Has DRG payment influenced the technical efficiency and productivity of diagnostic technologies in Portuguese public hospitals? An empirical analysis using parametric and non‐parametric methods

The use of Diagnosis Related Groups (DRG) as a mechanism for hospital financing is a currently debated topic in Portugal. The DRG system was scheduled to be initiated by the Health Ministry of Portugal on January 1, 1990 as an instrument for the allocation of public hospital budgets funded by the National Health Service (NHS), and as a method of payment for other third party payers (e.g., Public Employees (ADSE), private insurers, etc.). Based on experience from other countries such as the United States, it was expected that implementation of this system would result in more efficient hospital resource utilisation and a more equitable distribution of hospital budgets. However, in order to minimise the potentially adverse financial impact on hospitals, the Portuguese Health Ministry decided to gradually phase in the use of the DRG system for budget allocation by using blended hospitalspecific and national DRG casemix rates. Since implementation in 1990, the percentage of each hospitals budget based on hospital specific costs was to decrease, while the percentage based on DRG casemix was to increase. This was scheduled to continue until 1995 when the plan called for allocating yearly budgets on a 50% national and 50% hospitalspecific cost basis. While all other nonNHS third party payers are currently paying based on DRGs, the adoption of DRG casemix as a National Health Service budget setting tool has been slower than anticipated. There is now some argument in both the political and academic communities as to the appropriateness of DRGs as a budget setting criterion as well as to their impact on hospital efficiency in Portugal. This paper uses a twostage procedure to assess the impact of actual DRG payment on the productivity (through its components, i.e., technological change and technical efficiency change) of diagnostic technology in Portuguese hospitals during the years 1992–1994, using both parametric and nonparametric frontier models. We find evidence that the DRG payment system does appear to have had a positive impact on productivity and technical efficiency of some commonly employed diagnostic technologies in Portugal during this time span.

Analysis and optimisation of the performance of nonlinear optical communication systems

We investigate the feasibility of simultaneous suppressing of the amplification noise and nonlinearity, representing the most fundamental limiting factors in modern optical communication. To accomplish this task we developed a general design optimisation technique, based on concepts of noise and nonlinearity management. We demonstrate the immense efficiency of the novel approach by applying it to a design optimisation of transmission lines with periodic dispersion compensation using Raman and hybrid Raman-EDFA amplification. Moreover, we showed, using nonlinearity management considerations, that the optimal performance in high bit-rate dispersion managed fibre systems with hybrid amplification is achieved for a certain amplifier spacing – which is different from commonly known optimal noise performance corresponding to fully distributed amplification. Required for an accurate estimation of the bit error rate, the complete knowledge of signal statistics is crucial for modern transmission links with strong inherent nonlinearity. Therefore, we implemented the advanced multicanonical Monte Carlo (MMC) method, acknowledged for its efficiency in estimating distribution tails. We have accurately computed acknowledged for its efficiency in estimating distribution tails. We have accurately computed marginal probability density functions for soliton parameters, by numerical modelling of Fokker-Plank equation applying the MMC simulation technique. Moreover, applying a powerful MMC method we have studied the BER penalty caused by deviations from the optimal decision level in systems employing in-line 2R optical regeneration. We have demonstrated that in such systems the analytical linear approximation that makes a better fit in the central part of the regenerator nonlinear transfer function produces more accurate approximation of the BER and BER penalty. We present a statistical analysis of RZ-DPSK optical signal at direct detection receiver with Mach-Zehnder interferometer demodulation

