Factors affecting emergency department length of stay of patients admitted to telemetry and critical care units

The purpose of this study was to determine the emergency department (ED) length of stay (LOS) of patients admitted to inpatient telemetry and critical care units and to identify the factors that contribute to a prolonged ED LOS. It also examined whether there was a difference in ED LOS between clients evaluated by an ED physician, an Advanced Registered Nurse Practitioner (ARNP) or a Physician's Assistant (PA).^ A data collection tool was devised and used to record data obtained by retrospectively reviewing 110 charts of patients from this sample. The mean ED LOS was 286.75 minutes. Multiple factors were recorded as affecting the ED LOS of this sample, including: age, diagnosis, consultations, multiple radiographs, pending admission orders, nurse unable to call report/busy, relatives at bedside, observation or stabilization necessary, bed not ready and infusion in progress. No significant difference in ED LOS was noted between subjects initially evaluated by a physician, an ARNP or a PA. ^

The relationship between self-esteem and job performance

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

Consumer (dis)satisfaction response to disconfirmation: An examination of the form and the underlying process

The purpose of this dissertation was to examine the form of the consumer satisfaction/dissatisfaction (CS/D) response to disconfirmation. In addition, the cognitive and affective processes underlying the response were also explored. ^ Respondents were provided with information from a prior market research study about a new brand of printer that was being tested. This market research information helped set prior expectations regarding the print quality. Subjects were randomly assigned to an experimental condition that manipulated prior expectations to be either positive or negative. Respondents were then provided with printouts that had performance quality that was either worse (negative disconfirmation) or better (positive disconfirmation) than the prior expectations. In other words, for each level of expectation, respondents were assigned to either positive or negative disconfirmation condition. Subjects were also randomly assigned to a condition of either a high or low level of outcome involvement. ^ Analyses of variance indicated that positive disconfirmation led to a more intense CS/D response than negative disconfirmation, even though there was no significant difference in the intensity for positive and negative disconfirmation. Intensity of CS/D was measured by the distance of the CS/D rating from the midpoint of the scale. The study also found that although outcome involvement did not influence the polarity of the CS/D response, the more direct measures of processing involvement such as the subjects' concentration, attention and care in evaluating the printout did have a significant positive effect on CS/D intensity. ^ Analyses of covariance also indicated that the relationship between the intensity of the CS/D response and the intensity of the disconfirmation was mediated by the intensity of affective responses. Positive disconfirmation led to more intense affective responses than negative disconfirmation. ^

Web-based report generators, data visualization, and Web-to-database connectivity

Because some Web users will be able to design a template to visualize information from scratch, while other users need to automatically visualize information by changing some parameters, providing different levels of customization of the information is a desirable goal. Our system allows the automatic generation of visualizations given the semantics of the data, and the static or pre-specified visualization by creating an interface language. We address information visualization taking into consideration the Web, where the presentation of the retrieved information is a challenge. ^ We provide a model to narrow the gap between the user's way of expressing queries and database manipulation languages (SQL) without changing the system itself thus improving the query specification process. We develop a Web interface model that is integrated with the HTML language to create a powerful language that facilitates the construction of Web-based database reports. ^ As opposed to other papers, this model offers a new way of exploring databases focusing on providing Web connectivity to databases with minimal or no result buffering, formatting, or extra programming. We describe how to easily connect the database to the Web. In addition, we offer an enhanced way on viewing and exploring the contents of a database, allowing users to customize their views depending on the contents and the structure of the data. Current database front-ends typically attempt to display the database objects in a flat view making it difficult for users to grasp the contents and the structure of their result. Our model narrows the gap between databases and the Web. ^ The overall objective of this research is to construct a model that accesses different databases easily across the net and generates SQL, forms, and reports across all platforms without requiring the developer to code a complex application. This increases the speed of development. In addition, using only the Web browsers, the end-user can retrieve data from databases remotely to make necessary modifications and manipulations of data using the Web formatted forms and reports, independent of the platform, without having to open different applications, or learn to use anything but their Web browser. We introduce a strategic method to generate and construct SQL queries, enabling inexperienced users that are not well exposed to the SQL world to build syntactically and semantically a valid SQL query and to understand the retrieved data. The generated SQL query will be validated against the database schema to ensure harmless and efficient SQL execution. (Abstract shortened by UMI.)^

