Group Purchasing Organizations (GPOs) play a significant role in the healthcare industry. The presence of GPOs helps the healthcare centers to offload their responsibilities so that they can focus on more critical areas which require attention like providing quality care. This thesis involves the comparison of three models of procurement operations in terms of cost efficiency. This cost comparison model features a healthcare organization associated with a national GPO, a healthcare organization which procures by self sourcing (not associated with a GPO), and a hybrid procurement model involving a national GPO and a regional GPO. The comparison model highlighted the cost effectiveness of these three different ways of procurement, which threw significant light on the purchasing operations of healthcare organizations. In the second part of this research study, we formulated a method to measure the degree of access to innovative products across the above mentioned procurement models either involving on-contract (from a GPO) purchasing, or off-contract purchasing (from individual manufacturers not affiliated to GPO) or both. We also identified the metrics for innovation and measure the innovativeness of products. Based on the literature study, it was found that purchasing groups may also be an entry barrier to new suppliers (Zweig 1998), with big national GPOs dominating the market and dictating the pricing of commodities. The first hypothesis H1 of this research study was stated as "National GPOs (Group Purchasing Organizations) enable the healthcare establishments to lower the cost of medical services and operations." The second hypothesis H2 of this research study was acknowledged as "National GPOs a barrier to entry of Innovative product manufacturers in the healthcare industry." This thesis will identify the advantages and disadvantages of each type of procurement operation and address the economic issues which affect the relationship between a healthcare center and a GPO. The proposed research would indirectly help to identify whether cost savings are being shared by the links in the downstream supply chain and the savings are being percolated to the patients for the added welfare of the society. It will also identify the importance of innovative products in the society and will raise the bar of specialty treatments without compromising on the level of service being offered to the patients. This thesis will also highlight positive aspects of niche manufacturers of innovative products with smaller volumes which are currently marginalized in the market by the big national players. To the best of the author's knowledge, the research objective of measuring innovation of products has not been addressed yet in academic literature and will have the benefit of comparing three different purchasing models used in healthcare industry.

La ricerca segnala e documenta il complesso processo di comunicazione fra la società e i partecipanti alla skateculture.

The outcome of a production process might not only deviate from a theoretical maximum due to inefficiency, but also because of non-controllable influences. This raises the issue of reliability of Data Envelopment Analysis in noisy environments. I propose to assume an i.i.d. data generating process with bounded noise component, so that the following approach is feasible: Use DEA to estimate a pseudo frontier first (nonparametric shape estimation). Next apply a ML-technique to the DEA-estimated efficiencies, to estimate the scalar value by which this pseudo-frontier must be shifted downward to get the true production frontier (location estimation). I prove, that this approach yields consistent estimates of the true frontier. (author's abstract) / Series: Department of Economics Working Paper Series

Human actions have led to the destruction or degradation of natural habitats in virtually all parts of the Earth. Ecosystem restoration is one method to mitigate the effects of habitat loss. But restoration ecology is a young discipline and there is much left to be learned about how to effectively restore ecosystem functioning. This dissertation examines how soil amendments and planted herbaceous species diversity affect the restoration of ecosystem functions in wetlands, while also testing basic ecological questions that help us understand ecosystem function. Using data from the greenhouse and from the biodiversity and ecosystem function field experiment in Duke Forest, in Durham, NC, I examine how plant trait diversity, average plant traits, and environmental conditions influence nitrogen (N) removal from restored wetlands. Field data collected from a restored wetland in Charlotte, NC, enables me to examine how soil organic amendments influence the development of soil properties, processes, and plant communities. Finally, combining field data from both sites, I compare how soil properties influence denitrification potential in both restored wetlands. One unanswered question in the research relating biodiversity and ecosystem function is whether species diversity or species traits are more important drivers of ecosystem function. The first portion of my dissertation poses several hypotheses about how plant traits, plant trait diversity (calculated as a multivariate measure of plant trait diversity), and environmental conditions are likely to influence two ecosystem functions, biomass N and denitrification potential (DEA), and then examines these hypotheses in a restored wetland in the Piedmont of N.C. Using multiple linear regression, I demonstrate that functional diversity (FD), of traits important for plant growth had no effect on biomass N, but two plant traits, leaf area distribution ratio (LADR) and water use efficiency (WUE), had strong negative effects. Soil inorganic N also had a positive effect. For DEA, FD of traits related to denitrification also did not have a significant effect, but there was evidence of a weak positive effect. Two plant traits had positive effects on DEA, aboveground biomass and aboveground biomass C:N ratio; two traits, belowground biomass C:N ratio and root porosity, had negative effects. Soil inorganic N and soil organic matter also had positive effects on DEA. Results from a Principal Components Analysis (PCA) clustering plant species in trait-space, suggest that <em>Carex</em>, <em>Scirpus</em>, and <em>Juncus</em> species tend to be associated with traits that maximize biomass N, while there is no specific region of trait space or set of species that correspond to high DEA. Instead, there are multiple plant trait combinations that can lead to high DEA. These results suggest that, even though plant diversity (as measured by FD) does not significantly influence biomass N or denitrification, plant trait diversity is important to maintaining multiple ecosystem functions simultaneously. Restored wetlands tend to have lower levels of soil organic matter than natural reference wetlands. Low soil organic matter can limit nutrient cycling as well as plant survival and growth in restored wetlands. In the second portion of my dissertation, I examine how soil compost amendments influence the development of soil properties and processes as well as plant communities at a restored wetland in Charlotte, NC. Using two-way analyses of variance, multiple comparisons of means, and regression, I determine that available N and phosphorus (P) increase with increasing soil organic matter in both the low and high marsh. Total microbial biomass (MB) and microbial activity (measured by denitrification potential (DEA)) also significantly increase with increasing organic matter in both marsh communities, as does soil moisture. Neither total plant biomass (in the low marsh), nor plant species richness (in the high or low marsh) demonstrate any consistent patterns with soil organic matter level in the first three years post-restoration. These results suggest that compost amendments can positively influence some soil properties (i.e. soil available N, P, microbial biomass, and soil moisture) and some ecosystem functions including nutrient cycling (such as denitrification potential), but may have limited early impacts on plant communities. In restoration ecology there is a general assumption that restoring ecosystem structure will also restore ecosystem function. To test this fundamental assumption, I examine whether two restored wetlands demonstrate similar general relationships between soils variables (i.e. do the two systems have similar soil ecosystem structure), and whether the importance of each soil relationship is the same at both systems (i.e. do the two systems demonstrate the same soil function). I use structural equation modeling to both pose hypotheses about how systems function and to test them using field data. I determine that the same model structure of soil relationships is supported by data from these two distinct, yet typical urban restored wetland ecosystems (that is, the two systems have similar soil structure). At both systems higher soil organic matter is the most important predictor of higher DEA; however, most of the other relationships between soils variables are different at each system (that is, the two systems are not functioning in the same way). These results suggest that some fundamental relationships between soil properties and microbial functioning persist even when restored wetlands have very different land-use histories, plant communities, and soil conditions. However, restoring similar soil ecosystem structure does not necessarily lead to the restoration of similar soil function. Ultimately, I hope this research advances our understanding of how ecosystems function and improves future wetland restoration efforts. / Dissertation

