Effects of two intervention strategies on the behavior of nurses and nurse students related to advance directives

Advance directives are one mechanism for preserving the rights of individuals to exercise some control over their health care when serious illness may prevent them from direct participation. Nurses, as the health care providers with the closest and most sustained contact with critically ill and dying patients, are positioned to assist patients to plan for future health care needs. Although a majority of nurses favor the concept of advance directives for their patients and for themselves, they have not played a significant role in facilitating advance health care planning with their patients nor implemented advance health care planning for themselves.^ Research has also shown that differing forms of education and counseling increase the completion rates for advance directives in selected populations, mostly the elderly and seriously ill. Not yet developed are effective educational strategies to assist nurses and nurse students to make optimal contributions in assisting their clients' plans for future health care decision-making. This study sought to determine whether specific learning strategies (a) increased the involvement of nurses and nurse students in facilitating advance care planning with patients and (b) increased the percentage of the nurses' and nurse students' own personal advance care planning activities.^ The study compared two learning interventions and two populations, nurses and nurse students. The participants were randomly assigned to one of the two learning interventions, L1 or L2. Participants in L1 received a lecture, discussion and exploration of the forces impacting on advance directive behavior. Participants in L2 received the same intervention components with the additional component of group practice completing advance directives.^ Analysis of the data by chi-square and logistic regression did not support the hypotheses that the practice component would make a difference in the participants' facilitation of advance care planning with patients or in their own personal advance care planning activities. There were significant differences in post-intervention behavior between the nurse and nurse student groups. The nurses in the study did significantly more facilitation of advance care planning with patients and completed significantly more advance care documents than the nurse students post-intervention. However, the nurse students held more post-intervention family discussions than did the nurses. ^

Effect of an inservice on the teachers' knowledge of general school law, Section 504, and the Meta Consent Decree

It is generally assumed by educators that inservice training will make a significant difference in teacher knowledge of topics related to education. This investigation addressed that assumption by examining the effects of various factors, e.g., amount and timing of inservice training, upon teacher knowledge of educational law. Of special interest was teacher knowledge of the law as it pertained to ethnic and other characteristics of students in urban school settings. This study was deliberately designed to determine which factors should be later investigated in a more deterministic form, e.g., an experimental design.^ The investigation built upon that of Ogletree (1985), Osborne (1996) and others who focused on the importance of teacher development as a method to enhance professional abilities. The main question addressed in this study was, "How knowledgeable are teachers of school law, especially with regard to general school law, the Meta Consent Decree and Section 504 of the Rehabilitation Act of 1973."^ The study participants (N = 302) were from the Dade County School System, the fourth largest in the U.S. The survey design (approved by the System), specified participants from all levels and types of schools and geographic representations. A survey instrument was created, pilot tested, revised and approved for use by the district official representatives. After administration of the instrument, the resultant data was treated by several appropriate tests, e.g., multivariate analysis of variance (ANOVA).^ Several findings emerged from the analysis of the data: in general, teachers did not have sufficient knowledge of school law; factors, such as amount and level of education, and status and position were positively correlated with increased knowledge; factors such as years of experience, gender, race and ethnicity were not correlated with higher levels of knowledge. The most significant, however, was that when teachers had participated in several inservice training experiences, typically workshops, and, when combined with other factors noted above, their knowledge of school law was significantly higher. Specific recommendations for future studies were made. ^

The epidemiology of prostate cancer among multiethnic men

The research goal was to document differences in the epidemiology of prostate cancer among multicultural men [non-Hispanic White (NHW), Hispanic (H), non-Hispanic Black (NHB)], and Black subgroups, particularly among NHB subgroups [US-born (USB) and Caribbean-born (CBB)]. Study findings will be useful in supporting further research into Black subgroups. Aim 1 explored changes over time in reported prostate cancer prevalence, by race/ethnicity and by birthplace (within the Black subgroups). Aim 2 investigated relationships between observed and latent variables. The analytical approaches included confirmatory factor analysis (CFA for measurement models) and structural equation modeling (SEM for regression models). National Center for Health Statistics, National Health Interview Survey (NHIS) data from 1999–2008 were used. The study sample included men aged 18 and older, grouped by race/ethnicity. Among the CBB group, survey respondents were limited to the English-speaking Caribbean. Prostate cancer prevalence, by race showed a higher trend among NHB men than NHW men overall, however differences over time were not significant. CBB men reported a higher proportion of prostate cancer among cancers diagnosed than USB men overall. Due to small sample sizes, stable prostate cancer prevalence trends could not be assessed over time nor could trends in the receipt of a PSA exam among NHB men when stratified by birthplace. USB and CBB men differ significantly in their screening behavior. The effect of SES on PSA screening adjusted for risk factors was statistically significant while latent variable lifestyle was not. Among risk factors, family history of cancer exhibited a consistent positive effect on PSA screening for both USB and CBB men. Among the CBB men, the number of years lived in the US did not significantly affect PSA screening behavior. When NHB men are stratified by birthplace, CBB men had a higher overall prevalence of prostate cancer diagnoses than USB men although not statistically significant. USB men were 2 to 3 times more likely to have had a PSA exam compared to CBB men, but among CBB men birthplace did not make a significant difference in screening behavior. Latent variable SES, but not lifestyle, significantly affected the likelihood of a PSA exam.

