Hospital discharge planning in the provision of food and nutrition services for older adults post discharge

This descriptive study examined whether discharge planning ensures that food and nutrition services are provided to older adults following hospital discharge. The questionnaire was distributed to discharge planning professionals in 11 South Florida hospitals. Of the 84 respondents (88% response rate), most were female nurse case managers. Almost all reported job barriers including excessive patient loads, too many responsibilities, and limited community services. While physicians, registered nurses, social workers, physical therapists, were deemed "very important" in discharge planning,registered dietitians were not, and almost half consulted them infrequently, if at all. Over 84% said nutrition-related medical conditions/factors, "strongly influenced" discharge planning. Many did not have adequate information about nutrition-related community resources, eg, home delivered meals, food stamps, outpatient registered dietitians. Therewere no universal approaches in meeting the nutrition needs in 6 case scenarios. More communication among community services and hospitals is needed.

Fever, methods of fever management, and caretakers' perceptions of pediatric after-hour telephone triage and advice services for children between the ages of twelve months and three years with fever

Despite the frequency with which fevers occur in children ages 1–3 years, lack of knowledge and understanding about the implications of fever and methods of fever management often results in anxiety among caretakers, sometimes prompting them to seek help at nearby emergency departments. Caretakers often look to health care professionals for advice and guidance over the telephone. The purpose of this study was to investigate caretakers' knowledge of the implications of fever, methods of fever management, perceptions of pediatric telephone triage and advice services regarding fever, and the effectiveness of after hour telephone triage directed toward improving the caretakers' ability to manage their child's fever at home. Pre-triage questionnaires were completed by 72 caretakers over the telephone before the triage encounter. Twenty-two of those same caretakers whose children were triaged using the fever guideline completed and returned the mailed post-triage questionnaire. Descriptive statistics were used to analyze responses for the larger pre-intervention group and describe comparisons for the pre and post-triage responses in the smaller sample subset (n = 22). ^

A follow-up outcome evaluation of independent living services for foster care youth

This study aimed to evaluate the effectiveness of the Independent Living (IL) program targeting foster youths to prepare them for effective adulthood. The study employed a pre-post, two-group comparative research design. The IL group was composed of 49 young adults who participated in the IL or SIL (subsidized IL) program prior to their emancipation from foster care (mean age, 20.6 years). The comparison was made up of 18 young adults who experienced foster care but never participated in the IL or SIL programs (mean age, 20.2 years). Data were collected via a mailed survey that included the Daniel Memorial Independent Living Assessment (DMILA) and an additional questionnaire developed by the researcher. The study also examined: (1) why youth in foster care do not participate in IL programs, (2) how participating youth evaluate IL services and what recommendations they make to improve services, and (3) the internal consistency of the DMILA. Results suggest that the DMILA assessment has mediocre reliability. IL program participation is associated with better educational, employment, income, housing, early parenting-prevention, transportation, anger control, criminal-prevention, and self-evaluation outcomes. However, IL participation is not associated with better social support, perceived parenting competence, substance abuse-prevention, sexual risk-prevention outcomes, increased knowledge in money management skills, job seeking and job maintenance skills, interpersonal skills, or lower depression. Results also suggest that the outreach activities of the IL program may be flawed. IL participants reported the IL program was doing best in educational preparation, criminal involvement prevention, and money management preparation and least well in parenting preparation, housing preparation, employment preparation, and substance abuse prevention. To improve services, youths recommended primarily that IL counselors develop closer relationships with youths, that IL training better address organizational skills, and that monthly subsidy be raised and SIL eligibility requirements softened. The study's political context and limitations are also discussed and implications are derived regarding prevention, intervention, outreach, mentorship, empowerment, cross-systems collaboration, and future research. ^

Examining Technology Adoption and Management Perception of Inventory Management Systems: The Case of Aruba Restaurants

The purpose of this paper is to explore the use of automated inventory management systems (IMS) and identify the stage of technology adoption for restaurants in Aruba. A case study analysis involving twelve members of the Aruba Gastronomic Association was conducted using a qualitative research design to gather information on approaches currently used as well as the reasons and perceptions managers/owners have for using or not using automated systems in their facilities. This is the first study conducted using the Aruba restaurant market. Therefore, the application of two technology adoption models was used to integrate critical factors relevant to the study. Major findings indicated the use of an automated IMS in restaurants is limited, thus underscoring the lack of adoption of technology in this area. The results also indicated that two major reasons that restaurants are not adopting IMS technology are budgetary constraints and service support. This study is imperative for two reasons: (1) the results of this study can be used as a comparison for future IMS adoption, not only for Aruba’s restaurant industry but also for other Caribbean destinations and the U.S., (2) this study also provides insight into the additional training and support help needed in hospitality technology services.

Audit pricing, reporting quality, and auditor switches in the post -SOX period

The Sarbanes-Oxley Act represents an important watershed event in the history and regulation of the accounting profession. In this dissertation, I develop arguments as to why we can expect differences in auditor behavior before and after SOX and empirically test if indeed there were differences in auditor behavior before and after SOX. My dissertation consists of three essays. For the three essays, I investigate issues related to auditor independence, audit pricing, the impact of auditor changes in the post-SOX period. The motivation for the first part of my research comes from the SEC's assertions that there are differences between types of non-audit services in terms of their potential to adversely impact auditor independence. The first part of my dissertation empirically validates the SEC's assertions that auditors would be more conservative in those instances where the tax and other non-audit services fee ratios are high but not when the audit-related fee ratio is high. The second part of my study examines if auditors are less likely to "low ball" their audit fees in the period after SOX than in the period preceding SOX. Legislators, regulators, and the media have expressed concerns that auditors "low ball" the fees for initial year audits and that such low-balling can lead to reduced audit quality. I find that there is significant initial year audit fee discount in pre-SOX period and but the fee discount does not hold in post-SOX periods. The third part of my dissertation examines the association between auditor switches and auditor conservatism. I find that a large portion of Big 4 clients switch to non-Big 4 auditors and there is no significant evidence indicating that successor auditors are more conservative in the post-SOX period.

