A study of nutrition promotion in and consumer nutrition environments of hospitals

Dietary intake is a complex, health-related behavior, and although individual-level theoretical models explain some variation in dietary intake, comprehensive theoretical models such as the ecological framework describe the multiple levels which influence diet-related behaviors. Thus, the ecological framework is a preferred model for designing comprehensive nutrition interventions. While ecological-based nutrition interventions have been described, little work has focused on interventions in the hospital setting. Because hospitals are considered the hallmarks of health, it might seem that hospitals would regularly engage in worksite nutrition promotion; however, recent publications and other anecdotal evidence have indicated otherwise. The first paper of this dissertation systematically reviewed the scientific literature between 1996 and 2012 and identified 13 outcome evaluation trials for hospital-based worksite nutrition interventions. Of these 13 interventions, only one intervention targeted three of the four levels of the ecological framework and no intervention targeted all four levels. Only half of the interventions targeted the physical environment of hospitals, thus warranting more investigation into this specific level of the ecological framework in this setting. ^ A critical type of nutrition-related physical environments is the consumer nutrition environment. Although other tools measure the consumer nutrition environments of stores and restaurants, no tool specifically measured the consumer nutrition environments of hospitals until the CDC developed the Healthy Hospital Environment Scan for Cafeterias, Vending Machines, and Gift Shops (HHES-CVG). The HHES-CVG, a tool which measures the consumer nutrition environments of hospital cafeterias, vending machines, and gifts shops, was released in November 2011, and in the second paper of this dissertation, the reliability of this tool was investigated. Two trained raters visited 39 hospitals across Southern California between February and May 2012, and based on analyses of the raters' findings, the HHES-CVG exhibited strong reliability metrics (inter-observer agreement between 74 and 100%, and an intraclass correlation coefficient of 0.961 for the overall nutrition composite score). Because the HHES-CVG was found to be a reliable tool, the third paper of this dissertation presented HHES-CVG results from the 39 hospitals. Overall, hospitals only scored about one-fourth of the total possible points for the nutrition composite score, indicating that most facilities do not have acceptable consumer nutrition environments. Some of the best practices observed in cafeterias were significantly associated with having a large facility and with having a contracted foodservice operation, but overall nutrition composite score was not associated with any specific facility or operation type. ^ The dissertation concluded that much work is needed in order to improve the consumer nutrition environments of hospitals. Practitioners and healthcare administrators should consider starting with ecological-based interventions addressing all levels including the physical environment.^

Improving disclosure of medical errors: Including patients and family members in the disclosure process

Over the last decade, adverse events and medical errors have become a main focus of interest for the standards of quality and safety in the U.S. healthcare system (Weinstein & Henderson, 2009). Particularly when a medical error occurs, the disclosure of medical errors and its practices have become a focal point of the healthcare process. Patients and family members who have experienced a medical error might be able to provide knowledge and insight on how to improve the disclose process. However, patient and family member are not typically involved in the disclosure process, thus their experiences go unnoticed. ^ The purpose of this research was to explore how best to include patients and family members in the disclosure process regarding a medical error. The research consisted of 28 qualitative interviews from three stakeholder groups: Hospital Administrators, Clinical Service Providers, and Patients and Family Members. They were asked for their ideas and suggestions on how best to include patients and family members in the disclosure process. Framework Analysis was used to analyze this data and find prevalent themes based on the primary research question. A secondary aim was to index categories created based on the interviews that were collected. Data was used from the Texas Disclosure and Compensation Study with Dr. Eric Thomas as the Principal Investigator. Full acknowledgement of access to this data is given to Dr. Thomas. ^ The themes from the research revealed that each stakeholder group was interested and open to including patients and family members in the disclosure process and that the disclosure process should not be a "one-way" avenue. The themes gave many suggestions regarding how to best include patients and family members in the disclosure process of a medical error. Secondary aims revealed several ways to assess the ideas and suggestion given by the stakeholders. Overall, acceptability of getting the perspective of patients and family members was the most common theme. Comparison of each stakeholder group revealed that including patients and family members would be beneficial to improving hospital disclosure practices. ^ Conclusions included a list of recommendations and measureable appropriate strategies that could provide hospital with key stakeholders insights on how to improve their disclosure process. Sharing patients and family members experience with healthcare providers can encourage a shift in culture where patients are valued and active in participating in hospital practices. To my knowledge, this research is the very first of its kind and moves the disclosure process conversation forward in a patient-family member inclusion direction that will assist in improving disclosure practices. Future research should implement and evaluate the success of the various inclusion strategies.^

A scalable SIEM correlation engine and its application to the Olympic Games IT infrastructure

The security event correlation scalability has become a major concern for security analysts and IT administrators when considering complex IT infrastructures that need to handle gargantuan amounts of events or wide correlation window spans. The current correlation capabilities of Security Information and Event Management (SIEM), based on a single node in centralized servers, have proved to be insufficient to process large event streams. This paper introduces a step forward in the current state of the art to address the aforementioned problems. The proposed model takes into account the two main aspects of this ?eld: distributed correlation and query parallelization. We present a case study of a multiple-step attack on the Olympic Games IT infrastructure to illustrate the applicability of our approach.

