Among men living in the United States, prostate cancer is the second leading cause of cancer death, and, excluding skin cancers, it is the cancer diagnosed most frequently. While incidence and mortality rates have been declining, the American Cancer Society estimated that there were 220,800 men diagnosed with prostate cancer and more than 27,500 prostate cancer deaths in 2015. Various patient-level and community-level factors have been shown to influence the differential patterns of diagnosis, care, and outcomes for men with prostate cancer. Detailed information regarding the utilization of health services by prostate cancer patients, particularly those with higher propensity for health services use, could be used to inform efforts intended to improve the coordination and delivery of care to work towards the elimination of disparities. The purpose of the study is to facilitate a better understanding of the determinants of health services utilization by older males with prostate cancer in the United States by examining the relative influence and interaction effects of factors characterizing individual patients and their county of residence. Andersen's behavioral model of health services utilization is used as a framework to guide this study. A cross-sectional design is used to analyze administrative claims data from the 2008 Medicare Provider Analysis Review (MEDPAR) file (n=5,754). County-level data from Area Health Resources File (ARHF) are merged to include the community and contextual characteristics. American Hospital Association (AHA) annual survey data are also used to examine the importance of hospital attributes in a subset analysis (n=555). A two-stage approach is used for analyzing the data. First, several social and demographic variables are included in automatic interaction detector (AID) analysis to identify relatively homogenous subgroups of patients with similar service utilization patterns for emergency room visits and hospital length of stay. Second, regression analysis is performed in the full dataset including all patients, and in each subgroup to determine the amount of variance explained by predictor variables categorized as predisposing, enabling, and need-for-care factors. Hierarchical logistic regression is performed to analyze the variability in emergency room use, and hierarchical multiple regression is performed to analyze the variability in hospital length of stay. The results show that the need-for-care factors are dominant predictors of service use. However, the relative importance of the predictor variables varies by subgroups of prostate cancer patients identified in the initial AID analysis. The findings lend some support of the use of an integrated approach to examine the personal and social determinants of health services utilization by prostate cancer patients enrolled in the U.S. Medicare program. The theoretical framework and analytic approach employed in this study make it possible to obtain an in-depth understanding of the influential factors associated with emergency room use and length of stay for all-cause hospitalizations, which can be used to inform future research and efforts aimed at developing targeted interventions to improve the coordinated care and to reduce health disparities among Medicare beneficiaries with prostate cancer.

Social media tools, as the advanced technology, have penetrated into nonprofit management field prevalently. Nonprofit organizations adopt social media tools, such as Facebook, Twitter, YouTube, and Pinterest for attracting potential supporters, raising advocacy, and running fundraising campaigns. Social media tools break the limitation of time and space through the Internet. They change the way of how people communicate and interact with each other. The philanthropy industry hopes that social media tools could bring them the new opportunities to engage with their stakeholders, such as donors, volunteers, and customers. However, since this technology is still developing, the studies of using social media in nonprofit field are still at the infant stage. Many nonprofit practitioners are confused and questioning the effectiveness of adopting social media for civic engagement. The dissertation aims to examine how to adopt social media advantageously for helping nonprofit organizations to engage with their stakeholders. Therefore, this study uses a mix of methodology to examine how social media tools could help nonprofit organizations to gain a stronger relationship with their stakeholders. Also, the study explores in more details about the content that nonprofit organizations have sent on their social media platforms. To develop the theoretical framework, this study used social capital and social exchange theory as the guidance. To observe and examine the strategy of using social media in nonprofit organizations, the study is inspired and adopts the social media typology from Lovejoy and Saxton's (2012) research and the communication models from Lewis, Hamel, and Richardson's work (2001). The study proposed that to gain a stronger relationship with the stakeholders, nonprofit organizations should apply a well-designed comprehensive strategy with multiple goals on their social media platforms. This strategy should consider more about the stakeholders' desires and needs and allows the organizations to communicate with the stakeholders effectively. Also, the study also argues that the content that an organization presents on its social media would impact on the stakeholders' interaction greatly. The study targeted on the art/culture/humanities nonprofit organizations in the United States (n = 195). Data was collected directly from the targeted organization's social media platforms (Facebook and Twitter). The regression analysis was conducted to investigate what strategy that nonprofit organization used could gain a high engagement from their stakeholders. A content analysis was also conducted to explore what posts and tweets could influence how stakeholders react. The results indicate that most nonprofit organizations realize the importance of adopting social media, but a few of them still have not embraced the benefits of the technology essentially. Comparing with the activities on Twitter, both nonprofit organizations and their stakeholders were more active on Facebook. On social media, the primary goal for most nonprofit organizations was to disseminate the information. But sending out the information can be an effective strategy. If a nonprofit organization could combine their values/missions/programs with the hot spot on social media, it can promote the stakeholders' engagement greatly. Building a dialogic content on the organization's social media is still overlooked. But no evidence in this study shown that initiating a dialog would receive a high engagement from the stakeholders. The results of this study also show that a nonprofit organization delivered the posts or tweets more frequently does not necessarily mean it would receive a higher interactivity from its stakeholders. The organization's size (the annual budget) does not influence how nonprofit organizations used their social media tools to interact with their online stakeholders. Overall, the study explored how art/culture/humanities nonprofit organizations used their Facebook and Twitter to interact with their online stakeholders. The study helps both the researchers and the practitioners to understand the strategies of using social media tools in nonprofit organizations. It also reveals several practical examples to illustrate what kind of social media content could attract or discourage the online stakeholders' engagement. The study is also a good benchmark report for nonprofit practitioners to evaluate their social media usage.

