The purpose of this study was to begin testing of a downward cross-level model for studying the ability of older adults to transition from a nursing home after a Medicare Part A reimbursed stay. Transitions are known to be a weak point in the provision of healthcare to older adults and thus far, research has not identified those factors that influence older adult's transitions i.e., from the nursing home after a post acute stay. The theoretical background for this study was supported by Resource Dependency Theory which is a theory that contends that organizations are externally controlled by activities outside the organization such as the "free-market" economic model that predominates the nursing home industry. It was thought that nursing homes may prioritize their need for resident census above the resident's need for discharge. The hypothesis was that both individual resident characteristics and organizational characteristics might influence the ability of older adults to transfer from the nursing home after a Medicare Part A stay. The method of analysis in this study was contextual regression. Individual and facility characteristics were the independent variables and length of stay was the dependent variable. For this project, emphasis was placed on the development of a methodology for using the MDS in this and future research studies. Selection of variables and methods for variable computation were highlighted. Individual and facility characteristics and discharge disposition (level of care) were reported descriptively. Although facility characteristics did not contribute significantly to the model, individual characteristics explained 28% of the variance in the length of stay. Fifteen percent of individuals in the sample died during their Medicare Part A stay and 18% were readmitted to the hospital. The most prevalent diagnoses of the sample were hypertension (35%), falls (34%) and arthritis (32%). Findings suggest that individual characteristics account for only a portion of the length of stay for post acute nursing home residents. Further model testing is needed and should include a larger facility sample size and market characteristics to determine if those factors significantly influence the ability of older adults to transfer after the Medicare Part A stay ends.

Bakgrund Vistelsetiden på akutmottagningen på Centralsjukhuset i Kristianstad har studerats och en skillnad identifierades där män i större utsträckning än kvinnor hade en vistelsetid kortare än fyra timmar. Ingen direkt orsak till skillnaden i vistelsetid kunde urskiljas. Det identifierade fenomenet valdes att bearbetas med genus som begrepp. Syfte Syftet med studien var att undersöka orsaken till varför det är en skillnad i vistelsetid mellan män och kvinnor på akutmottagningen. Metod Metod för datainsamling var kvalitativ intervju. Informanter valdes strategiskt utifrån kriteriet att de arbetade på en akutmottagning, och bestod av olika yrkesprofessioner, kön samt yrkeserfarenhet. Två olika sjukhus i södra Sverige deltog i studien. Totalt inkluderas nio informanter. Semistrukturerade enskilda intervjuer med öppna frågor genomfördes och insamlad data analyserades genom kvalitativ innehållsanalys enligt Graneheim och Lundman. Resultat Skillnaden i vistelsetid på akutmottagningen upplevdes bero på att kvinnor söker med ospecifika och diffusa symtom/orsaker eller oro, sökorsaker som upplevdes mer tidskrävande. I motsatts upplevdes män söka med konkreta/specifika symtom eller allvarlig sjukdom/skada, sökorsaker som upplevdes mindre tidskrävande. Skillnaden upplevdes även bero på när i sjukdomsförloppet patienten söker, sociokulturella faktorer, biologiska könsskillnader samt olika kommunikationsmönster. Slutsatser Skillnaden i män respektive kvinnors vistelsetid på akutmottagningen upplevdes inte bero på vårdpersonalens medvetna handlingar, utan på patientens sökorsak, vald tidpunkt för besök, biologiska faktorer, sociokulturella faktorer samt kommunikativa faktorer. / Background The length of stay in the emergency department at Central Hospital in Kristianstad has been studied and a difference was identified where men more often than women had a length of stay less than four hours. No direct reason for the difference in length of stay could be discerned. This identified phenomenon has been selected to be analyzed with gender as a cause of inequality. Aim The aim of this study was to investigate the reason why there is a difference in length of stay between men and women in the Emergency Department. Methods Method of data collection was qualitative interviews. Informants were chosen strategically based on the criterion that they work in an Emergency Department, consist of various professions, sex and work experience. Two different hospitals in southern Sweden participated in the study. It included in total nine informants. Semi-structured individual interviews with open-ended questions were conducted, and the collected data were analyzed through qualitative content analysis by Graneheim and Lundman. Results The difference in length of stay in the emergency department was experienced due to women seeking with non-specific and diffuses symptoms/cause or concerns, reason to seek experienced more time consuming. Contrarily experienced men seek with concrete/specific symptoms or serious illness/injury, reason to seek experienced less time consuming. The difference was experienced also depend on when in the course of the disease the patient is seeking, socio-cultural factors, biological gender differences, and different communication patterns. Conclusions The difference in men and women's length of stay in the Emergency Department is experienced not to depend on nursing staff aware actions, but on the patient´s reason to seek, the selected time for visit, biological factors, socio-cultural factors, as well as communicative elements.

