Excessive screen time among children and adolescents has been associated with physical inactivity, obesity, bullying, sleep disorders and risky sexual behaviors. However, the relation between screen time and different types of high-risk sexual behaviors has not been well explored. The aim of this study was to determine the impact of screen time, (defined as watching television 3 or more hours per day, or playing video or computer games or using a computer 3 or more hours per day) on high-risk sexual behaviors:- early onset of sexual intercourse before the age of 13 years, having sexual intercourse with four or more sexual partners within the last 3 months, alcohol consumption or drug abuse before the last sexual intercourse, or unprotected intercourse without male or female condom use. Methods: Data from the 2015 Youth Risk Behavior Surveillance System (YRBSS), a national survey representative of 9th through 12th grade students in public and private schools in the United States was used. Logistic regression analysis was conducted to determine the association between the predictor variables and the different high-risk sexual behaviors. The model was adjusted for age, sex, and race. Out of 15,624 respondents, about a third (5,770) reported having had “high-risk” sexual intercourse. Results: Analysis showed that students (9th -12thgrade) who watched television 3 or more hours per day were 49% more likely to have been sexually active before the age of 13 years (aOR: 1.49, 95% CI: 1.23-1.80, p Conclusion: The study findings suggest that watching television 3 or more hours per day is more significantly associated with high-risk sexual behaviors than playing video or computer games or using a computer 3 or more hours per day. More research might need to be conducted to determine the ‘protective effect’ of screen time with video or computer games and computer use. In addition, parents, caregivers and all stakeholders should ensure screen time be limited toyouths.

The ACSM Metabolic Equation is a widely recognized equation for predicting metabolic intensity from walking speed. However, an equation that uses an observable metric (i.e., cadence [steps/min]), accounts for individual characteristics, and is validated across walking conditions may enable more accessible and accurate predictions of walking intensity. PURPOSE: To develop metabolic equations that predict metabolic intensity (oxygen consumption; mL/kg/min) from cadence using a large treadmill walking dataset (Study One) and cross-validate these equations during overground unconstrained and cadence-constrained walking conditions (Study Two). METHODS: In Study One, 193 adults (21-81 years) completed treadmill walking bouts while oxygen consumption was measured with indirect calorimetry (converted to metabolic equivalents [METs]; 1 MET=3.5 mL/kg/min=1 kcal/kg/min). Directly-observed step counts divided by bout duration produced cadence. The least squares regression of the cadence-intensity relationship produced a simple equation and a full equation was developed using best subsets regression (additional possible predictors of leg length, body mass, BMI, percent body fat, sex, and age). Predictive accuracy and bias of each cadence-based metabolic equation and the ACSM Metabolic Equation was evaluated through k-fold cross-validation. In Study Two, these three metabolic equations were applied to data collected from 20 young adults during overground walking at self-selected paces (unconstrained) and with foot-strikes entrained to music tempos (cadence-constrained). RESULTS: In Study One, the simple equation predicted walking intensity within 0.5 METs, on average, and approximately no bias (CONCLUSIONS: The simple equation performed comparably to the full equation (which accounted for individual characteristics) and appreciably better than the ACSM Metabolic Equation. The simple cadence-based metabolic equation is an improved, user-friendly tool for predicting and prescribing walking intensity with reasonable accuracy (within ~0.5 METs; 45 kcals/hr for the average American).

Threat perception related to environmental issues such as air pollution may be a determinant of pro-environmental behaviors. Among the potential threats of air pollution, include the perceived impacts on the psychological, social, and economic wellbeing of a community. Because of rapid increases in population growth, urbanization, and the mountainous landscapes, the American West is extremely susceptible to the adverse impacts of air pollution. A secondary data analysis was conducted using data from the Air Quality Perception Survey conducted in Cache County, Utah. The survey focused on the public perception of air pollution in Cache County and perceived impact on personal and community life. From a sample of 289 returned surveys, the data were examined to determine the possible link between threat perception and the decision to engage in specific pro-environmental and avoidance behaviors. The analysis found that threat perception predicted some pro-environmental and avoidance behaviors.

