Thesis (Ph. D.)--University of Hawaii at Manoa, 1981. / Bibliography: leaves 579-593. / Microfiche. / xxi, 593 leaves, bound 29 cm

Typescript. / Bibliography: leaves 201-251. / Microfiche. / xiv, 251 leaves, bound ill., maps 29 cm

Traditional fecal indicator bacteria such as fecal coliform, E.coli and enterococci have been shown to be unreliable indicators of the hygienic quality of recreational waters under tropical conditions. One of the major reasons for considering these bacteria as ineffective indicators of water quality in warm, tropical regions is that they are consistently found in natural environments (plants, soil, water) in the absence of any significant contamination of these environments. Since preliminary studies conducted in Hawaii had indicated soil as the major environmental source of elevated concentrations of these bacteria in environmental waters, the aim of this study was to focus on the soil environment to specifically address two assumptions made by regulatory agencies in using fecal bacteria as indicators of water quality: first, there should not be an environmental source of these indicator bacteria unrelated to sewage or fecal matter contamination, and second, the indicator bacteria do not multiply in the environment. To determine the validity of these two assumptions under tropical conditions in Hawaii and possibly other tropical locations, various experiments were conducted. The major findings are as follows. 1) Analysis of soil samples collected from various locations representing major soil groups on the island of Oahu showed that fecal indicator bacteria are naturally found in most of the soil environments, indicating that the fecal bacteria have adapted to the soil conditions to become part of soil biota. 2) Evidence was obtained to show that the soil contains adequate nutrients to sustain the populations of these bacteria. 3) Growth and multiplication of fecal indicator bacteria in natural soil was dependent on available nutrients (particularly carbon), moisture and competing microorganisms. In conclusion, tropical soil conditions are suboptimal for the multiplication of fecal indicator bacteria. Consequently, these bacteria in natural soil conditions will probably grow and multiply sporadically when conditions are relatively optimal. Although concentrations of fecal indicator bacteria in soil represent only a small fraction of the microbiota, their counts are significant enough in numbers not only to impact the quality of recreational waters but also to nullify two of the assumptions used in the application of recreational water quality standards. Thus, there is a need for an alternate and more reliable indicator of water quality in Hawaii and other tropical locations. / Department of Health, State of Hawaii; US Environmental Protection Agency

This thesis explores the concept of sustainability in the context of the community expectation for sustainability in cities. Effective sustainability performance requires all three pillars of environmental sustainability (stewardship), social equity and economic efficiency to achieve complementary outcomes rather than simply individual outcomes. For cities, one challenge of sustainability is centred on urban form, transport characteristics and the interactions between these and the communities they support. Better understanding of these dynamics is an important step in a meaningful interpretation of sustainability performance of cities. Reviews of methodological gaps in sustainability performance of cities are framed into a statement of problem. Gaps include a holistic assessment framework, methodologies to better understand urban dynamics, the drivers that produce sustainability performance and to objectively measure the performance of all three pillars of sustainability. The common transport planning and land-use planning methods are identified as suitable building blocks for improvements in sustainability assessment, and accessibility is established as an important part of sustainability. In a new approach to sustainability analysis, a sustainability framework is formulated. A concept of "environmental sustainability - accessibility space" is introduced as a novel visualisation of sustainability performance. Propositions are formed that a city's sustainability performance can be analytically quantified and simply visualised in terms of the three pillars of sustainability. Sydney, a global city with a history of planning, is the case study to empirically test the propositions, with the sustainability framework providing the conceptual reference points. Having developed a picture of the urban dynamics in the Sydney case study, the proposed sustainability metrics are developed and the propositions tested. Sustainability metrics consisting of three typologies are shown to indicate the sustainability performance characteristics for the three pillars of sustainability in terms of data set shape, frequency and spread in the "environmental sustainability accessibility space". The visualisations although built from many thousands of pieces of data provided a simple representation giving a holistic view of the sustainability characteristics and trends. Collectively, the sustainability framework, sustainability metrics, companion urban dynamics metrics, and urban system measures are demonstrated as a meaningful methodology in assessing city sustainability performance.

