Examination of the impact of personality, social, and cognitive factors on the co-occurrence of health risk behaviors among multi-problem youth: The utility of an integrative framework

Research has identified a number of putative risk factors that places adolescents at incrementally higher risk for involvement in alcohol and other drug (AOD) use and sexual risk behaviors (SRBs). Such factors include personality characteristics such as sensation-seeking, cognitive factors such as positive expectancies and inhibition conflict as well as peer norm processes. The current study was guided by a conceptual perspective that support the notion that an integrative framework that includes multi-level factors has significant explanatory value for understanding processes associated with the co-occurrence of AOD use and sexual risk behavior outcomes. This study evaluated simultaneously the mediating role of AOD-sex related expectancies and inhibition conflict on antecedents of AOD use and SRBs including sexual sensation-seeking and peer norms for condom use.^ The sample was drawn from the Enhancing My Personal Options While Evaluating Risk (EMPOWER: Jonathan Tubman, PI), data set (N = 396; aged 12-18 years). Measures used in the study included Sexual Sensation-Seeking Scale, Inhibition Conflict for Condom Use, Risky Sex Scale. All relevant measures had well-documented psychometric properties. A global assessment of alcohol, drug use and sexual risk behaviors was used.^ Results demonstrated that AOD-sex related expectancies mediated the influence of sexual sensation-seeking on the co-occurrence of alcohol and other drug use and sexual risk behaviors. The evaluation of the integrative model also revealed that sexual sensation-seeking was positively associated with peer norms for condom use. Also, peer norms predicted inhibition conflict among this sample of multi-problem youth. ^ This dissertation research identified mechanisms of risk and protection associated with the co-occurrence of AOD use and SRBs among a multi-problem sample of adolescents receiving treatment for alcohol or drug use and related problems. This study is informative for adolescent-serving programs that address those individual and contextual characteristics that enhance treatment efficacy and effectiveness among adolescents receiving substance use and related problems services.^

Development of a new student evaluation instrument of instructor effectiveness in online courses

The purpose of this study was to (a) develop an evaluation instrument capable of rating students' perceptions of the instructional quality of an online course and the instructor’s performance, and (b) validate the proposed instrument with a study conducted at a major public university. The instrument was based upon the Seven Principles of Good Practice for Undergraduate Education (Chickering & Gamson, 1987). The study examined four specific questions. 1. Is the underlying factor structure of the new instrument consistent with Chickering and Gamson's Seven Principles? 2. Is the factor structure of the new instrument invariant for male and female students? 3. Are the scores on the new instrument related students’ expected grades? 4. Are the scores on the new instrument related to the students' perceived course workload? ^ The instrument was designed to measure students’ levels of satisfaction with their instruction, and also gathered information concerning the students’ sex, the expected grade in the course, and the students’ perceptions of the amount of work required by the course. A cluster sample consisting of an array of online courses across the disciplines yielded a total 297 students who responded to the online survey. The students for each course selected were asked to rate their instructors with the newly developed instrument. ^ Question 1 was answered using exploratory factor analysis, and yielded a factor structure similar to the Seven Principles.^ Question 2 was answered by separately factor-analyzing the responses of male and female students and comparing the factor structures. The resulting factor structures for men and women were different. However, 14 items could be realigned under five factors that paralleled some of the Seven Principles. When the scores of only those 14 items were entered in two principal components factor analyses using only men and only women, respectively and restricting the factor structure to five factors, the factor structures were the same for men and women.^ A weak positive relationship between students’ expected grades and their scores on the instrument was found (Question 3). There was no relationship between students’ perceived workloads for the course and their scores on the instrument (Question 4).^

Factors influencing the implementation of substance use prevention programs in elementary schools