This applied research study was designed to examine hospital employees’ perceptions of safety as it relates to error reporting. Data from safety culture surveys at the research site showed a clear trend of a perception of a punitive environment for error reporting. Hospital administrators depend on error-report data to create safe and reliable systems for care; therefore, a safe reporting environment is a critical component of a safe and just culture. A recently developed instrument was used to survey the 1,730 employees at the northeastern community hospital regarding their perception of just culture and safety in the error-reporting process. No significant relationships were established between survey scores (perceptions of just culture) and the variables of age, gender, experience, and degree of training in just culture principles for the overall study population. However, significant differences were identified when comparing groups consisting of specific positions or specialties. Notably, administration and management had a more optimistic viewpoint of just culture than other groups, particularly technologists and technicians, who had a somewhat diminished perception of just culture. The findings of this applied research study have implications for hospital leaders seeking strategies to improve the safety cultures within their organizations. Measurement of specific dimensions of just culture may be valuable in these settings; particularly, stratification of survey results by position with analysis of gaps between leaders and frontline staff may provide a clue to the maturity of the safety culture. The study is a valuable addition to the safety culture research community as it aligns with and extends findings from previous research.

Quality assurance in healthcare is fundamental in ensuring the achievement of desired outcomes for patients. In 2011 a quality assurance plan was created at the East Tennessee State University (ETSU) dental hygiene program in order to meet accreditation standards. The purpose of this study was to evaluate this plan in order to determine its effectiveness in improving the quality of patient care indicators. One hundred fifty patient charts were selected and audited. Deficiencies were counted in the categories of assessment, treatment, documentation, referral, caries management, perio management, patient education, and follow-up. Research findings were varied; however, external variables with the potential to affect the study’s results were identified. Furthermore, statistical process control procedures indicated that the quality assurance program was effective or had the potential to be effective. Although further research is warranted, this study could be used to improve quality assurance practices at the ETSU dental hygiene program.

<p>Focus of Thesis This thesis focuses on the initial stages of developing the Ontario Decision Aid in Rectal Cancer for Stage II and III patients (ODARC). The ODARC is a DA meant to facilitate relevant information exchange among physicians and patients. Such a tool should enhance patient knowledge and accuracy of treatment expectations by effectively conveying to patients relevant information on treatment options and associated benefits and risks. The ODARC is designed for use during a physician-patient consultation. The ODARC prototype development was guided by a workbook on developing & evaluating patient DAs published by O’Connor & Jacobsen (for efficiency we will call this the Workbook).24 This latter document provides detailed instructions for a 7-step DA development process including: 1) assess patient and provider need 2) assess DA feasibility 3) define objectives of the DA 4) identify the framework to guide DA development 5) select tailored methods of decision support to be used in the DA 6) select the designs and measures to evaluate the aid and, 7) plan dissemination.24 In this thesis we have created a prototype ODARC as informed by Steps 1 to 5 of the Workbook. The last two steps covering evaluation and dissemination are beyond the scope and available resources of this current research effort, and can be considered as future research endeavours. This will be reviewed in the final chapter.</p> / Master of Science (MSc)

Introduction: For children born with physical disabilities, the perspectives and actions of their parents prove significant to their childhood developmental outcomes clinically, educationally, socially, and with regard to community participation. The lived world and perceptions of parents who have children with disabilities however is not well investigated. This study sought to understand parents’ framing of theirs and their children’s disability experiences. Family systems together with family systems intervention models, and disability theory were used to provide structure to interview instrumentation and subsequent analysis. Child-centered and ecologic influences were also used to track the transformative processes over time that infuses parental themes. Methods: Methods for this study followed traditions of heuristic phenomenology. Open-ended parental interviews, written and spoken, together with field notes were used to explore the meanings given to disability. Analysis focused on collective descriptions and critical themes. Results: The nine parents in this study revealed four dominant themes around which their children’s lived lives were both understood and framed. Navigating normal for us; Our pride and joy; Anything but disability; Lived lives, looking back. Each is expressed in the words of parents who reared a child with disabilities into adulthood. Discussion and Recommendations: Parental disability frameworks differ from medical model frameworks and those of disability studies but share similarities with each. The parent themes provided holistic views of what these families have lived and learned. Their perspectives provide potentially vital markers and points of inquiry for interventionists and team members who work with children and families. Themes may also offer categorical means to explore well-being and child outcomes. Additionally, the themes were transformative and empowering for parents, both in the discussion of individual matters and in their narratives. All participants iterated that they welcomed having their voices invited and heard.

