Communication is a key factor in the strategic self-presentation of political leaders and candidates for office. It is especially important for women in US politics who remain numerically underrepresented at all levels of government, particularly in leadership positions. Drawing from theories on self-presentation, social identity, and implicit communication, this dissertation explores the relationship between gender, language, and political leadership. How do female politicians present themselves as viable leaders in a male-dominated political arena? Existing research suggests that women adopt masculine behaviors to succeed in politics. I asked: Do they talk like men?

Informed by empirical work in social psychology and linguistics, I conceptualized feminine and masculine styles of communication in an original way. Using quantitative text analysis, survey, and experimental approaches, I investigated the gendered communication styles of US political leaders and the impact that such styles have for candidate evaluations.

Analyzing 567 of Hillary Clinton's interview and debate transcripts between 1992--2013, I found that as Clinton's political power grew, she spoke in an increasingly masculine way. To follow up on this case, I analyzed 2,484 interview and debate transcripts from 126 political leaders and found that, like Clinton, female leaders broadly conformed to masculine styles of communication. Despite this, partisan stereotypes encouraged a different, and sometimes conflicting, self-presentation, which suggests that the self-presentational strategies for attaining and maintaining power are not the same for Republican and Democratic women. In contrast, male leaders did not significantly alter their self-presentation when transitioning into different leadership roles. Among male leaders, Democrats and Republicans tended to conform to party stereotypes. In addition, survey results showed that individuals reliably associated masculine communication styles with men and the Republican party and feminine statements with women and the Democratic party. Experimental results showed that regardless of a candidate's gender, evaluations of warmth---but not competence---were significantly affected by the candidate's gendered style of communication.

Ultimately, these findings demonstrate how seemingly unremarkable linguistic structures---pronouns, articles, prepositions, emotional expressions and more---conform to, reflect, and cue two key factors underlying political behavior: partisanship and gender.

In this dissertation, I investigate how race is produced by looking at the reception experiences of Afro and Mestizo Mexican migrants to the New South. Despite the fact that Afro and Mestizo Mexicans are both phenotypically and culturally distinct from one another, they now assert a shared racial identity as minorities and as Latinos. Based on ethnographic field work in Winston-Salem, North Carolina, I argue that pervasive discrimination due to status drives Mexicans to assert a minority identity that is shaped by their understanding of African-American experiences, and that Mexicans as a whole in this context find themselves increasingly distanced from whites.

The literature on intergroup relations argues that racial and ethnic relations, particularly between minority groups, are rife with conflict and competition. Moreover, the immigration literature suggests that relations with African-Americans are particularly poor in part because upward mobility is achieved by avoiding associations with Blacks, and aspiring toward whiteness. However, in the case of contemporary Mexican migrants in Winston-Salem, I find the opposite processes emerging. Rather than a sense of closeness with whites, Mexicans express a sense of closeness with Blacks, increasingly viewing themselves as minorities and as similar to Blacks. I describe these positive interminority relations as emerging in three ways- through contact and social closeness; solidarity and a sense of shared discrimination; and an emerging sense of linked fate. Using a 12-month ethnographic case study of Winston-Salem, I seek to explain this counterintuitive outcome. My study shows that these positive relations are facilitated by their sense of shared status with African-Americans, an absence of resource competition, sustained positive contact with Blacks, and identifying a common enemy in whites. The implications of these findings for other U.S. communities are considered.

Over half of the world's population, approximately 3 billion people, rely on biomass fuels (wood, charcoal, dung, and agricultural residues) and liquid fuels such as kerosene in cook stoves to meet basic needs for cooking and heating. Most cook stoves in use operate indoors without sufficient ventilation, have low efficiencies, and produce products of incomplete combustion. Indoor air pollution of toxic gases and soot aerosols from household energy use in developing countries cause health problems for families, disproportionately affects women and children, and in aggregate, has significant effects on public health. Additionally, aggregate emissions of black carbon and greenhouse gases from the combustion of household fuels in cook stoves adversely affect the environment and pose a serious threat to global climate change.

This work looks at two components of household energy use in developing countries: 1) cook stove technology, and 2) assessing indoor concentrations of pollutants to determine personal exposure for public health. In this dissertation, the formulation of two computational fluid dynamics (CFD) models of the heat transfer, buoyant turbulent fluid flow, and combustion within a cook stove is described. Then, a model for indoor concentrations of pollutants in a room is described, and the model is applied to questions relevant to indoor air pollution and public health.

Introduction:The purpose of this study was to determine if differences could be detected in the presentation patterns and admission rates among frequent emergency department users (FEDU) of an urban emergency department over a 10-year period.

Methods: This was an IRB approved, retrospective review of all patients who presented to the ED 5 or more times for 3 distinct time periods: “year 0” 11/98-10/99, “year 5” 11/03–10/04, and “year 10” 11/08–10/9. FEDU were grouped into those with 5–9, 10–14, 15–19, and ≥ 20 visits per year. Variables analyzed included number of visits, disposition, and insurance status. We performed comparisons using Kolmogorov-Smirnov and chi-square tests. A P < 0.05 was considered significant.

