were surveyed about the frequency, determinants, and impacts of IPs in their workplace from September 2021 - September 2022. RESULTS: In total, 268 responses were received with 46.6% (n = 125) reporting experience with IPs. These 125 participants were more likely to work in the public sector and in LMICs. Approximately 65% reported accepting IPs to perform tests or release results. Obtaining faster results was the most commonly perceived reason for patients offering IPs. Overall, participants reported this activity had more negative than positive impacts on their workplace. CONCLUSIONS: This represents a first step in characterizing IPs within PALM and how this practice may impact access to these services in LMICs. Specifically, the fact that faster turn-around time was the most frequently perceived reason for offering IPs uncovers a potential barrier to improving PALM capacity in these regions.
2023-09-27T17:17:09Z
2023
Thesis
Glynn_washington_0250O_26168.pdf
http://hdl.handle.net/1773/50656
en_US
none
application/pdf
oai:digital.lib.washington.edu:1773/506572023-09-29T11:26:09Zcom_1773_4888col_1773_20986
Vietnamese in the Cultural Nation Building of the First Republic of Vietnam (1955-1963)
Tran, Johnathan
Giebel, Christoph
Southeast Asian studies
To Be Assigned
Thesis (Master's)--University of Washington, 2023
Once lacking a writing system, the Vietnamese language eventually eclipsed literary Chinese and French in official administrative capacities to become the official national language of modern Vietnam. By 1945, the linguistic imagination of Vietnam was not whether Vietnamese (tiếng Việt) and the Romanized “national language script” (chữ Quốc ngữ) should be cemented into the country’s national formation but rather how ideological concerns would shape the construction of Vietnamese language conventions. This thesis argues that language-making for the first administration of the Republic of Vietnam (RVN, 1955-1975), commonly referred to as the First Republic of Vietnam (1955-1963), was explicitly part of a larger cultural nation-building agenda aimed at actualizing the regime’s ideological aspirations. I first examine how language was deployed in the making of an all-Vietnamese postcolonial state. Then, I turn to two RVN national universities (in Saigon and Hue) to examine the role of the Vietnamese in the making of a Vietnamese national identity. Finally, I examine a RVN national archives source document that directly addresses how certain foreign loanwords should or should not be standardized in the Vietnamese vernacular, exposing a deference to traditional culture and practices.
2023-09-27T17:17:09Z
2023
Thesis
Tran_washington_0250O_26169.pdf
http://hdl.handle.net/1773/50657
en_US
none
application/pdf
oai:digital.lib.washington.edu:1773/506582023-09-29T11:26:10Zcom_1773_4888col_1773_20986
Impact of Carbidopa-Levodopa Enteral Suspension Initiation on Oral Medication Treatment Patterns in Persons with Parkinson’s Disease: A Retrospective Cohort Analysis
Baldwin, Zachary Thomas
Devine, Beth
Advanced Parkinson's Disease
Carbidopa-levodopa enteral suspension
Medication Treatment Patterns
Parkinson's Disease
Pharmaceutical sciences
To Be Assigned
Thesis (Master's)--University of Washington, 2023
Introduction: Parkinson’s disease (PD) patients experience gradual worsening of symptoms as their disease progresses, necessitating complicated poly-pharmaceutical regimens. These complex therapeutic regimens lead to decreases in quality of life and impact adherence to medications, which may lead to poorer symptom management. At later stages of disease, more permanent solutions exist for management of PD, such as carbidopa-levodopa enteral suspension (CLES).Objective: The objective for this research was to characterize the impact of CLES on medication treatment patterns in persons with PD.
Methods: We conducted a retrospective time-series analysis of a real-world claims database from the years 2015 to 2022, to evaluate medication utilization in adults with PD who initiated CLES (n=32). This population was covariate-balanced propensity score matched to eligible non-CLES controls in a 1:4 nearest neighbor (n=128) match. The index date was the date CLES was prescribed. Outcome measures, pills per day (PPD) and levodopa-equivalent daily dosages (LEDD), were created for each of the 12-months following from index for all individuals. We ran generalized mixed model regressions for all analyses to assess changes in outcomes over time.
