Liver resection, or hepatectomy, is a major abdominal surgery performed most often for the removal of malignant tumors of the liver, either primary or metastatic. It is often associated with significant blood loss and therefore, with blood transfusions. While transfusions are common, there is incomplete knowledge of their effects on clinical outcomes. Furthermore, both current practices and best practices in perioperative blood management, including blood product administration, are not well defined. This manuscript-based thesis will examine the clinical impact, current practices, and appropriate use of perioperative red blood cell transfusions for patients undergoing liver resection.

Internal communication is pivotal for the effectiveness of company procedures and ultimately the success of the company. Understanding more about the communicative needs of different employee groups is therefore important in order to convey a message in a satisfying manner to those employees. This explorative study is investigating communication preferences from a stakeholder perspective to find out what influences the appropriateness of using different communication channels when transmitting information to different stakeholder groups. Interviews with employees at different levels and functions at PostNord were conducted and analysed. We conclude that the top level stakeholder prefers face-to-face communication due to complex topics being discussed with a high need for feedback. The stakeholder at the middle organisational level preferred e-mail due to being constantly interrupted and therefore need to access information at later times. The bottom level consisted of two stakeholder groups that had high degree, respectively low degree of customer interaction. They both preferred face-to-face, for reasons that had grounds in strict working schedules and work tasks - they were not given time to take in information properly in any other way than scheduled meetings, and the stakeholder with low customer interaction mostly worked alone which made this stakeholder value meetings with other colleagues.

Cryoprecipitate is commonly used outside guidelines. In trauma, the appropriate cryoprecipitate dose and its impact on plasma fibrinogen levels are unclear. This retrospective study aims to evaluate: (1) the appropriateness of cryoprecipitate transfusion in trauma; and (2) the plasma fibrinogen response to cryoprecipitate transfusion during massive transfusion in trauma. Fibrinogen levels of < 1.0 g/L within 2 and 6 hours of cryoprecipitate transfusion were used for assessing appropriateness. Out of 394 events, 238 (60%) and 259 (66%) were considered appropriate using 2 and 6 hour criteria, respectively. A dose of 8.7 (±1.7) units caused a mean increase in fibrinogen levels of 0.55 (±0.24) g/L, or 0.06g/L per unit. In our hospital, where transfusion guidelines and policies for rapid blood product and laboratory turnaround times exist, it is possible to achieve high rates of appropriateness for cryoprecipitate transfusion in trauma. The current recommended dose causes a modest increase in fibrinogen levels.

Cryoprecipitate is commonly used outside guidelines. In trauma, the appropriate cryoprecipitate dose and its impact on plasma fibrinogen levels are unclear. This retrospective study aims to evaluate: (1) the appropriateness of cryoprecipitate transfusion in trauma; and (2) the plasma fibrinogen response to cryoprecipitate transfusion during massive transfusion in trauma. Fibrinogen levels of < 1.0 g/L within 2 and 6 hours of cryoprecipitate transfusion were used for assessing appropriateness. Out of 394 events, 238 (60%) and 259 (66%) were considered appropriate using 2 and 6 hour criteria, respectively. A dose of 8.7 (±1.7) units caused a mean increase in fibrinogen levels of 0.55 (±0.24) g/L, or 0.06g/L per unit. In our hospital, where transfusion guidelines and policies for rapid blood product and laboratory turnaround times exist, it is possible to achieve high rates of appropriateness for cryoprecipitate transfusion in trauma. The current recommended dose causes a modest increase in fibrinogen levels.

Acute respiratory tract infection (ARI) is the most common reason for outpatient medical visits in the United States, and frequently results in treatment with an antibiotic. Most ARIs have a viral etiology, thus antibiotic therapy will have little clinical benefit in these cases. It is estimated as much as one-half of all antibiotic utilization for ARI in outpatient settings is inappropriate. Importantly, this misuse is thought to be the primary driver of antibiotic resistance development among bacteria. Antibiotic resistant infections cause an estimated 2 million illnesses and 23,000 deaths annually in the United States, and associated costs exceed $30 billion. Despite our current understanding of relevant predictors of appropriate antibiotic use, less is known regarding seasonality. This dissertation explores effects of seasonality on antibiotic prescribing in three aspects: 1) seasonal variation in appropriateness of prescribing, and antibiotics prescribed among common ARIs; 2) specific predictors of observed seasonal variation in prescribing practices; and 3) implications of seasonality for guideline concordance & quality of care. Findings generated herein, could help inform interventions designed to promote more judicious use of antibiotics in healthcare.

