Objectives: Explain ideas to achieve meaningful, synergistic partnerships in combating the opioid crisis by leveraging unique areas of healthcare expertise (i.e., medical, payer, pharmacy) in collaboration with other key healthcare and policy experts. Describe innovative, results-driven solutions in development or in the marketplace to address opioid prescribing practices from the unique perspective of providers, pharmacists, health plans, patients and caregivers. Learn about the system breakdowns from patient and family member perspectives. Share possibilities for better integrating the voice and role of individuals living with addiction and caregivers into important solutions combating the opioid crisis. Identify the greatest, most near-term opportunities for improvements or system-wide changes, generally and for PQA.

Background: The quality of team-based care impacts patient post-hospitalization outcomes, yet there is a gap in our understanding of how specific team processes impact patient post-hospitalization outcomes. Shared Mental Models (SMMs) is a team process from organizational psychology; it provides an understanding of how providers coordinate complex tasks as a team. SMMs are the team members’ organized knowledge needed for effective team performance. Military research shows that teams with more convergent SMMs have higher performance and better outcomes. In healthcare, patient discharge exemplifies an activity that requires a high level of coordination among interprofessional team members. Two relevant domains of SMMs are Taskwork SMM (team assessment of patient’s readiness for hospital discharge) and Teamwork SMM (quality of day of discharge teamwork). Because of the newness of SMM to healthcare, we lack measures to understand SMMs among interprofessional discharge teams. Study Purpose & Aims: The purpose was to pilot a novel measurement approach assessing SMMs of discharge teams, and explore their relationships to patient 30-day post-hospitalization outcomes (quality of care transition and utilization of unplanned medical services). Aim 1 determined the content and degree of convergence of discharge teams’ SMMs (taskwork and teamwork). Aim 2 examined the relationship between discharge team SMMs and patient post-hospitalization outcomes. Methods: A prospective longitudinal pilot study was used to examine the SMMs of 64 unique discharge events in three inpatient units at a single hospital. Discharge team members independently completed a questionnaire measuring the Teamwork SMM (using the Shared Mental Model Scale) and the Taskwork SMM (using the Discharge Provider-Readiness for Hospital Discharge Scale). Data were collected from the patient 30 days post-discharge to determine the quality of transition (using the Care Transition Measure or CTM-15) and use of unplanned utilization of medical services (unplanned readmission or ED visit). Interrater Agreement (r*wg(j)) was used to determine the SMM convergence (or level of agreement) among the discharge team. The relationship between SMMs and the quality of transition outcome (n = 42) was determined using standard regression analysis. Logistic regression was used determine the relationship of SMMs with utilization of unplanned medical services (n = 56). Results: Overall, discharge teams reported high levels of Taskwork SMMs (M = 8.46, SD =.91) and Taskwork SMM Convergence (M = .90, SD =.10), indicating that the discharge team perceived and agreed that patients had high levels of readiness for hospital discharge. Discharge teams also reported having high-quality Teamwork SMMs (M = 6.11, SD = 0.39) and Teamwork SMM Convergence (M = .85, SD = .10), suggesting that most discharge teams perceived and agreed that high quality teamwork was provided during the discharge process. Discharge events from the three inpatient units significantly differed in their Teamwork and Teamwork SMM content and convergence scores. Discharge teams’ Teamwork SMMs and Taskwork SMMs were positively associated with the CTM-15 score, while controlling for key contextual factors (t = 3.94, p = .001; t = 3.94, p = .001, respectively). Conclusion : Discharge teams’ Taskwork SMM and Teamwork SMM was positively associated with patient-reported quality of transition from the hospital. There was insufficient evidence to support that utilization of unplanned medical services is related to discharge teams’ SMMs. Measuring the SMMs of the discharge team provides a method for assessing a team process critical to safe patient discharges.

