A performance assessment method for hospitals:the case of municipal hospitals in Angola

Over 60% of the recurrent budget of the Ministry of Health (MoH) in Angola is spent on the operations of the fixed health care facilities (health centres plus hospitals). However, to date, no study has been attempted to investigate how efficiently those resources are used to produce health services. Therefore the objectives of this study were to assess the technical efficiency of public municipal hospitals in Angola; assess changes in productivity over time with a view to analyzing changes in efficiency and technology; and demonstrate how the results can be used in the pursuit of the public health objective of promoting efficiency in the use of health resources. The analysis was based on a 3-year panel data from all the 28 public municipal hospitals in Angola. Data Envelopment Analysis (DEA), a non-parametric linear programming approach, was employed to assess the technical and scale efficiency and productivity change over time using Malmquist index.The results show that on average, productivity of municipal hospitals in Angola increased by 4.5% over the period 2000-2002; that growth was due to improvements in efficiency rather than innovation. © 2008 Springer Science+Business Media, LLC.

Quantitative risk assessment of groundwater quality utilizing GIS technology and coupled groundwater models

The thesis presents a two-dimensional Risk Assessment Method (RAM) where the assessment of risk to the groundwater resources incorporates both the quantification of the probability of the occurrence of contaminant source terms, as well as the assessment of the resultant impacts. The approach emphasizes the need for a greater dependency on the potential pollution sources, rather than the traditional approach where assessment is based mainly on the intrinsic geo-hydrologic parameters. The risk is calculated using Monte Carlo simulation methods whereby random pollution events were generated to the same distribution as historically occurring events or a priori potential probability distribution. Integrated mathematical models then simulate contaminant concentrations at the predefined monitoring points within the aquifer. The spatial and temporal distributions of the concentrations were calculated from repeated realisations, and the number of times when a user defined concentration magnitude was exceeded is quantified as a risk. The method was setup by integrating MODFLOW-2000, MT3DMS and a FORTRAN coded risk model, and automated, using a DOS batch processing file. GIS software was employed in producing the input files and for the presentation of the results. The functionalities of the method, as well as its sensitivities to the model grid sizes, contaminant loading rates, length of stress periods, and the historical frequencies of occurrence of pollution events were evaluated using hypothetical scenarios and a case study. Chloride-related pollution sources were compiled and used as indicative potential contaminant sources for the case study. At any active model cell, if a random generated number is less than the probability of pollution occurrence, then the risk model will generate synthetic contaminant source term as an input into the transport model. The results of the applications of the method are presented in the form of tables, graphs and spatial maps. Varying the model grid sizes indicates no significant effects on the simulated groundwater head. The simulated frequency of daily occurrence of pollution incidents is also independent of the model dimensions. However, the simulated total contaminant mass generated within the aquifer, and the associated volumetric numerical error appear to increase with the increasing grid sizes. Also, the migration of contaminant plume advances faster with the coarse grid sizes as compared to the finer grid sizes. The number of daily contaminant source terms generated and consequently the total mass of contaminant within the aquifer increases in a non linear proportion to the increasing frequency of occurrence of pollution events. The risk of pollution from a number of sources all occurring by chance together was evaluated, and quantitatively presented as risk maps. This capability to combine the risk to a groundwater feature from numerous potential sources of pollution proved to be a great asset to the method, and a large benefit over the contemporary risk and vulnerability methods.

Assessment of time frequency warping for use as a reference degradation for assessing synthetic speech

At present there is no standard assessment method for rating and comparing the quality of synthesized speech. This study assesses the suitability of Time Frequency Warping (TFW) modulation for use as a reference device for assessing synthesized speech. Time Frequency Warping modulation introduces timing errors into natural speech that produce perceptual errors similar to those found in synthetic speech. It is proposed that TFW modulation used in conjunction with a listening effort test would provide a standard assessment method for rating the quality of synthesized speech. This study identifies the most suitable TFW modulation variable parameter to be used for assessing synthetic speech and assess the results of several assessment tests that rate examples of synthesized speech in terms of the TFW variable parameter and listening effort. The study also attempts to identify the attributes of speech that differentiate synthetic, TFW modulated and natural speech.

