Magister Chirurgiae Dentium - MChD / Mandibular fractures are common facial injuries, occurring twice as frequently as fractures of the bones of the midface. Only the nasal bones are fractured more often as the result of trauma to the face (Olson eta/ 1982; Theriorletal 1987; Shepherd et al 1988; Dodson et al 1990; Lownie et al 1996). In many oral and maxillofacial units, the treatment of fractures of the mandible form the major proportion of the services rendered. Internationally it is accepted that there are two methods of treatment for fractures of the mandible, namely, closed and open reduction. Closed reductions are performed in dentate patients either under local or general anaesthesia. This method entails the placement of eyelet wires between or around teeth in both arches and then placing the patient into intermaxillary fixation. This is the method of choice when treating an undisplaced fracture of the mandible.

Purpose – The purpose of this paper is to propose a systematic approach to measuring, tracking, monitoring and continuously improving efficiency, availability and quality in healthcare operational settings. Design/methodology/approach – The proposed measure of healthcare operational effectiveness (HOE) consists of three indicators. They include an availability indicator, an quality indicator, and an efficiency indicator. The proposed approach tends to facilitate the systematic improvement at the different facets of operational effectiveness. Findings – The proposed operational performance approach based on the HOE is consistent with the themes of performance measures and measurement reported in the literature. Research limitations/implications – The proposed healthcare operational effectiveness approach represents a serious attempt at quantifying the key facets of service effectiveness in healthcare operational settings. The validation of this performance assessment and measurement approach is worthy of future research. Practical implications – The approach advocated by the HOE has operational and strategic relevance to decision makers of healthcare organizations. Originality/value – This paper presents a practical, systematic approach toward enhancing operational effectiveness in healthcare organizations. Relevant implementation issues associated with the proposed approach are also addressed.

La presente tesis fue elaborada con la finalidad de analizar la asignación de costos en el proceso productivo del arroz y su incidencia en la toma de decisiones financieras. La evaluación se dará en las empresas molineras de la región San Martin en Tarapoto en el año 2018, ya que producen arroz y ofrecen servicios de molino. Bajo este escenario, nuestra tesis se desarrolla en el sector agrícola, especialmente en el del arroz, que es un producto básico para las canastas familiares en todo el país. Por ello, se analizará desde el proceso de cultivo del arroz hasta la cosecha y comercialización, para verificar si están optimizando recursos. En adición a ello, la función de la correcta asignación de los costos y gastos incurridos durante la etapa de producción es que exista un control financiero para determinar cómo viene realizando sus operaciones la empresa. El impacto que trae consigo nuestra tesis, es también de validar el alcance de las políticas contables; como la NIC 2 Inventarios y NIC 41 Agricultura principalmente en el sector agrícola, ya que muchas veces, la norma no es muy clara del todo y no tiene un alcance completo para el sector, por lo mismo que la industria tiene factores ajenos (ambientales principalmente) que hace más complicada el manejo de sus procesos internos. De esta forma, realizamos la presente tesis para que sirva como aporte a las empresas del sector, a que pueden generar ventajas competitivas, a través del control interno y de su correcta aplicación de la norma contable. Esto genera que se puede tomar mejores decisiones financieras y evaluar si los productos que ofrecen a los diversos clientes, generan rentabilidad y valor agregado para la empresa. Ya que, si se logra identificar mejoras en las etapas de producción, la empresa va tener mejor posición en el sector, y en consecuencia, mayores ingresos y recursos para mejorar infraestructura, tecnología, etc. / This thesis was prepared in order to analyse the allocation of costs in the rice production process and its impact on financial decision-making. The evaluation will be given in the mill companies of the San Martin region in Tarapoto in 2018, since these companies produce rice and offer mill services. Under this scenario, our thesis is developed in the agricultural sector since, at present, it is one of the markets that is constantly growing, especially that of rice, which is the basic product for family baskets around the country. In turn, if from the rice cultivation process to harvest and marketing, they are optimizing resources. In addition to this, the function of the correct allocation of costs and expenses incurred during the production stage is that there is a financial control to determine how the company is carrying out its operations. The impact that our thesis brings is also to validate the scope of accounting policies; such as IAS 2 Inventories and IAS 41 Agriculture mainly in the agricultural sector, since many times, the standard is not very clear at all, so the industry has other factors (mainly environmental) that makes the management of its internal processes. In this way, we carry out this thesis to serve as a contribution to companies in the sector, which can generate competitive advantages, through internal control and its correct application of the accounting standard. This generates that you can make better financial decisions and evaluate whether the products they offer to the various clients generate profitability and benefit for the company. Since, if it is possible to identify improvements in the production stages, the company will have a better position in the sector, and consequently, greater revenues and resources to improve infrastructure, technology, etc. / Tesis

Thesis (M.S.)--Massachusetts Institute of Technology, Dept. of Civil Engineering, 1980. / MICROFICHE COPY AVAILABLE IN ARCHIVES AND ENGINEERING. / Bibliography: leaves 88-89. / by Sergio Rodolfo Jara Díaz. / M.S.