ABSTRACT Key words: major trauma, mortality, emergency pre-hospital, performance indicators. Australian and New Zealand Standard Research Classifications: Division 11 (Medical and Health Sciences); Group 1117 (Public Health and Health Services) Background Response times are a common performance measure for many ambulance services and emergency medical response systems and are considered to be a standard measure of emergency medical services quality. The development of formalised Emergency Medical Systems in Australia and internationally have almost universally assumed a link between shorter response times and improved patient outcome measured by survival. While the evidence to support time-criticality for patients who experience a cardiac arrest is considered unequivocal, the assumption that response and scene times are universally important across all patient groups is not consistently supported by the research evidence. Little is known about whether or not the importance of time-dependent performance measures vary as a function of the Emergency Medical System arrangements to which they apply, the skill set of attending paramedics or the epidemiology of the target population. Despite this, response times continue to be one of the key performance measures for ambulance services regardless of the wider health services system in which they operate. Given the significant investment in paramedic training and increasing levels of clinical responsibility witnessed in the last decade, the development of a robust body of evidence about whether this investment and expertise alters outcomes for patients is yet to develop and there has been little shift in measures of performance. Major traumatic injury is associated with significant disease burden in Australia as elsewhere in the world. An estimated 1,500 Queenslanders die each year as a result of major traumatic injury and injury remains the single most common cause of death in Queenslanders between the ages of 1 and 35 years. As such, injury has a massive impact on the health of Queenslanders. Each year, around 10% of Queenslanders will suffer from an injury of some kind and it is known that injury results in 10% of all hospital admissions and 40-60% of attendances at hospital Emergency Departments. In Australia, injury is recognised as one of the seven National Health Priority Areas by the Australian Government. While this document provides for the setting of broad targets for reduction in injury and its social, economic and health corollaries, little advice is provided regarding health service performance with this target group. The emergency pre-hospital environment is absent in this and most strategic policy documents of this ilk in Australia. This thesis has two core aims: • to provide for the first time a descriptive analysis of major trauma in Queensland for the period 1998-2001 including description of the systemic factors influencing patient mortality; and in the light of these findings to • examine the utility of emergency pre-hospital time-dependent performance indicators as predictors of mortality in this patient group. The period of interest 1998-2001 was selected to provide a baseline for the development of the Queensland Trauma Plan implemented by government in 2007. Methods This thesis involved three key activities: (1) a review of the literature on the basis for time-dependent measures of pre-hospital performance in trauma, impacts of system design and emergency pre-hospital skill set on mortality from major trauma; (2) a descriptive quantitative analysis of linked patient data over a four year period (1998-2001) of the relationship between pre-hospital time and mortality; and (3) the theoretical development of alternative emergency pre-hospital performance measures for trauma. Results Of the 23,462 patients in the study population, 29.0% (n= 6,793) died as a consequence of their injuries. Fifteen percent (15.0%) of the patients died in the pre-hospital environment. After adjustment for age, sex and severity (GCS<9) and the presence or absence of co-morbidities, a response interval in excess of 10 minutes (the State benchmark for high acuity cases) did not affect all-cause, all-age mortality from major trauma (OR 1.03; 95%CI 0.93-1.13) compared to response times < 10 minutes. Similarly, no significant effect of response interval >10 minutes (OR 1.11; 95%CI 0.98-1.26) was noted in the pre-hospital period. Scene time >20 minutes (OR 0.75; CI 0.65-0.86) improved the chance of survival to hospital by comparison to scene times <20 minutes. At all times in the pre-hospital care continuum, the presence of an Intensive Care Paramedic improved survival (OR 1.29; 95%CI 1.13-1.48) when compared to solely Advanced Care Paramedic crews, however this effect was not sustained for overall mortality. Conclusions Traditional time-dependent emergency pre-hospital performance measures are not associated with pre-hospital survival from major traumatic injury in Queensland. This finding differs from the experience of similar systems in Canada and elsewhere and may be due to differences in trauma profile, system arrangements, skill sets and funding models. Alternatively, the system operating in Queensland may in fact be optimised in terms of response, scene and transfer times given the size and geography of the State. This study has confirmed the positive survival benefit associated with highly skilled paramedics in the field and demonstrates that time-dependent performance measures should not be considered proxy measures of survival. New performance indicators specifically targeted to patient outcomes need to be developed to monitor the performance of trauma systems in the pre-hospital sector.

