This research examines the safety and cost effectiveness of an institutional policy on discharge of preterm infants with Apnea of Prematurity (AOP) from the Virginia Commonwealth University Medical Center Newborn Intensive Care Unit (VCUNC NICU) with caffeine therapy and a cardiorespiratory monitor. This practice policy was developed over a decade ago as a cost containment measure in neonatal care and continues to be implemented today despite the lack of a formal evaluation. The secondary objective was to examine through a review of the literature the psychosocial impact of premature birth on the family and the potential effect on the infant's hospital discharge. The evaluation of this policy is based on the conceptual framework of effectiveness, efficiency, and equity in health care. Results were used to generate policy recommendations.This is a retrospective case study of 933 infants admitted to the VCU Medical Center and the community hospital NICU between 1993 and 2002 diagnosed with Apnea of Prematurity. Data was obtained from the Neonatal Information System database at Virginia Commonwealth University Health System (VCUHS), the Virginia Department of Health, and the VCUHS hospital information system. In this mixed methods study, the infants were divided into two groups: 1) those discharged from the hospital on caffeine citrate therapy, and a cardiorespiratory monitor for continued management of apnea; and 2) those that were hospitalized until resolution of apnea. Data was analyzed for differences in mortality and morbidity, hospital readmissions and cost of hospital care from birth to 1 year of age. Interviews were conducted with NICU clinicians to obtain a qualitative perspective on this policy. No significant differences were found in the mortality rate between the two groups (p=.65), and the causes of the four deaths were unrelated to Apnea of Prematurity. Mean hospital costs were approximately $58,000 in both groups. Bronchiolitis was the leading cause for hospital readmission and there was no difference in the rate of hospital readmissions. Based on interviews with NICU clinicians, the policy works well and early discharge is advantageous to the infant and family. Therefore, we find no reason to not continue this policy. Study results support the importance and direction for further research on early discharge of infants with AOP and enhanced epidemiologic surveillance of this population.

Historically public sector personnel policies and practices have been targets of reform. These reforms consisted of transferring private sector techniques to a public sector perceived to be more bureaucratic and less efficient. Private sector research is replete with evidence of a connection between "superior" human resource management (HRM) practices and the performance outcome of profitability. Public sector outcomes are more difficult to connect directly to management practices. As a result, the focus of public sector reform has become one of improving the processes of management rather than improving the outcomes of government. The linkage between reform and outcome is assumed.This study attempts to add to the literature by tying local government HRM practices to the organization level performance outcome of un-enhanced general obligation municipal bond rating. A database was obtained from the International City/County Management Association (ICMA) containing the results of an HRM survey in 2000 of all U.S. municipalities with a population over 10,000. The municipal bond rating was then used as a performance proxy and dependent variable; the greater the number of high performing HRM practices employed by a municipality, the higher the bond rating or the higher the performance. The study sample consisted of 366 municipalities both responding to the survey and with bond ratings meeting the criteria of the study. The results of a binary logistic regression analysis showed intensive recruitment, family oriented work practices, job flexibility and open communication to be strong predictors of high performance. Decentralized HRM decisions, pay for performance programs and incentives for group participation were not associated with high performance. These findings suggest municipalities are likely to improve their performance by implementing the practices found to be predictive of higher bond ratings. However, differences between private and public sectors need to be considered when implementing change and a systems view helps minimize "deadly combinations" and maximize "powerful connections". Also, organization culture and the structure of the HRM system need to be considered. Additional research is recommended to further develop and validate the use of the municipal bond rating as a measure of a government level performance outcome.