Concepts and methods of quantitative assessment of risk to groundwater resources

This work presents a two-dimensional approach of risk assessment method based on the quantification of the probability of the occurrence of contaminant source terms, as well as the assessment of the resultant impacts. The risk is calculated using Monte Carlo simulation methods whereby synthetic contaminant source terms were generated to the same distribution as historically occurring pollution events or a priori potential probability distribution. The spatial and temporal distributions of the generated contaminant concentrations at pre-defined monitoring points within the aquifer were then simulated from repeated realisations using integrated mathematical models. The number of times when user defined ranges of concentration magnitudes were exceeded is quantified as risk. The utilities of the method were demonstrated using hypothetical scenarios, and the risk of pollution from a number of sources all occurring by chance together was evaluated. The results are presented in the form of charts and spatial maps. The generated risk maps show the risk of pollution at each observation borehole, as well as the trends within the study area. This capability to generate synthetic pollution events from numerous potential sources of pollution based on historical frequency of their occurrence proved to be a great asset to the method, and a large benefit over the contemporary methods.

Activity and affect:repeated within-participant assessment in people after joint replacement surgery

Objective: Between-participant research has shown that high negative affectivity predicts greater activity limitations and vice versa. This study examined both between- and within-participant associations of negative and positive affectivity with activity levels using ecological momentary assessment. Method: Participants were 25 people who had undergone joint replacement surgery 12 months previously. Participants made multiple reports of their activity and positive and negative affectivity over a single day using, a computerized diary. Activity was also objectively recorded using an activity monitor. The following day, participants made a self-report of their activity over the measurement day and general positive and negative affectivity levels were recorded. Results: Higher self-reported walking time over the whole measurement day was associated with higher general positive affectivity but not negative affectivity. However, using ecological momentary assessment, higher diary reports of negative affectivity predicted increased activity levels while positive affectivity neither predicted nor was predicted by activity. Conclusion: These findings demonstrate the importance of within-participant methodology in detecting subtle and immediate effects of individuals' mood on behavior that may differ from findings investigating between-participant effects over longer time periods.

Life cycle assessment in the food supply chain:a case study

This research aims at assessing the environmental impact of the poultry supply chain from cradle to grave using case study research and also life cycle assessment (LCA). While a limited number of generic poultry production LCA studies have been published, fewer yet assess the whole process of a specific organisation, none comparing the increased impact of further processing. Our results show that irrespectively of the impact assessment method utilised, the process of producing portions is considerably higher in total environmental impact due to the extra raw material required to produce the same mass into retail. Our research contributes to the growing number of LCA studies and could be used by practitioners for comparison against national and international averages. From a theoretical point of view, this research provides new insights into the relationship between vertically integrated supply chains and environmental performance which has not been examined in the past.

A study of the effect of harmonics in the system on the performance of residual current-operated circuit-breakers and electromechanical overcurrent relays

Residual current-operated circuit-breakers (RCCBs) have proved useful devices for the protection of both human beings against ventricular fibrillation and installations against fire. Although they work well with sinusoidal waveforms, there is little published information on their characteristics. Due to shunt connected non-linear devices, not the least of which is the use of power electronic equipment, the supply is distorted. Consequently, RCCBs as well as other protection relays are subject to non-sinusoidal current waveforms. Recent studies showed that RCCBs are greatly affected by harmonics, however the reasons for this are not clear. A literature search has also shown that there are inconsistencies in the analysis of the effect of harmonics on protection relays. In this work, the way RCCBs operate is examined, then a model is built with the aim of assessing the effect of non-sinusoidal current on RCCBs. Tests are then carried out on a number of RCCBs and these, when compared with the results from the model showed good correlation. In addition, the model also enables us to explain the RCCBs characteristics for pure sinusoidal current. In the model developed, various parameters are evaluated but special attention is paid to the instantaneous value of the current and the tripping mechanism movement. A similar assessment method is then used to assess the effect of harmonics on two types of protection relay, the electromechanical instantaneous relay and time overcurrent relay. A model is built for each of them which is then simulated on the computer. Tests results compare well with the simulation results, and thus the model developed can be used to explain the relays behaviour in a harmonics environment. The author's models, analysis and tests show that RCCBs and protection relays are affected by harmonics in a way determined by the waveform and the relay constants. The method developed provides a useful tool and the basic methodology to analyse the behaviour of RCCBs and protection relays in a harmonics environment. These results have many implications, especially the way RCCBs and relays should be tested if harmonics are taken into account.

