Facial fractures are commonly present in hospital patients admitted for trauma care. The establishment of clinical indicators for uncovering facial fractures has been insufficiently studied. The main objectives of this study were to determine midface facial fracture diagnostics, etiology, characteristics, indicators, related outcomes, and treatments within a trauma patient population. A clinical epidemiologic study was conducted using a retrospective observational design. Level I trauma center data was used from the years of 2007-2009. Key data sources were Iowa Methodist Trauma registry, radiographic scans and notes, electronic medical records, and billing records. A case-control and a retrospective cohort design were used to address study objectives. Analyses included bivariate comparative tests along with multivariate logistic regression modeling. The study demonstrated that the majority of facial fractures in the patient population were diagnosed with maxillofacial computed tomography scans. Patients had a median of 2 (interquartile range: 2-4) facial fractures with the orbit bones being the most commonly fractured bones. Of patients with fracture, 48% had a direct or indirect health outcome related to their fracture and 51% of patients had their fracture left to self-resolve with minimal self-care. Statistically significant indicators of facial fracture included the presence of periorbital contusion, open wound of the forehead, epistaxis, blood in ethmoid sinus, and blood in maxillary sinus, while motor vehicle collision appeared to have a disproportionately low relationship with fracture. Based on these risk factors, three potential risk groups for facial fracture were proposed, stratifying study patients into subpopulations per their estimated risk level. Study results will help clinicians better understand facial fracture. The revealed indicators and risk levels for facial fracture may serve to help determine when fractures may be present in similar trauma patient populations. Further research should be conducted to validate the internal validity as well as the generalizability of study results in other trauma centers and patients.

Resource dependencies have increased substantially at colleges and universities over the years due to economic declines, recessionary periods, and decreased funding from state allocations. The purpose of this study was to advance an understanding of private support for higher education as a source of supplementary funding. As the environment continues to become more competitive for outside resources, institutions of higher education can benefit from more substantive and objective research on private voluntary support to better meet their growing needs for additional resources. Effective financial management requires a greater understanding of the expected size of financial contributions to assist with strategic planning and managing expenditure demands. This is especially true during periods of broad economic downturn when many institutions' revenue sources simultaneously suffer economic shocks through reduced endowment earnings; reductions in state appropriations; and external pressures by students, parents, and other stakeholders to keep tuition rates low. The same economic pressures that affect institutional revenue sources also affect the receipt of charitable contributions. Thus, the relationship between charitable donations and the economy is central to understanding whether these contributions help to stabilize the volatility of institutional revenues. This study examined private giving data reported to the Council for Aid to Education's annual Voluntary Support of Education survey from 1987 to 2012. Only gifts contributed by alumni, foundations, corporations, other individuals, and parents to public and private baccalaureate, master's, and doctoral institutions were considered. Giving data were adjusted through the Consumer Price Index, standardized by enrollment, and correlated with three economic indicators: Average Duration of Unemployment, Employees on Nonagricultural Payrolls, and the Standard & Poor's 500 Stock Price Index. The statistical analysis selected to examine each of the four research questions was multiple linear regression used to discover to what relationships exist between economic indicators and private giving to higher education by institutional type, institutional classification, and giving source. This study revealed that differences in private giving exist when correlated to economic indicators. Based on these results, it appears that charitable funding directed to support higher education institutions are based to some extent on resource providers' ability to expend support at particular times in the economic environment. As observed throughout all four research questions, the Average Duration of Unemployment indicator had a larger impact on charitable giving to higher education than did the Standard & Poor's 500 Stock Price Index indicator. The results of the Fisher's r to z transformations indicated that the regression model for alumni giving to public higher education institutions was determined to be the statistically strongest prediction model, followed by the regression model for foundation giving to public institutions. While fundraising continues to be only one source of additional funding, it cannot be ignored that the generosity of private donors since the earliest days of this country has helped to create, support and sustain the vital functions of colleges and universities. While the pursuit of private support may have been left primarily to the private institutions over the years, more recent developments in state and government funding patterns to higher education make the constant search for additional support sources a reality for today's public higher education institutions as well. Academic leadership must be cognizant that fiscal flexibility in times of economic prosperity as well as in times of economic downturns can be supplemented by the philanthropic intent of those interested in not only an institution's presence or prestige but also by its impact on students, families, communities, customers, and the economy. Institutions of higher education and their institutional advancement programs can greatly benefit from research studies that provide additional substantive and objective research.

