Children with special health care needs: Comparison of the effects of home care setting, prescribed pediatric extended care setting, and long-term care setting on child and family health outcomes and health care service use

Technological advances during the past 30 years have dramatically improved survival rates for children with life-threatening conditions (preterm births, congenital anomalies, disease, or injury) resulting in children with special health care needs (CSHCN), children who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who require health and related services beyond that required by children generally. There are approximately 10.2 million of these children in the United States or one in five households with a child with special health care needs. Care for these children is limited to home care, medical day care (Prescribed Pediatric Extended Care; P-PEC) or a long term care (LTC) facility. There is very limited research examining health outcomes of CSHCN and their families. The purpose of this research was to compare the effects of home care settings, P-PEC settings, and LTC settings on child health and functioning, family health and function, and health care service use of families with CSHCN. Eighty four CSHCN ages 2 to 21 years having a medically fragile or complex medical condition that required continual monitoring were enrolled with their parents/guardians. Interviews were conducted monthly for five months using the PedsQL™ Generic Core Module for child health and functioning, PedsQL™ Family Impact Module for family health and functioning, and Access to Care from the NS-CSHCN survey for health care services. Descriptive statistics, chi square, and ANCOVA were conducted to determine differences across care settings. Children in the P-PEC settings had a highest health care quality of life (HRQL) overall including physical and psychosocial functioning. Parents/guardians with CSHCN in LTC had the highest HRQL including having time and energy for a social life and employment. Parents/guardians with CSHCN in home care settings had the poorest HRQL including physical and psychosocial functioning with cognitive difficulties, difficulties with worry, communication, and daily activities. They had the fewest hours of employment and the most hours providing direct care for their children. Overall health care service use was the same across the care settings.

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. ^

Children with Special Health Care Needs: Comparison of the Effects of Home Care Setting, Prescribed Pediatric Extended Care Setting, and Long-Term Care Setting on Child and Family Health Outcomes and Health Care Service Use

Technological advances during the past 30 years have dramatically improved survival rates for children with life-threatening conditions (preterm births, congenital anomalies, disease, or injury) resulting in children with special health care needs (CSHCN), children who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who require health and related services beyond that required by children generally. There are approximately 10.2 million of these children in the United States or one in five households with a child with special health care needs. Care for these children is limited to home care, medical day care (Prescribed Pediatric Extended Care; P-PEC) or a long term care (LTC) facility. There is very limited research examining health outcomes of CSHCN and their families. The purpose of this research was to compare the effects of home care settings, P-PEC settings, and LTC settings on child health and functioning, family health and function, and health care service use of families with CSHCN. Eighty four CSHCN ages 2 to 21 years having a medically fragile or complex medical condition that required continual monitoring were enrolled with their parents/guardians. Interviews were conducted monthly for five months using the PedsQL TM Generic Core Module for child health and functioning, PedsQL TM Family Impact Module for family health and functioning, and Access to Care from the NS-CSHCN survey for health care services. Descriptive statistics, chi square, and ANCOVA were conducted to determine differences across care settings. Children in the P-PEC settings had a highest health care quality of life (HRQL) overall including physical and psychosocial functioning. Parents/guardians with CSHCN in LTC had the highest HRQL including having time and energy for a social life and employment. Parents/guardians with CSHCN in home care settings had the poorest HRQL including physical and psychosocial functioning with cognitive difficulties, difficulties with worry, communication, and daily activities. They had the fewest hours of employment and the most hours providing direct care for their children. Overall health care service use was the same across the care settings.

The effect of direct instruction in story grammar using deep processing on the reading and writing achievement of second-graders

The purpose of this study was to investigate the effects of direct instruction in story grammar on the reading and writing achievement of second graders. Three aspects of story grammar (character, setting, and plot) were taught with direct instruction using the concept development technique of deep processing. Deep processing which included (a) visualization (the drawing of pictures), (b) verbalization (the writing of sentences), (c) the attachment of physical sensations, and (d) the attachment of emotions to concepts was used to help students make mental connections necessary for recall and application of character, setting, and plot when constructing meaning in reading and writing.^ Four existing classrooms consisting of seventy-seven second-grade students were randomly assigned to two treatments, experimental and comparison. Both groups were pretested and posttested for reading achievement using the Gates-MacGinitie Reading Tests. Pretest and posttest writing samples were collected and evaluated. Writing achievement was measured using (a) a primary trait scoring scale (an adapted version of the Glazer Narrative Composition Scale) and (b) an holistic scoring scale by R. J. Pritchard. ANCOVAs were performed on the posttests adjusted for the pretests to determine whether or not the methods differed. There was no significant improvement in reading after the eleven-day experimental period for either group; nor did the two groups differ. There was significant improvement in writing for the experimental group over the comparison group. Pretreatment and posttreatment interviews were selectively collected to evaluate qualitatively if the students were able to identify and manipulate elements of story grammar and to determine patterns in metacognitive processing. Interviews provided evidence that most students in the experimental group gained while most students in the comparison group did not gain in their ability to manipulate, with understanding, the concepts of character, setting, and plot. ^