Class of 2009 Abstract / OBJECTIVES: The purpose of the study was to determine the rate of Clostridium difficile infections (CDI) in hospitalized patients and the various factors that were associated with the risk of developing CDI by examining patient discharge data for hospitals in 37 states in the United States using Healthcare Cost and Utilization Project (HCUP). METHODS: Patient discharge information for all patients obtained using HCUP census for the years 2002-2005, either for primary or secondary (all-listed) occurrences of CDI using the ICD-9-CM code (008.45) specific for intestinal infections due to C. difficile, were included in the study. Regression analysis, either Generalized Linear Model log-link or power-link, or a logistic regression was employed to control for the multiple independent variables. RESULTS: The incidence rate for CDI was 9.4% for the years 2002-2005. Among the concomitant diagnoses and procedures, essential hypertension, volume depletion, congestive heart failure, urinary tract infection and venous catheterization were the top 5. The length of stay (LOS) for CDI was associated with being Black, Hispanic or Other race category, number of diagnoses and procedures, primary expected payer of Medicaid, private insurance and other (including worker’s compensation, CHAMPUS,CHAMPVA etc), and all groups classified based on median household income category for patient’s zip code. Predictors of CDI related to inpatient total hospital charges were being female, race (other than black), number of diagnoses and procedures, Death, LOS, patient location and with self-pay and no charge categories as primary expected payer. Predictors of higher CDI related inpatient hospital deaths were age, female sex, Hispanic race, number of diagnoses and procedures, LOS and having Medicaid, self-pay or other as primary expected payer. CONCLUSIONS: LOS, inpatient total hospital charges, and inpatient mortality were dependent on several patient and other characteristics.

Class of 2009 / OBJECTIVES: To determine and characterize the relative impact of patient demographics on hospital inpatient charges, length of stay, and inpatient mortality in patients with ovarian cancer from 2002-2005. METHODS: A retrospective database analysis of AHRQ’s Health Care Cost and Utilization Project (HCUP) Nationwide Inpatient Sample databases was conducted spanning from January 1, 2002, to December 31, 2005.Data were collected regarding age, race, payer status, median household income, location of hospital (urban/rural), comorbidities, procedures, total charges, length of stay, and inpatient mortality. Multivariate and gamma regression methods were utilized to examine incremental risks associated with length of stay, total charges, and inpatient mortality, after controlling for all other variables. RESULTS: Overall, data from 246,012 hospital admissions were obtained. The average length of stay of patients was 6.58 days (SD = 7.22), the average number of diagnoses was 7.18 (SD = 3.36), the average number of procedures performed was 2.71 (SD = 2.66). A total of 14,485 (5.9%) patients died during hospitalization. The average total charge was $29,698 (SD = $42,951). The IRR was 0.886 (95%CI, -0.105 to -0.04) for patients who were Hispanic, and 1.089 (95%CI, 0.017–0.153) for patients who were Black compared to patients who were white. When compared to patients who lived in large, metropolitan areas, the IRR was 0.88 (95%CI, -0.146 to - 0.109) for patients located in smaller, metropolitan areas, and the IRR was 0.74 (95%CI, -0.335 to -0.268) for patients located in non- urban areas. CONCLUSIONS: Patient demographics were found to have associations, both directly and indirectly, with length o

