Dentre as empresas atuando na Base da Pirâmide socioeconômica, os bancos comerciais têm-se destacado nos últimos anos. Eles têm participado em operações de microcrédito por meio de uma forma contratual de concessão de crédito, os empréstimos de microcrédito de responsabilidade individual, cujos riscos e custos de transação são elevados. Estudos reconhecem que nem todas as estratégias empresariais voltadas aos mercados da Base da Pirâmide são bem sucedidas. Porém, existem condições para que seja possível desenvolver estratégias focadas em atender as necessidades desses mercados, de modo que possibilitem a criação de valor compartilhado. O objetivo central do presente trabalho é levantar indícios de como a forma contratual de responsabilidade individual no microcrédito pode contribuir para a criação de valor compartilhado. O objeto de análise é a forma contratual de responsabilidade individual de Microcrédito Produtivo Orientado no mercado brasileiro. A abordagem metodológica escolhida é exploratória e qualitativa, por meio do método de estudo de caso de um programa de microcrédito. Ao cruzar informações da literatura com os dados coletados na etapa empírica, constatou-se o papel fundamental dos agentes de microcrédito na forma contratual de responsabilidade individual. A boa operação do programa de microcrédito analisado depende do trabalho do agente de microcrédito, o qual deve estar bem capacitado e treinado para exercer suas atribuições. Adicionalmente, sua atuação deve estar alinhada com o posicionamento estratégico do banco. A criação de valor tangível e intangível para empresa observada está intimamente relacionada com o bom funcionamento do programa, o qual, além de buscar atender as necessidades da comunidade, deve manter uma operação eficiente para alcançar os objetivos empresariais. / Amongst the companies working in the socioeconomic Base of the Pyramid, commercial banks have been a highlight in recent years. They have participated in microcredit operations through a contractual form of lending, the microcredit loan of individual liability, for which risk and transaction costs are high. Studies recognize that not all business strategies addressing the Base of the Pyramid markets are successful. However, there are conditions that allow the development of strategies focusing on meeting the needs of these markets in order to enable the creation of shared value. The main goal of this research is to raise evidences of how the contractual form of individual liability in microcredit can contribute to creating shared value. The object of analysis is the microcredit\'s contractual form of individual liability in Brazil. The methodological approach chosen to meet the research goals is exploratory, through a qualitative method of a case study of a microcredit program. While crossing information from the literature with data collected in empirical stage, the strategic role of microcredit agents was noticed in the contractual form of individual responsibility. The good operation of the microcredit program analyzed depends on the microcredit agent\'s dedication, who not only must be well qualified and trained to perform his duties, but also his performance should be aligned with the bank\'s strategic positioning. The creation of tangible and intangible value to the company observed is closely related to the proper functioning of the program, which, in addition to seeking to meet the needs of the community, must maintain an efficient operation to achieve business objectives.

The purpose of our study is to investigate what difference a shared leadership can make in an organization. We also wanted to know how social work professionals describe shared leadership and how its changes and consequences work out in an organization. To be able to answer the purpose of this study, we decided to do a case study. The interviews are conducted in an social work organization. We have conducted a focus group interview with three employees, an interview with each of the two area managers having a shared leadership, an interview with the social manager, an interview with the operations manager and one with a politician. In this study we used both an abductive and a qualitative approach by doing six interviews. The conclusion of our study is that the implement of a shared leadership have many advantages for the organization-from the employees at the bottom to the politician at the top. The results show that it is not an easy task to perform a shared leadership. It takes two willingly people and a lot of characteristics to do it. We have learned that this type of leadership is not for all managers. Some managers want to run the show on their own.

Despite increasing philosophical knowledge of disaster planning and preparedness, disasters still remain a challenge in many communities. As a result, communities, environment and economies remain considerably vulnerable and at the risk of disaster destruction hence, sustainable development is undermined. The purpose of this study is to review and assess the state of community readiness in order to prevent and mitigate common hazards in the City of Johannesburg, especially in previously disadvantaged communities such as Protea-South. A survey and interviews was conducted with the local community members. Results show that, this community like many others, is at high risk, due to their living circumstances. e.g. the presence of densely built shacks on a flood plain; poor hygiene and sanitation, pollution, poverty etc. There is therefore a need for a paradigm shift by institutions from emergency response and the provision of hard infrastructure to disaster prevention, preparedness and soft infrastructure provision by means of an approach encompassing collaborative planning.

