Doctor of Philosophy

dissertationThe problem of information transfer between healthcare sectors and across the continuum of care was examined using a mixed methods approach. These methods include qualitative interviews, retrospective case reviews and an informatic gap analysis. Findings and conclusions are reported for each study. Qualitative interviews were conducted with 16 healthcare representatives from 4 disciplines (medicine, pharmacy, nursing, and social work) and 3 healthcare sectors (hospital, skilled nursing care and community care). Three key themes from a Joint Cognitive Systems theoretical model were used to examine qualitative findings. Agreement on cross-sector care goals is neither defined nor made explicit and in some instances working at cross purposes. Care goals and information paradigms change as patients move from hospitalbased crisis stabilization, diagnosis and treatment to a postdischarge care to home or skilled nursing recovery, function restoration, or end of life support. Control of the transfer process is variable across institutions with little feedback and feed-forward. Lack of knowledge, competency and information tracking threatens sector interdependencies with suspicion and distrust. Sixty-three patients discharged between 2006 and 2008 from hospitals to skilled nursing facilities were randomly selected and reviewed. Most notably missing are discharge summaries (30%), nursing assessments or notes (17%), and social work documents (25%). Advanced directives or living wills necessary for end of life support were present in only 6% of the cases. The presence of information on activities of daily living (ADLs), other disabling conditions, and nutrition was associated with positive outcomes at the 0.001, 0.04 and 0.08levels. Consistent geriatric information transfer across the continuum is needed for relevant care management. An interoperability gap analysis conducted on the LINC (Linking Information Necessary for Care) transfer form determined its interoperability to be the semantic level 0. Detailed Clinical Models representing care management processes are challenged by the lack of consensus in terminology standards across sectors. Construction of information transfer solutions compliant with the Centers of Medicare and Medicaid Services (CMS) Stage 2 meaningful use criteria must address syntactic and semantic standards, map sector terminologies within care management processes, and account for the lack of standard terminologies in allied health domains

ROTOЯ Review

The ROTOЯ partnership between Huddersfield Art Gallery and the University of Huddersfield was established in 2011. ROTOЯ I and II was a programme of eight exhibitions and accompanying events that commenced in 2012 and was completed in 2013. ROTOЯ continues into 2014 and the programme for 2015 and 2016 is already firmly underway. In brief, the aim of ROTOЯ is to improve the cultural vitality of Kirklees, expand audiences, and provide new ways for people to engage with and understand academic research in contemporary art and design. Why ROTOЯ , Why Now? As Vice Chancellors position their institutions’ identities and future trajectories in context to national and international league tables, Professor John Goddard1 proposes the notion of the ‘civic’ university as a ‘place embedded’ institution; one that is committed to ‘place making’ and which recognises its responsibility to engaging with the public. The civic university has deep institutional connections to different social, cultural and economic spheres within its locality and beyond. A fundamental question for both the university sector and cultural organisations alike, including local authority, is how the many different articulations of public engagement and cultural leadership which exist can be brought together to form one coherent, common language. It is critical that we reach out and engage the community so we can participate in local issues, impact upon society, help to forge well-being and maintain a robust cultural economy. Within the lexicon of public centered objectives sits the Arts Council England’s strategic goals, and those of the Arts and Humanities Research Council – in particular its current Cultural Value initiative. What these developments reveal is that art and design education and professional practice, its projected oeuvre as well as its relationship to cultural life and public funding, is now challenged with having to comprehensively audit its usefulness in financially austere times. It was in the wake of these concerns coming to light, and of the 2010 Government Spending Review that ROTOЯ was conceived. These issues and the discussions surrounding them are not completely new. Research into the social benefits of the arts, for both the individual and the community, was championed by the Community Arts Movement in the 1960s. During the 1980s and ‘90s, John Myerscough and Janet Wolff, amongst others, provided significant debate on the role and value of the arts in the public domain. What these discussions demonstrated was a growing concern that the cultural sector could not, and should not, be understood in terms of economic benefit alone. Thankfully, the value of the relationships between art, education, culture and society is now recognised as being far more complex than the reductive quantification of their market and GDP benefits. Writing in ‘Art School (Propositions for the 21st Century)’, Ernesto Pujol proposes:‘…it is absolutely crucial that art schools consider their institutional role in support of democracy. The history of creative expression is linked to the history of freedom. There is a link between the state of artistic expression and the state of democracy.’ When we were approached by Huddersfield Art Gallery to work collaboratively on an exhibition programme that could showcase academic staff research, one of our first concerns was to ask the question, how can we really contribute to cultural leadership within the town?’ The many soundbite examples of public engagement that we might underline within our annual reports or website news are one thing, but what really makes a difference to a town’s cultural identity, and what affects people in their daily lives? With these questions in mind we sought a distinctive programme within the muncipal gallery space, that would introduce academic research in art, design and architecture beyond the university in innovative ways

