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2020

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Early Detection Of Asthma Via Enhanced Resolution Of Small Airways Using Ultra-Low Frequency Impulse Oscillometry, Christopher M. Aguilar Jan 2020

Early Detection Of Asthma Via Enhanced Resolution Of Small Airways Using Ultra-Low Frequency Impulse Oscillometry, Christopher M. Aguilar

Open Access Theses & Dissertations

Examination of lung function for diagnosis and monitoring of diseases such as chronic obstructive pulmonary disease (COPD) and asthma can be performed with a variety of pulmonary function testing (PFT) techniques. The most commonly prescribed of these procedures are spirometry and whole-body plethysmography. However, these active participation tests depend on forced breathing maneuvers, may be physically exhausting, might not produce enough information, and are susceptible to being subject-dependent. In contrast, passive PFT approaches such as the forced oscillation technique (FOT) and the impulse oscillometry system (IOS) are increasingly being utilized for measuring lung mechanics because they require only minimal participation, …


Structure-Property-Performance Evaluation Of Refractory Metal Incorporated Gallium Oxide Thin Films For Extreme Environment Applications, Anil Krishna Battu Jan 2020

Structure-Property-Performance Evaluation Of Refractory Metal Incorporated Gallium Oxide Thin Films For Extreme Environment Applications, Anil Krishna Battu

Open Access Theses & Dissertations

An approach is presented to design refractory-metal (RM) incorporated Ga2O3-based materials with controlled structural, mechanical, and optical properties. A model system based on molybdenum (Mo) doped Ga2O3 (GMO) has been considered to elucidate the combined effect of RM-doping and processing parameters on the properties and oxygen sensor performance of GWO nanomaterials. The molybdenum (Mo) content in Ga2O3 was varied from 0 to 11 at% in the sputter-deposited Ga-Mo-O films. Molybdenum was found to significantly affect the structure and optical properties. While low Mo content (≤4 at%) results in the formation of single-phase (β-Ga2O3), higher Mo content results in amorphization. Chemically …


Predicting Competency In Motivational Interviewing Through An Objective Empathy Task, Kylah Moneek Clark Jan 2020

Predicting Competency In Motivational Interviewing Through An Objective Empathy Task, Kylah Moneek Clark

Open Access Theses & Dissertations

In the process of disseminating motivational interviewing (MI) it is important to identify who benefits from initial workshops and which trainees would benefit from an extended training model that involves coaching and performance feedback, which has recently been advocated. Prior research attempting to determine who benefits from training has failed to show associations between baseline self-reported empathy and training outcomes. However, the use of an objective empathy task may address the shortcoming of prior research. The purpose of the present study was to predict competency in motivational interviewing skills following training using an objective empathy task. In addition, we investigated …


Brokering Social Capital: A Qualitative Case Study On How A Hispanic Serving Institution Fosters Social Capital For First-Generation, Latinx, On-Campus Student Employees, Christian Corrales Jan 2020

Brokering Social Capital: A Qualitative Case Study On How A Hispanic Serving Institution Fosters Social Capital For First-Generation, Latinx, On-Campus Student Employees, Christian Corrales

Open Access Theses & Dissertations

Around 80 percent of undergraduates enrolled in U.S. higher education institutions are employed (Carnevale et al., 2015; Kena, Musu-Gillette, Robinson, Wang, Rathbun, Zhang, & Velez, 2015). Research shows that student employment is one of the most critical activities that affect students' post-secondary experiences and decisions while enrolled (Pascarella & Terenzini, 2005; Perna 2010; Riggert et al., 2006; Tinto, 1993). The present study aimed at understanding how employing organizations and workplace environments of first-generation Latinx on-campus student employees influenced their ability to build social capital and navigate through higher education.

