Essays in Health Economics and Health Information Systems

The accelerating cost of healthcare in the United States has prompted increased policy debate. Although it is estimated that prescription drug spending accounts for only eleven percent of total healthcare expenditures, there is evidence that this rate of spending is increasing faster than spending on other types of healthcare. A proven method of decreasing prescription drug spending is by using less expensive generic medications when available. We estimate the price elasticities of switching from branded to generic drugs in three dominant drug classes: antidepressants, statins, and central nervous system agents. We find the price elasticities of switching varies by drug and is between 0.01 and 0.09.Despite long-standing use of mandatory generic substitution laws, their exact effect on generic fill-rate and prescription drug spending has not been identified. We use the Tennessee Affordable Drug Act of 2005 to identify the effect of implementing the mandatory generic substitution of drugs by pharmacists. Using a differences-in-differences framework, we estimate the effect of this policy on the percentage of generic drugs dispensed in the state of Tennessee. We find the effect to vary across drug classes and health insurance types, with the greatest effect occurring within Point of Service insurance plans among non-chronic prescription drug users. We propose extensions to the technology acceptance model (TAM) for the adoption of integrated electronic health records that are shared by multiple healthcare providers. In particular, we propose a conceptual model in which we incorporate two new factors &mdash trust and access to shared information &mdash into the TAM. We find a statistically significant effect of shared information on perceived usefulness. We also find a significant effect of trust on both perceived usefulness and behavioral intent to use integrated electronic health records. Our analysis provides insights into the effects of these factors on intent to use integrated electronic health records for both clinical and non-clinical staff

What Is the Process of Relational Work of the Nurse?

The process of how nurses work in relationships to accomplish their work is presented in this dissertation. This study has made the relational work process of nurses explicit. While research demonstrates that increased nurse staffing is associated with better patient outcomes and with nurses experiencing less burnout and job dissatisfaction, the process is not explored in the empirical literature. The research question was: “What is the process of relational work of the nurse?” Data collection and analysis conformed to the process of classical grounded theory. Interviews were face to face with 23 registered nurses working as direct care staff nurses on inpatient units. Data analysis (constant comparison) occurred concurrently with data collection. The core category, Coming Together to Get Through, emerged from the data as how nurses worked collectively to accomplish their work. Without the help from their nursing, and physician, colleagues they could not finish each day’s work completely and do the best for their patients. The ten temporal categories of the process are: Spending Time, Knowing Other Nurses and Doctors, Asserting Authority, Trusting and Respecting, Being Approachable, Relying on One Another, Needing Each Other, Helping Each Other, Getting the Work Done, and Did the Best for Our Patients. This is the first study to empirically discover a basic social process that demonstrates how the nurse works in relationships. The importance of social and relational constructs and their creation in an organization posits relationships as work and the building blocks of work in organizations. Discovery of this substantive theory of relational work allowed for conceptualization of an explicit work process. This empirical knowledge fills a gap in the literature that may affect appropriate staffing levels which in turn impact both patient and professional outcomes. Future research will focus on creation of a scale of the relational work of nurses, the process of interprofessional relational work, and if high levels of relational work are a pathway to decreased levels of moral distress and burnout, as well as improved professional satisfaction, and better patient outcomes

On the Origin of Shame: Feelings of Disgust toward the Self

Shame and disgust are believed to be evolved psychological solutions to different adaptive challenges and, thus, independent emotions. Shame is thought to promote the maintenance of social hierarchies (Gilbert, 1997; Fessler, 2004), whereas disgust is believed to encourage disease avoidance (Curtis et al., 2004; Oaten et al., 2009). Although shame and disgust are often treated as orthogonal emotions, they share some important commonalities. Both shame and disgust involve bodily concerns, have been described as moral emotions, and encourage avoidance of social interaction. The purpose of the current studies was to investigate the relation between shame and disgust. More specifically, the current research examined whether shame is experienced, at least in part, as disgust toward the self. As shame is often confounded with guilt (Tangney et al., 2007), it was important to demonstrate the uniqueness of the relation between shame and disgust. Thus, guilt was included as a comparison variable. In Study 1, disgust sensitivity and fear of contamination were positively correlated with shame, but not guilt, even after controlling for guilt and negative affect. In Study 2, a disgust induction increased shame, but not guilt, for individuals who were sensitive to disgust. In Study 3, a disgust induction led to an unanticipated significant reduction in shame, whereas a purity induction did not affect shame. In Study 4, inducing disgust increased shame for those who were less sensitive to disgust, but not for those who were more sensitive to disgust. The current research provides initial evidence that there is a unique relation between shame and disgust. Across all 4 Studies, disgust sensitivity and shame propensity were positively correlated even after controlling for negative affect and guilt propensity. However, the results of the three experimental studies provide conflicting evidence as to the causal nature of this relation

