Small business owners are the primary initiators of innovation and economic growth but fail at high rates. Fifty percent of small businesses fail within the first 5 years of operations. Through the lens of systems theory, the purpose of this multiple case study was to explore the strategies some small salon business owners use to remain in business for longer than 5 years. Using purposeful sampling, the 7 owners of small salon business owners in the southeastern United States were selected based upon evidence of their strategies to sustain their businesses for longer than 5 years. Data were collected through semistructured, face-to-face interviews and a review of business licenses, certifications, and financial records. During data analysis using Yin's 5-step process of compiling, disassembling, reassembling, interpreting, and drawing data-based conclusions, 4 major themes emerged: (a) business growth strategy, (b) customer relationship strategy, (c) financial capital strategy, and (d) marketing strategy. The findings indicated that implementing strategies to maintain business growth, building relationships with customers, securing sufficient financial capital, and engaging in effective marketing are essential for small salon business owners to survive in business longer than 5 years. The implications for positive social change include the potential for small salon business owners to generate employment, sustain the livelihood of employees, contribute to the local economy, and reduce local unemployment rates.

Doctor Scientiae / In utero exposure to teratogens, increasing urbanization, rapid nutritional transition from poverty to affluence, adoption of a Western-style diet and physical inactivity have contributed to the growing obesity epidemic in the low-income countries. To investigate the associations between in utero exposure to alcohol and nicotine on the growth and development of children aged five years from a low-income setting. These effects will be observed in children aged five years as a reduced pancreas and kidney size, higher aorta and carotid intima thickness as well as higher visceral abdominal adiposity measurements.

Communication, in its most basic sense, is foundational for any personal, human interaction and relationship. As theatre artists, we are charged with communicating complex story lines, conceptual ideas, and emotion to an audience. Sound communication is paramount to every aspect of a musical production, be it communication between actors/characters, actor and director, amongst the production team, and arguable the most important, between the actors and the audience. My years of education as a Masters in Fine Arts candidate in Musical Theatre have been spent polishing my ability to communicate physical and emotional choices with greater accuracy, depth, and truth. By staging Jason Robert Brown‟s musical The Last Five Years and performing the role of Jamie, this performance thesis will explore, develop, and examine my mastery of the aforementioned varied forms of communication, all of which are necessary in building a successful musical production. Research will be conducted to gather information on relevant topics, including the history of The Last Five Years, the life of Jason Robert Brown, and his musical and theatrical influences. By further understanding Brown, his life, and his ideas about his works, I hope to more fully understand and communicate the message of the musical itself. A dramatic and musical structural analysis will provide further depth and insight into the piece, with the hopes of informing my production and individual performance. A thorough character analysis will provide connective tissue that will allow myself, as the actor, to more effectively communicate the psychological and emotional make up of the character Jamie. Lastly, the thesis document will culminate with a production journal, documenting the pre-production, rehearsal, and performance process. Through the journaling process, I will document and address the iii journey that I have experienced with the production, giving focus and attention to its many obstacles and discoveries, successes and failures, all of which have contributed to my personal growth as a young theatre artist.