Results: PPD was reduced in CLES initiators compared to matched CLES non-initiators, a result that was seen in the first month and sustained through 12 months after treatment initiation (p<0.01 for each month). The likelihood of taking 5 or more PPD was reduced by up to 94% in individuals initiating CLES when compared to controls (OR 0.06, 95% CI 0.01, 0.37 in month 4 after treatment). Mean oral LEDD was reduced in CLES initiators compared to controls, with reductions ranging between 250 and 497 mg compared to baseline. The proportion of individuals taking 500 mg or more LEDD was significantly reduced within the first half of the year after treatment but was not found to be reduced after 6 months when compared to controls.
Conclusion: Results suggest that CLES substantially reduced medication burden, improving aspects of overall pill burden in addition to oral levodopa requirements for individuals with advanced PD, with the greatest impact seen within the first month after treatment.
2023-09-27T17:17:10Z
2023
Thesis
Baldwin_washington_0250O_26073.pdf
http://hdl.handle.net/1773/50658
en_US
CC BY
application/pdf
oai:digital.lib.washington.edu:1773/506592023-09-29T11:26:10Zcom_1773_4888col_1773_20986
Heart Failure Patients’ Use of and Attitudes Toward the Internet and Mobile Health for Self-Care
Sohn, Albert
Turner, Anne M
health information
heart failure
internet
mHealth
patient experiences
self-care
Information science
Medicine
Public health
To Be Assigned
Thesis (Master's)--University of Washington, 2023
Heart failure is a complex clinical syndrome that is mentioned in approximately 1 in 8 death certificates in the United States. Adherence to heart failure self-care behaviors is critical to minimize complications and prevent hospital readmissions. Mobile health technologies offer promising opportunities for enhancing self-care by enabling remote tracking and providing timely reminders. We sought to investigate three characteristics of heart failure patients with respect to their personal health information seeking behavior: (1) extent to which they use the internet to search for heart failure information; (2) extent to which they are familiar with mobile health apps and devices; and (3) perceptions they have about using an activity tracker or smartwatch to assist them in managing their heart failure self-care. Fifty heart failure patients were asked about their internet and mobile health usage. The structured interview included questions adapted from the Health Information National Trends Survey. More than 50% of the patients reported using the internet to search for heart failure information in the past 12 months, experience using health-related apps, and thoughts that an activity tracker or smartwatch could help them manage heart failure. Qualitative analysis of the structured interviews revealed six themes: trust in their physicians, alternatives to mobile health apps, lack of need for or knowledge about mobile health devices, financial barriers to activity tracker and smartwatch ownership, benefits of tracking and reminders, and uncertainty of their potential due to lack of knowledge. Trust in their doctors was a major factor for heart failure patients who reported not searching for health information on the internet. While those who used mobile health apps and devices found them to be useful, patients who did not use these devices were generally unaware of or unknowledgeable about them. Patient-provider discussions about the potential uses of mobile health apps and devices with respect to heart failure self-care may impact their usage.
2023-09-27T17:17:10Z
2023-09-27T17:17:10Z
2023
Thesis
Sohn_washington_0250O_26030.pdf
http://hdl.handle.net/1773/50659
en_US
none
application/pdf
oai:digital.lib.washington.edu:1773/506602023-09-29T11:26:11Zcom_1773_4888col_1773_20986
Patterns of Outpatient Mental Health Care Utilization Among Medicaid Patients Served by Harborview Mental Health and Addictions Services (HMHAS) After Population Health Stratification (PHS) Model Implementation
Combs, Paige Marie
Edmonds, Amy
Spigner, Clarence
Medicaid
Mental health
Outpatient Community-Based Settings
Population health stratification
Service delivery adherence
Value-based payment models
Public health
Social work
To Be Assigned
Thesis (Master's)--University of Washington, 2023
University of Washington Department of Health Systems and Population Health Medicaid patients with the greatest need for mental health services often do not receive adequate outpatient mental health services, resulting in worse outcomes for the patient and increased utilization of costly and less effective inpatient and emergency services. Those with severe mental health needs disproportionately experience co-occurring health challenges and social adversities. Increasingly, population health stratification (PHS) and value-based payment strategies are being implemented to incentivize mental health care providers within Medicaid integrated care networks to increase outpatient mental health services for clients at greatest risk of adverse health and social outcomes. In King County, Washington, a new PHS model and value-based payment reform was implemented by the King County Integrated Care Network (KCICN) in July 2020 with the goal to increase quality of care for populations with the greatest need. To support Harborview Mental Health and Addictions Services (HMHAS) – a Seattle outpatient mental health clinic – we conducted a descriptive analysis examining their patient population and whether PHS level of care was related to engagement in outpatient services and type of outpatient services in the context of the PHS level of care and value-based payment model. This descriptive analysis examined Recovery Services Medicaid patients ages19 and older who