Development of ``HealthServe'': A measure of customer service orientation in healthcare

An assessment tool designed to measure a customer service orientation among RN's and LPN's was developed using a content-oriented approach. Critical incidents were first developed by asking two samples of healthcare managers (n = 52 and 25) to identify various customer-contact situations. The critical incidents were then used to formulate a 121-item instrument. Patient-contact workers from 3 hospitals (n = 102) completed the instrument along with the NEO-FFI, a measure of the Big Five personality factors. Concurrently, managers completed a performance evaluation scale on the employees participating in the study in order to determine the predictive validity of the instrument.^ Through a criterion-keying approach, the instrument was scaled down to 38 items. The correlation between HealthServe and the supervisory ratings of performance evaluation data supported the instrument's criterion-related validity (r =.66, p $<$.0001). Incremental validity of HealthServe over the Big Five was found with HealthServe accounting for 46% of the variance.^ The NEO-FFI was used to assess the correlation between personality traits and HealthServe. A factor analysis of HealthServe suggested 4 factors which were correlated with the NEO-FFI scores. Results indicated that HealthServe was related to Extraversion, Openness to Experience, Agreeableness, Conscientiousness and negatively related to Neuroticism.^ The benefits of the test construction procedure used here over the use of broad-based measures of personality were discussed as well as the limitations of using a concurrent validation strategy. Recommendations for future studies were provided. ^

Development of risk based treatability and engineering measures for reducing exposure to lead contaminated media in the Miami inner city, Florida

A major consequence of contamination at the local level’s population as it relates to environmental health and environmental engineering is childhood lead poisoning. Environmental contamination is one of the pressing environmental concerns facing the world today. Current approaches often focus on large contaminated industrial size sites that are designated by regulatory agencies for site remediation. Prior to this study, there were no known published studies conducted at the local and smaller scale, such as neighborhoods, where often much of the contamination is present to remediate. An environmental health study of local lead-poisoning data in Liberty City, Little Haiti and eastern Little Havana in Miami-Dade County, Florida accounted for a disproportionately high number of the county’s reported childhood lead poisoning cases. An engineering system was developed and designed for a comprehensive risk management methodology that is distinctively applicable to the geographical and environmental conditions of Miami-Dade County, Florida. Furthermore, a scientific approach for interpreting environmental health concerns, while involving detailed environmental engineering control measures and methods for site remediation in contained media was developed for implementation. Test samples were obtained from residents and sites in those specific communities in Miami-Dade County, Florida (Gasana and Chamorro 2002). Currently lead does not have an Oral Assessment, Inhalation Assessment, and Oral Slope Factor; variables that are required to run a quantitative risk assessment. However, various institutional controls from federal agencies’ standards and regulation for contaminated lead in media yield adequate maximum concentration limits (MCLs). For this study an MCL of .0015 (mg/L) was used. A risk management approach concerning contaminated media involving lead demonstrates that the linkage of environmental health and environmental engineering can yield a feasible solution.

Physiological performance measures and tolerance limits of estuarine indicator species in south Florida

Current water management practices in South Florida have negatively impacted many species inhabiting Florida Bay. Variable and high salinity has been identified as a key stressor in these estuaries. The Comprehensive Everglades Restoration Plan (CERP) includes water redistribution projects that will restore natural freshwater flows to northeastern Florida Bay. My studies focused on the following central theme and hypotheses: Biological performance measures (i.e., growth, reproduction, survival), behavior (i.e., habitat preference and locomotor behavior) and diversity of estuarine fish will be controlled by changes in salinity and water quality that will occur as a result of the restoration of freshwater flow to the bay. A series of acute and subchronic physiological toxicity studies were conducted to determine the effects of salinity changes on the life stages (embryo/larval, juvenile, adult) and fecundity of four native estuarine fish (Cyprinodon variegatus, Floridichthys carpio, Poecilia latipinna, and Gambusia holbrooki). Fish were exposed to a range of salinity concentrations (freshwater to hypersaline) based on salinity profiles in the study areas. Growth (length, weight) and survival were measured. Salinity trials included both rapid and gradual change events. Results show negative effects of acute, abrupt salinity changes on fish survival, development and reproductive success as a result of salinity stress. Other studies targeted reproduction and critical embryo-larval/neonate development as key areas for detecting long-term population effects of salinity change in Florida Bay. Adults of C. variegates and P. latipinna were also examined for behavioral responses to pulsed salinity changes. These responses include changes in swimming performance, locomotor behavior and zone preference. Finally, an ecological risk assessment was conducted for adverse salinity conditions in northeastern Florida Bay. Using the U.S. EPA's framework, the risk to estuarine fish species diversity was assessed against regional salinity profiles from a 17-year database. Based on the risk assessment, target salinity profiles for these areas are recommended for managers.^