The relationship between participation in unethical behaviors during the nursing student experience and participation in unethical behaviors as a registered nurse

The effect of unethical behaviors in health care settings is an important issue in the safe care of clients and has been a concern of the nursing profession for some time. The purpose of this study was to examine the relationship between use of unethical behaviors in the nursing student experience and the use of unethical behaviors in the workplace as a registered nurse. In addition, the relationship between the severity of unethical behaviors utilized in the classroom, clinical setting and those in the workplace was examined. To insure greater honesty in self-report, only a limited number of demographic variables were requested from participants.^ During the summer of 1997, a 56 item questionnaire was distributed to registered nurses enrolled in either undergraduate or graduate courses in a public or private institution. The participants were asked to self-report their own use of unethical behaviors as well as their peers use of unethical behaviors. In order to assign a severity score for each item, nursing school faculty were asked to rate severity of unethical behaviors which could be used during the nursing student experience and nursing administrators were asked to rate unethical behaviors which could be used in the workplace.^ A significant positive relationship was found between individuals' use of unethical behaviors during nursing school and those used in the workplace $r=.630.$ A significant positive relationship was found between the severity of unethical behaviors used in the nursing student experience and the severity of unethical behaviors used in the workplace $r=.637.$ No relationship was found between years of practice, type of initial nursing education and whether or not the participant was raised inside or outside the United States and the use of unethical behaviors. ^

The relationship between self-esteem and job performance

The purpose of this study was to conduct a meta-analysis of the relationship between self-esteem and job performance. Overall, 49 studies were gathered and coded by their sample size, correlation estimate, and the reliability of the two measures being correlated. The data was processed using the interactive meta-analysis program called INTNL, which takes into account interactive effects between the artifacts (i.e., unreliability in the independent and dependent measures as well as sampling error). Analyses of four potential moderators were examined--type of self-esteem, the source of job performance, the type of setting and the type of self-esteem measures. Results indicated that the relationship between self-esteem and job performance is positive. However, there was only a weak support for moderating influences. Procedures to enhance employees' self-esteem are recommended. ^

High-resolution cyclostratigraphy of the Cenomanian-Turonian interval: Paleoceanographic implications, a comparison between deep sea drilling project site 386 and 144

The purpose of this study was to determine the extent to which oceanic anoxic events (OAE's) are recorded in deep-water deposits of the former western Tethyan Sea, by investigating the Cenomanian-Turonian time interval characterized by the worldwide OAE 2 event. The study improved our knowledge of the possible controlling mechanisms that triggered this event at these sites, and furthered our understanding of this global phenomenon. This was examined by high-resolution, multi-proxy analyses of sediments at DSDP Sites 386 and 144, including sedimentology, scanning electron microscopy, stable isotopes, bulk and clay mineralogy, major and trace element geochemistry, biomarkers, and paleontological data. ^ The results provide a better stratigraphic resolution for the Cenomanian-Turonian, which allowed for more precise determination of chronologic boundaries, sedimentation rates at DSDP Site 386, and a more accurate calculation of the frequency of the cycles recorded in the sequence, which fall predominantly within the precession (∼23 kyr) and short eccentricity (∼100 kyr) ranges. The combined proxies allow assessment of the correlation of δ13Corg, and major and trace elements with the predominance of cyanobacteria. These organisms were the main producers of the organic matter during the dysoxic and euxinic conditions of OAE 2 at DSDP Site 386. A huge amount of microcrystalline quartz of eolian origin is also associated with OAE 2. The geochemical proxies further provide evidence that OAE 2 was linked to increased volcanism outside the deep water of the proto-Atlantic Ocean. The clays in the Turonian sediments are terrigenous and derived predominantly from eolian transport. Comparing DSDP Site 386 and 144 with stratotype sections, the δ13C org and TOC data indicate that OAE 2 seems diachronous throughout the proto-Atlantic Ocean. ^ This study concludes that the development of anoxic conditions in the deep water of the Atlantic during the latest Cenomanian-Turonian resulted from a combination of factors related to local oceanic setting and mitigated by global tectonism and climate. The data provide a more comprehensive view of the interacting factors that led to sustained high productivity of the cyanobacteria and photosynthetic protists that produced organic-carbon-rich deposits in the world's oceans. ^

