911 resultados para Risk Adjusted Return on Capital
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Thesis (Ph.D.)--University of Washington, 2016-06
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In patients hospitalised with acute coronary syndromes (ACS) and congestive heart failure (CHF), evidence suggests opportunities for improving in-hospital and after hospital care, patient self-care, and hospital-community integration. A multidisciplinary quality improvement program was designed and instigated in Brisbane in October 2000 involving 250 clinicians at three teaching hospitals, 1080 general practitioners (GPs) from five Divisions of General Practice, 1594 patients with ACS and 904 patients with CHF. Quality improvement interventions were implemented over 17 months after a 6-month baseline period and included: clinical decision support (clinical practice guidelines, reminders, checklists, clinical pathways); educational interventions (seminars, academic detailing); regular performance feedback; patient self-management strategies; and hospital-community integration (discharge referral summaries; community pharmacist liaison; patient prompts to attend GPs). Using a before-after study design to assess program impact, significantly more program patients compared with historical controls received: ACS: Angiotensin-converting enzyme (ACE) inhibitors and lipid-lowering agents at discharge, aspirin and beta-blockers at 3 months after discharge, inpatient cardiac counselling, and referral to outpatient cardiac rehabilitation. CHF. Assessment for reversible precipitants, use of prophylaxis for deep-venous thrombosis, beta-blockers at discharge, ACE inhibitors at 6 months after discharge, imaging of left ventricular function, and optimal management of blood pressure levels. Risk-adjusted mortality rates at 6 and 12 months decreased, respectively, from 9.8% to 7.4% (P=0.06) and from 13.4% to 10.1% (P= 0.06) for patients with ACS and from 22.8% to 15.2% (P < 0.001) and from 32.8% to 22.4% (P= 0.005) for patients with CHF. Quality improvement programs that feature multifaceted interventions across the continuum of care can change clinical culture, optimise care and improve clinical outcomes.
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While environmental legislation in Australia regulates tourism development, it is less effective in operational areas because of the dependency of tourism on environmental resources that are not managed by operators, and the small but incremental nature of operational impacts. The absence of functional environmental standards for tourism means that little guidance exists: a problem compounded by variability in the diversity of operation types and receiving environments, as well as the accessibility of information by a non-technical audience. While legislation and economic considerations may provide impetus to adopt environmental practices, it is proposed that an environmental philosophy is necessary for tourism businesses to seek out and maintain alternative sustainable modes of operation. Review of the environmental audit process used by a Queensland resort suggests commitment to continual improvement in environmental performance is attributable to individual and corporate ethics. While the case is an ecotourism operation, the literature indicates that these factors have relevance to tourism generally. Although client satisfaction and return on investment objectives are constraints, environmental auditing can provide impetus for practical expression of environmental objectives. Facilitation of ethically-motivated voluntary action may be more effective in achieving tourism's environmental objectives than codifying standards in static legislation.
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A rapid increase in the number and size of protected areas has prompted interest in their effectiveness and calls for guarantees that they are providing a good return on investment by maintaining their values. Research reviewed here suggests that many remain under threat and a significant number are already suffering deterioration. One suggestion for encouraging good management is to develop a protected-area certification system: however this idea remains controversial and has created intense debate. We list a typology of options for guaranteeing good protected-area management, and give examples, including: danger lists; self-reporting systems against individual or standardised criteria; and independent assessment including standardised third-party reporting, use of existing certification systems such as those for forestry and farming and certification tailored specifically to protected areas. We review the arguments for and against certification and identify some options, such as: development of an accreditation scheme to ensure that assessment systems meet minimum standards; building up experience from projects that are experimenting with certification in protected areas; and initiating certification schemes for specific users such as private protected areas or institutions like the World Heritage Convention.
