Diabetes Miletus (DM) is one of the major health problems in the United States. Despite all efforts made to combat this disease, its incidence and prevalence are steadily increasing. One of the common and serious side effects of treatment among people with diabetes is hypoglycemia (HG), where the level of blood glucose falls below the optimum level. Episodes of HG vary in their severity. Nevertheless, many require medical assistance and are usually associated with higher utilization of healthcare resources such as frequent emergency department visits and physician visits. Additionally, patients who experience HG frequently have poor outcomes such as higher rates for morbidities and mortality. Although many studies have been conducted to explore the risk factors associated with HG as well as others that looked into the level of healthcare utilization and outcomes among patients with HG, most of these studies failed to establish a theoretical foundation and integrate a comprehensive list of personal risk factors. Therefore, this study aimed to employ Andersen's health Behavior Model of health care utilization (BM) as a framework to examine the problems of HG. This holistic approach facilitates enumerating predictors and examining differential risks of the predisposing (P), enabling (E) and need-for-care (N) factors influencing HG and their effects on utilization (U) and outcomes (O). The population derived from the national inpatient sample of the Healthcare Cost and Utilization Project (HCUP) database and included all non-pregnant adult diabetic patients admitted to hospitals' Emergency Departments (EDs) with a diagnosis of HG from 2012-2014. Based on the BM framework, different factors influencing HG utilization and outcome were grouped under the P, E, or N component. Utilization was measured by patients' length of stay (LoS) in the hospital and the total charges incurred for the stay. Outcome was assessed based on the severity ranging from mortality (the worst), severe complications, mild complications, to no complications (the best). Structural Equation Modeling (SEM) followed by Decision Tree Regression (DTREG) were performed. SEM helped in testing multiple hypotheses developed in the study as well as exploring the direct and indirect impact of different risk factors on utilization and outcome. The results of the analysis show that N is the most influential component of predictors of U and O. This is parallel to what was repeatedly found in different studies that employed the BM. Regarding the other two components, P was found to have some effect on O, while E influences the total charge. Interaction effects of predictors were noted between some components, which indicate the indirect effect of these components on U and O. Subsequently, DTREG analysis was conducted to further explore the probability of the different predictor variables on LoS, total charge, and outcome. Results of this study revealed that the presence of renal disease and DM complications among HG patients play a key role in predicting U and O. Furthermore, age, socio-economic status (SES), and the geographical location of the patients were also found to be vital factors in determining the variability in U and O among HG patients. In conclusion, findings of this study lend support to the use of the BM approach to health services use and outcomes and provide some practical applications for healthcare providers in terms of using the predictive model for targeting patient subgroups (HG patients) for interventions among diabetic patients. Moreover, policy implications, particularly related to the Central Florida area, for decision makers regarding how to approach the growing problem of DM can be drawn from the study results.

State court systems function in much the same manner as any other government agency in terms of organization and management to utilize public resources in order to provide a public service. The question posed in the late 19th century was whether the courts should be organized and managed as they had been for centuries as local entities locally controlled and operated or transferred to the state level. The desired end was a more efficient use of public resources to achieve faster disposition of cases. This reorganization, called unification, was made up of three individual components: 1) consolidation required the reduction in the number of types of trial court in a state to one or two 2) centralization required the surrendering to the state's chief justice, later the newly created office of state court administrator, all managerial control over these courts, and 3) judicial rulemaking required removing from the legislature the power to create rules of practice and procedure in the courts, instead turning that power over to the courts themselves in the form of judicial councils or later state supreme courts. Unification, relying on principles of scientific management, served as the basis for state court reorganization for nearly a century, however the assumption that consolidation, centralization, and judicial rulemaking would lead to greater levels of efficiency in the courts remained effectively untested. Data for the year 2013 was collected to measure state court efficiency in two ways: case clearance rates (number of cases disposed divided by the number of cases filed) and case clearance rates per judge (number of cases disposed divided by the number of judges). An ordinary least squares regression found no apparent relationship between a state's level of unification and its ability to clear its trial court caseloads.

The Medicaid Home and Community Based Services Waiver (HCBS) funds services for people with developmental disabilities in community based group homes. The purpose of the Medicaid HCBS Waiver is to: (1) support alternatives to institutions, (2) promote independence, (3) maximize functioning, and (4) support community integration. Direct care staff members have primary, day to day contact with people with developmental disabilities living in group home settings. Residential agencies for people with developmental disabilities have the responsibility to train direct care staff in the use of effective teaching strategies in order to realize the purpose of the Medicaid HCBS waiver. Direct care staff's knowledge of effective teaching strategies will afford people with mental retardation an opportunity for greater independence and help them achieve their maximum potential within the community. This study set out to evaluate what factors were related to direct care staff members' knowledge of effective teaching strategies. The factors investigated include agencies use of evidence based staff training practices, feedback as a performance management strategy, and Certified Behavior Analysts involvement with the training and support of direct care staff. A random sample of 294 direct care staff members who work in 55 different group homes throughout the State of Florida participated in the study. Direct care staff members' average score on the knowledge of effective teaching strategies quiz was 23.31 out of 50 questions. The maximum score achieved was 43. These findings indicated that the direct care staff members generally did not demonstrate knowledge of effective teaching strategies. The findings of this investigation demonstrated a statistically significant positive relationship between direct care staff members who received empirically derived staff training and knowledge of effective teaching strategies. Additionally, the investigation found a statistically significant positive relationship between the behavior analyst involvement and direct care staff members' knowledge about how to teach. The investigation failed to identify a statistically significant relationship between performance feedback and knowledge about how to teach. This research is important to policy formulation as it relates to the efficient and effective delivery of supports for people with developmental disabilities.