Physiological performance measures and tolerance limits of estuarine indicator species in South Florida

Current water management practices in South Florida have negatively impacted many species inhabiting Florida Bay. Variable and high salinity has been identified as a key stressor in these estuaries. The comprehensive Everglades Restoration Plan (CERP) includes water redistribution projects that will restore natural freshwater flows to northeastern Florida Bay. My studies focused on the following central theme and hypotheses: Biological performance measures (i.e., growth, reproduction, survival), behavior (i.e., habitat preference and locomotor behavior) and diversity of estuarine fish will be controlled by changes in salinity and water quality that will occur as a result of the restoration of freshwater flow to the bay. A series of acute and subchronic physiological toxicity studies were conducted to determine the effects of salinity changes on the life stages (embryo/larval, juvenile, adult) and fecundity of four native estuarine fish (Cyprinodon variegatus, Floridichthys carpio, Poecilia latipinna, and Gambusia holbrooki). Fishe were exposed to a range of salinity concentrations (freshwater to hypersaline) based on salinity profiles in the study areas. Growth (length, weight) and survival were measured. Salinity trials included both rapid and gradual change events. Results show negative effects of acute, abrupt salinity changes on fish survival, development and reproductive success as a result of salinity stress. Other studies targeted reproduction and critical embryo-larval/neonate development as key areas for detecting long-term population effects of salinity change in Florida Bay. Adults of C. variegatus and P. latipinna were also examined for behavioral responses to pulsed salinity changes. These responses include changes in swimming performance, locomotor behavior and zone preference. Finally, an ecological risk assessment was conducted for adverse salinity conditions in northeastern Florida Bay. Using the U.S. EPA's framework, the risk to estuarine fish species diversity was assessed against regional salinity profiles from a 17-year database. Based on the risk assessment, target salinity profiles for these areas are recommended for managers.

International stock portfolio selection and performance measures recognizing higher moments of return distributions

Since the seminal works of Markowitz (1952), Sharpe (1964), and Lintner (1965), numerous studies on portfolio selection and performance measure have been based upon the mean-variance framework. However, several researchers (e.g., Arditti (1967, and 1971), Samuelson (1970), and Rubinstein (1973)) argue that the higher moments cannot be neglected unless there is reason to believe that: (i) the asset returns are normally distributed and the investor's utility function is quadratic, or (ii) the empirical evidence demonstrates that higher moments are irrelevant to the investor's decision. Based on the same argument, this dissertation investigates the impact of higher moments of return distributions on three issues concerning the 14 international stock markets.^ First, the portfolio selection with skewness is determined using: the Polynomial Goal Programming in which investor preferences for skewness can be incorporated. The empirical findings suggest that the return distributions of international stock markets are not normally distributed, and that the incorporation of skewness into an investor's portfolio decision causes a major change in the construction of his optimal portfolio. The evidence also indicates that an investor will trade expected return of the portfolio for skewness. Moreover, when short sales are allowed, investors are better off as they attain higher expected return and skewness simultaneously.^ Second, the performance of international stock markets are evaluated using two types of performance measures: (i) the two-moment performance measures of Sharpe (1966), and Treynor (1965), and (ii) the higher-moment performance measures of Prakash and Bear (1986), and Stephens and Proffitt (1991). The empirical evidence indicates that higher moments of return distributions are significant and relevant to the investor's decision. Thus, the higher moment performance measures should be more appropriate to evaluate the performances of international stock markets. The evidence also indicates that various measures provide a vastly different performance ranking of the markets, albeit in the same direction.^ Finally, the inter-temporal stability of the international stock markets is investigated using the Parhizgari and Prakash (1989) algorithm for the Sen and Puri (1968) test which accounts for non-normality of return distributions. The empirical finding indicates that there is strong evidence to support the stability in international stock market movements. However, when the Anderson test which assumes normality of return distributions is employed, the stability in the correlation structure is rejected. This suggests that the non-normality of the return distribution is an important factor that cannot be ignored in the investigation of inter-temporal stability of international stock markets. ^

