Patients

The complex problems of the twenty-first century cannot be effectively addressed with twentieth century top-down bureaucratic governance alone because of limited stakeholder participation in collective decision making and/or implementation. The somewhat limited stakeholder participation in the policy process, especially, that of target populations, can impact generating viable solutions to complex problems. Collaborative governance has emerged as a promising alternative to traditional management in addressing contemporary complex problems. Collaborative governance is thus a type of governance that promotes joint participation of state and non-state stakeholders in decision making and/or implementation by using agreed upon processes of engagement to collectively address problems. Such governance is especially beneficial for addressing the challenges posed by the human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). This dissertation uses the collaborative governance concept to explicate the efforts of HIV Health Services Planning Councils in Broward County and Palm Beach County of South Florida with the purpose of accentuating how collaborative governance works in providing various categories of services to meet the needs of people with AIDS (PWAs), as part of the implementation of the Ryan White CARE Act. The study focuses on critical variables of collaborative governance such as facilitative leadership and institutional design, the collaborative process variables such as trust building, commitment to the process and shared understanding, and outputs such as allocation priorities of the Councils. This study employed mixed methods in collecting data from various relevant sources.

Progress, Regress examines the narrator's journey through the world of mental illness. Psychologist Lisa James has a new client, six-year-old Megan Cooper, who has been diagnosed with child-onset schizophrenia. Megan's young age and the severity of her illness rattle Lisa, and make her question not only her role as a psychologist and a mother, but also her own mental state.

Diminished affective behavior is a frequently observed concomitant of cognitive dysfunction in the Human Immunodeficiency Virus (HIV), yet little is known about their relationship. A neuropsychological battery and electroencephalogram (EEG) recording was conducted on 29 HIV+ (Mage = 35.6 years, SD =5.36) and 30 HIV- (Mage =32.9 years, SD =6.39) women recruited from a family AIDS care program in South Florida. Using an emotion regulation paradigm, we compared event-related potentials (ERPs) following cues to view-neutral, view-negative and reappraise-negative images from the International Affective Picture System (IAPS). A group X instruction interaction was found for the P200 and early (400-1000 ms) late positive potential (LPP). Executive function, i.e., frequent task-switching predicted the attenuation of the early and late LPP following cues to up-regulate negative emotions. Greater response inhibition predicted attenuation of the LPP during the down-regulation of negative emotions. These findings suggest limited cognitive resources for the reappraisal of emotions in women with HIV.

Wigging Out, a memoir, chronicles my first chemotherapy treatment which began in 2008 for the autoimmune disease Lupus. The primary focus is on how identity is affected by disability. Each symptom of my disease and side effect from my medications prompted a reevaluation of my identity as I felt a change both in myself and in the way others perceived me. In order to maintain a sense of control, I tried several techniques to pass and cover my disabled status, including the use of prosthetic hair pieces. Ultimately, the use of prosthetics made accepting my situation more difficult as it encouraged holding onto a former identity rather than creating a new one. It was not until I stopped using prosthetics as a form of denial and instead adopted them as part of a new identity that I was finally able to achieve the confidence necessary to fight for my life.

Traumatic Brain Injury (TBI) is a disability resulting in functional impairments and heightened dependence on others. Family members of persons with TBI can assume added responsibilities during the adjustment to the disability and rehabilitation process, placing strain on the family system. Community re-integration is a primary goal of the rehabilitation process for persons with TBI as this is a step in developing autonomy and promoting independence and productive activity throughout different areas of the person's life (e.g., work, social networks, and home life). This study was designed to examine predictors of community re-integration outcomes of TBI survivors and empirically test the resiliency model of family stress, adjustment, and adaptation while incorporating family needs by surveying caregiving family members. Specific aims of the study include validating relationships of the resiliency model with individual and family outcomes in adaptation and supporting future recommendations for healthcare providers working with families with members with TBI.

This study investigates the relationship of three protective factors : self transcendance, social interest, and spirituality to well-being among adults living with HIV or AIDS. It is the first study to explore the relationships of these protective factors to well-being. A convenience sample of 115 adults living with HIV or AIDS completed the Self-Transcendance Scale, the Social Interest Index- Short Form-Revised, the Spiritual Perspective Scale, and the Index of Well-Being. The participants were adults diagnosed with HIV or AIDS residing in a large southeastern U.S. city. Data were analyzed with correlational and multiple regression methods. Statistically significant positive moderate to strong relationships were found between well-being and self transcendance (r=.66, p<.001 ), social interest (r=.51, p<.001), and spirituality (r=.39, p<.001). A stepwise regression demonstrated that self transcendance held the highest variance on well-being among the three protective factors (43%). Additionally, self-transcendane and social interest accounted for 45% of the variance in well-being. In short, the hypothesized positive relationship among these protective factors with well-being was supported. This study provides theoretical and empirical support for linking self transcendance, social interest, and spirituality to well-being among adults living with HIV or AIDS. The clinical implications of these findings are also discussed.

Breast and prostate cancers are the most commonly diagnosed forms of cancer in women and men in the United States. The federal government has played an active role in dedicating resources toward breast and prostate cancers since the early 1990s, when policy actors successfully lobbied Congress to adopt policies that increased awareness and spending. Using theories of social construction, I argue that the key to their success was the ability of these policy actors to socially construct the illnesses of breast and prostate cancers into politically attractive public issues that appealed to federal policymakers. Through the use of embedded collective case study and content analysis of newspaper coverage and congressional data, this dissertation demonstrates how the social constructions of these illnesses impacted the way that breast and prostate cancers were treated as they moved through the policy process. The way in which social construction influenced the types of policies that were adopted to deal with these illnesses is also examined. Because social construction is a multidimensional and dynamic process, several different elements of this process were examined in this dissertation: the ways that policy actors attracted attention to these illnesses, how gender influenced advocacy efforts, the symbolic aspects of these illnesses, and the way the illnesses were defined on systemic and institutional agendas. Since this dissertation examines two different policy issues, the similarities and differences in breast and prostate cancer policymaking were analyzed. I found that discussing breast and prostate cancers in relation to their social constructions provides support for the importance of symbolism and non-rational policy-making processes.

This work of creative nonfiction is meant to explore the effects of combat-related post-traumatic stress disorder in American war veterans and their families. As a work of blended literary journalism and memoir, the author interviewed afflicted veterans from World War II to the current Iraq and Afghanistan wars, included scholarly research, and reflected on how her father's dealings with the disorder have affected her family.