Doctor of Philosophy / Department of Agronomy / Jianming Yu / Knowledge of the genetic bases of grain quality traits will complement plant breeding efforts to improve the end use value of sorghum (Sorghum bicolor (L.) Moench). The objective of the first experiment was to assess marker-trait associations for 10 grain quality traits through candidate gene association mapping on a diverse panel of 300 sorghum accessions. The 10 grain quality traits were measured using the single kernel characterization system (SKCS) and near-infrared reflectance spectroscopy (NIRS). The analysis of the accessions through 1,290 genome-wide single nucleotide polymorphisms (SNPs) separated the panel into five subpopulations that corresponded to three major sorghum races (durra, kafir, and caudatum), one intermediate race (guinea-caudatum), and one working group (zerazera/caudatum). Association analysis between 333 SNPs in candidate genes/loci and grain quality traits resulted in eight significant marker-trait associations. A SNP in starch synthase IIa (SSIIa) gene was associated with kernel hardness (KH) with a likelihood ratio–based R[superscript]2 (R[subscript]L[subscript]R[superscript]2) value of 0.08. SNPs in starch synthase (SSIIb) gene (R[subscript]L[subscript]R[superscript]2 = 0.10) and loci pSB1120 (R[subscript]L[subscript]R[superscript]2 = 0.09) was associated with starch content. Sorghum is a crop well adapted to the semi arid regions of the world and my harbor genes for drought tolerance. The objective of second experiment was to identify quantitative trait loci (QTLs) for yield potential and drought tolerance. From a cross between Tx436 (food grain type) and 00MN7645 (drought tolerant) 248 recombinant inbred lines (RILs) was developed. Multi-location trials were conducted in 8 environments to evaluate agronomic performance of the RILs under favorable and drought stress conditions. The 248 RILs and their parents were genotyped by genotyping-by-sequencing (GBS). A subset of 800 SNPs was used for linkage map construction and QTL detection. Composite interval mapping identified a major QTLs for grain yield in chromosome 8 and QTL for flowering time in chromosome 9 under favorable conditions. Three major QTLs were detected for grain yield in chromosomes 1, 6, and 8 and two flowering time QTLs on chromosome 1 under drought conditions. Six QTLs were identified for stay green: two on chromosome 4; one each on chromosome 5, 6, 7, and 10 under drought conditions.

Background: The HIV epidemic is a serious public health concern globally. There are 1,692,242 million known non-citizens in South Africa; this is equivalent to 3.3% of the total South African population (Statistics South Africa [STATS SA], 2011) this reflects global trends relating to number of non-citizens living in foreign countries (Vearey, 2008). Migration is an important demographic process to consider when studying HIV transmission as it increases migrants’ susceptibility to HIV (International Organisation for Migration [IOM], 2010). International migration, which is the movement of people across international borders, can result in migrants finding themselves in spaces of vulnerability which may lead to risky sexual behaviour (IOM, 2010). Furthermore, access to healthcare may be limited due to the dynamics of living in a foreign country. Internal migration, defined as the movement of people within the borders of a country (IOM, 2010) may result in ‘intra-urban’ inequalities that inhibit access to basic services such as housing and healthcare (Nunez et al, 2011). Despite it being the smallest province in the country, Gauteng has the highest level of in-migration, with an estimated net inflow of 367 100 internal migrants as for the period 2006–2011 (STATS SA, 2011). Globally, international migrants are more seriously considered as a concern for HIV transmission. However, in South Africa, internal migrants are equally as concerning particularly due to their circular migratory patterns. Knowledge of one’s status is a crucial first step in management of HIV. Voluntary HIV testing remains a challenging aspect of public health interventions, especially amongst key populations such as migrants (WHO, 2010). Although numerous studies have been conducted around migration and HIV, there remained a need for an investigation into the factors that influence HIV testing among Johannesburg residents. This is particularly significant, given the rapidly increasing levels of migration into the city, as well as the high urban HIV prevalence, which has been found to be twice high as that in rural areas and highest within urban informal settlements (Vearey, 2010). Therefore, this study set out to examine factors associated with HIV testing among residents of Johannesburg, in an attempt to determine whether migration status matters or