Thesis (Ed. D.) University of Missouri-Columbia, 2006. / The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. Title from title screen of research.pdf file (viewed on July 31, 2007) Includes bibliographical references.

D.Phil. (Engineering Management) / One of the greatest challenges faced by the post-1994 South African democratic government is an immense backlog and shortage of housing for poverty-stricken South Africans. Since 1994, the government has embarked on aspiring housing programmes in order to engage in mass delivery of housing, which was done to fulfill the vision of adequate housing for all, as reflected in the South African National Housing Policy Framework. Over the last seventeen years, the programmes have delivered more than 3 million houses to families, who had no proper housing previously, providing more than 13 million people with secure homes; thus ensuring that essential services were made available to advance the lives of ordinary people. This research investigated and modeled subsidised low-income resident’s satisfaction. The primary aim of the research was to model to what extent dwelling unit features, neighbourhood features, building quality, services provided by government, beneficiary participation, needs and expectations predict the occupants’ residential satisfaction, which were classified as the exogenous variables. A conceptual integrated holistic residential satisfaction model was developed based on the theory developed from the literature review and the Delphi Study findings. The Questionnaire Survey was conducted for the purpose of validating the conceptual model. The survey was conducted in three metropolitan municipalities and one district municipality in the Gauteng Province of South Africa. Results from the investigation pertained to three broad areas. The first results related to theory on housing studies. The findings were that the study addressed the lack of theoretical information about which factors are most significant in predicting resident satisfaction in subsidised low-income housing. The findings also revealed the theory that low-income housing occupants’ satisfaction is multi-faceted and that the latent variables thus lead to residential satisfaction outcome variables which could be used for residential satisfaction measurement. The second set of findings relates to the Delphi Study. The findings from this study were that a number of factors (dwelling unit features, neighbourhood features amongst others), considered to be paramount determinants of residential satisfaction in South Africa low-income housing are similar to the determinants in other cultural contexts. Further findings from literature and the Delphi Study indicated that subsidised low-income housing residential satisfaction could be a six-factor model defined by the influence of dwelling unit features...

Accurate Evaluation and Management (E&M) billing and coding is an essential skill for medical clinicians. Consequences of incorrect E&M billing and coding include delayed patient treatment, delayed reimbursements from third party payers, and even charges of insurance fraud. The accuracy of billing and coding is especially salient in practices whose patient population is covered primarily by Medicare/Medicaid, as is the case in many Northeast Tennessee clinics. Despite the importance of accurate E&M billing and coding, recently graduated physicians moving into their first year of residency are often under-informed regarding proper billing and coding. Much of their knowledge about the process is picked up piecemeal over the course of their residency. The purpose of this study is to educate incoming post-graduate year one (PGY1) medical residents on the E&M billing and coding system for a rural Family Medicine clinic. During their first month as PGY1 resident physicians, participants were given a survey to assess their knowledge of E&M billing and coding for outpatient encounters. Participants then attended an educational session on this topic and received handouts that they could reference in the future. The participants were then surveyed again. Data analysis is currently underway. A repeated measure t-test will be utilized to determine if the educational session and informational handouts led to a statistically significant increase in PGY1 resident knowledge of E&M billing and coding. It is expected that participants will show significant knowledge gains as a result of the educational training. This research has important implications for medical resident training, particularly in rural practices that treat large populations covered by Medicare/Medicaid.

At least 11 million Americans are diagnosed with chronic obstructive pulmonary disease (COPD), and there is a high likelihood millions more suffer from the disease but are undiagnosed. Spirometry is a medical test to determine how well a patient’s lungs work, and is used to diagnosis COPD. Despite this test’s utility, resident providers may be uneducated about or uncomfortable with administering spirometry. Past research has demonstrated that brief educational interventions can lead to clinically significant improvements in knowledge of spirometry. The purpose of this study is to compare family medicine residents’ responses regarding the use of spirometry in a rural Family Medicine Residency clinic before and after an educational program on the topic. Researchers will administer a survey to resident physicians at the Family Physicians of Bristol clinic about their knowledge regarding spirometry; residents will then be resurveyed after an educational program. It is expected that resident providers will show significant gains in their knowledge of spirometry after the completion of the educational program. Results of this project will be useful in identifying methods to increase medical providers’ awareness and comfort with spirometry, which will hopefully lead to increased accurate diagnosis of airway diseases.