Women and Performance in Corporate America

Women and Performance in Corporate America The glass ceiling has been shattered. Women like Indra Nooyi, the CEO of PepsiCo.; Angela Braly, the CEO of Wellpoint; and Patricia Woertz, the CEO of Archer Daniels Midland, are proof that women can achieve top leadership positions in corporate America. However, the scarcity of female leaders occupying the top ranks of corporate America, and the significant wage gap between men and women, suggest that there are significant complications along the path toward success for women in the corporate world.The data show that a disproportionately small number of women are making it to top leadership positions in corporate America. According to the US Department of Labor, in 2007 women accounted for 46% of the total work force, and 51 % of all workers in management, professional, and related occupations. Women outnumbered men in occupations including financial managers, human resource managers, education administrators, medical and health service managers, accountants and auditors, budget analysts, and property, real estate, and social and community association managers (US Department of Labor, 2007). However, women hold only 15.2% of board director positions, 15.7% of corporate officer positions, and 6.2% of top earner positions (Catalyst, 2009b). Additionally, according to a 2008 Corporate Library survey, only 2.6% of Fortune 500 companies currently have female CEOs (as cited in Jones, 2009).The data also show that women earn less than men in the work force. The US Department of Labor found that women working full time in 2007 made only 80% of the salaries of men (US Department of Labor, 2008). Studies designed to control for factors other than gender have not been able to account for the wage gap between men and women (Eagly & Carli, 2007, US Government Accountability Office, 2003). Even among CEO's of fortune 500 companies, female CEO's make only 85% of the salaries of male CEO's (Jones, 2009).

Investigating and Understanding Student Learning Outcomes in an Online and Face-to-Face Graduate Level Legal Administration Course: An Embedded Mixed Methods Design

Online education is a new teaching and learning medium with few current guidelines for faculty, administrators or students. Its rapid growth over the last decade has challenged academic institutions to keep up with the demand, while also providing a quality education. Our understanding of the factors that determine quality and effective online learning experiences that lead to student learning outcomes is still evolving. There is a lack of consensus on the effectiveness of online versus face-to-face education in the current research. The U.S. Department of Education conducted a meta-analysis in 2009 and concluded that student-learning outcomes in online courses were equal to and, often times, better than face-to-face traditional courses. Subsequent research has found contradictory findings, and further inquiry is necessary. The purpose of this embedded mixed methods design research study is to further our understanding of the factors that create quality and successful educational outcomes in an online course. To achieve this, the first phase of this study measured and compared learning outcomes in an online and in class graduate-level legal administration course. The second phase of the study entailed interviews with those students in both the online and face-to-face sections to understand their perspectives on the factors contributing to learning outcomes. Six themes emerged from the qualitative findings: convenience, higher order thinking, discussions, professor engagement, professor and student interaction, and face-to-face interaction. Findings from this study indicate the factors students perceive as contributing to learning outcomes in an online course are consistent among all students and are supported in the existing literature. Higher order thinking, however, emerged as a stronger theme than indicated in the current research, and the face-to-face nature of the traditional classroom may be more an issue of familiarity than a factor contributing to learning outcomes. As education continues to reach new heights and developments in technology advance, the factors found to contribute to student learning outcomes will be refined and enhanced. These developments will continue to transform the ways in which we deliver and receive knowledge in both traditional and online classrooms. While there is a growing body of research on online education, the field’s evolution has unsettled earlier findings and posed new areas to investigate.

Copy of receipt to Samuel Sewall and William Welsteed, 1726/7 March 4

This copy of a receipt documents funds received by Harvard College from Samuel Sewall and William Welsteed, the executors of the estate of Bridget Usher, for the purchase of books for the College Library.

