This thesis argues for providing spiritual care in primary care for Massachusetts persons with disabilities having Medicare and Medicaid as their primary insurers. It outlines an advocacy strategy to (1) increase awareness of the importance of spiritual care as key to primary care, (2) get buy-in for spiritual care as an optional primary care service to Medicaid beneficiaries needing nonmedical supports and services to live in the community due to mental health diagnosis or physical disability, and (3) put forward a statutory or regulatory proposal requiring One Care plans to provide certified peer chaplains as a covered service starting 2023.

Human beings have relied on outdoor public spaces for thousands of years to recreate, socialize, exercise, and conduct business. As climate change leads to more severe weather including flooding, prolonged heatwaves, and wildfires, our ability to safely spend time outdoors is increasingly under threat. While a lot of attention has focused on bolstering the resilience of physical infrastructure, social infrastructure such as public parks are often left behind. To address this issue, this project uses East Potomac Park in Washington, DC as a case study to explore architectural interventions to physically and socially adapt parks for climate change. The existing park, which sits on a sinking island constructed in the early 20th century, is frequently forced to close due to tidal flooding. Utilizing a managed retreat along the southwestern edge of the park, the northeastern edge can be reconstructed as a resilient park for the next century. A series of interconnected pavilions each contain a unique architectural program coupled with passive and active environmental strategies to create comfortable recreational opportunities throughout the year. Specifically, sawtooth roofs, brise soleil, and vegetation are explored to manage temperatures, light, and airflow. / Master of Architecture / Human beings have relied on outdoor public spaces for thousands of years to recreate, socialize, exercise, and conduct business. As climate change leads to more severe weather including flooding, prolonged heatwaves, and wildfires, our ability to safely spend time outdoors is increasingly under threat. While a lot of attention has focused on bolstering the resilience of physical infrastructure, such as roads and bridges, social infrastructure such as public parks are often left behind. To address this issue, this project uses East Potomac Park in Washington, DC as a case study to explore architectural strategies to physically and socially adapt parks for climate change. The existing park, which sits on a sinking island constructed in the early 20th century, is frequently forced to close due to tidal flooding. Utilizing a managed retreat along the southwestern edge of the park, the northeastern edge can be reconstructed as a resilient park for the next century with a series of interconnected pavilions housing recreational or social space.

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Thesis (MBA)--Stellenbosch University, 2005. / ENGLISH ABSTRACT: This thesis researches World Class Manufacturing Techniques (WCMT) and their applicability in a Non-Production Environment such as an inbound call centre in the financial services sector. These WCMT involve a set of innovative techniques and principles, which are applied by foremost manufacturing companies. These techniques however, are not sacred and one always needs to refer back to the objectives of World Class Manufacturing, namely to (a) Eliminate waste, (b) Improve quality, (c) Shorten lead times, (d) Reduce costs, and (e) Improve morale and seek other improvements. The importance lies in attaining the objectives in the context of the necessary manufacturing tasks. Companies applying these techniques demonstrate significant productivity gains, production synergies, reduced rework and more reliable on-time delivery. In the highly competitive global market, these offer a competitive advantage for such companies. A critical and essential element of a company's strategic vision is a clearly defined and healthy competitive advantage. It is imperative that a company's vision is clearly aligned to its business objectives and goals. The WCMT is a tool that aligns the business vision and strategic objectives to realize its competitive advantage. By aligning the vision to its competitive advantage, it is crucial that the company challenge its existing production processes and the way in which it operates. Existing production processes need to be continuously reviewed and adjusted where necessary to sustain the competitive advantage. This paper is a practical example of how a non-production organisation can apply these WCMT to sustain its competitive advantage. The WCMT such as Theory of Constraints (TOC), Just in Time (JIT) and Total Quality Management (TQM) are discussed and applied in the inbound call centre of a medical aid administration company. In a relatively short time span, some remarkable sustainable productivity improvements were achieved. This would imply that these WCMT could be applied in traditional non-production environments. / AFRIKAANSE OPSOMMING: Hierdie navorsings werkstuk ondersoek Wêreld Klas Vervaardigings Tegnieke (WCMT) en die moontlike toepassing daarvan in 'n nie-vervaardigings omgewing, soos 'n inbeldienssentrum in die finansiële dienste sektor. Hierdie WCMT omsluit 'n groep innoverende tegnieke wat huidiglik aangewend en toegepas word in die meeste vervaardigings ondernemings. Hierdie tegnieke is nie beperk nie en verwys altyd terug na die doelstellings van WCMT naamlik (a) Vermindering van afval, (b) Verbetering van