were served between July 2020 – December 2022. We also conducted additional analyses to improve understanding of demographic and health-related characteristics among patients and the relationship between the PHS and the Level of Care Utilization System (LOCUS) levels of care, which each serve as indicators of patient need for mental health services. We found that around 1 in 3 patients required a higher level of care than can be provided in an outpatient setting, that patients with the higher levels of care were disproportionately unable to meet service delivery adherence, and that patients with higher levels of care had higher prevalence of case management and peer services than lower level of care patients. Findings suggested that the clinic may not be equipped to meet the high needs of patients and that efforts to meet the basic needs of these individuals may be important to support their engagement in mental health services. Future research is needed to examine unintended consequences of PHS and value-based payment models and that explores strategies that successfully engage high need patients in outpatient care, such as a strong therapeutic alliance and more intensive case management and housing supports.
2023-09-27T17:17:10Z
2023-09-27T17:17:10Z
2023
Thesis
Combs_washington_0250O_25834.pdf
http://hdl.handle.net/1773/50660
en_US
none
application/pdf
oai:digital.lib.washington.edu:1773/506612023-09-29T11:26:12Zcom_1773_4888col_1773_20986
Evaluating Heterogeneity in Treatment Effects and Economic Value of Tumor-Agnostic Drugs
Chen, Yilin
Carlson, Josh J
Bayesian hierarchical model
Comparative effectiveness
Cost-effectiveness
External control
Heterogeneity
Real-world evidence
Epidemiology
Economics
Biostatistics
To Be Assigned
Thesis (Ph.D.)--University of Washington, 2023
Tumor-agnostic drugs (TAD), also known as histology-independent treatments, have the potential to benefit patients who currently have limited therapeutic options. TAD typically received accelerated approvals based on basket trials which included a small number of multi-cohort, single-arm studies. However, the evaluation of TAD poses major challenges for health technology assessment agencies, such as the potential heterogeneity in treatment effect by tumor type, the lack of comparative data due to single-arm studies, and variable standard of care (SoC) across tumor types. Consequently, these challenges create significant uncertainty regarding the expected clinical and economic impact of TAD. In Aim 1, I used Bayesian hierarchical models (BHM) to assess heterogeneity in treatment outcomes across tumor types and improve estimates of tumor-specific treatment outcomes from Phase II basket trials, which are crucial for healthcare decision-making. My analysis revealed high heterogeneity and uncertainty in survival endpoints, including median progression-free survival (PFS) and median overall survival (OS), although the treatment effects are more similar when judged by surrogate endpoint at approval. Metrics such as intra-class correlation can be used to quantify the variation between groups, which could inform a recommendation of TAD for use in all tumor types or a restricting subset of patients. The findings from our study are important because they demonstrated that BHM could reduce uncertainty of estimates derived from basket trial evidence, potentially improving confidence in tumor-agnostic decision making, despite small sample sizes in some tumor types. The methods presented in this study can be applied to the future assessment of TAD. In Aims 2 and 3, I address comparative effectiveness and economic value of TAD with single-arm trial evidence. To overcome the challenge of lacking comparators, I created eight external controls using observational data from the TriNetx electronic health databases. The Copula method was employed to simulate correlated trial samples while matching the dependence structure of the trial baseline covariates to that in the real-world population. Additionally, an inverse odds weighting approach was used to further balance the baseline characteristics between the trial and external control arms. Weighted Cox regressions showed that patients with MSI-H/dMMR advanced/metastatic colorectal and endometrial cancers receiving pembrolizumab were associated with significant prolonged PFS but not OS than real-world patients receiving chemotherapies. This analysis demonstrated that incorporating external control data in early phase trials may provide a more comprehensive understanding of treatment effects of tumor-agnostic drugs than relying solely on single-arm trials. Finally, using adjusted efficacy inputs from Aim 1 and external controls from Aim 2, I assessed the economic value of pembrolizumab compared to SoC across 8 tumor types to inform coverage and reimbursement decisions in the United States. A partitioned survival model with three health states (i.e., progression-free, post-progression, and death) was developed to evaluate the cost-effectiveness of pembrolizumab for previously treated patients with advanced or metastatic MSI-H/dMMR cancers. We found substantial variation in the economic value across tumor types, with pembrolizumab being a cost-effective strategy in treating colorectal and endometrial cancers at $150,000 willingness-to-pay per quality adjusted life years threshold, compared to SoC chemotherapies. However, pembrolizumab was not found to be cost-effective in treating other assessed cancers. The main findings from value of stratification estimates suggest that recommendations for using pembrolizumab in specific patient populations, based on comparative effectiveness or net health benefit, could result in greater overall value to the healthcare system compared to a tumor-aggregated recommendation.
