The clinical competency of practicing and nonpracticing faculty of associate degree schools of nursing

This study assesses and describes the perception of clinical competency and the relationship to clinical practice of full-time nursing faculty in the associate degree nursing programs in the state of Florida. The study was developed around one major hypothesis and four research questions. The Hygiene-Motivators Theory proposed by Herzberg, Mausner, and Snyderman (1959) provided the conceptual framework to explain factors that would motivate a person to expand workload and maintain job satisfaction.^ Data were collected from the 244 faculty members teaching full-time at the 15 associate degree schools of nursing accredited by the National League for Nursing in the state of Florida. A total of 186 faculty (76%) responded and 175 (72%) cases were used for data analysis.^ Two instruments were modified and combined for the investigation. The instruments were the Faculty Perception of Practice Questionnaire (Parascenzo, 1983) and a three-part Attributes Deemed Necessary for Faculty to Proclaim Clinical Competency (Smith, 1991) scale. Computer analyses employing descriptive and inferential statistics were performed.^ The findings revealed that faculty were closely divided as to practice activities with more faculty nonpracticing than practicing. Factors identified as impediments to increased clinical practice were identified as teaching load and personal/family responsibilities that lead to a lack of time and lack of opportunity. Those faculty who practice did so as moonlighters in positions that would not require advanced training. Both the practicing and nonpracticing faculty reported a high level of satisfaction with their activities as a means of maintaining clinical practice. While both groups reported a high level of expertise, those practicing faculty perceived themselves to be more clinically competent on the attributes of knowledge, skills, and on the total attribute scale. It was further revealed that perception of competency declined with the length of time spent out of practice. There was no difference in the two groups on the attributes of values/attitude. ^

Endothelin receptor B and neural crest derived melanocyte development

Neural Crest cells (NCC) constitute a unique embryonic cell population that arises between the prospective epidermis and the dorsal aspect of the neural tube of vertebrates. NCC migrate ventromedially and dorsolaterally throughout the developing embryo giving rise to the peripheral nervous system constituents and melanocytes that ultimately reside in the skin and hair follicles respectively. Mice and humans with mutations in the Endothelin receptor b (Ednrb) gene manifest strikingly similar phenotypes characterized by hypopigmentation, hearing loss and megacolon these are due to absence of melanocytes in the skin and inner ear and lack of enteric ganglia in the distal part of the gut, respectively. Piebald lethal mice and humans with Hirschsprung's disease or Waardenburg syndrome carry different mutations in the Ednrb gene. The major goals of this project were to determine whether the action of Ednrb in NCC is required prior to commitment of these cells to the melanocytic lineage and to investigate its potential participation in the actual process of commitment. In order to achieve these goals transgenic mice that express Ednrb under two different regulatory elements were created. The first, Dct-Ednrb, expresses Ednrb under the control of the DOPAchrome tautomerase (Dct) promoter to direct expression to already committed melanocyte precursors. The second, Nes-Ednrb, expresses Ednrb under the regulation of the human nestin gene second enhancer to direct expression to pre-migratory NCC. Crosses of the Dct-Ednrb mouse with piebald lethal showed that the transgene was capable of rescuing the hypopigmentation phenotype of the later. This result indicates that the action of Ednrb after NCC commit to the melanocytic lineage is sufficient for normal melanocyte development. The Dct-Ednrb was further crossed with two other hypopigmentation mutants that carry mutations in the transcription factors Sox10 and Pax3. The transgene rescued the phenotype of the Sox10 mutant only. This suggests that Ednrb interacts with Sox10 but not with Pax3 during melanocyte development. The Nes-Ednrb mice developed a hypopigmentation phenotype that was augmented when crossed with piebald lethal or lethal spotting (mutation in Edn3, the ligand for Ednrb) mice but was rescued by over expression of Edn3. These results suggest that alterations in Ednrb expression early in development affect melanocyte development. This study provides novel information necessary to better understand the early embryonic development of NCC, clarifies specific interactions between different melanogenic genes and, could eventually help in the implementation of therapies for human pigmentary genetic disorders. ^