kwaliteit, (c) Verkorting van wag periodes, (d) Verlaging van kostes, en (e) Verbeterende personeel moraal en die voortdurende soeke na ander verbeteringe. Die belangrikheid van WCMT lê in die bereiking van hierdie bogenoemde doelwitte binne die konteks van die noodsaaklike vervaardigings metodes. Ondernemings wat hierdie tegnieke toepas vind groot produksiekapasiteit verbeteringe, produksie sinergie, 'n verlaging in die oordoen van foutiewe werk en ondervind ook grotendeels meer gereelde op-tyd aflewering. In die hoogs kompeterende globale mark bied die WCMT die broodnodige mededingende voordeel aan hierdie ondernemings. Die kritieke en belangrike bestanddeel van 'n onderneming se strategie en visie is die onderneming se vermoë om 'n deeglike en gesonde mededingende voordeel bo sy mededingers te hê. Dit is van kardinale belang dat die onderneming se visie behoorlik in lyn is met die onderneming se strategiese doelwitte. Hierdie WCMT is 'n instrument wat die onderneming kan aanwend ten einde sy visie en strategiese doelwitte, asook sy kompeterende voordeel, te bereik. Dit is krities belangrik dat 'n onderneming se visie en sy kompeterende doelwitte gesinkroniseer en gelykgestel is en verder dat die onderneming ook sy huidige produksie prosesse herevalueer, asook die manier waarop die onderneming opereer. Huidige produksie prosesse moet voortdurend geherevalueer en aangepas word waar nodig, ten einde die onderneming se voortdurende kompeterende voordeel te behou. Hierdie navorsings stuk is 'n voorbeeld van die praktiese toepassing van WGMT en hoe hierdie tegnieke 'n onderneming behulpsaam kan wees ten einde sy kompeterende voordeel te behou. Die WGMT soos die Teorie van Beperkings (TOC), Net Betyds (JIT) en Totale Kwaliteit Beheer (TQM) word deeglik ondersoek en bespreek. Die navorser ondersoek voorts die moontlikheid om hierdie tegnieke toe te pas in 'n in beldienssentrum by 'n administrateur van mediese fondse. In 'n relatiewe kort periode het die navorser noemenswaardige en voortdurende produksie verbetering teweeg gebring deur die toepassing van WGMT. Die navorser het afgelei dat hierdie WGMT nie net beperk is tot die vervaardigings sektor nie, maar dat dit ook in die nie-vervaardigings sektor doeltreffend aangewend kan word.

Conservation of intertidal habitats in the UK is vital in order to continue to support nationally and internationally important populations of non-breeding waterbirds. Historic reclamation for agriculture and industry has resulted in the loss and degradation of large areas of these intertidal habitats in estuaries and they continue to be threatened by sea-level rise. Managed realignment is one method which is increasingly being used to restore intertidal habitats. As managed realignment is a relatively new restoration technique, the extent to which knowledge of the biology of estuaries is applicable to managed realignment sites is unclear. Habitat restoration is often unsuccessful or incomplete, so a detailed knowledge of both the natural system and the characteristics of restored systems will usually be necessary to recreate fully-functional estuarine habitats. This thesis focuses on Nigg Bay Managed Realignment Site (Nigg Bay MRS), the first managed realignment site in Scotland, and follows the first four years of ecological development to gain an understanding of how breached realignment can be used to restore intertidal habitats to support non-breeding waterbirds. This thesis has six major aims: (i) to describe the development of saltmarsh, (ii) to describe the development of intertidal flat, (iii) to describe the colonisation by non-breeding waterbirds (iv) to determine how tidal cycle and weather affect patterns of waterbird use, (v) to determine which factors affect the spatial distribution of waders and finally (vi) to determine the patterns of use by individual birds. Four summers after the re-establishment of tidal conditions, almost all of the saltmarsh species recorded on the nearby saltmarsh had colonised Nigg Bay MRS, although recognisable communities had yet to establish. Three winters after the re- establishment of tidal conditions in Nigg Bay MRS, the sediments had a significantly smaller particle size and higher organic matter content compared to the fine sands of the adjacent intertidal flats. The intertidal invertebrate community also differed from the adjacent intertidal flats. Nigg Bay MRS attracted large numbers of non-breeding waterbirds and supported each of the most common wader and wildfowl species present in the wider estuary. Nigg Bay MRS performs a number of important functions for non-breeding waterbirds by: (i) providing a foraging and resting habitat when the tide is absent and intertidal sediments in Nigg Bay are exposed; (ii) providing a foraging resource as the tide passes over the intertidal sediments within the site once the intertidal flats in Nigg Bay are inundated; and (iii) providing a high tide roosting site. On days with low temperatures and high wind speeds, more waterbirds use Nigg Bay MRS, suggesting that it is likely to be providing sheltering benefits. Nigg Bay MRS also provides top-up feeding habitat. The factors that often influence the spatial distributions of waders in estuaries appear to be operating within Nigg Bay MRS. Wader densities are greater on the intertidal flats when they are accessible than on the saltmarsh. Wader densities are also greatest close to creeks and drainage channels, possibly due to higher invertebrate densities, more accessible prey or sheltering benefits. Colour-ringing and radio-tracking of Common Redshank established that Nigg Bay MRS has a subset of regular users, including both adults and juveniles, and the wader assemblage at night may differ from the assemblage during the day. These findings are discussed in terms of the implications for locating, designing and managing future managed realignment projects.

