Health care utilization behavior of elders in a multicultural urban environment

The objective of this research is to determine the influences of social, environmental, behavioral, and economic forces on the health care service utilization of four racial/ethnic groups of non-institutionalized elders in a multicultural urban environment. To address these issues this dissertation examines three intertwined themes of culture, aging, and health, using a sample of elders residing in Miami-Dade County, FL in four racial/ethnic groups: white non-Hispanic; black non-Hispanic English speakers; Cuban; and non-Cuban Hispanic. ^ The research questions were analyzed using both quantitative and qualitative data. Data for the quantitative component uses telephone survey data from the Dade County Needs Assessment. The purpose of this component is to develop a more comprehensive model of elder health care utilization behavior. The qualitative component uses data from focus groups from Dade County Needs Assessment, archival data and a literature review of previous ethnographic research. The purpose of this component is to gain a better understanding of the social construction of the terms “age”' and “aging,” as well as to place issues of health and health care in the lives of elders. ^ The findings raised several important issues. First, just because people share a common chronological age does not mean that they are the same in every other respect. Examining elders as a homogeneous group of users of formal health care services in a community is simplistic. Placing “aging” and “health” in a cultural context is important. My findings confirm that the meaning of “aging” and “old” are socially constructed. Further, the term “aging” is NOT synonymous with ill health or frailty. This was a consistent finding in both the quantitative and qualitative results. ^ While all aging individuals share a mutual orientation toward aging (i.e., biological process), they do not age the same way (i.e., social construction of “aging”). Thus, policymakers and others serving the elder population must be aware of the particular cultural context, as well as the previous life experiences of the individuals that they serve. This analysis documents the importance of culture and geographic community in understanding health care service utilization of elders. ^

The order selection and lot sizing problem in the make-to-order environment

This research is motivated by the need for considering lot sizing while accepting customer orders in a make-to-order (MTO) environment, in which each customer order must be delivered by its due date. Job shop is the typical operation model used in an MTO operation, where the production planner must make three concurrent decisions; they are order selection, lot size, and job schedule. These decisions are usually treated separately in the literature and are mostly led to heuristic solutions. The first phase of the study is focused on a formal definition of the problem. Mathematical programming techniques are applied to modeling this problem in terms of its objective, decision variables, and constraints. A commercial solver, CPLEX is applied to solve the resulting mixed-integer linear programming model with small instances to validate the mathematical formulation. The computational result shows it is not practical for solving problems of industrial size, using a commercial solver. The second phase of this study is focused on development of an effective solution approach to this problem of large scale. The proposed solution approach is an iterative process involving three sequential decision steps of order selection, lot sizing, and lot scheduling. A range of simple sequencing rules are identified for each of the three subproblems. Using computer simulation as the tool, an experiment is designed to evaluate their performance against a set of system parameters. For order selection, the proposed weighted most profit rule performs the best. The shifting bottleneck and the earliest operation finish time both are the best scheduling rules. For lot sizing, the proposed minimum cost increase heuristic, based on the Dixon-Silver method performs the best, when the demand-to-capacity ratio at the bottleneck machine is high. The proposed minimum cost heuristic, based on the Wagner-Whitin algorithm is the best lot-sizing heuristic for shops of a low demand-to-capacity ratio. The proposed heuristic is applied to an industrial case to further evaluate its performance. The result shows it can improve an average of total profit by 16.62%. This research contributes to the production planning research community with a complete mathematical definition of the problem and an effective solution approach to solving the problem of industry scale.