Results: We found a a 66% increase in FEDU patients over the decade studied, with a significant increase in both the number of FEDU in each visit frequency category over the 3 time periods (P < 0.0001), as well as the total number of visits by each group of FEDU (P < 0.0001). The proportion of FEDU visits for the 5–9 group resulting in admission increased from 25.9% to 29% from year 0 to year 10 (P < 0.001), but not for the other visit groups. In comparing admission rates between FEDU groups, the admission rate for the 5–9 group was significantly higher than the ≥ 20 group for the year 5 time period (P < 0.001) and the year 10 time period (P < 0.001) and showed a similar trend, but not significant, at year 0 (P = 0.052). The overall hospital admission rate for emergency patients over the same time span remained stable at 22-24%. The overall proportion of uninsured FEDU was stable over the decade studied, while the uninsured rate for the overall ED population for the same time periods increased.

Conclusion: The results demonstrate the FEDU population is not a homogeneous group of patients. Increased attention to differences among FEDU groups is necessary in order to plan more effective interventions. [West J Emerg Med. 2013;14(3):243–246.]

Objective: To determine if the effective use of Health Information Technologies (HIT) and the Electronic Medical Record (EMR) affects emergency department (ED) usage in a complicated frequently presenting patient population.

Methods: A retrospective, observational study of 45 patients enrolled in our Frequent User Program called Community Resources for Emergency Department Overuse (CREDO) between June 2005 and July 2007. The study was conducted at an urban hospital with greater than 95,000 annual visits. Patients served as their own historical controls. In this pre-post study, the pre-intervention control period was determined by the number of months the patient had been enrolled in the program. The pre- and post-intervention time periods were the same for each patient but varied between patients. The intervention included using HIT to identify the most frequently presenting patients and creating individualized care plans for those patients. The care plans were made available through the EMR to all healthcare providers. Study variables in this study intervention included ED charges, lab studies ordered, number of ED visits, length of stay (LOS), and Total Emergency Department Contact Time (TEDCT), which is the product of the number of visits and the LOS. We analyzed these variables using paired T-tests. This study was approved by the institutional review board.

Results: Forty-five patients were enrolled, but nine were excluded for no post enrollment visits; thus, statistical analysis was conducted with n=36. The ED charges decreased by 24% from $64,721 to $49,208 (p=0.049). The number of lab studies ordered decreased by 28% from 1847 to 1328 (p=0.04). The average number of ED visits/patient decreased by 25% from 67.4 to 50.5 (p=0.046). The TEDCT decreased by 39% from 443.7 hours to 270.6 hours (p=0.003).

Conclusion: In this pre-post analysis of an intervention targeting ED frequent users, the use of HIT and the EMR to identify patients and store easily accessible care plans significantly reduced ED charges, labs ordered, number of ED visits, and the TEDCT. [West J Emerg Med 2010; 11(4):348-353.]

Introduction: Emergency departments (ED) manage a wide variety of critical medical presentations. Traumatic, neurologic, and cardiac crises are among the most prevalent types of emergencies treated in an ED setting. The high volume of presentations has led to collaborative partnerships in research and process development between experts in emergency medicine (EM) and other disciplines. While psychosis is a medical emergency frequently treated in the ED, there remains a paucity of evidence-based literature highlighting best practices for management of psychotic presentations in the ED. In the absence of collaborative research, development of best practice guidelines cannot begin. A working group convened to develop a set of high-priority research questions to address the knowledge gaps in the care of psychotic patients in the ED. This article is the product of a subgroup considering “Special Populations: Psychotic Spectrum Disorders,” from the 2016 Coalition on Psychiatric Emergencies first Research Consensus Conference on Acute Mental Illness.

Methods: Participants were identified with expertise in psychosis from EM, emergency psychiatry, emergency psychology, clinical research, governmental agencies, and patient advocacy groups. Background literature reviews were performed prior to the in-person meeting. A nominal group technique was employed to develop group consensus on the highest priority research gaps. Following the nominal group technique, input was solicited from all participants during the meeting, questions were iteratively focused and revised, voted on, and then ranked by importance.

Results: The group developed 28 separate questions. After clarification and voting, the group identified six high-priority research areas. These questions signify the perceived gaps in psychosis research in emergency settings. Questions were further grouped into two topic areas: screening and identification; and intervention and management strategies.

Conclusion: While psychosis has become a more common presentation in the ED, standardized screening, intervention, and outcome measurement for psychosis has not moved beyond attention to agitation management. As improved outpatient-intervention protocols are developed for treatment of psychosis, it is imperative that parallel protocols are developed for delivery in the ED setting.

ABSTRACT

Introduction: In the United States, the number of patients presenting to the emergency department for a mental health concern is significant and expected to grow. The breadth of the medical evaluation of these patients is controversial. Attempts have been made to establish a standard evaluation for these patients, but to date no nationally accepted standards exist.

Objective: A task force of the American Association of Emergency Psychiatry, consisting of physicians from Emergency Medicine, physicians from Psychiatry, and a psychologist was convened to form consensus recommendations on the medical evaluation of psychiatric patients presenting to emergency departments.

Method: The task force reviewed existing literature on the topic of medical evaluation of psychiatric patients in the emergency department (Part I) and then combined this with expert consensus (Part II).

Results: In part I, terminological issues and existing evidence on medical exams and laboratory studies of psychiatric patients in the emergency department are discussed.

Conclusions: Emergency physicians should work cooperatively with psychiatric receiving facilities in order to decrease unnecessary testing while increasing the quality of medical screening exams for psychiatric patients who present to emergency departments.