Master of Science / Department of Hospitality Management and Dietetics / Kevin R. Roberts / The Centers for Disease Control and Prevention estimated that one in six Americans become ill,128,000 are hospitalized, and 3,000 die each year due to foodborne illness. Children are at a higher risk of acquiring foodborne illness than adults for several reasons, including: an immune system that has yet to fully develop, limiting their ability to fight infections; a lack of control over the food they consume because their meals are usually provided by others; and the lack of awareness of food safety risks. Thus, it is critical to ensure that childcare center employees practice safe food handling. The purpose of this study was to explore the food safety knowledge, practices, and barriers to safe food handling practices of childcare center employees. Observations were conducted in 10 childcare centers in Manhattan, Kansas. Each childcare center was observed for two days during lunch preparation and service. Observations of foodservice employees were conducted in the kitchen using a structured observation form. Teacher observations were conducted in the classroom using detailed notes. A questionnaire was used to collect demographic, food safety training, and food safety knowledge information. SPSS (v. 20.0) was used to analyze data. Childcare center employees had high average scores on the safety knowledge assessment. The majority of employees received some type of food safety training. Time pressures, availability of equipment, and small food preparation space were found as the main barriers to implementing safe food handling. Childcare center foodservice workers and teachers were knowledgeable about handwashing and time/temperature control, but failed to utilize on the job. Results of this study will help childcare educators to develop materials to improve food safety practices and encourage owners/managers of childcare centers to enhance their food safety behaviors.

Master of Science / Department of Grain Science and Industry / Sajid Alavi / The objective of the study was to investigate extrusion as an alternative processing method and grain sorghum as a viable substitute for corn in fortified blended foods (FBFs) used in nutrition and food assistance programs around the world. In the first part of this study, sorghum-soy blend (SSB), corn-soy blend (CSB) and whole corn-soy blend (WCSB) were developed using extrusion and compared with traditional CSB13 for physico-chemical and sensory properties. After milling of extrudates, average particle size (PS) ranged between 341-447 microns, with 78-85% below 600 microns. In general, Bostwick flow rates (VB=12-23 cm/min) of rehydrated blends (11.75% solids) were within standard specifications but higher than CSB13. Descriptive sensory analysis indicated that the sorghum-based rehydrated blends were significantly less lumpy and had a more uniform texture as compared to corn-based blends and CSB13. In the second part, the impact of decortication level and process conditions was investigated with respect to sorghum-based extruded blends. Degree of gelatinization of the whole sorghum-soy blend (WSSB) and decorticated sorghum-soy blend (DSSB) extrudates ranged from 93-97%. Expansion ratio (ER=3.6-6.1) was correlated with specific mechanical energy input (SME=145-415 kJ/kg; r=0.99) and average particle size after milling (PS=336-474 microns; r= -0.75). Rehydrated blends at 20% solids concentration provided recommended energy density (0.8 kcal/g) for FBFs. Bostwick flow rates had high correlation (r = -0.91) with pasting data (final viscosity) obtained using rapid visco analyzer (RVA). Addition of oil (5.5%) prior to extrusion was also studied, and resulted in process instabilities and also lower shelf-life as determined via descriptive sensory analysis (rancid and painty attributes) and gas chromatography-mass spectroscopy (hexanal, heptenal and octanal concentrations). In conclusion, extruded sorghum-soy blends met standard specifications for energy density and consistency (Bostwick flow rate), and were superior in some aspects as compared to extruded corn-soy blends and traditional corn-soy blends (CSB13). Relationships between extrusion mechanical energy input, expansion, particle size after milling and consistency of rehydrated blends were established. Consistency of the rehydrated blends is an extremely important criterion as it affects the ease of ingestion by target consumers (children below 5 years, in this case).