Cost and performance analysis of new wood-fuelled power plant concepts

The objective of the thesis was to analyse several process configurations for the production of electricity from biomass. Process simulation models using AspenPlus aimed at calculating the industrial performance of power plant concepts were built, tested, and used for analysis. The criteria used in analysis were performance and cost. All of the advanced systems appear to have higher efficiencies than the commercial reference, the Rankine cycle. However, advanced systems typically have a higher cost of electricity (COE) than the Rankine power plant. High efficiencies do not reduce fuel costs enough to compensate for the high capital costs of advanced concepts. The successful reduction of capital costs would appear to be the key to the introduction of the new systems. Capital costs account for a considerable, often dominant, part of the cost of electricity in these concepts. All of the systems have higher specific investment costs than the conventional industrial alternative, i.e. the Rankine power plant; Combined beat and power production (CUP) is currently the only industrial area of application in which bio-power costs can be considerably reduced to make them competitive. Based on the results of this work, AsperiPlus is an appropriate simulation platform. How-ever, the usefulness of the models could be improved if a number of unit operations were modelled in greater detail. The dryer, gasifier, fast pyrolysis, gas engine and gas turbine models could be improved.

A comparative and longitudinal analysis of the evolving relationship between the environment and the strategy, structure and performance of selected organisations in the British carpet industry 1959-1986:a firms in sector perspective of organisational adaptation

Orthodox contingency theory links effective organisational performance to compatible relationships between the environment and organisation strategy and structure and assumes that organisations have the capacity to adapt as the environment changes. Recent contributions to the literature on organisation theory claim that the key to effective performance is effective adaptation which in turn requires the simultaneous reconciliation of efficiency and innovation which is afforded by an unique environment-organisation configuration. The literature on organisation theory recognises the continuing confusion caused by the fragmented and often conflicting results from cross-sectional studies. Although the case is made for longitudinal studies which comprehensively describe the evolving relationship between the environment and the organisation there is little to suggest how such studies should be executed in practice. Typically the choice is between the approaches of the historicised case study and statistical analysis of large populations which examine the relationship between environment and organisation strategy and/or structure and ignore the product-process relationship. This study combines the historicised case study and the multi-variable and ordinal scale approach of statistical analysis to construct an analytical framework which tracks and exposes the environment-organisation-performance relationship over time. The framework examines changes in the environment, strategy and structure and uniquely includes an assessment of the organisation's product-process relationship and its contribution to organisational efficiency and innovation. The analytical framework is applied to examine the evolving environment-organisation relationship of two organisations in the same industry over the same twenty-five year period to provide a sector perspective of organisational adaptation. The findings demonstrate the significance of the environment-organisation configuration to the scope and frequency of adaptation and suggest that the level of sector homogeneity may be linked to the level of product-process standardisation.

Evaluating small business performance : a matched pair analysis of African Caribbean owned businesses in the UK

African Caribbean Owned Businesses (ACOBs) have been postulated as having performance-related problems especially when compared with other ethnic minority groups in Britain. This research investigates if ACOBs may be performing less than similar firms in the population and why this maybe so. Therefore the aspiration behind this study is one of ratifying the existence of performance differentials between ACOBs and White Asian Owned Businesses (WAOBs), by using a triangulation of methods and matched pair analysis. Every ACOB was matched along firm specific characteristics of age, size, legal form and industry (sector), with similar WAOBs. Findings show support for the hypothesis that ACOBs are more likely to perform less than the WAOBs; WAOBs out-performed ACOBs in the objective and subjective assessments. Though we found some differentials between both groups in the entrepreneur’s characteristics and various emphases in strategic orientation in overall business strategy. The most likely drivers of performance differentials were found in firm activities and operations. ACOBs tended to have brands that were not as popular in the mainstream with most of their manufactured goods being seen as ‘exotic’ while those by WAOBs were perceived as ‘traditional’. Moreover, ACOBs had a higher proportion of clients constituting of individuals than business organisations while the WAOBs had a higher proportion consisting of business organisations.