The purpose of this study was to investigate the environmental factors that impact on childhood diarrhoea in children under five years old in Akakikality sub city Addis Ababa, Ethiopia. Objectives of the study were to determine the prevalence of diarrhoea and to determine the environmental factors that impact on diarrhoea in children under five years old. A survey was done and a non-experimental approach was used in this descriptive and analytical quantitative study using a cross sectional study design. The instrument was a self-designed questionnaire. The target population for this study was all mothers or caretakers of children under five years found in the described study context – the sample size was 299. In this study 12.7% of the children had diarrhoea during the survey. Proper utilization of toilets, hand washing and safe storage of water in the households using narrow mouthed water containers were significant predictors of diarrhoea in the children. / Health Studies / M.A. (Public Health)

The purpose of this study was to investigate the environmental factors that impact on childhood diarrhoea in children under five years old in Akakikality sub city Addis Ababa, Ethiopia. Objectives of the study were to determine the prevalence of diarrhoea and to determine the environmental factors that impact on diarrhoea in children under five years old. A survey was done and a non-experimental approach was used in this descriptive and analytical quantitative study using a cross sectional study design. The instrument was a self-designed questionnaire. The target population for this study was all mothers or caretakers of children under five years found in the described study context – the sample size was 299. In this study 12.7% of the children had diarrhoea during the survey. Proper utilization of toilets, hand washing and safe storage of water in the households using narrow mouthed water containers were significant predictors of diarrhoea in the children. / Health Studies / M.A. (Public Health)

Trata-se de um estudo retrospectivo, com o objetivo de avaliar a correlação entre o tamanho das lâminas palatinas e índice oclusal em pacientes com fissura unilateral completa de lábio e palato. Foram avaliados modelos de estudo de 339 pacientes que foram moldados em três fases distintas: pré-queiloplastia (fase1) pré-palatoplastia (fase 2) e dentadura decídua completa ou mista precoce (fase 3). A queiloplastia foi realizada entre 3 e 6 meses de idade, pelas técnicas de Spina ou Millard e a palatoplastia foi realizada entre 9 e 18 meses, pelas técnicas de von Langenbeck ou Furlow. 4 cirurgiões realizaram as cirurgias, mas cada paciente foi operado de lábio e palato pelo mesmo cirurgião. As lâminas palatinas foram medidas de imagens escaneadas dos modelos das fases 1 e 2, utilizando-se do programa Adobe Photoshop CS2. O índice oclusal foi avaliado nos modelos das fases 3 utilizando o índice de proposto por Atack et al. 1997, conhecido por índice dos 5 anos de idade. A medida das lâminas palatinas foi comparada entre as fases 1 e 2 e mostrou haver um crescimento médio de 0,5 cm. A amplitude da fissura em sua porção central mostrou apresentou um valor médio de 1,13 na fase 1 e 0,69 na fase 2. A correlação entre o tamanho das lâminas palatinas e o índice oclusal foi dada pela aplicação da correlação de Spearman. Os resultados mostraram que houve correlação negativa significante entre o tamanho da lâmina palatina e o índice oclusal apenas para os pacientes operados por um dos cirurgiões e somente em uma técnica cirúrgica (Millard com Furlow). Acredita-se que outros fatores envolvidos no processo reabilitador possam ter mais influência no resultado do índice oclusal do que o tamanho das lâminas palatinas. A habilidade do cirurgião em realizar determinada técnica e com ela conseguir os seus melhores resultados, parece ser determinante no resultado de crescimento facial destes pacientes. / This retrospective study evaluated the correlation between the size of palatal shelves and the occlusal index in patients with complete unilateral cleft lip and palate. The study evaluated dental casts of 339 patients whose impressions were obtained at three different stages: before cheiloplasty (stage 1), before palatoplasty (stage 2) and in the complete deciduous or early mixed dentition (stage 3). Cheiloplasty was performed at 3 to 6 months of age by the Spina or Millard techniques and palatoplasty was performed at 9 to 18 months by the von Langenbeck or Furlow technique. Four surgeons performed the surgeries, yet each patient was submitted to lip and palate repair by the same surgeon. The palatal shelves were measured on scanned images of dental casts of stages 1 and 2, using the software Adobe Photoshop CS2. The occlusal index was evaluated on the dental casts of stage 3 using the index proposed by Atack et al. 1997, known as 5-year-old index. The dimension of palatal shelves compared between stages 1 and 2 evidenced a mean growth of 0.5 cm. The cleft width at the central portion presented a mean value of 1.13 in stage 1 and 0.69 in stage 2. The correlation between the size of palatal shelves and the occlusal index was analyzed by the Spearman correlation test. The results demonstrated significant negative correlation between the size of palatal shelves and the occlusal index only for patients operated by one of the surgeons and only for one surgical technique (Millard with Furlow). It is believed that other factors involved in the rehabilitation process may have greater influence on the occlusal index outcome than the size of palatal shelves. The surgeons skill in performing a certain technique and achieve his or her best outcomes seems to be a determining factor for the facial growth outcome of these patients.