Clinical foundations and information architecture for the implementation of a federated health record service

Clinical care increasingly requires healthcare professionals to access patient record information that may be distributed across multiple sites, held in a variety of paper and electronic formats, and represented as mixtures of narrative, structured, coded and multi-media entries. A longitudinal person-centred electronic health record (EHR) is a much-anticipated solution to this problem, but its realisation is proving to be a long and complex journey. This Thesis explores the history and evolution of clinical information systems, and establishes a set of clinical and ethico-legal requirements for a generic EHR server. A federation approach (FHR) to harmonising distributed heterogeneous electronic clinical databases is advocated as the basis for meeting these requirements. A set of information models and middleware services, needed to implement a Federated Health Record server, are then described, thereby supporting access by clinical applications to a distributed set of feeder systems holding patient record information. The overall information architecture thus defined provides a generic means of combining such feeder system data to create a virtual electronic health record. Active collaboration in a wide range of clinical contexts, across the whole of Europe, has been central to the evolution of the approach taken. A federated health record server based on this architecture has been implemented by the author and colleagues and deployed in a live clinical environment in the Department of Cardiovascular Medicine at the Whittington Hospital in North London. This implementation experience has fed back into the conceptual development of the approach and has provided "proof-of-concept" verification of its completeness and practical utility. This research has benefited from collaboration with a wide range of healthcare sites, informatics organisations and industry across Europe though several EU Health Telematics projects: GEHR, Synapses, EHCR-SupA, SynEx, Medicate and 6WINIT. The information models published here have been placed in the public domain and have substantially contributed to two generations of CEN health informatics standards, including CEN TC/251 ENV 13606

Drop-out mayors and graduate farmers: Educational fertility differentials by occupational status and industry in six European countries

Background: Understanding the relationship of education to fertility requires the disentangling of the potentially confounding effect of social status, which is highly correlated with education. Objective: We contribute to this aim by examining educational fertility differentials within occupational groups and industries across a broad swath of Central and Eastern Europe, specifically Austria, Greece, Hungary, Romania, Slovenia, and Switzerland. Methods: Cross-sectional individual-level census samples from the Integrated Public Use Microdata Series (IPUMS) are sufficiently large to contain sizeable numbers of unusual combinations, e.g., university graduates in low-status jobs or primary school dropouts in professional categories. Completed cohort fertility, as well as the share childless and with high parity, are regressed on effects for educational attainment, occupation, industry, and all their interactions within a Bayesian framework, and the contributions to the outcome variation are analysed. Results: Education has a strong, consistent association with fertility outcomes when industry and occupation are held constant. Furthermore, fertility by industry and occupation yields fairly disparate patterns. We also find that differences in completed fertility across countries can be attributed to country-specific compositional differences in education, industry, and occupation, and to interaction effects. However, differences by country in the baseline rate of childlessness and high parity cannot be attributed to such compositional effects. Conclusions: The educational fertility gradient in the settings studied cannot be attributed to an occupational composition effect. (authors' abstract

Undergraduate and Graduate Course Descriptions, 2013 Summer

Wright State University undergraduate and graduate course descriptions from Summer 2013

Undergraduate and Graduate Course Descriptions, 2013 Summer

Wright State University undergraduate and graduate course descriptions from Summer 2013

The Development and Testing of a Measurement System to Assess Intensive Care Unit Team Performance

