Timeliness, efficiency and public procurement in hip surgery in Italy

Considering different perspectives, the scope of this thesis is to investigate how to improve healthcare resources allocation and the provision efficiency for hip surgeries, a resource-intensive operation, among the most frequently performed on the elderly, with a trend in volume that is increasing in years due to population aging. Firstly, the effect of Time-To-Surgery (TTS) on mortality for hip fracture patients is investigated. The analysis attempts to account for TTS endogeneity due to the inability to fully control for variables affecting patient delay – e.g. patient severity. Exploiting an instrumental variable model, where being admitted on Friday or Saturday predicts longer TTS, findings show exogenous TTS does not have a significant effect on mortality. Thus suggesting surgeons prioritize patients effectively, neutralizing the adverse impact of longer TTS. Then, the volume-outcome relation for total hip replacement surgery is analyzed, seeking to account for selective referral, which may be present in elective surgery context, and induce reverse causality issue in the volume-outcome relation. The analysis employs a conditional choice model where patient travel distance from all regions' hospitals is used as a hospital choice predictor. Findings show the exogenous hospital volume significantly decreases adverse outcomes probability, especially in the short run. Finally, the change in public procurement design enforced in the Romagna LHA (Italy) is exploited to assess its impact on hip prostheses cost, surgeons' implant choice, and patient health outcomes. Hip prostheses are the major cost-driver of hip replacement surgeries, hence it is crucial to design the public tender such that implant prices are minimized, but cost-containment policies have to be weighted with patient well-being. Evidence shows that a cost reduction occurred without a significant surgeons’ choices impact. Positive or no effect of surgeons specialization is found on patients outcomes after the new procurement introduction.

Experimenting with the role of performance of hygiene and motivators on customer satisfaction: studying the temporal effect

Marketers continuously attempt to identify important attributes and innovate in order to understand how attribute performance could lead to customer satisfaction in the short term and in the long term. Understanding the impact of customer satisfaction may offer a competitive edge to companies. Researchers are discussing the importance of performance attributes in leading to satisfaction; however, there is no clear understanding of whether an attribute that leads to satisfaction at one time (e.g., short run) can cause it also in the long run, without excluding the possibility that it could lead to dissatisfaction and no satisfaction. The present research tries to understand anomalies related to asymmetric attribute performance and satisfaction over time with the help of Herzberg's (1967) Two-Factor Theory (TFT) and construal level theory (CLT). More precisely, there are main purposes of this dissertation. First, the present research tries to understand whether positive or negative hygiene attribute performance and motivator attribute factors exert different weights on overall customer satisfaction depending on the time elapsed from the service experience. Second, to test if positive or negative hygiene/motivator attribute performance affect to revisit intention and to word of mouth by considering mediating role of satisfaction. The results reveal that in the near past (NP) experience, the positive performance of hygiene concrete attributes creates a differential effect on overall satisfaction higher than the negative performance of hygiene concrete attributes. Results also confirmed mediating role of satisfaction in the relationship between attribute performance and revisit intention for near past condition but not for distant past. Likewise significant relationship was found for the mediating role of satisfaction in the relationship between attribute performance and word of mouth (WOM) for near past condition but not for distant past.

Progettazione ed Implementazione Front-End di un Sistema Integrato di Customer Assistance in ambito Industry 4.0