Political economy of Caribbean drug trafficking: The case of the Dominican Republic

The purpose of this dissertation was to examine the relationship between narcotics trafficking and the processes of economic liberalization and democratization in the Caribbean. The salient social, political and economic processes were explored at each juncture of the drug trafficking chain to determine why certain groups and locales became integrated in the global narcotics economy. It also considered the national security implications of the global narcotics economy. ^ The Global Commodity Chain framework allowed the study to examine the social, political and economic processes that determine how a commodity is produced, transported, distributed and consumed in the global economy. A case study method was used to specify the commodity (cocaine) and locations (U.S. and Dominican Republic) where these processes were examined. ^ The important contributing factors in the study included: a liberalizing global economy, the social processes of migration, the formation of enclaves in the U.S., the opening of the political process and institutional weakness in the country of origin. All of these factors contributed to the Dominican Republic and Dominican migrants becoming key players in the cocaine commodity chain. It concluded that narcotics trafficking as a national security issue remains a fluid concept, contingent on specific cultural and historic antecedents. ^

Managerial work roles of health care executives in the changing environment of academic medical centers

The current U.S. health care system faces numerous environmental challenges. To compete and survive, health care organizations are developing strategies to lower costs and increase efficiency and quality. All of these strategies require rapid and precise decision making by top level managers. The purpose of this study is to determine the relationship between the environment, made up of unfavorable market conditions and limited resources, and the work roles of top level managers, specifically in the settings of academic medical centers. Managerial work roles are based on the ten work roles developed by Henry Mintzberg, in his book, The Nature of Managerial Work (1973). ^ This research utilized an integrated conceptual framework made up of systems theory in conjunction with role, attribution and contingency theories to illustrate that four most frequently performed Mintzberg's work roles are affected by the two environment dimensions. The study sample consisted of 108 chief executive officers in academic medical centers throughout the United States. The methods included qualitative methods in the form of key informants and case studies and quantitative in the form of a survey questionnaire. Research analysis involved descriptive statistics, reliability tests, correlation, principal component and multivariate analyses. ^ Results indicated that under the market condition of increased revenue based on capitation, the work roles increased. In addition, under the environment dimension of limited resources, the work roles increased when uncompensated care increased while Medicare and non-government funding decreased. ^ Based on these results, a typology of health care managers in academic medical centers was created. Managers could be typed as a strategy-formulator, relationship-builder or task delegator. Therefore, managers who ascertained their types would be able to use this knowledge to build their strengths and develop their weaknesses. Furthermore, organizations could use the typology to identify appropriate roles and responsibilities of managers for their specific needs. Consequently, this research is a valuable tool for understanding health care managerial behaviors that lead to improved decision making. At the same time, this could enhance satisfaction and performance and enable organizations to gain the competitive edge . ^

Factors affecting the nodulation and growth of tropical woody legume seedlings

This study surveys the occurrence of nodulation in woody legume species in Panamá and Costa Rica, describes nodule and root characteristics, and researches host-bacteria specificity, nodulation potential of soils, and the effects of light, added nitrogen, and rhizobia and VA mycorrhizal fungi inoculation on seedling growth. I examined 83 species in 37 genera and found 80% to be nodulated. Percent nodulated species in the Caesalpinioideae, Mimosoideae, and Papilionoideae was 17, 95, and 86, respectively, with no correlation between nodule morphology and tribal classification. Nodules formed mainly at root branch points which supports epidermal breaks as an important rhizobia infection route. More non-nodulated than nodulated species had root hairs. Several species emitted volatile sulfur-containing compounds, including the toxic compound ethylmercaptan, from roots, germinating seeds, and other tissues. These emissions may have an allelopathic action against pathogens, predators, or other plants. In contrast to the general non-specificity of most legumes for rhizobia, Mimosa pigra L. was highly specific and only nodulated in flooded soils. This species' specificity, combined with a limited occurrence of its root nodule bacteria may limit its natural distribution, but its spread as an invasive weed is facilitated when fill material from rivers is deposited in other areas. ^ An experimental light level of 1.5% of full sun completely inhibited seedling nodulation, as do similar naturally low levels in forest understory. In the forest, trees and seedlings were not nodulated. in some soils with suspected high N content. For six experimental species, added N progressively increased seedling growth while decreasing nodule biomass; at the highest level of added N nodulation was completely suppressed. Species and individuals showed variation in nodule biomass at high N applications which may indicate an opportunity for genetic selection for optimal N acquisition. Rhizobia inoculation had a small positive effect on seedling shoot growth, but VA mycorrhiza inoculation overwhelmingly increased seedling size, biomass, and leaf mineral concentration. In lowland tropical forest, VA mycorrhizal colonization appears indispensable for legume nodulation because of the fungus' ability to supply P in deficient soils. This requirement makes the legume-rhizobia-mycorrhiza association obligately tripartite. ^