Teamwork is essential for ensuring the quality and safety of healthcare delivery in the intensive care unit (ICU). Complex procedures are conducted with a diverse team of clinicians with unique roles and responsibilities. Information about care plans and goals must also be developed, communicated, and coordinated across multiple disciplines and transferred effectively between shifts and personnel. The intricacies of routine care are compounded during emergency events, which require ICU teams to adapt to rapidly changing patient conditions while facing intense time pressure and conditional stress. Realities such as these emphasize the need for teamwork skills in the ICU. The measurement of teamwork serves a number of different purposes, including routine assessment, directing feedback, and evaluating the impact of improvement initiatives. Yet no behavioral marker system exists in critical care for quantifying teamwork across multiple task types. This study contributes to the state of science and practice in critical care by taking a (1) theory-driven, (2) context-driven, and (3) psychometrically-driven approach to the development of a teamwork measure. The development of the marker system for the current study considered the state of science and practice surrounding teamwork in critical care, the application of behavioral marker systems across the healthcare community, and interviews with front line clinicians. The ICU behavioral marker system covers four core teamwork dimensions especially relevant to critical care teams: Communication, Leadership, Backup and Supportive Behavior, and Team Decision Making, with each dimension subsuming other relevant subdimensions. This study provided an initial assessment of the reliability and validity of the marker system by focusing on a subset of teamwork competencies relevant to subset of team tasks. Two raters scored the performance of 50 teams along six subdimensions during rounds (n=25) and handoffs (n=25). In addition to calculating traditional forms of reliability evidence [intraclass correlations (ICCs) and percent agreement], this study modeled the systematic variance in ratings associated with raters, instances of teamwork, subdimensions, and tasks by applying generalizability (G) theory. G theory was also employed to provide evidence that the marker system adequately distinguishes teamwork competencies targeted for measurement. The marker system differentiated teamwork subdimensions when the data for rounds and handoffs were combined and when the data were examined separately by task (G coefficient greater than 0.80). Additionally, variance associated with instances of teamwork, subdimensions, and their interaction constituted the greatest proportion of variance in scores while variance associated with rater and task effects were minimal. That said, there remained a large percentage of residual error across analyses. Single measures ICCs were fair to good when the data for rounds and handoffs were combined depending on the competency assessed (0.52 to 0.74). The ICCs ranged from fair to good when only examining handoffs (0.47 to 0.69) and fair to excellent when only considering rounds (0.53 to 0.79). Average measures ICCs were always greater than single measures for each analysis, ranging from good to excellent (overall: 0.69 to 0.85, handoffs: 0.64 to 0.81, rounds: 0.70 to 0.89). In general, the percent of overall agreement was substandard, ranging from 0.44 to 0.80 across each task analysis. The percentage of scores within a single point, however, was nearly perfect, ranging from 0.80 to 1.00 for rounds and handoffs, handoffs, and rounds. The confluence of evidence supported the expectation that the marker system differentiates among teamwork subdmensions. Yet different reliability indices suggested varying levels of confidence in rater consistency depending on the teamwork competency that was measured. Because this study applied a psychometric approach, areas for future development and testing to redress these issues were identified. There also is a need to assess the viability of this tool in other research contexts to evaluate its generalizability in places with different norms and organizational policies as well as for different tasks that emphasize different teamwork skills. Further, it is important to increase the number of users able to make assessments through low-cost, easily accessible rater training and guidance materials. Particular emphasis should be given to areas where rater reliability was less than ideal. This would allow future researchers to evaluate team performance, provide developmental feedback, and determine the impact of future teamwork improvement initiatives

Copyright, Commodification, and Culture: Locating the Public Domain

The relationship between increased commodification and the public domain in copyright law is the subject of considerable controversy, both political and theoretical. The paper argues that beliefs about what legal definition the public domain requires depend crucially on implicit preconceptions about what a public domain is. When considered in broader historical context, the term public domain has a specific set of denotative and connotative meanings that constitute the artistic, intellectual, and informational public domain as a geographically separate place, portions of which are presumptively eligible for privatization. This idea meshes well with the current push toward commodification in copyright. The paper then tests this metaphorical construct of the public domain against descriptive and theoretical accounts of the ways that forms of artistic expression develop, and argues that the metaphor in fact describes the public aspects of artistic, intellectual, and informational culture rather badly. Attention to the social parameters of creative practice suggests that the common in culture is not a separate place, but a distributed property of social space. The legally constituted common should both mirror and express this disaggregation. The paper offers a different organizing metaphor for the relationship between the public and the proprietary that matches the theory and practice of creativity more accurately: The common in culture is the cultural landscape within which creative practice takes place. This in turn suggests a need to recalibrate the doctrines that determine the scope of a copyright owner\u27s rights during the copyright term, particularly those that establish the right to control the preparation and exploitation of copies and derivative works

2010 - 2011, Gardner-Webb University Academic Catalog

2010 - 2011, Gardner-Webb University Academic Catalog. A. Frank Bonner, president.https://digitalcommons.gardner-webb.edu/undergraduate-academic-catalogs/1025/thumbnail.jp

2012 - 2013, Gardner-Webb University Academic Catalog

2012 - 2013, Gardner-Webb University Academic Catalog. A. Frank Bonner, president.https://digitalcommons.gardner-webb.edu/undergraduate-academic-catalogs/1027/thumbnail.jp