Facing a paradigm shift in professional credentialing: Preparedness of registered dietitians for Professional Development 2001

In the year 2001, the Commission on Dietetic Registration (CDR) will begin a new process of recertifying Registered Dietitians (RD) using a self-directed lifelong learning portfolio model. The model, entitled Professional Development 2001 (PD 2001), is designed to increase competency through targeted learning. This portfolio consists of five steps: reflection, learning needs assessment, formulation of a learning plan, maintenance of a learning log, and evaluation of the learning plan. By targeting learning, PD 2001 is predicted to foster more up-to-date practitioners than the current method that requires only a quantity of continuing education hours. This is the first major change in the credentialing system since 1975. The success or failure of the new system will impact the future of approximately 60,000 practitioners. The purpose of this study was to determine the readiness of RDs to change to the new system. Since the model is dependent on setting goals and developing learning plans, this study examined the methods dietitians use to determine their five-year goals and direction in practice. It also determined RD's attitudes towards PD 2001 and identified some of the factors that influenced their beliefs. A dual methodological design using focus groups and questionnaires was utilized. Sixteen focus groups were held during state dietetic association meetings. Demographic data was collected on the 132 registered dietitians who participated in the focus groups using a self-administered questionnaire. The audiotaped sessions were transcribed into 643 pages of text and analyzed using Non-numerical Unstructured Data - Indexing Searching and Theorizing (NUD*IST version 4). Thirty-four of the 132 participants (26%) had formal five-year goals. Fifty-four participants (41%) performed annual self-assessments. In general, dietitians did not currently have professional goals nor conduct self-assessments and they claimed they did not have the skills or confidence to perform these tasks. Major barriers to successful implementation of PD 2001 are uncertainty, misinterpretation, and misinformation about the process and purpose, which in turn contribute to negative impressions. Renewed vigor to provide a positive, accurate message along with presenting goal-setting strategies will be necessary for better acceptance of this professional development process. ^

Ethnic groups and institutions: A study of institutional engineering in four Central and Eastern European countries

The issue of institutional engineering has gained a renewed interest with the democratic transitions of the Central and Eastern European countries, as for some states it has become a matter of state survival. The four countries examined in the study – Macedonia, Slovakia, Romania and Bulgaria – exemplify the difficulty in establishing a stable democratic society in the context of the resurgence of national identity. The success of ethnonational minorities in achieving the desired policies affirming or expanding their rights as a group was conditioned upon the cohesion of the minority as well as the permissiveness of state institutions in terms of participation and representation of minority members. The Hungarian minorities in Slovakia and Romania, the Turkish minority in Bulgaria, and the Albanian minority in Macedonia, formed their political organizations to represent their interests. However, in some cases the divergence of strategies or goals between factions of the minority group seriously impeded its ability to obtain the desired concessions from the majority. The difficulty in the pursuit of policies favoring the expansion of minority rights was further exacerbated in some of the cases by the impermissiveness of political institutions. The political parties representing the interest of ethnonational minorities were allowed to participate in elections, although not without suspicions about their intent and even strong opposition from majority groups, but participation in elections and subsequent representation in legislative bodies did not translate into adoption of the desired policies. The ethnonational minorities' inability to effectively influence the decision-making process was the result of the inadequacy of democratic institutions to process these demands and channel them through the normal political process in the absence of majority desire to accommodate them. Despite the promise of democratic institutions to bring about a major overhaul of the policies of forceful assimilation and disregard for minority rights, the four cases analyzed in the study demonstrate that in effect ethnonational minorities continued to be at the mercy of the majority, especially if the minority was unable to position itself as a balancing actor.