The use of context in the classification of urban aerial imagery

Urban regions present some of the most challenging areas for the remote sensing community. Many different types of land cover have similar spectral responses, making them difficult to distinguish from one another. Traditional per-pixel classification techniques suffer particularly badly because they only use these spectral properties to determine a class, and no other properties of the image, such as context. This project presents the results of the classification of a deeply urban area of Dudley, West Midlands, using 4 methods: Supervised Maximum Likelihood, SMAP, ECHO and Unsupervised Maximum Likelihood. An accuracy assessment method is then developed to allow a fair representation of each procedure and a direct comparison between them. Subsequently, a classification procedure is developed that makes use of the context in the image, though a per-polygon classification. The imagery is broken up into a series of polygons extracted from the Marr-Hildreth zero-crossing edge detector. These polygons are then refined using a region-growing algorithm, and then classified according to the mean class of the fine polygons. The imagery produced by this technique is shown to be of better quality and of a higher accuracy than that of other conventional methods. Further refinements are suggested and examined to improve the aesthetic appearance of the imagery. Finally a comparison with the results produced from a previous study of the James Bridge catchment, in Darleston, West Midlands, is made, showing that the Polygon classified ATM imagery performs significantly better than the Maximum Likelihood classified videography used in the initial study, despite the presence of geometric correction errors.

The impact on agriculture of the drawdown of shallow watertables

The promoters of the large groundwater developments implemented in the 1970's paid little attention to the effects of pumping on soil moisture. A field study, conducted in 1979 in the Tern Area of the Shropshire Groundwater Scheme, revealed that significant quantities of the available moisture could be removed from the root zone of vegetation when drawdown of shallow watertables occurred. Arguments to this effect, supported by the field study evidence, were successfully presented at the Shropshire Groundwater Scheme public inquiry. The aim of this study has been to expand the work which was undertaken in connection with the Shropshire Groundwater Scheme, and to develop a method whereby the effects of groundwater pumping on vegetation can be assessed, and hence the impacts minimised. Two concepts, the critical height and the soil sensitivity depth, formulated during the initial work are at the core of the Environmental Impact Assessment method whose development is described. A programme of laboratory experiments on soil columns is described, as is the derivation of relationships for determining critical heights and field capacity moisture profiles. These relationships are subsequently employed in evaluating the effects of groundwater drawdown. In employing the environmental assessment technique, digitised maps of relevant features of the Tern Area are combined to produce composite maps delineating the extent of the areas which are potentially sensitive to groundwater drawdown. A series of crop yield/moisture loss functions are then employed to estimate the impact of simulated pumping events on the agricultural community of the Tern Area. Finally, guidelines, based on experience gained through evaluation of the Tern Area case study, are presented for use in the design of soil moisture monitoring systems and in the siting of boreholes. In addition recommendations are made for development of the EIA technique, and further research needs are identified.

Using an experiential business game to stimulate sustainable thinking in marketing education

Recent years have seen a significant increase in the importance of environmental protection and sustainability to consumers, policy makers, and society in general. Reflecting this, most organizations are at least aware of this new agenda and wish to be seen as taking steps to improve behaviors in this regard. However, there appears to be a gap between this evolving agenda and the comparatively low level of knowledge that marketing managers actually have of the environmental impact of their own functional decisions. We suggest that this low knowledge level may be due, in part, to the marketplace focus of foundational marketing educational programs, and we attempt to show how broadening the horizons of marketing courses can help students (i.e., future managers) more deeply understand the environmental consequences of their actions. We demonstrate the use of a novel business game, based on the Life Cycle Assessment method, as the foundational cornerstone for the development of a broad understanding of the environmental impact of marketing decisions and actions for the entire life cycle of a product—from raw material extraction to ultimate disposal. The results of an empirical study show that this approach increases students’ appreciation for, and understanding of, these fundamental environmental sustainability concepts.

