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The current study examines the relationship between service utilization and child outcomes, and the role fidelity to the principles of the wraparound care coordination process plays in mediating that relationship. One hundred and twenty-one participants at three separate Children’s Mental Health Services (CMHS)-funded Systems of Care national evaluation sites in three states were administered the Wraparound Fidelity Index (WFI), designed to measure adherence to the principles of wraparound; child outcomes measures, including the Child Behavior Checklist (CBCL) and the Child and Adolescent Functional Assessment Scale (CAFAS); and the Multi-Sector Service Contact Questionnaire (MSSC), designed to assess services received. Data were analyzed using hierarchical multiple regression and linear mixed models in order to examine the mediational role fidelity plays at two levels, children and wraparound facilitators, and at three different time points, baseline, six-month follow-up, and twelve-month follow-up. No statistically significant relationships were found between wraparound fidelity and child outcomes at six-month follow-up. Also, at six-month follow-up, the level of services the child and family received significantly predicted child outcomes related to externalizing symptoms but not to internalizing symptoms or functional impairment; however, this relationship was not mediated by fidelity to the wraparound process. From baseline to six-month follow-up and twelve-month follow-up, no statistically significant relationships were found between wraparound fidelity and child outcomes across wraparound facilitators. Also, no statistically significant relationships were found between the level of services the child and family received and child outcomes. A mediation model from baseline to six-month follow-up and twelve-month follow-up was not viable due to the null findings. Exploratory analyses were conducted. Implications of these findings and directions for future studies are discussed.

Master of Public Health / Food, Nutrition, Dietetics and Health / Sandra B. Procter / Purpose: The objective of this study was to compare characteristics of urban and rural counties in Kansas in order to identify and seek explanations for differences in health factors and population health outcomes. Methods: Select data from the County Health Rankings and Roadmaps program were examined within or using the context of the USDA, Economic Research Service 2013 Rural-Urban Continuum Code (RUC) classification scheme. A comparison of all 19 urban counties vs. all 86 rural counties was conducted, followed by a comparison of counties as they were classified on the rural-urban continuum. Findings: More evidence of health disparities was observed when using the rural-urban continuum comparison than by the strict urban vs. rural comparison. Health determinants, behaviors, and outcomes, were generally more unfavorable in rural counties, but this was mostly captured through the RUC comparison. On average, RUC 4 and RUC 5 communities (both rural) were most disadvantaged when compared to counties that fell somewhere else on the continuum. Overall, there were higher rates of injury death, preventable hospital stays, and premature death in rural areas. Conclusions: The favorable and unfavorable health factors and health outcomes did not present only in urban areas nor only in rural areas nor did they present only in one RUC. These findings showed that there is a complexity to health disparities that cannot be easily captured or addressed without careful attention to the nature of the specific communities in which they are found.

D.Tech. / South Africa, as a developing country, is in search of an approach to education that could overhaul the problems associated with the historical education system. Outcomes-based education was introduced in South Africa on the assumption that it would lead to an increase in the quality of education by improving the standard of teaching and learning performance and by providing a curriculum that is more relevant to learners‘ needs. A focus of this research project is to empower physiology lecturers with the relevant teaching, learning and assessment skills needed to implement outcomes-based education within a constructivist framework. This research study describes the development of learning interventions for physiology that exploits the congruencies between constructivist perspectives on learning and the individual attributes of students as defined by learning styles and instructional design principles. This development research project was conducted in four phases: an extensive literature review in which teaching, learning and assessment models and theories were integrated into Curry‘s 'Onion model‘; the design of questionnaires, based on the literature reviewed, to compile a profile of the students registered for physiology at the University of Johannesburg; a pilot study; implementation of the questionnaires; and analysis of the data. Concurrent with this the different teaching, learning and assessment interventions, as identified in the literature, were implemented and evaluated continuously. A questionnaire was designed and implemented to determine student‘s views on these different interventions. Observations were also captured in a teaching diary and during semi-structured interviews with students. The literature review revealed that although there is a vast amount of information available on teaching, learning and assessment most of the models, theories and strategies described do not address the presence of more than one style at a time. This study makes a contribution to the field of instructional design for physiology with the development and application of the proposed model for 'Whole brain learning‘, as well as the proposed model for designing learning interventions entitled 'The 3‘D‘s of designing learning interventions‘.