This dissertation argues that there are three basic types of health care systems used in industrial nations: free market (private insurance and provision), universal (public insurance and private provision), and socialized (public insurance and provision). It examines the role of market forces (supply and demand) within the health care systems and their effects on health outcomes by constructing an integrative model of health care markets and policies that is lacking within the scientific and academic literature. The results show that, free market systems have decreased access to care, good quality of care, and are economically inefficient resulting in 2.7 years of life expectancy lost and wasted expenditures (expenditures that do not increase life expectancy) of $3474 per capita ($1.12 trillion per year in the U.S.). Socialized systems are the most economically efficient systems but have decreased access to care compared to universal systems, increased access to care compared to free market systems and have the lowest quality of care of all three systems resulting in 3 months of life expectancy lost per capita and a saving of $335 per capita. Universal systems perform better than either of the other 2 systems based on quality and access to care. The models show that health insurance is a Giffen Good; a good that defies the law of demand. This study is the first fully demonstrated case of a Giffen good. This investigation shows how the theoretically informed integrative model behaves as predicted and influences health outcomes contingent upon the system type. To test and substantiate this integrative model, regression analysis, Time-Series-Cross-Section analysis, and structural equation modeling were performed using longitudinal data provided and standardized by the Organization for Economic Cooperation and Development (OECD). The results demonstrate that universal health care systems are superior to the other two systems.