not. Methods: This is a quantitative study with a sample size of 487 Johannesburg residents. International (n=150) and internal migrants (n=293) were examined in relation to each other and a comparative group of Johannesburg natives (n=44). STATA version 11 was utilised to conduct secondary data analysis of the RENEWAL survey (2008). This data, which was collected using a cross-sectional study design, was acquired from the African Centre for Migration and Society (ACMS) at the University of the Witwatersrand. Univariate descriptive analysis, bivariate chi-squared test and multivariate, logistic regression models were employed. Results: Levels of HIV testing were found to be higher amongst internal migrants (56%) when compared to international migrants (42%), (x2(1) =0.62; Pr=0.004). There was only a slight difference between Johannesburg natives and internal migrants who reported a 55% chance of HIV testing (x2(2) =8.32; Pr=0.016).These findings were only significant at the bivariate level. Overall, factors that were significantly associated with HIV testing amongst residents are: sex (95% CI 2.01 to 4.88; p=0.000); type of residence (95% CI 0.29 to 0.76; p=0.003); knows where to locate a testing facility (95% CI 1.41 to 3.50; p=0.001) and knows that anti-retroviral treatment (ART) is free (95% CI 1.93 to 4.83; p=0.000). Income was significantly associated with HIV testing amongst migrants (95% CI 0.40 to 0.90, p=0.016). Females were three times more likely (3.14) to test for HIV when compared to males. The odds of getting an HIV test by those who resided in informal settlements were less (0.48) when comparing with those who stay in formal housing. Residents who knew where to locate a HIV testing facility were twice (2.22) as likely to get tested for HIV as compared to those who did not know where to find one. Residents who knew that ART is free were three times as likely (3.05) to get tested for HIV as compared to those who did not. Those who were not earning a salary were less likely (0.61) to get tested for HIV compared to those who were earning a salary. Conclusion: The fact that migrant status, that is -internal versus international migration as a variable is not significant against HIV testing at the multivariate level indicates that there are far more important mediating factors that determine HIV testing than migration. More importantly, a more detailed and focused exploration into the length of stay of migrants in the city as well as the effect of urban inequalities on health, is needed.

Introdução: A Associação Internacional para o Estudo da Dor (IASP) tem estimulado a organização de Programas de Tratamento de Dor Aguda (SDAP) para um manejo mais efetivo, bem como avaliar seu impacto em desfechos passiveis de mensuração. Estudos têm sido conduzidos para mostrar a necessidade dos hospitais organizarem serviços de dor aguda pós-operatória, com vistas a melhora do tratamento da dor e para avaliar o processo de recuperação do paciente, redução do tempo de internação consequente ao uso de técnicas analgésicas mais eficazes. Então o objetivo deste estudo foi comparar o tempo de internação de pacientes submetidos a cirurgias eletivas com alta probabilidade de apresentarem dor pós operatória intensa sob os cuidados de uma equipe multidisciplinar especializada do SDAP comparado a uma coorte submetida a procedimentos cirúrgicos equivalentes no mesmo período, que tiveram seu tratamento da dor pós-operatório sob o cuidado da cirurgia equipe. Métodos: trata-se de uma coorte naturalista, retrospectiva, que incluiu 1011 pacientes com idade superior a 18 anos, de ambos os sexos submetidos à cirurgia eletiva de grande porte, tais como cirurgias torácicas com toracotomia, cirurgias proctológicas com abertura da cavidade abdominal e cirurgias ortopédicas para prótese de joelho e quadril. Os dados foram obtidos a partir do pontuaria o eletrônico do Hospital de Clinicas de Porto Alegre (HCPA) no período compreendido entre 2011 e 2015. Resultados: Avaliamos retrospectivamente 1050 pacientes assim distribuídos [cirurgia proctológica 506 (50,4%), cirurgia torácica 216 (21,36%) e cirurgia ortopédica 293 (29,17%)]. A média (SD) da internação hospitalar em pacientes sob o atendimento do SDAP foi de 7,84 (4,41) comparado controles correspondentes