COSTS AND EFFECTS OF ARKANSAS' LONG-TERM CARE DEMONSTRATION PROJECT (MEDICAID, CHANELLING, COMMUNITY ASSESSMENT)

The purpose of this study was to assess the impact of the Arkansas Long-Term Care Demonstration Project upon Arkansas' Medicaid expenditures and upon the clients it serves. A Retrospective Medicaid expenditure study component used analyses of variance techniques to test for the Project's effects upon aggregated expenditures for 28 demonstration and control counties representing 25 percent of the State's population over four years, 1979-1982.^ A second approach to the study question utilized a 1982 prospective sample of 458 demonstration and control clients from the same 28 counties. The disability level or need for care of each patient was established a priori. The extent to which an individual's variation in Medicaid utilization and costs was explained by patient need, presence or absence of the channeling project's placement decision or some other patient characteristic was examined by multiple regression analysis. Long-term and acute care Medicaid, Medicare, third party, self-pay and the grand total of all Medicaid claims were analyzed for project effects and explanatory relationships.^ The main project effect was to increase personal care costs without reducing nursing home or acute care costs (Prospective Study). Expansion of clients appeared to occur in personal care (Prospective Study) and minimum care nursing home (Retrospective Study) for the project areas. Cost-shifting between Medicaid and Medicare in the project areas and two different patterns of utilization in the North and South projects tended to offset each other such that no differences in total costs between the project areas and demonstration areas occurred. The project was significant ((beta) = .22, p < .001) only for personal care costs. The explanatory power of this personal care regression model (R('2) = .36) was comparable to other reported health services utilization models. Other variables (Medicare buy-in, level of disability, Social Security Supplemental Income (SSI), net monthly income, North/South areas and age) explained more variation in the other twelve cost regression models. ^

Using intervention mapping to develop a community garden program at the women's home

This culminating experience was a practice based intervention conducted by an organization, utilizing an intervention mapping approach for the program planning. It took place summer 2010 through spring 2011 and included incorporating a community garden into the Gusto wellness program at The Women's Home. This organization offers long-term residential care, and therapeutic services. Literature relating to community gardens and nutrition behavior change was reviewed. Short-term objectives included: 1) Conducting a needs assessment using focus groups, 2) Designing gardening program components based on intervention mapping guidelines, 3) Constructing a garden bed at Midtown Community Garden for use of The Women's Home, 4) Planning and implementing gardening education, and 5) Assessing feasibility of the garden program. The target population included 24 residents living at the residential dormitory of The Women's Home at the time of this project. The major variables are intervention mapping constructs including: 1) Needs assessment, 2) Preparing matrices of change objectives, 3) Selecting theory-informed intervention methods and practical strategies, 4) Producing program components and materials, 5) Planning program adoption, implementation, and sustainability, and 6) Planning for evaluation. The specific focus was lack of access to fresh fruits and vegetables (FV) for this population. Focus group responses revealed interest in community garden participation. Matrices of change were developed for lack of FV access based on performance objectives for behavioral and environmental factors and related determinants and theory. Methods and strategies were developed to implement a community garden and encourage participation. Program components included initiating a garden club, networking activities, creating gardening curriculum, and participating at Midtown Community Garden. Adoption and implementation performance objectives were outlined, and many were carried out. Evaluation questions were designed and outcomes of the garden project were discussed. ^ Outcomes of the project included exposure of garden topics and activities for The Women's Home residents, focus group responses revealing an interest in gardening among this population, gardening program components designed based on intervention mapping steps, and a constructed garden bed that was used for planting vegetables and flowers through fall 2010. Limited resources and budget along with a lack of a residential coordinator at The Women's Home were the main limiting factors for this project. Future garden projects can be developed using the intervention mapping process.^

Community health workers: The critical link to sustainable, healthy societies in low-resource settings---A model for the Baylor Shoulder to Shoulder Foundation