Active interdepartmental participation of the biomedical engineering technician (BMET) with clinicians is an opportunity to reduce systemic events guided by empirical evidence that 1) establishes adverse events with medical equipment and 2) associates nursing effectiveness with access to functioning equipment. Though prior research has documented interdependency in nurse-physician relationships (and in such non-clinical health support services as laboratory and pharmaceutical departments), few studies in mainstream literature on quality have related medical professional interdependencies to the BMET. The promotion of National Patient Safety Goals, federal legislation (the Safe Device Act of 1990), and recommendations from agencies— The Joint Commission and the United States Center for Disease Control and Prevention (CDC), all point to a multidisciplinary approach for detecting and resolving systemic problems. Therefore, comprehending the interdependent role of the BMET in hospital care is important for reducing persistent problems like Nosocomial Infections (NI) and other adverse systemic events that affect clinical outcomes. Industry research documents the positive contributions of BMET professional integration into facility management in Management Information Systems (MIS), and empirical evidence has shown that their professional contributions influence nursing performance and thus, patient outcomes. Yet, BMET integration to departments like Infection Control and Central Sterile where BMETs' specific knowledge of medical equipment can apply directly is rare, if not entirely absent. Delaying such professional integration can hamper effective response to offset the Centers for Medicare and Medicaid (CMS) payment reductions that went into effect on October 1, 2008. The CMS denies payment for treatment of infections it deems 'preventable' by proper interdependent precautions. Infections already under scrutiny as preventable include mediastenitis, urinary tract infections, and catheter-related blood stream infections. Furthermore, formal Medicare Conditions of Participation (CoP) now require hospitals to develop initiatives to reduce medical errors by identifying and addressing threats to patient safety. In both these challenges the medical equipment used in clinical care can adversely affect patient outcomes. Clearly, the health care system must tackle the common healthcare associated infections (HAI) just mentioned as well as others that may be added to the CMS list, or face overwhelming financial costs. Understanding the BMET professional relationship with nursing, given the structural and process considerations of the level of quality (LOQ) as measured by Clinical Effectiveness, Clinical Efficiency, and Regulatory Compliance, will be essential for meeting this challenge. This study's extensive literature review led to the development of a conceptual hypothesized model based on Donabedian's 1988 Triad of Structure, Process, and Outcome and fused with Integrated Empirical Ethics as a foundation for BMET professional interdependency and for consolidated attack on adverse systemic events. This theoretical integration has the potential to advance quality of clinical care by illuminating the factors directly or indirectly influencing patient outcomes. Primary data were gathered through the Biomedical Engineering Interdepartmental Survey that collected BMETs' professional perceptions of organizational factors (Structural Complexity), process factors (Process Adequacy), and Level of Quality and Control variables yielding information about the individual respondents and the facilities where they work. The unit of analysis in this study is the biomedical engineering technician functioning in hospital support services to ensure patient safety and quality of care. Initial survey results underwent data cleansing to eliminate the impact of missing items. Next, Confirmatory Factor Analysis applied to the survey data determined the construct validity and reliability of the measurement instrument. Statistically tested regression models identified structure and process factors that may affect the LOQ in terms of systemic adverse events and lack of compliance. The statistical analysis and assumption tests that confirm internal validity infer that hospital Level of Quality is significantly influenced at R2 = 88.1% by Structural Complexity. The combined measurement model and models for each latent construct achieved Cronbach α results > 0.7, indicating internal reliability of the Biomedical Engineering Interdepartmental (BEI) survey instrument. The final measurement models of the latent constructs—structural complexity (six factors), process adequacy (five factors), and level of quality (six factors) are correlated and significant at t > 1.96, p < .001 (2-tailed). The Structural Equation Model without controls are correlated and significant at t > 1.96 on all factors, indicating an approximate standard distribution at p < .001 level (2-tailed). Goodness of fit model analysis findings indicates that the models reasonably fit the data. The largest correlation is expressed between structural complexity and process adequacy (0.217 to 0.461), p=.01 (2-tailed). Respondent and facility control variables added to the Structural Equation Model are correlated with low impact but not statistically significant. The findings have implications for theory, methodology, external policy, and internal hospital administrative management. The theoretical contributions of the study include the instrument development, measurement models, and the Structural Equation Model for hospital level of quality. The statistical analysis of the relationships of Donabedian's Triad indicates that both structural complexity and process adequacy are explanatory for the outcome variable of level of quality. Several statistically significant predictors of quality support an integrated approach to systemic problems. They are Uniform Standards, Inter-Professional Training, Coordination Evidence, Interdepartmental Work and Device Failure Recognition. Moreover, the application of Integrated Empirical Ethics provides a foundation for management resolution that can improve the hospital level of quality by consolidating divergent internal and external controls by providing implementation guidance to overcome medical plurality as empirical evidence continues to emerge. The study defines the outcome measures of Quality—Effectiveness, Efficiency, and Regulatory Compliance in the context of Clinical Engineering. The study results suggest pertinent external policy recommendations, foremost of which arises from the responses to the item concerning Uniform Standards: "Standards are applied equally across all departments." In the BMET community, only about 20 per cent strongly agree with this statement; approximately 33 per cent agree. Because of divergent ethical and national regulatory policies applied to professional affiliations rather than the medical community at large, a policy adapting regulatory initiatives having the same focus on patient outcomes (e.g., CMS CoP; National Patient Safety Goals) would generate the best initiatives for reducing systemic adverse events and policy conflicts. Finally, results suggest that internal hospital administrators can improve the level of quality through internal process changes, in particular by addressing the process adequacy factor of Regular Meetings for the survey item: "Nursing and biomedical engineering conduct regularly scheduled meetings on equipment issues." Less than 10 per cent of the BMETs surveyed strongly agreed and about one-third agreed that this aspect of interdepartmental teamwork was accepted. The study confirms the evolution of the interdependent professional dynamic within healthcare exemplified by the combination of multiple predictors of the Level of Quality from Organizational Culture, Level of Coordination and Interdepartmental Medical Device Management. Hospital administrators can find simple, cost-effective solutions to improve clinical effectiveness (a key indicator of quality) in the components of the intervening variable of process adequacy. For example, statistical evidence shows that regular meetings between nursing and biomedical staff about equipment issues and/or linking the BMET department goals to Organization Objectives are ways to improve quality.