Al giorno d'oggi, l'industry 4.0 è un movimento sempre più prominente che induce ad equipaggiare gli impianti industriali con avanzate infrastrutture tecnologiche digitali, le quali operano sinergicamente con l'impianto, al fine di controllare ed aumentare la produttività, monitorare e prevenire i futuri guasti, ed altro ancora. In questo ambito, gli utenti sono parte integrante della struttura produttiva, in cui ricoprono ruoli strategici e flessibili, collaborano fra loro e con le macchine, con l’obiettivo di affrontare e risolvere proattivamente una vasta gamma di problemi complessi. In particolare, la customer assistance nel settore industriale può certamente variare in relazione a molteplici elementi: il tipo di produzione e le caratteristiche del prodotto; l'organizzazione ed infrastruttura aziendale interna; la quantità di risorse disponibili che possono essere impiegate; il grado di importanza ricoperto dalla customer assistance nel settore industriale di riferimento; altri eventuali fattori appartenenti ad un dominio specifico. Per queste ragioni, si è cercato di individuare e categorizzare nel modo più accurato possibile, il lavoro svolto in questo elaborato ed il contesto nel quale è stato sviluppato. In questa tesi, viene descritta un'applicazione web per erogare assistenza al cliente in ambito di industria 4.0, attraverso il paradigma di ticketing o ticket di supporto/assistenza. Questa applicazione è integrata nel sistema Mentor, il quale è attivo già da anni nel settore industriale 4.0. Il progetto Mentor è una suite di applicazioni cloud-based creata dal gruppo Bucci Industries, una multinazionale attiva nell'industria e nell'automazione con sede a Faenza. In questo caso di studio, si presenta la progettazione ed implementazione della parte front-end del suddetto sistema di assistenza, il quale è integrato ed interconnesso con un paio di applicazioni tipiche di industria 4.0, presenti nella stessa suite di applicazioni.

Customer care e inbound marketing. Il caso Golee

L'elaborato tratta la customer care, ovvero l'insieme delle attività volte a fornire cura e attenzione nei confronti del cliente. Si illustra, inoltre, l'inbound marketing, una metodologia che attira i clienti tramite una canalizzazione degli stessi verso l'impresa. Entrambi i concetti sono stati analizzati ed applicati in Golee, azienda produttrice di un software gestionale per le società sportive. Golee, impiegando una strategia di inbound marketing e focalizzandosi sulle attività di customer care, negli ultimi anni è riuscita a fidelizzare un gran numero di clienti, aumentando vigorosamente il proprio valore aziendale.

Interesses fisicos no lazer : a influencia do esporte de alto rendimento para a criança na relação lazer-escola-processo educativo

Universidade Estadual de Campinas . Faculdade de Educação Física

Acolhendo o acolhedor: o caminho mais curto para a humanização da assistência

INTRODUÇÃO: o acolhimento tem se constituído num potente disparador de mudanças. Este trabalho reflete a satisfação experimentada, resultante da atuação num ambiente altamente sinérgico e produtivo. OBJETIVO: implantação e implementação da assistência materno-neonatal a partir do acolhimento ao cliente interno. MÉTODO: realizou-se observação direta do cotidiano em setores distintos do Hospital Maternidade Interlagos (HMI) -SES/SP e seu Ambulatório. Foram realizadas entrevistas semi-estruturadas com dois profissionais da equipe multidisciplinar, as quais subsidiaram oficinas de humanização no ambiente hospitalar. Os profissionais foram divididos em áreas de exercício profissional, da administrativa à assistencial. RESULTADOS: ocorreu implantação do Comitê de Acolhimento e Humanização da Assistência Materno-Neonatal no Hospital Maternidade Interlagos, com participação dos líderes de acolhimento na gerência institucional, provendo melhor desempenho individual e coletivo no exercício laboral na Unidade Hospitalar

Hybrid Method to Assess Sensitive Process Interruption Costs Due to Faults in Electric Power Distribution Networks

This paper shows a new hybrid method for risk assessment regarding interruptions in sensitive processes due to faults in electric power distribution systems. This method determines indices related to long duration interruptions and short duration voltage variations (SDVV), such as voltage sags and swells in each customer supplied by the distribution network. Frequency of such occurrences and their impact on customer processes are determined for each bus and classified according to their corresponding magnitude and duration. The method is based on information regarding network configuration, system parameters and protective devices. It randomly generates a number of fault scenarios in order to assess risk areas regarding long duration interruptions and voltage sags and swells in an especially inventive way, including frequency of events according to their magnitude and duration. Based on sensitivity curves, the method determines frequency indices regarding disruption in customer processes that represent equipment malfunction and possible process interruptions due to voltage sags and swells. Such approach allows for the assessment of the annual costs associated with each one of the evaluated power quality indices.