On waveform analysis, the adaptive task technique, and the effect of vibration on manual control skill

A re-examination of fundamental concepts and a formal structuring of the waveform analysis problem is presented in Part I. eg. the nature of frequency is examined and a novel alternative to the classical methods of detection proposed and implemented which has the advantage of speed and independence from amplitude. Waveform analysis provides the link between Parts I and II. Part II is devoted to Human Factors and the Adaptive Task Technique. The Historical, Technical and Intellectual development of the technique is traced in a review which examines the evidence of its advantages relative to non-adaptive fixed task methods of training, skill assessment and man-machine optimisation. A second review examines research evidence on the effect of vibration on manual control ability. Findings are presented in terms of percentage increment or decrement in performance relative to performance without vibration in the range 0-0.6Rms'g'. Primary task performance was found to vary by as much as 90% between tasks at the same Rms'g'. Differences in task difficulty accounted for this difference. Within tasks vibration-added-difficulty accounted for the effects of vibration intensity. Secondary tasks were found to be largely insensitive to vibration except secondaries which involved fine manual adjustment of minor controls. Three experiments are reported next in which an adaptive technique was used to measure the % task difficulty added by vertical random and sinusoidal vibration to a 'Critical Compensatory Tracking task. At vibration intensities between 0 - 0.09 Rms 'g' it was found that random vibration added (24.5 x Rms'g')/7.4 x 100% to the difficulty of the control task. An equivalence relationship between Random and Sinusoidal vibration effects was established based upon added task difficulty. Waveform Analyses which were applied to the experimental data served to validate Phase Plane analysis and uncovered the development of a control and possibly a vibration isolation strategy. The submission ends with an appraisal of subjects mentioned in the thesis title.

Performance analysis of DSRC priority mechanism for road safety applications in vehicular networks

Dedicated short range communications (DSRC) has been regarded as one of the most promising technologies to provide robust communications for large scale vehicle networks. It is designed to support both road safety and commercial applications. Road safety applications will require reliable and timely wireless communications. However, as the medium access control (MAC) layer of DSRC is based on the IEEE 802.11 distributed coordination function (DCF), it is well known that the random channel access based MAC cannot provide guaranteed quality of services (QoS). It is very important to understand the quantitative performance of DSRC, in order to make better decisions on its adoption, control, adaptation, and improvement. In this paper, we propose an analytic model to evaluate the DSRC-based inter-vehicle communication. We investigate the impacts of the channel access parameters associated with the different services including arbitration inter-frame space (AIFS) and contention window (CW). Based on the proposed model, we analyze the successful message delivery ratio and channel service delay for broadcast messages. The proposed analytical model can provide a convenient tool to evaluate the inter-vehicle safety applications and analyze the suitability of DSRC for road safety applications.

Political leadership:character and performance. A comparative analysis of British political leadership, 1997-2010.

Classical and contemporary scholarship on leadership has referred to political performance and the ability of political actors to deploy the self to political purpose. Literature on contemporary British politics (Hennessy, 2001; Marquand, 2008, King, 2009) has highlighted the qualitative shift in political leadership from the mid-1990s towards a focus upon the image, style, celebrity and performance of political leaders, and the shift towards the presidentialisation or semi-presidentialisation of the prime minister (Foley, 2001). However, the literature has lacked a focus upon political performance and a methodology for assessing leadership performance within cultural and institutional contexts. This thesis assesses British political leadership performance from 1997-2010 through the proposal of a framework of political performance to suit comparative purpose. The framework consisting of culture, institutions and performance is used to assess the performance of the case studies (Tony Blair, Gordon Brown and David Cameron, and Gordon Brown, David Cameron and Nick Clegg in the televised Leaders’ Debates of 2010). The application of the framework to the case studies will allow us to a) analyse political performance within given cultural and institutional contexts; b) establish the character traits and other aspects of a politician’s political persona; and c) appraise the role and effects of performance and persona upon the political process.

