The use of therapeutic assessment in treatment planning and outcomes measurement of clients in a community mental health center

Houser, Sabrina A Texas Woman's University 2005 해외박사(DDOD)

Measuring treatment outcomes, particularly in community-based settings, is critical. This study was designed to explore the impact of therapeutic assessment (TA) (Finn & Tonsager, 1992, 1995) upon presenting symptoms, quality-of-life, and functioning of clients seeking services in a Community Mental Health Clinic. Using a manipulated assessment design (Hayes et al. 1987) 100 participants were randomly assigned to either receive information from the assessments administered or no such assessment information. It was hypothesized that the provision of this assessment information contributes to improved treatment outcomes. The hypothesis was not supported. Several reasons for this outcome are highlighted with considerations for additional research in community-based settings to promote the collaboration between science and practice and serve the best interests of the profession and public.

Nitrogen Fertilizer Management in the Context of the Midwestern Corn Agro-Ecological System: An Environmental Sociological Analysis

Houser, Matthew Kaleb Michigan State University ProQuest Dissertations & 2018 해외박사(DDOD)

Farmers' agricultural management behaviors are influenced by structural political-economic factors and overtly connected to the biophysical environment. However, to this point environmental sociology, a field dedicated to studying environment-so. To enhance the current literature on farmer N management decision making, I utilize theoretical frameworks and concepts from sociology and environmental sociology to examine N fertilizer use among Midwestern corn farmers in five states: Illinois. To accomplish these goals, I use a three paper format. Across these empirical papers, I focus on farmers' application rate of synthetic nitrogen fertilizer, as it is widely considered the dimension of management most influential in determining t.

Dissolved organic carbon in lakes: Effects on thermal structure, primary production, and hypolimnetic metabolism

Houser, Jeffrey Neil The University of Wisconsin - Madison 2001 해외박사(DDOD)

Watershed characteristics determine the inputs of dissolved organic carbon (DOC) and nutrients into lakes. In-lake processes modify these inputs to determine lake characteristics. I examined the role of allochthonous DOC as a master variable that affects the thermal structure of lakes during summer stratification, primary production, ecosystem respiration, and dynamics of the biota. I combined comparative studies, theoretical modeling, and ecosystem experiments to address the following questions: (1) Is light important in the interactions of algal biomass and DOC concentrations? (2) How does the input of allochthonous nutrients (which affects chlorophyll concentrations) and DOC (which determines water color) affect lake thermal structure? (3) What effect does DOC have on hypolimnetic metabolism? (4) Do short-term fluctuations in food-web structure have long term effects on lake nutrient dynamics and primary production?. The response of algal biomass to increased nutrient inputs was lower in a high DOC lake than a low DOC lake. Modeling results indicate that light absorption by colored DOC is a reasonable mechanism behind this pattern. Colored lakes have epilimnia that are more shallow, darker, and colder than clear lakes. Colored lakes also experience more pronounced diel temperature cycles and higher resistance to mixing across the thermocline. Lakes with higher DOC inputs have higher rates of hypolimnetic metabolism as indicated by the rates of accumulation of dissolved inorganic carbon (DIC) and methane (CH₄). Furthermore, in most lakes DOC concentrations declined during the stratified season and the accumulations of DIC + CH₄ in lake hypolimnia were positively correlated with, and of comparable magnitude to, this DOC decline. In a related study, I evaluated long-term effects of temporary food web manipulations as biological controls of nutrient cycling and primary production in lakes. Though the upper level of Tuesday Lake's food web had recovered from a food web manipulations conducted in 1985–1986, zooplankton and <italic> Chaoborus</italic> remained below their premanipulation abundance; chlorophyll <italic> a</italic> remained low, and the dominant premanipulation phytoplankton had not reappeared. Thus, inputs of nutrients and DOC from the landscape affect the primary production, respiration and thermal structure of lakes, and these effects can be modified by in-lake interactions and biological processes.

Nurse staffing levels and patient outcomes

Houser, Elizabeth P The Johns Hopkins University 2005 해외박사(DDOD)