Reconfiguration of distribution networks to minimize loss and disruption costs using genetic algorithms

In this paper a computational implementation of an evolutionary algorithm (EA) is shown in order to tackle the problem of reconfiguring radial distribution systems. The developed module considers power quality indices such as long duration interruptions and customer process disruptions due to voltage sags, by using the Monte Carlo simulation method. Power quality costs are modeled into the mathematical problem formulation, which are added to the cost of network losses. As for the EA codification proposed, a decimal representation is used. The EA operators, namely selection, recombination and mutation, which are considered for the reconfiguration algorithm, are herein analyzed. A number of selection procedures are analyzed, namely tournament, elitism and a mixed technique using both elitism and tournament. The recombination operator was developed by considering a chromosome structure representation that maps the network branches and system radiality, and another structure that takes into account the network topology and feasibility of network operation to exchange genetic material. The topologies regarding the initial population are randomly produced so as radial configurations are produced through the Prim and Kruskal algorithms that rapidly build minimum spanning trees. (C) 2009 Elsevier B.V. All rights reserved.

The Future of the Australian-U.S. Security Relationship

Australia is an increasingly important ally for the United States. It is willing to be part of challenging global missions, and its strong economy and growing self-confi dence suggest a more prominent role in both global and regional affairs. Moreover, its government has worked hard to strengthen the link between Canberra and Washington. Political and strategic affi nities between the two countries have been refl ected in--and complemented by--practiced military interoperability, as the two allies have sustained a pattern of security cooperation in relation to East Timor, Afghanistan and Iraq in the last 4 years. This growing collaboration between the two countries suggests that a reinvention of the traditional bilateral security relationship is taking place. At the core of this process lies an agreement about the need for engaging in more proactive strategic behavior in the changing global security environment, and a mutual acceptance of looming military and technological interdependence. But this new alliance relationship is already testing the boundaries of bipartisan support for security policy within Australia. Issues of strategic doctrine, defense planning, and procurement are becoming topics of fi erce policy debate. Such discussion is likely to be sharpened in the years ahead as Australia’s security relationship with the United States settles into a new framework.

Cost-effectiveness analysis of humanitarian relief interventions: visceral leishmaniasis treatment in the Sudan

Spending by aid agencies on emergencies has quadrupled over the last decade, to over US$ 6 billion. To date, cost-effectiveness has seldom been considered in the prioritization and evaluation of emergency interventions. The sheer volume of resources spent on humanitarian aid and the chronicity of many humanitarian interventions call for more attention to be paid to the issue of 'value for money'. In this paper we present data from a major humanitarian crisis, an epidemic of visceral leishmaniasis (VL) in war-torn Sudan. The special circumstances provided us, in retrospect, with unusually accurate data on excess mortality, costs of the intervention and its effects, thus allowing us to express cost-effectiveness as the cost per Disability Adjusted Life Year (DALY) averted. The cost-effectiveness ratio, of US$ 18.40 per DALY (uncertainty range between US$ 13.53 and US$ 27.63), places the treatment of VL in Sudan among health interventions considered 'very flood value for money' (interventions of less than US$ 25 per DALY). We discuss the usefulness of this analysis to the internal management of the VL programme, the procurement of funds for the programme, and more generally, to priority setting in humanitarian relief interventions. We feel that in evaluations of emergency interventions attempts could be made more often to perform cost-effectiveness analyses, including the use of DALYs, provided that the outcomes of these analyses are seen in the broad context of the emergency situation and its consequences on the affected population. This paper provides a first contribution to what is hoped to become an international database of cost-effectiveness studies of health outcome such as the DALY.

Employee reactions to behavioural control under conditions of stress: the moderating role of self-efficacy

Extensive research conducted in the occupational stress literature has failed to provide convincing support for the stress-buffering effects of work control on employee adjustment. Drawing on research conducted in the laboratory context, it was proposed that the stress-buffering effects of work control on employee adjustment would be more marked at high, rather than low, levels of self-efficacy. In a sample of 100 customer service representatives, a significant three-way interaction among role conflict, work control and self-efficacy (measured at Time 1) was observed on (low) depersonalization (measured at Time 2). Consistent with expectations, work control reduced the negative effects of work stress on this outcome measure only for employees who perceived high levels of self-efficacy at work. In addition, there was evidence to suggest that self-efficacy moderated the main effects of work control on job satisfaction and somatic health. These findings are discussed hi terms of their theoretical contribution to the job strain model, and also in relation to workplace interventions designed to improve levels of employee adjustment.

