This dissertation is composed of two essays that examine the role of public and private health insurance on healthcare access, use, and cost containment. In Chapter 1, Dugan, Virani, and Ho examine the impact of Medicare eligibility on healthcare utilization and access. Although Medicare eligibility has been shown to generally increase health care utilization, few studies have examined these relationships among the chronically ill. We use a regression-discontinuity framework to compare physician utilization and financial access to care among people before and after the Medicare eligibility threshold at age 65. Specifically, we focus on coronary heart disease and stroke (CHDS) patients. We find that Medicare eligibility improves health care access and physician utilization for many adults with CHDS, but it may not promote appropriate levels of physician use among blacks with CHDS. My second chapter examines the extent to which the managed care backlash affected managed care's ability to contain hospital costs among short-term, non-federal hospitals between 1998 and 2008. My analysis focuses on health maintenance organizations (HMOs), the most aggressive managed care model. Unlike previous studies that use cross-sectional or fixed effects estimators to address the endogeneity of HMO penetration with respect to hospital costs, this study uses a fixed effects instrumental variable approach. The results suggest two conclusions. First, I find the impact of increased HMO penetration on costs declined over the study period, suggesting regulation adversely impacted managed care's ability to contain hospital costs. Second, when costs are decomposed into unit costs by hospital service, I find the impact of increased HMO penetration on inpatient costs reversed over the study period, but HMOs were still effective at containing outpatient costs.

Many geoenvironmental applications make use of granular drainage layers. Design guidelines for these drains recommend a granular soil that provides for filtration of the adjacent base soil. Filtration criteria have been developed through laboratory studies in which fine soils under a concentrated gradient of water are protected from erosion by a filter soil. The primary objective in these studies has been the geotechnical stability of earth-fill structures, while drainage was a secondary consideration. Granular drainage layers have therefore been constructed using fine sand. The subsequent migration of fine soil into these drains has resulted in significant loss in permeability. The main research objective was to develop design criteria for granular drains to be used for long term operation in environmental applications. The secondary objective was to investigate the relationships between grain size distribution of drain materials and clogging by fines. This was done through a laboratory study where changes in permeability were measured in granular soils infiltrated with fines. Lastly, the effect of salinity on fines deposition was also investigated. The hypothesis of the current study is that coarser granular drains minimize the impact of clogging and provides a better alternative to traditional drain designs for long term environmental applications. The laboratory study was performed with three granular drainage soils: a French Drain sand designed using the traditional filter design method, a coarser uniform sand, and a coarser graded sand with approximately 40% gravel sized particles. Three fine soils were used to infiltrate the drainage soils; however, their particle size distributions were not significantly different from one another. The results indicate that the permeability of all three drainage soils could be reduced by approximately one order of magnitude with continuous flow of a high concentration of fines (5 g/L). The permeabilities of the sands were reduced to a lesser extent with a lower concentration of fines. Permeabilities of the graded soils decreased more slowly with a lower concentration of fines, when considering pore volumes of flow. However, the rate of permeability decrease was ultimately influenced by the amount of fines delivered to the sample. A lower concentration of fines did not significantly slow the rate of permeability reduction in the uniform sand. All three sands retained a similar mass of fines (samples were split and fines content measured following each test). Salinity in the pore water did not significantly affect deposition, likely due to the fact that the fines contained a small amount of clay sized particles. When considering that all three drainage soils became clogged with fines during the tests, the coarse soils maintained a relatively high permeability due to the fact that their pre-test permeabilities were high. This information, along with the results from the literature review, has led to the development of recommended new design criteria for granular drains to be used for long-term geoenvironmental applications. Test results from an earlier study found that dispersive soils subject to high gradients can be successfully protected by a filter coarser than the coarse graded soil used in the current study. It therefore follows that a granular soil intended for groundwater collection applications can be made to be coarser than the current accepted practice. A proposed granular drain design band is presented in the current study.

Unauthorized computer access by employees is the most common hacking behavior in every company. Hence, it is necessary to first understand why an employee engages to commit it and then find effective methods of prevention to reduce the crime rate. Many studies on computer hacking has discussed the reasons for the behavior, for example: neutralization theory, differential association theory and containment theory. However, those theories and perspectives were adopted independently in past research. In this study, we combine those perspectives and create an integrated model to explain the employee¡¦s intention to commit unauthorized computer access. Data collected from 351employees in Taiwan confirmed our hypotheses and were tested against the research model. The results support the theoretical model in explaining how neutralization theory and containment theory may affect an employee¡¦s intention to commit unauthorized computer access. Finally, we found that neutralization is the most important factor to take into account when organizations develop and implement security policies or education which can decrease employees¡¦ intentions to commit unauthorized computer access.