On July 1, 1994, Taiwan¡¦s Executive Yuan ratified and determined the Ministry of Justice would dispatch personnel from drug enforcement related units and the Taiwanese High Prosecutor¡¦s Office would establish a ¡§Drug Enforcement Unit.¡¨ Each District Prosecutor¡¦s Office established an ¡§executive drug enforcement unit¡¨ and attempts were made to resolve problems arising from drug enforcement units being subsumed under different units. However, at present drug enforcement still suffers from the problem of various actors vying for jurisdiction over various matters related to drug enforcement. In addition, no national database for drug enforcement, has, as yet, been established, making it more difficult to solve drug related criminal cases. The drug related units of various government organs lack horizontal lines of communication, thus leading to wasted cooperative resources when dealing with international organs. That is why a study of drug enforcement responsible authorities has been an important and pressing issue. This thesis will discuss cross-national drug enforcement institutions in the United States based on exploring their social, political, economic background, to consider the provisions of international drug trends, and reference to the U.S. Drug Enforcement Administration of manpower, budget , training and other mechanisms so on, and provide future scholars and explore the practical possibility of development of anti-drug system. It will be expected to let our drug enforcement work more effective and reduce the spread of drugs in our country by researching U.S. law enforcement cooperation model.

Due to the social environment transition and the health care reform, hospital¡¦s transformation has made the high cost nurse resource of the medical organization issue. While facing salary pressure and nursing shortages, nursing leadership has taken an important role in stabilizing/establishing a positive work environment and maintaining good health care quality and job performance. In the past, personality and leadership have been proved to relate to job performance, but few studies show the relationship between these three variables. This study investigates which dimensions of the Five-Factor Model of personality of the head nurse (HN) are related to job performance. This study also analyzes the HN and investigates whether leadership style moderates personality-job performance relations. This study carried out a survey research and secondary date analysis in three regional hospitals of Kaohsiung-Pingtung area. The sample included 35 HN and 174 nurses who worked with their HN for over 6 months. t-test was used to examine the difference of personalities and leadership style in different demographic variables. In addition, the Tobit regression model explained significant portions of variance in these criterions. Results support the hypothesis that openness and extraversion are positively related to job performance. Results also support the hypothesis that consideration is appeared to moderate relationships between openness and job performance. This study show that personality influences job performance. Moreover, it shows that the leadership style could be the moderator between personality and job performance. This study suggested that personality might be a crucial factor in selection and recruiting of head nurses. In addition, providing training in leadership will facilitate the job performance. This study suggests that future studies should increase the sample size in terms of decision making units as well as random selection from different hospital levels.