Comparison of subjective and objective methods to determine the retinal arterio-venous ratio using fundus photography

Purpose: To assess the inter and intra observer variability of subjective grading of the retinal arterio-venous ratio (AVR) using a visual grading and to compare the subjectively derived grades to an objective method using a semi-automated computer program. Methods: Following intraocular pressure and blood pressure measurements all subjects underwent dilated fundus photography. 86 monochromatic retinal images with the optic nerve head centred (52 healthy volunteers) were obtained using a Zeiss FF450+ fundus camera. Arterio-venous ratios (AVR), central retinal artery equivalent (CRAE) and central retinal vein equivalent (CRVE) were calculated on three separate occasions by one single observer semi-automatically using the software VesselMap (ImedosSystems, Jena, Germany). Following the automated grading, three examiners graded the AVR visually on three separate occasions in order to assess their agreement. Results: Reproducibility of the semi-automatic parameters was excellent (ICCs: 0.97 (CRAE); 0.985 (CRVE) and 0.952 (AVR)). However, visual grading of AVR showed inter grader differences as well as discrepancies between subjectively derived and objectively calculated AVR (all p < 0.000001). Conclusion: Grader education and experience leads to inter-grader differences but more importantly, subjective grading is not capable to pick up subtle differences across healthy individuals and does not represent true AVR when compared with an objective assessment method. Technology advancements mean we no longer rely on opthalmoscopic evaluation but can capture and store fundus images with retinal cameras, enabling us to measure vessel calibre more accurately compared to visual estimation; hence it should be integrated in optometric practise for improved accuracy and reliability of clinical assessments of retinal vessel calibres. © 2014 Spanish General Council of Optometry.

A critical assessment of the finite element method for calculating electric and magnetic fields

The present dissertation is concerned with the determination of the magnetic field distribution in ma[.rnetic electron lenses by means of the finite element method. In the differential form of this method a Poisson type equation is solved by numerical methods over a finite boundary. Previous methods of adapting this procedure to the requirements of digital computers have restricted its use to computers of extremely large core size. It is shown that by reformulating the boundary conditions, a considerable reduction in core store can be achieved for a given accuracy of field distribution. The magnetic field distribution of a lens may also be calculated by the integral form of the finite element rnethod. This eliminates boundary problems mentioned but introduces other difficulties. After a careful analysis of both methods it has proved possible to combine the advantages of both in a .new approach to the problem which may be called the 'differential-integral' finite element method. The application of this method to the determination of the magnetic field distribution of some new types of magnetic lenses is described. In the course of the work considerable re-programming of standard programs was necessary in order to reduce the core store requirements to a minimum.

A fuzzy levelised energy cost method for renewable energy technology assessment

Renewable energy project development is highly complex and success is by no means guaranteed. Decisions are often made with approximate or uncertain information yet the current methods employed by decision-makers do not necessarily accommodate this. Levelised energy costs (LEC) are one such commonly applied measure utilised within the energy industry to assess the viability of potential projects and inform policy. The research proposes a method for achieving this by enhancing the traditional discounting LEC measure with fuzzy set theory. Furthermore, the research develops the fuzzy LEC (F-LEC) methodology to incorporate the cost of financing a project from debt and equity sources. Applied to an example bioenergy project, the research demonstrates the benefit of incorporating fuzziness for project viability, optimal capital structure and key variable sensitivity analysis decision-making. The proposed method contributes by incorporating uncertain and approximate information to the widely utilised LEC measure and by being applicable to a wide range of energy project viability decisions. © 2013 Elsevier Ltd. All rights reserved.

Practical assessment of neural network applications

This paper reports the initial results of a joint research project carried out by Aston University and Lloyd's Register to develop a practical method of assessing neural network applications. A set of assessment guidelines for neural network applications were developed and tested on two applications. These case studies showed that it is practical to assess neural networks in a statistical pattern recognition framework. However there is need for more standardisation in neural network technology and a wider takeup of good development practice amongst the neural network community.