9 resultados para Policy, planning and management in health

em Digital Commons at Florida International University


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This is an empirical study whose purpose was to examine the process of innovation adoption as an adaptive response by a public organization and its subunits existing under varying degrees of environmental uncertainty. Meshing organization innovation research and contingency theory to form a theoretical framework, an exploratory case study design was undertaken in a large, metropolitan government located in an area with the fourth highest prevalence rate of HIV/AIDS in the country. A number of environmental and organizational factors were examined for their influence upon decision making in the adoption/non-adoption as well as implementation of any number of AIDS-related policies, practices, and programs.^ The major findings of the study are as follows. For the county government itself (macro level), no AIDS-specific workplace policies have been adopted. AIDS activities (AIDS education, AIDS Task Force, AIDS Coordinator, etc.), adopted county-wide early in the epidemic, have all been abandoned. Worker infection rates, in the aggregate and throughout the epidemic have been small. As a result, absent co-worker conflict (isolated and negligible), no increase in employee health care costs, no litigation regarding discrimination, and no major impact on workforce productivity, AIDS has basically become a non-issue at the strategic core of the organization. At the departmental level, policy adoption decisions varied widely. Here the predominant issue is occupational risk, i.e., both objective as well as perceived. As expected, more AIDS-related activities (policies, practices, and programs) were found in departments with workers known to have significant risk for exposure to the AIDS virus (fire rescue, medical examiner, police, etc.). AIDS specific policies, in the form of OSHA's Bloodborn Pathogen Standard, took place primarily because they were legislatively mandated. Union participation varied widely, although not necessarily based upon worker risk. In several departments, the union was a primary factor bringing about adoption decisions. Additional factors were identified and included organizational presence of AIDS expertise, availability of slack resources, and the existence of a policy champion. Other variables, such as subunit size, centralization of decision making, and formalization were not consistent factors explaining adoption decisions. ^

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Modern civilization has developed principally through man's harnessing of forces. For centuries man had to rely on wind, water and animal force as principal sources of power. The advent of the industrial revolution, electrification and the development of new technologies led to the application of wood, coal, gas, petroleum, and uranium to fuel new industries, produce goods and means of transportation, and generate the electrical energy which has become such an integral part of our lives. The geometric growth in energy consumption, coupled with the world's unrestricted growth in population, has caused a disproportionate use of these limited natural resources. The resulting energy predicament could have serious consequences within the next half century unless we commit ourselves to the philosophy of effective energy conservation and management. National legislation, along with the initiative of private industry and growing interest in the private sector has played a major role in stimulating the adoption of energy-conserving laws, technologies, measures, and practices. It is a matter of serious concern in the United States, where ninety-five percent of the commercial and industrial facilities which will be standing in the year 2000 - many in need of retrofit - are currently in place. To conserve energy, it is crucial to first understand how a facility consumes energy, how its users' needs are met, and how all internal and external elements interrelate. To this purpose, the major thrust of this report will be to emphasize the need to develop an energy conservation plan that incorporates energy auditing and surveying techniques. Numerous energy-saving measures and practices will be presented ranging from simple no-cost opportunities to capital intensive investments.

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The purpose of the study was to investigate the physiological and psychological benefits provided by a self-selected health and wellness course on a racially and ethnically diverse student population. It was designed to determine if students from a 2-year Hispanic serving institution (HIS) from a large metropolitan area would enhance their capacity to perform physical activities, increase their knowledge of health topics and raise their exercise self-efficacy after completing a course that included educational and activity components for a period of 16 weeks. A total of 185 students voluntarily agreed to participate in the study. An experimental group was selected from six sections of a health and wellness course, and a comparison group from students in a student life skills course. All participants were given anthropometric tests of physical fitness, a knowledge test, and an exercise self-efficacy scale was given at the beginning and at the conclusion of the semester. An ANCOVA analyses with the pretest scores being the covariate and the dependent variable being the difference score, indicated a significant improvement of the experimental group in five of the seven anthropometric tests over the comparison group. In addition, the experimental group increased in two of the three sections of the exercise self-efficacy scale indicating greater confidence to participate in physical activities in spite of barriers over the comparison group. The experimental group also increased in knowledge of health related topics over the comparison group at the .05 significance level. Results indicated beneficial outcomes gained by students enrolled in a 16-week health and wellness course. The study has several implications for practitioners, faculty members, educational policy makers and researchers in terms of implementation of strategies to promote healthy behaviors in college students and, to encourage them to engage in regular physical activities throughout their college years.