Community health workers (CHWs) can serve as a bridge between healthcare providers and communities to positively impact social determinants of health and, thus, the overall health of the population. The potential to effect lasting change is particularly significant within resource-poor settings with limited access to formally trained health care providers such as the small, rural village of Santa Ana Intibucá, Honduras and surrounding areas—located on the geographically and politically isolated border of Honduras and El Salvador. The Baylor Shoulder to Shoulder Foundation (BSTS) works in conjunction with Santa Ana's volunteer health committee to bring a health brigade that has provided health care and public health projects to the area at least twice a year since 2001. They have also hired a full-time Honduran physician, a Honduran in-country administrative director, and built a clinic; yet, no community health worker program exists. This CHW program model is the response to a clear need for a CHW program within the area served by BSTS and presents a CHW program model specific to Santa Ana Intibucá and surrounding areas to be implemented by BSTS. Methods used to develop this model include reviewing the literature for recommendations from leading authorities as well as successfully implemented CHW programs in comparable regions. This information was incorporated into existing knowledge and materials currently being used in the area. Using the CHW model proposed here, each brigade, in conjunction with the communities served, can help develop new modules to respond to the specific health priorities of the region at that time, incorporating consistent modes of contact with the local physician and the CHWs to provide refresher courses, training in new topics of interest, and to be reminded of the importance of community health workers' role as the critical link to healthy societies. With cooperation, effort, and support, the brigade can continue to help integrate a sustainable CHW system in which communities may be able to maximize the care they receive while also learning to care for their own health and the future of their communities.^

Method for the evaluation of social projects

This instrument was part of the research project "Research on Evaluation of Health and Education Plans and Programs in the Province of Buenos Aires", developed by the of Chair Preventive Psychology of the Psychology course of studies at the School of Humanities and Educational Sciences, National Univer- sity of La Plata (Argentina). The basis for proposing an assessment instrument is the need for a method enabling analysis, systematization of knowledge and the assignment of values distributed into scales and organized in general charts, on social programs. Its main concern is the analysis of health and education programs and projects, restricted to certain specific areas or regions, in search for theoretic trustworthi-ness, methodological accuracy as well as pragmatic operability. This is the result of four years of researching said programs at system, service and community levels.

Method for the evaluation of social projects

This instrument was part of the research project "Research on Evaluation of Health and Education Plans and Programs in the Province of Buenos Aires", developed by the of Chair Preventive Psychology of the Psychology course of studies at the School of Humanities and Educational Sciences, National Univer- sity of La Plata (Argentina). The basis for proposing an assessment instrument is the need for a method enabling analysis, systematization of knowledge and the assignment of values distributed into scales and organized in general charts, on social programs. Its main concern is the analysis of health and education programs and projects, restricted to certain specific areas or regions, in search for theoretic trustworthi-ness, methodological accuracy as well as pragmatic operability. This is the result of four years of researching said programs at system, service and community levels.

Method for the evaluation of social projects

This instrument was part of the research project "Research on Evaluation of Health and Education Plans and Programs in the Province of Buenos Aires", developed by the of Chair Preventive Psychology of the Psychology course of studies at the School of Humanities and Educational Sciences, National Univer- sity of La Plata (Argentina). The basis for proposing an assessment instrument is the need for a method enabling analysis, systematization of knowledge and the assignment of values distributed into scales and organized in general charts, on social programs. Its main concern is the analysis of health and education programs and projects, restricted to certain specific areas or regions, in search for theoretic trustworthi-ness, methodological accuracy as well as pragmatic operability. This is the result of four years of researching said programs at system, service and community levels.

Social development benefits of hydroelectricity CDM projects in Brazil

In recent years, the concept of sustainable development has become increasingly recognized and important. Within organizations, sustainable development is often portrayed as a balancing act, and requires a combination of three elements to be considered: economy, environment, and society. Traditionally, organizational management research has been focused on economical and environmental fronts. However, social aspects are also important for organizations, especially those in emerging and developing countries. The goal of this paper is to investigate the potential of Clean Development Mechanism (CDM) projects to deliver social benefits in Brazil?s hydroelectricity sector. The investigation involved the assessment of 46 registered hydro CDM projects under the Kyoto Protocol in terms of their potential impact on the envisaged social development goals. Two case studies were also examined. Results indicate that organizations managing hydroelectric initiatives in Brazil can provide the pathway towards achieving a number of important social benefits. Successful projects were found to have good community involvement and were managed by both cooperative ventures and money making corporations. The research also identified several challenges that are hindering hydro CDM projects from delivering more social benefits, and enabled a number of recommendations to be extracted for the organizations facing these challenges.