Prevention scientists have called for more research on the factors affecting the implementation of substance use prevention programs. Given the lack of literature in this area, coupled with evidence that children as early as elementary school engage in substance use, the purpose of this study was to identify the factors that influence the implementation of substance use prevention programs in elementary schools. This study involved a mixed methods approach comprised of a survey and in-person interviews. Sixty-five guidance counselors and teachers completed the survey, and 9 guidance counselors who completed the survey were interviewed individually. Correlation analyses and hierarchical multiple regression were conducted. Quantitative findings revealed ease of implementation most frequently influenced program implementation, followed by beliefs about the program's effectiveness. Qualitative findings showed curriculum modification as an important theme, as well as difficulty of program implementation. The in-person interviews also shed light on three interrelated themes influencing program implementation – The Wheel, time, and scheduling. Results indicate the majority of program providers modified the curriculum in some way. Implications for research, policy, and practice are discussed, and areas for future research are suggested.^

The Use of Thermal Capacity in Measuring the Effectiveness of Meals on Wheels Transport Containers

The Meals on Wheels (MOW) program is designed to help combat hunger in persons needing assistance. MOW has a duty not only to provide food but also to ensure that it reaches eligible clients safely. Given the population that MOW serves, transporting food safely takes on increased importance. This experiment focused on the major food safety issue of maintaining temperature integrity through the use of transport containers. For containers that did not contain electric heating elements, several factors influenced how fast the food temperature fell. Those factors included the U-value and size of the container as well as how many meals were in the container. As predicted, the smaller the U-value, the longer it took the temperature to fall. Larger containers did better at maintaining food temperatures, provided they were fully loaded. In general, fully loaded small and medium containers were better at maintaining food temperatures than larger containers loaded with the same number of meals.

The relationship between selected standardized test scores and performance in advanced placement math and science exams: Analyzing the differential effectiveness of scores for course identification and placement

There is a national need to increase the STEM-related workforce. Among factors leading towards STEM careers include the number of advanced high school mathematics and science courses students complete. Florida's enrollment patterns in STEM-related Advanced Placement (AP) courses, however, reveal that only a small percentage of students enroll into these classes. Therefore, screening tools are needed to find more students for these courses, who are academically ready, yet have not been identified. The purpose of this study was to investigate the extent to which scores from a national standardized test, Preliminary Scholastic Assessment Test/ National Merit Qualifying Test (PSAT/NMSQT), in conjunction with and compared to a state-mandated standardized test, Florida Comprehensive Assessment Test (FCAT), are related to selected AP exam performance in Seminole County Public Schools. An ex post facto correlational study was conducted using 6,189 student records from the 2010 - 2012 academic years. Multiple regression analyses using simultaneous Full Model testing showed differential moderate to strong relationships between scores in eight of the nine AP courses (i.e., Biology, Environmental Science, Chemistry, Physics B, Physics C Electrical, Physics C Mechanical, Statistics, Calculus AB and BC) examined. For example, the significant unique contribution to overall variance in AP scores was a linear combination of PSAT Math (M), Critical Reading (CR) and FCAT Reading (R) for Biology and Environmental Science. Moderate relationships for Chemistry included a linear combination of PSAT M, W (Writing) and FCAT M; a combination of FCAT M and PSAT M was most significantly associated with Calculus AB performance. These findings have implications for both research and practice. FCAT scores, in conjunction with PSAT scores, can potentially be used for specific STEM-related AP courses, as part of a systematic approach towards AP course identification and placement. For courses with moderate to strong relationships, validation studies and development of expectancy tables, which estimate the probability of successful performance on these AP exams, are recommended. Also, findings established a need to examine other related research issues including, but not limited to, extensive longitudinal studies and analyses of other available or prospective standardized test scores.