This research study examines how faculty perceive academic freedom at a metropolitan university. Thirty structured interviews were conducted with social science faculty, who have been tenured for 10 years or more, at Virginia Commonwealth University (VCU). These faculty came from the departments of Sociology, Psychology, Anthropology, Political Science, Urban Studies, Criminal Justice, Women’s Studies, and African-American Studies. The following five questions were the central research questions: (a) how do core faculty in the social sciences at VCU define academic freedom; (b) do these same faculty perceive academic freedom to be a significant feature of a career in higher education; (c) do these same faculty perceive any existing threats to their academic freedom; (d) how do these faculty define academic tenure; and (e) how did these faculty learn about academic freedom and tenure. Where previous research has often focused on comparing and contrasting faculty perceptions of academic freedom from different institutions, ranks and disciplines, this research targeted a fairly homogenous population of faculty in order to identify any common socialization experiences, both formal and informal, which may have contributed to common perceptions. The findings suggest that these faculty do not share a common perception of academic freedom. Where most of the respondents did agree that academic freedom protected both research and teaching, approximately half of the respondents did not associate any institutional limitations or professional responsibilities with academic freedom. Most of the respondents considered academic freedom to be a significant feature of an academic career. They perceived the current threats to academic freedom to be largely stemmed from within the institution. In particular, they believed that a top- down business model of leadership coupled with a weak academic culture to be the most significant threats to academic freedom. They defined tenure primarily as a means of protecting their own academic freedom through job security. Lastly, most of them learned about academic freedom very vicariously and informally, which helps explain the varied perceptions of what academic freedom means to them and how it should be exercised.

Mammalian one—cell embryos can be genetically altered, implanted into the female's uterus, and subsequently develop into biologically mature organisms in the usual manner. If the resultant adult organisms reproduce, the genetic change may be passed on to future generations. In humans, the procedure is known alternatively as "human genetic engineering" or "human germline gene therapy." Bioethicists distinguish between genetic engineering intended for the prevention or treatment of disease ("treatment germline gene therapy") and genetic engineering intended for non—medical enhancement of certain characteristics ("enhancement germline gene therapy"). Human genetic engineering has the potential to effectively replace deleterious genes such as the gene for cystic fibrosis or sickle cell disease — with a normal gene. Thus, not only is disease avoided in the next generation, but all future generations are spared the effects of the disease—causing gene as well. The current public policy consensus is that human genetic engineering, whether intended for treatment or enhancement, is ethically impermissible. The primary reason is that present genetic engineering technology carries an unacceptable level of risk for use in humans. There is, however, good reason to believe that genetic engineering will become acceptably safe for use in humans, thereby eliminating the major ethical barrier to the technology. In fact, several policy statements already have suggested that, once safe, treatment genetic engineering ought to be permitted while enhancement genetic engineering ought not to be permitted. Part of the concern surrounding genetic enhancement is that bad consequences — such as morally objectionable eugenics practices — might ensue. But another objection is that human genetic enhancement is intrinsically problematic. In other words, at least very radical genetic enhancements violate what it is that makes human beings intrinsically valuable. Drawing on a Wittgensteinian view of human beings, the present work proposes a conception of ethically significant humanness — "human beingness" — that is potentially threatened by certain kinds or degrees of human genetic enhancement. The impact of human beingness on the future direction of human gene therapy policy, and in other policy areas, is discussed.

American higher education exists today in an environment of accountability. The public is demanding full participation in addressing the considerable social, health and economic problems facing society. Despite explicit statements of commitment to public service and community outreach however, according to numerous studies conducted over the past twenty years, universities are not articulating this commitment in faculty roles and rewards. This study advances the discussion of roles and rewards at one particular model of institution — the urban university. The focus is on the behavior and attitudes of academic leaders at these unique institutions to determine the extent to which faculty public service activities are valued . The liberal arts/humanities/sciences schools at urban universities are the unit. of analysis based on the knowledge these faculty can contribute to the solution of social problems. A descriptive research design was developed to determine the prevalence of certain attitudes at a sample of urban universities. Cross-sectional and case study methods were used to survey 70 institutions. Based on the findings of the study, the conclusion is drawn that, overall, strategies, rewards and structures at the majority of liberal arts/humanities/sciences schools that were part of this study are not in alignment with the public service mission. Authors of organizational theory claim that congruence — alignment of goals and rewards — is necessary for success. Interviews with deans of schools that were determined to be "successful" in aligning rewards yielded common philosophies regarding articulating the service mission. For example: • Boyer's broadest view of scholarship has been incorporated into efforts to redefine faculty roles and rewards. • "The partnership is the new concept that replaces volunteer work with creative, mutually-rewarded research and teaching in the community setting."