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A suite of seagrass indicator metrics is developed to evaluate four essential measures of seagrass community status for Florida Bay. The measures are based on several years of monitoring data using the Braun-Blanquet Cover Abundance (BBCA) scale to derive information about seagrass spatial extent, abundance, species diversity and presence of target species. As ecosystem restoration proceeds in south Florida, additional freshwater will be discharged to Florida Bay as a means to restore the bay's hydrology and salinity regime. Primary hypotheses about restoring ecological function of the keystone seagrass community are based on the premise that hydrologic restoration will increase environmental variability and reduce hypersalinity. This will create greater niche space and permit multiple seagrass species to co-exist while maintaining good environmental conditions for Thalassia testudinum, the dominant climax seagrass species. Greater species diversity is considered beneficial to habitat for desired higher trophic level species such as forage fish and shrimp. It is also important to maintenance of a viable seagrass community that will avoid die-off events observed in the past. Indicator metrics are assigned values at the basin spatial scale and are aggregated to five larger zones. Three index metrics are derived by combining the four indicators through logic gates at the zone spatial scale and aggregated to derive a single bay-wide system status score standardized on the System-wide Indicator protocol. The indicators will provide a way to assess progress toward restoration goals or reveal areas of concern. Reporting for each indicator, index and overall system status score is presented in a red–yellow–green format that summarizes information in a readily accessible form for mangers, policy-makers and stakeholders in planning and implementing an adaptive management strategy.

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Men, particularly minorities, have higher rates of diabetes as compared with their counterparts. Ongoing diabetes self-management education and support by specialists are essential components to prevent the risk of complications such as kidney disease, cardiovascular diseases, and neurological impairments. Diabetes self-management behaviors, in particular, as diet and physical activity, have been associated with glycemic control in the literature. Recommended medical care for diabetes may differ by race/ethnicity. This study examined data from the National Health and Nutrition Examination Surveys, 2007 to 2010 for men with diabetes (N = 646) from four racial/ethnic groups: Mexican Americans, other Hispanics, non-Hispanic Blacks, and non-Hispanic Whites. Men with adequate dietary fiber intake had higher odds of glycemic control (odds ratio = 4.31, confidence interval [1.82, 10.20]), independent of race/ethnicity. There were racial/ethnic differences in reporting seeing a diabetes specialist. Non-Hispanic Blacks had the highest odds of reporting ever seeing a diabetes specialist (84.9%) followed by White non-Hispanics (74.7%), whereas Hispanics reported the lowest proportions (55.2% Mexican Americans and 62.1% other Hispanics). Men seeing a diabetes specialist had the lowest odds of glycemic control (odds ratio = 0.54, confidence interval [0.30, 0.96]). The results of this study suggest that diabetes education counseling may be selectively given to patients who are not in glycemic control. These findings indicate the need for examining referral systems and quality of diabetes care. Future studies should assess the effectiveness of patient-centered medical care provided by a diabetes specialist with consideration of sociodemographics, in particular, race/ethnicity and gender.

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A wireless mesh network is a mesh network implemented over a wireless network system such as wireless LANs. Wireless Mesh Networks(WMNs) are promising for numerous applications such as broadband home networking, enterprise networking, transportation systems, health and medical systems, security surveillance systems, etc. Therefore, it has received considerable attention from both industrial and academic researchers. This dissertation explores schemes for resource management and optimization in WMNs by means of network routing and network coding.^ In this dissertation, we propose three optimization schemes. (1) First, a triple-tier optimization scheme is proposed for load balancing objective. The first tier mechanism achieves long-term routing optimization, and the second tier mechanism, using the optimization results obtained from the first tier mechanism, performs the short-term adaptation to deal with the impact of dynamic channel conditions. A greedy sub-channel allocation algorithm is developed as the third tier optimization scheme to further reduce the congestion level in the network. We conduct thorough theoretical analysis to show the correctness of our design and give the properties of our scheme. (2) Then, a Relay-Aided Network Coding scheme called RANC is proposed to improve the performance gain of network coding by exploiting the physical layer multi-rate capability in WMNs. We conduct rigorous analysis to find the design principles and study the tradeoff in the performance gain of RANC. Based on the analytical results, we provide a practical solution by decomposing the original design problem into two sub-problems, flow partition problem and scheduling problem. (3) Lastly, a joint optimization scheme of the routing in the network layer and network coding-aware scheduling in the MAC layer is introduced. We formulate the network optimization problem and exploit the structure of the problem via dual decomposition. We find that the original problem is composed of two problems, routing problem in the network layer and scheduling problem in the MAC layer. These two sub-problems are coupled through the link capacities. We solve the routing problem by two different adaptive routing algorithms. We then provide a distributed coding-aware scheduling algorithm. According to corresponding experiment results, the proposed schemes can significantly improve network performance.^