This study aimed at investigating the current practices and methods adopted by roads agencies around the world with regard to collection, analysis and utilization of the data elements pertaining to the main pavement condition indicators in pavement management systems (PMS). It also aimed at identifying the main predictors associated with each condition indicator and the factors that govern pavement structural and functional performance. Development of a new performance index that incorporates parameters or measures related to the main condition indicators (surface defects, roughness, deflection and skid resistance) and establishing the weight to be assigned to each indicator based on the relative impact on pavement condition was also one of the main objectives of this study. Thousands of pavement sections were subjected to thorough testing and inspection over the last few years to collect data pertaining to the main condition indicators. The collected data encompass visual distress survey, deflection measurements, roughness and skid resistance measurements. Collection of various condition indicators was accomplished according to well known international standards. The collected data were processed, tabulated and analyzed for the purpose of development of performance models and to prove certain theories or good practices. / Advanced tools and machines were utilized to collect these data with a high degree of accuracy. The Falling Weight Deflectometer (FWD) was used to collect deflection data for structural analysis. Two Non-contact laser roughness measuring devices mounted on vehicles were heavily used for collecting roughness, texture, and rutting data. Distress data were collected using a manual procedure adopted and standardized at the Pavement Management System Unit of Dubai Emirate. Powerful engineering and statistical softwares were used in the analysis for the purpose of processing the data, back calculating the main parameters pertaining to pavement response, establishing the correlation matrices between various dependent variables and their predictors, and finally, applying linear and non linear regression analysis to develop reliable and predictable deterioration models for the uses of pavement management system. The analysis procedure was supplemented by a vast literature review for the up to date information along within deep investigations and verifications for some of the current practices, theories and models used in pavement design and pavement evaluation with more emphasis on the inherent drawbacks associated to these models and procedures. The study confirmed that pavement condition deterioration and performance can be best predicted and evaluated based on four main condition indicators; First, surface distress to assess the physical condition of the pavements and detect the inherent problems and defects caused by various factors affecting pavement performance. Second; roughness measurements to evaluate the riding quality of the pavement. / Third; deflection to calculate pavement response (stress and strains) and to assess pavement structural capacity and calculating the remaining life, and finally, skid resistance measurement to assess the level of safety and surface texture properties. Thorough study and investigation of the physical condition indicators and the associated parameters, confirmed that pavement distress data are vital elements in each pavement management system. Distress data can be used effectively to identify the main problems associated with pavement performance, causes of deterioration, maintenance measures needed to prevent the acceleration of the distress, the rehabilitation schemes needed to improve the pavement condition and finally to prepare maintenance work programs and to estimate the annual maintenance needs under an open or limited budget. Alligator cracking was found to have the heaviest impact on pavement condition. Distress density, probable causes of deterioration and distress propagation rate are the required parameters in PMS. Roughness was found to have a basic influence on pavement condition and the type of selected treatment. The use of Roughness data in terms of International Roughness Index (IRI) can be optimized in PMS by using this indicator in the following forms: / Roughness, as an objective measure, can be used as a good performance predictor of the current riding quality of pavements in service and reflects the inherent imperfections and built-in irregularities embodied in the road pavement surface. Roughness measurement can be used as a reference to establish construction specifications and provides through the PMS system an organized feedback approach to correct the persistent design deficiencies detected after road construction. Roughness can be used effectively in the planning process for maintenance works and to select the candidate sections through calculating the functional remaining life based on the estimated terminal value using Roughness-Age, Roughness-ESAL, and Roughness-PSI models. Lane–IRI along with the Difference between the left and right wheel IRI values, termed as “ Yaw” are the most suitable forms to be used in PMS to report about roughness characteristics. Yaw term can be used effectively to report or feed back about geometric imperfections that exist on the road surface such as improper cross slope, shoving and the probable drainage problems. The roughness cumulative distribution curves can be used as a planning tool in PMS to report at the network level. These curves indicate the network health and the required funding at different level of risks, so proactive measures can be taken and the required budgets can be made available. / Deflection data were found to form a basic component of the PMS. It was found that these data can be used at both network and project levels. Direct deflection measurements were found Not to be the ideal form to report about structural capacity at the network level. It is rather can be used at project level to detect weak spots and critical pavements layers. At the network level, the back calculated parameters from deflection basin such as Pavement Modulus (Ep), Asphalt and Pavement Curvature (CUR), Cross Sectional Area and the other deflection basin characteristics are much more appropriate for reporting about pavement structural conditions and calculating the structural remaining life in PMS. The design deflection and curvature that characterize the pavement have been found to be calculated based on the mean along with the two times the standard deviation of the measured data. The Effective Structural Number (SNeff) was found to have good correlations with the Total Pavement Thickness (Ht), the value of the deflection measured at the center of the loading plate ( D0 ) and the difference between D0 and the deflection measured at 450mm from the center of the loading plate ( D0 - D450 ). The first two variables were found to account for more than 92% of the structural capacity prediction model. / Traffic variable in terms of the accumulated standard repetitions (ESAL) was found to account for more than 60% of the deflection model predictability. Other variables such as E value, asphalt and base layer thicknesses can improve the predictability of the model if included. The concept of the relative value of effective pavement modulus to the original pavement modulus (Eeff/E0) was found to gives a reliable representation about the exhausted and the remaining life of the in-service pavement structure. The study showed that the pavement is reported to be structurally failed, when the effective asphalt or pavement modulus is about 20 - 35 % of its original design value which is equal to the modulus of the unbound material. It was also found that when the area of the fatigue cracking and the patching distresses exceeds 17% of the total pavement section area, or the depth of rutting is more than 15mm, the pavement is reported to be structurally failed and major rehabilitation or reconstruction should be applied. Skid resistance can be reported in the form of International Friction Index (IFI), as a well defined universal index, along with other two numbers; F60 Friction (Microtexture) related number measured at 60 km/h velocity and Macrotexture related number and Vp, which constitute the IFI index can be used in Pavement management system applications to report about skid resistance characteristics and the network level of safety. These three figures can be used to report about pavement condition, accidents, airports operations, and maintenance management surveys. / In this study, new methods and models were developed and suggested to be used in PMS as an alternative to the current available methods which were found to be impractical in certain cases. Finally, further research efforts are recommended to explore the uses of other parameters in particular those related to deflection basin analysis, cross sectional area, curvature, and pavement moduli. Skid resistance testing and reporting method should be subjected to further research works for the purpose of standardizing reporting methods, identifying the relative impact of main predictors i.e. megatexture, macrotexture and microtexture components and to develop performance models.