The exploration enhancement workshop: An exploration-based approach to facilitating identity formation in young adults

This dissertation reports an investigation of the utility of two intervention programs to facilitate identity formation by way of exploration, one designed from an explicitly self-construction point of view and the other designed from an explicitly self-discovery point of view. The self-construction program was implemented using cognitive skills and orientations derived from Berzonsky (1989), Grotevant (1987), and Kurtines (1999). The self-discovery program was implemented using affective insight development strategies derived from Csikszentmihalyi (1990), Maslow (1968), and Waterman (1990). Three sets of measures were used: (a) cognitive identity measures, (b) affective identity measures, and (c) overall identity measures. Ninety undergraduates from Florida International University completed the intervention. Participants were assigned to one of three intervention conditions (Cognitive, Affective, and Control) and were pretested and posttested on cognitive, affective, and overall identity measures. Intervention strategies were introduced and discussed in the context of specific goals and choices that participants brought to group. Intervention results were then analyzed in terms of the effectiveness of the intervention conditions in promoting their respective developmental domains. The intervention was effective in promoting identity development in comparison to the control condition, with the cognitive condition facilitating cognitive competence and the affective condition facilitating affective insight. Results are discussed in the context of the constructivist and discovery perspectives, as well as in light of the broadened view of exploration offered in this paper. ^

Differences in learning style preference among students of diverse ethnicities, gender, academic placement level, and academic achievement

This investigation studied the differences in learning styles among ethnically diverse secondary science students from a multicultural urban high school. It examined whether there were learning style differences among samples based on ethnicity, gender, academic grouping, and academic achievement. The learning style elements were based on scores of the Dunn, Dunn, and Price Learning Style Inventory (LSI) (1997). The sample (n = 476) consisted of students enrolled in Life Science courses. The analyses of data were made by one way analysis of variance (ANOVA) and multivariate analysis of variance (MANOVA). ^ Significant differences were found among students for three of the four groups tested. The largest numbers of differences in learning style element preference were in academic grouping, with eight significant differences showing small or medium effect sizes. There were four significant differences between genders and one significant difference among ethnic groups. Effect size was small. The data analyses showed that individual differences have a much bigger effect than group differences on learning style, and that proportions in learning style element categories reveal more information than means of groups. ^ This study implied the need to increase awareness of differences in learning styles among students and help educators to understand them. Other predictors of learning styles might account for a large amount of the unexplained variation. Overall, this study reinforces the body of existing literature. ^

A computer based approach to improve the dietary and physical activity patterns of a diverse group of adolescents

Diet and physical activity patterns have been implicated as major factors in the increasing prevalence of childhood and adolescent obesity. It is estimated that between 16 and 33 percent of children and adolescents in the United States are overweight (CDC, 2000). Moreover, the CDC estimates that less than 50% of adolescents are physically active on a regular basis (CDC, 2003). Interventions must be focused to modify these behaviors. Facilitating the understanding of proper nutrition and need for physical activity among adolescents is the first step in preventing overweight and obesity and delaying the development of chronic diseases later in life (Dwyer, 2000). The purpose of this study was to compare the outcomes of students receiving one of two forms of education (both emphasizing diet and physical activity), to determine whether a computer based intervention (CBI) program using an interactive, animated CD-ROM would elicit a greater behavior change in comparison to a traditional didactic intervention (TDI) program. A convenience sample of 254 high school students aged 14-19 participated in the 6-month program. A pre-test post-test design was used, with follow-up measures taken at three months post-intervention. ^ No change was noted in total fat, saturated fat, fruit/vegetables, or fiber intake for any of the groups. There was also no change in perceived self-efficacy or perceived social support. Results did, however, indicate an increase in nutrition knowledge for both intervention groups (p<0.001). In addition, the CBI group demonstrated more positive and sustained behavior changes throughout the course of the study. These changes included a decrease in BMI (ppre/post<0.001, ppost/follow-up<0.001), number of meals skipped (ppre/post<0.001), and soda consumption (ppre/post=0.003, ppost/follow-up=0.03) and an increase in nutrition knowledge (ppre/post<0.001, ppre/follow-up <0.001), physical activity (ppre/post<0.05, p pre/follow-up<0.01), frequency of label reading (ppre/follow-up <0.0l) and in dairy consumption (ppre/post=0.03). The TDI group did show positive gains in some areas post intervention, however a return to baseline behavior was shown at follow-up. Findings of this study suggest that compared to traditional didactic teaching, computer-based nutrition and health education has greater potential to elicit change in knowledge and behavior as well as promote maintenance of the behavior change over time. ^