I BREATHE THE WORDS: Childhood Mindfulness in Daily Life, a Hermeneutic Phenomenological Study

Mindfulness, the intentional practice and result of paying attention, on purpose, to one’s moment-by-moment experience, without judgment (Kabat-Zinn, 1994), is a promising adjunct intervention for children addressing a variety of academic, behavioral, psychological, and somatic challenges. This qualitative study explored the child’s lived experience applying mindfulness skills to daily life to address a gap in the research, deepening a collective understanding of children’s lived experiences practicing mindfulness. This study aimed to fill this gap in the literature by exploring the essence of this phenomenon through the text of many children’s experiences. This work answered the research question, “What is the child’s experience of using mindfulness in daily life?” Hermeneutic phenomenology was the methodology for this work as it focused on the lived experience of children and the lens that my unique lived experience as a mindfulness educator and researcher offers. Thus, I hermeneutically analyzed 1,136 quotations from children found in my reflective teaching notes during 2014–2018, before this study’s inception, in response to the question, “How did you use your mindfulness in the last week?” This work offers a literature review that provides a foundational definition, an in-depth exploration of the components of mindfulness, the impact of mindfulness on the brain, developmental theory, trauma and ACEs, mindfulness interventions that take place both in and out of school, the involvement of parents and teachers in students learning mindfulness, awareness and regulation practices, the impact of regular practice, participant benefit, and the impact of self-selective participation. Thematic analysis, largely informed by van Manen’s (1990) work, brought to light findings relevant to these areas

Collaborative, Cross-Campus Hybrid Course Development and Implementation

Sponsored by Teagle Foundation, cohorts of faculty members collaborated across six Lehigh Valley, Pennsylvania private liberal arts colleges to develop and implement instructional materials/modules and cross-campus courses using hybrid-learning approaches. In this panel, participating faculty from two of four pilot projects discuss their experiences with hybrid learning, cross-campus collaboration, and new pedagogical possibilities for traditional students in online arenas. Attendees will hear about two shared hybrid/blended courses (Media and Society/Media Literacy and Media Industries) dedicated to helping students understand media structures and power, ideological messages in media, and develop awareness of the centrality of media in a democracy to become critical media consumers and producers in society. These courses used a shared learning management system (Moodle) with joint classroom experiences that included interactive lectures, videos, and shared research projects, course reading responses, discussion forums, and online presentations and developed Media Literacy Week, a cross-campus event in Fall 2015 held jointly on two campuses. Attendees will also learn about another cross-campus collaboration featuring community-based learning and research (CBLR), beginning with a new quantitative research course in Fall 2015 and linking two marketing research courses in Spring 2016. Students explored issues in primary data collection, data cleaning, and research question development for CBLR projects in the first course and produced video tutorials on IRB and research methods for use in the later courses. Students in marketing research courses collaborated across campuses using video-conferencing technologies, Canvas, and Google to critique and edit the data collection and analysis experiences

Spatial cueing by a novel agent in preschool children and adults

In the current study we assessed preschool children and adults' reflexive, covert spatial attentional response to a novel entity. In particular, we assessed whether covert attention was selectively engaged after construing the novel entity as an agent. Previous research has demonstrated that children and adults' covert spatial attention may be flexibly engaged by a non-directional cueing stimulus (e.g., a circle), however this attentional response is neither spontaneous nor is it reflexive (i.e., participants were told that the stimulus predicted the eventual target's location). For the first time we have shown that covert spatial attention is spontaneously and reflexively engaged by a morphologically unfamiliar cueing character when it is interpreted as an agent but not otherwise. The implication of this finding for theoretical accounts of the development of covert attention and agency attributions more generally are discussed

