Factors affecting emergency department length of stay of patients admitted to telemetry and critical care units

The purpose of this study was to determine the emergency department (ED) length of stay (LOS) of patients admitted to inpatient telemetry and critical care units and to identify the factors that contribute to a prolonged ED LOS. It also examined whether there was a difference in ED LOS between clients evaluated by an ED physician, an Advanced Registered Nurse Practitioner (ARNP) or a Physician's Assistant (PA).^ A data collection tool was devised and used to record data obtained by retrospectively reviewing 110 charts of patients from this sample. The mean ED LOS was 286.75 minutes. Multiple factors were recorded as affecting the ED LOS of this sample, including: age, diagnosis, consultations, multiple radiographs, pending admission orders, nurse unable to call report/busy, relatives at bedside, observation or stabilization necessary, bed not ready and infusion in progress. No significant difference in ED LOS was noted between subjects initially evaluated by a physician, an ARNP or a PA. ^

Factors affecting the nodulation and growth of tropical woody legume seedlings

This study surveys the occurrence of nodulation in woody legume species in Panamá and Costa Rica, describes nodule and root characteristics, and researches host-bacteria specificity, nodulation potential of soils, and the effects of light, added nitrogen, and rhizobia and VA mycorrhizal fungi inoculation on seedling growth. I examined 83 species in 37 genera and found 80% to be nodulated. Percent nodulated species in the Caesalpinioideae, Mimosoideae, and Papilionoideae was 17, 95, and 86, respectively, with no correlation between nodule morphology and tribal classification. Nodules formed mainly at root branch points which supports epidermal breaks as an important rhizobia infection route. More non-nodulated than nodulated species had root hairs. Several species emitted volatile sulfur-containing compounds, including the toxic compound ethylmercaptan, from roots, germinating seeds, and other tissues. These emissions may have an allelopathic action against pathogens, predators, or other plants. In contrast to the general non-specificity of most legumes for rhizobia, Mimosa pigra L. was highly specific and only nodulated in flooded soils. This species' specificity, combined with a limited occurrence of its root nodule bacteria may limit its natural distribution, but its spread as an invasive weed is facilitated when fill material from rivers is deposited in other areas. ^ An experimental light level of 1.5% of full sun completely inhibited seedling nodulation, as do similar naturally low levels in forest understory. In the forest, trees and seedlings were not nodulated. in some soils with suspected high N content. For six experimental species, added N progressively increased seedling growth while decreasing nodule biomass; at the highest level of added N nodulation was completely suppressed. Species and individuals showed variation in nodule biomass at high N applications which may indicate an opportunity for genetic selection for optimal N acquisition. Rhizobia inoculation had a small positive effect on seedling shoot growth, but VA mycorrhiza inoculation overwhelmingly increased seedling size, biomass, and leaf mineral concentration. In lowland tropical forest, VA mycorrhizal colonization appears indispensable for legume nodulation because of the fungus' ability to supply P in deficient soils. This requirement makes the legume-rhizobia-mycorrhiza association obligately tripartite. ^

Performance accountability in the federal-state transportation program: Factors affecting successful implementation

Governmental accountability is the requirement of government entities to be accountable to the citizenry in order to justify the raising and expenditure of public resources. The concept of service efforts and accomplishments measurement for government programs was introduced by the Governmental Accounting Standards Board (GASB) in Service Efforts and Accomplishments Reporting: Its Time Has Come (1990). This research tested the feasibility of implementing the concept for the Federal-aid highway construction program and identified factors affecting implementation with a case study of the District of Columbia. Changes in condition and performance ratings for specific highway segments in 15 projects, before and after construction expenditures, were evaluated using data provided by the Federal Highway Administration. The results of the evaluation indicated difficulty in drawing conclusions on the state program performance, as a whole. The state program reflects problems within the Federally administered program that severely limit implementation of outcome-oriented performance measurement. Major problems identified with data acquisition are: data reliability, availability, compatibility and consistency among states. Other significant factors affecting implementation are institutional barriers and political barriers. Institutional issues in the Federal Highway Administration include the lack of integration of the fiscal project specific database with the Highway Performance Monitoring System database. The Federal Highway Administration has the ability to resolve both of the data problems, however interviews with key Federal informants indicate this will not occur without external directives and changes to the Federal “stewardship” approach to program administration. ^ The findings indicate many issues must be resolved for successful implementation of outcome-oriented performance measures in the Federal-aid construction program. The issues are organizational and political in nature, however in the current environment resolution is possible. Additional research is desirable and would be useful in overcoming the obstacles to successful implementation. ^