Unified model for performance analysis of IEEE 802.11 ad hoc networks in unsaturated conditions

IEEE 802.11 standard has achieved huge success in the past decade and is still under development to provide higher physical data rate and better quality of service (QoS). An important problem for the development and optimization of IEEE 802.11 networks is the modeling of the MAC layer channel access protocol. Although there are already many theoretic analysis for the 802.11 MAC protocol in the literature, most of the models focus on the saturated traffic and assume infinite buffer at the MAC layer. In this paper we develop a unified analytical model for IEEE 802.11 MAC protocol in ad hoc networks. The impacts of channel access parameters, traffic rate and buffer size at the MAC layer are modeled with the assistance of a generalized Markov chain and an M/G/1/K queue model. The performance of throughput, packet delivery delay and dropping probability can be achieved. Extensive simulations show the analytical model is highly accurate. From the analytical model it is shown that for practical buffer configuration (e.g. buffer size larger than one), we can maximize the total throughput and reduce the packet blocking probability (due to limited buffer size) and the average queuing delay to zero by effectively controlling the offered load. The average MAC layer service delay as well as its standard deviation, is also much lower than that in saturated conditions and has an upper bound. It is also observed that the optimal load is very close to the maximum achievable throughput regardless of the number of stations or buffer size. Moreover, the model is scalable for performance analysis of 802.11e in unsaturated conditions and 802.11 ad hoc networks with heterogenous traffic flows. © 2012 KSI.

Time-resolved Q-factor measurement and its application in performance analysis of 42.6 Gbit/s packets generated by SGDBR lasers

We demonstrate a novel time-resolved Q-factor measurement technique and demonstrate its application in the analysis of optical packet switching systems with high information spectral density. For the first time, we report the time-resolved Q-factor measurement of 42.6 Gbit/s AM-PSK and DQPSK modulated packets, which were generated by a SGDBR laser under wavelength switching. The time dependent degradation of Q-factor performance during the switching transient was analyzed and was found to be correlated with different laser switching characteristics in each case.

Performance analysis of 20 Gbit/s RZ-DPSK non-slope matched transoceanic submarine links

This paper studies the performance of a typical non-slope matched transoceanic submarine link using 20Gb/s channel rate and RZ-DPSK modulation with different duty cycles. Through comparison with direct error counting, we have also demonstrated the limitations of the available numerical approaches to the BER estimation for return-to-zero differential phase-shift keying (RZ-DPSK). The numerical results have been confirmed by experiments, and indicate that 20 Gb/s RZ-DPSK transmission is a feasible technique for the upgrade of existing submarine links.

Measurement of hospital performance

The rationale for carrying out this research was to address the clear lack of knowledge surrounding the measurement of public hospital performance in Ireland. The objectives of this research were to develop a comprehensive model for measuring hospital performance and using this model to measure the performance of public acute hospitals in Ireland in 2007. Having assessed the advantages and disadvantages of various measurement models the Data Envelopment Analysis (DEA) model was chosen for this research. DEA was initiated by Charnes, Cooper and Rhodes in 1978 and further developed by Fare et al. (1983) and Banker et al. (1984). The method used to choose relevant inputs and outputs to be included in the model followed that adopted by Casu et al. (2005) which included the use of focus groups. The main conclusions of the research are threefold. Firstly, it is clear that each stakeholder group has differing opinions on what constitutes good performance. It is therefore imperative that any performance measurement model would be designed within parameters that are clearly understood by any intended audience. Secondly, there is a lack of publicly available qualitative information in Ireland that inhibits detailed analysis of hospital performance. Thirdly, based on available qualitative and quantitative data the results indicated a high level of efficiency among the public acute hospitals in Ireland in their staffing and non pay costs, averaging 98.5%. As DEA scores are sensitive to the number of input and output variables as well as the size of the sample it should be borne in mind that a high level of efficiency could be as a result of using DEA with too many variables compared to the number of hospitals. No hospital was deemed to be scale efficient in any of the models even though the average scale efficiency for all of the hospitals was relatively high at 90.3%. Arising from this research the main recommendations would be that information on medical outcomes, survival rates and patient satisfaction should be made publicly available in Ireland; that despite a high average efficiency level that many individual hospitals need to focus on improving their technical and scale efficiencies, and that performance measurement models should be developed that would include more qualitative data.