Teachers' experiences in and perceptions of their 12th-grade British literature classrooms

The purpose of this study was to understand the experiences and perceptions of 12th-grade literature teachers about curriculum, Post-Colonial literature, and students. Theories posed by Piaget (1995), Vygotsky (1995), and Rosenblatt (1995) formed the framework for this micro-ethnographic study. Seven teachers from public and private schools in South Florida participated in this two-phase study; three teachers in Phase I and four in Phase II. All participants completed individual semi-structured interviews and demographic surveys. In addition, four of the teachers were observed teaching. The analysis yielded three themes and two sub-themes: (a) knowledge concerned teachers' knowledge of British literature content and Post-Colonial authors and their literature; (b) freedom described teachers' freedom to choose how to teach their content. Included in this theme was dilemmas associated with 12th-grade classrooms which described issues that were pertinent to the 12th-grade teacher and classroom that were revealed by the study; and (c) thoughts about students described teachers' perceptions about students and how literature might affect the students. Two subthemes of knowledge were as follows:(1) text complexity described teacher responses to a Post-Colonial text's complexity and (2) student desirability/teachability described teachers' perception about how desirable Post-Colonial texts would be to students and whether teachers would be willing to teach these texts. The researcher offers recommendations for understanding factors associated with 12th-grade teachers perceptions and implications for enhancing the 12th-grade experience for teachers and curriculum, based on this study: (a) build teacher morale and capacity, (b) treat all students as integral components of the teaching and learning process; teachers in this study thought teaching disenfranchised learners was a form of punishment meted out by the administration, and (c) include more Post-Colonial authors in school curricula in colleges and schools as most teachers in this study did not study this type of literature nor knew how to teach it.

Infant feeding practices of Cuban mothers residing in Dade County, Florida

Research has shown that infant feeding practices differ between cultures. A convenience sample of 51 first generation Cuban mothers with infants birth to 12 months of age were surveyed to identify their infant feeding practices, and why they introduce foods to their infants in the manner in which they do. Data obtained from the mothers' responses to an English/Spanish Questionnaire were summarized by frequencies. Findings revealed that Cuban mothers consider a variety of foods from the major four food groups to be suitable for their infants. They introduced solids to their infants at the average age of four months and fed their infants in the manner in which they did because they thought it was healthy/nutritious. Cuban mothers may feed their infants as taught by health care professionals if their infant feeding practices are incorporated in the culture specific infant feeding programmes developed by the health team.

Making life choices : facilitating identity formation in young adults

This dissertation makes a contribution to the growing literature on identity formation by formulating, implementing, and testing the effectiveness of a psychosocial intervention, the Making Life Choices (MLC) Workshops, designed to facilitate the process of identity formation. More specifically, the MLC Workshops were designed to foster the development and use of critical cognitive and communicative skills and competencies in choosing and fulfilling life goals and values. The MLC Workshops consist of a psychosocial group intervention that includes both didactic and group experiential exercises. The primary research question for this study concerned the effectiveness of the MLC Workshop relative to a control condition. Effectiveness was evaluated on two levels: skills development and reduction of distress. First, the effectiveness of MLC in fostering the development of critical competencies was evaluated relative to a control condition, and no statistically significant differences were found. Second, the effectiveness of MLC in decreasing life distress was also evaluated relative to the control condition. While participants in the MLC workshop had no significant decrease in distress, they did have statistically significant improvement in life satisfaction in the Personal Domain.

The effect of instruction on the study behaviors and academic achievement of community college students

The purpose of this study was twofold. It was designed to determine (a) the efficacy of an intervention designed to increase the frequencies of appropriate study behaviors on the part of community college students who were preparing for academic mathematics activities and (b) whether any increase in appropriate study behavior frequency was accompanied by increased academic achievement in college preparatory mathematics classes. A total of 126 Miami Dade College students participated in this study. Two developmental (remedial) mathematics classes were randomly assigned as the experimental group, and two others were assigned as the control group. All students also took a College Survival (SLS) class. The Study Behavior Inventory (SBI) and the Computerized Placement Test (CPT) were administered to the four classes. The SBI was used as a pre- and post-test. The SLS curriculum and classroom time were the same for both groups. However, students in the treatment groups received instruction designed to increase the frequency of effective study behaviors associated with the three factors identified in the SBI, while the students in the control group participated in activities that did not emphasize study behaviors. A series of analysis of covariance procedures were used to analyze four hypotheses. The first three hypotheses proposed that students who were instructed in the use of appropriate study behaviors would score higher on the three factors of the Study Behavior Inventory than those who were not. The fourth hypothesis proposed that a greater proportion of mathematics students who were instructed in the use of appropriate study behaviors would receive a passing grade in their course than students who were in the control group. The four hypotheses were tested at the .05 level of significance. This study revealed that students who received instruction in appropriate study behaviors scored higher in the use of appropriate study behaviors and in mathematics achievement than students who did not. Additional research is needed to investigate whether these effects would persist over time, or be found in subjects other than mathematics.