Personality is something that sets every human being apart, yet it is something that has been quite hard to pinpoint. Recently, neuroscientists have begun pinning down the neural correlates of personality traits – with focus on the Big Five, sparking a whole new subfield within personality research, known as personality neuroscience. By using neuroscientific methods and techniques to find the underpinnings of the Big Five have led to a deeper and broader understanding of how genetics and the environment integrate into making individuals who they are. This research has also been helpful in the prediction of various outcomes e.g. academic performance and achievement and neuropsychological disorders. In this thesis, the supposed neural correlates of the Big Five are examined through thorough and critical investigations, where evidence from some of the existing relevant studies is reviewed and compared, as well as the different problems and complexities that the field of personality neuroscience is dealing with. The findings in this thesis shows that extraversion has neurobiological basis in the frontal areas of the brain, neuroticism with reduced volume in the frontal areas, agreeableness with frontoparietal areas that are related to theory of mind as well as temporal regions, conscientiousness with frontal parts that are associated with planning and goal-orientation, and openness/intellect with frontoparietal areas as well as subcortical regions, which have been linked with intelligence and creativity. However, some of the correlations were inconsistent and scattered and further research needs to be done. The analysis of academic achievement and performance, as well as neuropsychological disorders and the Big Five with neuroimaging as a method, have shown to be limited, thus much more research is needed.

Thesis advisor: Kenji Hayao / This paper discusses the forces driving variation in the success of state pension system retrenchment. Two case studies are presented: the United Kingdom’s largely successful effort in 1986, and Germany’s less than stellar effort in 2001. After examining the general impact of institutional effects, ideology, path dependency, and demographic pressures on retrenchment, the importance of these factors in each country is discussed. These two countries are particularly enlightening due to their prototypical natures and opposing democratic traditions. One objective of this paper is to explain an unexpected outcome: the successful retrenchment produced in a low-pressure environment in the U.K., and ineffective reform in Germany in a high-pressure environment. This discussion frames the factors that determine successful retrenchment as such: whether a government has the ‘will,’ or motive, to retrench, whether it has the capability to do so, and whether it has the awareness and acumen to implement low-visibility strategies. I find that low-visibilities are extremely important to success in this area, and due to the nature of pension policy, the implications of this conclusion may be applicable to other policy-making challenges. / Thesis (BA) — Boston College, 2009. / Submitted to: Boston College. College of Arts and Sciences. / Discipline: College Honors Program. / Discipline: Political Science Honors Program. / Discipline: Political Science.

Thesis advisor: Larry Ludlow / While there was a wealth of research in the 1970s and 1980s that suggests students’ on-campus college housing environment impacts student experiences and outcomes, interest has waned over the last several decades. Since then, the landscape of higher education has changed; a national focus on accountability and the rise in student-paid tuition costs has shaped higher education as a marketable good. These changes warrant a need to revisit the impact of on-campus housing environments as postsecondary institutions, often with limited financial and land resources, strategize ways to successfully meet incoming millennials’ housing needs while striving for recruitment, retention, and then students’ success during college. The present study took an exploratory approach to this understudied topic. This mixed-method study explored how residence hall location (i.e., living on the main campus or a satellite campus) and room type (i.e., living in a single, double, triple, forced triple, or quad room) impacted first-year college experiences and outcomes for traditional students. Findings show that housing conditions had an impact, particularly for those assigned less desired housing conditions (i.e., living on the satellite campus or in a forced triple room). Students in forced triple rooms did not frequently study in their room, felt crowded, had significantly lower GPAs than students who lived in double rooms, and engaged in fewer discussions with diverse others than those in triple rooms. In addition, while survey data found no differences in satisfaction by location, focus group participants who lived on the satellite campus expressed frustration with the university shuttle bus and felt removed from university-affiliated and other social activities and events. Focus group discussions suggest that entering college with clear expectations of housing conditions can prepare students to navigate housing challenges and ease the transition to college. Institutions should consider offering resources and support to students prior to matriculating and then once at college. Furthermore, institutions should be mindful of the social implications of geographically separating the first-year student cohort. Findings have practical implications for institution administrators and policy makers. / Thesis (PhD) — Boston College, 2016. / Submitted to: Boston College. Lynch School of Education. / Discipline: Educational Research, Measurement and Evaluation.