Modern organizations face many significant challenges because of turbulent environments and a competitive global economy. These competitive demands have forced many organizations to increase levels of flexibility and adaptability through the use of virtual environments, and global teams are prevalent in business organizations. Although significant research has been conducted on virtual teams, the development of shared understanding among the members of these teams has not been studied adequately. Time/space barriers, communication complexities, and team diversity hinder the development of shared understanding in these teams. Based on the Media Synchronicity Theory (MST), a new theoretical model was created that used the constructs use of communication media, mode of interaction and team diversity to ascertain the influence shared understanding in global virtual teams. Additionally, the research model examined the relationship between shared understanding and team performance. The developed, web-based survey measured the participants’ use of communication media, mode of interaction, diversity, shared understanding, and team performance in virtual environments. The survey was administered through SurveyMonkey and distributed to a pool of opt-in respondents from firms with virtual teams. A total of 118 respondents participated in the study. The findings of this study indicate that use of communication and familiarity with systems are strong determinants of shared understanding, and subsequently shared understanding is a strong predictor of team performance. The study also indicates that mode of interaction is less of a predictor of shared understanding, and that cultural diversity, modified diversity construct, did not influence shared understanding. As virtual teams continue to proliferate, executive leaders and managers must ensure that teams and environments are designed for collaboration through use of communication technologies that promote synchronicity, and that its members are familiar with systems which subsequently promotes shared understanding.

Esta tese apresenta uma reflexão filosófica sobre a retomada epistemológica representada pela Produção Partilhada do Conhecimento. Ao contrário do saber universitário, marcado pelo uso da razão metódica originada no Iluminismo no século XVII, que distingue sujeito de objeto, a Produção Partilhada do Conhecimento busca a interatividade entre estatutos epistemológicos distintos, onde sujeitos tornam-se ao mesmo tempo objetos. A partir da análise do encontro entre os saberes da oralidade em culturas tradicionais, e o saber racional metódico da ciência universitária, a passagem da oralidade à escrita no processo de colonização das Américas e o uso da hipermídia no século XXI, o trabalho apresenta contribuições de Hans-Georg Gadamer, Jürgen Habermas e Paul Ricoeur quanto à necessidade de uma hermenêutica que estabeleça o entendimento entre culturas distintas, e enfim demonstra como a hipermídia representa um intermeio adequado pelo qual esta hermenêutica se expressa, ilustrando com exemplos de casos como o do pesquisador Caio Lazaneo junto a comunidades indígenas, e o trabalho dos pesquisadores do Instituto Socioambiental junto às comunidades quilombolas do Vale do Ribeira. / This thesis presents a philosophical reflection on the epistemological recovery represented by the Shared Production of Knowledge. Contrary to university knowledge, marked by the use of methodical reason originated in the Enlightenment in the seventeenth century, which distinguishes subject from object, the Shared Production of Knowledge seeks the interactivity between distinct epistemological statutes, where subjects become objects at the same time. Based on the analysis of the meeting between oral knowledge in traditional cultures and the methodical rational knowledge of university science, the transition from orality to writing in the colonization process of the Americas and the use of hypermedia in the 21st century, the work presents contributions of Hans-Georg Gadamer, Jürgen Habermas and Paul Ricoeur on the need for a hermeneutic that establishes the understanding between distinct cultures, and finally demonstrates how hypermedia represents one intermedia by which this hermeneutic is expressed, illustrating with examples of cases like the researcher Caio Lazaneo with indigenous communities, and the work of researchers from the Socioambiental Institute with the quilombolas (descendants of enslaved Africans) communities of the Vale do Ribeira.