As informações de mortalidade são úteis para avaliar a situação de saúde de uma população. Dados de mortalidade confiáveis produzidos por um sistema de informação de saúde nacional constituem uma ferramenta importante para o planejamento de saúde. Em muitos países, sobretudo em desenvolvimento, o sistema de informação de mortalidade continua precário. Apesar dos esforços feitos em Moçambique para melhoria das estatísticas de mortalidade, os desafios ainda prevalecem em termos de tecnologias de informação, capacidade técnica de recursos humanos e em termos de produção estatística. O SIS-ROH é um sistema eletrônico de registro de óbitos hospitalares de nível nacional, implementado em 2008 e tem uma cobertura de apenas 4% de todos os óbitos anuais do país. Apesar de ser um sistema de nível nacional, ele presentemente funciona em algumas Unidades Sanitárias (US), incluindo o Hospital Central da Beira (HCB). Dada a importância deste sistema para monitorar o padrão de mortalidade do HCB e, no geral, da cidade da Beira, este estudo avalia a qualidade do SIS-ROH do HCB. É um estudo descritivo sobre a completitude, cobertura, concordância e consistência dos dados do SIS-ROH. Foram analisados 3.009 óbitos de menores de 5 anos ocorridos entre 2010 e 2013 e regsitrados no SIS-ROH e uma amostra de 822 Certificados de Óbitos (COs) fetais e de menores de 5 anos do HCB. O SIS-ROH apresentou uma cobertura inferior a 50% calculados com os dados de mortalidade estimados pelo Inquérito Nacional de Causas de Morte (INCAM). Verificamos a utilização de dois modelos diferentes de CO (modelo antigo e atual) para o registro de óbitos referentes ao ano de 2013. Observou-se completitude excelente para a maioria das variáveis do SISROH. Das 25 variáveis analisadas dos COs observou-se a seguinte situação: 9 apresentaram completitude muito ruim, sendo elas relativas à identificação do falecido (tipo de óbito e idade), relativas ao bloco V em que dados da mãe devem ser obrigatoriamente preenchidos em caso de óbitos fetais e de menores de 1 ano (escolaridade, ocupação habitual, número de filhos tidos vivos e mortos, duração da gestação) e relativas às condições e às causas de óbito (autópsia e causa intermédiacódigo); 3 variáveis apresentaram completitude ruim relativas à identificação do falecido (NID) e relativas às condições e causas de morte (causa intermédia - descrição e causa básica - código); 9 apresentaram completitude regular relativas à identificação do falecido (data de nascimento e idade), relativas ao bloco V (idade da mãe, tipo de gravidez, tipo de parto, peso do feto/bebé ao nascer, morte do feto/bebé em relação ao parto) e relativas às condições e causa de óbito (causa direta- código, causa básica descrição); 2 apresentaram completitude bom relativas à identificação do falecido (sexo e raça/cor) e, por último, 2 apresentaram completitude excelente relativas ao local de ocorrência de óbito (data de internamento e data de óbito ou desaparecimento do cadáver). Algumas variáveis do SIS-ROH e dos COS apresentaram inconsistências. Observou-se falta de concordância para causa direta entre o SIS-ROH e os COs. Conclusão: Moçambique tem feito esforços para aprimorar as estatísticas de mortalidade, porém há lacunas na qualidade; a análise rotineria dos dados pode identificar essas lacunas e subsidiar seu aprimoramento. / The mortality information is useful to assess the health status of a population. Reliable mortality data produced by a national health information system is an important tool for health planning. In many countries, especially developing countries, the mortality information system is still precarious. Despite efforts in Mozambique to improve mortality statistics, challenges still prevail in terms of information technology, technical capacity and human resources and statistical production. The SIS-ROH is an electronic system of national-level hospital deaths registration, implemented in 2008 and has a coverage of only 4% of all annual deaths in the country. Despite being a national system, it currently works in some health units (US), including Beira Central Hospital (HCB). Given the importance of this system to monitor the mortality pattern of HCB and, in general, the city of Beira, this study evaluates the quality of SIS-ROH HCB. It is a descriptive study on the completeness, coverage, compliance and consistency of the SIS-ROH data and examined a sample of 822 HCB deaths Certificates (COs) of fetal and children under 5 years of age. We find the use of two different models of CO (former and current model) for the registration of deaths related to the year 2013. We observed excellent completeness for most SIS-ROH variables. Of the 25 variables of COs there was the following situation: 9 had very bad completeness, which were relating to the identification of the deceased (type of death and age) on the V block in the mother\'s data, where must be filled in case of stillbirths and children under 1 year of age (education, usual occupation, number of living children taken and killed, gestational age) and on the conditions and causes of death (autopsy and intermediate-code causes); 3 variables had bad completeness concerning the identification of the deceased (NID) and on the conditions and causes of death (intermediate cause - description and basic cause - code); 9 showed regular completeness concerning the identification of the deceased (date of birth and age) on the V block (mother\'s age, type of pregnancy, mode of delivery, weight of the fetus / baby birth, death of the fetus / baby compared to delivery) and on the conditions and causes of death (direct cause code, basic cause description); 2 showed good completeness concerning the identification of the deceased (sex and race / color) and, finally, 2 showed excellent completeness concerning the place of occurrence of death (date of admission and date of death or the disappearance corpse). The SIS-ROH had coverage below 50% calculated on mortality data estimated by the National Survey of Causes of Death (INCAM). Some SIS-ROH variables and COS showed inconsistencies. There was a lack of agreement to direct cause between SIS-ROH and COs.

