Coping with a diagnosis of Alzheimer's disease: A client and caregiver perspective

The purpose of this study was to examine how individuals and their caregivers cope with a diagnosis of Alzheimer's disease. The sample size consisted of six patients with Alzheimer's disease and seven caregivers. The caregivers included spouses and adult children. The study was conducted at an academic medical center in the South Florida area. Using a phenomenological approach, data were collected by audiotaped interviews. Data were analyzed following the seven steps of Colaizzi (1978).^ The results of the study indicated that clients experienced fear, social withdrawal, decreased self-esteem and a need for love and support. Caregivers experienced psychological strain, burden, lifestyle adjustments and sacrifice. Both clients and caregivers identified numerous strategies for coping with Alzheimer's disease. The findings reflect the need for a holistic approach to promoting the quality of life for patients and caregivers. ^

Pilot study: Intranet communication among chronically ill hospitalized pediatric individuals

Hospitalization can be a very stressful experience, especially for children. With the use of technology, Intranet communication can be successful in obtaining interaction that these individuals lack to accomplish a positive adjustment to the hospital setting. The purpose of this exploratory, pilot project is to examine the use of networking chronically ill, hospitalized children with other hospitalized chronically ill children through Intranet communication.^ A target population of chronically ill hospitalized children, in at least Piaget's concrete operational stage, was asked to use the Intranet system to network with other chronically ill hospitalized children during their hospital stay, for one month or until discharge. The length of time of usage was recorded on a log sheet, and questionnaires were filled out at the end of the study.^ Statistical analysis was utilized to determine frequency of network usage, duration, demographics, and the impact on hospitalization. Results indicated that Intranet communication between chronically ill hospitalized children was utilized by the participants from 7-15 age groups; and had a positive impact on their hospitalization. ^

Algorithms for efficient transaction management and consistent queries in client -server semantic object-oriented parallel databases

Large read-only or read-write transactions with a large read set and a small write set constitute an important class of transactions used in such applications as data mining, data warehousing, statistical applications, and report generators. Such transactions are best supported with optimistic concurrency, because locking of large amounts of data for extended periods of time is not an acceptable solution. The abort rate in regular optimistic concurrency algorithms increases exponentially with the size of the transaction. The algorithm proposed in this dissertation solves this problem by using a new transaction scheduling technique that allows a large transaction to commit safely with significantly greater probability that can exceed several orders of magnitude versus regular optimistic concurrency algorithms. A performance simulation study and a formal proof of serializability and external consistency of the proposed algorithm are also presented.^ This dissertation also proposes a new query optimization technique (lazy queries). Lazy Queries is an adaptive query execution scheme which optimizes itself as the query runs. Lazy queries can be used to find an intersection of sub-queries in a very efficient way, which does not require full execution of large sub-queries nor does it require any statistical knowledge about the data.^ An efficient optimistic concurrency control algorithm used in a massively parallel B-tree with variable-length keys is introduced. B-trees with variable-length keys can be effectively used in a variety of database types. In particular, we show how such a B-tree was used in our implementation of a semantic object-oriented DBMS. The concurrency control algorithm uses semantically safe optimistic virtual "locks" that achieve very fine granularity in conflict detection. This algorithm ensures serializability and external consistency by using logical clocks and backward validation of transactional queries. A formal proof of correctness of the proposed algorithm is also presented. ^

Predictors of client retention in alternative -to -prison substance abuse programs