In 1988, the Australian Federal Government released the document Higher Education: A Policy Statement which was intended to improve the efficiency and effectiveness of the higher education sector. This paved the way for the application of performance indicators (Pls) across higher education, most notably the creation of a link between Pls (called the Composite Index) and the research component of the annual government funding to universities. Although PIS for teaching became popular, funding for the teaching component was not directly attached to PIS and remained largely based on student enrolments. The purpose of this study is to examine the perceptions of university academics in Australia on the effects of research and teaching as a result of the introduction of funding based on research Pls. The academic literature suggests that Pls can bring about desirable effects but it also warns that their imposition, particularly by the government on universities, may lead to unintended and undesirable effects, such as goal displacement and strategic manipulation, which may be designed to enhance apparent research performance. To guide the investigation, it was hypothesised that the government's Pls which focus on research will be integrated into the universities' internal policies; will encourage universities to place a high priority on the research activities funded by the Pls; will lead to significantly more paperwork; will contribute to a significant change in the approach to research but not to teaching; and will result in academics adopting negative attitudes towards Pls. Two basic sources of information were obtained to evaluate these hypotheses. First, the administrations of selected universities were consulted, and staff interviewed, to gauge the degree of change that had been implemented by the universities. Second, a questionnaire was constructed in order to assess academics' attitude towards Pls, and their perceptions of an association between Pls and their institutional reward system. The questionnaire also assessed changes in research, teaching and paperwork activities. The universities selected characterised the different kinds of universities found in the Unified National System of the Australian higher education system. One hundred and fifty-two academics from these universities were surveyed by the questionnaire. Thirty percent of these academics participated in a structured interview. The disciplines from which the academics were selected for participation included arts/humanities, science, and professional studies which included a natural science based profession and a social science based profession. In addition, a case study of one of these universities was carried out. The institutions were found to have reorganised their internal policies to incorporate and focus on the Pls in the government's Composite Index. The academics surveyed were generally found to have negative attitude towards their institutional Pls, although staff of higher rank had relatively more positive views. Reasons for their dissatisfaction included the inability of Pls to capture the various dimensions of academic work and privileging research over teaching. For a majority of the academics, the introduction of Pls was associated with a rise in paperwork load and a change in the approach to research in terms of focusing on publications and external research grant applications, particularly those counted in their institutional PI-based funding schemes. The time devoted to these activities, as well as the number of publications and grants for which they were expected to apply, have significantly increased. It was found that staff did use various strategies to maximise their PI scores, such as writing shorter papers in order to increase the quantity of publications. The proportion who changed their approach to teaching was also sizeable; most of them were concerned about getting students through their courses with minimum fuss by having lower ambitions for students and pandering to their superficial needs. However, the proportion who changed their teaching was significantly less than those who changed their research. One possible reason could be the lack of special incentives to increase their emphasis on teaching.

Thesis (Ph. D.) -- Lincoln University, 2008. / Also available via the World Wide Web.

Thesis (M. Sc.)--Brock University--[St. Catherines, Ontario], 2006. / Includes bibliographical references (leaves 102-118).

Thesis (M.A.)--University of Nevada, Reno, 2007. / "May, 2007." Includes bibliographical references (leaves 62-65). Online version available on the World Wide Web.

Thesis (Ph. D.)--West Virginia University, 2007. / Title from document title page. Document formatted into pages; contains ix, 135 p. : ill. Vita. Includes abstract. Includes bibliographical references (p. 119-130).