As informações de mortalidade são úteis para avaliar a situação de saúde de uma população. Dados de mortalidade confiáveis produzidos por um sistema de informação de saúde nacional constituem uma ferramenta importante para o planejamento de saúde. Em muitos países, sobretudo em desenvolvimento, o sistema de informação de mortalidade continua precário. Apesar dos esforços feitos em Moçambique para melhoria das estatísticas de mortalidade, os desafios ainda prevalecem em termos de tecnologias de informação, capacidade técnica de recursos humanos e em termos de produção estatística. O SIS-ROH é um sistema eletrônico de registro de óbitos hospitalares de nível nacional, implementado em 2008 e tem uma cobertura de apenas 4% de todos os óbitos anuais do país. Apesar de ser um sistema de nível nacional, ele presentemente funciona em algumas Unidades Sanitárias (US), incluindo o Hospital Central da Beira (HCB). Dada a importância deste sistema para monitorar o padrão de mortalidade do HCB e, no geral, da cidade da Beira, este estudo avalia a qualidade do SIS-ROH do HCB. É um estudo descritivo sobre a completitude, cobertura, concordância e consistência dos dados do SIS-ROH. Foram analisados 3.009 óbitos de menores de 5 anos ocorridos entre 2010 e 2013 e regsitrados no SIS-ROH e uma amostra de 822 Certificados de Óbitos (COs) fetais e de menores de 5 anos do HCB. O SIS-ROH apresentou uma cobertura inferior a 50% calculados com os dados de mortalidade estimados pelo Inquérito Nacional de Causas de Morte (INCAM). Verificamos a utilização de dois modelos diferentes de CO (modelo antigo e atual) para o registro de óbitos referentes ao ano de 2013. Observou-se completitude excelente para a maioria das variáveis do SISROH. Das 25 variáveis analisadas dos COs observou-se a seguinte situação: 9 apresentaram completitude muito ruim, sendo elas relativas à identificação do falecido (tipo de óbito e idade), relativas ao bloco V em que dados da mãe devem ser obrigatoriamente preenchidos em caso de óbitos fetais e de menores de 1 ano (escolaridade, ocupação habitual, número de filhos tidos vivos e mortos, duração da gestação) e relativas às condições e às causas de óbito (autópsia e causa intermédiacódigo); 3 variáveis apresentaram completitude ruim relativas à identificação do falecido (NID) e relativas às condições e causas de morte (causa intermédia - descrição e causa básica - código); 9 apresentaram completitude regular relativas à identificação do falecido (data de nascimento e idade), relativas ao bloco V (idade da mãe, tipo de gravidez, tipo de parto, peso do feto/bebé ao nascer, morte do feto/bebé em relação ao parto) e relativas às condições e causa de óbito (causa direta- código, causa básica descrição); 2 apresentaram completitude bom relativas à identificação do falecido (sexo e raça/cor) e, por último, 2 apresentaram completitude excelente relativas ao local de ocorrência de óbito (data de internamento e data de óbito ou desaparecimento do cadáver). Algumas variáveis do SIS-ROH e dos COS apresentaram inconsistências. Observou-se falta de concordância para causa direta entre o SIS-ROH e os COs. Conclusão: Moçambique tem feito esforços para aprimorar as estatísticas de mortalidade, porém há lacunas na qualidade; a análise rotineria dos dados pode identificar essas lacunas e subsidiar seu aprimoramento. / The mortality information is useful to assess the health status of a population. Reliable mortality data produced by a national health information system is an important tool for health planning. In many countries, especially developing countries, the mortality information system is still precarious. Despite efforts in Mozambique to improve mortality statistics, challenges still prevail in terms of information technology, technical capacity and human resources and statistical production. The SIS-ROH is an electronic system of national-level hospital deaths registration, implemented in 2008 and has a coverage of only 4% of all annual deaths in the country. Despite being a national system, it currently works in some health units (US), including Beira Central Hospital (HCB). Given the importance of this system to monitor the mortality pattern of HCB and, in general, the city of Beira, this study evaluates the quality of SIS-ROH HCB. It is a descriptive study on the completeness, coverage, compliance and consistency of the SIS-ROH data and examined a sample of 822 HCB deaths