Materialidad poética: arquitectura suiza en el entorno de los Grisones 1992-2004

El entorno alpino de los Grisones ha sido un laboratorio donde experimentar un método arquitectónico procedente de diversas fuentes durante los años 70 en la ETHZ. Este método ha producido durante las últimas tres décadas un discurso teórico propiamente suizo alemán. La tradición continúa siendo un valor cultural para la comunidad alpina de los Grisones, que apuesta por seguir relacionando la arquitectura con su historia y su paisaje. La especificidad de cada entorno suizo alemán es un hecho obvio pero, por encima de sus rasgos característicos, hay un denominador común que les da unidad en silencio: se trata de una idea de la construcción. El fenómeno de los Grisones es territorial en su localización concreta, pero comparte el trasfondo teórico del resto de la arquitectura suizo alemana reciente. La tesis recorre transversalmente las condiciones que han dado lugar a esa trayectoria común hasta la actualidad, en que la arquitectura suizo alemana se halla precisamente en un momento de cambio generacional. La obra de Peter Märkli constituye en esta tesis un paradigma de la voluntad suizo alemana por formar parte de la continuidad cultural de la arquitectura, como una actitud de resistencia compartida frente al mundo globalizado. La tesis se articula a partir de ocho proyectos recientes, realizados por arquitectos suizo alemanes en el entorno del territorio alpino de los Grisones. Estos proyectos condensan la trayectoria arquitectónica suizo alemana durante el siglo XX, así como el fenómeno arquitectónico que ha tenido lugar en el entorno de los Grisones durante las últimas tres décadas. La tesis analiza a través de cada pareja de proyectos los episodios teóricos, artísticos y filosóficos más relevantes que se sintetizan en estas obras, así como sus referentes arquitectónicos y la dimensión trascendente de los materiales en los que la cultura suiza hunde sus raíces: la madera, la piedra y el hormigón. Las vanguardias pictóricas, el Movimiento Moderno y las corrientes humanistas y regionalistas que se fueron sucediendo durante el pasado siglo, configuran el escenario en el que tomó cuerpo la sensibilidad arquitectónica suizo alemana reciente, que emerge a través de la compleja red de relaciones establecidas entre el panorama suizo y el internacional. El mismo bagaje teórico subyace al territorio suizo alemán a nivel general, por lo que asociarlo a través de esta tesis a proyectos realizados en un entorno característico, permite acceder a una realización concreta de ese debate en un entorno tan particular como son los Grisones. La aproximación a los proyectos es de carácter fenomenológico: la experiencia directa de los mismos ha sido el sustrato fundamental del enfoque de la tesis. El trabajo de campo no se limitó a visitar los proyectos que vertebran la tesis, sino que trató de abarcar las obras más relevantes de la producción suizo alemana reciente en los Grisones, con el fin de adquirir cierto grado de sensibilidad perceptiva hacia la singularidad de su identidad territorial. La tesis hace especial hincapié en las obras de Peter Märkli y Peter Zumthor, representantes de los dos extremos del discurso suizo alemán reciente, respecto a la materialidad y al carácter de la secuencia espacial, sistemático o fluido respectivamente, pero que asimismo comparten el clasicismo formalista que subyace al fenómeno suizo alemán. Los dos proyectos que establecen el periodo 1992-2004 explorado por esta investigación constituyen dos hitos fundamentales. El Museo de La Congiunta en Giornico de Peter Märkli se construyó en 1992 y se erige a partir de entonces como un icono arquitectónico de la condensación típicamente suizo alemana de base reductiva. Este paradigma de síntesis conceptual y constructiva comenzó a forjarse en la década de 1930 de la mano del Konkrete Kunst formulado por Max Bill, que es la única manifestación artística genuinamente suiza del siglo XX y que desarrolló pictóricamente los valores de precisión, rigor, racionalismo y abstracción afines a la sensibilidad suizo alemana. En segundo lugar, el proyecto para la rehabilitación de la Villa Garbald y la construcción de la Torre Roccolo en Castasegna llevado a cabo por Miller & Maranta en 2004, supuso la consumación de la Analoge Architektur, que fue la primera corriente arquitectónica propiamente suiza, desarrollada durante la década de 1980 por Miroslav Sik. La Deutscher Tendenza es un periodo de la trayectoria suizo alemana reciente poco conocido, representado por una figura tan relevante como es Peter Zumthor. Las obras que proyectó Zumthor entre 1979 y 1985 forman parte de un periodo en que el arquitecto se encontraba profundamente influido por el neorracionalismo italiano, como ilustra la escuela de Churwalden de 1983. La arquitectura suizo alemana reciente exploró sistemáticamente los sistemas compositivos de las vanguardias pictóricas y del Movimiento Moderno, por encima de su formalismo concreto. La segunda fase de la obra de Zumthor entre 1985 y 1996 se caracteriza por la transfiguración del plano libre del sistema compositivo neoplasticista desarrollado por De Stijl, plano que adquirió grosor hasta convertirse en la caja articuladora de la fluidez de la secuencia espacial. El formalismo de Zumthor en esta fase implica la prioridad del esquema compositivo, compuesto por un perímetro regular en el que se reúnen las cajas que, como las superficies de color de las composiciones de Mondrian, articulan el espacio a su alrededor. La Residencia de Masans de Zumthor de 1993 es un