2023-09-27T17:17:10Z
2023
Thesis
Chen_washington_0250E_25433.pdf
http://hdl.handle.net/1773/50661
en_US
CC BY
application/pdf
oai:digital.lib.washington.edu:1773/506622023-09-29T11:26:13Zcom_1773_4888col_1773_20986
Characterization of Nafion-based Resistive Switching Devices
Bhandari, Pritam
Choi, Seungkeun
Electrical engineering
To Be Assigned
Thesis (Master's)--University of Washington, 2023
The development of computers in the modern era has escalated the race towards the development of powerful and efficient memory devices. By using advanced miniaturization techniques and new materials, we have been able to dramatically reduce the size of the memory devices while increasing the storage capacity and computing performance. However, we are reaching a point of slower growth in the computing performance of MOSFET-based nonvolatile memory devices. It becomes increasingly difficult to further decrease the size of memory devices. Hence, the next generation memory technology must have the following features to meet the high computing performance in the era of artificial intelligence: low-power consumption, fast switching, non-volatile, high-density fabrication. Resistive Random-Access Memory Devices (ReRAM) meets all those requirements; hence, is considered as one of the promising candidates for the next generation memory technologies. In this research, a ReRAM device with Nafion as a switching layer was fabricated. To characterize the resistive switching performance, Nafion was annealed at three different temperatures: 30°C, 60°C, and 90°C. In order to study the effect of different electrode, we used two different bottom electrodes (Au and Cu) and Al as a top electrode. The devices with Cu as a bottom electrode exhibited good resistive switching properties while the device with Au as a bottom electrode showed little or negligible switching performance. We found that the performance of switching was best when Nafion was annealed at 60°C. However, the experiment shows a wide variation of device performance even in the same substrate, indicating the importance of uniform film thickness and quality of Nafion.
2023-09-27T17:17:10Z
2023-09-27T17:17:10Z
2023
Thesis
Bhandari_washington_0250O_26234.pdf
http://hdl.handle.net/1773/50662
en_US
none
application/pdf
oai:digital.lib.washington.edu:1773/506632023-09-29T11:26:14Zcom_1773_4888col_1773_20986
Participant Satisfaction with a Hormonal Intrauterine Device (IUD) Counseling Video
Guijosa, Linda
Shimkin, Genya N.
anticipatory counseling video
hormonal intrauterine device
reproductive health
women's health
Public health
To Be Assigned
Thesis (Master's)--University of Washington, 2023
INTRODUCTION: The purpose of this study was to conduct a secondary analysis on hormonal IUD participant feedback data to assess the feasibility of implementing an anticipatory counseling video on a large scale to reach diverse audiences. This analysis also informs future versions of the video for patients representing diverse sociodemographic groups.OBJECTIVES: The primary objectives of this study include: 1. Examine differences between demographic groups based on counseling video ratings; 2. Summarize qualitative feedback on the video; and 3. Provide recommendations for improving the video based on participant feedback.