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Urban inequality has emerged as one of the dominant themes of modern life and globalization. More than three million people experienced homelessness in the United States last year; in Miami-Dade, more than 15,000 individuals were homeless. Surviving extreme poverty, and exiting or avoiding homelessness, involves negotiating a complex mix of public and private assistance. However, a range of factors influence what types of help are available and how they can be accessed. Frequently, larger social structures determine which resource are available, leaving many choices entirely out of the individual's control. For single men, who are ineligible for many benefits, homelessness can be difficult to avoid and even harder to exit. My study seeks to better understand how adult, minority men living in extreme poverty in Miami-Dade negotiate their daily survival. Specific research questions address: Do black and Hispanic men who are homeless or at risk of homelessness have different personal characteristics and different experiences in avoiding or exiting homelessness? How does Miami's response to extreme poverty/homelessness, including availability of public benefits and public and private service organizations, either maximize or constrain the choices available to this population? And, what is the actual experience of single, adult men who are homeless or at risk of homelessness, in negotiating their daily survival? A mixed methods approach combines quantitative survey data from 7,605 homeless men, with qualitative data from 54 semi-structured interviews incorporating the visual ethnography techniques of Photo Elicitation Interviewing. Results show the differences experienced by black and Hispanic men who are poor and homeless in Miami. Findings also highlight how the community's official and unofficial responses to homelessness intersect with the actual experiences of the persons targeted by the policies and programs, challenging preconceived notions regarding the lives of persons living in extreme poverty. It adds to the existing body of literature by focusing on the urban Miami context, emphasizing disparities amongst racial and ethnic groups. Findings are intended to provide an empirically grounded thesis that humanizes the subjects and illuminates their personal experiences, helping to inform public policy around the needs of extremely poor populations.

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Malaria is a threat to United States military personnel operating in endemic areas, from which there have been hundreds of cases reported over the past decade. Each of these cases might have been avoided with proper adherence to malaria chemoprophylaxis medications. Military operations may detract from the strict 100% adherence required of these preventive medications. However, the reasons for non-adherence in military populations are not well understood. This behavior was investigated using a cross sectional study design on a convenience sample of U.S. Army Ranger volunteers (n=150) located at three military instillations. Theoretical support was based on components of the Health Belief Model, the Theory of Reasoned Action/Theory of Planned Behavior, and the Social Cognitive Theory. ^ Data on knowledge, attitudes, and practices, as well as multiple environmental domains was collected using an original yet unvalidated questionnaire. The data was analyzed using bivariate Pearson correlations, binary logistic regression, and moderated logistic regressions employing a 0.05 criterion of statistical significance. Power analyses predicted 96-98% power for this analysis. ^ Multiple significant medium strength Pearson correlation coefficients were identified relative to the two dependent variables Take medications as directed and Intend to take the medications as directed the next time. Binary logistic regression analyses identified multiple variables that may predict behavioral intentions to adhere to these preventive medications, as a proxy for behavioral change. Moderated logistic regression analyses identified Command Support for adherence to these medications as a potential significant moderator that interacts with independent variables within three domains of the survey questionnaire. ^ The findings indicate that there may be potential significant beneficial effects, which may improve this behavior in this population of Rangers through 1) promoting affirmative interpersonal communications that emphasize adherence to these medications, 2) including malaria chemoprophylaxis medications in the mission planning process, and 3) military command support, in the form of including the importance of proper adherence to these medications in the unit safety briefings.^

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Marine Areas for Responsible Artisanal Fishing (AMPR) have emerged as a new model for co-managing small-scale fisheries in Costa Rica, one that involves collaboration between fishers, government agencies and NGOs. This thesis aims to examine the context for collective action and co-management by small-scale fishers; evaluate the design, implementation, and enforcement of AMPRs; and conduct a linguistic analysis of fisheries legislation. The present work relies on the analysis of several types of qualitative data, including interviews with 23 key informants, rapid rural assessments, and legal documents. Findings demonstrate the strong influence of economic factors for sustaining collective action, as well as the importance of certain types of external organizations for community development and co-management. Additionally, significant enforcement gaps and institutional deficiencies were identified in the work of regulating agencies. Legal analysis suggests that mechanisms for government accountability are unavailable and that legal discourse reflects some of the most salient problems in management.