Managed aquifer recharge (MAR) is the purposeful recharge of an aquifer for later recovery or environmental benefits and represents a valuable method for sustainable water resources management. Models can be helpful tools for the assessment of MAR systems. This review encompasses a survey and an analysis of case studies which apply flow and transport models to evaluate MAR. The observed modeling objectives include the planning or optimization of MAR schemes as well as the identification and quantification of geochemical processes during injection, storage and recovery. The water recovery efficiency and the impact of the injected water on the ambient groundwater are further objectives investigated in the reviewed studies. These objectives are mainly solved by using groundwater flow models. Unsaturated flow models, solute transport models, reactive geochemical models as well as water balance models are also frequently applied and often coupled. As each planning step to setup a new MAR facility requires cost and time investment, modeling is used to minimize hazard risks and assess possible constraints of the system such as low recovery efficiency, clogging and geochemical processes.

A 15.5-mile portion of the I-85 high-occupancy vehicle (HOV) lane in the metropolitan area of Atlanta, GA was converted to a high-occupancy toll (HOT) lane as part of a federal demonstration project designed to provide a reliable travel option through this congested corridor. Results from the I-85 demonstration project provided insight into the results that may follow the Georgia Department of Transportation's planned implementation of a $16 billion HOT lane network along metropolitan Atlanta's other major roadways [2]. To evaluate the impacts of the conversion, it was necessary to measure changes in corridor travel speed, reliability, vehicle throughput, passenger throughput, lane weaving, and user demographics. To measure such performance, a monitoring project, led by the Georgia Institute of Technology collected various forms of data through on-site field deployments, GDOT video, and cooperation from the State Road and Toll Authority (SRTA). Changes in the HOT lane's speed, reliability or other performance measure can affect the demographic and vehicle characteristics of those who utilize the corridor. The purpose of this particular study was to analyze the changes to the vehicle characteristics by comparing vehicle occupancy, vehicle classifications, and vehicle registration data to their counterparts from before the HOV-to-HOT conversion. As part of the monitoring project, the Georgia Tech research team organized a two-year deployment effort to collect data along the corridor during morning and afternoon peak hours. One year of data collection occurred before the conversion date to establish a control and a basis from which to compare any changes. The second year of data collection occurred after the conversion to track those changes and observe the progress of the lane's performance. While on-site, researchers collected data elements including visually-observed vehicle occupancy, license plate numbers, and vehicle classification [25]. The research team obtained vehicle records by submitting the license plate tag entries to a registration database [26]. In previous work, vehicle occupancy data were collected independently of license plate records used to establish the commuter shed. For the analyses reported in this thesis, license plate data and occupancy data were collected concurrently, providing a link between occupancy records of specific vehicles and relevant demographic characteristics based upon census data. The vehicle records also provided characteristics of the users' vehicles (light-duty vehicle vs. sport utility vehicle, model year, etc.) that the researchers aggregated to identify general trends in fleet characteristics. The analysis reported in this thesis focuses on identifying changes in vehicle characteristics that resulted from the HOV-to-HOT conversion. The data collected from post-conversion are compared to pre-conversion data, revealing changes in vehicle characteristics and occupancy distributions that most likely resulted from the implementation of the HOT lane. Plausible reasons affecting the vehicle characteristics alterations will be identified and further demographic research will enhance the data currently available to better pinpoint the cause and effect relationship between implementation and the current status of the I-85 corridor. Preliminary data collection outliers were identified by using vehicle occupancy data. However, future analysis will reveal the degree of their impact on the project as a whole. Matched occupancy and license plate data revealed vehicle characteristics for HOT lane users as well as indications that the tested data collectors are predominantly synchronized when concurrently collecting data, resulting in an argument to uphold the validity of the data collection methods. Chapter two provides reasons for why HOT lanes were sought out to replace I-85's HOV lanes. Chapter two will also provide many details regarding how the HOT lanes function and it will describe the role the Georgia Institute of Technology played in the assessment the HOV-to-HOT conversion. Chapter three includes the methodologies used to complete this document while chapter four provides results and analysis for the one year period before the conversion and the one year period after the conversion.