Inadequate nurse staffing has resulted in increased morbidity, mortality, and medical costs in hospitalized patients (American Nurses Association & Lewin-VHI, Inc., 1995; Aiken, Clarke, Sloane, Sochalski, & Silber, 2002; Flood & Diers, 1988). Evidence of poor patient outcomes has not resulted in public policy initiatives largely because there is "an insufficient body of evidence that links changes in hospital nurse staffing to adverse effects on quality of patient care" (Buerhaus & Needleman, 2000, p. 12). The purpose of this descriptive comparative study is to explore the relationship of nurse staffing levels to indices that rate the impact of nursing care. The theoretical framework for this study is the Quality Health Outcomes Model (QHOM), an adaptation of the Donabedian Structure, Process, Outcomes Model (Donabedian, 1973). A secondary analysis of the 2001 Nationwide Inpatient Sample (NIS) was conducted. This database of 5,636,496 discharge cases was linked to data from the 2001 American Hospital Association Annual Survey (n = 685 hospitals). The study employed the Patient Safety Indicator (PSI) software tool developed by the Agency for Healthcare Research and Quality (AHRQ) was used to identify discharge cases that included indicators for decubitus ulcers, failure to rescue, post-operative deep vein thrombosis, and post-operative pulmonary failure (dependent variables). Nurse staffing was defined as a ratio of hospital-reported nurse full-time equivalents/average daily census. The analysis explored the relationship of nurse staffing to the PSIs using bivariate correlations and Poisson regression controlling for hospital characteristics. The findings included a statistically significant inverse relationship of nurse staffing levels to patient outcomes. Specifically, it is estimated that for each one unit increase in nurse staffing there would be a decrease of 23% in decubitus ulcer (p < 0.001), 16% decrease in post-operative deep vein thrombosis (p < 0.001), and 8% decrease in failure to rescue (p < 0.001) hospital rate of occurrence. Post-operative respiratory failure demonstrated a 6% decrease per one unit increase in nurse staffing but was not significant. Skill-mix, LPN to RN ratio, was not found to be significantly related to PSI. Nurse staffing levels explained 11% of variance for decubitus ulcer (p < 0.01), 38.4% for post-operative respiratory failure (p < 0.01), and 27.5% for post-operative deep vein thrombosis (p < 0.001). This study offers an opportunity to understand the inverse relationship of nurse staffing levels and patient outcomes.

Observations of supercell tornado evolution using a mobile, rapid-scan, x-band radar

Houser, Jana B The University of Oklahoma 2013 해외박사(DDOD)

On 24 May 2011, a series of supercell thunderstorms and violent tornadoes tore through central Oklahoma. A mobile, rapid-scan, X-band, polarimetric, Doppler radar (RaXPol), collected data from one of those storms as it produced two tornadoes west and northwest of Oklahoma City. Volume scans of 360° PPIs at nine elevation angles were collected every ∼17 seconds for nearly 30 minutes, and single elevation angle (1°) PPI's were collected every ∼ 2 seconds for 6 minutes. The first tornado, rated an EF3, was documented from intensification to decay, and the second tornado, reaching EF5 strength, was documented from genesis through mature phase. Maximum Doppler velocities in the second tornado were observed to reach 124 m s-1. The life cycles of the tornadoes and their parent supercell are examined herein, with particular emphasis on how their structures and features evolved over the short time scales observable by RaXPol. The roles of storm-scale features in the formation, maintenance, and decay of the tornadoes are examined and placed into context with previous studies. In an effort to determine the chronology of how and when tornadic rotation evolves on short time scales, several analysis methods are employed to examine the time-height relationship of the circulation associated with the tornadoes. These methods include quantifying the difference between the maximum and minimum inbound and outbound velocities (ΔVmax) associated with the Doppler radar detected vortex, and three dimensionally calculating and analyzing an estimate of vorticity based on the radial velocity field. Other rapidly evolving aspects of the tornadoes' life-cycles are examined as well. Polarimetric observations are used to enhance the kinematic and storm-scale analyses. An attempt was made to retrieve the two and three-dimensional wind fields from single-Doppler data using the Tracking Radar Echoes by Correlation technique, with the desired end result of calculating trajectories. Unfortunately, this method did not prove to be accurate enough to determine confidently the wind field, which would have allowed for a more detailed examination of quantitative storm-scale properties. Even its qualitative accuracy was questionable. Therefore, this method is not used for analyzing the storm. The most important conclusions from the results of this study include: 1) Prior to the formation of tornado 2, rotation initially is present only at the lowest analysis level, but tornadic-strength rotation develops nearly simultaneously (within ∼30 s) over a depth of several km. No evidence of the dynamic pipe effect is observed. 2) The parent supercell exhibits an atypical mesocyclone and tornado cycling process prior to the formation of tornado 2. 3) A rear flank gust front surge acts detrimentally to tornado 1 but beneficially to tornado 2. 4) A horizontal vortex just ahead of the rear flank gust front coincident with a weak reflectivity band and a narrow channel of inbound velocities in the radar data appears to contribute to the intensification of the tornado. All conclusions significantly benefited from the rapid temporal observations available for this dataset since they all involved processes that evolved over periods of less than four minutes; (1) and (4) occurred in less than two minutes.