The effectiveness of an intelligent tutoring system on the attitude and achievement of developmental mathematics students in a community college

This study examined the effectiveness of intelligent tutoring system instruction, grounded in John Anderson's ACT theory of cognition, on the achievement and attitude of developmental mathematics students in the community college setting. The quasi-experimental research used a pretest-posttest control group design. The dependent variables were problem solving achievement, overall achievement, and attitude towards mathematics. The independent variable was instructional method. Four intact classes and two instructors participated in the study for one semester. Two classes (n = 35) served as experimental groups; they received six lessons with real-world problems using intelligent tutoring system instruction. The other two classes (n = 24) served as control groups; they received six lessons with real-world problems using traditional instruction including graphing calculator support. It was hypothesized that students taught problem solving using the intelligent tutoring system would achieve more on the dependent variables than students taught without the intelligent tutoring system. Posttest mean scores for one teacher produced a significant difference in overall achievement for the experimental group. The same teacher had higher means, not significantly, for the experimental group in problem solving achievement. The study did not indicate a significant difference in attitude mean scores. It was concluded that using an intelligent tutoring system in problem solving instruction may impact student's overall mathematics achievement and problem solving achievement. Other factors must be considered, such as the teacher's classroom experience, the teacher's experience with the intelligent tutoring system, trained technical support, and trained student support; as well as student learning styles, motivation, and overall mathematics ability.

The effectiveness of an enhanced congnitive behavioral intervention in improving behavioral outcomes related to HIV prevention

This study analyzed outcomes of an enhanced cognitive-behavioral intervention with dually diagnosed severely mentally ill adults. It specifically addressed the improvement of attitudes, skills, self-efficacy to use condoms and the heightening of condom use. The data were analyzed via a randomized three-group repeated measures design composed of the experimental (E-CB), standard care (SC) comparison or a no-treatment control condition as the between-subjects variable and pre-post measure as the within-subjects variable. The ECB focused on cooperative, application, hands-on, skill-building and role-playing activities for sexual assertiveness, negotiation in risk-taking and proper condom use. The SC comparison, was didactic in its approach and addressed risk- taking and proper condom use in one session, but did not involve application approaches to problem-solving risky situations or condom use. Multiple assessments were conducted at pre-, post- and six months post-intervention. The analysis indicated that the E-CB intervention led to more favorable attitudes toward condoms and to improved and maintained skills regarding their use by participants six months after the intervention compared to the standard care and control groups. No significant improvements in self-efficacy were found. A repeated measures ANOVA conducted on the transformed values of percentage of vaginal condom use indicated no significant differences between the experimental and standard care conditions but both had a significantly higher mean percentage vaginal condom use than the control group, averaged across pre- and six-month post-intervention. No gender differences were seen in attitudes, skills or self-efficacy to use condoms. This study shed light upon the effectiveness of the instructional approach for the enhancement of attitudes, skills and self-efficacy outcomes related to HIV prevention. For heightened effectiveness, future approaches must address multiple factors impacting learning in this population.

Examination of Personality, Social and Cognitive Factors on the Co-Occurrence of Health Risk Behaviors among Multi-Problem Youth: The Utility of An Integrative Framework

Research has identified a number of putative risk factors that places adolescents at incrementally higher risk for involvement in alcohol and other drug (AOD) use and sexual risk behaviors (SRBs). Such factors include personality characteristics such as sensation-seeking, cognitive factors such as positive expectancies and inhibition conflict as well as peer norm processes. The current study was guided by a conceptual perspective that support the notion that an integrative framework that includes multi-level factors has significant explanatory value for understanding processes associated with the co-occurrence of AOD use and sexual risk behavior outcomes. This study evaluated simultaneously the mediating role of AOD-sex related expectancies and inhibition conflict on antecedents of AOD use and SRBs including sexual sensation-seeking and peer norms for condom use. The sample was drawn from the Enhancing My Personal Options While Evaluating Risk (EMPOWER: Jonathan Tubman, PI), data set (N = 396; aged 12-18 years). Measures used in the study included Sexual Sensation-Seeking Scale, Inhibition Conflict for Condom Use, Risky Sex Scale. All relevant measures had well-documented psychometric properties. A global assessment of alcohol, drug use and sexual risk behaviors was used. Results demonstrated that AOD-sex related expectancies mediated the influence of sexual sensation-seeking on the co-occurrence of alcohol and other drug use and sexual risk behaviors. The evaluation of the integrative model also revealed that sexual sensation-seeking was positively associated with peer norms for condom use. Also, peer norms predicted inhibition conflict among this sample of multi-problem youth. This dissertation research identified mechanisms of risk and protection associated with the co-occurrence of AOD use and SRBs among a multi-problem sample of adolescents receiving treatment for alcohol or drug use and related problems. This study is informative for adolescent-serving programs that address those individual and contextual characteristics that enhance treatment efficacy and effectiveness among adolescents receiving substance use and related problems services.

