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Dementia is characterized as a progressive loss of brain function that results in the deterioration of many cognitive and physical abilities. Alzheimer’s disease (AD) is the most common form of dementia, causing steady declines in memory, functional abilities, and mental functioning. With a projected increase of degenerative illnesses, such as AD, family caregiving for individuals with the disease is also steadily increasing. Caring for an individual with AD has been characterized as a “career,” and within this career are a number of key transitions, including the onset of caregiving. Preexisting caregiving research reveals a number of negative consequences for AD family caregivers, including depression, overload, and physical health complications. The purpose of this study was to examine how different patterns of caregiving onset (gradual and abrupt) and role occupancy (how many roles the caregiver is holding) impact mental health and physical health outcomes for AD caregivers. This study also explored how cognitive decline and behavioral problems found within the care-recipient have the potential to moderate these relationships. Cross-sectional, quantitative data from one hundred participants completing self-administered surveys was used in this study. A series of one-way ANOVAS and multiple regression analyses were conducted to address the study’s aims. Results indicated that care-recipient cognition and behavioral problems moderated the relationship between caregiving onset and mental health outcomes, including depression, role overload, and role captivity for caregivers who experienced a more abrupt entry into the caregiving role. Results suggest the importance of considering moderating factors within the caregiving career, as well as different caregiving onset transitions. Clinical implications of the findings are discussed, as well as directions for future research, including prospective caregiving research.

Objective: Patient-reported outcomes (PROs) are measures collected from a patient to determine how he/she feels or functions in regards to a health condition. Longitudinal PROs, which are collected at multiple occasions from the same individual, may be affected by response shift (RS). RS is a change in a person’s self-evaluation of a target construct. Latent variable models (LVMs) are statistical models that relate observed variables to latent variables (LV). LVMs are used to analyze PROs and detect RS. LVs are random variables whose realizations are not observable. Factor scores are estimates of LVs for each individual and can be estimated from parameter estimates of LVMs. Factor scoring methods to estimate factor scores include: Thurstone, Bartlett, and sum scores. This simulation study examines the effects of RS on factor scores used to test for change in the LV means and recommend a factor scoring method least affected by RS. Methods: Data from two time points were fit to three confirmatory factor analysis (CFA) models. CFA models are a type of LVM. Each CFA model had different sets of parameters that were invariant over time. The unconstrained (Uncon) CFA model had no invariant parameters, the constrained (Con) model had all the parameters invariant, and the partially constrained (Pcon) model had some of the parameters invariant over time. Factor scores were estimated and tested for change over time via paired t-test. The Type I error, power, and factor loading (the regression coefficient between an observed and LV) and factor score bias were estimated to determine if RS influenced the test of change over time and factor score estimation. Results: The results depended on the true LV mean. The Type I error and power were similar for all factor scoring methods and CFA models when the LV mean was 0 at time 1. For LV mean of 0.5 at time 1 the Type I error and power increased as RS increased for all factor scores except for scores estimated from the Uncon model and Bartlett method. The biases of the factor loadings were unaffected by RS when estimated from an Uncon model. The factor scores estimated from the Uncon model and the Bartlett and sum scores method had the smallest factor score biases. Conclusion: The factor scores estimated from the Uncon model and the Bartlett method was least affected by RS and performed best in all measures of Type I error, statistical power, factor loading and factor score bias. Estimating factor scores from PROs data that ignores RS may result in erroneous (or biased) estimates.

Background: Staphylococcus aureus (SA) infections are common and important within the hospital environment. The case fatality rate of invasive Staphylococcus aureus (SA) infections is between 20-40%. Whether the infection is due to methicillin resistant SA (MRSA) or methicillin sensitive SA (MSSA) may determine outcomes. Literature to date is inconclusive regarding whether antimicrobial resistance in SA affects patient outcomes. Host factors, infection-host interactions, and treatment-related factors may also influence case fatality. Objectives: The purpose of this study was to determine if patients with MRSA invasive infections were more likely to die than those with MSSA invasive infections, and what factors were associated with death. Methods: A retrospective matched case control study was designed, comparing cases of MRSA with controls of MSSA invasive disease from hospitals participating in the Canadian Nosocomial Infection Surveillance Program (CNISP). Two analyses were run: the first, to identify the variables associated with MRSA vs. MSSA infections, and the second, to determine the variables associated with death in invasive Staphylococcal aureus (S. aureus) infections. Backward logistic regression analysis was used for the MRSA vs. MSSA analysis and a hierarchical logistic regression model for assessment of risk factors for death. Results: In the logistic regression MRSA model the variables: recent prior use of antibiotics, Charlson Comorbidity Index score > 2 and not having received appropriate empiric antibiotics were associated with MRSA vs. MSSA infections. The hierarchical model identified older age, higher CCI scores, immunosuppression, bloodstream infection, septic shock, neurological dysfunction and not receiving appropriate empiric antibiotic as associated with death. MRSA infection was not more likely to be associated with increased mortality than MSSA infection. Those with a resistant infection (MRSA) however, were less likely to receive appropriate empiric antibiotic treatment. Conclusions: Appropriate empiric antibiotics are the most important and only modifiable risk factor identified. Elderly patients who are on immunosuppressive drugs and have chronic comorbid conditions need to be monitored and screened more often since they are more at risk for death than others.