A systems level analysis of transcriptional regulation in the yeast mating response

Houser, John The University of North Carolina at Chapel Hill 2012 해외박사(DDOD)

All cells must detect and respond to changes in their environment, often through changes in gene expression. The yeast pheromone pathway has been extensively characterized and is an ideal system for studying transcriptional regulation. Here we combine computational and experimental approaches to study transcriptional regulation mediated by Ste12, the key transcription factor in the pheromone response. Our mathematical model is able to explain multiple counter-intuitive experimental results and led to several novel findings. For example, we found that the transcriptional repressors Dig1 and Dig2 positively affect transcription by stabilizing Ste12 and that this allows the transcriptional response to act on a different time scale than upstream pathway activity. We further test transcriptional regulation by exposing cells to pheromone concentrations that vary periodically in time and sweeping the frequency of the signal. Such a strategy is often used in engineering to characterize electric circuits. Using this tool we found that transcription persisted for ∼40min after the pheromone was off. To investigate the sources of memory, I developed an Euler solver that made use of the parallel nature of graphics processer units (GPU) to speed up model simulations by 3-4 orders of magnitude. This speedup made it possible to systematically search the parameter space of competing models of memory, fully characterizing their behavior. Using this tool we learned that the observed memory was due to both positive feedback and a slow deactivation step. We also validate our model by making specific predictions and testing them experimentally.

Staged Lives: Identity Construction of Lesbian, Bisexual, and Gay Wind Band Conductors in the Midwest

Houser, Russell John Boston University ProQuest Dissertations & Theses 2021 해외박사(DDOD)

Examining the association between co-occurring mental and substance use disorders and institutional misconduct among female state inmates

Houser, Kimberly A Temple University 2011 해외박사(DDOD)

In view of the vast numbers of individuals with co-occurring mental health and substance use disorders within the offender population, the scarcity of research on the potential exacerbating effects of co-occurring disorders on prisoner misconduct is surprising. With a sample of 1,470 incarcerated women offenders in Pennsylvania, this study examined prisoner misconduct among four distinct groups: 1) inmates with co-occurring disorders, 2) those with mental illness only, 3) inmates with substance use disorders only, and 4) prisoners with no mental health or substance use disorders net the effects of other factors demonstrated in prior studies to influence institutional misconduct. Results suggested that female prisoners with mental health and co-occurring disorders were significantly more likely than those with no disorders to be charged with prison misconduct. Co-occurring disorder inmates were also more likely to be charged with both minor and serious misconduct compared to inmates with no disorders. The results of this study suggest that mental health and co-occurring disorders may hinder the ability of some female offenders to successfully assimilate to the prison environment as evidenced by higher rates of institutional misbehavior. Practice and policy implications are discussed.

Decision-making and communication practices of nurse practitioners in primary care settings: An ethnographic study

Houser, Bryan K University of Pittsburgh 2002 해외박사(DDOD)

How nurse practitioners (NPs) specifically contribute to clinical, quality, and cost outcomes (American Academy of Nurse Practitioners, 1994) and the distinguishing elements unique to their practices (Stanford, 1987) are not well understood. The aims of this ethnographic study were to (a) describe decision-making (DM) and communication practices (CPs) of NPs and (b) contribute to theory identifying the unique practice characteristics of NPs. Two research questions guided the study: (1) Are there defining characteristics of NPs' DM and CPs during clinical practice? (2) How do NPs' DM and CPs contribute to interactions with patients in the clinical setting?. This study used a purposeful sample of 11 NPs in 6 primary healthcare clinics. Data were divided into units, coded, and categorized while constant comparative and language analysis techniques were applied. While DM by NPs is largely eclectic, clearly NPs make greater use of pattern recognition than hypothetico-deductive DM. DM attended to the patient's contextual issues, allowed actual and potential issues into the conversation, demonstrated a lack of preoccupation with biomedical causes alone, and was greatly concerned with effects of disease and health promotion. Uncertainty emerged as a DM context with NPs consistently in pursuit of information to reduce uncertainty for themselves and their patients. The CPs of NPs unified the languages of medicine and care. NPs used terminology and defmed health and health practices in terms that mattered most to the patient. NPs reinforced the importance of the patient's perspective by providing ample time for, by initiating discussion about, and by seeking to resolve the patient's contextual issues thus contributing to personal bonding with patients. NPs created the perception for their patients that patients' input is the primary determinant of the trajectory and breadth of communications. NPs reinforced therapeutic understanding with verbal and non-verbal communications by maintaining certainty during speech, staying on topic by gently redirecting conversation, speaking with therapeutic purpose, changing emotional tone to reinforce understanding and to elicit patient response, maintaining personal proximity, using movements that have specific verbal meaning in lieu of speech, using emotional expression to reinforce and validate patient feelings, and using illustrators to reinforce expression.

Imitative research and development in the neo-schumpeterian theory of growth

Houser, Cindy Lea University of Florida 1995 해외박사