Collaborative, Cross-Campus Hybrid Course Development and Implementation

Sponsored by Teagle Foundation, cohorts of faculty members collaborated across six Lehigh Valley, Pennsylvania private liberal arts colleges to develop and implement instructional materials/modules and cross-campus courses using hybrid-learning approaches. In this panel, participating faculty from two of four pilot projects discuss their experiences with hybrid learning, cross-campus collaboration, and new pedagogical possibilities for traditional students in online arenas. Attendees will hear about two shared hybrid/blended courses (Media and Society/Media Literacy and Media Industries) dedicated to helping students understand media structures and power, ideological messages in media, and develop awareness of the centrality of media in a democracy to become critical media consumers and producers in society. These courses used a shared learning management system (Moodle) with joint classroom experiences that included interactive lectures, videos, and shared research projects, course reading responses, discussion forums, and online presentations and developed Media Literacy Week, a cross-campus event in Fall 2015 held jointly on two campuses. Attendees will also learn about another cross-campus collaboration featuring community-based learning and research (CBLR), beginning with a new quantitative research course in Fall 2015 and linking two marketing research courses in Spring 2016. Students explored issues in primary data collection, data cleaning, and research question development for CBLR projects in the first course and produced video tutorials on IRB and research methods for use in the later courses. Students in marketing research courses collaborated across campuses using video-conferencing technologies, Canvas, and Google to critique and edit the data collection and analysis experiences

Il bel paesaggio nel rapporto uomo-natura

Il bel paesaggio nel rapporto uomo-natura Introduzione I.Il soggetto e il paesaggio I.1.La scoperta estetica della natura come paesaggio I.1.1.Petrarca e la scalata al monte Ventoso I.1.2. Natura come paesaggio: prodotto dello spirito teoretico I.1.3. Un nuovo organo I.1.4.Uscire da sé per entrare nella natura I.1.5.Paesaggio: fenomeno moderno I.2.Paesaggio:un fenomeno creativo I.2.1. Natura, paesaggio e soggetto I.2.2. Il paesaggio e la Stimmung I.2.3. Paesaggio: lo stato d'animo della natura II.Il Regno di Prometeo II.1.Quel che la scienza non dice II.1.1.Una scienza antiestetica II.1.2. La concezione riduzionista dello spazio e del tempo II.1.3. Sistema tolemaico e copernicano II.1.4. Verità estetica: pittura e poesia II.1.5. Alcune considerazioni sulla pittura di paesaggio II.1.6. Sempre caro mi fu quest'ermo colle... II.1.7. La metaspazialità del paesaggio e il tempo della natura II.1.8.L'epifania di un paesaggio: il porto di Messina II.1.9. Scienze dello spirito e paesaggio II.2.L'orizzonte del fare: Praxis e perdita del paesaggio II.2.1.Paesaggio e libertà II.2.2.Faust e la devastazione del paesaggio II.2.3. La città di Prometeo e la scomparsa della natura II.2.4.Degradazione del paesaggio: gli spazi verdi II.2.5.Eclissi della finitezza aperta e della bellezza II.2.6. Essere o avere? II.2.7. Un'utopia pericolosa e le sue ragioni III. Il regno di Orfeo III.1. Orfeo e la liberazione di uomo e natura III.2. La natura come paesaggio III.3. Il recupero della posizione tolemaica III.4. Il paesaggio culturale III.5. La città di Anfione: armonia tra natura e storia III.6. Paesaggio: piacere per anima e corpo III.7. Bellezza e utilità IV. Paesaggio: tra estetica, ecologia, geofilosofia ed ecosofia IV.1. Educare alla bellezza IV.2.Umanesimo scientifico IV.3.Il paesaggio: dimensione estetica ed ecologica IV.4. Tutelare e mantenere IV.5. Identità estetica dei luoghi: paesaggio come natura, cultura e storia IV.6. Ecosofia Conclusione Bibliografia Sono analizzate modalità diverse di approccio nei confronti della realtà naturale, alcune delle quali (prometeismo, faustismo) non permettono di cogliere gli elementi qualitativi della natura e dunque non permettono di poter godere esteticamente del paesaggio (natura mediata esteticamente). Di contro, è sottolineato il carattere non epifenomenico della bellezza della natura, considerata fondamentale e strettamente connessa al benessere fisico e mentale dell'uomo. Si apre ad una visione ecosofica della natura che guardi ad essa e all'uomo in termini di salvaguardia e coappartenenza reciproca