Thesis advisor: Judith A. Vessey / Purpose: The purpose of this study was to elucidate changes in parents' perceptions of health related quality of life (HRQOL), functional status, and caregiver burden in children with severe cerebral palsy (CP) following extensive orthopedic surgery and to determine the amount of nonmedical out-of-pocket expenses (NOOPEs) incurred during hospitalization. Background: CP is the most common cause of childhood physical disability. Children with severe non-ambulatory CP have multiple complex medical problems and frequently develop hip dislocations and neuromuscular scoliosis; these require extensive orthopaedic surgical interventions to prevent progression. The surgical trajectory is costly, resource intensive, and complications are common. Decision-making needs to extend beyond anticipated physical and radiographic improvements to include patient-centered outcomes including HRQOL, functional status, caregiver impact, and financial burden. Currently, research on this second group of outcomes does not exist. Methods: A single group prospective cohort study (N=48) design was used to measure changes pre- and post- surgery. NOOPEs were collected on a daily basis from parents during their child's hospitalization. A linear mixed-model regression analysis for longitudinal data, incorporating serial patient measurements over one year, was used to assess changes in HRQOL, functional status, and caregiver impact using measures normed for this population (i.e., CPCHILD, ACEND). NOOPEs were calculated using descriptive statistics. Results: Significant declines in HRQOL and functional status were noted at six weeks post-operative with return to baseline at three months. Long-term significant (p = .005) improvements, however, were noted beginning at six months. Caregiver impact did not change significantly over time. The total NOOPEs for the inpatient ranged from $59.00-$6977.50 (Median = $479.30) with 1971.5 missed hours from work. Conclusion: Children with severe CP who undergo extensive orthopaedic surgery and their families experience improvements across a variety of patient-centered outcomes in the long-term following surgery. Nursing has a critical role in assisting families in decision-making around surgery and providing anticipatory guidance and support. / Thesis (PhD) — Boston College, 2013. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Previous research has demonstrated a significant impact of trainee participation on outcomes in a broad surgical patient population. With the current project, we aim to identify if a similar effect exists in emergency general surgery. A total of 141,010 patients who underwent emergency general surgery procedures were identified in the 2005-2010 National Surgical Quality Improvement Program database. Due to the non-random assignment of the more complex cases to resident participation, patients were matched (1:1) on known risk factors [age, gender, inpatient status, preexisting comorbidities (obesity, diabetes, smoking, alcohol use, steroid use, coronary artery disease, chronic renal failure, pulmonary disease)] and on preoperatively calculated probability for morbidity and mortality. Clinically relevant outcomes were compared with a t- or chi-squared test. The impact of resident participation on outcomes was quantified with multivariable regression modeling, adjusting for both the aforementioned risk factors and operative time. The most common procedures in the matched cohort (n=83,790) were appendectomy (39.9%), exploratory laparotomy (8.8%) and adhesiolysis (6.6%). Our findings suggest that trainee participation in emergency general surgery procedures prolongs operative time, increases intraoperative transfusions, and is independently associated with adverse postoperative outcomes, including wound, pulmonary, and venous thromboembolic complications, as well as urinary tract infections. This effect appears to be independent of the total intraoperative time, case complexity, and preexisting comorbid conditions. We also demonstrate that operative time is another important factor independently associated with intra- and post-operative transfusions, unplanned reoperations, longer hospital stays, infections, as well as wound, pulmonary, and venous thromboembolic complications, when baseline comorbidities and resident participation were adjusted for. Remediation strategies could include increased use of simulation training and increased faculty supervision of residents.

Objectives: A systematic literature review was conducted to investigate whether aging impacts on emotion regulation and whether there are relationships between aging, emotion regulation and psychosocial outcomes. An empirical study used a cross-sectional quantitative design to examine the nature of trauma exposure in a clinical group of older people. A novel model was developed to investigate the relationship between trauma exposure and psychosocial outcomes and to examine whether emotion dysregulation and resilience had a role in this relationship. Method: The search strategy used in the review identified 15 relevant papers which met the inclusion criteria which were assessed for quality and relevant findings extracted. The empirical study recruited 47 participants from psychological therapy services who completed six self-report measures of trauma exposure, resilience, emotion dysregulation, PTSD symptoms, quality of life, anxiety and depression. A bootstrapped corrected procedure was used to test the indirect effects of resilience and emotion regulation. Results: Results of the review indicated that older people used positive reappraisal more than younger people. Examining the relationship between age, emotion regulation and psychosocial outcomes was difficult because of differences in the nature of relationships investigated, the definition and measurement of variables and additional variables examined. Results of the empirical study indicated trauma exposure to be reported by all participants and to be directly related to PTSD symptoms. Further analysis indicated that emotion dysregulation partially mediated this relationship. Trauma exposure was not directly related to anxiety, depression and quality of life but was indirectly related through emotion dysregulation. Resilience was not found to be associated with trauma exposure. Conclusions: The review highlighted the complexity of the relationship between age, emotion regulation and psychosocial outcomes. Results of the empirical study improved understanding about the nature of trauma exposure in a clinical group of older people. It also supports the importance of emotion dysregulation as an intervening variable in the relationship between trauma exposure and psychosocial outcomes. Clinical practice issues and areas for future research were identified.