Selected psychosocial and demographic factors affecting levels of pre-retirement planning

In September 2002, the State of Florida implemented a new retirement structure for those employed in the Florida Public School System. Teachers were given the option to maintain their existing defined benefit plan or choose the newly offered defined contribution plan. The variables that affect planning for retirement are innumerable. Identifying the most significant variables is essential to understanding how one plans for retirement. ^ This study examined the relationship between hypothesized psychosocial and demographic factors and an individual's level of pre-retirement planning. The criterion variable, the level of pre-retirement planning, comprised two concepts. First, the time spent thinking about retirement was determined by the score an individual received on a pre-retirement planning scale. This scale included the concepts of information gathering, goals, anticipated resources, and long-range planning. Second, implementation of retirement plan procedures was determined by the percentage an individual annually deferred to retirement. ^ The survey used for data collection contained 50 close-ended items. It was distributed to all full-time teachers in nine randomly selected elementary, middle, and senior high schools throughout Miami-Dade County Public Schools. Multiple regression and crosstabulation indicated that math anxiety, general risk, years of service, and total family income were significant predictors of the level of pre-retirement planning, as measured by the pre-retirement planning scale. In addition, the statistical analysis indicated that math anxiety, internal locus of control, years of service, and total family income were significant predictors of the level pre-retirement planning, as measured by the amount deferred to retirement. An individual's level of math anxiety and family income were the two factors that were the most significant predictors for both concepts on the level of pre-retirement planning. ^ Based on the findings of the study, recommendations focused on assessing an individual's level of math anxiety and educating teachers, particularly pre-service candidates, about the factors that affect pre-retirement planning. Further research should investigate the benefit of such educational programs. ^

Global factors affecting women's participation in leadership

This dissertation is a multi-level, cross-cultural study of women in leadership conducted with both macro-society data and individual-level data aggregated to the country level. The research questions are, “What macro and micro forces are hindering or advancing women into business or political leadership?” “How do these forces impact the level of women's involvement in business and political leadership in a particular country?” Data was collected from 10 secondary sources, available for 213 countries, and includes about 300 variables for business leadership (N=115) and political leadership (N=181). To date, most women in leadership research has been Western- or US-based, and little rigorous empirical, multi-level research has been done across countries. The importance of cross-cultural studies on women in leadership stems from the potential to better understand why some countries have more women in positions of both business and political leadership; and the factors that affect women's involvement in such positions in different countries. A “Levels of Women's Participation in Leadership” country model is tested using cluster and discriminant analyses. Results indicate that the factors that affect women?s participation in leadership in countries with fewer women leaders are different from the factors that affect women's participation in countries with high levels of participation. This dissertation proposes that initiatives to increase participation of women in leadership need to consider the relevant factors that significantly affect countries at certain Levels of Women's Participation in Leadership. ^

Biogeochemical factors affecting the fate and transport of mercury in the terrestrial environment at Oak Ridge, Tennessee

