Research Objective: On behalf of the Appalachian Funders Network, with funding from the Robert Wood Johnson Foundation, East Tennessee State University and NORC at the University of Chicago documented the current burden of obesity, diabetes, and chronic disease mortality in central Appalachia. An analysis of county-level data was conducted in order to provide a comprehensive picture of the health condition of the region. Contributing factors, such as physical inactivity and food environment, were also investigated to determine how the built environment impacts obesity. Study Design: Several secondary data sources were utilized, including the County Health Rankings, CDC Diabetes Interactive Atlas, USDA Food Environment Atlas, and mortality data from the CDC National Center for Health Statistics, National Vital Statistics System. Variables analyzed included: adult obesity prevalence, adult diabetes prevalence, food insecurity, access to exercise opportunities, physical inactivity, and premature chronic disease mortality. The mortality analyses focused on four of the leading causes of death: heart disease, stroke, diabetes, and chronic lower respiratory disease, for persons age 25 to 64 from 2009 to 2013. When available, county-level estimates were used to create maps of the region, documenting the disparities compared to the rest of the nation. Population Studied: Health disparities were documented within the counties of central Appalachia, consisting of parts of Kentucky, North Carolina, Ohio, Tennessee, Virginia, and West Virginia. Principal Findings: More than two-thirds (68.6%) of the 234 counties in central Appalachia have an adult obesity prevalence above the national median of 30.9% (defined as BMI over 30). Over 85% of the counties in central Appalachia have a percentage of physically inactive adults higher than the national median of 26.4% (defined as not participating in physical activity or exercise in the past 30 days). When analyzing the combined chronic disease mortality for heart disease, stroke, diabetes and chronic lower respiratory disease, the combined national mortality rate is 93.0 deaths per 100,000 population. Nearly 90% of central Appalachian counties have a higher combined morality rate, and the state mortality rate for the Appalachian region of all six states is higher than the national rate. The disparity is more pronounced in rural communities, as the rural counties of central Appalachia have a higher mortality rate than urban counties within central Appalachia and rural counties across the United States. The combined mortality rate for these four diseases is 74% higher in rural central Appalachia than urban counties nationally. Conclusions: Compared to the rest of the country, people in central Appalachia are more likely to experience and prematurely die from obesity-related chronic disease, including diabetes and heart disease. Residents of rural central Appalachia face even more significant disparities as compared to urban residents within the region and nationally. Implications for Policy or Practice: Obesity and chronic disease in central Appalachia are significant public health concerns that must be addressed in order to improve the health of the region.

No description available.

No description available.

Background: Compared to other regions of the United States, people living in Appalachia bear a heavier burden from obesity related chronic conditions such as cardiovascular disease, stroke, diabetes, fibromyalgia, and sleep apnea as well as higher rates of premature mortality for those diseases. Childhood obesity in particular poses a burgeoning and understated threat to the public health system. Objectives: The purpose of this study was, working with the Appalachian Funders Network, identify the policies and practices that have a positive impact on the reduction of childhood obesity and chronic disease in central Appalachia (TN, VA, KY, WV, NC, and OH). Methods: Mixed methods approach was utilized. Survey of practitioners and funders identified efforts to reduce childhood obesity including obesity prevention, healthy eating and/or physical activity. Focus groups conducted across the region provided participant generated strategies to address gaps and needs. Results: Over 400 practitioners and 40 funders completed the survey. Eight focus groups were conducted across central Appalachia. Based on the finding, a set of recommendations to inform future grant making strategies will be compiled. Preliminary results demonstrate some areas of disconnect between funders and practitioners. Programs were more sustainable if funded from within the community rather than from an outside source. Further, the success of a program seems to be based on need and the collaboration of the practioners and funders. Conclusions: Using a mixed-methods approach, an aggregate of data provides a comprehensive picture of the current health condition of central Appalachia. Working with the Appalachian Funders Network, a group of 80 funders, the findings from this study have the potential to impact the work on practitioners and funders in the region. This collaboration hopes to promote a sustainable healthy lifestyle within Tennessee and greater Appalachia.

