The high cost of emergency department (ED) care is often viewed as an area for achieving cost savings through reduced utilization for inappropriate conditions. The implementation of outpatient prospective payment for Medicare ED patients heightens scrutiny of costs and utilization in the ED versus primary care settings. Data from hospital clinical records, financial records, and a provider survey was used to develop a costing methodology and complete a comparative analysis of the cost of care for three diagnoses by setting. Total costs were significantly higher in the ED due primarily to differences in ancillary tests and prescription drugs ordered.

Sustainability within wholesale is currently facing a significant challenge. Research has shown that sustainable solutions are most commonly achieved through win-win strategies. However, such strategies do not work when the push for sustainability is external, e.g. governmental. This study intends to review how stakeholders can be analysed to create shared value. Building on existing theories, it asks: How is the change towards sustainable transportation perceived by stakeholders and how does it affect the perceived value of the business? In this context, we define the studied stakeholders as customers and employees. Shared value is defined as an action that a business can take to add value for themselves and their customers, or for the society. Based on existing literature regarding sustainability and theories regarding stakeholders, a scenario-based online survey was distributed to customers of wholesale and employees (non-managerial) at Martin & Servera. Analysis of the responses demonstrate a significant disparity between what is expected, required and desired of the business from customers. The results indicate that the disparity between employees and customers complicate sustainable improvements. Therefore, sustainable improvements should be enhanced by reducing the disparity through e.g. communication between customers and employees. Further research is needed to distinguish if other stakeholders have a significant impact or not.

yes / Traditional rotor dynamics mainly focuses on the steady- state behavior of the rotor and shafting. However, for systems such as hydro turbine generating sets (HTGS) where the control and regulation is frequently applied, the shafting safety and stabilization in transient state is then a key factor. The shafting transient state inevitably involves multiparameter domain, multifield coupling, and coupling dynamics. In this paper, the relative value form of the Lagrange function and its equations have been established by defining the base value system of the shafting. Takingthe rotation angle and the angular speed of the shafting as a link, the shafting lateral vibration and generator equations are integrated into the framework of generalized Hamiltonian system. The generalized Hamiltonian control model is thus established. To make the model more general, additional forces of the shafting are taken as the input excitation in proposed model. The control system of the HTGS can be easily connected with the shafting model to form the whole simulation system of the HTGS. It is expected that this study will build a foundation for the coupling dynamics theory using the generalized Hamiltonian theory to investigate coupling dynamic mechanism among the shafting vibration, transient of hydro turbine generating sets, and additional forces of the shafting. / National Natural Science Foundation of China under Grant Nos. 51179079 and 50839003

Several contemporary virtue ethicists have provided systematic presentations of normative virtue ethics. The virtue ethical literature, however, does not contain much information on the meta-ethical roots of virtue theories. The present paper seeks to address this deficiency by examining the neo-Aristotelianism of Rosalind Hursthouse in an effort to ascertain what meta-ethical commitments are most consistent with her theory; these commitments are shown to be cognitivism, objectivism, and (in some form) naturalism. These positions are then put into dialogue with Moore’s seminal metaethical arguments against naturalism and agent-relative value. Ultimately I show that the literature on normative virtue ethics is rich enough to provide powerful responses to Moorean criticisms.