Increased treatment retention among substance abusing individuals has been associated with reduced drug use, fewer arrests, and decreased unemployment, as well as a reduction in health risk behaviors. This longitudinal study examined the predictors of client retention for alternative to prison substance abuse treatment programs through assessing the roles of motivational factors and the client-worker relationship. The sample was comprised of 141 male felony offenders who were legally mandated to community based long-term residential drug treatment programs. ^ The primary measures used in the study were the consecutive days a participant remained in treatment, Stages of Change Readiness Model and Treatment Eagerness Scale (SOCRATES), the Working Alliance Inventory (WAI), and The Readiness Ruler. Hierarchical multiple regression analysis was conducted for four hypotheses (a) participants who are more motivated to change at the time of entry will remain in treatment longer, (b) participants who have a strong therapeutic alliance will remain in treatment a greater number of consecutive days than participants who have weaker therapeutic alliance, (c) motivation to change, as measured at treatment entry, will be positively related to therapeutic alliance, (d) during the course of treatment variation in motivation to change will be predicted by the therapeutic alliance. ^ Results support the following conclusions: Among clients in alternative-to prison programs the number of days in treatment is positively related to their motivation to change. The therapeutic alliance is not a predictor of the number of days in treatment. Motivation to change, particularly recognition of a drug problem, is positively related to the therapeutic alliance. Changes in motivation to change in response to treatment are positively related to the therapeutic alliance among clients in an alternative to prison substance abuse treatment programs. These results carry forward prior research and have implications for social work practice, research, and social welfare policy. ^

Personal autonomy in discharge planning decision -making in mentally alert hospitalized elderly individuals: The social workers' perspective

This study was conducted to understand (a) hospital social workers' perspectives about patients' personal autonomy and self-determination, (b) their experiences, and (c) their beliefs and behaviors. The study used the maximum variation sampling strategy to select hospitals and hospital social work respondents. Individual interviews were conducted with 31 medical/surgical and mental health hospital social workers who worked in 13 hospitals. The data suggest the following four points. First, the hospital setting as an outside influence as it relates to illness and safety, and its four categories, mentally alert patients, family members, health care professionals, and social work respondents, seems to enhance or diminish patients' autonomy in discharge planning decision making. Second, respondents report they believe patients must be safe both inside and outside the hospital. In theory, respondents support autonomy and self-determination, respect patients' wishes, and believe patients are the decision makers. However, in practice, respondents respect autonomy and self-determination to a point. Third, a model, The Patient's Decision in Discharge Planning: A Continuum, is presented where a safe discharge plan is at one end of a continuum, while an unsafe discharge plan is at the other end. Respondents respect personal autonomy and the patient's self-determination to a point. This point is likely to be located in a gray area where the patient's decision crosses from one end of the continuum to the other. When patients decide on an unsafe discharge plan, workers' interventions range from autonomy to paternalism. And fourth, the hospital setting as an outside influence may not offer the best opportunity for patients to make decisions (a) because of beliefs family members and health care professionals hold about the value of patient self-determination, and (b) because patients may not feel free to make decisions in an environment where they are surrounded by family members, health care professionals, and social work respondents who have power and who think they know best. Workers need to continue to educate elderly patients about their right to self-determination in the hospital setting. ^

Development of a new client -server architecture for context aware mobile computing

This dissertation studies the context-aware application with its proposed algorithms at client side. The required context-aware infrastructure is discussed in depth to illustrate that such an infrastructure collects the mobile user’s context information, registers service providers, derives mobile user’s current context, distributes user context among context-aware applications, and provides tailored services. The approach proposed tries to strike a balance between the context server and mobile devices. The context acquisition is centralized at the server to ensure the reusability of context information among mobile devices, while context reasoning remains at the application level. Hence, a centralized context acquisition and distributed context reasoning are viewed as a better solution overall. The context-aware search application is designed and implemented at the server side. A new algorithm is proposed to take into consideration the user context profiles. By promoting feedback on the dynamics of the system, any prior user selection is now saved for further analysis such that it may contribute to help the results of a subsequent search. On the basis of these developments at the server side, various solutions are consequently provided at the client side. A proxy software-based component is set up for the purpose of data collection. This research endorses the belief that the proxy at the client side should contain the context reasoning component. Implementation of such a component provides credence to this belief in that the context applications are able to derive the user context profiles. Furthermore, a context cache scheme is implemented to manage the cache on the client device in order to minimize processing requirements and other resources (bandwidth, CPU cycle, power). Java and MySQL platforms are used to implement the proposed architecture and to test scenarios derived from user’s daily activities. To meet the practical demands required of a testing environment without the impositions of a heavy cost for establishing such a comprehensive infrastructure, a software simulation using a free Yahoo search API is provided as a means to evaluate the effectiveness of the design approach in a most realistic way. The integration of Yahoo search engine into the context-aware architecture design proves how context aware application can meet user demands for tailored services and products in and around the user’s environment. The test results show that the overall design is highly effective, providing new features and enriching the mobile user’s experience through a broad scope of potential applications.