Research has shown that many patients find it difficult to understand and retain information that is conveyed verbally by medical professionals. One solution to this problem is to give patients this information in a written form so that it can be reviewed when needed to maximize retention and understanding. When implementing this solution, care should be taken that the patient education materials (PEMs) are written in a way that is easily understood by the patient. PEMs should also be of good quality, meaning that they are comprehensive, without bias, evidence based, relevant, and balanced. Well written PEMs are especially important within the field of audiology as many patients find it particularly difficult to understand audiological and vestibular information. PEMs related to many different diagnoses and treatment within the field of audiology have been evaluated to ensure that they are appropriate for patients, but this evaluation has not yet been done for PEMs pertaining to benign paroxysmal positional vertigo (BPPV). BPPV is a common cause of dizziness where episodes are triggered by head movements such as tipping the head back. For this study, 11 PEMs pertaining to BPPV were gathered from professional organizations online and 3 were gathered from audiology clinics local to East Tennessee. Reading grade level was determined using the Fry Method and the Simple Measure of Gobbledygook (SMOG). Quality was determined using the DISCERN. The results of this study indicate that the current PEMs related to BPPV are not written at an appropriate reading level for patients as determined by the Agency for Healthcare Research and Quality (AHRQ). The conclusion of this study is that while some of the PEMs analyzed were found to be of good quality, many can and should be improved. Organizations such as the CDC and AHRQ have created materials to guide medical professionals through the process of improving their PEMs.

Cultural competence, mandated by Federal law since 1964, has not been appropriately addressed due to its lack of specifics and the lack of specifics within subsequent mandates. This study was designed to determine specific key elements of cultural and linguistic appropriateness which would "operationalize" cultural competence in the provision of healthcare services. Knowing the elements of cultural and linguistic appropriateness will assist non-Hispanic healthcare providers to remove personal barriers of cultural and linguistic differences for Texas' Hispanic population. The problem of cultural competence gained national focus during the Civil Rights movement of the '60s. Current research revealed that Hispanics continue to have the worst healthcare outcomes of any minority population. Census data reflecting that Hispanics are the fastest growing segment of the population, with Texas having the nation's second largest Hispanic population, make it imperative for healthcare providers to determine methods to improve healthcare for Texas' Hispanic population. A Delphi Technique was used to extract expert opinions from 26 highly qualified, Texas Hispanic healthcare providers regarding the key elements of cultural and linguistic appropriateness for Texas' Hispanic population. The ultimate goal of the research was to determine essential information which would assist non-Hispanic healthcare providers in removing personal barriers of cultural and linguistic appropriateness to the delivery of healthcare services for Texas' Hispanics. Through the approximately 16-month process of the Delphi Technique, the Panel produced 249 distinct elements in 11 groups of cultural appropriateness and 8 groups of linguistic appropriateness. Members of the Panel ranked the groups for importance, indicated the level of agreement/disagreement with each element, and rated each element for its individual importance. This study is important because it is the first time an expert panel of solely Hispanic healthcare providers has spoken collectively about what constitutes cultural and linguistic appropriateness. This research can provide a framework for professional practices, grant providing organizations, or evaluation teams to assess professionals and programs to determine their degree of cultural and linguistic appropriateness. The work can also form the basis for curricula to be used in Texas' healthcare professions preparatory schools or continuing education for practicing healthcare professionals.

This study assesses the scope of the Crosslinguistic Influence (CLI) hypothesis’ predictions with regard to early bilingual acquisition. To this end, we analyze longitudinal corpus data from four bilinguals attesting the acquisition of subjecthood (null versus overt; preverbal versus postverbal) and the pragmatic adequacy of early null and overt subjects in a null-subject language (i.e., Spanish) in combination with a language differing in its pro-drop parameter setting (i.e., English). Our results indicate that CLI barely affects the development of subjects in the null-subject language at the initial stages, namely at the outset of null and overt subjects, and in turn support the Separate Development Hypothesis. Our bilingual cohort patterns with their Spanish-acquiring monolingual peer in that both groups display comparable proportions of null subjects as well as acquisitional trajectories of null and overt subjects at the early stages of acquisition. Much like monolinguals, bilinguals begin to produce preverbal and postverbal subjects concurrently. The bilingual children and the monolingual child of this study actually produce extremely high rates of pragmatically appropriate covert and overt subjects, which are for the most part target-like from the start, thus pointing to the absence of CLI effects. In light of monolingual and bilingual data, the paper also revisits the hotly debated issue of the ‘no overt subject’ stage of Grinstead (1998, et seq.), its existence in child Spanish being questionable.