As healthcare and health systems become increasingly complex, expectations of what constitutes high quality care continue to evolve. Stakeholders now require contemporary and meaningful measures of system performance. As such, valid healthcare quality metrics are rapidly becoming essential for those providing and receiving healthcare to assess performance and motivate change. This thesis investigates the utility of quality indicators in trauma care. Multiple in-hospital indicators have been promulgated by various bodies for assessing quality of trauma care. The properties of ideal indicators have been widely documented however few published data have reported these properties for many trauma measures. The emphasis on trauma process measures (eg. time to interventions) highlights the need for indicators with known links to patient outcomes. This process-outcome link may be viewed as a measure of an indicator’s construct validity. As this property is unknown for many trauma indicators, this thesis focuses on the construct validity of a number of routinely utilised trauma indicators. In this thesis, the available in-hospital indicators proposed by The American College of Surgeons Committee on Trauma and additional indicators used in the Victorian State Trauma System were investigated for their relationships with patient outcomes. A small number of indicators were found to have statistically significant relationships with patient outcomes, however many indicators demonstrated counter-intuitive relationships, whereby high quality care was linked with poorer patient outcomes. These results suggested that links between indicators and outcomes may not be best measured using individual indicators for individual patients. Rather, a strategy for measuring patient outcomes at the hospital level may be needed. To combine multiple indicators into a single measure of hospital level performance, a number of composite methods were explored using two trauma registries. Three composite weighting schemes were employed. As composite measures are often used for provider ranking or benchmarking, the stability of hospital ranks between providers and over time was investigated. The composites were found to have moderate to strong correlations (0.76-0.99) however variability in composite hospital rankings existed, particularly for middle ranking facilities. The construct validity of each available indicator and composite score was investigated through the relationship with hospital level risk-adjusted mortality using Poisson regression models, risk adjusting for expected deaths using the TRISS formulation. Each composite measure demonstrated a significant association with mortality, with the mortality decrease across the middle 50% of each composite score ranging from 12.06% – 16.13%. These findings suggest that complex measures such as trauma composite indices may be better able to measure the interactions between processes within complex systems that influence quality of care. This thesis adds valuable insight into the use of indicators for assessing quality of care in trauma systems. The combination of individual indicators into composite forms appears to strengthen the construct validity of these measures. By demonstrating the process-outcome link for trauma composite indices, this thesis has identified a means of utilising process measures to assess hospital level performance that may become important for future public reporting and hospital funding schemes.