Predictors of client retention in alternative to prison substance abuse programs

Increased treatment retention among substance abusing individuals has been associated with reduced drug use, fewer arrests, and decreased unemployment, as well as a reduction in health risk behaviors. This longitudinal study examined the predictors of client retention for alternative to prison substance abuse treatment programs through assessing the roles of motivational factors and the client-worker relationship. The sample was comprised of 141 male felony offenders who were legally mandated to community based long-term residential drug treatment programs. The primary measures used in the study were the consecutive days a participant remained in treatment, Stages of Change Readiness Model and Treatment Eagerness Scale (SOCRATES), the Working Alliance Inventory (WAI), and The Readiness Ruler. Hierarchical multiple regression analysis was conducted for four hypotheses (a) participants who are more motivated to change at the time of entry will remain in treatment longer, (b) participants who have a strong therapeutic alliance will remain in treatment a greater number of consecutive days than participants who have weaker therapeutic alliance, (c) motivation to change, as measured at treatment entry, will be positively related to therapeutic alliance, (d) during the course of treatment variation in motivation to change will be predicted by the therapeutic alliance. Results support the following conclusions: Among clients in alternative-to prison programs the number of days in treatment is positively related to their motivation to change. The therapeutic alliance is not a predictor of the number of days in treatment. Motivation to change, particularly recognition of a drug problem, is positively related to the therapeutic alliance. Changes in motivation to change in response to treatment are positively related to the therapeutic alliance among clients in an alternative to prison substance abuse treatment programs. These results carry forward prior research and have implications for social work practice, research, and social welfare policy.

Development of a New Client-Server Architecture for Context Aware Mobile Computing

This dissertation studies the context-aware application with its proposed algorithms at client side. The required context-aware infrastructure is discussed in depth to illustrate that such an infrastructure collects the mobile user’s context information, registers service providers, derives mobile user’s current context, distributes user context among context-aware applications, and provides tailored services. The approach proposed tries to strike a balance between the context server and mobile devices. The context acquisition is centralized at the server to ensure the usability of context information among mobile devices, while context reasoning remains at the application level. Hence, a centralized context acquisition and distributed context reasoning are viewed as a better solution overall. The context-aware search application is designed and implemented at the server side. A new algorithm is proposed to take into consideration the user context profiles. By promoting feedback on the dynamics of the system, any prior user selection is now saved for further analysis such that it may contribute to help the results of a subsequent search. On the basis of these developments at the server side, various solutions are consequently provided at the client side. A proxy software-based component is set up for the purpose of data collection. This research endorses the belief that the proxy at the client side should contain the context reasoning component. Implementation of such a component provides credence to this belief in that the context applications are able to derive the user context profiles. Furthermore, a context cache scheme is implemented to manage the cache on the client device in order to minimize processing requirements and other resources (bandwidth, CPU cycle, power). Java and MySQL platforms are used to implement the proposed architecture and to test scenarios derived from user’s daily activities. To meet the practical demands required of a testing environment without the impositions of a heavy cost for establishing such a comprehensive infrastructure, a software simulation using a free Yahoo search API is provided as a means to evaluate the effectiveness of the design approach in a most realistic way. The integration of Yahoo search engine into the context-aware architecture design proves how context aware application can meet user demands for tailored services and products in and around the user’s environment. The test results show that the overall design is highly effective,providing new features and enriching the mobile user’s experience through a broad scope of potential applications.