No / Effective maintenance is a key for infrastructures’ high operational reliability. The integration of corrective repairs and schedule-based failure preventions has been a mainstream of modern maintenance, and an associated policy-making technique, delay-time modelling, is overviewed in this paper for optimising the maintenance cost-efficiency in different practical scenarios, including imperfect, opportunistic and nested maintenance. A few typical examples of its applications in minimising maintenance operating expenses are discussed in this paper and their results are explained to better demonstrate the benefits of the technique. This work aims to prepare for the future applications of the delay-time modelling in railway maintenance policy making.

Existing theories and literature seeking to explain small business reticence to engage in enterprise bargaining, at times adopt a generalised approach which precludes or at least limits their relevance and ability to explain small business choice at the industry and even organisational level. Such explanations cannot be detached from the external contextual framework in which an organisation operates and its own, often unique, strategic corporate response to the environmental influences which are challenging it. Labour flexibility vehicles including bargaining, if chosen to facilitate broader corporate strategies, can thereby, be regarded as functionally dependent upon and interactive with the corporate orientations and objectives of the organisation which in turn are environmentally influenced and shaped. The research principally provides a focused description and analysis of the experiences of Clothingco, a small, up market, vertically integrated clothing manufacturer and retailer, which has undergone various strategic readjustments at the corporate and industrial relations level throughout the 1990s, in response to externally driven pressures. The research presents firm evidence to suggest that Clothingco has selected its labour flexibility mechanisms so that they are consistent with and able to accomodate prevailing corporate strategies and orientations. Its strategic corporate readjustments throughout the 90s, which can be perceived as falling along the continuum of cost minimisation to productivity enhancement, have in particular registered differing choices with respect to labour flexibility vehicle and strategies. In the light of the findings, the research as a preferred labour flexibility vehicle at Clothingco. These are identified as: an increasing corporate focus towards cost minimisation throughout the 1990s, coupled with an inability by management to countenance union intervention in enterprise bargaining procedures. The interaction of both these factors, rendered enterprise bargaining from the point of view of management, both a strategically and industrially inferior labour flexibility vehicle to the use of contract labour. The research's strength lies in these areas which have been highlighted and which can be monitored and tested more comprehensively in future research. / Master of Commerce (Hons)

Inguinal hernia repair is the most common operation in general surgery. Its main challenge is to achieve low recurrence rates. With the introduction of mesh implants, first in open and later in laparoscopic repair, recurrence rates have decreased substantially. Therefore, the focus has been shifted from clinical outcome, such as recurrence, towards patient-experienced endpoints, such as chronic pain. In order to compare the results of open and laparoscopic hernia repair, a randomised multicentre trial - the Swedish Multicentre trial of Inguinal hernia repair by Laparoscopy (SMIL) - was designed by a study group from 11 hospitals. Between November 1996 and August 2000, 1512 men aged 30-70 years with a primary inguinal hernia were randomised to either laparoscopic (TEP, Totally ExtraPeritoneal) or open (Lichtenstein) repair. The primary endpoint was recurrence at five years. Secondary endpoints were short-term results, frequency of chronic pain and a cost analysis including complications and recurrences up to five years after surgery. In total, 1370 patients, 665 in the TEP and 705 in the Lichtenstein group, underwent operation. With 94% of operated patients available for follow-up after 5.1 years, the recurrence rate was 3.5% in the TEP and 1.2% in the Lichtenstein group. Postoperative pain was lower in the TEP group up to 12 weeks after operation, resulting in five days less sick leave and 11 days shorter time to full recovery. Patients in the TEP group had a slightly increased risk of major complications. Chronic pain was reported by 9-11% of patients in the TEP and 19-25% in the Lichtenstein group at the different follow-up points. Hospital costs for TEP were higher than for Lichtenstein, while community costs were lower due to shorter sick leave. By avoiding disposable laparoscopic equipment, the cost for TEP would be almost equal compared with Lichtenstein. In conclusion, both TEP and Lichtenstein repair have advantages and disadvantages for the patient. Depending on local resources and expertise both methods can be used and recommended for primary inguinal hernia repair.