Philosophiae Doctor - PhD / In order to manage public dental services, information is required about what work is being performed by the staff at the various clinics. Tally sheets have been used in the past to record treatment procedures but this is not an effective method of recording the amount of work done by staff at public dental clinics. But tally sheets are inaccurate, open to abuse, and fail to provide the necessary information for managers. Nor is it of any real value for providing feedback to staff on their performance. This inhibits a core aspect of job satisfaction for the staff, which is feedback. The staff just persevere, continue doing the same thing and feel frustrated. This contributes to poor work performance. Instead of using a tally sheet, 4 digit treatment codes are used for all treatment procedures (as used in the private sector for billing purposes) and additional codes were developed for services such as brushing programmes for which billing codes do not exist. These are recorded for each patient, together with a code for the patient category. A relative value unit (RVU) has been developed for each treatment code that has been weighted according to policy guidelines and the amount of time and effort required to provide the service. This was done for clinical treatment procedures as well as for community-based preventive activities. A computer program has been developed that captures the treatment codes which are saved in a number of databases that are linked to Excel pivot tables. The data can therefore be easily manipulated by the user to obtain the required information in the form of counts of procedures, monetary cost of the same clinical services in the private sector (useful with the proposed advent of National Health Insurance) and also in the form of relative value units. iii This is available for the current reporting period as well as for previous periods, allowing a detailed analysis of services rendered and staff performance over a period of time to show trends. Use is also made of an Objectives Matrix where the performance of each staff member can be measured according to seven objectives (Key Performance Areas) (five in the case of oral hygienists) to produce an overall Performance Index – which is a score out of ten. This enables performance appraisal to be carried out much easier than by comparing performance based on a number of diverse treatments provided. The data for all the public dental clinics in the Western Cape Province has been analysed for the period 1994 to 2012 using this system, and it has been shown that the system is sensitive enough to highlight problem areas as well as provide a balanced overall view of the service, as measured by a number of variables. The system is “low tech” in that it runs on a “stand alone” personal computer, but it could easily be applied to an integrated, networked information system provided the latter contained the treatment codes, and certain other patient, staff and clinic identifiers. It is therefore suitable for developing countries, such as South Africa, that may later develop a comprehensive Health Information System based on an electronic medical record. The emphasis is not on the information technology, it is focussed on the concepts behind the processing of the data into meaningful information for managing public dental services.

Philosophiae Doctor - PhD / In order to manage public dental services, information is required about what work is being performed by the staff at the various clinics. Tally sheets have been used in the past to record treatment procedures but this is not an effective method of recording the amount of work done by staff at public dental clinics. But tally sheets are inaccurate, open to abuse, and fail to provide the necessary information for managers. Nor is it of any real value for providing feedback to staff on their performance. This inhibits a core aspect of job satisfaction for the staff, which is feedback. The staff just persevere, continue doing the same thing and feel frustrated. This contributes to poor work performance. Instead of using a tally sheet, 4 digit treatment codes are used for all treatment procedures (as used in the private sector for billing purposes) and additional codes were developed for services such as brushing programmes for which billing codes do not exist. These are recorded for each patient, together with a code for the patient category. A relative value unit (RVU) has been developed for each treatment code that has been weighted according to policy guidelines and the amount of time and effort required to provide the service. This was done for clinical treatment procedures as well as for community-based preventive activities . A computer program has been developed that captures the treatment codes which are saved in a number of databases that are linked to Excel pivot tables. The data can therefore be easily manipulated by the user to obtain the required information in the form of counts of procedures, monetary cost of the same clinical services in the private sector (useful with the proposed advent of National Health Insurance) and also in the form of relative value units. This is available for the current reporting period as well as for previous periods, allowing a detailed analysis of services rendered and staff performance over a period of time to show trends. Use is also made of an Objectives Matrix where the performance of each staff member can be measured according to seven objectives (Key Performance Areas) (five in the case of oral hygienists) to produce an overall Performance Index - which is a score out of ten. This enables performance appraisal to be carried out much easier than by comparing performance based on a number of diverse treatments provided. The data for all the public dental clinics in the Western Cape Province has been analysed for the period 1994 to 2012 using this system, and it has been shown that the system is sensitive enough to highlight problem areas as well as provide a balanced overall view of the service, as measured by a number of variables. The system is "low tech" in that it runs on a "stand alone" personal computer, but it could easily be applied to an integrated, networked information system provided the latter contained the treatment codes, and certain other patient, staff and clinic identifiers. It is therefore suitable for developing countries, such as South Africa, that may later develop a comprehensive Health Information System based on an electronic medical record. The emphasis is not on the information technology, it is focussed on the concepts behind the processing of the data into meaningful information for managing public dental services.

