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Introduction: Due to our actual knowledge tinnitus in most cases results from abnormal neural activity elicited at any level of auditory pathways and is interpreted in auditory cortex as a perception of sound, which is not accompanied by any mechanic activity within the cochlea. Tinnitus patients usually present various degrees of cochlear dysfunction, which can be manifested as sensorineural hearing loss, loudness intolerance, a distinct decrease of the DPOAE amplitude, recruitment or abnormal efferent reduction of OAEs through contralateral acoustic stimulation. But 8-15% of tinnitus patients present normal audiometric profiles. In these patients the mechanism of tinnitus generation remains unclear. Aim of the study: The aim of the study was to assess DPOAE levels and EHF thresholds in tinnitus subjects with normal hearing and compare the data with those from a normally hearing control group without tinnitus, in order to evaluate if any detectable high frequency cochlear dysfunction might be responsible for the tinnitus generation. Material and methods: 175 tinnitus patients (group 1 – tinnitus in left ear - 47 patients, group 2 – tinnitus in right ear – 23 patients, group 3 – bilateral tinnitus – 105 patients) and 60 controls (group 4). Inclusion criteria: age up to 40, normal otoscopic examination, type A tympanometry, normal hearing (up to 20 dB) in PTA (250-8000 Hz), no loudness intolerance, constant tinnitus for at least 6 months of stable localization (site of tinnitus has not changed from the previous localization). In each patient high frequency audiometry (at 10, 12.5, 14 and 16 kHz) and DPOAE registration (L1=65 dB SPL, L2=55 dB SPL, f2/f1= 1.2, S/N≥3 dB) were performed. Then statistical analysis was applied for comparison between left and right ears in the same group and also across different group of patients. Results: statistically significant differences were observed mainly in unilateral tinnitus group. These differences were more evident in audiometric data than DPOAE data. Leftsided tinnitus was twice more frequent than right-sided tinnitus. Few statistically significant differences were found between bilateral tinnitus group and controls. Conclusions: Unilateral tinnitus in normally hearing individuals may be caused by the damage of the basal region of the cochlea. There is greater incidence of high frequency hearing loss (above 8 kHz) in the ear with tinnitus in comparison to control group. In unilateral tinnitus group, the organ of Corti at the site of tinnitus is more seriously damaged than in the opposite ear. The asymmetry of cochlear damage may be crucial for tinnitus lateralization. Bilateral tinnitus, more frequently than unilateral one, can result from other pathologies, not connected with the organ of Corti.

In the modern society, chronic diseases have become the leading causes of death. With early recognition and proper management, however, many of the complications from chronic diseases could be prevented or delayed. Taking such a proactive approach in managing a population often requires the use of team-based approaches and delegation of certain clinical and nonclinical tasks to nonphysician team members. This three-study dissertation used a combination of methods to explore contextual factors that influence primary care teamwork and physician-pharmacist collaboration. The first study quantitatively examined baseline barriers and facilitators of physician-pharmacist collaboration in clinics participating in the Collaboration Among Pharmacists and Physicians To Improve Outcomes Now (CAPTION) Trial. Pharmacist expertise and clinic staff support were found to be the most important facilitators for physicians, while insurance reimbursement and task design factors were important for pharmacists. The second study characterized clinic personnel experience participating in the CAPTION trial and explored determinants of disease state control. Higher proportions of indigent and minority populations and higher baseline pharmacy structure scores were found to be associated with lower blood pressure control. The third study qualitatively examined organizational influences on primary care team effectiveness and the roles of pharmacists in a separate sample of primary care clinics. A lack of organizational rewards for teamwork in primary care was identified and pharmacists were integrated into clinic workflow in various degrees. These findings will be informative for practice managers and health care professionals seeking to redesign their practice to meet increasing needs of patients with chronic diseases.

Parental involvement contributes to the improvement of student achievement. Although children entered kindergarten with varying levels of literacy development, parents might perceive kindergarten literacy instruction as a panacea for any lacking skills, therefore lessening their involvement in their children's literacy development. Thus, there was a need to understand parents' perceptions of the importance of (a) their involvement in the education of their children, (b) their role in their children's literacy development during kindergarten, and (c) their role in their children's early literacy development as influencing their children's overall literacy development. Bronfenbrenner's bioecological model of human development served as a guide for this qualitative exploratory case study. Semistructured telephone interviews were conducted with 11 kindergarten parents on their perceptions regarding their involvement in the literacy development of their child. Data analysis was guided by Yin's 5-phased cycle of analyzing case studies, through which 4 main themes emerged. First, the parents perceived their involvement in the early literacy of their children helped their children's overall literacy development. Second, they perceived their involvement in their child's education was important. Third, there was a change in the degree of involvement of parents once their children entered kindergarten. Last, parents perceived that their involvement in their children's literacy development was one of the various roles and responsibility they have in being a parent. The findings of this study may contribute to positive social change by serving as useful information that can assist schools and teachers in developing effective strategies for encouraging parental involvement for families with children in kindergarten.