Actionable pattern analysis in computing and business intelligence systems

With advances in science and technology, computing and business intelligence (BI) systems are steadily becoming more complex with an increasing variety of heterogeneous software and hardware components. They are thus becoming progressively more difficult to monitor, manage and maintain. Traditional approaches to system management have largely relied on domain experts through a knowledge acquisition process that translates domain knowledge into operating rules and policies. It is widely acknowledged as a cumbersome, labor intensive, and error prone process, besides being difficult to keep up with the rapidly changing environments. In addition, many traditional business systems deliver primarily pre-defined historic metrics for a long-term strategic or mid-term tactical analysis, and lack the necessary flexibility to support evolving metrics or data collection for real-time operational analysis. There is thus a pressing need for automatic and efficient approaches to monitor and manage complex computing and BI systems. To realize the goal of autonomic management and enable self-management capabilities, we propose to mine system historical log data generated by computing and BI systems, and automatically extract actionable patterns from this data. This dissertation focuses on the development of different data mining techniques to extract actionable patterns from various types of log data in computing and BI systems. Four key problems—Log data categorization and event summarization, Leading indicator identification , Pattern prioritization by exploring the link structures , and Tensor model for three-way log data are studied. Case studies and comprehensive experiments on real application scenarios and datasets are conducted to show the effectiveness of our proposed approaches.

The relationship between spirituality, knowledge and tuberculosis (TB) medication adherence among African Americans and Haitians

Tuberculosis (TB) is an infectious disease and nonadherence to medication can lead to new cases, multi-drug resistant TB, or potential death. Additionally, healthcare professionals and individuals with TB’s knowledge of the disease and medication adherence are crucial for successful completion of medication therapy. Patient education is one of the most important aspects of care provided in healthcare settings (CDC, 1994). TB tends to disproportionately affect minority and economically disadvantaged patient populations. The purpose of this mixed method study was to explore the relationship between spirituality, knowledge, and TB medication adherence among African Americans and Haitians. The primary research question was: What is the relationship between spirituality, knowledge and TB medication adherence among African Americans and Haitians? Quantitative data were gathered from 33 questionnaires and analyzed by two ANOVAs and four chi square analyses. The null hypothesis was not rejected; there was not a statistically significant relationship between spirituality and TB medication adherence (p =.208) among the study’s African Americans and Haitians. Qualitative data concerning participants’ knowledge of TB, gathered from 16 individual interviews further informed this analysis. Secondary research questions examined the role of spirituality, knowledge of TB and medication adherence among African Americans and Haitians. Four common themes emerged across both groups to answer the secondary research questions. Interviews revealed the themes: (a) God is in control, (b) stigmatization of TB, (c) lack of knowledge, and (d) fear of death. The theme lack of knowledge about TB was found to contribute to stigmatization of TB patients. However, in this study stigma and lack of knowledge were related to initial denial of symptoms and delayed diagnosis, but not found to be related to TB medication adherence. This study could help adult educators and health educators enhance their educational interventions, develop a better understanding of adult learning, resulting in early diagnosis and treatment ultimately decreasing transmission of TB, drug resistance, and potential death. Educators should be aware that TB patients’ spirituality may be an important part of how they cope with having TB. A larger scale study, conducted at multiple locations should be conducted to extend the findings of this small scale exploratory study. Further studies should be done to better determine what patient, healthcare provider and health care system factors might mediate relationships that may exist between lack of knowledge of TB, stigma and TB medication adherence.

Disaster Risk Management Disparity in the Caribbean: Evidence from Barbados, Dominican Republic, Jamaica and Trinidad and Tobago