A social capital lens was used to help understand student participants' …


3d Printed Alginate-Based Zinc Oxide Nanoparticle Scaffolds For Wound Healing, Carol Cleetus Jan 2020

3d Printed Alginate-Based Zinc Oxide Nanoparticle Scaffolds For Wound Healing, Carol Cleetus

Open Access Theses & Dissertations

Effective treatment of chronic wounds is essential for the prevention of infection and scar tissue formation, requiring a novel approach to address the limitations of existing options. This study utilizes Calcium Chloride (CaCl2) crosslinked alginate, a common biomaterial widely used in wound dressing, and UV activated Zinc Oxide (ZnO) nanoparticles (NPs) for their potential hydroxyl radical mediated antibacterial applications. ZnO NPs were synthesized by combustion method from Zinc Nitrate Hexahydrate and Sucrose. Scanning Electron Microscopy (SEM) and X-Ray Diffraction (XRD) characterization were used to verify composition and NP size. Terephthalic Acid, used as a fluorescent probe, confirmed the generation of …


Testing A Culturally Tailored Intervention To Promote Hpv Vaccination Intentions In Latina Young Adults, Erica Landrau Jan 2020

Testing A Culturally Tailored Intervention To Promote Hpv Vaccination Intentions In Latina Young Adults, Erica Landrau

Open Access Theses & Dissertations

The human papillomavirus (HPV) is the most common sexually transmitted infection in the United States and a known risk factor for cervical cancer. Several HPV vaccines have been approved as a primary prevention option. Vaccination rates remain low among Latinas, despite a disproportionately high rate of cervical cancer rates of among this population. Few culturally tailored interventions to promote HPV vaccination have been developed for Latina young adults. The first objective of the present study was to test the efficacy of a culturally-tailored fotonovela to increase intention to vaccinate among Mexican American female young adults. The second objective was to …


Comparing The Language Of Computer-Mediated Versus Face-To-Face Motivational-Type Interviews, Karla Deyanira Llanes Jan 2020

Comparing The Language Of Computer-Mediated Versus Face-To-Face Motivational-Type Interviews, Karla Deyanira Llanes

Open Access Theses & Dissertations

The current study seeks to determine if computer-mediated and face-to-face motivational-type interviews elicit the same level of affect words and insight words in young adults who are ambivalent about their marijuana use. One-hundred and fifty young adults from a large urban university were randomly assigned to complete a brief motivational-type interview using a standard face-to-face format or instead a novel computer-mediated format. In the computer-mediated format, the interviewer and participant communicated via computer from separate rooms. A two-month follow-up survey assessed each participant's past two-month marijuana use. Pennebaker's Linguistic Inquiry and Word Count (LIWC) program was used to determine if …


Working Memory Performance In Spanish-English Bilinguals' First And Second Languages, Jordan Allyssabeth Orozco Jan 2020

Working Memory Performance In Spanish-English Bilinguals' First And Second Languages, Jordan Allyssabeth Orozco

Open Access Theses & Dissertations

Background: Working memory is important for speech understanding in that speech recognition requires the processing, temporary storage, and manipulation of information during complex cognitive tasks. Previous research has shown contradictory findings on whether bilinguals have an advantage in working memory capacity compared to their monolingual counterparts. Differences in findings have been attributed to various factors to include task-dependent effects and poorly matched samples. Therefore, the existence of a bilingual advantage in working memory remains unclear.

Purpose: The purpose of this study was to examine the working memory performance of Spanish/English bilingual individuals compared to English monolingual individuals using a linguistically …


Examining The Role Of Perceptual Biases In Health Care Utilization Among Adults, Sandra L. Oviedo Ramirez Jan 2020

Examining The Role Of Perceptual Biases In Health Care Utilization Among Adults, Sandra L. Oviedo Ramirez

Open Access Theses & Dissertations

A large body of literature has identified significant racial and ethnic disparities in health care and health outcomes. In an effort to gain an understanding of how to achieve health equity, it is crucial that we broaden our search for factors beyond access factors that may explain these observed disparities. The present study examined how cultural differences related to attention (context vs. focal) and attribution (internal vs. external) influence individuals' propensity to identify symptoms as potential markers of poor health, and ultimately, report less utilization of professional health care services. Using a community sample of 252 (n = 134 Latinos …


Velocity Measurements Using A Piezoelectric Plate As A Sensor, Paul Perez Jan 2020

Velocity Measurements Using A Piezoelectric Plate As A Sensor, Paul Perez

Open Access Theses & Dissertations

In this study, the voltage output from a piezoelectric sensor placed in a test section is used to predict flow velocity changes. The piezoelectric made of PZT is thought to be advantageous due to its fast response time, potential durability at higher temperatures, and self-powered characteristics. Having said that this sensor could be implemented into the Hybrid Performance Project built by NETL to characterize and mitigate the probability of compressor surge and stall. The problem arises because of the added large volume between compressor and gas turbine and resultant changes to system fluid dynamics. The effect of the piezoelectric sensor …