METHODS: This secondary analysis is based on data from a randomized 1:1, double-blinded, placebo controlled online randomized trial conducted at the University of Washington. Both qualitative and quantitative approaches utilizing Microsoft Excel were used to analyze quantitative demographic data and qualitative IUD anticipatory counseling video feedback from the intervention group only (N=94). Qualitative data from the study questionnaire was coded to compare themes among participants from three locations to explore anticipatory counseling video recommendations using a transcendental phenomenology approach.
RESULTS: Participants had a generally favorable opinion of the components and quality of the video. They also had some recommendations to make improvements for future versions of this video. Overall, the study participants liked the visual diagrams and the ease of understanding of the video, and the least liked component was the length of the video.
DISCUSSION:
Given that participants mostly liked the video and felt it had educational value, clinics that offer counseling and insertion of IUDs should consider implementing anticipatory guidance videos to help their patients understand what to expect the first few months when using this contraceptive method.
2023-09-27T17:17:11Z
2023
Thesis
Guijosa_washington_0250O_26197.pdf
http://hdl.handle.net/1773/50663
en_US
CC BY-NC-SA
application/pdf
oai:digital.lib.washington.edu:1773/506642023-09-29T11:26:15Zcom_1773_4888col_1773_20986
Assessing Bias in Documentation of Alcohol Use Disorders in Primary Care Settings Across Intersections of Race or Ethnicity, Sex, and Socioeconomic Status: The Role of Symptoms and Stigma
Ellis, Robert L
Bradley, Katharine A
Alcohol
AUD Symptoms
Intersectionality
Race/Ethnicity
Socioeconomic status
Stigma
Public health
Mental health
Health sciences
To Be Assigned
Thesis (Ph.D.)--University of Washington, 2023
Alcohol use disorder (AUD) is harmful, with an 11.3% prevalence among adults living in the United States (U.S.), and is growing among key vulnerable demographics. Although there is effective AUD treatment available, only 4.6% of adults with AUD receive any alcohol-related treatment. Primary care has the potential to deliver evidence-based treatment and is accessible to most adults, making it an ideal setting for systematically improving both the diagnosis and treatment of AUD. However, in most clinical settings, including primary care, AUD is frequently underdiagnosed and undertreated. Part of this is likely due to a heavy reliance on clinicians’ subjective assessments of AUD symptoms (i.e., typically without standardized assessment measures of AUD symptoms) and which likely results in inconsistent and incomplete information about AUD symptoms. Additionally, the disparities in clinically-documented AUD across race, ethnicity, and sex shown in prior research suggest that there are likely potential biases in diagnosing practices in clinical settings. Further, the stigmatizing language used to describe mental health conditions, such as AUD, may reflect underlying biased beliefs held by clinicians making diagnoses, while also perpetuating stigma. These limitations imply that there is a need to develop, test, and adopt innovative approaches to assist clinicians in recognizing AUD symptoms in a systematic and standardized manner, which may help them accurately diagnose AUD in an unbiased manner. This dissertation describes the distribution of clinically-documented AUD and the proportion of AUD diagnoses reported in electronic health records (EHRs) using stigmatized language across intersecting identities, therefore providing foundational knowledge for whether bias occurs in the diagnosis of AUD in primary care settings. Specific aims of this dissertation were to: 1) describe patterns in the prevalence of clinically-documented AUD in EHRs in primary care patients across intersections of race or ethnicity, sex, and socioeconomic status (SES); 2) describe, among primary care patients who reported high-risk drinking, patterns in the prevalence of clinically-documented AUD in EHRs in primary care across intersections of race or ethnicity and sex, adjusting for patient-reported alcohol consumption and AUD symptoms; and 3) describe the proportion of AUD diagnoses documented in EHRs with stigmatized descriptors among primary care patients across intersections of race or ethnicity and sex. Aim 1 used Kaiser Permanente Washington (KPWA) EHR data linked to a census tract neighborhood deprivation index, representing community-level SES, from 439,375 adult primary care patients who completed alcohol screenings from 3/1/2015-9/30/2020. We described the prevalence of clinically-documented AUD based across 36 subgroups defined by intersections of race or ethnicity, sex, and terciles of community-level SES based on documented EHR diagnostic codes for AUD. Among women, the prevalence was highest for AI/AN women with middle SES, 1.5% (95% CI:1.0-2.3), and lowest for Asian women with middle SES, 