proyecto canónico de este sistema compositivo, que culmina en el esquema radial de las Termas de Vals de 1996. La imagen poética se convirtió en el lenguaje propio del pensamiento de la arquitectura suizo alemana, que permitía una reflexión no verbal, a partir de unos pocos arquetipos fundamentales. Los arquitectos del Ticino buscaron en la Tendenza italiana durante la década de 1970 una alternativa al insostenible modelo territorial que estaba destruyendo su paisaje cultural. Algunos de estos arquitectos comenzaron a dar clase durante esa década en la ETHZ, por lo que transmitieron sus inquietudes al alumnado e introdujeron a Aldo Rossi en la facultad, que era uno de los máximos representantes de la Tendenza. El método analógico de Rossi, basado en la psicología analítica de Carl Jung, fue una influencia fundamental en la ETHZ durante los años 70. Rossi partía de una teoría afín al colectivo intelectual suizo que los arquitectos de la ETHZ pronto comprendieron que debían independizar del contexto italiano, desarrollando su propio método a partir de 1985 con la Analoge Architektur. El valor de la preexistencia de acuerdo a este método incipiente se hallaba en su papel articulador de la continuidad cultural de una comunidad, que Miroslav Sik definió a partir de su concepto de Altneue (literalmente, lo Nuevo-Viejo). La fusión entre lo nuevo y lo viejo era la base de la espontaneidad con la que habían crecido los asentamientos históricamente. Sik consideraba que la continuidad dependía de la comprensión de los patrones preexistentes, con el objeto de mantener su vigencia mediante la incorporación de estrategias contemporáneas, que renovarían su significado sin perder su esencia. La Casa Gugalun en Versam de Zumthor de 1994 supone una aproximación a escala doméstica a este planteamiento. La arquitectura suizo alemana reciente a menudo busca en sus referentes plásticos una manera de explorar ámbitos poco accesibles para la disciplina arquitectónica. El pensamiento arquitectónico basado en la imagen poética se implementa a partir de la tectónica de la construcción, que es el medio para comunicar una idea vertebradora del proyecto de principio a fin. La construcción como medio introduce el concepto clave de la apariencia de la arquitectura, estrechamente relacionado con la filosofía idealista de Friedrich Schiller. La apariencia debe expresar el sentido conceptual de la obra, que los arquitectos suizo alemanes denominan idea, por lo que la construcción no tiene un valor por sí misma, sino en cuanto a la apariencia. La Capilla de Oberrealta de Christian Kerez de 1993 puede ser considerada una obra escultórica en el paisaje, más próxima a las artes plásticas que a la arquitectura. La tensión que surge entre la figura ideal y la pieza sometida a una sutil deformación confiere un carácter dinámico a la composición, que intensifica el efecto perceptivo, de acuerdo a la teoría del pensamiento visual de Rudolph Arnheim. La deformación al servicio de la psicología de la percepción es un fenómeno que caracteriza la arquitectura suizo alemana reciente. El concepto de Forme Forte (forma fuerte) fue introducido por Martin Steinmann para caracterizar el objeto arquitectónico denominado internacionalmente Swiss Box. Este concepto se caracteriza por una predilección por lo monolítico, lo unitario y lo arquetípico. La condición más sustancial de una Forme Forte es, sin embargo, la de configurar un elemento estructurador del entorno. Tanto la base morfológica de una Forme Forte, como su capacidad para estructurar el lugar, se corresponden con los conceptos de arquetipo y monumento de la teoría de Rossi. La tesis explora el sentido de la deformación en la producción suizo alemana reciente, a partir de la Escuela de Paspels de Valerio Olgiati de 1998 y la Torre Roccolo de Villa Garbald de Miller&Maranta de 1998. La teoría tectónica de Gottfried Semper y la razón de la forma de Adolf Loos constituyen el sustrato teórico, que relaciona la actividad existencial de habitar con la materialidad de la arquitectura suizo alemana reciente. La teoría tectónica de Semper fundamenta las revisiones posteriores de los sistemas constructivos tradicionales suizo alemanes. Esta influencia sirvió como base a la vanguardia suiza de la Neues Bauen, que desarrolló un racionalismo funcionalista durante las décadas de 1920 y 1930, que constituye una gramática de base no simbólica. Esta gramática constituye el fundamento de la transición del orden clásico a la materialidad como instrumento compositivo durante la segunda mitad del siglo XX, consolidando el concepto de la base material de la forma. La revisión de la tradición regionalista y racionalista llevada a cabo por la generación de arquitectos suizo alemanes de la década de 1950 y 1960, constituyó una investigación lingüística sustancial. Rudolph Olgiati es la figura determinante de este periodo. La revisión de esta investigación se codificó en clave estructuralista durante los años 70 en la ETHZ, influenciada por la presencia de Roland Barthes como profesor invitado. Esta revisión constituyó la base de la articulación tectónica propiamente suizo alemana todavía vigente, como ilustra expresamente la obra de Burkhalter&Sumi en esta tesis. La obra de Gion Caminada en Vrin entre 1995 y 2002 aporta una intensa investigación sobre el Strickbau, que implementa una y otra vez variaciones sobre un sistema tradicional, ilustrando las infinitas posibilidades que ofrece un lenguaje, paradójicamente limitado por los medios disponibles en un entorno alpino aislado. Para terminar Jürg Conzett es el ingeniero con el