The effects of expansion of cities on the fringe area are still the common problems of several countries as well as Turkey. The main problem stemming from rapid urban growth was described as urban sprawl that has been used as waste of land, time, and natural resources. Although sprawl becomes usually unplanned, uncontrolled, and uncoordinated, it can be claimed that some local and national government policies triggers the urban sprawl by creating planned areas more than required. The growth management policies are utilized to provide a responsible balance between development and the infrastructure needed to manage the impacts of development and to control urban sprawl. Four types of urban containment techniques have been used in several countries to control urban sprawl according to fundamental purposes of where to grow and where not to grow. These are greenbelt, urban growth boundary, urban service area and adjacent area. The main objective of this thesis is to investigate the impacts of urban growth on physical development of metropolitan cities and to critically evaluate the raison d&#039 / &ecirc / tre and changing meaning of adjacent areas concept in Turkish urban planning experience in a historical context. Ankara planning experiences are examined as a case study to what extent adjacent area is a functional and effective tool to control sprawl.

The main objective of this study is to shed light on some difficulties involved in the formulation of the problem of contingency in Leibniz&rsquo / s philosophical system. Leibniz&rsquo / s mature philosophy is characterized by the solutions he proposes for this problem, and the ontological ideas underlying or assisting them. &lsquo / The problem of contingency&rsquo / refers to the tension between his conceptual containment theory of truth and his claim that true existential propositions &ndash / that is, propositions which concern actual individuals &ndash / are all contingent. Though Leibniz does not seem to have one definite theory of contingency, two general lines of thought can nevertheless be discerned from his fragments on propositions and propositional truth. The first one is the infinite analysis theory, which is regarded in general as Leibniz&rsquo / s real theory of contingency, and the other is a theory of necessity, providing a division between absolute and hypothetical modalities. This thesis is not a study on the question whether Leibniz did really manage to solve the problem, but rather an attempt to trace the problem to its logical and ontological origins, and redefine it under a relatively simple form. It is first shown that Leibniz&rsquo / s theory of propositions relies heavily on his ontological conception of modalities, which covers the idea of a division between pure possibility and actuality / and then this idea is shown to be reflected on the logical level as a division between essential and existential truths. Finally it is argued that the two lines of thought and some peculiar characteristics of Leibniz&rsquo / s conception of modalities bring us to the conclusion that his real problem is the (deliberate) inability of his propositional calculus to express the difference between truths of reason (essential truths) and truths of fact (existential truths) as a logical structural one.

Abstract The purpose of this study was to investigate the drug-using behavioral patterns, drug abusers¡¦ cognition and inner-containment, the causes of HIV infection, the relationship between drug abuse and HIV infection, and the acceptable degree of the government¡¦s harm reduction program. This study adopted quantitative research design. A total number of 1083 (37.2% samples had HIV-infected) male drug abusers, whom sampled correctional institutions, including the drug treatment center, prison and detention house in Taiwan, were surveyed with self-reported questionnaire. Statistical methods, including descriptive analysis, Chi-square, t-test, Pearson correlation analysis and one-way ANOVA, were applied to proof the hypothesis of this study. The findings were as follows: I. The proportion of drug-using kin of drug abusers was up to 23.8%. According to the analysis, the proportion of drug-using siblings was 10.2%, cousins was 4.9%. II. Non-injecting drug users (NIDUS) had lower tendency in drug craving than injecting drug users (IDUS), but had higher tendency in inner-containment than IDUS. Therefore, increasing IDUS¡¦ confidence and coping skills to deal with craving is important element of relapse prevention program. IDUS had lower ability of abstinence, so they should be the prior client of harm reduction program to decrease the harm from drug injection. III. 52% samples used to needle-sharing would still have needle-sharing behaviors when facing drug craving. The key factor of sharing behaviors was they don¡¦t know how to resist the craving and urge of using drugs. Correcting drug users¡¦ irrational belief could aid in decreasing the craving for drug. Therefore, drug abusers whom don¡¦t have strong coping response and concept about the damage of drug abuse should be instructed stress management abilities and cognitive modification in drug treatment to effectively prevent relapse.