This study on risk and disaster management capacities of four Caribbean countries: Barbados, the Dominican Republic, Jamaica, and Trinidad and Tobago, examines three main dimensions: 1) the impact of natural disasters from 1900 to 2010 (number of events, number of people killed, total number affected, and damage in US$); 2) institutional assessments of disaster risk management disparity; and 3) the 2010 Inter-American Bank for Development (IADB) Disaster Risk and Risk Management indicators for the countries under study. The results show high consistency among the different sources examined, pointing out the need to extend the IADB measurements to the rest of the Caribbean countries. Indexes and indicators constitute a comparison measure vis-à-vis existing benchmarks in order to anticipate a capacity to deal with adverse events and their consequences; however, the indexes and indicators could only be tested against the occurrence of a real event. Therefore, the need exists to establish a sustainable and comprehensive evaluation system after important disasters to assess a country‘s performance, verify the indicators, and gain feedback on measurement systems and methodologies. There is diversity in emergency and preparedness for disasters in the four countries under study. The nature of the event (hurricanes, earthquakes, floods, and seismic activity), especially its frequency and the intensity of the damage experienced, is related to how each has designed its risk and disaster management policies and programs to face natural disasters. Vulnerabilities to disaster risks have been increasing, among other factors, because of uncontrolled urbanization, demographic density and poverty increase, social and economic marginalization, and lack of building code enforcement. The four countries under study have shown improvements in risk management capabilities, yet they are far from being completed prepared. Barbados‘ risk management performance is superior, in comparison, to the majority of the countries of the region. However, is still far in achieving high performance levels and sustainability in risk management, primarily when it has the highest gap between potential macroeconomic and financial losses and the ability to face them. The Dominican Republic has shown steady risk performance up to 2008, but two remaining areas for improvement are hazard monitoring and early warning systems. Jamaica has made uneven advances between 1990 and 2008, requiring significant improvements to achieve high performance levels and sustainability in risk management, as well as macroeconomic mitigation infrastructure. Trinidad and Tobago has the lowest risk management score of the 15 countries in the Latin American and Caribbean region as assessed by the IADB study in 2010, yet it has experienced an important vulnerability reduction. In sum, the results confirmed the high disaster risk management disparity in the Caribbean region.

An evaluation of functional impairment among children with anxiety disorders

Despite a considerable progress in developing and testing psychosocial treatments to reduce youth anxiety disorders, much remains to learn about the relation between anxiety symptom reduction and change in youth functional impairment. The specific aims of this dissertation thus were to examine: (1) the relation between different levels of anxiety and youth functional impairment ratings; (2) incremental validity of the Children Global Assessment Scale (CGAS); (3) the mediating role of anxiety symptom reduction on youth functional impairment ratings; (4) the directionality of change between anxiety symptom reduction and youth functional impairment; (5) the moderating effects of youth age, sex, and ethnicity on the mediated relation between youth anxiety symptom reduction and change in functional impairment; and (6) an agreement (or lack thereof) between youths and their parents in their views of change in youth functional impairment vis-à-vis anxiety symptom reduction. ^ The results were analyzed using archival data set acquired from 183 youths and their mothers. Research questions were tested using SPSS and structural equation modeling techniques in Mplus. ^ The results supported the efficacy of psychosocial treatments to reduce the severity of youth anxiety symptoms and its associated functional impairment. Moreover, the results revealed that at posttreatment, youths who scored either low or medium on anxiety levels scored significantly lower on impairment, than youths who scored high on anxiety levels. Incremental validity of the CGAS was also revealed across all assessment points and informants in my sample. In addition, the results indicated the mediating role of anxiety symptom reduction with respect to change in youth functional impairment at posttest, regardless of the youth’s age, sex, and ethnicity. No significant findings were observed with regard to the bidirectionality and an informant disagreement vis-à-vis the relation between anxiety symptom reduction and change in functional impairment. ^ The study’s main contributions and potential implications on theoretical, empirical, and clinical levels are further discussed. The emphasis is on the need to enhance existing evidence-based treatments and develop innovative treatment models that will not only reduce youth’s symptoms (such anxiety) but also evoke genuine and palpable improvements in lives of youths and their families.^

Disater Risk Management Disparity in the Caribbean: Evidence from Barbados, Dominican Republic, Jamaica and Trinidad and Tobago