Le travail présenté dans cette thèse porte sur le rôle du cortex prémoteur dorsal (PMd) au sujet de la prise de décision (sélection d’une action parmis nombreux choix) et l'orientation visuelle des mouvements du bras. L’ouvrage décrit des expériences électrophysiologiques chez le singe éveillé (Macaca mulatta) permettant d’adresser une fraction importante des prédictions proposées par l'hypothèse des affordances concurrentes (Cisek, 2006; Cisek, 2007a). Cette hypothèse suggère que le choix de toute action est l’issue d'une concurrence entre les représentations internes des exigences et des atouts de chacune des options présentées (affordances; Gibson, 1979). Un intérêt particulier est donné au traitement de l'information spatiale et la valeur des options (expected value, EV) dans la prise de décisions. La première étude (article 1) explore la façon dont PMd reflète ces deux paramètres dans la période délai ainsi que de leur intéraction. La deuxième étude (article 2) explore le mécanisme de décision de façon plus détaillée et étend les résultats au cortex prémoteur ventral (PMv). Cette étude porte également sur la représentation spatiale et l’EV dans une perspective d'apprentissage. Dans un environnement nouveau les paramètres spatiaux des actions semblent être présents en tout temps dans PMd, malgré que la représentation de l’EV apparaît uniquement lorsque les animaux commencent à prendre des décisions éclairées au sujet de la valeur des options disponibles. La troisième étude (article 3) explore la façon dont PMd est impliqué aux “changements d'esprit“ dans un procès de décision. Cette étude décrit comment la sélection d’une action est mise à jour à la suite d'une instruction de mouvement (GO signal). I II Les résultats principaux des études sont reproduits par un modèle computationnel (Cisek, 2006) suggérant que la prise de décision entre plusieurs actions alternatives peux se faire par voie d’un mécanisme de concurrence (biased competition) qui aurait lieu dans la même région qui spécifie les actions. / This thesis examines the role of the dorsal premotor cortex (PMd) in the process of decision making (action selection) and visual guidance of arm movements. The work describes electrophysiological experiments conducted in awake monkeys (Macaca mulatta) and tests a number of important predictions suggested by the affordance competition hypothesis (Cisek, 2006; Cisek, 2007a). This hypothesis suggests that decisions can be viewed as the result of a competition between internal representations of conflicting demands and opportunities for actions or affordances (Gibson, 1979). Specific interest is given to the interaction between spatial information and expected value (EV) in a proposed affordance competition mechanism for action selection. The first study presented (article 1) explores how EV is represented during the delay period in PMd. This study also describes how this area reflects the spatial metrics of the options and examines the interaction between value and spatial information. The second study (article 2) explores the mechanism of action selection in more detail and extends the results to ventral premotor cortex (PMv). This study also addresses the nature of value and spatial representations from a learning perspective. In a novel environment the spatial metrics of the actions seem to be invariably present in PMd, meanwhile EV representations appear only once the animals make behaviorally informed decisions about the value of the available options. The third study (article 3) explores how PMd is involved in “changes of mind” in which action selection is updated following a movement instruction (GO signal). III IV The major findings in all these studies are reproduced by a computational model (Cisek, 2006) suggesting that decisions between actions can be made through a biased competition process that takes place in the same region that specifies the actions.