The effects of advanced practice nurses (APNs) as intensivists in a surgical intensive care unit (SICU) on patient outcomes, healthcare charges, and apn intensivist services in the SICU

Intensive Care Units (ICUs) account for over 10 percent of all US hospital beds, have over 4.4 million patient admissions yearly, approximately 360,000 deaths, and account for close to 30% of acute care hospital costs. The need for critical care services has increased due to an aging population and medical advances that extend life. The result is efforts to improve patient outcomes, optimize financial performance, and implement models of ICU care that enhance quality of care and reduce health care costs. This retrospective chart review study examined the dose effect of APN Intensivists in a surgical intensive care unit (SICU) on differences in patient outcomes, healthcare charges, SICU length of stay, charges for APN intensivist services, and frequency of APNs special initiatives when the SICU was staffed by differing levels of APN Intensivist staffing over four time periods (T1-T4) between 2009 and 2011. The sample consisted of 816 randomly selected (204 per T1-T4) patient chart data. Study findings indicated reported ventilator associated pneumonia (VAP) rates, ventilator days, catheter days and catheter associated urinary tract infection (CAUTI) rates increased at T4 (when there was the lowest number of APN Intensivists), and there was increased pressure ulcer incidence in first two quarters of T4. There was no statistically significant difference in post-surgical glycemic control (M = 142.84, SD = 40.00), t (223) = 1.40, p = .17, and no statistically significant difference in the SICU length of stay among the time-periods (M = 3.27, SD = 3.32), t (202) = 1.02, p = .31. Charges for APN services increased over the 4 time periods from $11,268 at T1 to $51,727 at T4 when a system to capture APN billing was put into place. The number of new APN initiatives declined in T4 as the number of APN Intensivists declined. Study results suggest a dose effect of APN Intensivists on important patient health outcomes and on the number of APNs initiatives to prevent health complications in the SICU. ^

Consulting Services to Determine the Effectiveness of Vegetation Classification Using WorldView 2 Satellite Data for the Greater Everglades

The purpose of this project was to evaluate the use of remote sensing 1) to detect and map Everglades wetland plant communities at different scales; and 2) to compare map products delineated and resampled at various scales with the intent to quantify and describe the quantitative and qualitative differences between such products. We evaluated data provided by Digital Globe’s WorldView 2 (WV2) sensor with a spatial resolution of 2m and data from Landsat’s Thematic and Enhanced Thematic Mapper (TM and ETM+) sensors with a spatial resolution of 30m. We were also interested in the comparability and scalability of products derived from these data sources. The adequacy of each data set to map wetland plant communities was evaluated utilizing two metrics: 1) model-based accuracy estimates of the classification procedures; and 2) design-based post-classification accuracy estimates of derived maps.

Economic assessment of best management practices in the Mara River Basin : toward implementing payment for watershed services

The Mara River in East Africa is currently experiencing poor water quality and increased fluctuations in seasonal flow. This study investigated technically effective and economically viable Best Management Practices for adoption in the Mara River Basin of Kenya that can stop further water resources degradation. A survey of 155 farmers was conducted in the upper catchment of the Kenyan side of the river basin. Farmers provided their assessment of BMPs that would best suit their farm in terms of water quality improvement, economic feasibility, and technicalsuitability. Cost data on different practices from farmers and published literature was collected. The results indicated that erosion control structures and runoff management practices were most suitable for adoption. The study estimated the total area that would be improved to restore water quality and reduce further water resources degradation. Farmers were found to incur losses from adopting new practices and would therefore require monetary support.

The Effects of Advanced Practice Nurses (APNs) as Intensivists in a Surgical Intensive Care Unit (SICU) on Patient Outcomes, Healthcare Charges, and APN Intensivist Services in the SICU

Intensive Care Units (ICUs) account for over 10 percent of all US hospital beds, have over 4.4 million patient admissions yearly, approximately 360,000 deaths, and account for close to 30% of acute care hospital costs. The need for critical care services has increased due to an aging population and medical advances that extend life. The result is efforts to improve patient outcomes, optimize financial performance, and implement models of ICU care that enhance quality of care and reduce health care costs. This retrospective chart review study examined the dose effect of APN Intensivists in a surgical intensive care unit (SICU) on differences in patient outcomes, healthcare charges, SICU length of stay, charges for APN intensivist services, and frequency of APNs special initiatives when the SICU was staffed by differing levels of APN Intensivist staffing over four time periods (T1-T4) between 2009 and 2011. The sample consisted of 816 randomly selected (204 per T1-T4) patient chart data. Study findings indicated reported ventilator associated pneumonia (VAP) rates, ventilator days, catheter days and catheter associated urinary tract infection (CAUTI) rates increased at T4 (when there was the lowest number of APN Intensivists), and there was increased pressure ulcer incidence in first two quarters of T4. There was no statistically significant difference in post-surgical glycemic control (M = 142.84, SD= 40.00), t (223) = 1.40, p = .17, and no statistically significant difference in the SICU length of stay among the time-periods (M= 3.27, SD = 3.32), t (202) = 1.02, p= .31. Charges for APN services increased over the 4 time periods from $11,268 at T1 to $51,727 at T4 when a system to capture APN billing was put into place. The number of new APN initiatives declined in T4 as the number of APN Intensivists declined. Study results suggest a dose effect of APN Intensivists on important patient health outcomes and on the number of APNs initiatives to prevent health complications in the SICU.