Certificates (COs) of fetal and children under 5 years of age. We find the use of two different models of CO (former and current model) for the registration of deaths related to the year 2013. We observed excellent completeness for most SIS-ROH variables. Of the 25 variables of COs there was the following situation: 9 had very bad completeness, which were relating to the identification of the deceased (type of death and age) on the V block in the mother\'s data, where must be filled in case of stillbirths and children under 1 year of age (education, usual occupation, number of living children taken and killed, gestational age) and on the conditions and causes of death (autopsy and intermediate-code causes); 3 variables had bad completeness concerning the identification of the deceased (NID) and on the conditions and causes of death (intermediate cause - description and basic cause - code); 9 showed regular completeness concerning the identification of the deceased (date of birth and age) on the V block (mother\'s age, type of pregnancy, mode of delivery, weight of the fetus / baby birth, death of the fetus / baby compared to delivery) and on the conditions and causes of death (direct cause code, basic cause description); 2 showed good completeness concerning the identification of the deceased (sex and race / color) and, finally, 2 showed excellent completeness concerning the place of occurrence of death (date of admission and date of death or the disappearance corpse). The SIS-ROH had coverage below 50% calculated on mortality data estimated by the National Survey of Causes of Death (INCAM). Some SIS-ROH variables and COS showed inconsistencies. There was a lack of agreement to direct cause between SIS-ROH and COs.

Trata-se de um estudo retrospectivo, com o objetivo de avaliar a correlação entre o tamanho das lâminas palatinas e índice oclusal em pacientes com fissura unilateral completa de lábio e palato. Foram avaliados modelos de estudo de 339 pacientes que foram moldados em três fases distintas: pré-queiloplastia (fase1) pré-palatoplastia (fase 2) e dentadura decídua completa ou mista precoce (fase 3). A queiloplastia foi realizada entre 3 e 6 meses de idade, pelas técnicas de Spina ou Millard e a palatoplastia foi realizada entre 9 e 18 meses, pelas técnicas de von Langenbeck ou Furlow. 4 cirurgiões realizaram as cirurgias, mas cada paciente foi operado de lábio e palato pelo mesmo cirurgião. As lâminas palatinas foram medidas de imagens escaneadas dos modelos das fases 1 e 2, utilizando-se do programa Adobe Photoshop CS2. O índice oclusal foi avaliado nos modelos das fases 3 utilizando o índice de proposto por Atack et al. 1997, conhecido por índice dos 5 anos de idade. A medida das lâminas palatinas foi comparada entre as fases 1 e 2 e mostrou haver um crescimento médio de 0,5 cm. A amplitude da fissura em sua porção central mostrou apresentou um valor médio de 1,13 na fase 1 e 0,69 na fase 2. A correlação entre o tamanho das lâminas palatinas e o índice oclusal foi dada pela aplicação da correlação de Spearman. Os resultados mostraram que houve correlação negativa significante entre o tamanho da lâmina palatina e o índice oclusal apenas para os pacientes operados por um dos cirurgiões e somente em uma técnica cirúrgica (Millard com Furlow). Acredita-se que outros fatores envolvidos no processo reabilitador possam ter mais influência no resultado do índice oclusal do que o tamanho das lâminas palatinas. A habilidade do cirurgião em realizar determinada técnica e com ela conseguir os seus melhores resultados, parece ser determinante no resultado de crescimento facial destes pacientes. / This retrospective study evaluated the correlation between the size of palatal shelves and the occlusal index in patients with complete unilateral cleft lip and palate. The study evaluated dental casts of 339 patients whose impressions were obtained at three different stages: before cheiloplasty (stage 1), before palatoplasty (stage 2) and in the complete deciduous or early mixed dentition (stage 3). Cheiloplasty was performed at 3 to 6 months of age by the Spina or Millard techniques and palatoplasty was performed at 9 to 18 months by the von Langenbeck or Furlow technique. Four surgeons performed the surgeries, yet each patient was submitted to lip and palate repair by the same surgeon. The palatal shelves were measured on scanned images of dental casts of stages 1 and 2, using the