sob o cuidado da equipe cirúrgica, que apresentaram uma média (SD) de internação de 9,72 (8,64), respectivamente. Foram fatores associados com prolongada internação pós-operatória a mortalidade pós-operatória, reoperação cirúrgica e pacientes que necessitaram de terapia intensiva pós-operatória. Conclusão: Estes resultados sustentam a hipótese de que uma mudança no cuidado pós-operatório de pacientes submetidos a cirurgias com propensão para dor pós-operatória intensa, sob os cuidados de uma equipe multidisciplinar especializada do SDAP reduziu o tempo de internação pós-operatório comparado aos pacientes submetidos a cirurgias equivalentes com o tratamento da dor pós-operatória aos cuidados da equipe assistente. / Background: The American Pain Society stimulate to organize Programs of the Acute Pain Services (APS) fora most efficient pain management, as well to assesses its impact on the measurable outcomes. Studies around the world remind us of the imminent need for hospitals maintain service acute postoperative pain, since it is known that in this way, through better treatment of pain increases the likelihood of establishing strategies to improve patient recovery, coupled with reductions in average length of stay (hospital), more effective analgesic techniques and potential cost savings. Thus, this study compared the long hospital stay between patients underwent to care for a specialized multidisciplinary team of the APS, with a matched cohort suffered to same surgical procedures, during the same period, which had their postoperative pain management under the care of the surgical team. Methods: This is a retrospective naturalistic cohort that included 1011 patients older than 18 years, male and female underwent to elective major surgery, with an open cavity (proctologic and thoracic surgeries) and orthopedic surgeries (knee and hip replacement). The Electronic Information Database, comprehend the years of 2011 through 2015 at a teaching hospital in the south of Brazil. Results: We assessed retrospectively 1050 patients [proctologic surgery 506 (50.4%), thoracic surgery 216 (21.36%) and orthopedic surgery 293 (29.17%)]. The mean (SD) of hospital stay in patients under of the APS care was 7.84 (4.41) compared to their matched controls, which had a mean (SD) of hospital stay of 9.72 (8.64), respectively. Another risk factor for the long hospital stay were the postoperative mortality, surgical re-operation, and patients that needed postoperative intensive care. Conclusion: These findings support the hypothesis that a change in patients undergone to surgeries with a higher propensity to have severe postoperative pain with the postoperative pain management under a specialized multidisciplinary team of APS reduced the postoperative extended hospital stay.

Most stay-at-home mothers wish to return to the workplace; yet, the majority are not successful. There is a looming labor shortage and increasing organizational initiatives to increase female participation at most levels, providing opportunity for this talent pool. The purpose of this descriptive study was to examine the reentry strategies of networking, volunteerism, additional education, and additional training upon the reentry success for highly educated, stay-at-home mothers. In conjunction with the theoretical framework of the social cognitive career theory, self-efficacy, as measured by the New General Self-Efficacy Scale, was also examined as a reentry strategy. Survey research was used to gather data from previous stay-at-home mothers who had successfully reentered and stay-at-home mothers currently in the job search process (N=157). Logistic regressions and Pearson correlations were used to determine significant relationships between network size and self-efficacy upon reentry success; however, network size was negatively correlated with reentry success. The results of this study can be used by highly educated, stay-at-home mothers contemplating workplace reentry as well as vocational counselors who assist this group of job seekers. Highly educated, stay-at-home mothers can use the results of this study to improve their chances of effectively transitioning back into the workplace while also altering the perception of the traditional, stay-at-home mother.