Effectiveness of skills- versus metacognitive strategy-based approaches on reading comprehension of college developmental students

This study explored the relative value of behavioral and cognitive psychology as the basis of instruction for underprepared college students enrolled in developmental reading courses. Specifically this study examined the effects of a metacognitive strategy-based instructional approach (MSIA) modeling a metacognitive self-questioning technique (MSQT) versus a traditional skills-based instructional approach (SIA) on the Nelson-Denny reading comprehension scores of college developmental readers and whether there were significant differences in achievement based on instructional method used and on the sex of students. The sample consisted of 100 college developmental reading students who were enrolled in six intact sections of a reading course (REA0002). Participants completed a pretest of the comprehension subtest of the Nelson-Denny Reading Test (Form G). Three of these classes (n = 49) were taught using metacognitive-strategy instruction and three classes (n = 51) were instructed using skills-based instruction. They then received a semester of instruction intended to improve their reading comprehension. At the end of the semester, participants completed a post-test of the Nelson-Denny Reading Comprehension Test (Form H). A two (Between) x one (Within) Repeated Measures Analysis of Variance (ANOVA) was utilized to test each of the hypotheses of this study. Results showed that there were no significant differences in reading comprehension between the groups receiving the different instructional treatments and no differences in reading comprehension between the men and women participants. Based on the findings, implications for research and recommendations for future research were discussed.

Orthogonal frequency division multiplexing based air interfaces and multiple input multiple output techniques in cooperative satellite communications for 4th generation mobile systems

Recently, wireless network technology has grown at such a pace that scientific research has become a practical reality in a very short time span. Mobile wireless communications have witnessed the adoption of several generations, each of them complementing and improving the former. One mobile system that features high data rates and open network architecture is 4G. Currently, the research community and industry, in the field of wireless networks, are working on possible choices for solutions in the 4G system. 4G is a collection of technologies and standards that will allow a range of ubiquitous computing and wireless communication architectures. The researcher considers one of the most important characteristics of future 4G mobile systems the ability to guarantee reliable communications from 100 Mbps, in high mobility links, to as high as 1 Gbps for low mobility users, in addition to high efficiency in the spectrum usage. On mobile wireless communications networks, one important factor is the coverage of large geographical areas. In 4G systems, a hybrid satellite/terrestrial network is crucial to providing users with coverage wherever needed. Subscribers thus require a reliable satellite link to access their services when they are in remote locations, where a terrestrial infrastructure is unavailable. Thus, they must rely upon satellite coverage. Good modulation and access technique are also required in order to transmit high data rates over satellite links to mobile users. This technique must adapt to the characteristics of the satellite channel and also be efficient in the use of allocated bandwidth. Satellite links are fading channels, when used by mobile users. Some measures designed to approach these fading environments make use of: (1) spatial diversity (two receive antenna configuration); (2) time diversity (channel interleaver/spreading techniques); and (3) upper layer FEC. The author proposes the use of OFDM (Orthogonal Frequency Multiple Access) for the satellite link by increasing the time diversity. This technique will allow for an increase of the data rate, as primarily required by multimedia applications, and will also optimally use the available bandwidth. In addition, this dissertation approaches the use of Cooperative Satellite Communications for hybrid satellite/terrestrial networks. By using this technique, the satellite coverage can be extended to areas where there is no direct link to the satellite. For this purpose, a good channel model is necessary.