<p>Today’s business market is highly competitive, therefore companies need to be constantly updated and change the way they operate their business, in order to survive and remain competitive. The situation on today’s market requires that companies have the ability to quickly respond to market changes and new customer demands within short product lifecycles. In order to deal with this new market situation, companies need to improve the integration with other companies within their business. This integration facilitates the companies’ ability to quickly adapt to new market situations and survive on a fast changing market. One of the main underlying concepts of this collaborative commerce is Supply Chain Management (SCM) which integrates and coordinates a company’s processes both internally and externally. Information Technology (IT) could improve the effectiveness of SCM. IT-solutions make the business processes more effective and improves the integration with other actors within the supply chain. The purpose with this thesis is to describe and explain the effects for businesses and the consequences for its processes when implementing a real-time IT-Logistics solution together with identifying the critical success factors. The thesis has been conducted by studying theory regarding supply chain management, business renewal and implementation effects. Further, a case study has been conducted where three actors have been interviewed; a manufacturer (Volvo Powertrain), a subcontractor (Metallfabriken Ljunghäll AB) and a system developer (PipeChain). The analysis of the theoretical framework and the empirical research has contributed with an identification of major effects and consequences when implementing a real-time IT-Logistics solution. Some of the effects are: inventory reduction, higher delivery accuracy, improved relations and increased flexibility. Examples of consequences these effects have caused are: more accurate planning and production, effective production processes as well as an improved delivery process. Additionally, success factors for an implementation have been identified such as mutual trust, understanding of change and evaluation.</p> / <p>Konkurrensen är stor inom dagens affärsmarknad vilket medför att företag ständigt måste vara uppdaterade och förändra deras affärsverksamhet för att kunna överleva och vara konkurrenskraftiga på marknaden. Dagens marknadssituation erfodrar att företag snabbt kan reagera på marknadsförändringar och nya kundkrav vid allt kortare produktlivscyklar. För att företag skall kunna hantera denna nya marknadssituation måste företagen bli integrerade med varandra inom deras affärsområde. Denna integrering underlättar företagens förmåga att snabbt kunna anpassa sig till nya marknadssituationer och överleva på en snabbt föränderlig marknad. Ett utav de största grundläggande koncepten för denna integrering är flödeshantering (Supply Chain Management). Flödeshanteringen integrerar och koordinerar företagets processer både internt som externt. Informationsteknologi (IT) kan förbättra effektiviteten av flödeshanteringen. IT-lösningar skapar effektivare affärsprocesser och förbättrar integrationen med andra aktörer inom företagets försörjningskedja. Syftet med uppsatsen är att beskriva och förklara effekter för affärsverksamheten samt konsekvenser för dess affärsprocesser, vid en implementering av en realtidslogistiklösning. Uppsatsen syftar vidare till att identifiera framgångsfaktorer vid en sådan implementering. Uppsatsarbetet har genomförts genom en litteraturstudie där teori om flödeshantering, affärsförändring och implementationseffekter har behandlats. En fallstudie i uppsatsen har använts där tre aktörer har blivit intervjuade; en tillverkare (Volvo Powertrain), en underleverantör (Metallfabriken Ljunghäll) och en systemutvecklare (PipeChain). Analysen av litteraturstudien och den empiriska undersökningen har bidragit till en identifiering av huvudeffekter samt konsekvenser vid en implementering av en IT-logistiklösning. Några av dessa effekter är: lagerreducering, högre leveranssäkerhet, förbättrade relationer samt ökad flexibilitet. Exempel på konsekvenser dessa effekter har orsakat är: precisare planering och produktion, effektivare produktionsprocesser samt förbättrad leveransprocess. Vidare så har framgångsfaktorer för lyckad implementering identifierats så som ömsesidig tillit, förståelse för förändring samt utvärdering.</p>