Conservation subdivisions offer an alternative to large-lot residential developments along the urban fringe. These developments pride themselves on protecting ecologically sensitive land and providing an improved quality of life for residents. As suggested by Randall Arendt (1996), these goals are achieved by clustering homes on one portion of the site, while “half or more of the buildable land area is designated as undivided, permanent open space.” In order to gain information about the priorities and motivations of conservation subdivision residents in the Southeast United States, a survey was administered to homeowners within five conservation subdivisions. The results from this study revealed that open space, improved quality of life, and a strengthened community were important in each community. Additionally, homeowner satisfaction is prevalent among conservation subdivision residents. Lastly, demographic characteristics of these communities were analyzed. Recommendations are made for landscape architects and planning professionals for the future development of conservation subdivisions.

本論文はブロックチェーン技術を用いた，貧弱な情報通信(ICT)環境下での高信頼なデータ管理システムの設計と実装について述べたものである．住民データ管理システムの構築において最も重要な点の一つが，データの信頼性である．データを電子化して記録するときには，特にデータの改ざんが大きな課題になる．従ってデータの改ざんが起こらないこと，少なくとも改ざんされたことを検知することが必須となる．そこで着目したのがブロックチェーン技術である．ブロックチェーンの本質は，改ざんが原理的には不可能ではないが実質的には極めて困難な追記型データベース技術である．そこでその特性を利用して，信頼性の高い住民情報管理用のデータベースを構築できると考えた． / This study investigates the design and implementation of data management system with high level reliability and security by blockchain technology. The data access environment provided by blockchain is highly secure and trustworthy. In blockchain system, some data fragments are grouped into one piece called as blocks, and all blocks are connected to create a chain of blocks in database. When blocks are connected, hash value is used to connect blocks properly. Blockchain technology enables highly secure and reliable data management system under relatively poor ICT environment. For example, developing countries such as African countries do not have sufficient ICT environment. Therefore adopting blockchain technology is suitable for such countries. Based on this consideration, we started to build data management system on the blockchain system. / 博士(工学) / Doctor of Philosophy in Engineering / 同志社大学 / Doshisha University

No description available.

Unintended pregnancy rates remain a world wide public health concern. Healthy People 2030 has designated unintended pregnancies a key initiative, stating that increasing the use of contraception and decreasing unintended pregnancy is an important public health goal. According to the American Academy of Family Physicians, approximately one-half of the 6.6 million pregnancies each year in the United States are unintended. Family medicine physicians have an ideal position to provide contraception counseling in our communities. Unfortunately when surveyed, although 95% of medicine faculty and residents responded that contraceptive counseling is important, only one-quarter of providers reported providing contraceptive counseling “routinely” (defined as ≥ 80% of the time) to reproductive aged women during prevention-focused visits. Several studies have attempted to understand why primary care physicians are not routinely providing preconception and contraception counseling with multiple factors identified including inadequate knowledge of contraception methods (especially in regards to long-acting reversible contraceptives or LARCs), lack of time, lack of routine sexually history taking, and provider misconception regarding contraception. This study was completed as a quality improvement project among ETSU Health Family Medicine Kingsport residents. The aim of the quality improvement project was to determine if increasing awareness of gaps in contraception counseling and providing contraception counseling education would increase the rates of contraception counseling during yearly visits (well child checks, annual physicals, and annual wellness visits) for women of reproductive age (defined as ages 14-45). Clinic charts were reviewed in a 3 month time period pre and post an educational intervention. The educational intervention included a 1 hour lecture on current contraception methods and recommendations. A survey was also collected pre and post educational intervention to identify self-reported rates of contraception counseling and other perceived barriers to contraception counseling in our clinic. The rates of contraception were determined by either the presence or absence of the billing ICD-10 code Z30.09 (Encounter for contraceptive management). Pre-intervention chart review revealed a documented contraceptive counseling rate of 13% at annual preventative visits. Despite these low rates, 71% of residents surveyed pre-intervention strongly agreed that contraceptive counseling was important at annual exams for women of reproductive age. Post-intervention chart review revealed a contraceptive counseling rate of 31% at annual preventative visits, an 18% increase in contraceptive counseling. The results showed that while residents did not self-identify inadequate knowledge of contraceptive methods as a barrier to providing counseling, raising awareness of the importance of contraception counseling and providing an educational intervention did increase rates of contraception counseling. The major barrier identified by providers was a perceived lack of time. One limitation of this study was measuring contraceptive counseling rates by the use of the billing ICD-10 code of Z30.09. By only using this ICD code, visits that documented sexually activity, current contraceptive use, and/or history of prior hysterectomy but did not properly bill for Z30.09 were not included.

