Indiana University-Purdue University Indianapolis (IUPUI) / Given the numerous benefits of a healthy diet and exercise for cancer survivors, there has been an increase in the number of lifestyle intervention trials for this population in recent years. However, the extent to which adherence to a diet and exercise intervention predicts health-related outcomes among cancer survivors is currently unknown. To address this question, data from the Reach out to ENhancE Wellness in Older Cancer Survivors (RENEW) diet and exercise intervention trial were analyzed. RENEW was a yearlong telephone and mailed print intervention for 641 older (>65 years of age), overweight (body mass index: 25.0-39.9), long-term (>5 years post-diagnosis) survivors of colorectal, breast, and prostate cancer. Participants were randomized to the diet and exercise intervention or a delayed-intervention control condition. The RENEW telephone counseling sessions were based on determinants of behavior derived from Social Cognitive Theory (SCT) (e.g., building social support, enhancing self-efficacy). These factors have been hypothesized to improve health behaviors, which in turn should improve health outcomes. Thus, drawing on SCT and prior diet and exercise research with cancer survivors, I hypothesized that telephone counseling session attendance would be indirectly related to health-related outcomes (i.e., physical function, basic and advanced lower extremity function, mental health, and body mass index) through intervention-period strength and endurance exercise and dietary behavior (i.e., fruit and vegetable intake, saturated fat intake). The proposed model showed good fit to the data; however, not all of the hypothesized relationships were supported. Specifically, increased telephone counseling session attendance was related to engagement in all of the health behaviors over the intervention period. In turn, (a) increased endurance exercise was related to improvement in all of the health-related outcomes with the exception of mental health; (b) increased strength exercise was solely related to improved mental health; (c) increased fruit and vegetable intake was only related to improved basic lower extremity function; and (d) saturated fat intake was not related to any of the health-related outcomes. Taken together, these findings suggest that SCT determinants of behavior and the importance of session attendance should continue to be emphasized in diet and exercise interventions. Continued exploration of the relationship between adherence to a diet and exercise intervention and health-related outcomes will inform the development of more cost-effective and efficacious interventions for cancer and other medical populations.

Indiana University-Purdue University Indianapolis (IUPUI) / Background: Recent literature on medical professionalism claims that self-awareness and the ability to reflect upon one’s experiences is a critical component of professionalism; however there is a paucity of empirical evidence to support this claim. This study employed a mixed methods approach to explore the utility of reflective writing and self- and peer assessments in explaining professionalism lapses among medical students. Methods: A retrospective case-control study was conducted using students from Indiana University School of Medicine (IUSM) who had been disciplined for unprofessional behavior between 2006-2013 (case group; n=70). A randomly selected control group (n=230) was used for comparison. Reflective ability was assessed using a validated rubric to score students’ professionalism journals. Mean reflection scores and assessment scores were compared using t-tests. Logistic regression analysis was used to determine the impact of reflection scores and self- and peer assessment scores on the likelihood of having been disciplined for unprofessional behavior. Subsequent qualitative analysis further explored when and how students learned professionalism during their clinical experiences. Results: The study found that students in the case group exhibited lower reflective ability than control students. Furthermore, reflective ability was a significant factor in explaining the odds that a student had been cited for professionalism lapses. There were no differences in self-assessment scores between the two groups, but students in the case group had significantly lower peer assessment scores than control students. Peer assessment scores also had the greatest influence on the odds that a student had been cited for professionalism deficiencies during medical school. Qualitative analysis revealed that students learn professionalism from role models who demonstrated altruism and respect (or lack thereof). Conclusions: These findings suggest that students should be provided with guidance and feedback on their reflective writing to promote higher levels of reflection, which may reduce the number of students who are cited for professionalism lapses. These findings also indicate that peer assessments can be used to provide students with insightful feedback regarding their professional development. Finally, role models have a strong influence on students’ professional development, and therefore must be cognizant of the implicit messages their behaviors convey.

Indiana University-Purdue University Indianapolis (IUPUI) / Madeline Heilman’s (1983) Lack of Fit Model, which postulates why discrimination occurs in the selection of sex-typed jobs, has been applied to the interaction of applicant attractiveness. Yet recent research suggests that other appearance variables, namely sex-typed facial features, may be associated with perceptions of fit. Building upon Heilman’s 1983 model, the current study evaluated how sex-typed facial features relate to applicant selection for sex-typed fields. Undergraduate students were recruited for participation during the spring academic semester (n = 413) and data were analyzed using a 2x2x2 ANOVA. Results indicated that selection is significantly impacted by the three-way interaction of applicant sex, facial feature-type, and sex type of the applying field. Further, masculine-featured females and feminine-featured males were significantly less favored for selection within the feminine sex-typed field. Implications of these findings and the differential evaluation of male and female applicants in a feminine field are discussed.