Affidavit of the administrators of the estate of Hannah Lee, 17 January 1788

Handwritten affidavit declaring Isaac Story of Marblehead, Mass. the executor of the estate of Hannah Lee, with the estate's proceeds to be distributed to Thomas and Sarah Fayerweather, Thomas Hubbard Townsend of Needham, and Andrew and Mary Bordman of Tewksbury. The affidavit also appoints London merchants to recover lands in England.

Account book of the executors of the Henry Flynt estate, 1760-1767

The volume contains acknowledgements of the disbursements of Harvard Tutor Henry Flynt's estate written in the hands of the respective beneficiaries. The entries begin on February 27, 1760 following Flynt's death on February 13, 1760, and continue through May 9, 1767. Each receipt includes the date, name of the executors, description of the property, beneficiary's name, and signature. The beneficiaries include the wife of Sol. Davy, Dorothy Jackson, Edmund Quincy, J. Henry Quincy, Esther and Stephen Richard (received by attorney Nicholas Boylston), Dorothy Skinner (also received for her by her husband Richard Skinner), John Wendell, Edmund Wendell, Katherine Wendell, and Oliver Wendell, as well as Harvard College (received by Harvard Treasurer Thomas Hubbard), and the Deacons of the First Church of Cambridge. The volume also includes a loose document titled "Account from Messrs Edmund & Josiah Quincy Settled & Ballanced March 31, 1749."

Youth Sports: Implementing Findings and Moving Forward with Research

This paper reviews the literature, outlines practical implications, and discusses future studies in youth sport researc h. The literature is discussed in light of three potential benefits of youth sport participation 1) physic al health, 2) psycho- social development, and 3) motor skills acquisition. The ultimate objective of youth sport programs is to consider all the benefits of youth sport participation rather than focusing on one or two at the cost of the other(s). It is suggested that researchers, s port administrators, coaches, and parents work together to promote sporting activities and programs that are more likely to enhance children’s physical health, psychosocia l development and lifelong recreational or elite sport participation.

An Investigation of the Features and Effectiveness of the Full-Day Early Learning Kindergarten Program in Ontario

This dissertation includes two studies. Study 1 is a qualitative case study that describes enactment of the main components of a high fidelity Full-Day Early Learning Kindergarten (FDELK) classroom, specifically play-based learning and teacher-ECE collaboration. Study 2 is a quantitative analysis that investigates how effectively the FDELK program promotes school readiness skills, namely self-regulation, literacy, and numeracy, in Kindergarteners. To describe the main components of an FDELK classroom in Study 1, a sub-sample of four high fidelity case study schools were selected from a larger case study sample. Interview data from these schools’ administrators, educators, parents, and community stakeholders were used to describe how the main components of the FDELK program enabled educators to meet the individual needs of students and promote students’ SR development. In Study 2, hierarchical regression analyses of 32,207 students’ self-regulation, literacy, and numeracy outcomes using 2012 Ontario Early Development Instrument (EDI) data revealed essentially no benefit for students participating in the FDELK program when compared to peers in Half-Day or Alternate-Day Kindergarten programs. Being older and female predicted more positive SR and literacy outcomes. Age and gender accounted for limited variance in numeracy outcomes. Results from both studies suggest that the Ontario Ministry of Education should take steps to improve the quality of the FDELK program by incorporating evidence-based guidelines and goals for play, reducing Kindergarten class sizes to more effectively scaffold learning, and revising curriculum expectations to include a greater focus on SR, literacy, and numeracy skills.

Structured Sports and Physical Activities: Their Critical Role

Even though one recognizes the physical and psychological kindness of h more and more involvement of the children to the physical and sporty activities, these programs seem more and more inaccessible to some. This article underlines the importance school déprogrammes centered on structured physical and sporty activities. In the setting of a recent survey, one asked youngsters to 5th year to take in note all their activities (as diary calendar) during two days of consecutive week. L·s children that participated in structured physical and sporty activities before and after the hours class sembkient to pull a lot more phisir of their day that those that didn't participate in these activities. Besides, seuk the young that took to structured physical and sporty activities reached the rates recommended of daily physical activity. The article proposes to the school administrators, to the parents, to the children and to the collectivities various measures encouraging the adoption of additional programs centered on the physical and sporty activities in school environment.

Comparative data and analysis in state motor vehicle administration. Final report.

National Highway Traffic Safety Administration, Washington, D.C.

Traffic case adjudication systems: a seminar. Administrators' guide.

National Highway Traffic Safety Administration, Washington, D.C.

A model state classified licensing program. Guidelines for motor vehicle administrators.

Mode of access: Internet.

Disclosure of odometer readings on motor vehicle title documents. Guidelines for motor vehicle administrators.

Mode of access: Internet.