que han desarrollado sus proyectos la mayoría de los arquitectos en el entorno de los Grisones, formado durante 8 años con Zumthor y colaborador habitual de Caminada entre otros. Conzett es el referente que relaciona la ingeniería con la arquitectura en el ámbito de esta tesis, imprescindible en el contexto de esta investigación. ABSTRACT The Alpine setting of Grisons has been a laboratory for architectural experimentation with an approach forged in the 1970s from various sources in the Swiss Federal Institute of Technology in Zurich (ETHZ). This method has produced a uniquely German-Swiss theoretical discourse over the past three decades. Tradition continues to be a cultural value for Grisons, a region committed to continue linking its architecture with the region’s history and landscape. The specificity of the German-Swiss environment is obvious, but beyond its characteristic features, there is a common denominator that gives these settings a silent unity: it is an idea of building. The phenomenon of Grisons is geographic in its specific location, but it shares the theoretical basis of the rest of the new German-Swiss architecture. This thesis transversely delves into the conditions that have shaped this common path up to the present, just as German-Swiss architecture is going through a time of generational change. In this thesis, Märkli Peter's work constitutes a paradigm of the German-Swiss will to uphold the cultural and architectural continuity of the region, exemplifying an attitude of shared resistance to the globalized world. The thesis is structured around eight recent projects carried out by German-Swiss architects in the Alpine region of Grisons. These projects represent the trajectory of twentieth century German-Swiss architectural history, as well as the architectural phenomenon that has taken place in the environs of Grisons over the past three decades. Through these projects the thesis analyzes the most relevant theoretical, artistic and philosophical references that are synthesized in the works, as well as their architectural references and the transcendental dimension of the materials in which Swiss culture is rooted: wood, stone and concrete. The artistic avant-garde, together with Modernism and the humanistic and regional movements that occurred during the last century, set the stage for present-day German-Swiss architectural sensitivity, which emerges from a complex web of relationships established between the Swiss and international panorama. This same theoretical background and experience underlies all of the German-Swiss territory in general, so associating it through this thesis to a particular context allows the description of a specific embodiment of this debate, within the unique environment of Grisons. The methodological approach to analyzing the projects was phenomenological: direct experience is the main substrate underpinning the focus of the thesis. Field work was not limited to visiting the projects featured in the thesis, but rather encompassed the most important works of recent German-Swiss construction in the Grisons in order to gain some degree of perceptual sensitivity to the uniqueness of its territorial identity. The present paper puts special emphasis on the works of Peter Märkli and Peter Zumthor, who share the formal classicist perspective of the German-Swiss context but stand on opposite sides of the philosophical spectrum with regard to the notion of materiality and the nature of space, which they conceive as systematic or fluid, respectively. The two projects that establish the boundaries of the time period 1992–2004 explored by this research represent two key milestones. The Museum La Congiunta in Giornico, by Peter Märkli, was built in 1992 and quickly established itself as an architectural icon of German-Swiss reductionism. This paradigm of conceptual and constructive synthesis began to take shape in the 1930s under the banner of Konkrete Kunst (Concrete Art), led by Max Bill. The only genuinely Swiss artistic movement of the twentieth century, Konkrete Kunst was characterized by the artistic values of precision, rigor, rationalism and abstraction, sentiments that were very close to the German-Swiss tradition. Secondly, the project for the rehabilitation of Villa Garbald and the construction of the Roccolo Tower in Castasegna, conducted by Miller&Maranta in 2004, represented the consummation of the Analoge Architektur, which was the first truly Swiss architectural movement, spearheaded in the 1980s by Miroslav Sik. The Deutscher Tendenza is a little-known period of recent German-Swiss history, represented by the important figure of Peter Zumthor. The projects that Zumthor led between 1979 and 1985 are part of a period when Italian Neo-Rationalism exercised a profound influence on the architect, as illustrated by the Churwalden School, circa 1983. Recent German-Swiss architecture systematically explored the compositional systems of the artistic avant-garde and Modernism, beyond its specific formal aspects. The second phase of Zumthor's work, between 1985 and 1996, is characterized by the transfiguration of the free plane, neoplastic compositional system developed by De Stijl, a plane that thickened until it became the box articulating fluidity from the spatial sequence. Zumthor's formalism in this phase prioritizes the compositional scheme, consisting of a regular perimeter in which the boxes that -like Mondrian’s colored surfaces- arrange the space around it. Zumthor’s Masans Residence, circa 1993, is a canonical project of this compositional system, which