A Qualitative Study of Contextual Factors’ Impact on the Adaptation of a Caregiver-mediated Early Autism Intervention in South Africa

Background: Autism Spectrum Disorder (ASD) is a major global health challenge as the majority of individuals with ASD live in low- and middle-income countries (LMICs) and receive little to no services or support from health or social care systems. Despite this global crisis, the development and validation of ASD interventions has almost exclusively occurred in high-income countries, leaving many unanswered questions regarding what contextual factors would need to be considered to ensure the effectiveness of interventions in LMICs. This study sought to conduct explorative research on the contextual adaptation of a caregiver-mediated early ASD intervention for use in a low-resource setting in South Africa.

Methods: Participants included 22 caregivers of children with autism, including mothers (n=16), fathers (n=4), and grandmothers (n=2). Four focus groups discussions were conducted in Cape Town, South Africa with caregivers and lasted between 1.5-3.5 hours in length. Data was recorded, translated, and transcribed by research personnel. Data was then coded for emerging themes and analyzed using the NVivo qualitative data analysis software package.

Results: Nine contextual factors were reported to be important for the adaptation process including culture, language, location of treatment, cost of treatment, type of service provider, familial needs, length of treatment, support, and parenting practices. One contextual factor, evidence-based treatment, was reported to be both important and not important for adaptation by caregivers. The contextual factor of stigma was identified as an emerging theme and a specifically relevant challenge when developing an ASD intervention for use in a South African context.

Conclusions: Eleven contextual factors were discussed in detail by caregivers and examples were given regarding the challenges, sources, and preferences related to the contextual adaptation of a parent-mediated early ASD intervention in South Africa. Caregivers reported a preference for an affordable, in-home, individualized early ASD intervention, where they have an active voice in shaping treatment goals. Distrust of community-based nurses and health workers to deliver an early ASD intervention and challenges associated with ASD-based stigma were two unanticipated findings from this data set. Implications for practice and further research are discussed.

Bayesian Learning with Dependency Structures via Latent Factors, Mixtures, and Copulas

Bayesian methods offer a flexible and convenient probabilistic learning framework to extract interpretable knowledge from complex and structured data. Such methods can characterize dependencies among multiple levels of hidden variables and share statistical strength across heterogeneous sources. In the first part of this dissertation, we develop two dependent variational inference methods for full posterior approximation in non-conjugate Bayesian models through hierarchical mixture- and copula-based variational proposals, respectively. The proposed methods move beyond the widely used factorized approximation to the posterior and provide generic applicability to a broad class of probabilistic models with minimal model-specific derivations. In the second part of this dissertation, we design probabilistic graphical models to accommodate multimodal data, describe dynamical behaviors and account for task heterogeneity. In particular, the sparse latent factor model is able to reveal common low-dimensional structures from high-dimensional data. We demonstrate the effectiveness of the proposed statistical learning methods on both synthetic and real-world data.

Prudent Budget Planning and Budgetary Process Effectiveness: The Canadian Federal Government’s Experience (Working Paper 47)

In 1994, the Liberal government introduced a structured approach to prudent budgeting to provide the fiscal discipline needed to meet its debt reduction targets in which explicit prudence factors were introduced into the fiscal framework to reduce the amount of fiscal flexibility available for allocation in each annual budget. Although that framework was successful in contributing to the elimination of persistent budgetary deficits, this paper advances three linked arguments: • that additional but undisclosed prudence factors were also introduced into the fiscal framework to attenuate the political risk of missing budget targets; • that these undisclosed prudence factors are one cause of a number of unintended budgetary outcomes that put the effectiveness of the budgetary process at risk; and • that there is nothing inherently politically partisan about the Liberal’s approach to prudent budget planning and, changes to terminology and display notwithstanding, the present Conservative government has continued to apply most elements of that framework in its budgets. Moving from a single-year budget target to one that is expressed as a cumulative total over the election cycle is discussed as one option that would help preserve the merits of prudent budgeting.