Nursing home resident choice in daily life is recognized as vital to resident quality of life and quality of care. Advocacy and policy activities to promote resident choice abound, yet little research exists to guide nursing home staff in how to enable resident choice on a moment to moment basis. Our three studies developed conceptual and practical tools to elucidate the factors, challenges, and behaviors involved in enabling resident choice. We first crafted a conceptual model, the “REAlizing Resident CHoice (REACH)” model, as described in the first paper. The REACH model identifies the factors influencing staff efforts to enable resident choice and the broader contextual dimensions within which the resident-staff member relationship exists. The REACH model was developed through a literature review of 1,969 abstracts and expert opinion. The second study assessed 1) tensions nursing home staff members encounter when trying to enable resident choice and 2) resolutions employed in the face of these tensions. We conducted semi-structured, qualitative interviews with 26 staff participants in two Veterans Health Administration (VHA) Community Living Centers (i.e., nursing homes). Participants highlighted intra-personal, inter-personal, and organizational tensions that affected their resident choice enabling efforts. Resolutions to these tensions focused on preventive practices, education, reinforcement, deliberation, collaboration, and leadership. A formative assessment tool, the “Supporting Choice Observational Tool (SCOT),” was developed in the third study. The SCOT provides nursing home staff with detailed, non-graded feedback on how to offer and enable resident choice in-the-moment. We created the SCOT using the following methodologies, in order: ethnographic observation, tool piloting, expert panel consultation, and a representational algorithm. SCOT results can inform discussion amongst co-workers and supervisors on how to advance their resident choice enabling efforts. These three studies address an important research gap. They provide scientifically grounded concepts and tools to assist nursing home staff, researchers, and policy makers in advocating for and instituting resident choice. The REACH model can be used to frame future research, and future studies can be undertaken to validate the SCOT. Findings from the second study could improve quality improvement initiatives targeting tensions and resolutions in enabling resident choice. / 2018-02-17T00:00:00Z

Due to an increasingly aging population and long-term care available, the number of older adults seeking long-term care facilities is growing. Resident satisfaction indicators have become essential measurements of service quality. However, few studies have investigated the evidence on prevalent resident satisfaction indicators and associated factors. In order to understand what are the types of resident satisfaction measurements utilized in long-term care facilities in the United States and how these types of care services influence resident satisfaction, the researcher conducted the first study, which consists of a systematic scoping review by summarizing the evidence on the types of resident satisfaction indicators utilized in long-term care settings in the United States. The second study completed a further systematic review to summarize how nursing assistants impact resident satisfaction in long-term care settings.The third study aims to translate and validate a Chinese version of the resident satisfaction assessment based on the Ohio Long-term Care Resident Satisfaction Survey (OLCRSS). The fourth study will apply hierarchical regression to predict older adults' satisfaction with individual factors and care services factors in long-term care settings. The dissertation provided a holistic solution to measure resident satisfaction in long-term care settings, assist health providers in meeting the resident`s needs and improve the quality of the care. These studies are significant because they provide fundamental data for using evidence-based indicators of resident satisfaction to enhance the residents' quality of life. Findings could also add to the existing literature regarding resident satisfaction indicators.