Excess inpatient length of stay (LOS) varies between hospitals and is burdensome to patients and the overall healthcare system. Variation in LOS has often been associated with hospital-level factors, such as hospital efficiency and quality. Clostridium difficile infection (CDI) is an increasingly common hospital-acquired (HA) infection. This thesis explores the connection between hospital incidence of CDI and excess LOS in patients without a CDI. It is hypothesized that HA-CDI incidence may act as a "proxy variable" to capture unobserved hospital characteristics, such as hospital quality or efficiency, associated with prolonged LOS. In addition, hospitals with longer LOS may tend to observe more HA-CDI cases prior to discharge. This thesis analyzes the ability of CDI incidence to capture excess LOS variation across hospitals, while controlling for CDI cases that occur after discharge. We use data on hospital inpatient visits, spanning the years 2005-2011, from three data sources distributed by the Healthcare Cost and Utilization Project: the Nationwide Inpatient Sample (NIS), and the State Inpatient Databases (SID) for California and New York. The NIS provides discharge records from a nationwide sampling of hospitals in a given year. The SIDs are longitudinal populations of inpatient records in each state, and patient records can be linked across stays. We compute a variety of different measures of hospital CDI incidence and identify HA-CDI cases that occur after a patient is discharged. Various multivariable regression models are analyzed to predict LOS at an individual patient level. A generalized linear modeling approach is used, and different distributions and link functions are compared using the Akaike information criterion. A multilevel modeling approach is also used to estimate the amount of between-hospital variation in LOS that can be explained by HA-CDI incidence. We find CDI incidence to be a strong predictive factor for explaining a patient's LOS and is one of the strongest predictive variables we identified. Moreover, CDI incidence appears to primarily capture between-hospital variation in excess LOS. Although we find evidence that present-on-admission indicators may underreport cases of HA CDI, our findings suggest the connection between CDI incidence and excess LOS is driven primarily by CDI cases that are HA. In addition, when we account for HA-CDI cases that occur post-discharge, the relationship between CDI incidence and LOS appears even stronger. Our results suggest that CDI incidence may be a powerful tool for making comparisons of excess LOS across hospitals.

Previous research indicates that pre- and in-service teachers are not receiving adequate training to implement data-informed instructional decision making. This is problematic given the promise this decision making process holds for improving instruction and student learning. At the same time, many educators do not see the value of different types of assessment data (e.g. accountability data), and lack the knowledge, skills, and confidence to use available data to guide instructional decisions. The purpose of this study was to conduct a formative evaluation of an online training designed to improve Iowa pre- and in-service teachers’ perceptions about data, data knowledge, skills and confidence working with data. The training along with a data literacy test was administered online to 29 pre-service teachers from two Iowa universities. A pre-post design was used to assess changes in these data constructs. Results indicated that participants’ perceptions about external accountability data improved significantly after completing the training, as did their confidence working with data. However, most participants’ data performance were relatively stable pre-post training. A content analysis of responses pre-post revealed qualitative changes in some participants’ thinking about data. Participants rated the value, effectiveness and quality of the training and complementary materials. Ratings were mostly positive, with participants signifying the training and materials as valuable and effective for enhancing their understanding of data as well as their confidence working with data. Participants also identified opportunities for improving the training. The author concludes with a discussion of the results, implications for future research, and how the study adds to the existing literature and informs practice.