The effectiveness of corporate Web in small and médiumsized business: an analysis of Web Usability

Internet and the Web have changed the way that companies communicate with their publics, improving relations between them. Also providing substantial benefits for organizations. This has led to small and medium enterprises (SMEs) to develop corporate sites to establish relationships with their audiences. This paper, applying the methodology of content analysis, analyzes the main factors and tools that make the Websites usable and intuitive sites that promote better relations between SMEs and their audiences. Also, it has developed an index to measure the effectiveness of Webs from the perspective of usability. The results indicate that the Websites have, in general, appropriate levels of usability.

Cost-effectiveness of natriuretic peptide-based screening and collaborative care: a report from the STOP-HF (St Vincent's Screening TO Prevent Heart Failure) study

AIMS: Prevention of cardiovascular disease and heart failure (HF) in a cost-effective manner is a public health goal. This work aims to assess the cost-effectiveness of the St Vincent's Screening TO Prevent Heart Failure (STOP-HF) intervention.

METHODS AND RESULTS: This is a substudy of 1054 participants with cardiovascular risk factors [median age 65.8 years, interquartile range (IQR) 57.8:72.4, with 4.3 years, IQR 3.4:5.2, follow-up]. Annual natriuretic peptide-based screening was performed, with collaborative cardiovascular care between specialist physicians and general practitioners provided to patients with BNP levels >50 pg/mL. Analysis of cost per case prevented and cost-effectiveness per quality-adjusted life year (QALY) gained was performed. The primary clinical endpoint of LV dysfunction (LVD) with or without HF was reduced in intervention patients [odds ratio (OR) 0.60; 95% confidence interval (CI) 0.38-0.94; P = 0.026]. There were 157 deaths and/or emergency hospitalizations for major adverse cardiac events (MACE) in the control group vs. 102 in the intervention group (OR 0.68; 95% CI 0.49-0.93; P = 0.01). The cost per case of LVD/HF prevented was €9683 (sensitivity range -€843 to €20 210), whereas the cost per MACE prevented was €3471 (sensitivity range -€302 to €7245). Cardiovascular hospitalization savings offset increased outpatient and primary care costs. The cost per QALY gain was €1104 and the intervention has an 88% probability of being cost-effective at a willingness to pay threshold of €30 000.

CONCLUSION: Among patients with cardiovascular risk factors, natriuretic peptide-based screening and collaborative care reduced LVD, HF, and MACE, and has a high probability of being cost-effective.

TRIAL REGISTRATION: NCT00921960.

Protocolised weaning from mechanical ventilation: pairing a qualitative review with an effectiveness review

In our systematic review of protocolised weaning from mechanical ventilation (Blackwood 2014) we found significant heterogeneity that could not be explained by subgroup analysis (type of protocol, ICU). We suspected that factors unreported in the trials relating to context and mechanisms of using the weaning protocols contributed to the heterogeneity. Therefore we set out to conduct a Cochrane qualitative evidence-synthesis of ‘sibling studies’ (qualitative studies undertaken alongside the included trials that may have examined these factors) and ‘stand-alone’ qualitative studies reporting barriers and facilitators to successful implementation of weaning protocols. The qualitative review was novel, there were few templates or guidelines which challenged us to consider how best to synthesise and report this evidence. However, the benefits of conducting this review are that not only do we have a template for future qualitative syntheses for the ACE group, but specifically for trials of weaning protocols, we found context-specific evidence concerning if, how and why specific protocols have been effective in the settings in which they were delivered and received.

Safety Edge Crash Modification Factors, Tech Brief, 2016

This study evaluated the safety impact of the Safety Edge for construction projects in 2010 and 2011 in Iowa to assess the effectiveness of the treatment in reducing crashes.