The Friends for Life program is an evidence-based practice being used in schools to assist children to learn skills to manage anxiety. The Friends for Life program has been used by school districts in British Columbia, Canada, for over 10 years, yet there is little research on how the program is being implemented in schools by teachers. This qualitative case study investigated the implementation practice of the Friends for Life program by teachers in Grades 4 and 5. Semi-structured interviews were conducted with 8 teachers from a smaller school district in British Columbia, Canada. The results yielded themes, which described critical factors that helped or hindered teachers in implementing the program with fidelity. A key finding of the study demonstrated teachers were running the program weekly, as per program guidelines. A key factor that was identified as helping teachers to implement the program with fidelity was support of school counselors, district staff, and the building administrator. The implications for social change include providing school administrators with information, which can help them to support teachers to implement the Friends for Life program with fidelity. As a result of these findings the Friends for Life program may consider updating the training materials and program implementation protocols in order to ensure teachers are implementing the program with fidelity and therefore, children are learning the skills they need to manage their anxieties and worries.

There are 1.4 million active nonprofit organizations in the United States; however, funding sustainability often forces nonprofit senior leaders into closure, which can lead to increased unemployment and decreased services provided to local communities. Nonprofit senior leaders seek help from scholars, at times, to identify strategies to secure sustainable funding sources, improve the sustainability of funding, or prevent or reverse losses of funding to their organizations. Through the conceptual lens of the general systems theory, the 2015-2016 Baldrige Excellence Framework and Criteria, and single- and double-loop learning, this single-case study explored strategies used to secure sustainable funding for nonprofit organizations from businesses, foundations, and individual donations. Through a purposeful sample of 3 senior leaders of a small nonprofit organization located in Baltimore, Maryland, data collection occurred through semistructured interviews, a review of public and internal documents, as well as performance outcomes. Through thematic analysis, 4 themes emerged: process strengths, process opportunities, results strengths, and results opportunities. Identifying strategies to secure sustainable funding may assist nonprofit senior leaders when struggling in an environment in which the supply of critical resources is low. The findings have implications for positive social change for nonprofit senior leaders and the community. Nonprofit senior leaders that secure sustainable funding may offer a positive influence in communities by reducing unemployment, creating new jobs, providing tax payments, promoting philanthropy, and improving lives.

Despite over 50 years of software engineering as a formal practice, contemporary developers of bespoke software follow development practices that result in low-quality products with high development and maintenance costs. This qualitative case study sought to identify strategies used by software and enterprise architects for applying architectural best practices to improve bespoke software quality and lower the total cost of ownership. The study population was application and enterprise architects associated with delivering bespoke software for the enterprise architecture team at a large enterprise in the Nashville, Tennessee metropolitan area. Interview data were collected from 7 enterprise or solution architects; in addition, 47 organizational documents were gathered. Guided by the principles of total quality management, thematic analysis was used to identify codes and themes related to management of quality in software solutions. Prominent themes included focusing on customer satisfaction, collaborating and communicating with all stakeholders, and defining boundaries and empowering people within those boundaries. The findings from this research have implications for positive social change, including improved work-life balance, morale, and productivity of software and enterprise architects through streamlining development and maintenance activities.

Field programmable grid arrays (FPGA) are increasingly being adopted as the primary on-board computing system for autonomous deep space vehicles. There is a need to support several complex applications for navigation and image processing in a rapidly responsive on-board FPGA-based computer. This requires exploring and combining several design concepts such as systolic arrays, hardware-software partitioning, and partial dynamic reconfiguration. A microprocessor/co-processor design that can accelerate two single precision oating-point algorithms, extended Kalman lter and a discrete wavelet transform, is presented. This research makes three key contributions. (i) A polymorphic systolic array framework comprising of recofigurable partial region-based sockets to accelerate algorithms amenable to being mapped onto linear systolic arrays. When implemented on a low end Xilinx Virtex4 SX35 FPGA the design provides a speedup of at least 4.18x and 6.61x over a state of the art microprocessor used in spacecraft systems for the extended Kalman lter and discrete wavelet transform algorithms, respectively. (ii) Switchboxes to enable communication between static and partial reconfigurable regions and a simple protocol to enable schedule changes when a socket's contents are dynamically reconfigured to alter the concurrency of the participating systolic arrays. (iii) A hybrid partial dynamic reconfiguration method that combines Xilinx early access partial reconfiguration, on-chip bitstream decompression, and bitstream relocation to enable fast scaling of systolic arrays on the PolySAF. This technique provided a 2.7x improvement in reconfiguration time compared to an o-chip partial reconfiguration technique that used a Flash card on the FPGA board, and a 44% improvement in BRAM usage compared to not using compression.