0.1% (95% CI:0.1-0.2). Among men, the prevalence was highest for AI/AN men with high and middle SES, 2.0% (95% CI:1.1-3.4) and 2.0% (95% CI:1.2-3.2), respectively, and lowest for Asian men with high SES, 0.5% (95% CI:0.3-0.7). Black and Latine patients tended to have a lower prevalence of AUD than White patients, across all intersections of sex and SES except for Black women with high SES. The overall prevalence of clinically-documented AUD was 1.0% and varied across race or ethnicity and sex, but no consistent pattern emerged for SES. Aim 2 used KPWA EHR data from 14,442 adult patients who self-reported high-risk drinking (AUDIT-C score 7-12), had primary care encounters from 3/1/2015-2/28/2022, were Asian, Black, Latine, or White, and completed a DSM-5 Alcohol Symptom Checklist (0-11). We described the prevalence of clinically-documented AUD across 8 intersections of race or ethnicity and sex. Rates of clinically-documented AUD diagnoses increased as alcohol consumption and AUD symptoms increased. The prevalence of clinically-documented AUD diagnoses differed across the 8 intersectional subgroups differed in unadjusted analyses ranging from 12.2% (95% CI: 9.8-15.0) to 21.7% (95% CI: 17.7-26.3) but did not differ after adjustment for both AUDIT-C score and AUD symptoms ranging from 11.0% (95% CI: 8.7-13.8) to 15.1% (95% CI: 14.3-16.0). This suggests that observed differences in the prevalence of clinically-documented AUD diagnoses across intersectional subgroups likely were due to differences in alcohol consumption and AUD symptom burden across subgroups. Aim 3 used AUD text descriptors from adult primary care patients who were Asian, Black, Latine, and White and had AUD diagnoses documented in EHRs during primary care visits from 3/1/2015-5/31/2023. We described the proportion of AUD diagnoses documented with stigmatized descriptors across intersections of race or ethnicity and sex. The overall proportion of stigmatized AUD descriptors in the EHR was 18.6% or 88.5%, depending on whether stigmatized AUD descriptors excluded or included stigmatizing language from valid DSM-IV diagnoses, respectively (i.e., alcohol abuse, alcohol dependence). There appeared to be no meaningful variation across race or ethnicity, or intersections based on race or ethnicity and sex, but men had AUD diagnoses documented with a significantly higher proportion of stigmatized text descriptors compared to women. Findings suggest that further efforts are needed to reduce the amount of stigmatized language associated with alcohol use disorder in the EHR. Overall, the findings of this dissertation support the use of intersectional approaches to describing disparities in AUD, the use of standardized tools for AUD symptom assessment alongside routine population-based alcohol screenings, and efforts to reduce stigmatized language associated with alcohol use.
2023-09-27T17:17:11Z
2023
Thesis
Ellis_washington_0250E_26176.pdf
http://hdl.handle.net/1773/50664
en_US
none
application/pdf
oai:digital.lib.washington.edu:1773/506652023-09-29T11:26:16Zcom_1773_4888col_1773_20986
Examining the Conceptual Model of Compassion Fatigue in Spouse Caregivers of Women with Breast Cancer
Wu, Pei-Chin
Lewis, Frances Marcus FML
Caregiver behavioral-emotional adjustment
Compassion fatigue
Depressed mood
Family caregivers
Model development and testing
Physical symptoms
Nursing
To Be Assigned
Thesis (Ph.D.)--University of Washington, 2023
Purpose: The overall purpose of the dissertation was to develop a comprehensive theoretical framework of compassion fatigue in family caregivers, with three specific aims addressed through separate manuscripts. Specific Aim 1 involved synthesizing a conceptual definition of compassion fatigue in family caregivers by reviewing relevant literature. Specific Aim 2 focused on evaluating a measurement model of compassion fatigue in spouse caregivers of women with breast cancer. Specific Aim 3 examined the structural model of compassion fatigue in spouse caregivers by testing the hypothesized relationships between antecedent and consequent variables.Methods: Study 1 employed a scoping review approach, incorporating Rodgers’ Evolutionary Model for concept analysis, to identify essential properties, antecedents, and consequences of compassion fatigue in family caregivers from existing literature. Study 2 and Study 3 utilized secondary data from the Family Home Visitation Program, a randomized controlled trial of a couple-focused cognitive-behavioral intervention for spouse caregivers and women with newly diagnosed breast cancer. The analyses included baseline data from 214 spouse caregivers. Study 2 utilized exploratory and confirmatory factor analysis to evaluate the proposed measurement model for compassion fatigue. Study 3 evaluated a measurement model of the caregiver’s empathic response and used structural equation modeling to examine the relationships among caregiver's empathic response, compassion fatigue, and depressed mood and physical symptoms in spouse caregivers.