culminates in the radial pattern of the Therme Vals, circa 1996. The poetic image became the appropriate language of thought for German-Swiss architecture, which invited a nonverbal reflection inspired by a few fundamental archetypes. The architects of Ticino sought, through the Italian Tendenza of the 1970s, an alternative to the unsustainable territorial model that was destroying their cultural landscape. Some of these architects began to teach during that decade at ETHZ, and naturally they transmitted their unease to their students. These architects also introduced Aldo Rossi, one of the leading representatives of the Tendenza, to the school. Rossi’s analogue method, based on the analytical psychology of Carl Jung, was a major influence on the ETHZ during the 1970s. Rossi’s theoretical grounding was very much in tune with Swiss intellectualism, and it did not take long for architects from ETHZ to realize that they should break away from the Italian context, developing their own method from 1985 on with the Analoge Architektur. The value of the pre-existing conformity of this emerging method, stemmed from its role in facilitating the cultural continuity of a community, which Miroslav Sik defined in his concept of Altneue (literally, Old-new). This fusion of old and new was the basis for the spontaneity with which settlements had historically grown. Sik considered that continuity depended on understanding the existing patterns and sustaining their relevance through the incorporation of contemporary strategies, which would renew their meaning without losing their essence. Zumthor’s Gugalun House in Versam, circa 1994, is a domestic-scale approach to this philosophy. Modern German-Swiss architecture often looks to its references in visual art for a way to explore areas that are normally inaccessible to the architectural discipline. Architectural thinking based on the poetic image is achieved through a building’s tectonics, which communicate the core idea of a project from start to finish. The understanding of construction as a medium introduces the key concept of the appearance in architecture, closely related to the idealistic philosophy of Friedrich Schiller. The appearance should express the conceptual meaning of the work, which German-Swiss architects call the idea, so that the building does not have value in and of itself, but only in terms of its appearance. The Oberrealta Chapel by Christian Kerez, circa 1993, can be considered a sculpture in the landscape, closer to the visual arts than to architecture. The tension that arises between the ideal figure and the piece subjected to a subtle deformation confers a dynamic character onto the composition, intensifying the perceptual effect, according to Rudolf Arnheim’s theory of visual thought. The deformation in the service of the psychology of perception is a phenomenon that characterizes recent German-Swiss architecture. Martin Steinmann introduced the Forme Forte (Strong Form) concept to describe the architectural object known internationally as the Swiss Box. This concept is characterized by a predilection for all things monolithic, unitary and archetypal. The most substantial condition of a Forme Forte, however, is the configuration of a structuring element in the environment. Both the morphological basis of a Forme Forte and its ability to frame the place, correspond to the concepts of archetype and monument put forward by Rossi’s theory. The present thesis explores the sense of deformation in recent German-Swiss production, based on the School of Paspels by Valerio Olgiati, circa 1998 and the Roccolo Tower in Villa Garbald, by Miller&Maranta, circa 1998. Gottfried Semper’s tectonic theory and Adolf Loos’s reason for form constitute the theoretical foundation that links the existential activity of dwelling to the materiality of recent German-Swiss architecture. Semper’s tectonic theory laid the foundation for subsequent revisions of the German-Swiss traditional building systems. This influence was the basis for the Swiss avant-garde of Neues Bauen, which developed a functional rationalism during the 1920s and 30s that served as a non-symbolic grammatical foundation for the transition from classical order to materiality as a compositional tool. During the second half of the twentieth century, this architectural grammar helped consolidate the concept of the material base of the form. The revision of the regionalist and rationalist tradition, carried out by the generation of German-Swiss architects of the 1950s and 60s, constituted a substantial linguistic investigation. Rudolph Olgiati is the key figure of this period. The research was codified in terms of structuralism in the 1970s in ETHZ and influenced by the presence of Roland Barthes as a visiting professor. This revision was the basis of the uniquely German-Swiss tectonic design still in use today, as specifically illustrated by the work of Burkhalter & Sumi in this thesis. Gion Caminada's work in Vrin between 1995 and 2002 offers an extensive study on the Strickbau, which implements variations on a traditional system again and again, illustrating the endless possibilities of a language that paradoxically seems limited by the available resources in a remote Alpine setting. Finally, Jürg Conzett is the engineer with whom most architects in the Grisons region have developed their projects. Trained under Zumthor for 8 years, and a regular collaborator of Caminada, among others, Conzett is the reference point linking engineering with architecture in this thesis, essential in the context of this research.