Master of Science / Department of Industrial and Manufacturing Systems Engineering / Chih-Hang John Wu / The University of Kansas Medical Center’s Emergency Department is adopting a new residency program. In the past, generalized Residents have supported attending physicians during a required three month rotation in the Emergency Department. As of July 2010, the University of Kansas Medical Center’s Emergency Department has switched to a dedicated Emergency Medicine Residency program that allows recently graduated physicians the opportunity enter the field of Emergency Medicine. This thesis shows that although not initially a dedicated residency program provides an advantage to the Emergency Department. Discrete Event Simulations have been used to predict changes in processes, policies, and practices in many different fields. The models run quickly, and can provide a basis for future actions without the cost of actually implementing changes in policies or procedures. This thesis applies a learning curve in a Simulation Model in order to provide data that the University of Kansas Medical Center’s Emergency Department can utilize to make decisions about their new Residency Program. A generalized learning curve was used for the base model and compared to all alternatives. When it was compared with an alternative curve following a Sigmoid Function (Logistic Function), there were no significant differences. Ultimately, a Gompertz Curve is suggested for hospitals attempting to develop or improve their residency programs using learning curves because it is easily fitted to their desired shape. This thesis shows the effect that Residents have on the performance of the Emergency Department as a whole. The two major components examined for the generalized learning curve were the initial position for first year residents determined by the variable [alpha], and the shape of the curve determined by the variable [beta]. Individual changes the value of [alpha] had little effect. Varying values of [beta] have shown that smaller values elongate the shape of the curve, prolonging the amount of time it takes for a resident to perform at the level of the attending physician. Each resident’s personal value of [beta] can be used to evaluate the performance in the emergency department. Resident’s who’s [beta] value are smaller the emergency department’s expected value might have trouble performing.

No description available.

This dissertation examines the factors that have the most significant impact on the pace of change in the primary care (PC) sector in Ontario. In Canada, there have been many attempts to improve the PC system through the introduction of a variety of primary care reform (PCR) models. Some say that there is insufficient movement in the PC sector and that it is in a policy gridlock. Others assert that substantial progress has been made and that transformational change is proceeding. This dissertation demonstrates that PCR – the movement from PC to some form of primary health care (PHC) – is multi-dimensional and complex. It identifies the multiple dimensions of PHC and demonstrates that each dimension has implications for the structural relationships between the state and the medical association in the PC sector in Ontario. The framework for this dissertation was derived from three bodies of literature: PC/PHC, neo-institutionalism and professional autonomy. The research design used involves qualitative and quantitative methods, including historical analysis, document analysis, key informant interviews and qualitative data. The case study of PCR in Ontario demonstrates that while there have been some changes in the methods of physician payment and in the organization and delivery of PC, the majority of PCR models have not fundamentally altered the underlying institutional and structural relationships that characterize the sector. This includes the profession’s ability to control the political, economic and clinical aspects of care. Thus, the PCR models that propose the greatest amount of reform – those that alter structural relationships between the state and the medical association in a manner that results in a significant impact on the balance of power in the PC sector- are less likely to be adopted by physicians. This dissertation corroborates that the PCR models that have the greatest impact on professional autonomy are those that remain at the margins of the health care system, whereas the models that have little or no impact on autonomy have been more readily adopted.

The 2003 Severe Acute Respiratory Syndrome (SARS) outbreak in Canada highlights a broad range in ethical challenges, particularly in priority setting. Presently, a leading theory in ethical priority setting is Daniels’ and Sabin’s Accountability for Reasonableness (A4R), which enhances fair and legitimate procedural decision making in typical healthcare settings. A4R attempts to mitigate conflicting interests and facilitate fairness in deliberations over priority setting issues. Whether this framework may be applied to public health emergencies has yet to be examined. This qualitative study describes the outbreak through the lens of A4R and explores the applicability of A4R in atypical or emergent circumstances. Findings from 25 structured key informant interviews of public health officials suggest refinements to the framework may be required for emergency events. The presence of such a framework may minimize collateral damage during and after a response. The lessons may guide future preparedness efforts such as pandemic planning.