International Relations theory includes realist concepts of sovereign nation-states interacting in an anarchic world as they rationally determine their own national interests based upon ever-changing competition for power. In this interplay for power, nation-states may affect each other politically, economically, ideologically or militarily. This thesis focuses on effects of U.S. foreign policy and U.S. intervention in Guatemala in the time period surrounding the Guatemalan Revolution (1944-1954), with its "liberation" in 1954, and then into the early 1960s as the Guatemalan state began to be militarized. In this thesis I will answer the following question: How did the United States affect the sovereign nation of Guatemala, through economic policy, Cold War rationale, and military operations and thereby contribute to and facilitate the establishment of the nature of the Guatemalan counterinsurgency state? Through historically documented and officially acknowledged events an assessment will be made as to how these three elements singularly and also collectively influenced the internal workings of the Guatemalan state.

A bi-polar world emerged at the end of World War II. The United States and the Soviet Union were the world's superpowers and tensions between them spiraled consequently bringing about the Cold War. United States foreign policy during the Cold War revolved around containment policy. The Middle East during the Cold War was a region that the bi-polar world's superpowers wanted to influence, and protect. The United States during the Cold War warned the Soviet Union through presidential doctrines that it would fight to keep the Middle East from communism, and the Soviet Union's influence. The bi-polar international power structure did not allow the United States the ability to pick its battles. The power structure that constrained the Cold War forced the United States to react to the Soviet Union, and it forced foreign policy makers to always consider the Soviet Union's response to its policies. United States foreign policy in the Middle East during the Cold War threatened wit h military methods to solve local and regional instabilities. However, the United States was constrained by the bi-polar world thus, it was cautious of committing military troops in the region permanently and upsetting the region's delicate balance of power. United States foreign policy toward the Middle East has changed between 1981 and 2006. This change is in the direction of greater use of military methods to resolve what various administrations have perceived to be local and regional instability. This change in policy is partly attributable to changes in the United States power position in the world. A United States foreign policy shift in the Middle East occurred due to a change in the distribution of political power within the interstate system. This change has had the following result: the United States is no longer constrained by the bi-polar international power structure that characterized the Cold War period. The collapse of the Soviet Union created the uni-polar internationa l power structure. United States foreign policy is now capable of deploying the military to resolve local and regional instabilities in the Middle East, and that deployment has tended to become increasingly permanent in nature.

This thesis investigates the design of a CubeLab Module frame to facilitate biological research aboard the International Space Station (ISS). With the National Laboratory designation of the ISS by the United States Congress the barriers for use of the facility have been lowered for commercial and academic entities, allowing greater volume and diversity in the research that can be done. Researchers in biology and other areas could benefit from development and adoption of a plug-and-play payload containment system for use in the microgravity/space environment of the ISS. This research includes design and analysis of such a system. It also includes production and testing of a prototype. The relevant NASA requirements are documented, and they were considered during the design phase. Results from finite element analyses to predict performance of a proposed design under expected service conditions are reported. Results from functional testing of the prototype are also provided. A discussion of future work needed before the structure outlined in this thesis can become commercially viable is also presented.

The removal of heat from the containment building is an important consideration in the design of a nuclear power plant. In this investigation a simple rectangular natural circulation loop was simulated to determine whether it could possibly be used to remove usable quantities of heat from a containment building. The loop had a vertical pipe on the inside and outside of the containment building. These pipes acted as heat exchangers. Single phase and two phase cases were simulated by imposing a temperature on the respective vertical leg pipe walls and determining the heat absorption from the containment building. The heat was conveyed from the inside of the building to the outside via the natural circulation phenomenon. A literature study was done to cover topics relevant to this investigation. A theoretical model using conservation equations and control volumes was derived. This model was based largely on knowledge gleaned from the literature study. The theoretical model was a simple homogenous model, which was sufficiently detailed for a conceptual investigation. The theoretical model was then manipulated into a form suitable for use in a computer simulation program. Simplifications were made to the simulation model and underlying theory due to the nature of the investigation. The simulation model was validated against published experimental results. During the simulation phase a number of cases were investigated. These cases were divided into base cases and parametric studies. During the base case simulations the change of key fluid variables along the loop was examined. During the parametric studies the hot and cold leg inside wall temperatures, loop geometry and pipe diameter were varied. The effect of these parameters on the heat absorption from the containment was determined. The simulations showed that with the current assumptions about 75 to 120 of the natural circulation loops are needed depending on their geometry and containment conditions. The heat removal rates that were calculated varied from 50 kW to 600 kW for a single loop. As explained in the final chapter, there are many factors that influence the results obtained. The natural circulation concept was deemed to be able to remove usable quantities of heat from the containment building. / Thesis (M.Ing. (Nuclear Engineering))--North-West University, Potchefstroom Campus, 2012.