PhD, University of Cincinnati, 2024, Education, Criminal Justice, and Human Services: School Psychology

With youth currently experiencing elevated rates of mental and behavioral health concerns, the need for flexible and cost-effective interventions in schools is at an all-time high. This need is even more pronounced in alternative education settings, where students may be at higher risk for adverse outcomes if not adequately supported. Acceptance and commitment therapy (ACT) is one increasingly popular intervention in these settings, yet relatively little is known about its capacity to impact directly observable classroom behaviors, especially when administered in a group format. At present, existing studies on ACT in educational settings have focused primarily on internalizing problems, relied on indirect measures of behavior, or utilized individual therapy, which may be time- or cost-prohibitive. Considering these gaps in the literature and the growing need for school-based providers to understand the uses and limitations of the tools available to them, the present study aimed to investigate the effects of weekly ACT groups on directly observed classroom behaviors in an alternative education setting. Results of the study indicated that although the intervention was viewed favorably by group participants, a functional relation between the intervention and the level of classroom behavior was not observed. Limitations, implications for practice, and recommendations for future research are discussed.

Committee: Lori Vincent Ph.D. (Committee Chair); Rachel Saunders Ph.D. (Committee Member); Renee Hawkins Ph.D. (Committee Chair) Subjects: Educational Psychology

Doctor of Philosophy, Case Western Reserve University, 2018, Clinical Research

Dialysis is the major treatment for End Stage Renal Disease in the United States. Despite major quality improvement initiatives by the Centers for Medicare and Medicaid Services (CMS), dialysis costs remain high and patient outcomes are poor, especially in comparison to other countries. In particular, there is wide variation in patient outcomes between facilities, even when adjusting for patient case mix. Differences in patient to staff ratios at dialysis facilities has been suggested as a possible explanation for this variation but has not been tested. Because of the critical role of nutrition in maintaining patients' health while on dialysis, the role of the renal registered dietitian nutritionist (RDN) is of particular interest. We used facility-level data from CMS and structural equation modeling to assess the relationship between patient: full time equivalent (FTE) staff ratios for RDNs, nurses, dialysis technicians and social workers with the outcomes of standardized hospitalization rate, standardized mortality ratio, and did not find staffing ratios to be an important explanatory variable. However, these ratios are limited by the ecological fallacy and their limited specificity including the lack of qualitative information on what occurs during available staff time. Therefore, we also used direct observation of 14 RDNs in Northeast Ohio to quantify and describe RDN roles and the proportion of time they consume. We found that direct care consumed an average of 24.9±11.5% of RDNs' time, followed by professional communication at 20.9±6.7%. The average time for per patient interaction was 6:57±4:03 (m:ss). Patient: FTE RDN ratios were not correlated with time in direct care (r=0.02). Together these results demonstrate the difficulty in mandating staffing ratios or responsibilities that will result in improved patient outcomes.

Committee: James Spilsbury PhD (Committee Chair); Ashwini Sehgal MD (Advisor); Jeffrey Albert PhD (Committee Member); Hope Barkoukis PhD, RDN, LD (Committee Member) Subjects: Health Care Management; Nutrition

MPH, University of Cincinnati, 2015, Medicine: Epidemiology

Background: Tuberculosis (TB) is an infectious disease, which is a major global public health concern due to the change in its epidemiological pattern and mode of transmission. Even though tuberculosis is a curable and preventable disease, it is second only to HIV/AIDS as the greatest killer worldwide due to a single infectious agent. Universal migration is one of the risk factors in spreading of the TB infection. Its containment is a challenge for countries of low TB incidence. In low incidence countries, migrants face higher risk of exposure to TB infection due to overcrowded living and working conditions; increased vulnerability to HIV; malnutrition and substance abuse, induced by marginalization and social exclusion. Undocumented migrant patients have difficulty getting healthcare access, have poor health-seeking behavior due to lack of education and health literacy. Stigma and cultural belief are other factors, and they are afraid of getting caught and of deportation. Migrant patients present various challenges in the control of tuberculosis with higher rates of default in treatment which results in drug resistance TB. The aforesaid problems lead to delay in TB diagnosis among migrants and thus leading to spread of disease. Presently, in USA and Western Europe a majority of cases of TB occur in foreign-born individuals, re?ecting immigration from countries with high prevalence of TB. To attain effective TB control globally, an understanding of changing epidemiology by public health departments is needed. The use of directly observed therapy of short course (DOTS) is the 4 strategy recommended by World Health Organization (WHO) which is believed to lead success in reducing TB burden. Objectives: a) Identify factors influencing the success of DOTS program for the TB treatment in Gazan, Saudi Arabia (SA). b) Assess the success rate of the DOTS program. Methods: This project is primarily transcribed by (open full item for complete abstract)

Committee: Aimin Chen Ph.D. (Committee Chair); Marepalli Rao Ph.D. (Committee Member) Subjects: Public Health