As traditional family roles change and circumstances at home become increasingly varied in contemporary society, the experiences of children also undergo change. For instance, when fathers take on primary caregiving responsibilities, those differing circumstances also impact their children. Therefore, it is important for researchers to study how changing parental roles affect children in the home. Through the use of qualitative research design, this research focuses on how the experiences of children within the home may be impacted when fathers are the primary caregiver. Although previous research has examined several aspects of family dynamics with so-called stay-at-home fathers, research has not yet evaluated how full-time fathering in the home may impact children's educational and school experiences. This thesis describes six fathers' and six mothers' perspectives about their children's school experiences when the father provides childcare in the home while the mother works full-time outside the home. Results suggest that division of roles in a family can affect some areas of children's experiences and responses implied there are multiple interacting variables that contribute to the parental influences on children. Mothers focus on the social experiences of their children as components of overall school experience. Fathers more frequently talked about the emotional and behavioral components of school experience. The results inform the disciplines of family science, teacher education, and school psychology of key considerations when working with children in this nontraditional family arrangement.

Society of today is struggling with both large amounts of emissions as well as congestion on the roads. For this reason, AFRY in collaboration with Volvo GTT is working on develop and implement longer and heavier transports in traffic network. These combinations are called high capacity transport and have high performance-based demands. Dynamic stability is one demand that can be improved for the DUOCAT, which is a high capacity transport combination. The hypothesis is that a displacement backward in the direction of travel of the v-stay can improve the dynamic stability. The v-stay is a component of the rear wheel suspension and has an important function regarding dynamic stability by absorbing lateral forces. To achieve better dynamic stability, the goal is to create counter steering on the rear axle of the DUO-CAT through small design changes on the v-stay. The suggestion from Volvo is to move the v-stay backward in the direction of travel, which in this thesis has become the focus in both concept generation and design work. The thesis includes development of new concepts of the v-stay. An extensive evaluation process consisting of dynamic analysis was carried out in PTC Creo Parametric, which made it possible to compare the new concepts with the current v-stay. An important part of the thesis is to obtain a simplified model that simulate the physical conditions. The delimitations are to examine lateral acceleration with load on the axle and friction between asphalt and wheels. The maneuver in the analyses emulates a quick lane change at 80 km/h. This has resulted in a new concept that includes the current v-stay where only the position on the frame and axle is changed with the help of new fastening components. The new concept provides an increased counter steering of 6%. The conclusion is that a displacement backwards in the direction of travel of the vehicle gives an increased counter steering. Future work is required to achieve the desired improved steering and safety requirements.

Background: The incidence of neonatal opioid withdrawal syndrome (NOWS), a drug withdrawal syndrome mainly associated with opioid exposure in-utero has significantly increased in the United States over the last decade with infants with NOWS staying longer in the hospital than those without NOWS. Objectives: To determine if feeding tube use while on admission is associated with length of hospital stay among infants diagnosed with NOWS. We also compared the differences between infants with NOWS who required the use of feeding tubes while on admission, and those that did not, based on infant and maternal characteristics. Methods: This was a retrospective cohort study of infants delivered between July 1, 2011 and June 30, 2016 at Ballad Health System. Our inclusion criteria were infants who were exposed to opioids in-utero and received a diagnosis of NOWS based on 2 consecutive Finnegan scores of 10, or 3 consecutive scores of 8, or treatment with morphine. Medical chart record of 294 infants who met these criteria were reviewed for infant and maternal characteristics. Our outcome variable was infant length of hospital stay and our predictor variable was feeding tube use an indicator for feeding difficulties. Chi-square test and t-test were used to compare infant and maternal characteristics by feeding tube use. Simple linear regression models were used to assess the effect of feeding tube use and infant and maternal characteristics on infant length of hospital stay. Multiple linear regression was used to model infant length of hospital stay predicted by feeding tube use, while adjusting for neonatal intensive care unit (NICU) admission, treatment with morphine, and maternal benzodiazepine use during pregnancy. All analyses were done using SAS 9.4. Results: Of the 294 infants diagnosed with NOWS, 22.11% had feeding difficulties that necessitated use of feeding tubes. Infants who used feeding tubes were significantly more likely to be born preterm (20.31% vs 8.73%, p=0.0096) to be admitted into the NICU (98.46% vs 51.09%, p=