The provision of decent, affordable and well-located housing for low-income communities has been an intractable problem, especially for developing countries. The empirical puzzle that motivated this study is that, despite the adverse macro environment in Zimbabwe, there appears to be private-sector developers who are successfully developing housing benefiting the low-income group. This is so, despite numerous studies that claim that given the magnitude of the housing challenge, a neoliberal doxa in a developing country context as a solution is a fallacy. Working on the broad premise that these developments represent a successful adaptation to the structural environment, the main question guiding the study was - what accounts for the success of market provided low-income housing developments in Zimbabwe despite the environment not being conducive for it? The two sub-questions flowing from this main question were firstly, how does the structural environment enable and/or constrain private sector low-income developments in Zimbabwe? Secondly, what strategies do developers adopt in response to the structural enablers and/or constraints to develop low-income housing in Zimbabwe? From these questions, the study has two hypotheses – the first hypothesis is that despite the adverse environment there exists in Zimbabwe structural enablers that make market solutions to the low-income housing challenge possible. The second hypothesis states that developers have specific discernible strategies that they employ in response to the adverse operating environment to reduce development costs to levels that enable them to provide low-income housing successfully. Using the Structure-Agency model, which is a theoretical framework rooted in institutional economics, a conceptual model to study the development process was developed and used to theorise the impact of structure on agency in the development process. Empirical evidence was gathered using observation, household surveys, and semi-structured interviews. This evidence was obtained from five housing schemes, the local authority, central government, financiers and the developers of the housing schemes, and then processed using NVIVO and SPSS. The study finds that most challenges faced by developers emanate from the institutional environment and access to resources. These challenges are namely central-local government dynamics fuelled by political undertones, lack of access to land suitable for the target group, a bureaucratic and stiff regulatory framework as well as a lack of market provided developer and end-user finance. Enabling factors were mainly the withdrawal of the government in the provision of housing in line with World-Bank neoliberal orthodoxy and incapacitation of the local authority, which eliminated alternative sources of housing for the low income group other than market provided housing, thus widening the market base for the developers. Strategies used by the developers include developer provided finance to the target group, preselling developments, sidestepping the local authority through buying land at the periphery of the local authority boundary, sidestepping regulatory barriers through engaging in corruption, backward integration to promote efficient resource allocation, and an innovative approach to risk management that caters for the low-income group. The study concludes that all these strategies have one overriding objective of cost containment. The findings indicate that there is potential, appetite and scope for more private-sector engagement. On this basis, it is recommended that the key to unlocking this potential lies with the state, as there are several policy implications that flow from these findings if the highlighted constraints are to be addressed. The study makes a number of key contributions to knowledge on market solutions to the low-income housing challenge in the area of theory, methodology, policy and empirical data.

There is a growing realisation from the Australian government that new models of health care will need to be developed to address the disparity of access, increasing demand and escalating cost of traditional means of delivering health care. There is growing evidence showing health care services can be delivered safely and efficiently by email. Despite this body of evidence the clinical utility of email is occurring at a much slower rate than in other business areas. Technological barriers and privacy risks are often cited as cause of the fragmented adoption and utilisation of email-based telemedicine. In addressing these impediments, the service-delivery application needs to be considered. The service-delivery applications used in email-based telemedicine can be divided into two distinct categories. The first is ordinary email applications — such as the commercial products used for personal communication — and the second is where the health care provider undertakes the development of an email application purpose-written to support their telemedicine service. This aim of this research was to develop a decision support model (DSM) to address the complex issues in choosing the service-delivery application most appropriate for an email service. Three areas which would influence a provider’s decision were identified — i) privacy and security ii) economics and ii) quality of service — and investigated. Most emails are sent in plain text across the Internet and pose a privacy risk. Encryption of the email message is used to mitigate the risk. Two means of encryption were investigated: public key infrastructure (PKI) used in conjunction with ordinary email and secure web-mail applications, which require the development of a purpose-written application. Decisive factors in choosing the most appropriate privacy-enhancing technology for an email-based service were identified by a number of means including: technical assessment of encryption models, literature review, survey of users of an email-based telemedicine service and analysis of client applications used in a telemedicine service. This investigation established that correspondent’s perception to privacy risk, email client application support of PKI, risk tolerance to human error and the technical skill are decisive factors in choosing privacy-enhancing technology. The survey respondents considered a privacy breach during email communication was either likely or very unlikely regardless of whether the communication was encrypted or not. Indicating correspondents are unlikely to comply with encryption especially if the technology is cumbersome. Although the population was of a limited demographic, there was a large proliferation (around 87%) of web-mail clients — for example, Hotmail and Gmail — amongst the users of email-based telemedicine services. Web-mail clients cannot be secured with PKI. Hence, assessment of client-email applications used by correspondents in telemedicine will influence the type of privacy-enhancing technology. Technical assessment of privacy-enhancing technology has identified human-error as a risk when using PKI. Secure web-mail obviates human-error. Therefore, tolerance to human-error