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The operating room (OR) is accountable for most hospital admissions and is one of the most cost and work intensive areas in the hospital. From recent trends, we discover an unexpected parallel increase in expenditure and waiting time. Therefore, improving OR planning has become obligatory, particularly regarding utilization, and service level. Significant challenges in OR planning are the high variations in demand, processing times of surgical specialties, the trade-off between the objectives, and control of OR performance in long-term. Our model provides OR configurations at a strategical level of OR planning to minimize the tradeoff between the utilization and service level accounting for variation in both demand and processing times of surgical specialties. An adaptive control scheme is proposed to aid OR managers to maintain the OR performance within the prescribed controllable limits. Our model is validated using a simulation of demand and processing time data of surgical services at University of Kentucky Health Care.

Past literature attempts to resolve the issue of the motivation behind managers' choice of a given capital structure. Despite several decades of intensive research, there is still no consensus about which theory dominates capital structure decisions. The present study empirically investigates the relative importance of two prominent theories of capital structure- the trade-off and the pecking order theories by exploring the conditions under which each theory can explain the financing choices of firms. These conditions are defined along two dimensions: (i) a firm's degree of information asymmetry, and (ii) its observed leverage relative to target leverage. The results show that, in the short-run, pecking order theory has more explanatory power in explaining the financing choices of firms. The target leverage theory assumes limited importance: Over-leveraged firms, when faced with low adverse information, are more inclined to adapt to the trade-off policies. In the presence of high information asymmetry, however, firms appear to be more concerned about adverse selection costs and make financing decisions that are more consistent with the pecking order theory. An analysis of the market reaction to seasoned equity issuances during announcement periods reveals that firms with high information asymmetry are penalized more than firms with low information asymmetry. This may explain the contradiction when over-leveraged firms continue to issue debt. However, the situation is reversed in the long run. Firms' long term financing goals appear to follow the leverage re-balancing theory. An analysis of financial activities over a five-year period, subsequent to security issuance decisions when they appear to be inconsistent with trade-off theory, reveals that firms follow an active policy of moving closer to the target leverage. In sum, the notion of target capital structure appears to exist. In the short-term, the management's financing decisions are consistent with the modified version of the pecking order theory, leading to tactical deviations from the optimal capital structure. However, long-term analysis indicates that the pecking order effect is largely transitory in nature and firms actively pursue strategic reversals towards an optimal capital structure.

Parasite life histories influence many aspects of infection dynamics, from the parasite infrapopulation diversity to the fitness of the parasite (the number of successfully transmitted parasites). Studies of medically important parasites, such as the parasite responsible for malaria (Plasmodium spp.), demonstrate the usefulness of investigating the life histories of parasites to better understand infection characteristics such as parasite load and probability of transmission. The gregarines are a diverse group of apicomplexan parasites that infect invertebrates, and are particularly common in insects and annelids. Given the great biodiversity and importance of their hosts, coupled with their close evolutionary relationship with important human pathogens such as Cryptosporidium spp., relatively little is known about gregarine life histories. The exemplar gregarine genus, Monocystis, is an excellent example of how a well-known gregarine parasite can have relatively little known about its life history. Specifically, the low reproductive output of Monocystis spp. and the absence of asexual replication makes the currently accepted life cycle untenable. More data are needed on the life history traits and strategies of Monocystis spp. that allow the parasite to be maintained at high prevalence and parasitemia. Here, a newly discovered species of Monocystis, infecting the invasive earthworm Amynthas agrestis, is described and investigated to determine key life history traits and strategies. First, I propose improvements to the current standard of gregarine species descriptions by standardizing nomenclature and biometrics and including molecular data. I described the newly discovered M. perplexa using the proposed improvements to gregarine species descriptions and found evidence of host species-specificity and widespread prevalence of the parasite in local earthworm populations. Such important data would not otherwise be collected with use of the current standard of gregarine species description and demonstrates the potential of implementing the suggested improvements. The life history of M. perplexa was investigated by measuring various life history traits throughout the course of infection. Key life history traits such as parasite phenology, resource allocation, and reproductive output were measured for infections at three local earthworm populations to determine if there is variation in parasite life histories within or among earthworm populations. Substantial variation in parasite life history traits and trade-offs between traits were identified. Notably, there was a trade-off between timing to parasite maturity, resource allocation, and reproductive output. Surprisingly, there was a near-complete lack of transmissible stages produced in one population, despite being maintained at high prevalence and parasitemia. To determine whether life history strategies, such as mode of transmission and asexual replication, can explain the currently untenable life cycle of M. perplexa, the presence of vertical transmission and asexual replication was revealed. Quantitative real-time PCR was used to detect and quantify minute amounts of parasite in the worm eggs and embryos and revealed a high rate of vertical transmission at all local sites. Evidence of parasite replication within the developing host embryo was found; however, no asexual replication was identified early in the host's season. Last, all worm tissues examined had high concentrations of parasite DNA, including the clitellum, the organ that produces the worm egg capsule.