Thesis (Ph.D.)--McMaster University, 2006. / Supervisors: Martin D. Dooley ... [et al.]. Includes bibliographical references (p. 304-318).

<p>The aim of this thesis was to identify important aspects of surgical nursing care, designing strategic and clinical quality indicators in postoperative pain management, investigate content validity, develop and evaluate psychometric properties of an instrument to measure the indicators, test the applicability of the instrument and investigate patient and nurse assessment.</p><p>To identify the important aspects of nursing care which might impact on quality of care in surgical wards, it was conducted 4 focus group interviews with clinical nurses (n=20). A tentative model with 15 categories in 2 dimensions, elements of performance and prerequisites, emerged from the data analysis. The categories were, e.g. detecting and acting on signs and symptoms, informing and educating, promoting relationships, responsibility and attitudes. The model was used as a foundation for developing indicators in postoperative pain management, one in each category, each supported by a literature review. To assess the content validity of the indicators, a questionnaire was compiled and sent to registered nurses with a special interest in pain (n=210) and to a random sample of clinical nurses working in surgical wards (n=321). The groups assessed the indicators as essential for achieving high quality, realistic to carry out and possible for nurses to influence management. The first group validated 14 of the 15 indicators and the second group validated 12 as “major” factors in terms of being essential to achieve high quality of care. The remaining factors were classified as “supportive”. No indicator was discarded.</p><p>To measure the indicators, an instrument was developed and psychometric properties were evaluated. The indicators were converted to statements suitable for a patient questionnaire and were scored on a 5-point scale with higher values indicating higher quality of care. Patients (n=198) answered the questionnaire on their second postoperative day. The inter-item and item-total correlation coefficients were in a satisfactory range, and Cronbach’s coefficient alpha (0.84) supported internal consistency reliability. Four sub-scales, entitled communication, action, trust and environment emerged from the factor analysis with a total variance of 61.4%. The total scale correlated (rs=0.53) with the single item pain-relief-satisfaction question. The patients who reported more pain than expected scored lower on the total scale and the patients who received epidural analgesia reported higher scores on the total scale. A nurse questionnaire, similar to the patient questionnaire, was compiled. The responsible nurse at the time (n=63) answered 196 questionnaires paired with the individual patient. The new instrument appeared to be useful in identifying important areas for improvement both from the patients’ and nurses’ perspectives, based on the number of disagreements (1 and 2). Differences were found among departments. The patients’ assessments on the environment sub-scale and the overall satisfaction question were higher than the nurses’ assessments. The findings suggest initial support for the instrument as a means to measure the quality of nursing care in postoperative pain management. Key words: quality indicators; health care, pain; postoperative, focus groups, psychometrics, questionnaires, nursing care.</p> / On the day of the public defence of the doctoral thesis the status of the articles III was: Accepted; article IV and V was: Accepted for publishing.