Turkey and neo-Ottomanism: Domestic sources, dynamics and foreign policy

This study examined the relationship between the Turkish Islamic movements and the present government of the Justice and Development Party ( Adalet ve Kalkinma Partisi, AK Party). Since the AK Party came to power in 2002 it implemented unparalleled political reforms and pursued to improve Turkey’s relations with the EU. Opponents argued that because of the dominance of the secular military in Turkish politics, the AK Party is forced to secretly advance its Islamic agenda using the language and symbolism of democracy and human rights. This study argued that the ideas of the AK Party show similarities with the “Ottomanist” thought of the late Ottoman era. With special reference to the preservation of the Ottoman State, Ottomanism in an eclectic way was able to incorporate Islamic principles like freedom, justice and consultation into the political arena which was increasingly dominated by the secular European concepts. Literature on Islam and politics in Turkey, however, disregards the Ottoman roots of freedom and pluralism and tends to reduce the relationship between religion and state into exclusively confrontational struggles. This conceptualization of the political process relies on particular non-Turkish Muslim experiences which do not necessarily represent Islam’s venture in Turkey. Contrary to the prevailing scholarship, Islamic movements in Turkey, namely, Naqshbandi, National View and Nur, which are discussed in detail in this study, are not monolithic. They all uphold the same creedal tenets of Islam but they have sharp differences in terms of how they conceptualize the role of religious agency in politics. I argue that this diversity is a result of three distinct methodologies of Islamic religious life which are the Tariqah (Tarikat ), Shariah (Şeriat), and Haqiqah ( Hakikat). The differences between these three approaches represent a typological hierarchy in the formation of the Muslim/believer as an agent of Islamic identity. Through these different if not conflicting modes, the AK Party reconnected itself with Turkey’s Ottoman heritage in a post-Ottoman, secular setting and was able to develop an eclectic political identity of Neo-Ottomanism that is evident in the flexibility if not inconsistency of its domestic and foreign policy preferences.

An Exploratory Qualitative Study of the Proximal Goal Setting of Two Introductory Modeling Physics Students

A qualitative investigation on the impact of goal-setting strategies on self-efficacy of two students taking Introductory Modeling Physics was conducted. The study found that the problem solving process can be divided into two main themes: goal-setting and self-efficacy. Self-efficacy plays a role in the goal setting process of these two students, and may be linked to the retention of students in physics.

Comparison of two mentoring programs for at -risk Black adolescents: A traditional one -to -one mentoring program and a school -to -work transitional program

The purposes of this study were: (a) to compare the impact of One-to-One (OTO) mentoring interventions administered in the high school setting, and the workplace of the students who participated in the School-to-Work (STW) transitional program, and (b) to identify how the participants perceived their experience in the OTO mentoring program and the STW transitional program. A qualitative approach was used to identify how participants perceived their mentoring experiences with the STW and OTO mentoring programs by utilizing focus groups and content analysis. A quantitative approach was used to compare the statistical differences of outcomes between the STW and OTO mentoring programs, by utilizing descriptive statistics, independent samples t-tests, chi-square analyses, and logistic regression. The sample was limited to participants in the STW and OTO mentoring programs resulting in 21 participants for the qualitative approach and 114 participants for the quantitative approach. ^ Results from the qualitative approach indicated that focus group participants in the STW program were satisfied with the program and the relationship with their mentors. They also suggested that the STW program be lengthened to include the entire academic year. Participants from the OTO focus group were dissatisfied with their program due to inadequate mentor involvement. Results from the quantitative approach showed that the increase in school attendance for the STW program's at-risk Black male youth was statistically significant compared to the OTO program participants; the STW program participants displayed a better outlook for attending college that was statistically significant compared to those in the OTO program; and the OTO program participants displayed a better outlook for permanent employment compared to those in the STW program. ^ Therefore, this study finds that mentoring can contribute to reducing school absences and high school completion in order for at-risk Black adolescents to attend college. It is recommended that the OTO program be restructured to eliminate the disparity that exists regarding the administration of the STW program and the OTO program. ^

