PrefaceService quality has attracted considerable attention within the tertiary education sector, but despite this, little work has been concentrated on identifying its determinants from the standpoint of students being the primary customers. Thus, it would seem rational to develop a new measurement scale that incorporates not only the academic components, but also aspects of the total service environment as experienced by the student. Likewise, there are many areas of disagreement in the debate over how to measure service quality, and recent research has raised many questions over the principles on which the existing instruments are founded. Although these generic instruments have been tested with some degree of success in wide-ranging service industries, but their replication in higher education sector is still hazy. This paper describes the methodological development of HEdPERF (Higher Education PERFormanceonly), a new measuring instrument of service quality that captures the authentic determinants of service quality within the higher education sector. The proposed 41-item instrument has been empirically tested for unidimensionality, reliability and validity using both exploratory and confirmatory factor analysis (CFA). Such valid and reliable measuring scale would be a tool that tertiary institutions could use to improve service performance in the light of increased competition with the development of global education markets. The results from the current study are crucial because previous studies have produced scales that bear a resemblance to the generic measures of service quality, which may not be totally adequate to assess the perceived quality in higher education. Furthermore, previous researches have been too narrow, with an overemphasis on the quality of academics and too little attention paid to the non-academic aspects of the educational experience.Research findings confirmed that the six dimensions, namely, non-academic aspects, academic aspects, reputation, access, programme issues and understanding were distinct and conceptually clear. Therefore, it can be posited that student perceptions of service quality can be considered as a six-factor structure consisting of the identified six dimensions. Consequently, tertiary institutions should assess all the six dimensions of service quality to ascertain the level of services provided, and to determine which dimensions need improvement. Evaluating service quality level and understanding how various dimensions impact overall service quality would ultimately enable tertiary institutions to efficiently design the service delivery process. In addition, knowing the strengths and weaknesses of these dimensions and their relative influence may result in better allocation of resources so as to provide a better service to students.While many service quality attributes may influence a student's perception to a certain extent, the results also indicate that access, which relates to such aspects as approachability, ease of contact, availability and convenience has...

Purpose-This paper aims to test and compare the relative efficacy of three measuring instruments of service quality (namely Higher Education PERFormance (HEdPERF), SERVPERF and the moderating scale of HEdPERF-SERVPERF) within a higher education setting. The objective was to determine which instrument had the superior measuring capability in terms of unidimensionality, reliability, validity and explained variance. Design/methodology/approach-After a pilot test, data were collected from students in two public universities, one private university and three private colleges in Malaysia between January and March 2004, by the "contact person" route. From a total of 560 questionnaires, 381 were usable: a response rate of 68.0 per cent. This sample of nearly 400,000 students in Malaysian tertiary institutions was in line with the generalized scientific guideline for sample size decisions. Data were subjected to regression analysis. Findings-A modified five-factor structure of HEdPERF is put forward as the most appropriate scale for the higher education sector. Research limitations/implications-Since this study only examined the respective utilities of each instrument within a single industry, any suggestion that the HEdPERF is generally superior would still be premature. Nonetheless, the current findings do provide some important insights into how these instruments of service quality compare with one another. Practical implications-The single dominant factor on this study is "access", which has clear implications for institutions' marketing strategies. Originality/value-This is believed to be the first study of its kind carried out among consumers of the higher education service.

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Background Appendicitis remains a common indication for urgent surgical intervention in the United States, and early appendectomy has long been advocated to mitigate the risk of appendiceal perforation. To better quantify the risk of perforation associated with delayed operative timing, this study examines the impact of length of inpatient stay preceding surgery on rates of perforated appendicitis in both adults and children. Methods This study was a cross-sectional analysis using the National Inpatient Sample and Kids’ Inpatient Database from 1988–2008. We selected patients with a discharge diagnosis of acute appendicitis (perforated or nonperforated) and receiving appendectomy within 7 d after admission. Patients electively admitted or receiving drainage procedures before appendectomy were excluded. We analyzed perforation rates as a function of both age and length of inpatient hospitalization before appendectomy. Results Of 683,590 patients with a discharge diagnosis of appendicitis, 30.3% were recorded as perforated. Over 80% of patients underwent appendectomy on the day of admission, approximately 18% of operations were performed on hospital days 2–4, and later operations accounted for <1% of cases. During appendectomy on the day of admission, the perforation rate was 28.8%; this increased to 33.3% for surgeries on hospital day 2 and 78.8% by hospital day 8 (P < 0.001). Adjusted for patient, procedure, and hospital characteristics, odds of perforation increased from 1.20 for adults and 1.08 for children on hospital day 2 to 4.76 for adults and 15.42 for children by hospital day 8 (P < 0.001). Conclusions Greater inpatient delay before appendectomy is associated with increased perforation rates for children and adults within this population-based study. These findings align with previous studies and with the conventional progressive pathophysiologic appendicitis model. Randomized prospective studies are needed to determine which patients benefit from nonoperative versus surgically aggressive management strategies for acute appendicitis.

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Objective: Gastroschisis is a rare congenital abdominal wall defect through which intraabdominal organs herniate and it requires surgical management soon after birth. The objectives of this study were to profile patient characteristics of this anomaly utilizing data from two large national databases and to validate previous risk stratification categories of infants born with this condition.Methods: An analysis was performed using 13 years of the National Inpatient Sample database (1988-1996, 1998, 1999, 2001, 2002) and 3 years of the Kids' Inpatient Database (1997, 2000. These combined databases contain information from nearly 93 million discharges in the United States. Infants with gastroschisis were identified by International Classification of Disease-9 procedure code 54.71 (repair of gastroschisis) and an age at admission of <8 days. Variables of gender, race, geographic region, co-existing diagnoses, length of stay, hospital charges adjusted to 2005 dollars, complications and inpatient mortality were collected from the databases. Infants were divided into simple and complex categories based on the absence or presence of intestinal atresia, stenosis, perforation, necrosis or volvulus. Comparisons between groups were performed using Pearson's w 2 for categorical outcomes and the Kruskal-Wallis test for non-normally distributed continuous variables.Results: A total of 4344 infants with gastroschisis were identified. These were comprised of 44.0% female infants (n ¼ 1910), 46.4% male infants (n ¼ 2017) whereas 9.6% were not reported (n ¼ 415). Racial analysis showed the largest subset being white in 40.9% of infants (n ¼ 1775) with Hispanic infants being the next highest group reported at 17.2% (n ¼ 745). Co-existing intestinal anomalies were the most common, affecting 9.9% (n ¼ 429) infants, whereas certain cardiac (6.8%, n ¼ 294) and pulmonary (1.7%, n ¼ 72) conditions were also identified. Simple gastroschisis represented 89.1% (n ¼ 3870) of the group whereas 10.9% (n ¼ 474) were complex in nature. Simple and complex patients differed in median length of stay (28 vs 67 days, P<0.01), inpatient mortality (2.9 vs 8.7%, P<0.01) and median inflation-adjusted hospital charges ($90 788 vs $197 871, P<0.01).Conclusions: These data represent a national analysis of the largest group of infants with gastroschisis to date which further aids the characterization and understanding of this serious congenital condition.