This thesis seeks to address energy efficient design in a temperate climate in typical small, medium density housing, particularly in housing for the aged. The connections between energy efficient design and small, medium density housing were identified as contemporary issues related to Australian Government policies in two disparate areas. One policy area is reflected in the Government's commitment to assist older people, whether they are active, early retirees or the frail elderly, wealthy or poor, to live in their chosen place of residence. Increasingly this chosen place of residence may be a small, medium density dwelling. The other policy area is that related to reducing energy consumption in buildings. This policy is reflected in recently proclaimed building regulations aimed at reducing space heating/cooling requirements in housing. The building regulations include details of acceptable construction practice for energy efficiency that may not be appropriate in small, medium density housing. It was proposed in this thesis that extensive use of space heating and cooling in housing for the aged was required because well-established benchmarks for energy efficient design in a temperate climate were not generally appropriate in small, medium density dwellings and were particularly inappropriate in housing for the aged. `Appropriate' in this context referred to: indoor temperatures being acceptable without the need for space heating and cooling; retaining the site planning and general form of typical, medium density aged persons housing developments in suburban Australia; cost effectiveness over the life of a building; and fitting the needs of physically and financially vulnerable older people. / The methods used to examine the notion of appropriateness commenced with a literature review that related to the general physical and economic status of older people and their needs and responses to space heating and cooling in the home. Further, the literature review considered the principles of energy efficient design and benchmark criteria for energy efficiency. Arising from the literature review, two tools of study were used in order to develop a set of data encapsulating the salient features of small, medium density housing. The first was a multiple case study of typical housing for the aged. This was conceived as a way of determining if small, medium density dwellings could provide appropriate indoor thermal conditions and/or were designed to be energy efficient. The indoor temperatures were monitored in summer and winter and annual energy consumption was established and statistically analysed. The building designs were analysed in terms of their orientation, glazing areas, wall areas, volumes of thermal mass and ventilation capacity and compared with benchmarks for energy efficient design. The second tool involved a series of computer simulations of a typical small, medium density dwelling. The simulation process was utilised to determine if a new set of benchmarks for energy efficient small, medium density dwellings were required that would incorporate the notion of appropriateness. From the multiple case study it was found that, irrespective of design, indoor temperatures in 98% of dwellings were above the acceptable maximum summer temperature of 27.4°C in still air and indoor temperatures in all dwellings were found to be below the acceptable minimum daytime temperature of 19.8°C. / The findings also showed that some aspects of the benchmarks for energy efficient design were not appropriate in typical, medium density housing constructed specifically for the aged. From the simulation process it was discovered that acceptable temperatures could be achieved in small medium density housing if the principles of energy efficient design, incorporated within a new set of benchmarks, were integrated with appropriateness criteria for housing for the aged. The approach taken with the new benchmarks was to create both performance based and prescriptive design solutions. The performance model differs from the current benchmarks for energy efficient design in that it establishes key functional objectives for energy efficient design. Compared to the current benchmarks, the prescriptive design solutions show significant reductions in the areas of northerly glazing and total glazing. To compensate for the reduced area of northerly glazing, both direct and indirect means of solar gain are utilised for passive heating. The thesis outcomes have implications for three areas of the construction industry. The prescriptive design solutions presented in building regulations for energy efficiency in housing need to be qualified, the design briefs prepared for energy efficient construction of small, medium density housing need amendment and the approach taken by designers involved in energy efficient small, medium density housing needs to be reconsidered.

For various reasons, certain races tend to play particular sports. Sports with low costs of participation (e.g., basketball and football) have higher percentages of minority participants relative to sports with high costs of participation (e.g., golf). In addition to the cost of participation being a deterrent, stereotypes can also play a role into who plays various sports. Certain races tend to feel most competent in a particular sport (e.g., African Americans in basketball). This study focuses on the degree to which stereotypes contribute to the under representative rates of minorities in golf, compared to their overrepresented White counterparts. Data were collected from 217 students at a large US public university. A pilot test was used to develop a scale depicting the "general golfer." In the primary study, participants used a 7-point scale to rate the degree to which the "general golfer," Whites, Asians, Hispanics, and African Americans exhibited these characteristics. Examples of these characteristics include "refined", "etiquette", and "skillfulness." The scale items were all reliable. The correlation between the general golfer and Whites was the strongest (r = .50), followed by Asians (r = .36), Hispanics (r = .29), and African Americans (r = .23). The correlation between the general golfer and Whites was significantly stronger than correlations between the general golfer and African Americans, Hispanics, and Asians, t's > 2.3, p's < .05. In addition, Whites were viewed as more appropriate for golf relative to racial minorities. Stereotypes can influence which races people view as appropriate and not appropriate for golf. These stereotypes can in turn impact participation, or lack thereof, of certain races in golf. If certain racial groups are not considered appropriate for a sport in which mental strength, etiquette, and persistence are valued, this could also impact access to jobs in which these characteristics are also valued. In addition, these stereotypes can potentially lead to self-limiting behavior by the negatively affected races.