The Food Service Industry Environment: Market Volatility Analysis

In their dialogue entitled - The Food Service Industry Environment: Market Volatility Analysis - by Alex F. De Noble, Assistant Professor of Management, San Diego State University and Michael D. Olsen, Associate Professor and Director, Division of Hotel, Restaurant & Institutional Management at Virginia Polytechnic Institute and State University, De Noble and Olson preface the discussion by saying: “Hospitality executives, as a whole, do not believe they exist in a volatile environment and spend little time or effort in assessing how current and future activity in the environment will affect their success or failure. The authors highlight potential differences that may exist between executives' perceptions and objective indicators of environmental volatility within the hospitality industry and suggest that executives change these perceptions by incorporating the assumption of a much more dynamic environment into their future strategic planning efforts. Objective, empirical evidence of the dynamic nature of the hospitality environment is presented and compared to several studies pertaining to environmental perceptions of the industry.” That weighty thesis statement presumes that hospitality executives/managers do not fully comprehend the environment in which they operate. The authors provide a contrast, which conventional wisdom would seem to support and satisfy. “Broadly speaking, the operating environment of an organization is represented by its task domain,” say the authors. “This task domain consists of such elements as a firm's customers, suppliers, competitors, and regulatory groups.” These are dynamic actors and the underpinnings of change, say the authors by way of citation. “The most difficult aspect for management in this regard tends to be the development of a proper definition of the environment of their particular firm. Being able to precisely define who the customers, competitors, suppliers, and regulatory groups are within the environment of the firm is no easy task, yet is imperative if proper planning is to occur,” De Noble and Olson further contribute to support their thesis statement. The article is bloated, and that’s not necessarily a bad thing, with tables both survey and empirically driven, to illustrate market volatility. One such table is the Bates and Eldredge outline; Table-6 in the article. “This comprehensive outline…should prove to be useful to most executives in expanding their perception of the environment of their firm,” say De Noble and Olson. “It is, however, only a suggested outline,” they advise. “…risk should be incorporated into every investment decision, especially in a volatile environment,” say the authors. De Noble and Olson close with an intriguing formula to gauge volatility in an environment.

Cultural perceptions of space and place in the South Florida *environment

Public opinion polls in the United States reveal that a great majority of Americans are aware and show concern about ecological issues and the need to preserve natural areas. In South Florida, natural resources have been subjected to enormous strain as the pressure to accommodate a growing population has led to rapid development. Suburbs have been built on areas that were once natural wetlands and farmlands, and the impact today shows a landscape where natural places have all but disappeared. This dissertation examines the intersection between the perceptions that individuals living in the South Florida region have with respect to the natural environment and local ecological problems with where their relationship to nature takes place. ^ The research is based upon both quantitative and qualitative data. The principal methodology used in this research is the ethnographic method, which employed the data gathering techniques of in-depth interviewing and participant observation. The objective of the qualitative portion of the study was to determine how people perceive and relate to their immediate environment. The quantitative portion of the study employed telephone survey data from the FIU/Florida Poll 2000. Data collected through this survey provided the basis to statistically test responses to the research questions. ^ The findings show that people in South Florida have a general idea of the relationship between the human population and the environment but very little knowledge of how they individually affect each other. The experience of private places and public spaces in everyday life permits people to compartmentalize cultural values and understandings of the natural world in separate cognitive schemas. The appreciation of the natural world has almost no connection to their personal sense of obligation to preserve the environment. That obligation is only felt in their home space even though the South Florida environment overall struggles desperately with water shortages, land encroachment, and a rapidly expanding human population whose activities continuously aggravate an already delicate natural balance. ^

New trends in health architecture for children and the effects of the built environment on young patients

The objective of this thesis was to investigate the effects of the built environment on the outcome of young patients. This investigation included recent innovations in children's hospitals that integrated both medical and architectural case studies as part of their design issues. In addition, the intervention responded to man-made conditions and natural elements of the site. The thesis project, a Children's Rehabilitation Hospital, is located at 1500 N.W. River Drive in Miami, Florida. The thesis intervention emerged from a site analysis that focused on the shifting of the urban grid, the variation in scale of the immediate context and the visual-physical connection to the river's edge. Furthermore, it addressed the issues of overnight accommodation for patient's families, as well as sound control through the use of specific materials in space enclosures and open courtyards. The key to the success of this intervention lies in the special attention given to the integration between nature and the built environment. Issues such as the incorporation of nature within a building through the use of vistas and the exploitation of natural light through windows and skylights, were pivotal in the creation of a pleasant environment for visitors, employees and young patients.