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Freshwater is extremely precious; but even more precious than freshwater is clean freshwater. From the time that 2/3 of our planet is covered in water, we have contaminated our globe with chemicals that have been used by industrial activities over the last century in a unprecedented way causing harm to humans and wildlife. We have to adopt a new scientific mindset in order to face this problem so to protect this important resource. The Water Framework Directive (European Parliament and the Council, 2000) is a milestone legislative document that transformed the way that water quality monitoring is undertaken across all Member States by introducing the Ecological and Chemical Status. A “good or higher” Ecological Status is expected to be achieved for all waterbodies in Europe by 2015. Yet, most of the European waterbodies, which are determined to be at risk, or of moderate to bad quality, further information will be required so that adequate remediation strategies can be implemented. To date, water quality evaluation is based on five biological components (phytoplankton, macrophytes and benthic algae, macroinvertebrates and fishes) and various hydromorphological and physicochemical elements. The evaluation of the chemical status is principally based on 33 priority substances and on 12 xenobiotics, considered as dangerous for the environment. This approach takes into account only a part of the numerous xenobiotics that can be present in surface waters and could not evidence all the possible causes of ecotoxicological stress that can act in a water section. The mixtures of toxic chemicals may constitute an ecological risk not predictable on the basis of the single component concentration. To improve water quality, sources of contamination and causes of ecological alterations need to be identified. On the other hand, the analysis of the community structure, which is the result of multiple processes, including hydrological constrains and physico-chemical stress, give back only a “photograph” of the actual status of a site without revealing causes and sources of the perturbation. A multidisciplinary approach, able to integrate the information obtained by different methods, such as community structure analysis and eco-genotoxicological studies, could help overcome some of the difficulties in properly identifying the different causes of stress in risk assessment. In synthesis, the river ecological status is the result of a combination of multiple pressures that, for management purposes and quality improvement, have to be disentangled from each other. To reduce actual uncertainty in risk assessment, methods that establish quantitative links between levels of contamination and community alterations are needed. The analysis of macrobenthic invertebrate community structure has been widely used to identify sites subjected to perturbation. Trait-based descriptors of community structure constitute a useful method in ecological risk assessment. The diagnostic capacity of freshwater biomonitoring could be improved by chronic sublethal toxicity testing of water and sediment samples. Requiring an exposure time that covers most of the species’ life cycle, chronic toxicity tests are able to reveal negative effects on life-history traits at contaminant concentrations well below the acute toxicity level. Furthermore, the responses of high-level endpoints (growth, fecundity, mortality) can be integrated in order to evaluate the impact on population’s dynamics, a highly relevant endpoint from the ecological point of view. To gain more accurate information about potential causes and consequences of environmental contamination, the evaluation of adverse effects at physiological, biochemical and genetic level is also needed. The use of different biomarkers and toxicity tests can give information about the sub-lethal and toxic load of environmental compartments. Biomarkers give essential information about the exposure to toxicants, such as endocrine disruptor compounds and genotoxic substances whose negative effects cannot be evidenced by using only high-level toxicological endpoints. The increasing presence of genotoxic pollutants in the environment has caused concern regarding the potential harmful effects of xenobiotics on human health, and interest on the development of new and more sensitive methods for the assessment of mutagenic and cancerogenic risk. Within the WFD, biomarkers and bioassays are regarded as important tools to gain lines of evidence for cause-effect relationship in ecological quality assessment. Despite the scientific community clearly addresses the advantages and necessity of an ecotoxicological approach within the ecological quality assessment, a recent review reports that, more than one decade after the publication of the WFD, only few studies have attempted to integrate ecological water status assessment and biological methods (namely biomarkers or bioassays). None of the fifteen reviewed studies included both biomarkers and bioassays. The integrated approach developed in this PhD Thesis comprises a set of laboratory bioassays (Daphnia magna acute and chronic toxicity tests, Comet Assay and FPG-Comet) newly-developed, modified tacking a cue from standardized existing protocols or applied for freshwater quality testing (ecotoxicological, genotoxicological and toxicogenomic assays), coupled with field investigations on macrobenthic community structures (SPEAR and EBI indexes). Together with the development of new bioassays with Daphnia magna, the feasibility of eco-genotoxicological testing of freshwater and sediment quality with Heterocypris incongruens was