A phenomenology of crack abuse

The aim of this dissertation is to identify, describe, and explain the common experiences defining the crack abuser's life-world. Its method is phenomenological. Using basic cybernetic premises, a neurophysiologically oriented phenomenological framework concerning the constitution of thoughts, memories, and perceptions is first written. The framework is designed to hypothetically represent the neuropathology of crack abuse within a perspective that prescinds and describes the constitution, flow, and interdependence of experience. After the framework is written, the dissertation outlines the neuro-psychopharmacology of crack abuse and delimits crack abusers as a specific group within the more general population of cocaine users. It then represents the neuropathology of crack abuse within its phenomenological framework and uses the first-person accounts of forty-two crack dependents to actualize a phenomenological sketch of the crack abuser's life-world. The ethnographies afford the possibility of writing a “thick” description of the crack abuser's daily life—one that communicates the substance, order, and subjective and cultural dimensions of the dependent's defining experiences. ^ The dissertation's goals are successfully realized. The framework written and the ethnographies recorded and transcribed, the dissertation is able to identify, describe, and to a certain extent explain some of the common experiences defining the crack abusers life-world. The dissertation concludes that the crack abuser's life-world is organized around three primary and four secondary experiences. His primary experiences include: (1) an almost complete, yet fleeting, satisfaction of the ego's innate insufficiency and sublime, erotic-like stimulation of its core, (2) a fundamental inclination and expansion of the uniquely oriented euphoria-dysphoria dynamic that vivifies and orients the flow of consciousness, and (3) a change in the ego's innate structure. His secondary experiences include: (a) a characteristic aiming of projects, actions, and conduct toward the procurement and consumption of crack, (b) a denigration in the hold of legitimations and institutionalizations on the thematic field, (c) a strict alignment and a contraction in the scope of logical types pointing to the salient experiences within the stock of knowledge, and (d) for some crack abusers, ontological insecurity, despair, and exhaustion. ^

A comparison of the academic performance of students with General Educational Development credentials and high school diplomas at a selected community college

This study compared the performance of students who earned GED credentials in Florida with that of graduates of Florida high schools, when members of both groups enrolled for the first time in fall 1992 at an urban multicultural community college in south Florida. GED's and HSD's were matched on gender, race, age range, placement levels, and enrollment in college preparatory courses (reading, English, mathematics). The paired samples t-test compared course grades, first semester GPA, and total college GPA for the groups and subgroups of matched students at a probability level of .05. The McNemar test compared how many students in each group and subgroup re-enrolled for a second and third term, or ever; how many were placed on special academic status during their college enrollment; and how many graduated within 16 semesters. Differences between groups were found only for placement on probation—with HSD's on probation in significantly higher proportion than GED's. ^ Additional findings among subgroups revealed that male and Caucasian HSD subjects earned higher math grades than their GED counterparts. Male HSD's were more likely than male GED's to return to the college at some point after the first term. However, male HSD's were placed on probation in greater proportion than the GED's with whom they were matched. ^ Female GED's earned higher English grades and higher first semester and cumulative GPA's and returned to the college in greater proportion than their HSD counterparts. Black GED's earned higher first-semester GPA's, re-enrolled in terms 2 and 3 and graduated from the college in higher percentages than Black HSD's. Black HSD's were placed on probation in higher proportion than Black GED's. Lastly, greater percentages of HSD than GED subjects in the lowest age range (16–19) were placed on probation. ^ Results connected to the performance of Black GED subjects are likely to have been affected by the fact that 50% of Black study subjects had been born in Jamaica. The place of the GED in the constellation of methods for earning credit by examination is explored, future implications are discussed, and further study is recommended. ^

Globalization of the Internet: Convergence or a multicultural community?