Food customs of rural and urban Inupiaq elders and their relationships to select nutrition parameters, food insecurity, health, and physical and mental functioning

The Inupiaq Tribe resides north of the Arctic Circle in northwestern Alaska. The people are characterized by their continued dependence on harvested fish, game and plants, known as a subsistence lifestyle (Lee 2000:35-45). Many are suggesting that they leave their historical home and move to urban communities, places believed to be more comfortable as they age. Tribal Elders disagree and have stated, "Elders need to be near the river where they were raised" (Branch 2005:1). The research questions focused on differences that location had on four groups of variables: nutrition parameters, community support, physical functioning and health. A total of 101 Inupiaq Elders ≥ 50 years were surveyed: 52 from two rural villages, and 49 in Anchorage. Location did not influence energy intake or intake of protein; levels of nutrition risk and food insecurity; all had similar rates between the two groups. Both rural and urban Elders reported few limitations of ADLs and IADLs. Self-reported general health scores (SF-12.v2 GH) were also similar by location. Differences were found with rural Elders reporting higher physical functioning summary scores (SF-12.v2 PCS), higher mental health scores (SF-12.v2 MH), higher vitality and less pain even though the rural mean ages were five years older than the urban Elders. Traditional food customs appear to support the overall health and well being of the rural Inupiaq Elders as demonstrated by higher intakes of Native foods, stronger food sharing networks and higher family activity scores than did urban Elders. The rural community appeared to foster continued physical activity. It has been said that when Elders are in the rural setting they are near "people they know" and it is a place "where they can get their Native food" (NRC 2005). These factors appear to be important as Inupiaq Elders age, as rural Inupiaq Elders fared as well or better than Inupiaq Elders in terms of diet, mental and physical health.

Thermal imaging as a biometrics approach to facial signature authentication

This dissertation develops an image processing framework with unique feature extraction and similarity measurements for human face recognition in the thermal mid-wave infrared portion of the electromagnetic spectrum. The goals of this research is to design specialized algorithms that would extract facial vasculature information, create a thermal facial signature and identify the individual. The objective is to use such findings in support of a biometrics system for human identification with a high degree of accuracy and a high degree of reliability. This last assertion is due to the minimal to no risk for potential alteration of the intrinsic physiological characteristics seen through thermal infrared imaging. The proposed thermal facial signature recognition is fully integrated and consolidates the main and critical steps of feature extraction, registration, matching through similarity measures, and validation through testing our algorithm on a database, referred to as C-X1, provided by the Computer Vision Research Laboratory at the University of Notre Dame. Feature extraction was accomplished by first registering the infrared images to a reference image using the functional MRI of the Brain’s (FMRIB’s) Linear Image Registration Tool (FLIRT) modified to suit thermal infrared images. This was followed by segmentation of the facial region using an advanced localized contouring algorithm applied on anisotropically diffused thermal images. Thermal feature extraction from facial images was attained by performing morphological operations such as opening and top-hat segmentation to yield thermal signatures for each subject. Four thermal images taken over a period of six months were used to generate thermal signatures and a thermal template for each subject, the thermal template contains only the most prevalent and consistent features. Finally a similarity measure technique was used to match signatures to templates and the Principal Component Analysis (PCA) was used to validate the results of the matching process. Thirteen subjects were used for testing the developed technique on an in-house thermal imaging system. The matching using an Euclidean-based similarity measure showed 88% accuracy in the case of skeletonized signatures and templates, we obtained 90% accuracy for anisotropically diffused signatures and templates. We also employed the Manhattan-based similarity measure and obtained an accuracy of 90.39% for skeletonized and diffused templates and signatures. It was found that an average 18.9% improvement in the similarity measure was obtained when using diffused templates. The Euclidean- and Manhattan-based similarity measure was also applied to skeletonized signatures and templates of 25 subjects in the C-X1 database. The highly accurate results obtained in the matching process along with the generalized design process clearly demonstrate the ability of the thermal infrared system to be used on other thermal imaging based systems and related databases. A novel user-initialization registration of thermal facial images has been successfully implemented. Furthermore, the novel approach at developing a thermal signature template using four images taken at various times ensured that unforeseen changes in the vasculature did not affect the biometric matching process as it relied on consistent thermal features.