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Valet mellan aktiv respektive passiv fondförvaltning har sedan länge varit en omdiskuterad fråga inom privata fondsparandet. På senare tid har frågan kommit att återaktualiserat efter att de aktivt förvaltade storfonderna Allemansfond komplett och Kapitalinvest anklagats för vilseledande marknadsföring, då de inte har generat en högre avkastning än den generella marknaden. Inom den akademiska världen har erkända forskare och sedermera pristagare av Sveriges Riksbanks pris i ekonomisk vetenskap till Alfred Nobels minne, påvisat att aktivt förvaltade fonder inte kan generera en högre avkastning med hänsyn till förvaltningsavgifterna. Utifrån förvaltningsavgifterna påvisade betydelse har vi valt att studera effekten av de rabatterade förvaltningsavgifterna, inom Premiepensionssystemet. Studiens syfte är således att under tidsperioden, 1 januari 2004 till 31 december 2013, analysera om aktiv förvaltade fonder har genererat en högre riskjusterad avkastning än passivt förvaltade fonder, då hänsyn tagits till de rabatterade förvaltningsavgifterna. Studien baserades på dagliga marknadsnoteringar av 174 aktivt förvaltade premiepensionsfonder och årliga förvaltningsavgifter.  Vidare använde vi oss av ett globalt aktiemarknadsindex, MSCI World, som utifrån definitionen av passivt förvaltade fonder var synonymt med studiens jämförelseindex. I enlighet med studiens syfte använde vi oss av det riskjusterade avkastningsmåttet Sharpekvot för att kunna besvara studiens frågeställning.  Resultatet av studien påvisade att aktivt förvaltade fonder har genererat en högre avkastning än passivt förvaltade fonder då hänsyn tagits till förvaltningsavgifter. Då även fondernas risktagande togs i anspråk blev resultatet det motsatta och vi kan därigenom konstatera att aktivt förvaltade fonder har generat en lägre riskjusterad avkastning är passivt förvaltade fonder. Vidare har vi även kunnat konstatera att aktivt förvaltade fonder med låga förvaltningsavgifter har generat en högre såväl avkastning som riskjusterad avkastning än aktivt förvaltade fonder med höga förvaltningsavgifter. / The choice between active and passive fund management has long been a contentious issue within the private mutual fund investments. Lately, the issue has been widely discussed since the actively managed funds Allemansfond komplett and Kapitalinvest was accused of misleading marketing, since their performance has not overachieved the return of the general market. In the academic world, recognized scholars and later Laureate of the Sveriges Riksbank Prize in Economic Sciences in Memory of Alfred Nobel, has demonstrated that actively managed funds cannot generate a higher return with regard to management fees. Based on the importance of the management fees, we have chosen to study the effect of the discount management fees, within the Premiepensionssystemet. Therefore the study's objective is to analyse whether active managed funds have generated higher risk-adjusted returns than passively managed funds, reduced for the discounted management fees. The study will be limited to analyse the period between the 1st January 2004 to 31th December 20103 The study was based on daily market quotations of 174 actively managed Premiepensionsfonder and annual management fees. Furthermore, we used a global stock market index, MSCI World, by the definition of passively managed funds that was synonymous with the study's benchmark. In accordance with the study’s purpose, we used the risk-adjusted performance measure Sharpe ratio in order to answer the research question. The results of this study demonstrated that actively managed funds have generated higher returns than passively managed funds, reduced for the discounted management fees. When the funds' risk taking was committed, the result is the opposite, and we can thus conclude that actively managed funds have yield a lower risk-adjusted returns than passively managed funds. Furthermore, we also noted that actively managed funds with low management fees has generated higher returns as well as risk-adjusted returns than actively managed funds with high management fees.