Innovation projects performance: Analyzing the impact of organizational characteristics

This study analyzes the effect of organizational characteristics on the innovation project performance. This research applies fuzzy set Qualitative Comparative Analysis (fsQCA) to a large sample of Spanish firms appearing in the Community Innovation survey (CIS). The results show that the combination of organizational innovation, firm size and cooperationwith national and, especially, international firms is a sufficient condition for the success of innovation projects within the organization. Evidence also suggests that variables such as the investment on R&D peremployee or the seniority of the company do not affect the success of innovation projects. These findings help complement some results in previous studies on innovation projects performance.

Genome projects and gene pools: New germplasm for plant breeding?

Crop gene pools have adapted to and sustained the demands of agricultural systems for thousands of years. Yet, very little is known about their content, distribution, architecture, or circuitry. The presumably shallow elite gene pools often continue to yield genetic gains while the exotic pools remain mostly untapped, uncharacterized, and underutilized. The concept and content of a crop’s gene pools are being changed by advancements in plant science and technology. In the first generation of plant genomics, DNA markers have refined some perceptions of genetic variation by providing a glimpse of a primary source, DNA polymorphism. The markers have provided new and more powerful ways of assessing genetic relationships, diversity, and merit by infusing genetic information for the first time in many scenarios or in a more comprehensive manner for others. As a result, crop gene pools may be supplemented through more rapid and directed methods from a greater variety of sources. Previously limited by the barriers of sexual reproduction, the native gene pools will soon be complemented by another gene pool (transgenes) and perhaps by other native exotic gene pools through comparative analyses of plants’ biological repertoire. Plant genomics will be an important force of change for crop improvement. The plant science community and crop gene pools may be united and enriched as never before. Also, the genomes and gene pools, the products of evolution and crop domestication, will be reduced and subjected to the vagaries and potential divisiveness of intellectual property considerations. Let the gains begin.

Exploring mindfulness as a culturally sensitive intervention for the Deaf community

Mental health issues are as prevalent in the deaf community as the hearing community, if not more. Yet, Deaf individuals are often treated by mental health professionals less frequently and less effectively. Many systemic barriers exist that influence the lack of services provided to the Deaf community, primarily related to a lack of cultural understanding rooted in perceptions of Deaf individuals. However, the Deaf community may be best understood as a cultural minority, a unique community sharing a distinct culture, history, and language. This paper investigates the effects of systematic barriers and cultural misunderstanding among mental health professions regarding the Deaf community, explores the historical and current mental health problems Deaf individuals most commonly struggle with, and proposes a potential culturally sensitive intervention for the Deaf community based on these factors. To examine these issues, the author conducted a thorough review of Deaf cultural history and values, as well as a review of peer-reviewed articles regarding both Deaf mental health and mindfulness outcome studies. Based on this review, mindfulness may be an effective, culturally sensitive intervention that addresses both cultural and psychological components while working with the Deaf population.