Raising a child with a pervasive developmental disorder (PDD), particularly that of Fragile X Syndrome (FXS), is challenging, as it comes with parental stressors for both mothers and fathers. Research on these stressors has been limited to only the stressors that mothers of children with a PDD experience and has failed to thoroughly examine the experiences and stressors of fathers of children with a PDD, particularly that of FXS. Using Hill's ABC-X family stress theory, this quantitative research study investigated the effects of marital satisfaction due to the amount of shared childcare responsibilities and parental stress among the mothers and fathers of children diagnosed with FXS. This study also examined whether significant differences exist among these parents, who were recruited through the use of flyers, notices, and handouts that were randomly passed out to parents at the FXS Alliance of Texas located in the southwest region of Texas. Participants for this study were 128 parents of children with FXS, each of whom completed a demographic questionnaire, the Kansas Marital Satisfaction Scale, and The Sharing of Childcare Responsibilities Scale and Parental Stress Level Scale. An independent samples t test and multiple linear regression statistical analysis was employed. The results of the study indicated that parental stress associated with the amount of shared childcare responsibilities accounted for a significant degree of the variance in marital satisfaction. Yet the study did not find a significant mean difference in the level of parental stress that was experienced uniquely across gender. Potential social changes may include future development and improvements in treatment, therapeutic approaches, and predicted outcomes in efforts to enhance parental stress interventions so as to improve stress-related outcomes for parents of children with FXS.

Current heterogeneous CPU-GPU architectures integrate general purpose CPUs and highly thread-level parallelized GPUs (Graphic Processing Units) in the same die. This dissertation focuses on improving the energy efficiency and performance for the heterogeneous CPU-GPU system. Leakage energy has become an increasingly large fraction of total energy consumption, making it important to reduce leakage energy for improving the overall energy efficiency. Cache occupies a large on-chip area, which are good targets for leakage energy reduction. For the CPU cache, we study how to reduce the cache leakage energy efficiently in a hybrid SPM (Scratch-Pad Memory) and cache architecture. For the GPU cache, the access pattern of GPU cache is different from the CPU, which usually has little locality and high miss rate. In addition, GPU can hide memory latency more effectively due to multi-threading. Because of the above reasons, we find it is possible to place the cache lines of the GPU data caches into the low power mode more aggressively than traditional leakage management for CPU caches, which can reduce more leakage energy without significant performance degradation. The contention in shared resources between CPU and GPU, such as the last level cache (LLC), interconnection network and DRAM, may degrade both CPU and GPU performance. We propose a simple yet effective method based on probability to control the LLC replacement policy for reducing the CPU’s inter-core conflict misses caused by GPU without significantly impacting GPU performance. In addition, we develop two strategies to combine the probability based method for the LLC and an existing technique called virtual channel partition (VCP) for the interconnection network to further improve the CPU performance. For a specific graph application of Breadth first search (BFS), which is a basis for graph search and a core building block for many higher-level graph analysis applications, it is a typical example of parallel computation that is inefficient on GPU architectures. In a graph, a small portion of nodes may have a large number of neighbors, which leads to irregular tasks on GPUs. These irregularities limit the parallelism of BFS executing on GPUs. Unlike the previous works focusing on fine-grained task management to address the irregularity, we propose Virtual-BFS (VBFS) to virtually change the graph itself. By adding virtual vertices, the high-degree nodes in the graph are divided into groups that have an equal number of neighbors, which increases the parallelism such that more GPU threads can work concurrently. This approach ensures correctness and can significantly improve both the performance and energy efficiency on GPUs.

The induction of labor is medically indicated for many conditions in which delivering the baby outweighs the risk of continuing the pregnancy. Patients admitted for the induction of labor require adequate information to actively participate in decision making that affects their plan of care. The purpose of this quality improvement project was to improve the quality of healthcare delivery and promote patient engagement by providing consistent education using a teaching tool. The project question addressed the impact of a labor-induction teaching tool on improving patient education, participation, and overall satisfaction. The Plan-Do-Study-Act (PDSA) model was used to plan, implement, and evaluate the labor-induction teaching tool in a 9-room labor and delivery unit that averages approximately 1,500 births per year. The teaching tool content was obtained from existing patient education information from the organization's resource library. The nurses piloted the teaching tool for all patients admitted for the induction of labor for 3 weeks. Patient comments supported the use of the teaching tool to improve knowledge, increase participation in decision making, and enhance overall satisfaction. The nurses voluntarily completed an online survey that indicated the teaching tool was easy to use, positively impacted workflow, and supported informed choice. Patient charts were audited and showed a 94% compliance with documentation of education. The success of the teaching tool in improving patient education and decision-making capacity supports the development of other teaching tools, encourages patient and family-centered care, and improves the delivery of quality care.