Mercury (Hg) contamination problem in the United Sates has been an important issue due to its potential threat to human and ecological health. This thesis presents a study of two Hg-contaminated sites along the East Fork Poplar Creek (EFPC) at Oak Ridge. The top soils from the terrestrial areas, along with the soils from three vertical soil horizons at the EFPC bank were sampled and analyzed for total-Hg (THg), methyl-Hg, total-organic-carbon (TOC), and pH. The stream bank soils were also analyzed for the stable-Hg-isotopes (198Hg, 199Hg, 200Hg, 201Hg, and 202Hg). Furthermore, some of the soil samples (n=7) from the same study sites were investigated for phytoavailability of mercury as measured by degree of Hg translocation in aboveground biomass of Impatiens walleriana plants grown in the soils.^ The results showed a significant difference (p<0.001) in THg concentrations for the forest soils (42.40±4.98 mg/kg) and the grassland soils (8.71±2.30 mg/kg). The higher THg and methyl-Hg concentrations were commensurate with the higher TOC content in the soils (p<0.001). Also, the THg concentrations for the upstream site was higher (129.08±34.14 mg/kg) than the downstream site (24.31±3.47 mg/kg). The two sites also differed in their stable Hg isotope compositions (p<0.001 for δ199Hg). The stable isotope analysis indicated the increased level of mass dependent isotopic fractionation with increasing depths along the EFPC bank. The difference between the two study sites was also prominent in case of the Hg uptake by the plants, with higher Hg uptake from the upstream soils compared to that from the downstream soils. A significant correlation, r=0.93 p<0.01, was observed between the Hg uptake and the soil-THg concentrations. THg was higher in the leaves (1161.87±310.01 μg/kg) than in the flowers (206.13±55.23 μg/kg) or the stems (634.54±403.35μg/kg). ^ The level of Hg contamination increased with decreasing distance from the point source and was highly influenced by plants/microbes, soil-organic-content, and Hg-speciation. The isotopic study indicated the existence of an additional Hg source in the EFPC watershed, possibly atmospheric Hg-deposition. These findings are worth taking into account while planning any Hg remediation effort and developing Hg loading criteria as per the National Pollutant Discharge Elimination System (NPDES) Program.^

Factors affecting the concentration and flux of materials in two southern Everglades mangrove wetlands

Concentrations and fluxes of C, N, and P were measured in dwarf and fringe mangrove wetlands along the Taylor River, Florida, USA from 1996 to 1998. Data from these studies revealed considerable spatial and temporal variability. Concentrations of C, N, and P in the dwarf wetland showed seasonal trends, while water source was better at explaining concentrations in the fringe wetland. The total and dissolved organic carbon (TOC and DOC), total nitrogen (TN), and total phosphorus (TP) content of both wetlands was higher during the wet season or when water was flowing to the south (Everglades source). Concentrations of nitrate plus nitrite (NOx –), ammonium (NH4 +), and soluble reactive phosphorus (SRP) in the fringe wetland were all highest during the dry season or northerly flow (bay source). Nutrient concentrations most effectively explained patterns of flux in both wetlands. Increased wetland uptake of a given constituent was usually a function of its availability in the water column. However, the release of NOx – from the dwarf wetland was related to the NH4 + concentration, suggesting a nitrification signal. Nitrogen flux in the dwarf wetland was also related to surface water salinity and temperature. Our findings indicate that freshwater Everglades marshes are an important source of dissolved organic matter to these wetlands, while Florida Bay may be a source of dissolved inorganic nutrients. Our data also suggest that temperature, salinity, and nutrient concentrations (as driven by season and water source) influence patterns of materials flux in this mangrove wetland. Applying long-term water quality data to the relationships we extracted from these flux data, we estimated that TN and TP were imported by the dwarf wetland 87 ± 10 and 48 ± 17% of the year, respectively. With Everglades restoration, modifications in freshwater delivery may have considerable effects on the exchanges of nutrients and organic matter in these transitional mangrove wetlands.

Understanding Golf Country Club Members’ Loyalty: Factors Affecting Membership Renewal Decisions

Many private country clubs across the United States have experienced a declining or flat membership and smaller waitlists of members wanting to join. The objective of this study was to investigate whether member involvement, service quality, and perceived value, influence member satisfaction and intention to renew membership for members of private country clubs. An online survey instrument customized for the country club industry was distributed to members of two country clubs in northeast Ohio. Results indicate that involvement level of members and perceived value impact country club members’ satisfaction and intention to renew their membership. Managerial implications are discussed.