This thesis consists of three chapters and focuses on the relationship between foreign exchange rates and other areas of Finance. The first chapter is sole-authored and is titled `Foreign Exchange Rate Exposure and Corporate Policies.' The second chapter is coauthored work with Professor Emeritus Paul Weller, Assistant Vice President Chris Neely and Professor David Rapach and is titled `Can Risk Explain the Profitability of Technical Trading in Currency Markets.' The third chapter is titled `Foreign Exchange Movements and Cross-country Fund Allocation Decisions.' In the first chapter, I examine the relationship between foreign exchange rate exposure and corporate policies. Despite the fact that empirical tests estimate foreign exchange rate exposure net of corporate hedging, there are still firms that exhibit significant residual exposures. It is believed that when faced with higher foreign exchange rate exposure, companies are more likely to run into an underinvestment problem. Therefore, in the current study I explore whether foreign exchange rate exposure is reflected in corporate policies beyond hedging. I establish that companies with higher foreign exchange rate exposure tend to hold more cash, have a higher likelihood of accessing capital markets and are less likely to issue dividends. Further, the relationship between foreign exchange rate exposure and these corporate policies is more pronounced for firms for which the underinvestment problem is likely to be more severe, namely firms with higher growth opportunities and firms operating in more competitive industries. Additionally, I find that half of the significant foreign exchange rate exposures in my sample come from firms with only domestic sales. Thus, I believe that foreign exchange rate exposure is relevant not only to the decisions of multinational corporations with international involvement and deserves additional investigation. The second chapter examines the robust finding that technical trading rules applied to foreign exchange markets have earned substantial excess returns over long periods of time. However, the approach to risk adjustment has typically been rather cursory, and has tended to focus on the CAPM. We examine the returns to a set of dynamic trading rules and look at the explanatory power of a wide range of models: CAPM, quadratic CAPM, C-CAPM, Carhart's 4-factor model, an extended C-CAPM with durable consumption, Lustig-Verdelhan (LV) factors, volatility and skewness. Although skewness has some modest explanatory power for the observed excess returns, no model can plausibly account for the very strong evidence in favor of the profitability of technical analysis in the foreign exchange market. We conclude that these findings strengthen the case for considering models incorporating cognitive bias and the processes of learning and adaptation, as exemplified in the Adaptive Markets Hypothesis. The third chapter is motivated by the fact that success of investment in international equity markets is a function of the stock picking ability of the manager within the particular foreign market as well as the (un)favorable foreign exchange rate movements against the domestic currency. Therefore, the objective of this paper is to study in more detail the relationship between currency returns and the cross country equity flows of U.S. international equity mutual funds. We are interested whether mutual funds are able to take advantage of beneficial currency movements and more importantly whether they destroy value through inappropriate currency positions. We establish that funds are better at managing contemporaneous changes in currency movements rather than at predicting future changes. We find that 80% of the funds increase their portfolio exposure to a particular currency (by increasing the relevant country allocation) when it has positive returns and decrease the exposure to that currency when it has negative returns. Further, the average fund does not create or destroy significant value through its country allocation decisions. Moreover, mutual fund managers do not have an advantage in predicting certain currencies over others. Most importantly however, it has to be noted that international mutual funds are not eroding value through their currency management even in the case of the most active funds.

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Research on talent development has focused on K–12 and adult eminence. This investigation addressed the gap in knowledge regarding talent development between the ages of 18 and 27. The purpose was to explain how a group of emerging adults continued to develop their writing ability into talents valued by themselves and society. The key questions investigated the role of self-perception of high ability in writing in the process of talent development as a lived experience, and the relationship of high ability to adult identity formation. The study also investigated how changes in family relationships and the establishment of independence related to talent development in emerging adulthood. It was a multiple case study of 7 creative writers from top-20 MFA programs. The study results indicated a number of findings. Development of writing talent in emerging adulthood is related to achieving adult identity and independence. Self-perception of high ability was universal, as was creativity. Achievement represented the confluence of intention, intellect, volition, knowledge, and imagination expressed as original work. The psychological process of differentiation and integration was used in adapting to achieve individual goals. Achieving identity for these writers and poets meant finding their voices. Ability was a pervasive factor in achieving identity. Parents, teachers, and peers guided and believed in the subjects’ ability. Family support was generally unconditional. Family mental health issues did not prevent talent development and fathers had a strong impact on sons and daughters. Independence was related to identity and represented having established primacy of self-authority. Contrary to theory, participants benefited from continued institutional support.