risk will be decisive in choice of privacy-enhancing technology. PKI has received criticism for being user-unfriendly and requiring technical proficiency to use. This investigation has established the usability of secure web-mail is comparable to ordinary, unencrypted email. Indicating secure communication is feasible when services are not supported by technical expertise. The cost of providing an email-based service is influenced by the service-delivery application. To develop a purpose-written application will cost the heath care provider but staff may be able to work more efficiently because the resultant application contains telemedicine specific functionality that meet the exact requirements of the service. Staff resources to run an email-based telemedicine service using ordinary email were compared to staff resources to run the same service using a purpose-written application. The purpose-written application afforded a reduction of 3% in time for clinical staff. Ancillary staff savings were more pronounced with a 33% reduction in administrative staff time and a 21% reduction in supervisory staff time. A cost-minimisation analysis established at a workload of up to 5000 email consultations per annum it is more economical to the run the service with ordinary email. For higher workload volumes it is cheaper to run the service with a purpose-written application. The threshold of 5000 emails consultations is the point at which the higher initial development cost of a purpose- written application are offset by staff efficiencies. A sensitivity analysis established the most influential factor in the economic model was workload volume — development costs and variable costs had little influence on the threshold. Response time was established as a quality of service metric after investigation demonstrated increases in response time were strongly correlated with a decrease in utilisation rate. The response time to maximise the utilisation rate was 32h or less. Pre- and post- studies demonstrated a purpose-written application can reduce response times. Telemedicine specific functionality in a purpose-written application was also investigated. Conditions for a purpose-written application — for example, use of multi-disciplinary staff, a priority service model and continuum of care over multiple email exchanges — to be efficacious at reducing response times were established. The conditions identified in the privacy and security, economic and quality of service investigation were amalgamated into a DSM. The DSM was retrospectively tested by comparing the output of the model to a gold-standard of the actual service-delivery used by a number of subject organisations. When used to identify services that required a purpose-written application the DSM was 92% sensitive and 92% specific. The model was also tested prospectively and demonstrated 85% concordance from testers in the choosing the service-delivery application. Testing the DSM identified strengths for both ordinary email and purpose-written applications under different circumstances — indicating both are valid alternatives for email-based telemedicine. The individual requirements of a telemedicine service — for example, privacy requirements, participants, the workload volume, number of staff disciplines, mode of service — will dictate the choice of the most appropriate service-delivery application. Informed decision on when and why to use a service-delivery application has implications for the successful delivery of email-based telemedicine services because the choice of service-delivery application will affect: - The staff resources needed to run the service; - The capital cost of implementing a service; - The operating costs of running a service; - The response times to client emails which in turn, influences the utilisation of the service; - The privacy-enhancing technology which in turn, influences the usability and compliance to legislative and statutory requirements.

Since the late 1980s, the energy sector in Great Britain has undergone some core changes in its functionality; beginning with the early 1990s privatisation, followed by an increased green ambition, and commencing a transition towards a low-carbon economy. As the British energy sector prepares itself for another major overhaul, it also puts itself at risk for not being sufficiently prepared for the consequences this transition will have on the existing generating capacity, security of supply, and the national electricity market. Upon meeting existing targets, the government of the United Kingdom risks becoming complacent, putting energy regulation to the backseat and focusing on other regulatory tasks, while introducing cuts for thriving renewable and other low-carbon energy generating technologies. The government has implemented a variety of directives, initiatives, and policies that have sometimes been criticised due to their lack of clarity and potential overlap between energy and climate change directives. The government has introduced policies that aim to provide stable short-term solutions. However, a concrete way of resolving the energy trilemma and some of the long-term objectives and more importantly ways of achieving them are yet to be developed. This work builds on analysing each low-carbon technology individually by assessing its past and current state in the British energy mix. By accounting for the changes and progress the technology underwent in its journey towards becoming a part of the energy capacity in Great Britain, its impact on the future wholesale electricity prices is studied. Research covered in this thesis presents an assessment of the existing and incoming low-carbon technologies in Great Britain and their individual and combined impact on the future of British energy economics by studying their implications for the electricity market. The methodological framework presented here uses a cost-minimisation merit order model to provide useful insights for novel methods of electricity production and conventional thermal energy generation to aid with the aftermath of potential inadequate operational and fiscal flexibility. The thesis covers a variety of scenarios differing in renewable and thermal penetration and examines the impact of interconnection, energy storage, and demand side management on the British wholesale electricity prices. The implications of increasing low-carbon capacity in the British energy mix are examined and compared to similar developments across Europe. The analysis highlights that if the optimistic scenarios in terms of green energy installation are followed, there is sufficient energy supply, which results in renewable resources helping to keep the wholesale price of electricity down. However, if the desired capacity targets are not met, the lack of available supply could result in wholesale prices going up, especially in the case of a natural gas price increase. Although initially costly, the modernisation of the British grid leads to a long-term decrease in wholesale electricity prices and provides a greater degree of security of supply and flexibility for all market participants.