"Celebrated, Not Tolerated": How Transgender And Nonbinary Individuals Navigate The Social World, Hannah Penklis Jan 2020

"Celebrated, Not Tolerated": How Transgender And Nonbinary Individuals Navigate The Social World, Hannah Penklis

Open Access Theses & Dissertations

Seventeen individuals (4 trans men, 2 trans women, and 11 nonbinary people) were interviewed in this exploratory study on how transgender and nonbinary people feel about their bodies, and the role that social support plays in their experiences and feelings about their bodies. Semi-structured interviews revealed themes, including how transgender and nonbinary people interact with social support, their motivations for gender affirming medical interventions, and non-medical ways in which they alter their physical appearance. Participants reported a variety of experiences within their body across the spectrum of human experience: in some cases, individuals changed their weights dramatically; others felt strong …


Novel Tools For Community Based Assessment And Monitoring Of Forest Phenology Response To Environmental Variability And Change In The Tropics, Jennifer Christine Ramos-Chavez Jan 2020

Novel Tools For Community Based Assessment And Monitoring Of Forest Phenology Response To Environmental Variability And Change In The Tropics, Jennifer Christine Ramos-Chavez

Open Access Theses & Dissertations

Tropical ecosystems provide a variety of services and resources for global well-being. However, landscapes within this biome are undergoing rapid changes mostly due to anthropogenic activities. These systems are further impacted by current, extreme fluctuations in climate, including climate change and El Niño Southern Oscillation (ENSO). With predicted future increase in strength and occurrence of these climate oscillations, these landscapes and their plant communities will be impacted and changed. There is a gap in research and knowledge among tropical Indonesian landscapes in regards to the effects of global climate change at the community level. Therefore, there is an urgent need …


Mother Nature, Lady Justice: Ecofeminism And Judicial Decision-Making, Jonathan Alexis Picado Jan 2020

Mother Nature, Lady Justice: Ecofeminism And Judicial Decision-Making, Jonathan Alexis Picado

Open Access Theses & Dissertations

Ecofeminism offers a feminist perspective that links gender to how humans relate to the natural world. As such, this framework explores the connections between the oppression of nature and the oppression of women, such as widespread views that both women and nature are property, are to be dominated, and are most valuable when cultivated and curated by men. I apply this philosophical and sociological framework to judicial decision-making, where women judges should view environmental issues as women's issues and thus be more likely to vote in favor of the environmental protections relative to her male peers. I evaluate this theory …


Further Validation Of The Treatment Self-Regulation Questionnaire For Assessing Motivations For Responsible Drinking: A Test Of Self-Determination Theory, Dylan Richards Jan 2020

Further Validation Of The Treatment Self-Regulation Questionnaire For Assessing Motivations For Responsible Drinking: A Test Of Self-Determination Theory, Dylan Richards

Open Access Theses & Dissertations

Alcohol protective behavioral strategies (PBS) are cognitive-behavioral strategies used before, during, and/or after drinking to reduce alcohol use and alcohol-related problems. Self-determination theory (SDT) provides a potentially useful framework to understand motivations for responsible drinking, which is operationalized in the present study as PBS use. In the present study, the relation of motivations for responsible drinking, as assessed by the Treatment Self-Regulation Questionnaire (TSRQ), with other SDT constructs (psychological need satisfaction and dispositional autonomy) and PBS use, alcohol use, and alcohol-related problems were examined among college students drinkers. A sample of 507 college students who reported consuming alcohol at least …


Essays On The Spillover Effects Of Whistleblowing On Peer Firms, Emmanuel Joseph Sequeira Jan 2020

Essays On The Spillover Effects Of Whistleblowing On Peer Firms, Emmanuel Joseph Sequeira

Open Access Theses & Dissertations

This Dissertation examines the spillover effects of media reported corporate whistleblowing on industry peer firms in two essays. The first essay examines peer firm risk-taking and firm efficiency following a whistleblowing allegation. I find that peers significantly reduce their risk-taking following the allegation. They also increase their efficiency following the allegation and increase their market share at the expense of the whistleblowing firms, leading to increased profitability. My second essay examines peer firms' earnings management choices following a whistleblowing allegation. I find that peer firms significantly reduce their manipulation of real activities and reduce their use of accruals-based earnings management …