evaluated (Comet Assay and a protocol for chronic toxicity). However, the Comet Assay, although standardized, was not applied to freshwater samples due to the lack of sensitivity of this species observed after 24h of exposure to relatively high (and not environmentally relevant) concentrations of reference genotoxicants. Furthermore, this species demonstrated to be unsuitable also for chronic toxicity testing due to the difficult evaluation of fecundity as sub-lethal endpoint of exposure and complications due to its biology and behaviour. The study was applied to a pilot hydrographic sub-Basin, by selecting section subjected to different levels of anthropogenic pressure: this allowed us to establish the reference conditions, to select the most significant endpoints and to evaluate the coherence of the responses of the different lines of evidence (alteration of community structure, eco-genotoxicological responses, alteration of gene expression profiles) and, finally, the diagnostic capacity of the monitoring strategy. Significant correlations were found between the genotoxicological parameter Tail Intensity % (TI%) and macrobenthic community descriptors SPEAR (p<0.001) and EBI (p<0.05), between the genotoxicological parameter describing DNA oxidative stress (ΔTI%) and mean levels of nitrates (p<0.01) and between reproductive impairment (Failed Development % from D. magna chronic bioassays) and TI% (p<0.001) as well as EBI (p<0.001). While correlation among parameters demonstrates a general coherence in the response to increasing impacts, the concomitant ability of each single endpoint to be responsive to specific sources of stress is at the basis of the diagnostic capacity of the integrated approach as demonstrated by stations presenting a mismatch among the different lines of evidence. The chosen set of bioassays, as well as the selected endpoints, are not providing redundant indications on the water quality status but, on the contrary, are contributing with complementary pieces of information about the several stressors that insist simultaneously on a waterbody section providing this monitoring strategy with a solid diagnostic capacity. Our approach should provide opportunities for the integration of biological effects into monitoring programmes for surface water, especially in investigative monitoring. Moreover, it should provide a more realistic assessment of impact and exposure of aquatic organisms to contaminants. Finally this approach should provide an evaluation of drivers of change in biodiversity and its causalities on ecosystem function/services provision, that is the direct and indirect contributions to human well-being.
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This article considers the utilisation of the UK’s Prudential Borrowing Framework (PBF) and the associated Prudential Code for local government capital finance. It finds that the increased flexibility and local freedom are at the cost of less financial certainty in terms of the risks borne by local authorities and local tax payers. The PBF seems to encourage a less formal approach to risk, being considered inevitable and handled if and when adverse risk outcomes occur. Consequently capital projects may lack affordability, sustainability and prudence. The Prudential Indicators required by the Code are not easily understood by non-specialists and their calculation cannot be used to replace sound judgement or to identify the best financing option.
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Increased awareness of the crucial role of leadership as a competitive advantage for organisations (McCall, 1998; Petrick, Scherer, Brodzinski, Quinn, & Ainina, 1999) has led to billions spent on leadership development programmes and training (Avolio & Hannah, 2008). However, research reports confusing and contradictory evidence regarding return on investment and developmental outcomes, and a lot of variance has been observed across studies (Avolio, Reichard, Hannah, Walumbwa, & Chan, 2009). The purpose of this thesis is to understand the mechanisms underlying this variability in leadership development. Of the many factors at play in the process, such as programme design and delivery, organisational support, and perceptions of relevance (Mabey, 2002; Day, Harrison, & Halpin, 2009), individual differences and characteristics stand out. One way in which individuals differ is in their Developmental Readiness (DR), a concept recently introduced in the literature that may well explain this variance and which has been proposed to accelerate development (Avolio & Hannah, 2008, 2009). Building on previous work, DR is introduced and conceptualised somewhat differently. In this study, DR is construed of self-awareness, self-regulation, and self-motivation, proposed by Day (2000) to be the backbones of leadership development. DR is suggested to moderate the developmental process. Furthermore, personality dispositions and individual values are proposed to be precursors of DR. The empirical research conducted uses a pre-test post-test quasi-experimental design. Before conducting the study, though, both a measure of Developmental Readiness and a competency profiling measure are tested in two pilot studies. Results do not find evidence of a direct effect of leadership development programmes on development, but do support an interactive effect between DR and leadership development programmes. Personality dispositions Agreeableness, Conscientiousness, and Openness to Experience and value orientations Conservation, Open, and Closed Orientation are found to significantly predict DR. Finally, the theoretical and practical implications of findings are discussed.