The effects of goal setting and attributional feedback on self -efficacy for writing and writing achievement

This study investigated the effectiveness of goal setting and attributional feedback on self-efficacy for writing and writing achievement of students who are gifted underachievers. Students in grades 3, 4 and 5 participated. Five dependent measures were investigated: fluency, syntax, range, diversity and organization. The results indicated that a systematic writing instruction program increased self-efficacy for writing. In addition the self-efficacy strategies of goal setting and attributional feedback improve self-efficacy and increased some areas of writing achievement. The dependent measures most affected were fluency, syntax and organization. The students in this study did not improve their levels of vocabulary. This study included many practical applications for teachers to use in a classroom setting. ^

The effect of dual -language instruction on academic achievement as measured by the SAT: An evaluation of the "International Studies Program" of Miami -Dade County Public Schools

This study investigated the influence that receiving instruction in two languages, English and Spanish, had on the performance of students enrolled in the International Studies Program (delayed partial immersion model) of Miami Dade County Public Schools on a standardized test in English, the Stanford Achievement Test, eighth edition, for three of its sections, Reading Comprehension, Mathematics Computations, and Mathematics Applications.^ The performance of the selected IS program/Spanish section cohort of students (N = 55) on the SAT Reading Comprehension, Mathematics Computation, and Mathematics Application along four consecutive years was contrasted with that of a control group of comparable students selected within the same feeder pattern where the IS program is implemented (N = 21). The performance of the group was also compared to the cross-sectional achievement patterns of the school's corresponding feeder pattern, region, and district.^ The research model for the study was a variation of the "causal-comparative" or "ex post facto design" sometimes referred to as "prospective". After data were collected from MDCPS, t-tests were performed to compare IS-Spanish students SAT performance for grades 3 to 6 for years 1994 to 1997 to control group, feeder pattern, region and district norms for each year for Reading Comprehension, Mathematics Computation, and Mathematics Applications. Repeated measures ANOVA and Tukey's tests were calculated to compare the mean percentiles of the groups under study and the possible interactions of the different variables. All tests were performed at the 5% significance level.^ From the analyses of the tests it was deduced that the IS group performed significantly better than the control group for all the three measures along the four years. The IS group mean percentiles on the three measures were also significantly higher than those of the feeder pattern, region, and district. The null hypotheses were rejected and it was concluded that receiving instruction in two languages did not negatively affect the performance of IS program students on tests taken in English. It was also concluded that the particular design the IS program enhances the general performance of participant students on Standardized tests.^ The quantitative analyses were coupled with interviews from teachers and administrators of the IS program to gain additional insight about different aspects of the implementation of the program at each particular school. ^

Curricular perceptions of adult education at National Chun -Chin University, Chia -Yi, Taiwan

This research was conducted in Chia-Yi, Taiwan to study the needs of adult education participants to determine the factors necessary to provide direction for the development of university adult education curriculum and supportive government educational policies. Factors researched were characteristics of the adult learner, theories of adult learning, demands of adult education, and implications of university adult education as the theoretical foundation for the development of specific curriculum development efforts. The study investigated adult learning needs and their relationship with demographic variable. Analyzing the needs of adult education participant and the relative factors through a survey resulted in recommendations for the development of adult education program plans, content of curriculum, and teaching. Research questions were analyzed using descriptive statistics, frequencies, chi square, one-way analysis of variance (ANOVA), and post hoc analysis. ^ The study showed that most participants in these adult education activities were under forty, middle class, of above average educational levels, and either living or working in the city. People who were older, of lesser social and economic positions, with lower educational standards, and living/working in the country, did not participate as much in adult education opportunities. Recommendations included that in the planning or setting up of adult education activities, attention be given to all the possible barriers or problems that are likely to occur in people's participation, e.g., motivation, interests, content of courses, teaching methods, willingness of participation, qualification of teachers, time, funds, locations, and so on. It is suggested that the resolution of these problems can significantly increase the participation of adult education. ^

Bayesian Estimation of Small Proportions Using Binomial Group Test

Group testing has long been considered as a safe and sensible relative to one-at-a-time testing in applications where the prevalence rate p is small. In this thesis, we applied Bayes approach to estimate p using Beta-type prior distribution. First, we showed two Bayes estimators of p from prior on p derived from two different loss functions. Second, we presented two more Bayes estimators of p from prior on π according to two loss functions. We also displayed credible and HPD interval for p. In addition, we did intensive numerical studies. All results showed that the Bayes estimator was preferred over the usual maximum likelihood estimator (MLE) for small p. We also presented the optimal β for different p, m, and k.