This dissertation examines urban growth patterns in the Roanoke, Virginia, metropolis. It draws on the literature of contemporary human ecology and social area analysis to examine the effects of low-density development on low-income populations and racial minorities. The continuous spread of residential development beyond the boundaries of the central city and older suburbs into more distant, once rural areas is segregating the metropolitan area by race and income. Since the prominence of the so-called "Chicago School" of urban sociology (1913-1940), contemporary urban sociologists have outlined theories and methods to examine how American urban areas have changed and why. This dissertation is not about urban problems and solutions. It is about familiarizing readers with the theories of human ecology and social area analysis and their utility for explaining contemporary urban spatial patterns. If we are to get better and more equitable metropolitan areas, we must find out what really creates our urban areas, physically, economically, and socially. We must reach a deeper understanding of the forces and processes that have shaped them. Finally, we must understand the social consequences to urban life, relative to concentration of poverty and racial minorities in central cities. Toward that end, this study uses the statistical techniques called Social Area Analysis and Factorial Ecology to examine and describe the social-spatial patterns of the Roanoke, Virginia, metropolis, focusing on poverty and race. Specifically, the study uses 1980, 1990 and 2000 census data and the U.S. Geologic Survey of Land Use Cover to compute the factor analysis, construct the Socio-Economic Status (SES) index, rank the metropolis' census tracts based on the SES factors and develop the ecological growth model for the Roanoke metropolis. The analyses of the SES areas reveal that the metropolis' growth model is a combination of Ernest Burgess' concentric zone theory and Harris and Ullman's multiple nuclei model. Ultimately, the significance of this study lies not in the creation of an alternative theory of urban spatial patterns, but as an opportunity to amend more traditional approaches of human ecology so as to include racial segregation and income polarization as influences on metropolitan spatial patterns, and to produce a more integrated and accurate theoretical framework. This dissertation is organized as follows: Chapter 1 provides a brief introduction to the study. In Chapter 2, relevant literature regarding urban spatial patterns and contemporary human ecology is reviewed. Chapter 3 provides a thorough explanation of the research methodology. In Chapter 4, the results of the social area analysis and factor analysis are presented. GIS maps are also used to show the SES areas or multiple spatial patterns in the metropolis, especially the areas of concentrated poverty and race. In Chapter 5, the evolution of the metropolis' growth pattern is reviewed, and a contemporary ecological growth model is developed for the Roanoke metropolis. This model is then compared against the traditional human ecology growth models, including concentric zone theory, sector model theory and multiple nuclei theory. Chapter 6 concludes with a brief discussion of the consequences of the metropolis' growth pattern and the utility of the human ecological perspective for explaining contemporary urban spatial patterns, and suggestions for further research.

This study examines the patterns of involvement in terrorist activities for the Revolutionary People’s Liberation Party/Front (DHKP/C) and Turkish Hezbollah members. The study is based on the assumption that terrorists differ in terms of their involvement in terrorist activities. In this sense, there are full-time and part-time terrorists. Full-time terrorists act professionally and do the assignments given by their commanders. Part-time terrorists, on the other hand, act on a non-professional basis and have their own motivations to participate in terrorist activities. For part-timers, there are various factors that may have an effect on their degree of involvement in terrorist activities. Their decisions regarding whether to participate in a specific terrorist act can be influenced by individual factors as well as the instructions and assignments given to them. In this study, these factors are categorized under four different headings; demographic, relative deprivation, frustration, and social learning. Data regarding the involvement in terrorist activities (as measured by arrest records) and demographics (age, gender, marital status, social class), relative deprivation (education, work status), frustration (school dropout, loss of a loved one in a counter-terrorism operation, family arrest), and social learning (family association to a terrorist group and recruitment method) was collected from terrorists’ autobiographies. Research hypotheses were tested using bivariate and multivariate statistical analyses. The findings indicated that relative deprivation, frustration, and social learning models can explain the differences in the degree of involvement in terrorism for DHKP/C members, but not for Turkish Hezbollah members (controlling for demographic variables). The results showed that these three models may account for some of the differences in involvement in terrorist activities.

This study examines the deployment of Wireless E9-1-1 Phase One and Wireless E9-1-1 Phase Two as a diffusion of innovation. The research method used in this study is a cross-sectional study employing secondary data in a discriminant function analysis. The study population is Virginia units of local governments (95 counties and 39 cities) that had not deployed Wireless E9-1-1 Phase One or Wireless E9-1-1 Phase Two as of January 1, 2001. The period of time included in this study is from 2001 to 2006. The purpose of the study is to assess the overall accuracy of the three principle theories of policy innovation adoption: diffusion, internal determinants, and unified theory, which are variations of the fundamental diffusion theory, in predicting the deployment of wireless E9-1-1 by Virginia units of local government. This assessment was conducted by identifying Virginia specific variables from models associated with these policy innovation theories to determine the best performing model for the deployment of Wireless E9-1-1 throughout the Commonwealth of Virginia. The Virginia specific variables utilized in this study are: Wealth, Population, Fiscal Health, Dedicated Funding, Financial Dependency, Urbanization, Regionalism, and Proximity to Interstate. Dedicated Funding and Regionalism had the largest absolute size of correlation among the predictor variables for the deployment of Wireless E9-1-1 Phase One and Wireless E9-1-1 Phase Two, thus generating the best performing model. This information will provide the basis from which to develop a statewide comprehensive policy and plan for Next Generation 9-1-1 and will help provide an answer to the question of when and how governments get involved in designing and implementing a 9-1-1 emergency service network.