This study on risk and disaster management capacities of four Caribbean countries: Barbados, the Dominican Republic, Jamaica, and Trinidad and Tobago, examines three main dimensions: 1) the impact of natural disasters from 1900 to 2010 (number of events, number of people killed, total number affected, and damage in US$); 2) institutional assessments of disaster risk management disparity; and 3) the 2010 Inter-American Bank for Development (IADB) Disaster Risk and Risk Management indicators for the countries under study. The results show high consistency among the different sources examined, pointing out the need to extend the IADB measurements to the rest of the Caribbean countries. Indexes and indicators constitute a comparison measure vis-à-vis existing benchmarks in order to anticipate a capacity to deal with adverse events and their consequences; however, the indexes and indicators could only be tested against the occurrence of a real event. Therefore, the need exists to establish a sustainable and comprehensive evaluation system after important disasters to assess a country’s performance, verify the indicators, and gain feedback on measurement systems and methodologies. There is diversity in emergency and preparedness for disasters in the four countries under study. The nature of the event (hurricanes, earthquakes, floods, and seismic activity), especially its frequency and the intensity of the damage experienced, is related to how each has designed its risk and disaster management policies and programs to face natural disasters. Vulnerabilities to disaster risks have been increasing, among other factors, because of uncontrolled urbanization, demographic density and poverty increase, social and economic marginalization, and lack of building code enforcement. The four countries under study have shown improvements in risk management capabilities, yet they are far from being completed prepared. Barbados’ risk management performance is superior, in comparison, to the majority of the countries of the region. However, is still far in achieving high performance levels and sustainability in risk management, primarily when it has the highest gap between potential macroeconomic and financial losses and the ability to face them. The Dominican Republic has shown steady risk performance up to 2008, but two remaining areas for improvement are hazard monitoring and early warning systems. Jamaica has made uneven advances between 1990 and 2008, requiring significant improvements to achieve high performance levels and sustainability in risk management, as well as macroeconomic mitigation infrastructure. Trinidad and Tobago has the lowest risk management score of the 15 countries in the Latin American and Caribbean region as assessed by the IADB study in 2010, yet it has experienced an important vulnerability reduction. In sum, the results confirmed the high disaster risk management disparity in the Caribbean region.

Perceptions of French and Creole Among First-Generation Adult Haitian English Language Learners

Context: Due to a unique combination of factors, outdoor athletes in the Southeastern United States are at high risk of lightning deaths and injuries. Lightning detection methods are available to minimize lightning strike victims. Objective: Becoming aware of the risk factors that predispose athletes to lightning strikes and determining the most reliable detection method against hazardous weather will enable Certified Athletic Trainers to develop protocols that protect athletes from injury. Data Sources: A comprehensive literature review of Medline and Pubmed using key words: lightning, lightning risk factors, lightning safety, lightning detection, and athletic trainers and lightning was completed. Data Synthesis: Factors predisposing athletes to lighting death or injury include: time of year, time of day, the athlete’s age, geographical location, physical location, sex, perspiration level, and lack of education and preparedness by athletes and staff. Although handheld lightning detectors have become widely accessible to detect lightning strikes, their performance has not been independently or objectively confirmed. There is evidence that these detectors inaccurately detect strike locations by recording false strikes and not recording actual strikes. Conclusions: Lightning education and preparation are two factors that can be controlled. Measures need to be taken by Certified Athletic Trainers to ensure the safety of athletes during outdoor athletics. It is critical for athletic trainers and supervising staff members to become fully aware of the risks of lightning strikes in order to most effectively protect everyone under their supervision. Even though lightning detectors have been manufactured in an attempt to minimize death and injuries due to lightning strikes, none of the detectors have been proven to be 100% effective. Educating coaches, athletes, and parents on the risks of lightning and the detection methods available, while implementing an emergency action plan for lightning safety, is crucial to ensure the well being of the student-athlete population.