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The thesis is concerned with cross-cultural distance learning in two countries: Great Britain and France. Taking the example of in-house sales training, it argues that it is possible to develop courses for use in two or more countries of differing culture and language. Two courses were developed by the researcher. Both were essentially print-based distance-learning courses designed to help salespeople achieve a better understanding of their customers. One used a quantitative, the other qualitative approach. One considered the concept of the return on investment and the other, for which a video support was also developed, considered the analysis of a customer's needs. Part 1 of the thesis considers differences in the training context between France and Britain followed by a review of the learning process with reference to distance learning. Part 2 looks at the choice of training medium course design and evaluation and sets out the methodology adopted, including problems encountered in this type of fieldwork. Part 3 analyses the data and draws conclusions from the findings, before offering a series of guidelines for those concerned with the development of cross-cultural in-house training courses. The results of the field tests on the two courses were analysed in relation to the socio-cultural, educational and experiential background of the learners as well as their preferred learning styles. The thesis argues that it is possible to develop effective in-house sales training courses to be used in two cultures and identifies key considerations which need to be taken into account when carrying out this type of work.
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This paper aims to discuss the recent literature on Radio Frequency Identification (RFID) and reverse logistics (RL). Particular attention is applied to the bullwhip effect and its increase as RL activities are integrated into the supply chain. RFID is investigated as a tool to assist with integrating reverse and forward logistics into a seamless supply chain and reduce the bullwhip effect. However, further research is required within this area and in particular the return on investment for RFID-enabled integrated systems.
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This thesis describes the history of robots and explains the reasons for the international differences in robot diffusion, and the differences in the diffusion of various robot applications with reference to the UK. As opposed to most of the literature, diffusion is examined with an integrated and interdisciplinary perspective. Robot technology evolves from the interaction of development, supply and manufacture, adoption, and promotion. activities. Emphasis is given to the analysis of adoption, at present the most important limiting factor of robot advancement in the UK. Technical development is inferred from a comparison of surveys on equipment, and from the topics of ten years of symposia papers. This classification of papers is also used to highlight the international and institutional differences in robot development. Analysis of the growth in robot supply, manufacture, and use is made from statistics compiled. A series of interviews with users and potential users serves to illustrate the factors and implications of the adoption of different robot systems in the UK. Adoption pioneering takes place when several conditions exist: when the technology is compatible with the firm, when its advantages outweigh its disadvantages, and particularly when a climate exists which encourages the managerial involvement and the labour acceptance. The degree of compatibility (technical, methodological, organisational, and economic) and the consequences (profitability, labour impacts, and managerial effects) of different robot systems (transfer, manipulative, processing, and assembly) are determined by various aspects of manufacturing operations (complexity, automation, integration, labour tasks, and working conditions). The climate for adoption pioneering is basically determined by the performance of firms. The firms' policies on capital investment have as decisive a role in determining the profitability of robots as their total labour costs. The performance of the motor car industry and its machine builders explains, more than any other factor, the present state of robot advancement in the UK.
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Warehouse is an essential component in the supply chain, linking the chain partners and providing them with functions of product storage, inbound and outbound operations along with value-added processes. Allocation of warehouse resources should be efficient and effective to achieve optimum productivity and reduce operational costs. Radio frequency identification (RFID) is a technology capable of providing real-time information about supply chain operations. It has been used by warehousing and logistic enterprises to achieve reduced shrinkage, improved material handling and tracking as well as increased accuracy of data collection. However, both academics and practitioners express concerns about challenges to RFID adoption in the supply chain. This paper provides a comprehensive analysis of the problems encountered in RFID implementation at warehouses, discussing the theoretical and practical adoption barriers and causes of not achieving full potential of the technology. Lack of foreseeable return on investment (ROI) and high costs are the most commonly reported obstacles. Variety of standards and radio wave frequencies are identified as source of concern for decision makers. Inaccurate performance of the RFID within the warehouse environment is examined. Description of integration challenges between warehouse management system and RFID technology is given. The paper discusses the existing solutions to technological, investment and performance RFID adoption barriers. Factors to consider when implementing the RFID technology are given to help alleviate implementation problems. By illustrating the challenges of RFID in the warehouse environment and discussing possible solutions the paper aims to help both academics and practitioners to focus on key areas constituting an obstacle to the technology growth. As more studies will address these challenges, the realisation of RFID benefits for warehouses and supply chain will become a reality.