Investigation Of Iron Doped Gallium Oxide (Ga-Fe-O) System: Structure Property Relationship And Performance Evaluation For Optical And Catalytic Applications, Swadipta Roy Jan 2020

Investigation Of Iron Doped Gallium Oxide (Ga-Fe-O) System: Structure Property Relationship And Performance Evaluation For Optical And Catalytic Applications, Swadipta Roy

Open Access Theses & Dissertations

From September 2012 to May 2015, a phenocam monitored the seaward edge of a protected mangrove forest. Calculated GCC revealed seasonal greening patterns of a mangrove species, Rhizophoa apiculata, and an overall increase in the GCC, suggesting mangrove expansion. In comparing temperature and precipitation effects, it was found that this particular mangrove species had a greening optima at temperatures between 28°C and 28.5°C, and greening and canopy development response lag time of 10 weeks in response to precipitation. Tree saplings were monitored and showed to grow by 50%, mostly during a three month period during the rainy season. The establishment …


The Effects Of A 6-Week Controlled Whole-Body Vibration Training Program In Reducing Falls Risk Among Healthy Older Adults, Fabricio Saucedo Jr. Jan 2020

The Effects Of A 6-Week Controlled Whole-Body Vibration Training Program In Reducing Falls Risk Among Healthy Older Adults, Fabricio Saucedo Jr.

Open Access Theses & Dissertations

Falling is the second leading cause of accidental or injury-related death in the aging population worldwide and a leading cause of serious injury. Whole-body vibration (WBV) training has been implemented as a way to improve functional performance among the elderly and reduce the falls risk. The purposes of this study were: 1) examine to what extent a six-week course of WBV training reduced falls risk and improved fall outcomes in response to slips, and 2) examine whether the benefits of WBV training could be retained at least 2 months after the completion of the entire training session. A total of …


Partitioning Variation In Vegetation And Landscape Functionality In Arid Land Piosphere, Eahsan Shahriary Jan 2020

Partitioning Variation In Vegetation And Landscape Functionality In Arid Land Piosphere, Eahsan Shahriary

Open Access Theses & Dissertations

A piosphere is an interaction between vegetation community, watering point, and grazing livestock/wildlife. In this Dissertation, I begin by reviewing the concept of the piosphere, and the progress, knowledge gaps and common statistical approaches and errors in piosphere research. Landscape functionality, plant community distribution and their influencing factors on a piosphere in Iran are then investigated.

A total 862 piosphere publications of multiple types from 68 countries and 10 different languages during the period of 1915 â?? 2018 were reviewed. Australia was the most productive country followed by South Africa, the USA, Botswana and Argentina. Ivan Thrash is the most …


Effects Of Manual Resistance Training On Body Composition In Young Adults, Lizette America Terrazas Jan 2020

Effects Of Manual Resistance Training On Body Composition In Young Adults, Lizette America Terrazas

Open Access Theses & Dissertations

Resistance training (RT) is a form of exercise that is important for strength development. Manual Resistance Training (MRT) is an alternative mode of RT that utilize an external resistance provided by a partner. MRT requires minimal equipment and is a convenient form of training for individuals who do not have access to traditional weight training equipment The purpose of this study was to investigate the effects of 8 weeks of MRT intervention on Fat Mass (FM), Lean Mass (LM) and Bone Mineral Density (BMD) and to compare the changes to the Weight Resistance Training (WRT) group. Thirty young adult (Females:18, …


Spectroscopic Techniques To Characterize And Develop Sensing Methods For Titanium Dioxide Nanoparticles In Water, Reagan Scott Turley Jan 2020

Spectroscopic Techniques To Characterize And Develop Sensing Methods For Titanium Dioxide Nanoparticles In Water, Reagan Scott Turley

Open Access Theses & Dissertations

Titanium dioxide nanoparticles are being used in ever increasing amounts and applications in many consumer products and industrial processes including water treatment. These nanoparticles have not been shown to be toxic to humans via ingestion, but it is worthwhile to develop a portable and rapid detection method to quantify the concentration of nanoparticles in treated drinking water. Current detection methods include single particle inductively coupled plasma mass spectrometry, inductively coupled plasma optical emission spectrometry, tunneling electron microscopy and scanning electron microscopy. While extremely sensitive, these techniques are expensive and sometimes require extensive sample preparation before analysis. A preliminary study on …