Background: Staphylococcus aureus (SA) infections are common and important within the hospital environment. The case fatality rate of invasive Staphylococcus aureus (SA) infections is between 20-40%. Whether the infection is due to methicillin resistant SA (MRSA) or methicillin sensitive SA (MSSA) may determine outcomes. Literature to date is inconclusive regarding whether antimicrobial resistance in SA affects patient outcomes. Host factors, infection-host interactions, and treatment-related factors may also influence case fatality. Objectives: The purpose of this study was to determine if patients with MRSA invasive infections were more likely to die than those with MSSA invasive infections, and what factors were associated with death. Methods: A retrospective matched case control study was designed, comparing cases of MRSA with controls of MSSA invasive disease from hospitals participating in the Canadian Nosocomial Infection Surveillance Program (CNISP). Two analyses were run: the first, to identify the variables associated with MRSA vs. MSSA infections, and the second, to determine the variables associated with death in invasive Staphylococcal aureus (S. aureus) infections. Backward logistic regression analysis was used for the MRSA vs. MSSA analysis and a hierarchical logistic regression model for assessment of risk factors for death. Results: In the logistic regression MRSA model the variables: recent prior use of antibiotics, Charlson Comorbidity Index score > 2 and not having received appropriate empiric antibiotics were associated with MRSA vs. MSSA infections. The hierarchical model identified older age, higher CCI scores, immunosuppression, bloodstream infection, septic shock, neurological dysfunction and not receiving appropriate empiric antibiotic as associated with death. MRSA infection was not more likely to be associated with increased mortality than MSSA infection. Those with a resistant infection (MRSA) however, were less likely to receive appropriate empiric antibiotic treatment. Conclusions: Appropriate empiric antibiotics are the most important and only modifiable risk factor identified. Elderly patients who are on immunosuppressive drugs and have chronic comorbid conditions need to be monitored and screened more often since they are more at risk for death than others.

The Texas Statewide Youth Leadership Forum (TXYLF) provides self-advocacy training to high school youths with disabilities. TXYLF is an enhanced version of the Youth Leadership Forum (YLF) that is comprised of an initial five day training, a nine month support phase, regional YLFs, and the opportunity for participants to return to the five day training to serve as a mentor to their peers. This study’s purpose was to examine the TXYLF participants’ post-training outcomes and the relationships among advocacy involvement and adult outcomes. To achieve this purpose, former TXYLF participants were surveyed between one and six years after their participation in TXYLF. The correlational study analyzed descriptively the participants’ outcomes and inferentially, through logistic regression, the relationships among participants’ adult outcomes, self-advocacy involvement, and the various TXYLF participation components. The results demonstrated that TXYLF participants’ post-training postsecondary education attendance was higher than the national average for adults with disabilities. Participants with low incidence disabilities were involved in inclusive employment more often than the national average. A minority status increased the likelihood of involvement in secondary education advocacy, having a high incident disability increased the likelihood of post-training employment, and being under 21 years old increased the likelihood of living independently post-training, involvement in postsecondary education advocacy, and involvement in employment advocacy. Involvement in TXYLF for one full year, including involvement as a mentor, increased the likelihood of post-training employment; involvement in TXYLF’s nine month support phase and involvement as a mentor increased the likelihood of post-training postsecondary education attendance, postsecondary education advocacy, and employment advocacy. Attending a regional YLF further increased the likelihood of postsecondary education and postsecondary education advocacy. Furthermore, involvement in TXYLF as a mentor increased the likelihood of post-training employment, postsecondary education, and independent living. No significant relationships were observed for self-advocacy and adult-outcomes. Future research is needed that takes the findings of this study and establishes a causal relationship through a randomized group experimental design.

The purpose of this investigation is to test the mediational effect of parenting style on the association between child health status and child behavioural outcomes in children. Using cross-sectional data of children 4 and 5 years old from National Longitudinal Survey of Children and Youth (NLSCY) Cycle 4 2000-2001 the paper explores the degree to which child health status is related to child behavioural outcomes. In addition, the present study investigates the extent to which child health status is linked to parenting style. Another aim of this study is to explore the association between parenting style and child behavioural outcomes. Child outcome measures assessed in this study include: hyperactivity-inattention, emotional-disorder anxiety, conduct disorder — physical aggression, and indirect aggression. Child health status is assessed using the Health Utility Index Mark 3. The Health Utility Index gives a description of an individual's overall functional health, founded on eight attributes that include: vision, hearing, speech, mobility, dexterity, cognition, emotion, pain and discomfort. Parenting style is measured using several parenting scales that consist of: positive interaction, hostile/ineffective parenting, consistent parenting, and rational (punitive/aversive) parenting. Statistical analysis was conducted using Ordinary Least Squares (OLS) and logistic regression to test the conceptual model and the significance of relationships between the variables of interest. There was partial support for the mediational model of parenting style on the association between child health status and children behavioural outcomes. Specifically, both ineffective and rational parenting each showed a mediational effect. Child health status and child behavioural outcomes were found to have a strong relationship to each other. However, ineffective parenting was more strongly related to child behavoiural outcomes than child health status. This suggests that children that are exposed to ineffective parenting are at greater risk for developing behavioural difficulties than children receiving other forms of parenting. Moreover, children who receive this type of parenting and have poorer health are at even greater risk for developing these behavioural problems. However, these conclusions are tentative as the directionality of these relationships is uncertain because of the cross-section design of this study.