The purpose of this dissertation was to investigate cross-cultural differences in the use of the Internet. Hofstede's model of national culture was employed as the theoretical foundation for the analysis of cross-cultural differences. Davis's technology acceptance model was employed as the theoretical foundation for the analysis of Internet use. ^ Secondary data from an on-line survey of Internet users in 22 countries conducted in April 1997 by the Georgia Tech Research Corporation measured the dependent variables of Internet use and the independent variables of attitudes toward technology. Hofstede's stream of research measured the independent variables of the five dimensions of national culture. ^ Contrary to expectations, regression analyses at the country level of analysis did not detect cultural differences. As expected, regression analyses at the individual level of analysis did detect cultural differences. The results indicated that perceived usefulness was related to the frequency of Internet shopping in the Germanic and Anglo clusters, where masculinity was high. Perceived ease of use was related to the frequency of Internet shopping in the Latin cluster, where uncertainty avoidance was high. Neither perceived usefulness nor perceived ease of use was related to the frequency of Internet shopping in the Nordic cluster, where masculinity and uncertainty avoidance were low. ^ As expected, analysis of variance at the cluster level of analysis indicated that censorship was a greater concern in Germany and Anglo countries, where masculinity was high. Government regulation of the Internet was less preferred in Germany, where power distance was low. Contrary to expectations, concern for transaction security. was lower in the Latin cluster, where uncertainty avoidance was high. Concern for privacy issues was lower in the U.S., where individualism was high. ^ In conclusion, results suggested that Internet users represented a multicultural community, not a standardized virtual community. Based on the findings, specific guidance was provided on how international managers and marketers could develop culturally sensitive strategies for training and promoting Internet services. ^

The identification of early factors related to academic achievement among deaf students

The purpose of this research study was to examine specific factors believed to be related to academic achievement in deaf children. More specifically, this research sought to determine whether there was a significant difference in achievement between those students whose parents use oral communication only and those whose parents use some type of sign language. An additional purpose of this research was to determine if there was a significant difference in academic achievement with those deaf students who used amplification devices early in life. This study also sought to determine whether providing early intervention program which emphasizes and enables parents to develop a language rich environment had a significant impact on the academic achievement of deaf children and whether the age at which initial services are received influence deaf student's subsequent academic achievement. This study examined the relationship, if any, between intellectual ability and academic achievement among deaf children. Finally, this study sought to investigate the relationship between the degree of hearing loss and academic achievement. ^ Purposive sampling was used to select subjects for this study. All 228 eligible Deaf/Hard of Hearing (DHH) students enrolled in a Broward County Public School were included in the original sample. Sixty-one students actually participated in this study. A correlational method of statistical analysis as well as a cross classification (crosstabs) was used to analyze the data. ^ The results show that academic achievement in the areas of reading and mathematics was significantly related to parental mode of communication and the mode of communication used in school. Academic achievement, in the area of reading, was also signficantly related to intellectual ability. The reading achievement was also found to be significantly related to degree of hearing loss. Written language was not significantly related to any factors investigated in this study. ^ Additional research should be conducted to further investigate the low academic achievement among deaf children. The diversity among signing systems at school and between home and school should also be analyzed. Finally, future studies should examine curriculum and instruction methods to increase the academic achievement of deaf children. ^

Responses to racial segregation in a black Miami community

The present study examines the extent to which blacks are segregated in the suburban community of Coconut Grove, Florida. Hypersegregation, or the general tendency for blacks and whites to live apart, was examined in terms of four distinct dimensions: evenness, exposure, clustering, and concentration. Together, these dimensions define the geographic traits of the target area. Alone these indices can not capture the multi-dimensional levels of segregation and, therefore, by themselves underestimate the severity of segregation and isolation in this community. This study takes a contemporary view of segregation in a Dade County community to see if segregation is the catalyst to the sometime cited violent response of blacks. This study yields results that support the information in the literature review and the thesis research questions sections namely, that the blacks within the Grove do respond violently to the negative effects that racial segregation causes. This thesis is unique in two ways. It examines segregation in a suburban environment rather than an urban inner city, and it presents a responsive analysis of the individuals studied, rather than relying only on demographic and statistical data. ^