At the first Panorama in 1963, Anthony "Tony" Williams presented an arrangement of Slinger "Mighty Sparrow" Francisco's "Dan Is The Man (In The Van)" that would set the standard for Panoramas to come. As the competition continued arrangers like Bobby Mohammed, Earl Rodney, Jit Samaroo, and many others continued to present new ideas and techniques that became part of what is known as the "Panorama formula." In its current configuration the Panorama formula can be seen as an amalgamation of techniques introduced by past arrangers, but some argue that the formula has become too predictable and that arrangers who present works continuing to push the boundaries of the competition are often not rewarded, and perhaps punished for their efforts. This document will explore, through the history of the competition and the development of past arrangers, how the formulaic procedures of Panorama have developed. In addition, the recent works of arrangers Ray Holman, Liam Teague, and Andy Narell will be examined to see how they have challenged the expectations of the Panorama judges and the steelband community.

I would like to understand what kinds of connections exist between musical rhythm and poetic and linguistic rhythm, particularly the phenomenon of accent, so I investigated accent in art songs, examining twelve songs in an attempt to further understand how and if the accents and patterns found in poetry correlate to those found in songs based on this poetry. This study examines how the patterns of stressed and unstressed syllables in Lieder by Amy Beach, Richard Strauss, and Camille Saint-Saëns correlate with musical rhythmic and accent patterns in the resulting music. I systematically determined what kinds of accents were present, where they were present, and how they were related. I tracked nine different types of musical accents: agogic, contour, dynamic, articulation, metric, pitch, phrasing, structural, and textural. I then tracked the linguistic accents in the poems themselves, with the categories of meter, individual word stresses (if different from the meter), rhyme scheme, internal rhymes, and cadences (ends of sentences and questions). I then compared the accents found in the music to the accents found in the poetry. I then compared the correlation of linguistic and musical accents through graphic representation of the values I found. I found significant correlation between musical and linguistic accents in the twelve different pieces I studied. These results suggest that, for at least these three composers, the text does in fact influence the accent patterns of the music. For the songs of Beach and Strauss, there is a visual pattern in the graphs, which matches the meter of the text. The linguistic and musical accent patterns in both Beach and Strauss songs tended to be regularly alternating in a binary fashion, in keeping with the iambic meter. For Saint-Saëns, there was overall close correlation as well. The main difference between graphs for Saint-Saëns and the others seems to be the lack of a pattern in the relative accent strengths, which can be found in both the English and German graphs. French poetry does not have an iambic pattern to it; correspondingly the music doesn't show the regular binary alteration of accents. This pattern or lack thereof is part of the correlation that all of the pieces share between the music and the language, and the lack of pattern seems to demonstrate a particularity in the music in the case of French. Though showing how accents in music and text correlate in the songs of English-, German-, and French-speaking composers, this thesis does not fully determine how and if musical and linguistic accents correlate in music composers other than Amy Beach, Richard Strauss, and Camille Saint-Saëns.

Cancer immunotherapy has proven to be challenging as it depends on overcoming multiple mechanisms that mediate immune tolerance to self-antigens. In situ immunization is based on the concept that it is possible to break immune tolerance by inducing tumor cell death in situ in a manner that provides antigen presenting cells such as dendritic cells (DCs) with a wide selection of tumor antigens that can then be presented to the immune system and result in a therapeutic anticancer immune response. Based on recent advances in the understanding of antitumor immunity, we designed a three-step approach to in situ immunization to lymphoma: (1) Inducing immunogenic tumor cell death with the chemotherapeutic drug Doxorubicin (Dox). Dox enhances the expression of "eat-me" signals by dying tumor cells, facilitating their phagocytosis by dendritic cells (DCs). Due to the vesicant activity of Dox, microparticles (MPs) made of PLGA (a biodegradable polymer) can safely deliver Dox intratumorally and are effective vaccine adjuvants; (2) Enhancing antigen presentation and T cell activation using anti-OX40; (3) Sustaining T cell responses by checkpoint blockade using anti-CTLA-4. In vitro, Dox MPs were less cytotoxic to DCs than to B lymphoma cells, did not require internalization by the lymphoma cells, and significantly enhanced phagocytosis of tumor cells by DCs as compared to soluble Dox. In mice, this three-step therapy induced CD4- and CD8-dependent systemic immune responses that enhanced T cell infiltration into distant lymphoma tumors leading to their eradication and significantly improving survival. Our findings demonstrate that systemic antitumor immune responses can be generated locally by three-step therapy and merit further investigation of three-step therapy for immunotherapy of lymphoma patients. Furthermore, we designed another in situ immunization approach using PLGA MPs loaded with both Dox and CpG oligodeoxynucleotides (CpG). The addition of CpG was to further enhance the Dox MP design by including an agent that addresses Step Two in situ, by enhancing tumor antigen presentation by DCs. In vitro, we show that Dox/CpG MPs can kill B and T lymphoma cells and are less toxic to DCs than soluble Dox. In vivo, Dox/CpG MPs combined with anti-CTLA-4 and anti-OX40 generated systemic immune responses that suppressed injected and distant tumors in a murine B lymphoma model, leading to tumor-free mice. The combination regimen was also effective at reducing T cell lymphoma and melanoma tumor burdens. In conclusion, Dox/CpG MPs represent a versatile, efficient and safe tool for in situ immunization that could provide a promising component of immunotherapy for patients with a variety of types of cancer.