<p>Union participation is an integral part of almost every union. This thesis studies the dimensions of participation in local union activities. The study is based on a survey that was conducted at the Hamilton-Wentworth Elementary Teachers Local. The study looks at participation trends within this union, looking at variables such meeting attendance, voting behaviours, and social event attendance, among others. This study finds that participation in this union is relatively high compared to many unions in comparable studies. It also finds that gender was not a barrier to participation. Women in this union participated at a higher level than men. The study also outlines how union structure issues as well as leadership issues affect participation of the union members. This paper outlines why participation is important to this particular union, as well as why participation is important to unions in general.</p> / Master of Arts (MA)

Examining the practical utility of a structured decision-making tool and its impact on actual case dispositions for juveniles charged with sexual offenses is an important question to answer. While research has confirmed that structured decision-making contributes to positive youth and system outcomes, addressing how well these broad policies serve specific groups of offenders, such as juveniles charged with sexual offenses, has not yet received adequate empirical attention. Therefore, this dissertation sought to examine the strengths and limitations of using Florida's statewide disposition recommendation policies for juveniles who have been charged with sexual offenses. Specifically, the study sought to examine 1) the association between delinquency risk to reoffend and disposition alignment with the disposition recommendation provided by the FDJJ among juveniles charged with a sex offense and juveniles charged with other against-person felony offenses, 2) differences in dynamic risk domains across disposition match among juveniles charged with a sex offense and juveniles charged with other against-person felony offenses, and 3) whether being charged with a sex offense, compared to being charged with other against-person felony offenses, increased the likelihood that a juvenile would receive residential commitment. To answer these questions, administrative data was obtained from the Florida Department of Juvenile Justice. The data included juveniles whose cases were disposed in Florida between 2012 and 2017 and included juveniles who were charged with sex offenses and juveniles who were charged with other against-person felony offenses. A variety of bivariate (crosstabs, chi-squares, ANOVAs) and multivariate (logistic regression) statistical techniques were employed. The results of the proposed study may be used to improve Florida juvenile justice disposition recommendation practices for juveniles who have committed sexually-related offenses.

While many automated police data sharing systems have been implemented since the attacks of September 11, 2001, when police data sharing was announced to be a priority for law enforcement, little research is available concerning the impact of such systems on the ability of the police to solve crimes. To remedy this gap, this study evaluates the Federated Integrated Network for Data Exchange and Retrieval (FINDER) – an automated police data sharing system currently used by a large number of Florida and Alabama police agencies with development underway across the US. This research is the first study evaluating a police data sharing system using objective measures. As such, rather than using user perceptions about the data sharing system's effectiveness, as most of the existing studies have done in the past, this study uses Uniform Crime Report (UCR) offense clearance rates as an objective measure of police performance. Based on the existing literature, it is hypothesized in this study that the use of a police data sharing system improves the police agency's offense clearance rates. To test a set of hypotheses, panel data containing information on 99 police agencies collected annually over the course of 30 years – 1990 through 2019 – are analyzed using fixed effects models. The results of this research suggest that the use of a police data sharing system improves police agency total offense clearance rates as well as property offense clearance rates. No evidence is found to support the hypothesis that the use of a data sharing system improves violent offense clearance rates. This dissertation overviews the limitations of this study and implications of its findings and concludes with a set of recommendations for policymakers and police practitioners as well as suggests topics for future research.