Choices associated with automobiles for Men and Women: convergence or divergence?

The increase of the women purchase power has led some companies to adopt strategies of products differentiation as well as to produce specific products to the female public. The auto industry is not immune to this phenomenon, once the women represent, approximately half of the automobile sales in the country. Considering the consumption and the behavior differences between women and men, it has set the following question: are there differences between the choices associated to the automobile by men and the choices associated to the automobile by women? It has been presented to the participants items found in the people`s day-by-day, which are valorized by them, and the participants have been asked to choose and associate these items to the automobile. The results analysis revealed there are more similarities than differences between choices associated to the automobile by men ad choices associated to the automobile by women. The similarity between the choices suggests that the representations, the meanings and values assigned. to the car by men ana women are similar and thus the strategy of product differentiation does not apply to the automotive industry

Corruption and auctions

We investigate how corruption affects the outcome of a first-price auction (bidding behavior, efficiency and the seller's expected revenue). The auctioneer approaches the winner to offer the possibility of a reduction in his bid in exchange for a bribe. The bribe can be a percentage of the difference between the winning and the second-highest bid or a fixed amount. We show that there exists a symmetric bidding strategy equilibrium that is monotone, i.e., higher valuation buyers bid higher. Corruption does not affect efficiency but both the auctioneer's expected bribe and the seller's expected revenue depend on the format of the bribe payments. We also find the optimal bribe scheme.

Behavior Profile of Family Members of Donors and Nondonors of Organs

Organ transplant shortage is a global problem caused by several factors, most of which are related to members of the family, who play it major role in the donation process. Objective. We sought to determine the most determinant features in the donor profile that relate to positive decisions versus refusal of donation. Material and Methods. Fifty-six families who were approached by the Organ Procurement Organization (OPO) from November 2004 to April 2006 agreed to participate in this work. To assess donor profiles, we used it structured interview. Results. Parental involvement directly in decisions about donation lead to significantly less frequent consent (P = .005), young donor age was associated with a reduced probability of donation (P = .002), violent death negatively influenced donation consent, excluding suicide (P = .004). Conclusion. The present study showed violent death, young patient age, and parental donation consent to be the most important factors that make it harder to obtain consent organ donation. When a collateral relative (sibling/uncle) or children were responsible for the donation decision, there was more success of consent.

Experimental multivisceral xenotransplantation

Background: Organ shortage impairs the proposition of multivisceral transplantation to treat multiple organ failure. Interspecies (xeno) transplantation is a valid solution for organ shortage; however, suitable models of this advance are lacking. We describe an effective model of multivisceral xenotransplantation to study hyperacute rejection. Methods: Under general anesthesia, we in block recovered the distal esophagus, stomach, small bowel, colon, liver, pancreas, spleen, and kidneys from donors and implanted heterotopically in the lower abdomen of recipients. Animals were divided into four groups: I-canine donor, swine recipient (n = 6); II - swine donor, canine recipient (n = 5); III-canine donor, canine recipient (n = 4); and IV-swine donor, swine recipient (n = 5). Groups I and 11 comprised experimental (xenotransplantation) and III and IV control groups (allotransplantation). During the experiment, we appraised recipient evolution and graft modification by sequential biopsy up to 3 h. At this time, we killed animals for autopsy (experimental end point). Results: We accomplished all experiments successfully. Every grafts attained customary appearance and convenient urine output immediately after unclamp. Around 15 min after reperfusion, xenografts achieved signs of progressive hyperacute rejection and absence of urine output. At the end of experiments we observed moderate to severe hyperacute rejection at small bowel, colon, mesenteric lymph node, liver, spleen, pancreas, and kidney, while stomach and esophagus achieved mild lesions. In contrast, allograft achieved normal or minimum ischemia/reperfusion injury and constant urine output. Conclusion: The present procedure assembles a simple and effective model to study multivisceral xenotransplantation and may ultimately spread researches toward hyperacute rejection.