IMPORTANCE Multiple factors can be associated with the delayed repair of maxillofacial injuries that may be associated with increased morbidity. OBJECTIVE To assess factors affecting timing of repair and barriers which may exist in the management of maxillofacial trauma. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study at a tertiary care facility used the Current Procedural Terminology coding to identify adult patients undergoing operative repair of maxillofacial injuries between January 2010 and December 2013. Demographic information, presence and severity of concomitant injuries, as well as fracture-specific data including fracture type(s), mechanism of injury, and documented complications were recorded. Identifiable delays for medical, logistical, or other reasons were also documented. Multivariate regression modeling was used to determine factors associated with increased time to repair. A comparative analysis was used to identify association between complications and time to operative repair. MAIN OUTCOMES AND MEASURES Time to operative repair from date of presentation; association of known operative delay and perioperative complications. RESULTS Overall, 780 patients were included in the study. Of patients meeting inclusion criteria, mean (SD) age was 36.7 (14.2) years (range, 18-88 years), and 616 patients (79%) were male. Average time to repair was 6.5 days (range, 0-43 days), and 138 patients (17.7%) were observed to have a documented reason for delay for medical reasons (n = 62 [44.9%]), operating room logistical factors (n = 17 [12.3%]), or other reasons (n = 59 patients [42.8%]) either as a function of delayed patient presentation or failure of patients to make scheduled appointments or operations. Injury severity score (ρ = 0.45; P < .001), concurrent injuries (P < .001), decreased Glasgow Coma Scale (P < .001) and inpatient status at time of surgery (P < .001), were associated with increased time to repair. The observed complication rate was 13.6%. There was no statistically significant association between known operative delay and development of complications (χ 2 1 = 2.92; P = .08). CONCLUSIONS AND RELEVANCE Management of maxillofacial trauma appears to occur in a timely manner. Patient injury severity appears to have the greatest effect on timing of repair. While delays in operative repair may be unavoidable in certain circumstances, streamlining and managing causes of known delay may help improve and expedite patient care. LEVEL OF EVIDENCE 3.

Purpose The purpose of this paper is to investigate the effect of gamification design elements of virtual corporate social responsibility (CSR) game on customers’ continuance intention to participate in social value co-creation and the mediation effect of psychological benefit. Design/methodology/approach Three scenario simulation experiments of the between-subjects design were conducted to examine the influencing mechanism of reward mechanism of virtual CSR game on customers’ continuance intention to participate in social value co-creation. Findings The findings indicated that: there are significant differences between the effect of behavior-based reward and result-based reward on customers’ continuance intention to participate in social value co-creation; the psychological benefit plays a moderating role between game reward mechanism and customers’ intention to continuously participate in social value co-creation; the game narrative mode plays a moderating role in the influence of game reward mechanism on customers’ intention to continuously participate in social value co-creation; the background for game placement moderates the interactions of game narrative mode and game reward mechanism on customers’ continuance intention to participate in social value co-creation, namely there is significant interaction of gamification design elements on psychological benefit and customers’ continuance intention to participate in social value co-creation. Research limitations/implications This research has the following limitations. First, restricted by research conditions, the game scene, as the experiment material, can only be exposed to the participants in the form of text, thus customers’ psychological benefit (especially the entertainment experience) may be affected. Second, theoretical argument and literature support were not enough when the authors put forward the research hypotheses, due to the lack of research on the application of gamification in the CSR field. Third, considering the complexity, the authors took the psychological benefit as a unidimensional variable, in this research; it may be funnier to divide it into three variables. Finally, because the game design elements form into a virtual customer environment that jointly influences customers’ psychological benefit, the method of qualitative comparative analysis can be considered in future research. Practical implications It provides insights for marketers on the planning and design of a CSR strategy. The conclusions of this research have a certain guiding significance to the formulation of CSR strategy and the practice of social value co-creation. First, enterprises can apply gamification to the design of virtual CSR projects to promote customers’ continuance intention to participate in social value co-creation. Second, on the consideration of customers’ psychological benefit, enterprises should reasonably match such game design elements as game placement background, game narrative mode and game reward mechanism, when designing a virtual CSR game, so as to promote customers continuously participating in a virtual CSR project. Social implications Virtual CSR projects are in fact the activities that enterprise co-create social value with their stakeholders. So, the research on customers’ continuous participation in virtual CSR projects is helpful for increasing social welfare. Originality/value This study confirms the effect of reward mechanism of a virtual CSR game on customers’ continuance intention to participate in social value co-creation from the perspective of customer psychological benefit. It also provides insights for marketers on the planning and design of a CSR strategy.

No abstract