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In recent years the increased interest in introducing radio frequency technology (RFID) in warehousing was observed. First adopters of RFID reported numerous benefits, which included: reduced shrinkage, real-time tracking and better accuracy of data collection. Along with the academic and industrial discussion on benefits which can be achieved in RFID enabled warehouses there are reports on issues related to adoption of RFID technology in warehousing. This paper reviews results of scientific reports of RFID implementation in warehouses and discusses the adoption barriers and causes of not achieving full potential of the technology. Following adoption barriers are identified and set in warehousing context: lack of forseeable return on investment (ROI), unreliable performance of RFID systems, standarisation, integration with legacy systems and privacy/security concerns. As more studies will address these challenges, the realisation of RFID benefits for warehouses will become reality.
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This article investigates the performance of a model called Full-Scale Optimisation, which was presented recently and is used for financial investment advice. The investor’s preferences of expected risk and return are entered into the model, and a recommended portfolio is produced. This model is theoretically more accurate than the mainstream investment advice model, called Mean-Variance Optimization, as there are fewer assumptions made. Our investigation of the model’s performance is broader when it comes to investor preferences, and more general when it comes to investment type, as compared to previous studies. Our investigation shows that Full-Scale Optimisation is more widely applicable than earlier known.
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Secondary fibre paper mills are significant users of both heat and electricity which is mainly derived from the combustion of fossil fuels. The cost of producing this energy is increasing year upon year. These mills are also significant producers of fibrous sludge and reject waste material which can contain high amounts of useful energy. Currently the majority of these waste fractions are disposed of by landfill, land-spread or incineration using natural gas. These disposal methods not only present environmental problems but are also very costly. The focus of this work was to utilise the waste fractions produced at secondary fibre paper mills for the on-site production of combined heat and power (CHP) using advanced thermal conversion methods (gasification and pyrolysis), well suited to relatively small scales of throughput. The heat and power can either be used on-site or exported. The first stage of the work was the development of methods to condition selected paper industry wastes to enable thermal conversion. This stage required detailed characterisation of the waste streams in terms of proximate and ultimate analysis and heat content. Suitable methods to dry and condition the wastes in preparation for thermal conversion were also explored. Through trials at pilot scale with both fixed bed downdraft gasification and intermediate pyrolysis systems, the energy recovered from selected wastes and waste blends in the form of product gas and pyrolysis products was quantified. The optimal process routes were selected based on the experimental results, and implementation studies were carried out at the selected candidate mills. The studies consider the pre-processing of the wastes, thermal conversion, and full integration of the energy products. The final stage of work was an economic analysis to quantify economic gain, return on investment and environmental benefits from the proposed processes.
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This thesis explores the process of developing a principled approach for translating a model of mental-health risk expertise into a probabilistic graphical structure. Probabilistic graphical structures can be a combination of graph and probability theory that provide numerous advantages when it comes to the representation of domains involving uncertainty, domains such as the mental health domain. In this thesis the advantages that probabilistic graphical structures offer in representing such domains is built on. The Galatean Risk Screening Tool (GRiST) is a psychological model for mental health risk assessment based on fuzzy sets. In this thesis the knowledge encapsulated in the psychological model was used to develop the structure of the probability graph by exploiting the semantics of the clinical expertise. This thesis describes how a chain graph can be developed from the psychological model to provide a probabilistic evaluation of risk that complements the one generated by GRiST’s clinical expertise by the decomposing of the GRiST knowledge structure in component parts, which were in turned mapped into equivalent probabilistic graphical structures such as Bayesian Belief Nets and Markov Random Fields to produce a composite chain graph that provides a probabilistic classification of risk expertise to complement the expert clinical judgements