Education, earnings, and rates of return: The case of Taiwan

Educational planners and economists have long recognized the importance of education as a form of productive investment in both advanced countries and developing countries. In the case of Taiwan, along with impressive economic growth, there was an even faster rate of growth of the government's investment in education. This leads some to question whether education has any role in economic development. ^ The purpose of this study is to provide a broad overview of the role of education, in terms of private rates of return to education, in Taiwan. In the process, a variety of hypotheses about human capital theory are examined and an empirical study of Taiwan's earnings functions are tested to show that education can be an important instrument to increase private rate of return, even under conditions of scarcity of natural and physical resources. Data was collected using the Manpower Survey and Manpower Utilization Survey, conducted by the government. Research questions were analyzed using descriptive statistics, frequencies, and regression analysis. ^ Results indicated that the Manpower Development Plans have been the decisive influence in allowing Taiwan to develop its human resources and achieve success in meeting the needs of Taiwan's economy. The structure of age-earnings profiles showed a strong relationship between earnings and education, and the profiles that successively shift upward are associated with higher levels of education. In the cross-sectional results of the rate of return in 1997, each additional year of schooling leads to a 6.2% increase in income. As to the private rates of return to different levels of education, the results found that the private rates of return are 2.88%, 4.85% and 10.05% for primary, secondary and higher education respectively. In an intertemporal comparison for 1980, 1985, 1990 and 1997, the results showed no significant trend except the private rates of return for primary education have been falling from 3.9% to 2.88%. ^ On the basis of this study, for individual student or family in Taiwan, there is likely to be a strong demand for education, particularly at the higher level. Therefore, a well-developed higher educational level becomes essential and the content of curriculum in higher education becomes another crucial question facing planners in Taiwan if they are going to use education as a means to foster economic development. ^

Academic performance of college students in financial management and related prerequisite courses: A comparison of senior high school and commercial high school graduates attending Tamsui Oxford University College in Taiwan

In Taiwan, the college freshmen are recruited graduates of both senior high school and senior vocational school. The Ministry of Education (MOE) of the Republic of China prescribes the standards of curriculum and equipment for schools at all levels and categories. There exists a considerably different curriculum arrangement for senior high schools and vocational high schools in Taiwan at the present time. The present study used a causal-comparative research design to identify the influences of different post-secondary educational background on specialized course performance of college business majors. ^ The students involved in this study were limited to the students of four business-related departments at Tamsui Oxford University College in Taiwan. Students were assigned to comparison groups based on their post-secondary educational background as senior high school graduates and commercial high school graduates. The analysis of this study included a comparison of students' performance on lower level courses and a comparison of students' performance in financial management. The analysis also considered the relationship between the students' performance in financial management and its related prerequisite courses. The Kolb Learning Style Inventory (LSI) survey was administered to categorize subjects' learning styles and to compare the learning styles between the two groups in this study. The applied statistical methods included t-test, correlation, multiple regression, and Chi-square. ^ The findings of this study indicated that there were significant differences between the commercial high school graduates and the senior high school graduates on academic performances in specialized courses but not in general courses. There were no significant differences in learning styles between the two groups. These findings lead to the conclusion that business majors' academic performance in specialized courses were influenced by their post-secondary educational background. ^

Building democratic institutions in Mexico

The purpose of this study is to explore the process of building democratic institutions in Mexico, to examine how political parties shape the process of democratization, and how this process determines the degree of party system institutionalization.^ The appearance of competitive politics brought new challenges and opportunities to parties in Mexico. The aim was to identify how the broader political and economic environment has challenged Mexico's political party system, and specifically the transformation of Mexico's political party system.^ This research illustrates the logic of the deductive model, beginning with general, theoretical expectations about democratization and the economic reform. The empirical data were analyzed to determine whether the deductive expectations were supported by empirical reality. This study offers a comprehensive analysis that conciliates the 'political opening' that has produced favorable conditions for democratization and social integration, and the 'economic opening' that has counteracted since it generated social exclusionary processes. ^