Substance Use Among 7th - 9th Grade Adolescents: The Role Of Risk- Related Variables In The Probability Of Use Involving Tobacco, Alcohol And Marijuana, Susana A. Villalobos Jan 2020

Substance Use Among 7th - 9th Grade Adolescents: The Role Of Risk- Related Variables In The Probability Of Use Involving Tobacco, Alcohol And Marijuana, Susana A. Villalobos

Open Access Theses & Dissertations

The role of schools in preventing substance use among adolescents is a priority for public health advocates across the United States. In recent years the United States has seen an increase in prescription medication overdoses in adults and adolescents. A lack of research exists of adolescents in middle school substance use (Welsh, & Rappaport, 2018). Trends of adolescent substance use of tobacco, alcohol and marijuana continue to rise. Early onset use of legal and illegal substances has proven to increase the odds of long-term use of adolescence into adulthood. Parents, educators, community advocates and law enforcement have long tackled the …


The Influence Of Internalized Self-Prejudice On Anti-Gay Hate Crime Motivation, Ross Michael Templeton Jan 2020

The Influence Of Internalized Self-Prejudice On Anti-Gay Hate Crime Motivation, Ross Michael Templeton

Walden Dissertations and Doctoral Studies

The lesbian, gay, bisexual, transgendered, and queer (LGBTQ) community continues to be negatively impacted by high rates of anti-gay hate crime. Gay-rights activists continue to press for public policy changes to improve equality and reduce anti-gay sentiment. However, these efforts have not succeeded in reducing the number of attacks. Little is understood about what motivates perpetrators to commit violent acts against members of the LGBTQ community. This study explored how social coalitions and individual sexual identity development impact the motivation behind anti-gay hate crime from the perspective of convicted anti-gay hate crime offenders. The theoretical frameworks proposed for this study …


Cultural Identity As A Predictor Of Weight Loss In U.S. Hispanics, Leon Daniels Jan 2020

Cultural Identity As A Predictor Of Weight Loss In U.S. Hispanics, Leon Daniels

Walden Dissertations and Doctoral Studies

Research on behavioral weight-loss programs has guided the development of health-related, behavior-change interventions that contribute to combating overweight and obesity in the United States, and illnesses that co-occur with unhealthy weight. However, research on behavioral weight-loss programs that focus on the U.S. Hispanic population and cultural identity is largely unrepresented in the current literature. The purpose of this study was to quantitatively examine body mass index (BMI) decreases of U.S. Hispanics while observing their (a) motivation toward exercise, (b) cultural identity, (c) physical activity program type, (d) exercise frequency, and (e) demographic variables as predictors of weight-loss. Guiding this study …


High Lymph Node Positive To Sampled Ratio As A Potential Indication For Postoperative Radiation Therapy In Patients With Pn2 Non-Small-Cell Lung Cancer, Nikhil P Mankuzhy, Muayad F Almahariq, Craig W Stevens, Thomas J Quinn Jan 2020

High Lymph Node Positive To Sampled Ratio As A Potential Indication For Postoperative Radiation Therapy In Patients With Pn2 Non-Small-Cell Lung Cancer, Nikhil P Mankuzhy, Muayad F Almahariq, Craig W Stevens, Thomas J Quinn

Articles

Background: The role for postoperative radiation therapy (PORT) for patients with non–small-cell lung cancer (NSCLC) with mediastinal lymph node (LN) involvement (pN2 disease) is controversial. We performed a SEER analysis comparing surgery alone with PORT among patients with pN2 NSCLC. As we await the final results of the LUNG ART trial, a subset of patients with a high LN positive to sampled (LPR) ratio may benefit from PORT. Patients/methods: Patients with pN2 NSCLC, ranging from 1989-2016, were assessed from the Surveillance, Epidemiology and End Results (SEER) database. A propensity score (PS)-matched, inverse probability of treatment weighting (IPTW) analysis was conducted …


Exploring How Clinical Social Workers Screen Women For Adhd, Beth A. Walters Jan 2020