Extreme hurricane events of the past decade are responsible for several drag embedment anchor (DEA) mooring failures of mobile offshore drilling platforms stationed within the Gulf of Mexico. A proposed failure mechanism is caused by out-of-plane loading. The current status of DEA holding capacity is based on empirical design charts and does not include the effects of out-of-plane loading. Experimental modeling using a 1:10 scale generic DEA was performed at the Haynes Coastal Engineering Laboratory at Texas A & M University to examine the effects of out-of-plane load conditions. Instrumentation and specialized devices were constructed to measure the anchor's trajectory through a representative sample of Gulf of Mexico clay with average un-drained shear strength of 0.764 kPa (16 psf). The sediment basin allowed for drag distances of 4.87 m (16 ft) and an embedment depth of 1.37 m (4.5 ft). The measurements included pitch and roll of the anchor and line tension measured at the shank pad-eye. The variables modeled were fluke angle settings of 22°, 36° and 50°. The initial towline angle was varied from a minimum of 5° to upwards of 20°. Surface out-of-plane angles of 45° and 90° and embedment loading of 15°, 30° and 45° were examined. Curves of the ultimate holding capacity with respect to the out-of-plane towline angle and ultimate embedment depth were developed as functions of out-of-plane loading angles. Analysis of the rate effect indicates that a 46 percent increase in towing velocity causes an average 3 percent increase of holding capacity. The 50° fluke angle embeds an average of 0.7 fluke lengths deeper and has a holding capacity of 0.73 units greater than the 36° setting. The surface out-of-plane tests have a 5.1 percent reduction in holding capacity as the out-of-plane load angle increases from 45° to 90°. For all one fluke length initial towing distance tests, the ultimate holding capacity increases and the ultimate embedment depth decreases as the out-of-plane towing angle increases from 15° to 45°. The three fluke length initial towing distance tests indicate a contrasting trend, in that as the out-of-plane tow angle increases, both the ultimate holding capacity and ultimate embedment depth decrease.

Banking industry has been playing a significant role in the process of economic development of Taiwan. There exists an inseparable relationship between its operation quality and the steady growth of national economy. Nevertheless, the drastically increasing numbers of bank in the recent years have caused a vicious competition in this industry. Meanwhile, the global economic recession also leads to the continuous rise of the percentage of nonperforming loans, ever-reducing profit earning as well as the financial chaos and crisis in the banking industry. This study adopts a more reliable efficiency evaluation method------ Data Envelopment Analysis(DEA) to judge the operation performance of banks. Besides, the CCR model and BCC model in DEA (Data Envelopment Analysis) are employed to explore whether the source of low efficiency comes from pure technical efficiency or from scale efficiency. Through slack variable analysis, this study suggests some room of improvement for the input and output of the low-efficiency banks. In view that the percentage of nonperforming loans is one of the essential factors for evaluating the operation performance of banks, this study puts it in the output variable of DEA so as to overcome the paradoxical isotonicity being caused. After verification is made by the study, the results show that it is really workable.

This thesis measures the effects of transformation of Turkish banks from a &ldquo / traditional&rdquo / one to a &ldquo / modern&rdquo / one over the period 2002-2009 and 2008 global financial crisis on efficiency of Turkish banks. Malmquist Total Factor Productivity Index is constructed using data envelopment analysis to measure the efficiency change in Turkish banking sector. The paper also analyzes the sensitivity of efficiency measures to different descriptions of inputs and outputs by employing two different approaches to describe the inputs and outputs of a bank. The major difference between the approaches is the use of deposits and non-deposit funds as input or output. Both confirm that the efficiency of the Turkish banking sector had increased over the period under examination and 2008 global financial crisis had adversely affected the efficiency of Turkish banks. The results show that the banks which had advanced in transformation to modern banking before 2001 financial crisis had experienced higher than the average increments in efficiency in the post-2001 financial crisis period.

In this study, multicriteria sorting methods based on Data Envelopment Analysis (DEA) are developed to evaluate industrial Research and Development (R&amp / D) projects proposed to Technology and Innovation Grant Programmes Directorate (TEYDEB) of the Scientific and Technological Research Council of Turkey (T&Uuml / BITAK). Even though DEA is used extensively as a multicriteria decision making (MCDM) tool for ranking / to our knowledge, this study is the first attempt utilizing DEA for sorting purpose. A five level R&amp / D project selection criteria hierarchy and an assisting point allocation guide with a scale of ten-points are derived to measure and quantify the performance of the proposals. The interval pairwise comparison matrices determined from the judgments of TEYDEB managers are used to obtain weight intervals from Analytic Hierarchy Process (AHP) model. These weights are employed as assurance region constraints. Motivated from the fact that derived criteria constitute inputs and outputs of R&amp / D projects / DEA determining efficiencies based on inputs and outputs is utilized for sorting. Based on this approach, two threshold estimation models, PM1 and PM2, and five assignment models, APM1, APM2, APM3, APM4 and APM5, are proposed. The models are applied to a case study in which 60 projects are placed into four groups according to two reference sets composed of proposals from the year 2009. The well-known muticriteria sorting method, UTADIS, is also implemented for comparison. It is concluded that proposed methods are more stable than UTADIS and the integrated application of threshold estimation model PM2 and assignment model APM4 provides the best results.