Self -management factors, influences, and conditions for type 2 diabetes among Black ethnic groups in Miami, Florida and Abidjan, Cote d'Ivoire

The Dahlgren and Whitehead ecological theory provides the framework for a cross-sectional design to compare socio-demographic characteristics, living and working conditions, and lifestyle daily habits as well as cultural and ecological factors among six diabetic multiethnic Black groups in Miami and Abidjan. Approximately 180 Black Americans (African-, Caribbean-, and Haitian-) and 180 Black Africans (Akan, Malinke, and Krou) aged 20 years and older were surveyed. During the preliminary of this study participants' attitudes and behaviors were qualitatively assessed (N=60) and a tool was developed to describe, in the main study (N=360), differences in participants' strength of commitment to diabetes lifestyle self-management. Despite similarities found in terms of age and gender, statistically significant differences were also found within and among groups in terms of living and working conditions, education level, and religion. African American groups were more likely to participate in more diabetes classes than Haitian Americans and Caribbean Americans. However, African Americans were less likely to adhere to daily dietary and weight control regimens. Although, Black African groups reported limited access to equipment, facilities, and financial support they were more likely to follow dietary and weight control recommendations than Black American groups. Overall, African American participants showed the poorest attitudes towards recommended foods, Caribbean American respondents reported the best attitudes and behaviors towards weight control regimens, and the Malinke group had significantly more strength of commitment to successful weight control. Furthermore, Black African groups had significantly more strength of commitment to successful dietary adherence and significantly less support for weight control than Black American groups. ^ Significant differences found within Black groups suggest that understanding each patient's conditions may help healthcare professionals in initiating individualized appropriate counseling before goal setting, and in developing culturally relevant type 2 diabetes management programs. Moreover, significant differences exist in strength of commitment to lifestyle adherence among Black groups in Miami and Abidjan. Cultural, socio-demographic factors and self-management habits may explain differences in participants' outcomes. At the policy level, Black groups should not be approached as a homogenous group and assessment of the vulnerability of each ethnic group may be necessary in the decision-making process.^

Political strategy, leadership, and policy entrepreneurship in Japanese defense policy and politics: A comparison of three prime ministerships

Since the end of the Cold War, Japan's defense policy and politics has gone through significant changes. Throughout the post cold war period, US-Japan alliance managers, politicians with differing visions and preferences, scholars, think tanks, and the actions of foreign governments have all played significant roles in influencing these changes. Along with these actors, the Japanese prime minister has played an important, if sometimes subtle, role in the realm of defense policy and politics. Japanese prime ministers, though significantly weaker than many heads of state, nevertheless play an important role in policy by empowering different actors (bureaucratic actors, independent commissions, or civil actors), through personal diplomacy, through agenda-setting, and through symbolic acts of state. The power of the prime minister to influence policy processes, however, has frequently varied by prime minister. My dissertation investigates how different political strategies and entrepreneurial insights by the prime minister have influenced defense policy and politics since the end of the Cold War. In addition, it seeks to explain how the quality of political strategy and entrepreneurial insight employed by different prime ministers was important in the success of different approaches to defense. My dissertation employs a comparative case study approach to examine how different prime ministerial strategies have mattered in the realm of Japanese defense policy and politics. Three prime ministers have been chosen: Prime Minister Hashimoto Ryutaro (1996-1998); Prime Minister Koizumi Junichiro (2001-2006); and Prime Minister Hatoyama Yukio (2009-2010). These prime ministers have been chosen to provide maximum contrast on issues of policy preference, cabinet management, choice of partners, and overall strategy. As my dissertation finds, the quality of political strategy has been an important aspect of Japan's defense transformation. Successful strategies have frequently used the knowledge and accumulated personal networks of bureaucrats, supplemented bureaucratic initiatives with top-down personal diplomacy, and used a revitalized US-Japan strategic relationship as a political resource for a stronger prime ministership. Though alternative approaches, such as those that have looked to displace the influence of bureaucrats and the US in defense policy, have been less successful, this dissertation also finds theoretical evidence that alternatives may exist.