This study explores factors that influence the sexual attitudes and behaviors of adolescents specifically through an examination of social constructs that measure sexual beliefs and attitudes of adolescents and the relationships between race and gender and sexual beliefs and attitudes. As the U.S. has maintained one of the highest rates of unplanned teen pregnancy and births among industrialized nations, schools and community groups have struggled to combat teen pregnancy and worked toward designing effective prevention programs. Through an emphasis either on abstinence or safe sex practices, these programs strive to influence adolescents' sexual behavior. However, studies and reports reveal a paucity of research that examines adolescents' attitudes and beliefs of sexual behavior, especially for cultural- and gender- specific groups of adolescents. Drawing from social constructionist theory and multiracial and radical feminist theoretical frameworks, this study utilizes Virginia Abstinence Education Initiative (VAEI) data from surveys administered to adolescents measuring sexual attitudes, beliefs, and behaviors. This study examines race and gender differences among the participants with regard to beliefs and attitudes about sexual behavior. The goal is to both better understand race and gender influences on adolescents' sexual beliefs and attitudes and to provide information to those who are in the position to develop more successful and effective teen pregnancy prevention programs. Consistent with existing literature, findings indicate gender-based differences regarding sexual beliefs and attitudes and minimal race-based differences in this analysis. An intersectional analysis further suggests that although female adolescents across race held similar beliefs and attitudes regarding sexuality, there were differences across race among male adolescents.

A suicide attack is an extreme modus operandi of terrorism. This research examines the application of two similar sociological theories to terrorism and specifically, to suicide terrorism. Three models are built to test if Merton‘s strain theory can explain the propensities of provinces to produce terrorists and suicide bombers in the first phase. Next, in Phase 2 one model is built on a combination of altruistic and fatalistic type variables to test if Durkheim‘s anomie theory can explain the probability of a terrorist to become suicide bomber or not. The analyses of models 1, 2, and 3 are performed in Phase 1 using aggregate secondary data and the analysis of model 4 is performed in Phase 2 using individual level secondary data. While models 1 and 2 are employing multiple regression, models 3 and 4 use logistic regression analyses. Model 1 tests the propensity of a province to produce terrorists relative to six strain variables, while model 2 develops an optimum model, testing the same associations by using only three significant independent variables. Model 3 tests the probability of a province to produce a suicide bomber(s) using the same six indicators. Model 4 tests the probability of a terrorist to become a suicide bomber relative to anomie theory driven by seven indicators. The results reflect support for the overall model 1, while only the indicators of unemployment rate and political representation in the legislative assembly significantly contribute in explaining the propensity score of a province to produce a terrorist. However, the optimum model (2) includes three statistically significant indicators of unemployment rate, political representation in the legislative assembly, and quality of life. Although model 3 also emerged significant in its overall effect, only educational opportunity significantly contributes to explaining the probability of a province to produce a suicide bomber. Model 4 is also supported. The individual effects reveal that the indicators of age group, income level, and hierarchical position in the organization statistically contribute to explaining the probability of a terrorist to become a suicide bomber. In general, the research provides partial support for the application of strain and anomie theories to terrorism and suicide attacks.

The U.S. Trafficking Victims Protection Act of 2000 (TVPA) was the first piece of legislation designed to combat human trafficking on all fronts, both domestically and internationally, and was upheld as a model worldwide. Although human trafficking as an issue seemed to appear out of nowhere onto the congressional agenda and a number of heated debates ensued during .the making of the TVPA, the legislation passed quickly by an unlikely coalition of players. The purpose of this dissertation research was to gain insight into the forces which led to the making of the TVPA through the lens of the Advocacy Coalition Framework (ACF) model of the policy making process.The ACF's focus on belief systems in order to increase one's understanding of the policy making process makes it an interesting model to use to examine policy making in arenas dominated by issues that involve deeply held beliefs. The human trafficking policy subsystem is one such arena, in which beliefs and attitudes regarding sexual behavior, prostitution, morality, sexual deviancy, immigrants and immigration policy, feminist issues, and public health concerns come into play. In addition, human trafficking, widely acknowledged as a public evil, is a valence issue. This dissertation research also serves as a case to examine how the ACF "holds up" as a model used to examine valence issues.This study was a dual-method study in which in-depth interviews of twenty-one key policy players involved in the making of the legislation and a content analysis of congressional hearings related to human trafficking during the 1995-2000 time period were used as methodologies.Findings reveal that advocacy coalitions did exist within the human trafficking policysubsystem and that the primary coalition responsible for the focus on human trafficking as a legislative issue was a left/right coalition made up of radical feminists, conservativeChristians, and human rights organization representatives, which was built from a pre-existing coalition. With the support of my research findings, I pose the question: was the TVPA created to protect victims of human trafficking or was the issue of human trafficking used to push a greater moral agenda including abolishing prostitution worldwide?