Shared governance (SG) creates an evidence-based framework to support decision making in healthcare organizations by encouraging nursing staff ownership of nursing practice issues. This project assessed the current state of shared governance at a community hospital through: (a) deployment of Hess's Index of Professional Nursing Governance (IPNG) and the National Database of Nursing Quality Indicators (NDNQI) nursing satisfaction surveys which were open to nurses working in areas included in the SG framework at the project site, and (b) retrospective review of Unit Practice Council (UPC) and Nursing Senate (NS) minutes and agendas. Kotter's theory of change and the logic model informed interventions aimed at creating an effective SG. IPNG data were analyzed using Hess' scoring guidelines to establish total governance and subscale scores. Mean IPNG scores of nurse leaders, clinical nurse managers, and staff nurses were compared using a 1-way ANOVA based on job title, education, employment status, and shift. NDNQI results were analyzed based on benchmarked Magnet objectives and comparison to previous year's surveys. Meeting agendas and minutes were analyzed for attendance and initiation of interventions. Outcomes of this project included successful creation of a UPC on a medical telemetry unit; alignment of meeting times to promote attendance; paid access to remote meeting attendance; standardization of meeting minutes and agendas; and unit-specific, outcomes-data dashboards. Implementation of this model to improve the effectiveness of SG can lead to positive social change through improvement in the decision-making process in the nation's healthcare institutions. Inclusion of all members of the healthcare team in the decisions that impact practice helps ensure comprehensive, evidence-based, and patient-centric care.

Diabetes is emerging as a major threat to health, with global economic and social implications. Recent research has shown that the morbidity and mortality associated with diabetes can be reduced by timely and effective treatment. However, unless people with diabetes have access to this treatment, the impact of diabetes will continue to rise. This thesis therefore explores the current standards of care which people with diabetes receive. It also looks at factors likely to impact on delivery of diabetes care. Studies were conducted at two levels. In the studies described in Chapters 2 and 3, general data applicable to all or nearly all patients with diabetes were collected. This approach substantially eliminates selection bias but precludes the ability to examine clinical outcomes. In the other studies, detailed in Chapters 4, 5 and 6, specific aspects of diabetes care pertaining to more select groups of diabetic subjects were examined. This approach allows clinical parameters to be examined in more detail but is more subject to selection bias. It is hoped that the combination of these two approaches provides a more balanced view of the topic under examination. In Australia, the Medicare Program, a single government controlled universal health insurance fund, provides access to medical services for all residents. Medicare occasions of service data therefore represent the most comprehensive source of information regarding health service utilisation in Australia. The data does not account for people receiving diabetes care through public hospital based services. However, a survey of public hospitals within NSW (n=198), described in Chapter 2, showed that the number of individuals in this category is relatively small and represents only 5.2% of the diabetic population. Using Medicare item codes, and with the permission and assistance of the Commonwealth Department of Health and Aged Care, data were extracted on attendance to medical practitioners and utilisation of diabetes related procedures for people living in New South Wales (NSW) for the individual years between 1993 to 1997. All data were stratified by the presence of diabetes, gender and age group. Individuals were deemed to have diabetes if an HbA1c, which can only be ordered for a person with known diabetes, had been performed over the 5-year period and the sample size adjusted for the incidence of diabetes. Once adjusted, the number of people with diabetes in NSW for the individual years 1993 to 1997 were 143,920, 156,234, 168,216, 177,280 and 185,780. Comparison with 1996 census data confirmed a 91.7% capture of the total NSW population (5,495,900/5,995,545 individuals). The data were retrieved for NSW as a whole and for individual postcodes. Postcodes were then classified by population density as either major urban, urban or rural. On average over the study period, persons with diabetes accounted for 3.1% of the population but they used 5.5% of general practitioner services. As seen in Chapter 2, a large proportion of people with diabetes were also under the care of specialists and consultant physicians, up to 51.2% and 41.8% respectively, a 3 to 4 fold increase when compared with their non-diabetic counterparts. In regard to geographical location, once adjusted for age and gender, the odds ratio of attending a specialist was only slightly higher for people with diabetes living in areas of high population density when compared to people with diabetes living in rural areas. This ratio reached as high as 1.85 in regard to attendance to consultant physicians (Chapter 3). The odds ratio for the non-diabetic population was similar indicating that the difference in access to consultant physicians was not disease specific. Analysis of results showed that despite the increase in service utilisation, large proportions of people with diabetes were not routinely monitored in regard to diabetes and its complications across the State. By 1997, HbA1c was still not performed in over 40% of people with diabetes each year and only 11.6% of the diabetic population had undergone microalbuminuria estimation. Interestingly, the differences in levels of monitoring between rural and urban areas were surprisingly small. Monitoring of diabetes and its complications did improve in all parts of the State over the study period. However, the greatest improvement was seen in rural areas, despite rural patients having fewer attendances to general practitioners and fewer patients attending specialist care. In the face of finite resources and the rising prevalence of diabetes, an increasing number of patients will need to rely on general practitioners to provide diabetes care regardless of where they live. A 'shared care' approach which encourages and supports general practitioners to manage patients with diabetes, while giving them access to specialist services for those patients that require them, is increasingly being advocated as a way of maximising efficacy while minimising costs. Yet if health care professionals leave undone what they think is done by others, shared care can become neglected care. Chapter 4 reports a detailed audit of 200 randomly selected shared care patients who were assessed on two or more occasions. This study showed that the majority of specialist treatment recommendations are implemented by general practitioners. Doctors formally registered with the Diabetes Shared Care Programme and those who write longer referral letters were more likely to implement recommendations than their counterparts. Moreover, the average HbA1c and the complication profile of these patients were similar to those found in various studies around the world. This suggests that diabetes can be well managed by a shared care approach that is adequately integrated. To overcome the problem that data is lacking on those patients that did not return for specialist review, a further 200 shared care patients who were lost to follow up from the shared care system were traced. Information regarding whether treatment recommendations had been implemented was sought from both the referring doctor and the patient. Overall, information on 182 of the 200 patients could be obtained. As discussed in Chapter 5, comparison of the returned and non returned patients' demographic and clinical profiles at time of their initial specialist review showed that general practitioners differentiated between the 'more complicated' patients, choosing to re-refer those with macrovascular disease, while maintaining the care of 'less complicated' patients. Re-referral for specialist review was also dependent on the patient remaining under the care of their original doctor. Encouragingly, general practitioners seemed to take a more active role in the non-returned group. They included more details regarding type and duration of diabetes in the referral letters of patients who were not re-referred for specialist review. They also implemented more treatment recommendations in the non-returned group, with the difference in implementation rate for metabolic recommendations reaching statistical significance. This study also showed that movement of patients between doctors raises concern regarding continuity of care. The multi-factorial nature of diabetes means that best practice is not easily accommodated within a single appointment. Thus continuity of care becomes an important issue. To assess the current status, 479 consecutive patients referred to the Royal Prince Alfred Hospital Diabetes Centre in a 6-month period were recruited and underwent a detailed clinical assessment. They were also questioned regarding the number of general practitioners they attended and the length of time they had been under the care of the referring doctor. The results outlined in Chapter 6 showed that the majority of people with diabetes (87.7%) attended only one general practitioner and had been under the care of that doctor medium to long term. Younger patients, who were relatively healthy apart from the presence of diabetes, were more likely to attend several general practitioners or have changed their general practitioner within the last year. This lack of continuity had little difference on acute outcomes such as glycaemic and blood pressure control. Appropriately, continuity of care increased with increasing age and the increasing prevalence of diabetes complications, mainly macrovascular disease. These studies indicate that further efforts are required to improve the overall standard of diabetes care within Australia. At present there is a heavy dependency on specialist services. As the population ages and the number of people with diabetes increases, much of this burden will fall on general practitioners, as is already evident in rural areas. When provided with appropriate support and infrastructure, general practitioners are able to maintain standards of care through referral of patients with more complex medical problems and by maintaining the degree of continuity appropriate to the patient's needs. However, the collection of relevant information to monitor future trends in diabetes services provision is important. As shown in this thesis, Medicare data represents an easy and cost effective method with which to do so.