Psychosocial Distress Screening in a Community Cancer Center: An Examination of Gender Differences

Objective: The aim of this study was to gain a better understanding of the needs of male and female oncology patients within a community cancer setting to inform the provision of psychosocial services. Data obtained from 835 single-page measures of oncology patient distress were collected and analyzed to examine the relationship between gender and reported level of distress, the source of this distress, and requests for follow-up from psychosocial service providers.Method: Patients in medical and radiation oncology were given a distress screener tool that included a distress thermometer, a problem checklist, and a list of psychosocial service providers with whom the patient could request to speak.Results: Women reported higher levels of distress than men (p=.003). Women were also more likely than men to endorse practical problems as the cause of their distress (p=.003). A marginally significant relationship between gender and requesting the cancer resource navigator was also found (p=. 059)Conclusion: Gender is a salient factor in reported distress among cancer patients. Although no single variable can entirely explain an individual's response to cancer, male and female patients do appear to have distinctive, gender-specific needs. Psychosocial interventions that account for differences related to gender-role may be particularly beneficial. These results also illustrate the utility of consistent screening practices to better understand and meet the psychosocial needs of oncology

Psychosocial Distress Screening in a Community Cancer Center: An Exploratory Study of Distress Screening Across the Cancer Treatment Continuum

Purpose: The primary goal of this exploratory study is to demonstrate that distress screening across the course of cancer treatment is possible and provides valuable information about patient needs over time. Distress screening is aligned with guidelines from national accrediting organizations and may lead to improved health-related quality of life, satisfaction with medical care, and possibly survival.Methods: Medical, surgical, and radiation oncology patients completed a screening instrument before their appointments during a six-month period. Patients indicated their level of distress on four domains (practical, emotional, health and social concerns). De-identified data was collected, aggregated and descriptive statistics were analyzed.Results: Approximately 3000 screens were collected and 1500 cancer patients were screened. Of patients who indicated distress, 54% demonstrated a distress level of five or greater. Distress level eight was the most frequent level of distress indicated. The Cancer Dietitian was the most commonly requested healthcare team provider. The Health Concern domain was most frequently endorsed.Conclusion: NCCN, IOM and COC guidelines recommend distress screening in all cancer treatment centers, however implementation has proven difficult. This study adds to the literature about distress in cancer patients, demonstrates the feasibility of repeated distress screening and provides a model program demonstrating the implementation of repeated distress screening at a community cancer center. Findings highlight the importance of supportive oncology services due to the prevalence of high levels of distress. Findings demonstrate the importance of the Cancer Dietitian in supportive cancer care. Additionally, the research reveals a potential perceived stigma in seeking psychosocial oncology services.

DUI program as OEF/OIF Veterans Outreach: Descriptive Data from Two Community-Based Outpatient Clinics

Although initially conceived as providing simply the preventive portion of an extended continuum of care for veterans, the Driving Under the Influence (DUI) program has turned out to be an important outreach service for active duty or recently discharged OEF/OIF (Operation Enduring Freedom/Operation Iraqi Freedom) veterans. Veterans receive empirically-based, state-mandated education and therapy under the only Department of Veterans Affairs (VA) - sponsored DUI program in the State of Colorado, with the advantage of having providers who are sensitive to symptoms of Post-Traumatic Stress Disorder (PTSD) and other relevant diagnoses specific to this population, including Traumatic Brain Injury (TBI). In this paper, the rapid growth of this program is described, as well as summary data regarding the completion, discontinuation, and augmentation of services from the original referral concern. Key results indicated that for nearly one third (31.9%) of the OEF/OIF veterans who were enrolled in the DUI program, this was their initial contact with the VA health care system. Furthermore, following their enrollment in the DUI program, more than one fourth (27.6%) were later referred to and attended other VA programs including PTSD rehabilitation and group therapy, anger management, and intensive inpatient or outpatient dual diagnosis programs. These and other findings from this study suggest that the DUI program may be an effective additional pathway for providing treatment that is particularly salient to the distinctive OEF/OIF population; one that may also result in earlier intervention for problem drinking and other problems related to combat. Relevant conclusions discussed herein primarily aim to improve providers' understanding of effective outreach, and to enhance the appropriate linkages between OEF/OIF veterans and existing VA services.