Factors affecting the alignment of *grades and reading scores for third-grade students on the Florida Comprehensive Assessment Test

The purpose of this study was to aid in understanding the relationship between current Reading report card grading practices and standards-based state standardized testing results in Reading and factors associated with the alignment of this relationship. Report card and Florida Comprehensive Assessment Test (FLAT) data for 2004 were collected for 1064 third grade students in nine schools of one feeder pattern in Florida's Miami-Dade County Public Schools. A Third Grade Teacher Questionnaire was administered to 48 Reading teachers. The questionnaire contained items relating to teachers' education, teaching experience, grading practices, and beliefs about the FCAT, instructional Reading activities, methods, and materials. ^ Findings of this study support a strong relationship between report card grades and FCAT Reading achievement levels. However, individual school correlational analysis showed significant differences among schools' alignment measures. Higher teacher alignment between grades and FCAT levels was associated with teachers spending more time on individualized methods of Reading instruction and to teachers feeling there was not enough time to teach and help individual students. Lower teacher alignment of grades and achievement levels was associated with teachers taking homework into account in the final Reading grade. Teacher alignment of grades and achievement levels was not associated with teacher beliefs concerning the FCAT, instructional activities in Reading and Language Arts, the Reading program used, the model of delivery of the Reading program, instruction or type of instructional planning done by the teachers. ^ This study highlights the need for further investigations related to determining additional teacher factors that may affect the alignment relationship between report card grades and standards-based state standardized testing results. ^

Factors Affecting De Novo Urinary Retention after Holmium Laser Enucleation of the Prostate

Objective Patients can experience urinary retention (UR) after Holmium laser enucleation of the prostate (HoLEP) that requires bladder distension during the procedure. The aim of this retrospective study is to identify factors affecting the UR after HoLEP. Materials and Methods 336 patients, which underwent HoLEP for a symptomatic benign prostatic hyperplasia between July 2008 and March 2012, were included in this study. Urethral catheters were routinely removed one or two days after surgery. UR was defined as the need for an indwelling catheter placement following a failure to void after catheter removal. Demographic and clinical parameters were compared between the UR (n = 37) and the non-urinary retention (non-UR; n = 299) groups. Results The mean age of patients was 68.3 (±6.5) years and the mean operative time was 75.3 (±37.4) min. Thirty seven patients (11.0%) experienced a postoperative UR. UR patients voided catheter free an average of 1.9 (±1.7) days after UR. With regard to the causes of UR, 24 (7.1%) and 13 (3.9%) patients experienced a blood clot-related UR and a non-clot related UR respectively. Using multivariate analysis (p<0.05), we found significant differences between the UR and the non-UR groups with regard to a morcellation efficiency (OR 0.701, 95% CI 0.498–0.988) and a bleeding-related complication, such as, a reoperation for bleeding (OR 0.039, 95% CI 0.004–0.383) or a transfusion (OR 0.144, 95% CI 0.027–0.877). Age, history of diabetes, prostate volume, pre-operative post-void residual, bladder contractility index, learning curve, and operative time were not significantly associated with the UR (p>0.05). Conclusions De novo UR after HoLEP was found to be self-limited and it was not related to learning curve, patient age, diabetes, or operative time. Efficient morcellation and careful control of bleeding, which reduces clot formation, decrease the risk of UR after HoLEP.

UNDERSTANDING COUNTRY CLUB MEMBERS’ LOYALTY: FACTORS AFFECTING MEMBERSHIP RENEWAL DECISIONS

Many private country clubs across the United States have experienced a declining or flat membership and smaller waitlists of members wanting to join. The objective of this study was to investigate whether member involvement, service quality, and perceived value, influence member satisfaction and intention to renew membership for members of private country clubs. An online survey instrument customized for the country club industry was distributed to members of two country clubs in northeast Ohio. Results indicate that involvement level of members and perceived value impact country club members’ satisfaction and intention to renew their membership. Managerial implications are discussed.