World-Class Service

In the discussion - World-Class Service - by W. Gerald Glover, Associate Professor, Restaurant, Hotel and Resort Management at Appalachian State University and Germaine W. Shames, Hilton International, New York, Glover and Shames initially state: “Providing world-class service to today's traveler may be the key for hospitality managers in the current competitive market. Although an ideal, this type of service provides a mandate for culturally aware managers. The authors provide insight into several areas of cultures in collision.” Up to the time this essay is written, the authors point to a less-than-ideal level of service as being the standard in the hospitality industry and experience. “Let's face it - if we're ever to resurrect service, it will not be by going back to anything,” Glover and Shames exclaim. “Whatever it was we did back then has contributed to the dilemma in which we find ourselves today, handicapped by a reactive service culture in an age that calls for adaptiveness and global strategies,” the authors fortify that thought. In amplifying the concept of world-class service Glover and Shames elaborate: “World-class service is an ideal. Proactive and adaptive, world-class service feels equally right to the North American dignitary occupying the Presidential Suite, and the Japanese tourist staying in a standard room in the same hotel.” To bracket that model the authors offer: “At a minimum, it is service perceived by each customer as appropriate and adequate. At its best, it may also make the customer feel at home, among friends, or pampered. Finally, it is service as if culture matters,” Glover and Shames expand and capture the rule of world-class service. Glover and Shames consider the link between cultures and service an imperative one. They say it is a principle lost on most hospitality managers. “Most [managers] have received service management education in the people are people school that teaches us to disregard cultural differences and assume that everyone we manage or serve is pretty much like ourselves,” say Glover and Shames. “Is it any wonder that we persist in setting service standards, marketing services, and managing service staff not only as if culture didn't matter, but as if it didn't exist?!” To offer legitimacy to their effort Glover and Shames present the case of the Sun and Sea Hotel, a 500-room first class hotel located on the outskirts of the capital city of a small Caribbean island nation. It is a bit difficult to tell whether this is a dramatization or a reality. It does, however, serve to illustrate their point in regard to management’s cognizance, or lack thereof, of culture when it comes to cordial service and guest satisfaction. Even more apropos is the tale of the Palace Hotel, “…one of the grande dames of hospitality constructed in the boom years of the 1920s in a mid-sized Midwestern city in the United States.” The authors relate what transpired during its takeover in mid-1980 by a U.S.-based international hotel corporation. The story makes for an interesting and informative case study.

From Clerk and Cashier to Guest Service Agent

In their study - From Clerk and Cashier to Guest Service Agent - by Nancy J. Allin, Director of Quality Assurance and Training and Kelly Halpine, Assistant Director of Quality Assurance and Training, The Waldorf-Astoria, New York, the authors state at the outset: “The Waldorf-Astoria has taken the positions of registration clerk and cashier and combined them to provide excellent guest service and efficient systems operation. The authors tell how and why the combination works. That thesis statement defines the article, and puts it squarely in the crosshairs of the service category. Allin and Halpine use their positions at the Waldorf-Astoria in New York City to frame their observations “The allocation of staff hours has been a challenge to many front office managers who try their hardest to schedule for the norm but provide excellent, efficient service throughout the peaks,” Allin and Halpine allude. “…the decision [to combine the positions of registration clerk and cashier] was driven by a desire to improve guest service where its impact is most obvious, at the front desk. Cross-trained employees speed the check-in and check-out process by performing both functions, as the traffic at the desk dictates,” the authors say. Making such a move has resulted in positive benefits for both the guests and the hotel. “Benefits to the hotel, in addition to those brought to bear by increased guest satisfaction, include greater flexibility in weekly scheduling and in granting vacations while maintaining adequate staffing at the desk,” say Allin and Halpine . “Another expected outcome, net payroll savings, should also be realized as a consequence of the ability to schedule more efficiently.” The authors point to communication as the key to designing a successful combination such as this, with the least amount of service disruption. They bullet-point what that communication should entail. Issues of seniority, wage and salary rates, organizational charting, filing, scheduling, possible probationary periods, position titles, and physical layouts are all discussed. “It is critical that each of the management issues be addressed and resolved before any training is begun,” Allin and Halpine suggest. “Unresolved issues project confusion and lack of conviction to line employees and the result is frustration and a lack of commitment to the combination process,” they push the thought Allin and Halpine insist: “Once begun, training must be ongoing and consistent.” In the practical sense, the authors provide that authorizing overtime is helpful in accomplishing training. “Training must address the fact that employees will be faced with guest situations which are new to them, for example: an employee previously functioning as a cashier will be faced with walking guests. Specific exercises should be included to address these needs,” say the authors.