Development and verification of control and protection strategies in hybrid AC/DC power systems for smart grid applications

Modern power networks incorporate communications and information technology infrastructure into the electrical power system to create a smart grid in terms of control and operation. The smart grid enables real-time communication and control between consumers and utility companies allowing suppliers to optimize energy usage based on price preference and system technical issues. The smart grid design aims to provide overall power system monitoring, create protection and control strategies to maintain system performance, stability and security. This dissertation contributed to the development of a unique and novel smart grid test-bed laboratory with integrated monitoring, protection and control systems. This test-bed was used as a platform to test the smart grid operational ideas developed here. The implementation of this system in the real-time software creates an environment for studying, implementing and verifying novel control and protection schemes developed in this dissertation. Phasor measurement techniques were developed using the available Data Acquisition (DAQ) devices in order to monitor all points in the power system in real time. This provides a practical view of system parameter changes, system abnormal conditions and its stability and security information system. These developments provide valuable measurements for technical power system operators in the energy control centers. Phasor Measurement technology is an excellent solution for improving system planning, operation and energy trading in addition to enabling advanced applications in Wide Area Monitoring, Protection and Control (WAMPAC). Moreover, a virtual protection system was developed and implemented in the smart grid laboratory with integrated functionality for wide area applications. Experiments and procedures were developed in the system in order to detect the system abnormal conditions and apply proper remedies to heal the system. A design for DC microgrid was developed to integrate it to the AC system with appropriate control capability. This system represents realistic hybrid AC/DC microgrids connectivity to the AC side to study the use of such architecture in system operation to help remedy system abnormal conditions. In addition, this dissertation explored the challenges and feasibility of the implementation of real-time system analysis features in order to monitor the system security and stability measures. These indices are measured experimentally during the operation of the developed hybrid AC/DC microgrids. Furthermore, a real-time optimal power flow system was implemented to optimally manage the power sharing between AC generators and DC side resources. A study relating to real-time energy management algorithm in hybrid microgrids was performed to evaluate the effects of using energy storage resources and their use in mitigating heavy load impacts on system stability and operational security.

Development of physics-based models and design optimization of power electronic conversion systems

The main objective for physics based modeling of the power converter components is to design the whole converter with respect to physical and operational constraints. Therefore, all the elements and components of the energy conversion system are modeled numerically and combined together to achieve the whole system behavioral model. Previously proposed high frequency (HF) models of power converters are based on circuit models that are only related to the parasitic inner parameters of the power devices and the connections between the components. This dissertation aims to obtain appropriate physics-based models for power conversion systems, which not only can represent the steady state behavior of the components, but also can predict their high frequency characteristics. The developed physics-based model would represent the physical device with a high level of accuracy in predicting its operating condition. The proposed physics-based model enables us to accurately develop components such as; effective EMI filters, switching algorithms and circuit topologies [7]. One of the applications of the developed modeling technique is design of new sets of topologies for high-frequency, high efficiency converters for variable speed drives. The main advantage of the modeling method, presented in this dissertation, is the practical design of an inverter for high power applications with the ability to overcome the blocking voltage limitations of available power semiconductor devices. Another advantage is selection of the best matching topology with inherent reduction of switching losses which can be utilized to improve the overall efficiency. The physics-based modeling approach, in this dissertation, makes it possible to design any power electronic conversion system to meet electromagnetic standards and design constraints. This includes physical characteristics such as; decreasing the size and weight of the package, optimized interactions with the neighboring components and higher power density. In addition, the electromagnetic behaviors and signatures can be evaluated including the study of conducted and radiated EMI interactions in addition to the design of attenuation measures and enclosures.

Norm-based comparison of SF -12 physical and mental health scale scores for a sample of employees of Broward County

In the new health paradigm, the connotation of health has extended beyond the measures of morbidity and mortality to include wellness and quality of life. Comprehensive assessments of health go beyond traditional biological indicators to include measures of physical and mental health status, social role-functioning, and general health perceptions. To meet these challenges, tools for assessment and outcome evaluation are being designed to collect information about functioning and well-being from the individual's point of view.^ The purpose of this study was to profile the physical and mental health status of a sample of county government employees against U.S. population norms. A second purpose of the study was to determine if significant relationships existed between respondent characteristics and personal health practices, lifestyle and other health how the tools and methods used in this investigation can be used to guide program development and facilitate monitoring of health promotion initiatives.^ The SF-12 Health Survey (Ware, Kosinski, & Keller, 1995), a validated measure of health status, was administered to a convenience sample of 450 employees attending one of nine health fairs at an urban worksite. The instrument has been utilized nationally which enabled a comparative analysis of findings of this study with national results.^ Results from this study demonstrated that several respondent characteristics and personal health practices were associated with a greater percentage of physical and/or mental scale scores that were significantly "worse" or significantly "better" than the general population. Respondent characteristics that were significantly related to the SF-12 physical and/or mental health scale scores were gender, age, education, ethnicity, and income status. Personal health practices that were significantly related to SF-12 physical and/or mental scale scores were frequency of vigorous exercise, presence of chronic illness, being at one's prescribed height and weight, eating breakfast, smoking and drinking status. This study provides an illustration of the methods used to analyze and interpret SF-12 Health Survey data, using norm-based interpretation guidelines which are useful for purposes of program development and collecting information on health at the community level. ^