Objective: To evaluate the tendencies of utilization of Angiotensin converting enzyme inhibitors and Angiotensin II receptors antagonists in Lithuania during 2005-2007 years. Methods: MEDLINE database was searched to identify and evaluate all literature relating to pharmacokinetic and pharmacodynamic characteristics of Angiotensin converting enzyme inhibitors and Angiotensin II antagonists. Utilization data of Angiotensin converting enzyme inhibitors (plain and combinations) and Angiotensin II antagonists (plain and combinations) in Lithuania over three years (2005 – 2007) period were obtained from SoftDent, JSC database. The retail prices of agents acting on the Renin-angiotensin-aldosterone selected from Reimbursed Medical Products Reference Prices Lists of 2005, 2006, 2007 years. Drugs were classified according to the Anatomic Therapeutic Chemical system and use was quantified in terms of defined daily doses (ATC/DDD). Consumption of Angiotensin converting enzyme inhibitors (plain and combinations) and Angiotensin II antagonists (plain and combinations) was calculated by DDD methodology and expressed as DDD per 1.000 inhabitants per day. Pharmacoeconomic calculations were done according to cost minimization and reference price methodologies. Results: According to meta-analysis, number of included studies (69 publications) that evaluated various treatment and head-to-head efficacy comparisons found in literature no consistent differential effects of ACEIs versus ARBs on... [to full text] / Tikslas: atlikti Angiotenziną konvertuojančių fermentų inhibitorių ir Angiotenzino II antagonistų suvartojimo tendencijų Lietuvoje analizę 2005 – 2007 metais. Metodai: Duomenys apie Angiotenziną konvertuojančio fermento inhibitorių ir Angiotenzino II antagonistų farmakokinetines ir farmakodinamines savybes buvo surinkti iš MEDLINE elektroninių duomenų šaltinių. Duomenys apie AKF inhibitorių (paprastų ir sudėtinių) ir Angiotenzino II antagonistų (paprastų ir sudėtinių) suvartojimą Lietuvoje per 2005 – 2007 metus gauti iš UAB SoftDent duomenų bazės. Renino-angiotenzino-aldosterono sistemą veikiančių vaistų mažmeninės kainos išrinktos iš Lietuvos kompensuojamų vaistinių preparatų 2005, 2006, 2007 metų kainynų. Vaistai buvo suklasifikuoti pagal anatominę terapinę cheminę (ATC) klasifikaciją. AKFI inhibitorių (paprastų ir sudėtinių) ir Angiotenzino II antagonistų (paprastų ir sudėtinių) suvartojimas buvo vertinamas pagal apibrėžtos dienos dozės (DDD – daily defined dose) metodiką, o duomenys įvertinti pagal DDD skaičių, tenkantį 1000 gyventojų per vieną dieną. AKF inhibitorių (paprastų ir sudėtinių) ir Angiotenzino II antagonistų (paprastų ir sudėtinių) farmakoekonominei analizei atlikti buvo taikytas kainų mažinimo bei standartinės kainos nustatymo metodai. Rezultatai: Vadovaujantis metaanalizių, įvairių klinikinių tyrimų 69 publikacijomis bei išsamia AKF inhibitorių ir Angiotenzino II antagonisų efektyvumo palyginimo analize galima teigti, kad šių vaistų grupių poveikis... [toliau žr. visą tekstą]