The effect of global warming is a growing concern for the global community. This concern is reflected in politics, business, corporate charters, local government charters, electronic and print media and so on. The core to this issue is green house gas (GHG) emissions due to anthropogenic activities. In a developed country such as Australia, residential green house gas emissions are responsible for about 20% of its total GHG emissions. Therefore, sustainability in the housing sector is important towards overall reduction of GHG emissions. Australia's progress in sustainable housing is discussed. There are legislation and financial incentives towards sustainable housing. All the states and territories and the Commonwealth provide financial incentives for PV energy, rain water tank, solar hot water systems to supplement high initial set up cost. A number of high quality rating tools are developed in Australia to facilitate and administer energy efficient design for residential and commercial buildings. There are many good examples of sustainable housing throughout Australia. The Ecohome at Cairnlea, Melbourne is a demonstration home as well as part of this research project. This standard home added with 'off the shelf' sustainable features and having a FirstRate star rating of 6 stars is intended for the volume home market. This thesis presents sustainability outcomes of the Ecohome. Thermal performance of the Ecohome is presented qualitatively and quantitatively. Monitoring data from 14 months' show that approximately two-thirds of the time, indoor temperatures remained in comfort zone (18-26 C) without artificial heating or cooling. Monitoring of indoor air quality included carbon dioxide, humidity and carbon monoxide. Monitoring data from sealed house and while the residents were living in are presented. Humidity level was within 35-45% most of the time while carbon dioxide was under recommended level (1080ppm) in the lower floor (living area and kitchen). Carbon monoxide level within the house was negligible. Significant energy and water savings were realised in the Ecohome. On per capita basis, 45% savings in water usage, 30% savings in electricity usage while similar gas usage was observed compared to average Melbourne home. Residents' feedback on sustainable features was mostly positive (except sisal carpet). Several thermal performance indicators are proposed and presented. These include 'Attenuation Factor', 'Time Lag', 'Heating and Cooling Need' in degree hours, 'Degree C Warmer' and 'Percentage Time in Comfort Zone'. Some of these concepts were used by some authors with different nomenclature; therefore, an attempt was made to unify them. Monitoring data was utilized to measure thermal performance of the Ecohome using these indicators. Prediction of indoor temperature when outside temperature is known is of much interest. Statistical and empirical methods were employed for this purpose. Both statistical method and Givoni method produce reasonably good prediction with deviations from actual observations being in the range of 2 to 3 deg C. This research provides valuable monitoring results in this emerging field. Proposed thermal performance indicators are a significant contribution to the body of knowledge.

This thesis addresses the question ‘How and why does collaboration influence the outcomes of stakeholders in the Jeddah Festival?’ Past research has found that a number of characteristics of stakeholder collaboration are important in achieving desired group and individual outcomes. While these studies have identified various relationships between individual characteristics and selected outcomes, there has been little research on their relative importance and interaction. Within the events literature, the characteristics of inter-organization stakeholder collaboration, the different outcomes required from this collaboration and the correlation between characteristics and outcomes have received little attention. This research addresses this gap and examines the perceptions of event stakeholders regarding the characteristics of collaboration and the collaborative outcomes perceived as important. It also explores the differences in collaborative characteristics and outcomes for stakeholder salience groups. In particular it applies a single case study design to examine the interaction between the collaboration characteristics and outcome for stakeholders involved in the Jeddah Festival held annually in Jeddah Saudi Arabia. The research uses content analysis of transcribed interviews conducted with Jeddah Festival stakeholder’s to identify the characteristics of stakeholder collaboration and collaborative outcomes. Results indicate that governance and trust were the characteristics of collaboration with the highest frequencies during interviews. Outcomes of collaboration were identified at the individual and collective level with network development, resources and social capital most frequently mentioned. A correlation analysis between characteristics and outcomes using a Spearman rank correlation identified that governance and trust were the characteristics with the most significance for achieving both individual and collective outcomes. Stakeholder salience groups were found to differ in the frequency of mention of both characteristics and outcomes. The research found that the nature of the collaborative environment is positive in part due to the initial legitimatization process and also to survivor bias. Overall these findings provide evidence of the interaction between stakeholder collaboration characteristics and outcomes in the Jeddah Festival and provide guidance for how this collaboration may be improved.

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