Dissatisfaction amongst US physicians has been steadily increasing over the past few decades as health care reform changes the practice of medicine (Hoff, Young, Xiang, & Raver, 2015; Rosenstein, & Mudge-Riley, 2010). In 2008, physician dissatisfaction rates had increased to 19% (Mazaurenko & Menachemi, 2012). By 2012, 42% of physicians voiced dissatisfaction, with family medicine reporting most likely to be dissatisfied (Sorrell & Jennings, 2014). One factor that could affect physician career dissatisfaction/satisfaction that has not been studied is collaborative relationships with other healthcare providers, such as nurse practitioners. This study used secondary quantitative data from the National Survey of Primary Care Physicians and Nurse Practitioners (2012). Logistic regression was used to analyze the relationship of nurse practitioner collaboration and the other independent variables with the dependent variable of physician career satisfaction. In order to address the research goals the independent variables of primary interest were as follows 1) whether PCPs work with NPs in their office; 2) what the quality of the PCP relationship is with the NPs; 3) what is the share of work performed by NPs. Descriptive statistics and binary logistic regressions were run to test the significance of the three hypotheses. Analysis yielded many observational results on the PCPs descriptively but did not show any significant results on the proposed hypotheses regarding PCP career satisfaction. However, one of the greatest strengths of this study was the attempt to bridge the gaps of knowledge regarding PCP and NP collaboration and physician career satisfaction. The fact that results were not significant does not negate the need for further studies on this issue, especially since no other studies exist. In conducting future research, obtaining a larger sample of PCPs, including PCPs who work with NPs, would be an important step in correcting some of the limitations of this study. The lack of significant results also raises further questions regarding the difference between career and job satisfaction with the latter referring to the current work environment rather than the cumulative career experience.

Opioid-related deaths have increased rapidly over the last couple of decades due to the overprescribing of prescription opioids and the availability of illicit drugs from family members, friends, or street dealers. To address this crisis, this research will attempt to identify how health literacy levels affect knowledge, attitudes, and behaviors. Hence, this study is informed by the Knowledge-Attitude-Behavior (KAB) Model. The KAB model is used to determine the influence of knowledge and attitudes on behaviors, which includes prescription drugs, illicit drugs, and fentanyl. This dissertation aims to explore the relationships between health literacy, knowledge, attitude, and behavior for opioids (prescription and illicit). This study will also explore how these relationships differ by socioeconomic status and demographics. This study used a survey methodology to engage college students from a southeastern university as the participants of this study. The findings of this study show there is an association between health literacy and the KAB model. Additionally, there is an association between the components of the model and gender, ethnicity, and lifetime behavior, which supports what is found in the literature. The results from this study will be useful for opioid researchers and public health organizations so opioid-related information is disseminated in a plain language format to the public. The dissemination of information is significant because it will guide the opioid knowledge of college students and can essentially influence their behavior.

The 2008 financial recession has seen increased poverty, job loss, and homelessness as well as decreased spending in health care, education, sanitation, and housing. These factors can lead to tensions across a number of sectors and underscore the need for innovation in for-profit, nonprofit and government organizations. One area of innovation in the nonprofit sector to supplement revenues is by adding social enterprise activity. Social enterprise is the pursuit of earned income activities for an organization that is driven by a community mission or value. Because financial and social problems are becoming increasingly intertwined, this study seeks to understand the impacts of social enterprises on nonprofit organizations. The research uses existing data from Guidestar based on nonprofit IRS Form 990 as well as responses to an original survey administered to nonprofit organizations throughout Florida. This study will indicate if there are financial and social impacts on nonprofit organizations that have a social enterprise. Multiple regression analysis is used to estimate the impact of social enterprises on their respective nonprofits. Examining financial and social outcomes, the study determines the impact of social enterprises on a nonprofit's finances and mission.