software Adobe Photoshop CS2. The occlusal index was evaluated on the dental casts of stage 3 using the index proposed by Atack et al. 1997, known as 5-year-old index. The dimension of palatal shelves compared between stages 1 and 2 evidenced a mean growth of 0.5 cm. The cleft width at the central portion presented a mean value of 1.13 in stage 1 and 0.69 in stage 2. The correlation between the size of palatal shelves and the occlusal index was analyzed by the Spearman correlation test. The results demonstrated significant negative correlation between the size of palatal shelves and the occlusal index only for patients operated by one of the surgeons and only for one surgical technique (Millard with Furlow). It is believed that other factors involved in the rehabilitation process may have greater influence on the occlusal index outcome than the size of palatal shelves. The surgeons skill in performing a certain technique and achieve his or her best outcomes seems to be a determining factor for the facial growth outcome of these patients.

L’accès financier limité aux soins de santé a suscité l’instauration de politiques sanitaires de subvention des soins en Afrique. Au Burkina Faso, une ONG, en complémentarité avec la politique sanitaire nationale subventionne à 100% depuis septembre 2008 les soins et les médicaments pour les enfants de moins de cinq ans dans le district sanitaire de Dori. L’intervention regroupe formation du personnel soignant, supervisions et suppression de paiement des soins et des médicaments. L’objectif de l’étude est d’analyser l’effet de cette intervention sur l’adéquation des prescriptions médicales. Neuf centres de santé ont été pris en compte. Au total 14956 ordonnances d’enfants de moins de cinq ans ciblés par l’intervention ont été sélectionnées par échantillonnage systématique à partir des registres de consultation un an avant et un an après l’instauration de l’intervention. Quatorze prescripteurs ont été interviewés. Les prescriptions ont été analysées par comparaison au référentiel de l’OMS ainsi qu’au référentiel national. Le discours des prescripteurs a été analysé en vue de comprendre leur perception de leur changement de pratiques depuis de début de la subvention. L’intervention a eu pour effet de diminuer l’utilisation des injections (Rapport de cote (RC) =0,28; p<0,005) dans le cas des infections respiratoires aiguës (IRA). Elle a entraîné une diminution de l’utilisation inappropriée des antibiotiques dans les cas de paludisme seul (RC=0,48; p<0,0005). Le nombre moyen de médicaments par ordonnance a également diminué de 14% dans les cas d’IRA (p<0,0005). Les prescripteurs ont affirmé pour la plupart que leurs pratiques se sont soit maintenues soit améliorées. L’intervention a entrainé une amélioration de l’adéquation des prescriptions médicales dans certains cas. / The limited financial access to health care has encouraged the creation of health policies for subsidizing care in Africa. In Burkina Faso, an NGO, in line with the national health policy has been subsidizing care and medicines for children under five years in the health district of Dori since September 2008. The program includes training of health workers, supervision and removal of fees for health care and medication. The aim of the study was to analyze the effect of this free care program on the adequacy of drugs prescriptions. Nine health centers were taken into account. A total of 14,956 prescriptions of the target group of children under five years were collected from consultation records a year before and after the introduction of free care program. In addition, fourteen prescribers were interviewed. The prescriptions were analyzed in comparison to the WHO and the national reference. The prescribers’ responses were analyzed to understand their perception of their change in practice since the introduction of the free care program. The study showed that the free care program had an effect by decreasing the use of injections (Odds Ratio (OR) =0.28, p < 0.005) in acute respiratory infections (ARI) cases. It also led to decrease in inappropriate use of antibiotics in the case of malaria (OR=0.48, p<0.0005). The average number of drugs per prescription was also found to have decreased by 14% (p<0.0005) in ARI cases. Several prescribers asserted that their practices are maintained or improved. The program leads to an improvement in the adequacy of drugs prescriptions.