Consolidating Security and Development in Colombia: Lessons for Peru and Panama

Colombia's increasingly effective efforts to mitigate the power of the FARC and other illegitimately armed groups in the country can offer important lessons for the Peruvian government as it strives to prevent a resurgence of Sendero Luminoso and other illegal non-state actors. Both countries share certain particular challenges: deep economic, social, and in the case of Peru ethnic divisions, the presence of and/or the effects of violent insurgencies, a large-scale narcotics production and trafficking, and a history of weak state presence in large tracts of isolated and scarcely-populated areas. Important differences exist, however in the nature of the insurgencies in the two countries, the government response to them and the nature of government and society that affects the applicability of Colombia's experience to Peru. The security threat to Panama from drug trafficking and Colombian insurgents --often a linked phenomenon-- are in many ways different from the drug/insurgent factor in Colombia itself and in Peru, although there are similar variables. Unlike the Colombian and Peruvian cases, the security threat in Panama is not directed against the state, there are no domestic elements seeking to overthrow the government -- as the case of the FARC and Sendero Luminoso, security problems have not spilled over from rural to urban areas in Panama, and there is no ideological component at play in driving the threat. Nor is drug cultivation a major factor in Panama as it is in Colombia and Peru. The key variable that is shared among all three cases is the threat of extra-state actors controlling remote rural areas or small towns where state presence is minimal. The central lesson learned from Colombia is the need to define and then address the key problem of a "sovereignity gap," lack of legitimate state presence in many part of the country. Colombia's success in broadening the presence of the national government between 2002 and the presence is owed to many factors, including an effective national strategy, improvements in the armed forces and police, political will on the part of government for a sustained effort, citizen buy-in to the national strategy, including the resolve of the elite to pay more in taxes to bring change about, and the adoption of a sequenced approach to consolidated development in conflicted areas. Control of territory and effective state presence improved citizen security, strengthened confidence in democracy and the legitimate state, promoted economic development, and helped mitigate the effect of illegal drugs. Peru can benefit from the Colombian experience especially in terms of the importance of legitimate state authority, improved institutions, gaining the support of local citizens, and furthering development to wean communities away from drugs. State coordinated "integration" efforts in Peru as practiced in Colombia have the potential for success if properly calibrated to Peruvian reality, coordinated within government, and provided with sufficient resources. Peru's traditionally weak political institutions and lack of public confidence in the state in many areas of the country must be overcome if this effort is to be successful.

Development of test-based wind-driven rain intrusion model for hurricane-induced building interior and contents damage

Major portion of hurricane-induced economic loss originates from damages to building structures. The damages on building structures are typically grouped into three main categories: exterior, interior, and contents damage. Although the latter two types of damages, in most cases, cause more than 50% of the total loss, little has been done to investigate the physical damage process and unveil the interdependence of interior damage parameters. Building interior and contents damages are mainly due to wind-driven rain (WDR) intrusion through building envelope defects, breaches, and other functional openings. The limitation of research works and subsequent knowledge gaps, are in most part due to the complexity of damage phenomena during hurricanes and lack of established measurement methodologies to quantify rainwater intrusion. This dissertation focuses on devising methodologies for large-scale experimental simulation of tropical cyclone WDR and measurements of rainwater intrusion to acquire benchmark test-based data for the development of hurricane-induced building interior and contents damage model. Target WDR parameters derived from tropical cyclone rainfall data were used to simulate the WDR characteristics at the Wall of Wind (WOW) facility. The proposed WDR simulation methodology presents detailed procedures for selection of type and number of nozzles formulated based on tropical cyclone WDR study. The simulated WDR was later used to experimentally investigate the mechanisms of rainwater deposition/intrusion in buildings. Test-based dataset of two rainwater intrusion parameters that quantify the distribution of direct impinging raindrops and surface runoff rainwater over building surface — rain admittance factor (RAF) and surface runoff coefficient (SRC), respectively —were developed using common shapes of low-rise buildings. The dataset was applied to a newly formulated WDR estimation model to predict the volume of rainwater ingress through envelope openings such as wall and roof deck breaches and window sill cracks. The validation of the new model using experimental data indicated reasonable estimation of rainwater ingress through envelope defects and breaches during tropical cyclones. The WDR estimation model and experimental dataset of WDR parameters developed in this dissertation work can be used to enhance the prediction capabilities of existing interior damage models such as the Florida Public Hurricane Loss Model (FPHLM).^