A comprehensive homeless policy includes emergency housing, transitional housing, permanent housing, and prevention components. Researchers have determined that all four categories of homeless assistance are essential to address the needs of the diverse groups that comprise the homeless population. This dissertation focuses on the prevention component which is designed to assist those in marginal economic circumstances who experience an unavoidable housing crisis. Several states have state-sponsored and state-funded homeless prevention programs. The Commonwealth of Virginia authorized funding for the Homeless Intervention Program (HIP) in FY 1989-90. A Short-Term Study of the first group of participants conducted by Johnson, Brooks, Hambrick, and Richardson (1991) provided evidence that the 1989-90 participants remained in stable housing for six months after leaving the program. The Longer-Term Study discussed in this dissertation was conducted four years after the participants received HIP assistance and involved enrollees from two of the eight original program sites. The data were gathered through the use of mail and telephone surveys and focused interviews. The results indicate that HIP contributed to the housing stability of the majority of the longer-term study participants who have, in the four years since receiving HIP assistance, remained housing self-sufficient. This study recognizes the implications of the time dimension in program evaluation as put forth by Salamon (1976). Accordingly, in addition to ascertaining whether there was a diminishment in the staying power of HIP, other program results more closely associated with latent and sleeper effects were uncovered.

Recent studies conducted by oversight agencies show that improvements are needed in Federal personnel office (FPO) operations. The existing literature and research in the field of public personnel administration provides little guidance as to what types of changes or interventions will improve service quality. The purpose of this study is to identify organizational variables that influence FPO service quality. This study is based on the multiple-constituency model of organizational effectiveness and the body of literature pertaining to service quality research conducted in private sector service industries. The investigator developed a conceptual model of FPO service quality based on the findings from service quality research and from various Federal personnel studies. Using the conceptual model as a guide, the statement of the problem became: How do the organizational dimensions of FPO access, human resource management (HRM) program design, FPO staff qualifications, FPO staff attitudes, Federal manager status, and Federal manager support influence the quality of FPO service as perceived by Federal managers? Within these six dimensions, sixteen variables were identified for testing. The research design was based on determining the association of sixteen predictor variables to the criterion variable of perceived service quality, using analytical surveys randomly administered to 72 personnel specialists and 269 Federal managers in six Federal government organizations. Of the sixteen variables tested, six had a significant relationship to managers' perceptions of service quality. These were FPO proximity, HRM program responsiveness, FPO staff training, FPO service standards, and a managers' supervisory level and authority for HRM actions. The primary significance of the study is that it extends service quality theory to Federal personnel administration, it provides an additional dimension to the current multiple constituency models of personnel office effectiveness, and it provides guidance on how to improve FPO service quality.

Public housing, in growing urban communities like Daytona Beach, Florida is involved in a perpetual struggle for its continued existence. Public housing programs face serious problems in addition to financial difficulties. Many have acquired the reputation of being worse living environments than the slums they were supposed to replace. Although public housing originally served the so called "working poor", it has gradually become the "housing of last resort" for America's poorest citizens. Over the years, it has become obvious that public housing has acquired a rather poor image of being a large conglomeration of low income citizens housed in large impersonal concrete structures. The focus of the study centers on the examination of public housing, its occupants and the negative image that seems to be perpetuated within these lower income areas of cities like Daytona Beach, Florida.

The State Comptroller is an important state official. This research is intended to determine whether method of selection of the state comptroller (election or appointment), organizational configuration of the state comptroller's agency, professional qualifications of the state comptroller, or length of tenure served by the state comptroller have an impact on the effectiveness of the performance of the state comptroller’s agency. This research utilized a multi-constituency model of effectiveness. Under this model, effectiveness was defined as satisfaction of the needs of major constituencies of the state comptroller’s agency. Major constituencies of the state comptroller’s agency were identified. Variables to determine effectiveness for each constituency were also identified. Cross tabulations were prepared that compared the measures of effectiveness for each constituency (dependent variables) to the independent variables; method of selection, organizational configuration, certification of the state comptroller, and length of tenure of the state comptroller. In summary, the research produced the following findings: Method of selection was found to be a factor in satisfaction of the needs of the financial community, an external constituency of the state comptroller's agency. Generally, more political, higher profile comptrollers, those appointed by and serving at the pleasure of the governor and those who are directly elected, were found to be more effective than lower profile, less political comptrollers appointed at lower levels of government. Method of selection was not found to be a factor in satisfaction of the needs of other, internal constituencies. Organizational configuration of the comptroller’s agency in the context of the larger government was not found to be a factor in effectiveness. Professional certification of the state comptroller was not found to be a factor in effectiveness of the state comptroller. Elected comptrollers, who are less likely to be professionally certified than comptrollers selected by other methods, are effective. Tenure in office on the part of the state comptroller is not a factor in effectiveness of the comptroller’s agency.