Indiana University-Purdue University Indianapolis (IUPUI) / A study design has been developed that employs a dual modeling approach to identify factors associated with facility-level cancer screening improvement and how this is mediated by the use of clinical decision support. This dual modeling approach combines principles of (1) Health Informatics, (2) Cancer Prevention and Control, (3) Health Services Research, and (4) Organizational Change/Theory. The study design builds upon the constructs of a conceptual framework developed by Jane Zapka, namely, (1) organizational and/or practice settings, (2) provider characteristics, and (3) patient population characteristics. These constructs have been operationalized as measures in a 2005 HRSA/NCI Health Disparities Cancer Collaborative inventory of 44 community health centers. The first, statistical models will use: sequential, multivariable regression models to test for the organizational determinants that may account for the presence and intensity-of-use of clinical decision support (CDS) and information systems (IS) within community health centers for use in colorectal, breast, and cervical cancer screening. A subsequent test will assess the impact of CDS/IS on provider reported cancer screening improvement rates. The second, computational models will use a multi-agent model of network evolution called CONSTRUCT® to identify the agents, tasks, knowledge, groups, and beliefs associated with cancer screening practices and CDS/IS use to inform both CDS/IS implementation and cancer screening intervention strategies. This virtual experiment will facilitate hypothesis-generation through computer simulation exercises. The outcome of this research will be to identify barriers and facilitators to improving community health center facility-level cancer screening performance using CDS/IS as an agent of change. Stakeholders for this work include both national and local community health center IT leadership, as well as clinical managers deploying IT strategies to improve cancer screening among vulnerable patient populations.

Indiana University-Purdue University Indianapolis (IUPUI) / The Antler and Sonoma orogenies occurred along the southwest-trending passive Pacific margin of North America during the Paleozoic concluding with the accretion of the McCloud Arc. A southeast-trending sinistral transform fault truncated the continental margin in the Permian, becoming a locus for initiation of an east-dipping subduction zone creating the Sierran magmatic arc. Constrained in age between two early Triassic tuff layers, the volcanic clasts in the breccia of Frog Lakes represent one of the earliest records of mafic magmatism in the eastern Sierra Nevada. Tholeiitic rock clasts found in the breccia of Frog Lakes in the Saddlebag Lake pendant in the east central Sierra Nevada range in composition from 48% to 63% SiO2. Boninites produced by early volcanism of subduction initiation by spontaneous nucleation at the Izu-Bonin-Mariana arc are more depleted in trace element concentrations than the clasts while andesites from the northern volcanic zone of the Andes produced on crust 50 km thick have similar levels of enrichment and provide a better geochemical modern analogue. Textural analysis of the breccia of Frog Lakes suggest a subaqueous environment of deposition from a mature magmatic arc built on continental crust > 50 km thick during the Triassic. The monzodiorites of Saddlebag and Odell Lakes are temporal intrusive equivalents of the breccia of Frog Lakes and zircon geochemistry indicates a magmatic arc petrogenesis.

Indiana University-Purdue University Indianapolis (IUPUI) / Environmental planning is very cumbersome work for environmentalists, government agencies like USDA and NRCS, and farmers. There are a number of conflicts and issues involved in such a decision making process. This research is based on the work to provide a common platform for environmental planning called WRESTORE (Watershed Restoration using Spatio-Temporal Optimization of Resources). We have designed a system that can be used to provide the best management practices for environmental planning. A distributed system was designed to combine high performance computing power of clusters/supercomputers in running various environmental model simulations. The system is designed to be a multi-user system just like a multi-user operating system. A number of stakeholders can log-on and run environmental model simulations simultaneously, seamlessly collaborate, and make collective judgments by visualizing their landscapes. In the research, we identified challenges in running such a system and proposed various solutions. One challenge was the lack of fast optimization algorithm. In our research, several algorithms are utilized such as Genetic Algorithm (GA) and Learning Automaton (LA). However, the criticism is that LA has a slow rate of convergence and that both LA and GA have the problem of getting stuck in local optima. We tried to solve the multi-objective problems using LA in batch mode to make the learning faster and accurate. The problems where the evaluation of the fitness functions for optimization is a bottleneck, like running environmental model simulation, evaluation of a number of such models in parallel can give considerable speed-up. In the multi-objective LA, different weight pair solutions were evaluated independently. We created their parallel versions to make them practically faster in computation. Additionally, we extended the parallelism concept with the batch mode learning. Another challenge we faced was in User Modeling. There are a number of User Modeling techniques available. Selection of the best user modeling technique is a hard problem. In this research, we modeled user's preferences and search criteria using an ANN (Artificial Neural Network). Training an ANN with limited data is not always feasible. There are many situations where a simple modeling technique works better if the learning data set is small. We formulated ways to fine tune the ANN in case of limited data and also introduced the concept of Deep Learning in User Modeling for environmental planning system.