A novel method for rapid and selective extraction of male DNA from rape kits using alkaline lysis and pressure cycling technology (PCT)

There is an increasing demand for DNA analysis because of the sensitivity of the method and the ability to uniquely identify and distinguish individuals with a high degree of certainty. But this demand has led to huge backlogs in evidence lockers since the current DNA extraction protocols require long processing time. The DNA analysis procedure becomes more complicated when analyzing sexual assault casework samples where the evidence contains more than one contributor. Additional processing to separate different cell types in order to simplify the final data interpretation further contributes to the existing cumbersome protocols. The goal of the present project is to develop a rapid and efficient extraction method that permits selective digestion of mixtures. ^ Selective recovery of male DNA was achieved with as little as 15 minutes lysis time upon exposure to high pressure under alkaline conditions. Pressure cycling technology (PCT) is carried out in a barocycler that has a small footprint and is semi-automated. Typically less than 10% male DNA is recovered using the standard extraction protocol for rape kits, almost seven times more male DNA was recovered from swabs using this novel method. Various parameters including instrument setting and buffer composition were optimized to achieve selective recovery of sperm DNA. Some developmental validation studies were also done to determine the efficiency of this method in processing samples exposed to various conditions that can affect the quality of the extraction and the final DNA profile. ^ Easy to use interface, minimal manual interference and the ability to achieve high yields with simple reagents in a relatively short time make this an ideal method for potential application in analyzing sexual assault samples.^

The relationship between participation in unethical behaviors during the nursing student experience and participation in unethical behaviors as a registered nurse

The effect of unethical behaviors in health care settings is an important issue in the safe care of clients and has been a concern of the nursing profession for some time. The purpose of this study was to examine the relationship between use of unethical behaviors in the nursing student experience and the use of unethical behaviors in the workplace as a registered nurse. In addition, the relationship between the severity of unethical behaviors utilized in the classroom, clinical setting and those in the workplace was examined. To insure greater honesty in self-report, only a limited umber of demographic variables were requested from participants. During the summer of 1997, a 56 item questionnaire was distributed to registered nurses enrolled in either undergraduate or graduate courses in a public or private institution. The participants were asked to self-report their own use of unethical behaviors as well as their peers use of unethical behaviors. In order to assign a severity score for each item, nursing school faculty were asked to rate severity of unethical behaviors which could be used during the nursing student experience and nursing administrators were asked to rate unethical behaviors which could be used in the workplace. A significant positive relationship was found between individuals' use of unethical behaviors during nursing school and those used in the workplace r = .630. A significant positive relationship was found between the severity of unethical behaviors used in the nursing student experience and the severity of unethical behaviors used in the workplace r = .637. No relationship was found between years of practice, type of initial nursing education and whether or not the participant was raised inside or outside the United States and the use of unethical behaviors.

Turkey and Neo-Ottomanism: Domestic Sources, Dynamics and Foreign Policy

This study examined the relationship between the Turkish Islamic movements and the present government of the Justice and Development Party (Adalet ve Kalkinma Partisi, AK Party). Since the AK Party came to power in 2002 it implemented unparalleled political reforms and pursued to improve Turkey’s relations with the EU. Opponents argued that because of the dominance of the secular military in Turkish politics, the AK Party is forced to secretly advance its Islamic agenda using the language and symbolism of democracy and human rights. This study argued that the ideas of the AK Party show similarities with the “Ottomanist” thought of the late Ottoman era. With special reference to the preservation of the Ottoman State, Ottomanism in an eclectic way was able to incorporate Islamic principles like freedom, justice and consultation into the political arena which was increasingly dominated by the secular European concepts. Literature on Islam and politics in Turkey, however, disregards the Ottoman roots of freedom and pluralism and tends to reduce the relationship between religion and state into exclusively confrontational struggles. This conceptualization of the political process relies on particular non-Turkish Muslim experiences which do not necessarily represent Islam’s venture in Turkey. Contrary to the prevailing scholarship, Islamic movements in Turkey, namely, Naqshbandi, National View and Nur, which are discussed in detail in this study, are not monolithic. They all uphold the same creedal tenets of Islam but they have sharp differences in terms of how they conceptualize the role of religious agency in politics. I argue that this diversity is a result of three distinct methodologies of Islamic religious life which are the Tariqah (Tarikat), Shariah (Şeriat), and Haqiqah (Hakikat). The differences between these three approaches represent a typological hierarchy in the formation of the Muslim/believer as an agent of Islamic identity. Through these different if not conflicting modes, the AK Party reconnected itself with Turkey’s Ottoman heritage in a post-Ottoman, secular setting and was able to develop an eclectic political identity of Neo-Ottomanism that is evident in the flexibility if not inconsistency of its domestic and foreign policy preferences.