Commitment language as a predictor of alcohol and marijuana use outcomes among adolescents in school -based group treatment

Despite widespread recognition of the problem of adolescent alcohol and other drug (AOD) abuse, research on its most common treatment modality, group work, is lacking. This research gap is alarming given that outcomes range from positive to potentially iatrogenic. This study sought to identify change mechanisms and/or treatment factors that are observable within group treatment sessions and that may predict AOD use outcomes. This NIH (F31 DA 020233-01A1) study evaluated 108, 10-19 year olds and the 19 school-based treatment groups to which they were previously assigned (R01 AA10246; PI: Wagner). Associations between motivational interviewing (MI) based change talk variables, group leader MI skills, and alcohol and marijuana use outcomes up to 12-months following treatment were evaluated. Treatment session audio recordings and transcripts (1R21AA015679-01; PI: Macgowan) were coded using a new discourse analysis coding scheme for measuring group member change talk (Amrhein, 2003). Therapist MI skills were similarly measured using the Motivational Interviewing Treatment Integrity instrument. Group member responses to commitment predicted group marijuana use at the 1-month follow up. Also, group leader empathy was significantly associated with group commitment for marijuana use at the middle and ending stages of treatment. Both of the above process measures were applied in a group setting for the first time. Building upon MI and social learning theory principles, group commitment and group member responses to commitment are new observable, in-session, process constructs that may predict positive and negative adolescent group treatment outcomes. These constructs, as well as the discourse analysis method and instruments used to measure them, raise many possibilities for future group work process research and practice.

The relationship of aptitude, course grades, and program length, to performance on a standards based test (NCLEX -RN)

The purpose of this study was threefold: first, to investigate variables associated with learning, and performance as measured by the National Council Licensure Examination for Registered Nurses (NCLEX-RN). The second purpose was to validate the predictive value of the Assessment Technologies Institute (ATI) achievement exit exam, and lastly, to provide a model that could be used to predict performance on the NCLEX-RN, with implications for admission and curriculum development. The study was based on school learning theory, which implies that acquisition in school learning is a function of aptitude (pre-admission measures), opportunity to learn, and quality of instruction (program measures). Data utilized were from 298 graduates of an associate degree nursing program in the Southeastern United States. Of the 298 graduates, 142 were Hispanic, 87 were Black, non-Hispanic, 54 White, non-Hispanic, and 15 reported as Others. The graduates took the NCLEX-RN for the first time during the years 2003–2005. This study was a predictive, correlational design that relied upon retrospective data. Point biserial correlations, and chi-square analyses were used to investigate relationships between 19 selected predictor variables and the dichotomous criterion variable, NCLEX-RN. The correlation and chi square findings indicated that men did better on the NCLEX-RN than women; Blacks had the highest failure rates, followed by Hispanics; older students were more likely to pass the exam than younger students; and students who passed the exam started and completed the nursing program with a higher grade point average, than those who failed the exam. Using logistic regression, five statistical models that used variables associated with learning and student performance on the NCLEX-RN were tested with a model adapted from Bloom's (1976) and Carroll's (1963) school learning theories. The derived model included: NCLEX-RNsuccess = f (Nurse Entrance Test and advanced medical-surgical nursing course grade achieved). The model demonstrates that student performance on the NCLEX-RN can be predicted by one pre-admission measure, and a program measure. The Assessment Technologies Institute achievement exit exam (an outcome measure) had no predictive value for student performance on the NCLEX-RN. The model developed accurately predicted 94% of the student's successful performance on the NCLEX-RN.