The objectives of this study were to measure and describe the overall satisfaction of Hispanics/Latinos with services they receive from Chesterfield County's Health Department and compare it to that of African Americans and Caucasians. Also, the objectives were to analyze reasons for different levels of satisfaction, assess the nature and degree of satisfaction with particular services, and suggest implications of the Hispanic/Latino opinions for public policy. While the empirical literature revealed that Hispanics/Latinos experience lower levels of satisfaction with health care services, this study did not provide evidence to support this theory.This is a multi-method non-experimental research design combining a cross-sectional design and qualitative interviews. Quantitative data was collected through a patient satisfaction survey, in both English and Spanish, incorporating both closed and open-ended questions. Qualitative data was collected through taped in-depth interviews conducted with each subject to obtain their perspective on the services provided by the Health Department.The Spanish and English research instrument (Appendix C and D) was a self-designed survey to provide a more comprehensive approach to assess customer satisfaction of health services, collect demographic information, and determine how to better deliver these services. The survey consisted of 46 questions (and several follow-up questions) with 23 questions pertaining to the six satisfaction dimensions. These dimensions were measured by a Likert-type response scale ranging from strongly agrees to strongly disagree.Item identification was based on suggestions offered by staff of Chesterfield County's Health Department, theoretical concepts introduced in the literature review and miscellaneous information adapted from the following surveys: The Connecticut Surgical Group - Patient Satisfaction Survey (2004); SERVQUAL--an instrument for measuring quality service (1990); and The Patient's View on Health Care by RAND and UMQC (1994). Authors of these surveys suggest satisfaction be assessed across the following dimensions: reliability, responsiveness, competence, access, courtesy, communication, credibility, security, understanding/knowledge of the customer, and tangibles (appearance of physical facilities). Data were collected from 166 non-Hispanic/Latino and 90 Hispanic/Latino patients that were 18 years of age or older and receive services, at Chesterfield County, Virginia's Health Department. The independent variables were sex, age, level of school completed, income, marital status, children, ethnic background, ability to speak English, modes of transportation, and length of residency in Chesterfield County, Virginia. Dependent variables in the analyses included the six dimensions of satisfaction--staff reliability, staff responsiveness, staff courtesy, staff communication, access to Health Department services, and Health Department Facilities. The data were analyzed through several inferential statistical techniques--univariate, bivariate, multivariate, and nonparametric.Results of the tests indicated that overall, ethnic background only influenced satisfaction with services across two dimensions--staff responsiveness and staff courtesy. However, there were noted differences in the measured levels of satisfaction across the racial/ethnic groups. This study also found that valid comparisons can be made among Hispanics/Latinos, African Americans, and Caucasians on their levels of satisfaction using the 23 measures. Population characteristics had no influence on the differences in satisfaction among the racial ethnic/groups. Results of the in-depth interview revealed that respondents were satisfied with the services as well as the quality of the services provided by the Health Department.

This study examines the relationship between popular support for the Kurdish Worker’s Party (PKK), which is an ethnic insurgent and terrorist organization mainly operating in Turkey, and its terrorist activities during the pre-and post-election periods in Turkey . Popular support has been measured through popular votes for the political party affiliated with the PKK in 1999 general, 2004 local and 2007 general elections. Two leading theories of social movements, Resource Mobilization Theory (RMT) and Relative Deprivation Theory (RD), were used as theoretical approach. The study uses secondary data and constructs a longitudinal design. An advanced statistical analysis technique, a generalized hierarchical linear model: time nested within subjects (or GHLM repeated measures) was employed in this study. Findings indicate that popular support is positively related to terrorist attacks of the PKK in Turkey. More popular support for the insurgent leads to more terrorist attacks. Furthermore, terrorist attacks gradually increased over the pre-election period of general elections. However, terrorist attacks abruptly increased upon the election but then subsequent terrorist attacks decline over the post-election periods.