Prompt diagnosis and treatment of necrotizing fascitis reduces the morbidity and mortality rates of this devastating disease. To examine the clinical outcomes of using negative pressure wound therapy in the adjunctive management of wounds secondary to necrotizing fascitis, a retrospective review of medical records was conducted. Participants included 11 consecutive patients (16 wounds) with a diagnosis of necrotizing fascitis admitted to a teaching hospital between 2000 and 2005 and treated on an inpatient basis with negative pressure wound therapy. The patients included seven men, four women (average age 54 years; range 18 to 82 years). Variables abstracted from the medical records and consultation notes included: demographic information, tissue and blood bacteriological data, wound history, wound healing outcomes, duration of negative pressure wound therapy, length of hospital stay, and mortality and morbidity information. Variables were entered into an electronic database and analyzed. Operative tissue biopsies were obtained and all participants received serial surgical debridements as well as infection, nutrition, and hemodynamic support. Negative pressure wound therapy was applied to the wound(s) at 125 mm Hg continuous negative pressure until reconstructive closure could be performed. Most wounds (10) were on lower extremities, seven patients presented with sepsis, and beta-hemolytic Streptococcus was identified in nine wounds. Mean number of negative pressure wound therapy treatment days was 25 (range: 7 to 74), mean length of stay was 67 days (range: 21 to 186). All wounds were successfully closed ĝ€" 73% received split-thickness skin grafts, 27% required flaps, 100% limb salvage was achieved, and all patients survived. No negative pressure wound therapy or dressing-associated complications were observed. Negative pressure wound therapy was found to be a viable adjunctive treatment in the management of wounds associated with necrotizing fascitis.

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BACKGROUND: There is continued attention towards using patient demographic and clinical characteristics available in health administrative data when case mix adjusting the measurement of length of stay (LOS) for hospitalized children. However, little is known about what proportion of children’s LOS is explained by these characteristics. OBJECTIVES: The objectives of the study were to quantify the amount of variation in LOS within and across hospitals that is explained by demographic and clinical factors of hospitalized pediatric patients. METHODS: A retrospective cohort analysis was completed of 818,848 hospitalizations for any reason occurring from 1/1/2014 to 12/31/2014 in one of 44 freestanding children’s hospitals in the Pediatric Health Information Systems (PHIS) dataset. A generalized linear model was derived to simultaneously regress demographic factors [age, race/ethnicity, payer, rural residence, health professional shortage area (HPSA) residence, income, and distance traveled], and clinical factors (severity of illness, type and number of chronic conditions) on LOS. The percentage of LOS attributable to each characteristic within each hospital was quantified using the covariance test of the hospital random effect. RESULTS: The factors with the greatest impact on LOS were severity of illness and chronic condition type and number, with a median (interquartile range) of 16.8% (IQR 15.0%-19.4%) and 4.0% (IQR 2.9%-4.5%) of LOS, respectively, explained by these characteristics across hospitals. LOS varied significantly (p<0.05) with both severity of illness and chronic condition type and number for all 44 hospitals in the cohort. All patient demographic factors, (age, race/ethnicity, payer, rural residence, HSPA residence, income, and distance traveled) had minimal impact on LOS, with <0.1% of LOS explained by each characteristic. Across hospitals, 78.3% (IQR 75.8-80.2%)] of LOS remained unexplained by the patient characteristics under study. CONCLUSIONS: Patients’ clinical characteristics ascertained from administrative data account for approximately one-fifth of LOS whereas their demographic characteristics account for a negligible amount. Efforts to optimize the efficiency of inpatient care for hospitalized children might benefit from uncovering how much of the vast amount of unexplained LOS is due to modifiable aspects of care quality. / 2018-06-16T00:00:00Z