<p>The purpose of this paper was, on the basis of the association’s annual reports, to describe appropriate key performance indicators for non-profit associations. The purpose was furthermore to study how the associations show their goal-attainment.</p><p> </p><p>The research was delimited to contain the second category of non profit associations, which include sports associations. The authors choose three non profit associations, which according to the law, shall draw up annual reports. The three ice hockey associations HV71, MODO Hockey and Frölunda Hockey Club, were thereafter chosen on the basis of those delimits. The research was furthermore delimited to include the parent associations only.  </p><p> </p><p>The authors obtained the basis of the paper through studies of literature and annual reports and via an interview. The authors described different key performance indicators based on these studies and analytical assumptions.</p><p> </p><p>In the study it appeared that all of the three studied associations largely present their goal-attainment in the statement of activity, which is a part of the annual report. The financial key performance indicators that appeared were “the equity ratio” and “the gross profit margin”, which are considered to be appropriate for these three sport associations. It also appeared that the described appropriate non financial key performance indicators could be used as statistical measures to show the three studied association’s goal-attainments and with that consolidate the credibility in their annual reports.   </p>

<p>Bakgrund: Schizofreni är en sjukdom som drabbar cirka 1 % av befolkningen, men en evidensbaserad, effektiv behandling med få biverkningar saknas. Denna litteraturstudie syftar till att kartlägga kvalitetsindikatorer som utgör grunden för en god omvårdnad av patienter med schizofreni. Syfte: Att sammanställa och belysa kvalitetsindikatorer som förväntas säkerställa en god kvalitet i omvårdnad och bemötande av patienter med schizofreni. Design: Litteraturstudie Metod: Litteraturstudie av 17 vetenskapliga artiklar, en review-artikel samt fyra debattartiklar om behandling av schizofreni, som analyserats och kvalitetsgranskats för att kunna belysa vilka faktorer som utgör kvalitetsindikatorer vid omvårdnad av patienter med schizofreni. Resultat: Kvalitetsindikatorer vid omvårdnad av patienter med schizofreni är ett holistiskt synsätt där patienten står i centrum och vården ges av välutbildade vårdgivare. Patienten ska erbjudas möjlighet att vara aktiv i sin behandling. Behandlingsmetod ska väljas och/eller kombineras efter patientens individuella behov och önskemål samt syfta till att involvera anhöriga i vårdprocessen. Slutsats: Det finns många omvårdnadsmetoder för schizofreni, vilken som ger bäst effekt varierar då diagnosen är mycket individuell. Det är viktigt att vårdgivare i samråd med patienten anstränger sig för att finna den metod som passar individen bäst.</p> / <p>Background: Schizophrenia is a psychiatric diagnosis which affects about 1 % of the population. However, there is no evidence based effective treatment with limited side-effects available. This literature review seeks to clarify quality indicators which constitute the basis for a good treatment and care for patients with schizophrenia. Aim: To compile and illuminate quality indicators expected to guarantee good quality of the care and treatment received by patients with schizophrenia. Design: Literature study. Methods: For this review 17 scientific articles, one review and four papers on the subject of treatment of schizophrenia were analyzed and quality examined in order to illuminate the factors which constitute the basis of quality indicators for good treatment and care for patients with schizophrenia. Results: Quality indicators in caring for patients with schizophrenia constitute a holistic, patient centered approach. The caregivers are well educated and the patient is encouraged to take an active part in the treatment. The method of treatment should be chosen and/or combined in accordance with the patient’s individual needs and wishes. It also aims to include close relations in the caring process. Conclusion: There are many methods of treatment available for schizophrenia. It is however a very individual diagnosis, and which treatment gives the best effect varies from case to case. It is important that caregivers, while including the patient in the process, strive to find the method most suited to the individual.</p>

Thesis (M.Com. (Management Accounting))--North-West University, Potchefstroom Campus, 2007.

Thesis (M.Com. (Risk Management))--North-West University, Potchefstroom Campus, 2009.