Factors Affecting the Adoption of New Technology: the case of 311 Government Call Centers

Government call centers (311) were first created to reduce the volume of non-emergency calls that were being placed to emergency 911 call centers. The number of 311 call centers increased from 57 in 2008 to about 300 in 2013. Considering that there are over 2,700 municipal government units across the United States, the adoption rate of the 311 centers is arguably low in the country. This dissertation is an examination of the adoption of 311 call centers by municipal governments. My focus is specifically on why municipal governments adopt 311 and identifying which barriers result in the non-adoption of 311 call centers. This dissertation is possibly the first study to examine the adoption of 311 call centers in the United States. The dissertation study has identified several significant factors in the adoption and non-adoption of 311 government call centers. The following factors were significant in the adoption of 311 government call centers: managerial support, financial constraints, organizational responsiveness, strategic plan placement, and technology champion. The following factors were significant barriers that resulted in the non-adoption of a 311 government call center; no demand from citizens, start up costs, annual operating costs, unavailability of funding, and no obvious need for one.If local government entities that do not have a 311 government call center decide to adopt one, this study will help them identify the conditions that need to be in place for successful adoption to occur. Local government officials would first need to address the barriers in setting up the 311 call centers.

Factors Affecting Current and Future Treeline Locations and Dynamics in the Peruvian Andes

The elevational distributions of tropical treelines are thought to be determined by temperature, and are predicted to shift upslope in response to global warming. In contrast to this hypothesis, global-scale studies have shown that only half of all studied treelines are shifting upslope. Understanding how treelines will respond to climate change has important implications for global biodiversity, especially in the tropics, because tropical treelines generally represent the upper-elevation distribution limit of the hyper-diverse cloudforest ecosystem. In Chapter 1, I introduce the idea that grasslands found above tropical treelines may represent a potential grass ceiling which forest species cannot cross or invade. I use an extensive literature review to outline potential mechanisms which may be acting to stabilize treeline and prevent forest expansion into high-elevation grasslands. In Chapters 2-4, I begin to explore these potential mechanisms through the use of observational and experimental methods. In Chapter 2, I show that there are significant numbers of seedlings occurring just outside of the treeline in the open grasslands and that seed rain is unlikely to limit seedling recruitment above treeline. I also show that microclimates outside of the closed-canopy cloudforest are highly variable and that mean temperatures are likely a poor explanation of tropical treeline elevations. In Chapter 3, I show that juvenile trees maintain freezing resistances similar to adults, but nighttime radiative cooling near the ground in the open grassland results in lower cold temperatures relative to the free atmosphere, exposing seedlings of some species growing above treeline to lethal frost events. In Chapter 4, I use a large-scale seedling transplant experiment to test the effects of mean temperature, absolute low temperature and shade on transplanted seedling survival. I find that increasing mean temperature negatively affects seedling survival of two treeline species while benefiting another. In addition, low temperature extremes and the presence of shade also appear to be important factors affecting seedling survival above tropical treelines. This work demonstrates that mean temperature is a poor predictor of tropical treelines and that temperature extremes, especially low temperatures, and non-climatic variables should be included in predictions of current and future tropical treeline dynamics.

Factors affecting BMI and hemoglobin levels of mothers and infants in Kuwait

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Factors affecting growth and survival of snowy egret nestlings

It is widely believed that wading birds in the Everglades have declined as a result of historic water management practices. I determined growth rates for Snowy Egret (Egretta thula) chicks by assessed the nestling body condition through measurement of body weight and skeletal traits. A growth index was calculated as a residual of body weight regressed on age. A body condition index was calculated as the residual of body weight regressed on a skeletal trait (tarsus). Growth was significantly related to water level and hatch date. Survival rates were calculated to day 14, 21, and 50. Survival to 50 days of age was significantly related to hatch date and order. Survival to 21 days of age was significantly related to water level and hatching order. Survival to 14 days of age was marginally related to hatching order. Growth and survival is greatly influenced by water level and hatch date.