Health care reimbursement is changing, and hospitals are finding it difficult to receive payment due to insurers' denial of services already rendered to patients. A denial can be considered an underpayment by the insurer to the hospital. Using a Six Sigma approach, a large hospital system in the southeast United States found that individual hospitals were not focused strictly on denials, but other tasks as well. Hospital administrators conducted a literature review and found that centralizing denials management team has improved reimbursement outcomes elsewhere. Therefore, the hospital system implemented a centralized denials unit to focus on overturning insurer denials while the patient was still hospitalized. The purpose of the project was to develop an evaluation plan to determine whether the pilot centralized denials management unit could overturn an additional 5% or more of the concurrent denials compared with the current individual hospital-based denials management approach. The quantitative evaluation plan will guide review of data collected from one organization to determine payer trends on the types of denials received and reasons for the denials. Understanding the pattern of denials is expected to uncover opportunities for denials coordinators in the dedicated centralized management unit to challenge payers based on contract language or medical necessity. If the centralized denials management unit is shown to reduce denials, it will be considered for expansion corporate wide. The social change expected through a successful denials management unit program is that the hospitals in the system will recover payment for services rendered and will be able to continue to provide quality care in the communities they serve.

This research aims to study the effects of organization downsizing programs on the staff in the field of electronic media. There used to be only three television networks in Taiwan, which were TTV, CTV, and CTS. Followed by the approval of the Cable Television Law in 1993, cable TV providers began to enter the market and sprout like mushrooms. A point worth noting is that Taiwan's fourth terrestrial TV station, FTV, officially founded and joined the market in 1997. Significant changes were then brought to Taiwan¡¦s media landscape. The advantages of the three original TV networks were disappearing and taken by the newly emerged cable TV stations. Thanks to the free market mechanism, the competition among news media has become even more and more intense over the last three or four years. A medium which has strong constitution appears to have better performance and is able to maintain certain market share; while those have weak constitutions would often suffer losses in business, in which the most serious are the three original terrestrial TV stations. It makes no exception for cable TV networks, either. Deficit occurs in many cable TV stations, such as CTI, ERA, USTV, STV and Global TV, whereas SET, TVBS, ETTV, and GTV could still obtain profits. The above factors show that downsizing in the field of electronic media must be carried out. The subjects of this research were a group of TV news reporters who have gone through organization downsizing. Interviews were designed to discover the reporters¡¦ perception, involvement, organizational identity and intention to continue in office in search of the best downsizing model. The results are as follows: (1) Downsizing programs have certain impact on staff. Organizations which encourage voluntary demission or retirement might hardly achieve its goal of downsizing in a short while, but survivors would relatively tend to be less likely to resign from office. On the contrary, when compulsory or semi-compulsory methods are used, survivors would be devastated or even muddle along. Such situation might even cause lots of survivors to quit. (2) Thetrimming of personal in electronic media, areusually due to unbalance of information, causing current employee¡¦s varies in working behavior and attitude, cause by age, experience and rank difference. It means that because of freer flow of information, employees that are higher age, more experience, and higher rank, are less affected in behavior and attitude, and more stable. On the other hand, employees that are lower age, less experience and work in the basic level, because of the lack of information, when personal trimming begins, they become more anxious and start quitting. (3)Having a comprehensive scheme, informing and making the employees involved in the whole decision making process, as well as engaging in appropriate dialogue would all increase the willingness of survivors to continue in office and weaken their tendency to resign. (4)Employees who agree with their organization's values and feel a strong sense of connection with their organization tend to be less likely to quit; while others would have stronger inclination to resign.