En los Estados Unidos, los latinos suelen tener menos acceso a la educación, el trabajo, y el seguro médico en comparación con los blancos no-latinos, pero aun así el grupo parece superar ciertos obstáculos de la salud. Las estadísticas de la población latina muestran mayor longevidad y otras tasas favorables en comparación con los blancos no-latinos. Los expertos han titulado esta contradicción “La Paradoja Hispana Epidemiológica”. Desafortunadamente, la investigación de la paradoja está llena de generalizaciones y presuposiciones erróneas sobre la población latina diversa. Esta tesis investiga los participantes que producen generalizaciones sobre la supuesta paradoja para mostrar que estas generalizaciones impiden un entendimiento claro. Antes de llegar a conclusiones e implicaciones, es necesario diseccionar la paradoja para poder entender esta diversidad y especificar los aspectos que realmente necesitan explicaciones. El análisis de la aparente paradoja tiene mucho que decirnos no sólo sobre la población latina, sino también sobre las maneras en que se estudia la salud y cómo se presenta información sobre la salud al público. Una examinación de las investigaciones de la paradoja puede dar luz a estos discursos generales.

This thesis study evaluates access to care at an internal medicine unit with solely semi-private rooms at Baystate Medical Center (BMC). Patients are divided into two types: Type I patient consumes one bed; Type II patient occupies two beds or an entire semi-private room as a private space for clinical reasons, resulting in one empty but unavailable (blocked) bed per Type II patient. Because little data is available on blocked beds and Type II patients, unit-level hospital bed planning studies that consider blocked beds have been lacking. This thesis study bridges that gap by building a single-stream and a two-stream discrete micro-simulation model in Excel VBA to describe unit-level bed queue dynamics at hourly granularity in the next 48-hour time horizon, using historical arrival rates and census-dependent discharge rates, supplemented with qualitative results on complexity of patient-level discharge prediction. Results showed that while we increase additional semiprivate beds, there was notable difference between the traditional single-stream model and the two-stream model concerning improvement in bed queue size. Possible directions for future research include patient-level discharge prediction considering both clinical and nonclinical milestones, and strategic redesign of hospital unit(s) considering overflows and internal transfers.

The medical device manufacturing industry has a deficiency in determining how to improve supplier performance for the components and systems they purchase. Many complex medical devices require components from superb suppliers. But how does a medical device manufacturer (MDM) impartially assess supplier performance to know which suppliers to continuing with (or even boost purchase volumes) and which suppliers they should exit? This study describes which supplier-specific metrics are most important to medical device manufacturers (MDMs) so they can utilize this supplier performance scorecard backed by real-world inputs. This research will focus on five categories to measure MDM supplier performance (Quality, Price, Delivery, Customer Service, and Partnership) across twenty-three (23) metrics. Because this is a focus of MDM supplier performance, we are not focusing on analysis of device sales to the final customer (e.g., distributors or group purchasing organizations {GPO}). The study will follow a framework including research analysis of supplier performance management in other industries, methods to attain data from MDMs via survey, results and analysis of the data, conclusions, and an easily understandable MDM supplier performance scorecard. In the survey, 135 MDM professionals replied when asked to rate twenty-three (23) supplier performance metrics, across five (5) categories aggregated from nine (9) different industries. The survey yielded a myriad of results including, weighting factors of each of the metrics, and those data results were used to compile an MDM supplier performance scorecard utilizing real-world feedback. The analysis revealed the ratings of importance of the categories as: Quality (43%), Delivery (24%), Customer Service (4%), Partnership (13%), Price (8%) and associated weights for the twenty-three (23) metrics that matter most to an MDM when creating a performance scorecard for their supplier base. Three contributions that this research will add to the body of knowledge: An in-depth review of supplier performance across many different industries (i.e., non-healthcare and healthcare) for contrasting/comparing evidence. A detailed MDM survey and statistical analysis on the topic of supplier performance management. An easily understandable and useable MDM supplier performance scorecard (via MS Excel) for MDM supply chain and/or operations users and/or managers.