Aim: To describe and analyze the demographic profile and the dental treatment needs, workload and costs of the 2007 and 2008 CF recruit population (N=10,641). Method: Treatment procedures and costs were aggregated and calculated, beginning from the date of a member’s enrolment, over a period that ranged between 13 to 36 months. Associations between treatment services and the demographic variables were tested using one-way ANOVA and chi-square tests. Independent samples T-test was used to compare means. Linear regression models were used to determine the influence of demographic variables on treatment cost. Results: Treatment needs and costs varied with recruit age, gender, rank, first language (French/English), birthplace (Canada/Foreign), tobacco use, province and census tract. The cost of treatment for the entire population was $13.9M. Mean cost per recruit was $1224 over an average period of 26 months. Outsource costs ($2.9M) were driven by referrals for restorative, endodontic and oral surgery procedures.

The 2003 Severe Acute Respiratory Syndrome (SARS) outbreak in Canada highlights a broad range in ethical challenges, particularly in priority setting. Presently, a leading theory in ethical priority setting is Daniels’ and Sabin’s Accountability for Reasonableness (A4R), which enhances fair and legitimate procedural decision making in typical healthcare settings. A4R attempts to mitigate conflicting interests and facilitate fairness in deliberations over priority setting issues. Whether this framework may be applied to public health emergencies has yet to be examined. This qualitative study describes the outbreak through the lens of A4R and explores the applicability of A4R in atypical or emergent circumstances. Findings from 25 structured key informant interviews of public health officials suggest refinements to the framework may be required for emergency events. The presence of such a framework may minimize collateral damage during and after a response. The lessons may guide future preparedness efforts such as pandemic planning.

Aim: To describe and analyze the demographic profile and the dental treatment needs, workload and costs of the 2007 and 2008 CF recruit population (N=10,641). Method: Treatment procedures and costs were aggregated and calculated, beginning from the date of a member’s enrolment, over a period that ranged between 13 to 36 months. Associations between treatment services and the demographic variables were tested using one-way ANOVA and chi-square tests. Independent samples T-test was used to compare means. Linear regression models were used to determine the influence of demographic variables on treatment cost. Results: Treatment needs and costs varied with recruit age, gender, rank, first language (French/English), birthplace (Canada/Foreign), tobacco use, province and census tract. The cost of treatment for the entire population was $13.9M. Mean cost per recruit was $1224 over an average period of 26 months. Outsource costs ($2.9M) were driven by referrals for restorative, endodontic and oral surgery procedures.

The purpose of this study was to explore what makes the interorganizational referral process effective and efficient from the perspectives of acute care referral senders and post acute care referral receivers. The referral process was conceptualized as the classic communication model involving a sender, receiver, information, a communication channel and contextual factors such as formalization and relationships. The hypotheses proposed that the relationships between each of the variables information usefulness, communication channel richness, and degree of formalization affected each of perceived referral process effectiveness and efficiency through the variable ‘relational coordination’. Key informants who either sent referrals from acute care settings or who received them in post acute care inpatient settings were asked to discuss each variable. These results were combined with those of a literature review to develop questionnaires containing a scale with acceptable Chronbach alpha for each. Surveys were disseminated through networks and associations involved in acute and post acute stroke and hip fracture care and in discharge planning and Long Term Care. Useable responses included 114 surveys from referral senders and 171 from referral recipients. Baron and Kenny’s four step test for mediation was used to test the hypotheses. For senders, each of channel richness (adjR2 = 10% p= 0.001), information usefulness (adjR2 = 16% p= 0.000), and formalization (adjR2 = 10% p= 0.000) were significantly related to perceived effectiveness. For channel richness, the relationship with perceived effectiveness was partially mediated by relational coordination (adjR2 = 19% p= 0.001). This was also the case for the relationship between information usefulness and perceived effectiveness (adjR2 = 0.20; p=000). For receivers, channel richness is related to perceived effectiveness through relational coordination (adjR2 = 12% p= 0.003). This was also the case for information usefulness (adjR2 = 13% p= 0.000). In neither group were any of the variables significantly related to efficiency. We may conclude that in the referral process, channel richness and information usefulness are related to perceived effectiveness for both senders and receivers. These may provide an important return on investment if chosen as an areas for referral process improvement, if accompanied by concurrent investments in relational coordination.