Abstract available through the Annals of Behavioral Medicine.

With the passage of the Affordable Care Act, states were given the option to expand their Medicaid programs. Since then, thirty-eight states and Washington, D.C., have done so. Previous work has identified the widespread effects of expansion on enrollment and the financial implications for individuals, hospitals, and the federal government, yet administrative expenditures have not been considered. Using data from all fifty states for the period 2007-17, our study estimated the effects of Medicaid expansion overall, as well as differing effects by the size and nature of the expansions. Using a quasi-experimental approach, we found no overall effect of expansion on administrative spending. However, the size of the expansion may have produced differing effects. States with small expansions experienced some increases in administrative spending, whereas states with large expansions experienced some decreases in administrative spending, including a $77 reduction in per enrollee administrative spending compared with nonexpansion states. As more states consider expanding their Medicaid programs, our findings provide evidence of potential effects.

To date, police organizations have not been rigorously analyzed by organizational scholars and most analysis of these organizations has been captured through a single construct. The purpose of this study is to develop confirmatory police organizational analysis by validating a multi-dimensional conceptual framework that explains the relationships among three constructs: environmental constraints, the design structures of police organizations, and organizational performance indicators. The modeling is deeply rooted in contingency theory, and the influence of isomorphism and institutional theory on the covariance structure model are investigated. One hundred and thirteen local police organizations from the State of Florida are included in this non-experimental, cross-sectional study to determine the direct effect of the environmental constraints on the performance of police organizations, the indirect effect of environmental constraints on the performance of police organizations via the organizational design structure of police organizations, and the direct affect of organizational design structure on performance of police organizations. For the first time, structural equation modeling and data envelopment analysis are used together to confirm the effects of the environment on police organization structure and performance. The results indicate that environmental social economic disparity indicators have a large positive effect on police resources and a medium effect on police efficiency. Propensity of crime indicators has a large negative effect on police resources, and population density has a small to medium negative effect on crime clearance. Structure has a much smaller effect on performance than the environment. The results of the efficiency analysis revealed unexpected findings. Three of the top five largest police organizations in the study scored maximum efficiency. The cause of this unexpected result is explained and confirmed in the covariance model. The study methodology and results enhances the understanding of the relationship among the constructs while subjecting environmental and police organizational data to two comprehensive analytical techniques. The policy implications and practical contributions of the study provide new knowledge and information to organizational management of police organizations. Furthermore, the study establishes a new approach to police organizational analysis and police services management research called Police Services Management Research (PSMR) that encompasses a variety of disciplines with a primary responsibility of theory building and the selection of theoretical framework.

Background Discrimination is a pervasive societal issue that monumentally impacts people of color (POC). Many Black, Asian, and Hispanic/Latinx individuals report experiencing race-based discrimination in their lifetime. Discrimination has previously been linked to adverse health outcomes among POC, including stress, depressive, and posttraumatic stress disorder symptoms. These health disparities are posited to have become exacerbated by COVID-19 and the racial awakening of 2020. The current study examined the short- and long-term effects of discrimination on stress, depression, and oppression-based trauma among POC. Methods Participants were (n = 398) who identified as Black, Indigenous, Hispanic/Latinx, and Asian completed an online self-report survey assessing discrimination, depression, stress, and oppression-based trauma collected at 3 time points: (T1) beginning of the COVID-19 pandemic (May 2020), (T2) 6 weeks later during the racial awakening of 2020 (June 2020), (T3) one year later (June 2021). Results Significant positive paths were revealed from T1 discrimination to T2 depression, T2 stress, and T3 oppression-based trauma. The association between T1 discrimination and T3 oppression-based trauma was partially mediated by T2 depression, but not by stress; total and total indirect effects remained significant. The final model accounted for a significant proportion of the variance in T3 oppression-based trauma, T2 depression, and T2 stress. Conclusion Findings are consistent with prior research linking discriminatory experiences with mental health symptomatology and provide evidence that race-based discrimination poses harmful short-and long-term mental health consequences. Further research is necessary to better understand oppression-based trauma to improve the accuracy of clinical diagnosis and treatment of POC.