Managing postoperative pain continues to be a challenging public health problem. The organization under study was experiencing a prolonged length of hospital stay (LOS) in the post-total knee and hip replacement surgery population that was causing system-wide patient flow issues. The purpose of this quality improvement project was to educate patients through an established education class on pain expectations, strategies on managing pain, discharge planning, and physical therapy expectations with a goal of reducing pain and LOS. The health belief model was used as a guide to incorporate new content into the educational program that addressed patient knowledge on pain, concerns, fears, and misconceptions related to surgery. New content was added to the class on strategies to improve postoperative pain to help the organizational need to meet 2- to 3-day LOS. The project compared differences in pain levels and LOS in participants who completed the preoperative education and those who did not. The project methodology was a retrospective nonexperimental pretest and posttest design, and a quantitative analysis was used to compare pain levels measured by visual analog scale in documented charts during hospital stay. LOS was measured from data collected from chart review. The findings revealed lower pain levels during the hospital stay of those who completed the educational program. The patients who did not attend the class had an average mean LOS of 5 days as compared to 3 days LOS for those who attended the preoperative class. The project impacts social change on an organizational level by demonstrating that patients undergoing joint replacement surgery benefit from the revised educational plan, which results in early mobility, better pain control, and decreased LOS.

Juvenile Correctional officers are important to the function of secure facilities because they maintain constant contact with offenders. This quantitative study sought to determine why turnover rates continue to rise and offered insight into retaining officers. This study utilized Abraham Maslow's Hierarchy of Needs theory as the foundation for explaining relationships between the variables: quality supervision and intent to stay and job satisfaction, job search, and job embeddedness of juvenile correctional officers across the United States. Survey data were collected from 247 juvenile correctional officers using a web-based survey containing 5 scales including Quality of Supervision and Intent to Stay, and Job Embeddedness, Job Satisfaction, and Job Search. The relationship between quality of supervision and intent to stay and job embeddedness, job satisfaction, and job search, were analyzed through correlational and multiple regression analyses. An ordinal regression analysis determined that of the variables examined, job satisfaction was a significant factor in the quality of supervision for juvenile correctional officers supervising female youth in secure facilities. A multiple linear regression analysis determined that of the variables analyzed only job satisfaction and job search had a significant effect on juvenile correctional officers supervising female youth intent to stay employed at secure female facilities. This research enhances the body of knowledge examining the cause of individuals' intent to stay and quality of supervision. Reduction of employee turnover increase of job satisfaction, and quality of supervision can positively benefit juvenile justice organizations by enabling correctional staff to meet the overall mission of keeping youth and communities safe.

Emergency department (ED) crowding is a serious problem in the United States. Crowding in the ED can result in delays that may negatively affect patient outcomes and increase the cost of care. The purpose of this project was to understand strategies that can help to improve patient flow in the ED. The plan-to-do-study act model for process improvement influenced this project. Secondary data were collected for a 2-month period to determine the impact of workflow processes (patient boarding time in ED, surge capacity and workflow processes including the impact of ancillary departments) on the movement of admitted patients from the ED to the inpatient units. Descriptive statistics were used to provide numerical summaries, frequencies, and percentages for the identified variables. The findings were consistent with an increased length of stay and longer ED boarding of patients due to the workflow process. Resulting recommendations included standardized calls for report on admitted patients within 30 minutes, timely discharge of patients, collaboration with attending physicians to facilitate evaluation of patients and orders, modification of staffing roles to ensure adequate staff, and identification of staff transporters to ensure timely transport of patients to their rooms. The findings helped to inform the development of a Bed Utilization Policy. The policy has been shared with the organization with the recommendation to implement and further evaluate to help manage bed flow. Development of utilization strategies that contribute to facilitating throughput will promote positive social change by providing nurses with the tools to help prepare for and respond to unexpected increases in patient volume. Improving efficiency with flow can help to improve patient care, timeliness, and safety.

The purpose of this thesis is to explore how stay-at-home fathers view their role as the primary caregiver, and how they encounter opposing masculinity issues. This is explored through discussion about daily life, the decision to stay home, and household labor, a particularly interesting reflection of gender roles and equality. The two research questions used to explore this included: How do stay-at-home fathers understand their masculinity and social role? How does talk about the negotiation of household labor in stay-at-home father/career mother families illustrate masculinity issues? Through an analysis of interviews of eight present or past stay-at-home fathers, I capture the ways that these fathers describe and discuss the stay-at-home parent role. By looking at how these men define and interpret the specific challenges they face while in this role, I help tell the stories of stay-at-home father/career mother families, and understand whether these families, too, experience Hochschild's "stalled revolution."