The use of neuromuscular electrical stimulation (NMES) for the treatment of swallowing disorders has become increasingly popular, yet little is known about its long-term effects on muscle physiology. This study indirectly assessed suprahyoid muscle physiology using electromyography (EMG) during a jaw-opening task that was completed before training, immediately after training, and two-weeks after training. Comparisons were made in muscle performance between control participants who engaged in effortful swallowing training and participants who received conjunctive NMES during effortful swallow training. All participants completed four weeks of swallowing exercises conducted five days a week (20 sessions) and consisting of 120 swallows each session. Results revealed that participants collectively improved their peak force production following training, but peak force and EMG median frequency did not vary as a function of training method. The observed high variability in median frequency between trials in addition to the documented improvement in function without a measured change in physiology suggests the need to consider alternate electrode placements during EMG or other tools of assessment. These findings suggests that both effortful swallow training and long-term conjunctive NMES with effortful swallowing improves jaw-opening strength of healthy adults, though adding NMES to the treatment was no more effective than training without it. Further research is necessary to determine the effects of long-term NMES training on swallowing physiology in vivo using other indirect measurements, or direct measurements such as muscle biopsy if possible.

The purpose of this dissertation research was to bring voice to university custodians as blue-collar workers by exploring the manner in which four custodians interact with students on a university campus. The following research questions framed this study: 1) In what ways do four campus custodians interact with students during their work day at a large public university? 2) In what ways do those custodians talk about students and their interactions with students? This study adopted a critical philosophical lens that acknowledged the historically-marginalized voice of custodians as campus blue-collar workers. Extant research on blue-collar worker identity theory and college student-staff interactions and mentoring literature, as well as the author's own blue-collar background, informed and framed the study. Qualitative data sources for this ethnographically-grounded case study were four campus custodians employed in three residence halls during the academic year at a large, public university in the Midwest. A moderate participant observation strategy melded with a semi-structured interview protocol were employed. Data were collected and transcribed during seventy-five hours of observations throughout a six-week time span. Mutual benefits to both college student success and custodial staff occupational esteem were identified in custodial staff-student interactions. More specifically, custodial staff participants were found to indirectly support college student success via formally acknowledged and performed cleaning and maintenance duties of observing, protecting, and promoting the health of college students. Additionally, custodial staff directly supported college student success via informally-performed actions of remembering, comforting, advising, exchanging and keeping gifts, and participating in events with students. Based on these findings, this study advises college and university decision-makers to consider custodians as important mentors for, and allies to, college student success. Suggestions for professional practice include 1) Acknowledging and leveraging custodians' unique assets and contributions, 2) Fostering relationships between students and custodians, 3) Increasing custodian's opportunities for professional development, 4) Considering custodians' potential to support student success in custodian hiring decisions, and 5) Training Custodial Staff in Basic Crisis Intervention. Future research should examine custodians as formal mentors, explore social justice concerns relative to blue-collar campus workers, and study the influence of custodian-student interactions on custodial staff job satisfaction and performance.