Made available in DSpace on 2010-04-20T21:00:18Z (GMT). No. of bitstreams: 3 ernestokabashimaturma2003.pdf.jpg: 14228 bytes, checksum: dee04567d9b7d510262698cc8b1aac7a (MD5) ernestokabashimaturma2003.pdf: 322209 bytes, checksum: 07320e4df8ce4733adad8f20e464b5f9 (MD5) ernestokabashimaturma2003.pdf.txt: 96815 bytes, checksum: 7704291ee38c7a6004795b3faa07da1f (MD5) Previous issue date: 2006-02-01T00:00:00Z / Esta dissertação estuda a aplicação da estratégia Pairs Trading no mercado acionário brasileiro. Envolve basicamente a identificação de pares de ações que tenham movimentos de preço semelhantes e posteriormente a operação do diferencial entre seus preços. É possível observar no mercado a existência de um valor de equilíbrio de longo prazo para alguns pares de ações e quando o diferencial divergir de certa quantidade pré-definida opera-se o diferencial no intuito de que o mesmo retorne ao seu valor de equilíbrio de longo prazo, ou seja, espera-se que ocorra uma reversão à média do diferencial. A metodologia para a identificação desses pares de ações que descrevem movimentos semelhantes vem do conceito de cointegração. Essa metodologia é aplicada sobre as ações do índice Bovespa de 04-Jan-1993 a 30-Jun-2005. Inicialmente é feita uma pré-seleção dos pares de ações via correlação, ou medida de distância. Para a seleção final é feito o teste de cointegração, onde é utilizado o método de Dickey-Fuller aumentado (Augmented Dickey-Fuller test – ADF) para verificar a existência de raiz unitária da série de resíduo da combinação linear do logaritmo dos preços. Após a seleção, os pares são simulados historicamente (backtesting) para se analisar a performance dos retornos dos pares de ações, incluindo também os custos operacionais. / This dissertation addresses the application of Pairs Trading strategy in the Brazilian equity market. Basically it consists in the identification of the stock pairs, that have similar price movements, which can be subsequently traded based on their prices spread. It can be observed in the market that a long-term equilibrium value can be determined between some pairs of stocks and when this spread diverges to a certain predetermined value from the mean, it is traded in the expectation that it will return to the long term equilibrium value, i.e., the spread mean reversion. The methodology used to identify the pairs of stocks, which have similar movements, is derived from the concept of cointegration. This methodology was applied to all of the stocks that compose the Bovespa index from 04-Jan-1993 to 30-Jun-2005. Initially pairs of stocks were pre-selected using correlation, or distance measure. The Augmented Dickey-Fuller test (ADF) was also used in order to determine the cointegrated pairs. ADF is used to verify the existence of the unit root in the residual time series of the logarithm of prices. After the selection was completed the chosen pairs were backtested in order to analyze the performance of their returns, with the addition of the operational costs.

Uncertainty in rainfall forecasts affects the level of quality and assurance for decisions made to manage water resource-based systems. However, eliminating uncertainty in a complete manner could be difficult, decision-makers thus are challenged to make decisions in the light of uncertainty. This study provides statistical models as an approach to cope with uncertainty, including: a) a statistical method relying on a Gaussian mixture (GM) model to assist in better characterize uncertainty in climate model projections and evaluate their performance in matching observations; b) a stochastic model that incorporates the El Niño–Southern Oscillation (ENSO) cycle to narrow uncertainty in seasonal rainfall forecasts; and c) a statistical approach to determine to what extent drought events forecasted using ENSO information could be utilized in the water resources decision-making process. This study also investigates the relationship between calibration and lead time on the ability to narrow the interannual uncertainty of forecasts and the associated usefulness for decision making. These objectives are demonstrated for the northwest region of Costa Rica as a case study of a developing country in Central America. This region of Costa Rica is under an increasing risk of future water shortages due to climate change, increased demand, and high variability in the bimodal cycle of seasonal rainfall. First, the GM model is shown to be a suitable approach to compare and characterize long-term projections of climate models. The GM representation of seasonal cycles is then employed to construct detailed comparison tests for climate models with respect to observed rainfall data. Three verification metrics demonstrate that an acceptable degree of predictability can be obtained by incorporating ENSO information in reducing error and interannual variability in the forecast of seasonal rainfall. The predictability of multicategory rainfall forecasts in the late portion of the wet season surpasses that in the early portion of the wet season. Later, the value of drought forecast information for coping with uncertainty in making decisions on water management is determined by quantifying the reduction in expected losses relative to a perfect forecast. Both the discrimination ability and the relative economic value of drought-event forecasts are improved by the proposed forecast method, especially after calibration. Positive relative economic value is found only for a range of scenarios of the cost-loss ratio, which indicates that the proposed forecast could be used for specific cases. Otherwise, taking actions (no-actions) is preferred as the cost-loss ratio approaches zero (one). Overall, the approach of incorporating ENSO information into seasonal rainfall forecasts would provide useful value to the decision-making process - in particular at lead times of one year ahead.