No description available.

We present an algorithm to store data robustly in a large, geographically distributed network by means of localized regions of data storage that move in response to changing conditions. For example, data might migrate away from failures or toward regions of high demand. The PersistentNode algorithm provides this service robustly, but with limited safety guarantees. We use the RAMBO framework to transform PersistentNode into RamboNode, an algorithm that guarantees atomic consistency in exchange for increased cost and decreased liveness. In addition, a half-life analysis of RamboNode shows that it is robust against continuous low-rate failures. Finally, we provide experimental simulations for the algorithm on 2000 nodes, demonstrating how it services requests and examining how it responds to failures.

Conventional parallel computer architectures do not provide support for non-uniformly distributed objects. In this thesis, I introduce sparsely faceted arrays (SFAs), a new low-level mechanism for naming regions of memory, or facets, on different processors in a distributed, shared memory parallel processing system. Sparsely faceted arrays address the disconnect between the global distributed arrays provided by conventional architectures (e.g. the Cray T3 series), and the requirements of high-level parallel programming methods that wish to use objects that are distributed over only a subset of processing elements. A sparsely faceted array names a virtual globally-distributed array, but actual facets are lazily allocated. By providing simple semantics and making efficient use of memory, SFAs enable efficient implementation of a variety of non-uniformly distributed data structures and related algorithms. I present example applications which use SFAs, and describe and evaluate simple hardware mechanisms for implementing SFAs. Keeping track of which nodes have allocated facets for a particular SFA is an important task that suggests the need for automatic memory management, including garbage collection. To address this need, I first argue that conventional tracing techniques such as mark/sweep and copying GC are inherently unscalable in parallel systems. I then present a parallel memory-management strategy, based on reference-counting, that is capable of garbage collecting sparsely faceted arrays. I also discuss opportunities for hardware support of this garbage collection strategy. I have implemented a high-level hardware/OS simulator featuring hardware support for sparsely faceted arrays and automatic garbage collection. I describe the simulator and outline a few of the numerous details associated with a "real" implementation of SFAs and SFA-aware garbage collection. Simulation results are used throughout this thesis in the evaluation of hardware support mechanisms.

No description available.

We consider asynchronous multiprocessors where processes communicate only by reading or writing shared memory. We show how to implement consensus, all comparison primitives (such as CAS and TAS), and load-linked/store-conditional using only a constant number of remote memory references (RMRs), in both the cache-coherent and the distributed-shared-memory models of such multiprocessors. Our implementations are blocking, rather than wait-free: they ensure progress provided all processes that invoke the implemented primitive are live. Our results imply that any algorithm using read and write operations, comparison primitives and load-linked/store-conditional, can be simulated by an algorithm that uses read and write operations only, with at most a constant-factor increase in RMR complexity.