Type 2 diabetes (T2DM) is a health epidemic that continues to worsen. A major concern is that treatment adherence rates hover around 50%, despite the introduction of new medications, treatments, and technology. Lack of adherence by patients can lead to complications like blindness, kidney disease, and amputations. While there have been many studies conducted to evaluate patient factors related to adherence, fewer studies have been conducted to evaluate the role of the physician-patient relationship. The purpose of this study was to examine the correlation between the physician-patient relationship and patient treatment adherence, and examine the moderators of age, education, ethnicity, and income. Gender was included as a moderator in a secondary analysis. Two theories formed the theoretical framework of this study: biopsychosocial model and self-efficacy theory. This quantitative nonexperimental study was completed with survey data collected from 92 participants in the United States ages 18 or older who were under treatment for T2DM for at least a year, and who had seen their physician at least once in the previous year. Correlational and regression analyses were conducted using data from the modified Clinician and Group Survey and the Diabetes Management Self-Questionnaire. The physician-patient relationship predicted treatment adherence, and gender moderated the relationship. These findings suggest the importance of the physician-patient relationship as a factor in patient treatment adherence. This has important implications for social change because an understanding of which physician factors lead to treatment adherence may help improve patient outcomes, reduce T2DM complications, improve patient quality of life, and reduce healthcare costs.

The purpose of this outcome-based program evaluation project study was to investigate how professional development (PD) influenced the shared values of 25 district teachers regarding instructional technology and their collaboration and instructional practices using instructional technology. Inclusion criteria included (a) participants had to be 18 years or older and (b) participants had to be a certified teacher. Guided by Mishra and Koehler's TPACK theory and Guskey's model for PD evaluation, the research was designed to determine (a) how teachers demonstrate collaboration using instructional technology as a result of PD, (b) what shared values teachers have adopted regarding instructional technology as a result of PD, and (c) how the authentic teaching practices of participants have changed because of the technology PD. Data were collected through Likert surveys, interviews, and classroom observations. Data analysis included descriptive statistics for the quantitative portion, and identification of emerging themes for the qualitative portion. The results reflected ways technology is being implemented into instructional strategies. The implication of this study for social change includes support for including collaboration and shared values in professional development to improve instructional strategies incorporating technology, which can lead to improved learning environments. Teachers and the school can benefit by having the knowledge of how technology and PD provided by the OETT grant enhanced instruction. Social changes that may occur due to the findings of this study include the school gaining a better understanding of the influence of technology in instruction on student learning and identifying tools that potentially increased teacher uses of the technologies purchased as well as teacher application of the knowledge gained in the PD provided through the grant.

This thesis presents an implementation of a multi-threaded C library for performing data parallel computations on MIMD shared memory systems, with support for user defined operators and one-dimensional sparse arrays. Multi-threaded parallel execution was achieved by the use of the POSIX threads, and the library exposes several functions for performing data parallel computations directly on arrays. The implemented functions were based on a set of primitives that many data parallel programming languages have in common. The individual scalability of the primitives varied greatly, with most of them only gaining a significant speedup when executed on two cores followed by a significant drop-off in speedup as more cores were added. An exception to this was the reduction primitive however, which managed to achieve near optimal speedup in most tests. The library proved unviable for expressing algorithms requiring more then one or two primitives in sequence due to the overhead that each of them cause.