Exploring How Clinical Social Workers Screen Women For Adhd, Beth A. Walters

Walden Dissertations and Doctoral Studies

Women with attention-deficit/hyperactivity disorder (ADHD) are often overlooked in clinical mental health settings. If social workers do not screen their female clients for ADHD, then the theory of distributive justice inherent in the National Association of Social Worker’s code of ethics would suggest the women they see in clinical mental health settings are not receiving the services they need and deserve. Yet, little is known concerning how clinical social workers screen adult female clients for ADHD. The purpose of this qualitative study was to explore how licensed independent clinical social workers in Massachusetts screen for ADHD in the women they …


Juvenile Arrest And Recidivism Rate In Fulton County, Georgia, Norell Combs Jan 2020

Juvenile Arrest And Recidivism Rate In Fulton County, Georgia, Norell Combs

Walden Dissertations and Doctoral Studies

The purpose of a Juvenile Justice Department in the United States justice system is to prevent juvenile offenses and to promote the smooth transition of young offenders when they are leaving rehabilitation centers and reentering society. That purpose essentially dedicates itself to fight against rehabilitation of youth. The Department of Juvenile Justice in Fulton County, Georgia (DJJFC), has created rehabilitation programs to facilitate this transition process for young offenders. Fulton County including its citizens, school system, parents, and juveniles would benefit from this issue being resolved. The purpose of this research was to explore the juvenile arrest and recidivism rates …


A Health Care Management Organization's Internal Controls Strategy For Managed Care, Elizabeth E. David Jan 2020

A Health Care Management Organization's Internal Controls Strategy For Managed Care, Elizabeth E. David

Walden Dissertations and Doctoral Studies

A lack of effective operational internal controls among health management organization (HMO) leaders could lead to poor operational practices, mismanagement of the government's health care funds, increased health care spending, and a negative impact on patient health outcomes. Grounded in transformational leadership theory, the purpose of this qualitative, single case study was to explore successful internal control strategies used by leaders at a southeastern Pennsylvania HMO. Data were collected from semistructured interviews with 5 participants who held positions of director or above within the organization for at least 3 years, had institutional knowledge, and had responsibility for overseeing the organization's …


Improving Rabies Aftercare By Educating Emergency Department Providers Of Care, Gloria Denise Evans Jan 2020

Improving Rabies Aftercare By Educating Emergency Department Providers Of Care, Gloria Denise Evans

Walden Dissertations and Doctoral Studies

According to an evaluation completed by the local health department in the state where the project was conducted, patients were not returning to the emergency department (ED) for post-exposure prophylaxis (PEP) rabies vaccine as recommended. Educating the ED providers on care, who are usually the first point of contact after an animal bite with possible rabies virus transmission, is critical to improving patients' outcomes secondary to rabies postexposure. The focused for this project is educating ED personnel about rabies PEP administration after rabies virus exposure which will their increase knowledge regarding rabies follow-up care. Lewin's change theory provided the theoretical …


Faulty Development In Simulation For Professional Nurse Educators, Jill Johnson Jan 2020

Faulty Development In Simulation For Professional Nurse Educators, Jill Johnson

Walden Dissertations and Doctoral Studies

There is a shortage of nursing faculty adequately prepared in the use of simulation technology. The purpose of this qualitative case study was to examine nursing faculty's experiences and perceptions regarding faculty development related to simulation technology. Benner's model of skill acquisition and Kolb's theory of experiential learning were the conceptual frameworks used to support the study. Research questions addressed the experiences and perceptions of faculty development and the improvement of nursing skills in simulation-based activities. Data were collected through semistructured interviews with 7 educators who had taught using simulation technology. Data analysis included organizing the data and reading it …


Strategies For Implementing The International Organization For Standardization 15189 For Medical Laboratories, Wilson Mtotela Jan 2020

Strategies For Implementing The International Organization For Standardization 15189 For Medical Laboratories, Wilson Mtotela

Walden Dissertations and Doctoral Studies

Inadequate quality management systems (QMS) in medical laboratories result in errors, which cost the United States healthcare industry approximately $29 billion per year. Healthcare managers who fail to implement the International Organization for Standardization (ISO) 15189 QMS are at high risk of managing costs. Grounded in Lewin’s 3-step organizational change model and the force field analysis, the purpose of this qualitative multiple case study was to explore strategies healthcare managers use to design, develop, and implement an ISO 15189 QMS using a mentorship approach. The participants comprised 5 healthcare managers from the United Republic of Tanzania, East Africa, who implemented …