This thesis examines the discipline of English studies in South Africa through a review of articles published in 11 academic journals over the period 1958-2004. The aims are to gain a better understanding of the functions of peer-reviewed journals, to reveal the presence of rules governing discursive production, and to uncover the historical shifts in approach and choice of disciplinary objects. The Foucauldian typology of procedures determining discursive production, that is: exclusionary, internal and restrictive procedures, is applied to the discipline of English studies in order to elucidate the existence of such procedures in the discipline. Each journal is reviewed individually and comparatively. Static and chronological statistical analyses are undertaken on the articles in the 11 journals in order to provide empirical evidence to subvert the contention that the discipline is unruly and its choice of objects random. The cumulative results of this analysis are used to describe the major shifts primarily in ranges of disciplinary objects, but also in metadiscursive and thematic debates. Each of the journals is characterised in relation to what the overall analysis reveals about the mainstream developments. The two main findings are that, during the period under review, South African imaginative written artefacts have moved from a marginal position to the centre of focus of the discipline; and that the conception of what constitutes the `literary' has returned to a pre-Practical criticism definition, broadly inclusive of a variety of types of artefact including imaginative writing, such as autobiography, letters, journals and orature. / English Studies / D. Litt. et Phil. (English)

The prevalence of divorce within society is reflected in the rising divorce rate worldwide. Consequently, divorce has become more accepted, although adolescents from divorced families are considered at risk for maladjustment. The aim of this study is to give a voice to adolescents who have experienced their parents' divorce and to highlight their resilience despite the challenges they faced. The epistemological framework is social constructionism. In-depth interviews with two adolescents who have experienced the divorce of their parents were undertaken. The method of analysis used was `Thematic content analysis'. The participants' stories were recounted through the lens of the researcher in the form of themes. Recurring themes in these stories were elucidated and linked with the literature. This study allowed rich and detailed descriptions about adolescents' experiences to emerge, which the researcher hopes will broaden the therapeutic understanding of the complexities of divorce for the adolescents who survive it. / Psychology / MA (Clinical Psychology)

This study was aimed at giving a voice to two people, constructed as anxious. The epistemological framework is social constructionism. Two in-depth interviews with individuals who constructed themselves, or accepted the constructions of others of themselves as anxious, were done. The 'case study approach' was chosen as most suitable method to gain access to the information. 'Thematic content analysis' was the method of analysis. The life stories of participants were reconstructed in terms of themes. Recurring themes in these life stories were elucidated and linked with the literature. This study allowed valuable and rich information about the life stories of two anxious people to emerge. Amongst the identified themes, 'sensitivity' and the need for 'authenticity' were identified as particularly important areas for clinical practice and future research. Lay people wishing to gain a better understanding of either their own or their loved one's anxiety could also benefit from this study. / Psychology / M.A. (Clinical Psychology)

This study investigated the performance of health workers in the decentralised services in Uganda in order to develop a management framework that may be used to improve performance. The study followed a mixed research methodology and was descriptive. The survey design was used to collect quantitative data by means of a structured questionnaire. Qualitative data was collected using a semi-structured interview guide. The study population for the quantitative strand comprised 276 health workers including doctors, clinical officers, and professional nurses working in four districts: Kumi, Mbale, Sironko and Tororo. The health workers were selected using stratified random sampling. The population for qualitative strand was health services managers (N=21) from the same districts. The managers were selected purposively. Quantitative data was analysed using SPSS version 18.0, while qualitative data was coded and analysed manually. The findings revealed that the performance of health workers is generally affected by health systems and work environment related factors. The findings indicated that health workers are skilled, competent, and generally have positive attitudes and behaviours towards their clients. The study uncovered loop holes in performance management in the district health sectors. In most cases there is no target setting, no performance management planning, performance indicators are not clearly defined, and the schedules for performance measurement are not always followed. There is limited career progression and lack of functional performance feedback and rewarding mechanisms. Although health workers are committed, there is widespread political interference and nepotism in the district health sector management. Overall, the researcher is optimistic that if the proposed performance management framework is implemented, the performance of health workers might improve. / Health Studies / D. Litt. et Phil. (Health Studies)