A barrier cited by primary care administrators in integrating behavioral health is financial risk. Fee-for-service billing mechanisms remain complex and there is little empirical guidance on cost-effective models. This study was an economic evaluation of an integrated care model in a pediatric private practice clinic. The study evaluated cost benefits by examining specific delivery indices such as concerns presented, time spent, billing codes used, and reimbursement received in regards to pediatric primary care visits by comparing days when an on-site Behavioral Health Consultant (BHC) was available versus Non-BHC Days. All 3 hypotheses were supported: 1) more patients were seen in clinic on BHC Days; 2) more revenue was generated on BHC Days; and 3) incorporation of the BHC was cost-effective. Findings showed that time saved by having a BHC onsite increased provider productivity, resulting in an additional $1,142 in revenue generated on a BHC Day when compared to a Non-BHC Day.

"But how do you pay for it?" Sigh no more! The indirect benefits of hiring a Behavioral Health Consultant have been demonstrated in large health care industry but not in small, stand-alone practices. Until now! In this session, we will tell you how we answered this worn-out question with a short study comparing productivity and income in one small rural pediatric practice on days with a BHC and days without. Come find out how we showed the providers and staff how this practice saved over $1,000 per day when the BHC was present. We'll also talk about how we've marketed this data to other practices and third party payers.

Much research has explored the cost effectiveness of psychotherapy for schizophrenia. However, to date, no studies have investigated the cost effectiveness of family and individual therapy for schizophrenia in the "real world" of managed care. The purpose of the present study is to compare the cost effectiveness of individual and family therapy for schizophrenia in one leading Health Care Insurer: CIGNA. Six years of outpatient data (2001–2006) and more than 2,100 unique schizophrenic outpatients are included. Research questions in this study concern the total treatment costs, the cost effectiveness, recidivism rates and the dropout rates of individual and family outpatient therapy. The findings show that family therapy is a more cost effective treatment than individual therapy by having lower total treatment costs and recidivism rates. However, family therapy has higher dropout rates than individual therapy.

Erosion is a natural process that occurs when soil particles are detached from one site and transported to another by water or wind, and can occur naturally or be accelerated by humans. Sediment can cause direct mortality or reduce growth of fish and other aquatic resources, particularly larval fish and eggs. Three treatments consisting of compost and jute netting, crimped straw with native seeds, and jute netting and vegetation filter strip were used to evaluate loss of runoff water and sediment on steep slopes. Erosion plots were built on slopes of 27 percent and filled with soil. The treatments were applied in triplicate and irrigated at 14-day intervals. Each erosion plot was irrigated with approximately 79 gallons of water for 10 hours and runoff was collected in pre-weighed containers during each period. After each collection, runoff from each plot was measured and recorded by subtracting the weight of each empty container from the combined weight of water and sediment. Turbidity, pH, and electrical conductivity were measured, and the separate weights of runoff and dry sediment were determined. The combination of jute netting over a layer of commercially available compost was over 99 percent effective at reducing runoff and sediment loss as compared to the untreated control erosion plots. Jute netting combined with a vegetative filter strip of creeping wild rye was over 94 percent and 99 percent effective at reducing runoff and sediment loss when compared to the untreated control erosion plots, respectively. Runoff and sediment loss from plots treated with crimped straw and native seeds was significantly greater than that of the other treatments, yet this treatment was over still 80 percent effective at reducing runoff and nearly 97 percent effective at reducing sediment loss. The cost-effectiveness of each treatment was evaluated based on the cost of the total treatment compared to the amount of water each treatment prevented from leaving the site, using the control plots as a baseline. The combination of jute and vegetation filter strip cost approximately $0.47 per liter of water prevented from leaving the site and was almost as effective at reducing runoff and sediment loss as was jute combined with compost, which cost $1.04 per liter. While each of the three treatments significantly reduced runoff and sediment loss when compared to the barren control plots, the jute and filter strip treatment was the most cost-effective of the three treatments. All treatments were effective at decreasing runoff and sediment loss when compared to the control, though no significant difference in runoff was observed between the control and any of the treatments after ten weeks. Thus, erosion control BMPs should be implemented well before the first storm causing runoff in order to be most effective.

To fill a gap in the literature and to better inform decision making in oncology, this doctoral thesis investigates the role and impact of analytical methods in the economic evaluation of oncology medications through three main chapters which have been recently published. Chapter 2 presents a systematic literature survey of published economic evaluations in oncology over a 10-year period in order to identify, examine, and describe analytical methods that have been utilized (published in Pharmacoeconomics Open in 2021). This chapter demonstrated that greater detail in reporting of extrapolation methods, statistical techniques, and validation procedures is needed in order to conform with best practices outlined in existing economic evaluation guidelines. Chapter 3 complements the work of chapter 2 but takes a different perspective through an examination of the methods reported in economic evaluations published by HTA agencies in Canada, the UK, and Australia (published in Current Oncology in 2022). This chapter revealed significant reporting discrepancies across the agencies and concluded that common standards for reporting the results of HTAs should be implemented. Building on chapters 2 and 3, chapter 4 provides a model-based health technology re-assessment of an oncology drug approved on the basis of interim trial data using recently published long-term follow up data (published in Current Oncology in 2023). The findings from this chapter highlight the importance of transparency in the reporting of methods, the impact of using a life-cycle approach to HTA, and demonstrate the existence of a tradeoff between clinical/economic uncertainty and the value of the incremental cost-effectiveness ratio (ICER). The final chapter provides the overall conclusions of the research and presents avenues for future research. / Thesis / Doctor of Philosophy (PhD)

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