Academic library services have now significantly developed and are applying some knowledge management (KM) principles in the provision of library services. KM is about enhancing the use of organizational knowledge through sound practices of KM and organizational learning. KM practices encompass the capture and/ or acquisition of knowledge, its retention and organization, its dissemination and re-use, and responsiveness to the new knowledge. The focus of this research was on KM principles and practices that may be in place in the Metropolitan College of New York (MCNY) library. The objective was to find out how knowledge was identified, captured, organized and retained in order to enhance performance and improve the quality of service in the library. There is uncertainty about whether the use of KM principles and tools could partly solve the library‟s approach to improving its quality of service to its community in the modern information environment. KM has been implemented in commercial and business environments towards operational advantages and financial gains and its survival principles and tools may help the library to improve performance and fulfil its mandate. A mixed methods research methodology encompassing a questionnaire, observation, interviews, and use of institutional documents was used with an action research design for generating new knowledge and understanding of library concerns. The findings of this study indicate that KM concepts were not universally understood at MCNY, and that collaboration of librarians and faculty in creating an educational environment meaningful and relevant for the study programmes offered by the College was essential. The MCNY library practices were not deliberately based on KM but the study established that they were amenable to KM practice. It was making efforts to share know-how so as to reduce duplication of effort, relying on library staff to identify, integrate, acquire, organize internal and external knowledge for the benefit of the whole College. The recommendation was to perform a knowledge inventory. This could help develop appropriate institution-wide policies and practices for proper and well organized methods of integrating work processes, collaborating and sharing (including the efficient use of Web 2.0 platforms), and developing an enabling institutional culture. / Information Science / D.Litt. et Phil. (Information Science)

To cope with constant changes in the economic environment, organizations continuously strive to implement appropriate business models that will contribute to increased productivity, reduced costs and a competitive advantage. Organisations need however to choose among different business models and select the option that offer the greatest potential to improve their service delivery, reducing costs and enable them to focus on their core business. This study conceptualized the shared services business model, by focusing on key factors, such as the rationale for implementing a shared services unit over other business models, establishing the processes followed by the banking industry with the implementation of a human capital shared services model, identifying the advantages versus disadvantages of the implementation of the model and to provide recommendations for the development and implementation of shared services models within specific organisational context. The researcher conducted mixed method research to address the research problem which incorporated both qualitative and quantitative research. In the study research was conducted in three phases. During the first phase exploratory research was conducted, consisting of desk study research and industry reports as well as surveys, periodicals and academic publications.During the second phase qualitative research was conducted, through semi-structured interviews. Findings from this research phase were used during the third phase, which was a quantitative study, whereby information gathered from the interviews informed the design of questionnaires. It is evident from the results that there were many similarities between the analyses of the interviews and questionnaires in relation to the literature review. Many commonalities amongst the three banks were identified during the implementation process and in many instances corroborated statements by key authors during the literature review. Both the interviews and analysis of the questionnaires confirmed cost savings, improved customer services and standardization as benefits of a shared services model. It was concluded that the implementation of a human capital shared services model within the banking sector in South Africa contribute positively to each of the banks used in the sample, both from a cost perspective as improvement of efficiencies. It was further concluded that the processes, systems and people involved in the implementation process are critical to successful implementation. Based on the information gathered the researcher recommends that a project team be appointed from inception to finalization of the implementation of a shared services model, which will be required to deal with the planning phase, feasibility study and the full implementation plan relating to the implementation of the model. In practice, this study will provide shared services managers with insights with regards to the implementation process to be followed for implementing a human capital shared services model. It can also provide valuable insight to management with regard to important or key factors to consider, ensuring the effective implementation of the model. Findings of this study may also be extended to other organizations in South Africa, considering the implementation of the shared services model. / Graduate School for Business Leadership / Thesis (M.B.A.)