Le travail présenté dans cette thèse porte sur le rôle du cortex prémoteur dorsal (PMd) au sujet de la prise de décision (sélection d’une action parmis nombreux choix) et l'orientation visuelle des mouvements du bras. L’ouvrage décrit des expériences électrophysiologiques chez le singe éveillé (Macaca mulatta) permettant d’adresser une fraction importante des prédictions proposées par l'hypothèse des affordances concurrentes (Cisek, 2006; Cisek, 2007a). Cette hypothèse suggère que le choix de toute action est l’issue d'une concurrence entre les représentations internes des exigences et des atouts de chacune des options présentées (affordances; Gibson, 1979). Un intérêt particulier est donné au traitement de l'information spatiale et la valeur des options (expected value, EV) dans la prise de décisions. La première étude (article 1) explore la façon dont PMd reflète ces deux paramètres dans la période délai ainsi que de leur intéraction. La deuxième étude (article 2) explore le mécanisme de décision de façon plus détaillée et étend les résultats au cortex prémoteur ventral (PMv). Cette étude porte également sur la représentation spatiale et l’EV dans une perspective d'apprentissage. Dans un environnement nouveau les paramètres spatiaux des actions semblent être présents en tout temps dans PMd, malgré que la représentation de l’EV apparaît uniquement lorsque les animaux commencent à prendre des décisions éclairées au sujet de la valeur des options disponibles. La troisième étude (article 3) explore la façon dont PMd est impliqué aux “changements d'esprit“ dans un procès de décision. Cette étude décrit comment la sélection d’une action est mise à jour à la suite d'une instruction de mouvement (GO signal). I II Les résultats principaux des études sont reproduits par un modèle computationnel (Cisek, 2006) suggérant que la prise de décision entre plusieurs actions alternatives peux se faire par voie d’un mécanisme de concurrence (biased competition) qui aurait lieu dans la même région qui spécifie les actions. / This thesis examines the role of the dorsal premotor cortex (PMd) in the process of decision making (action selection) and visual guidance of arm movements. The work describes electrophysiological experiments conducted in awake monkeys (Macaca mulatta) and tests a number of important predictions suggested by the affordance competition hypothesis (Cisek, 2006; Cisek, 2007a). This hypothesis suggests that decisions can be viewed as the result of a competition between internal representations of conflicting demands and opportunities for actions or affordances (Gibson, 1979). Specific interest is given to the interaction between spatial information and expected value (EV) in a proposed affordance competition mechanism for action selection. The first study presented (article 1) explores how EV is represented during the delay period in PMd. This study also describes how this area reflects the spatial metrics of the options and examines the interaction between value and spatial information. The second study (article 2) explores the mechanism of action selection in more detail and extends the results to ventral premotor cortex (PMv). This study also addresses the nature of value and spatial representations from a learning perspective. In a novel environment the spatial metrics of the actions seem to be invariably present in PMd, meanwhile EV representations appear only once the animals make behaviorally informed decisions about the value of the available options. The third study (article 3) explores how PMd is involved in “changes of mind” in which action selection is updated following a movement instruction (GO signal). III IV The major findings in all these studies are reproduced by a computational model (Cisek, 2006) suggesting that decisions between actions can be made through a biased competition process that takes place in the same region that specifies the actions.