Results: Study 1 established an integrated conceptual framework of compassion fatigue in family caregivers, serving as a foundation for the dissertation study. Study 2 confirmed a three-factor model had the best fit for the data, indicating that powerlessness, emotional isolation, and emotional disengagement significantly contributed to the level of compassion fatigue experienced by spouse caregivers. Study 3 revealed that spouse caregivers’ empathic response could be organized into three domains: empathic ability, emotional contagion, and empathic concern. Spouse caregivers’ empathic response predicted compassion fatigue, and subsequently led to caregivers’ depressed mood and physical symptoms. The impact of empathic response on the two negative outcomes was fully mediated by compassion fatigue, highlighting the risk factor nature of empathic response in caregiving.
Conclusion: This dissertation addressed an important gap in the literature by providing a comprehensive understanding of compassion fatigue in spouse caregivers. The derived Empathic Response measure (9-item) and Compassion Fatigue measure (16-item) contribute to the development and validation of family caregiver-specific instruments for assessing empathic response and compassion fatigue. Future studies should explore potential moderators and thresholds of compassion fatigue, include diverse caregiving populations, and consider the influence of social determinants of health on compassion fatigue in family caregivers. Early detection and intervention in family caregivers experiencing compassion fatigue can effectively alleviate compassion stress, enhance family coping, and ultimately improve the quality of care family members provide to their loved ones.
2023-09-27T17:17:11Z
2023
Thesis
Wu_washington_0250E_25921.pdf
http://hdl.handle.net/1773/50665
en_US
none
application/pdf
oai:digital.lib.washington.edu:1773/506662023-09-29T11:26:17Zcom_1773_4888col_1773_20986
New Khmer Cinema: Generative Nostalgia and Community Encounters in the Phnom Penh Film Scene
Hollister, Andrew Putthirak
Grant, Jenna
Cambodia
Cinema
Film Festivals
Nostalgia
Phnom Penh
Southeast Asian studies
Film studies
To Be Assigned
Thesis (Master's)--University of Washington, 2023
The Cambodian film scene is undergoing a renaissance in the 21st century. This thesis examines the current trends of Cambodian independent cinema, with particular emphasis on community building and film discourse. As younger generations of artists take over, they offer new stories—drawn from their own experiences—which rethink the Cambodian present’s relationship with its past and imagine possibilities for the future. Drawing from ethnographic research, informal conversations, participation in film discussions, film festival programming, and film text analysis, I map an emerging ecosystem of Cambodian cinema that generates community at critical hubs for encounter between artists, audiences, and academics. This thesis is situated in time and place through several Phnom Penh film events and film spaces in the summer of 2022, including a book launch, film festival, cinema community center, and film club. These sites all constitute essential venues for film viewing and discussion, and reveal different practices of relating to cinema within a vibrant and growing film community. Drawing from my observations, I propose a framework of “generative nostalgia” through which to understand the current engagements with 1960s cinema and popular culture in the Cambodian arts today—a past that still lives in the present. Generative nostalgia represents a nostalgic practice grounded in the material conditions of the now, pragmatically pulling past cultural productions and aesthetics into present as a means to bridge the ruptured cultural continuity caused by the Cambodian genocide. It is a nostalgia that looks back only so it can look forward, trading sentimentality for determined practicality. Through close examination of Cambodian independent cinema and the concept of generative nostalgia, this thesis showcases the resiliency, expression, and innovation of Cambodia’s film community.
2023-09-27T17:17:11Z
2023-09-27T17:17:11Z
2023
Thesis
Hollister_washington_0250O_25958.pdf
http://hdl.handle.net/1773/50666
en_US
none
application/pdf