<p>One must consider cost effectiveness when deciding how resources within the health sector should be distributed. Quality adjusted life years (QALYs) are used to measure the value of different medical treatments. QALY is based on utility maximization theory, which suggests that a QALY is always a QALY regardless of who receives it. Therefore, a produced QALY is worth the same regardless of the age or the initial health of the patient. Previous research has shown that these assumptions do not seem to fit the real preferences of individuals. Further, there are different methods of acquiring QALYs that give different outcomes. Two of these methods are Time Trade Off (TTO), in which respondents are confronted with a valuation of health change in time, and Person Trade Off (PTO), where respondents are confronted with a valuation in persons. Arguably, PTO is the preferred method that takes greater account of how individuals wish to allocate the resources of the society. From a distribution perspective focusing on age and initial health status, this paper aims to empirically identify the differences between TTO and PTO considering the measurement of preferences for life quality. The aim is also to examine whether the results obtained are consistent with the theoretical assumptions that are required for the preference to be accepted as a cardinal utility. A quantitative survey was carried out with 58 medical and 61 economics students. Half of the students received PTO and the other half TTO questions. The data collected was analyzed comparing the methods, the two student groups and men against women.</p><p>The results from the survey show that, both with TTO and PTO, respondents on average believe that patients who are at a lower initial health level should be given priority over patients who are at a higher initial health level, and younger patients should be given priority over older patients. No significant differences were seen between PTO and TTO when it came to the age of the patient. Conversely, there was a significant difference between the methods for the valuation based on initial health status of patients. Measured with PTO a treatment for patients who are at a lower initial level is valued 28% higher than a treatment for those patients who are at a higher initial level, while the corresponding figure for TTO was 8%. Between medical students and economic students, there were significant differences in the question of age in the PTO. Between men and women differences were found in both methods.</p> / <p>Kostnadseffektivitet är en av faktorerna som ska tas i beaktande vid beslut om hur resurser inom hälso- och sjukvården ska fördelas. Kvalitetsjusterade levnadsår (QALY) används för att mäta effekten av olika insatser. Måttet baseras på nyttomaximeringsteori vilket leder till att en QALY alltid är en QALY oavsett vem den tillfaller - med andra ord är en QALY som produceras hos en patient lika mycket värd oavsett exempelvis patientens ålder eller initiala tillstånd. Dessa antaganden har i tidigare undersökningar visat sig stämma dåligt med individers preferenser men olika metoder för att ta fram QALY verkar ta olika mycket hänsyn till dem. Två av flera metoder är Time Trade Off (TTO), där respondenter ställs inför en värdering av hälsoförändringar i tid och Person Trade Off (PTO) där respondenter ställs inför en värdering i personer. PTO har påståtts vara en mer rättvisande metod som tar större hänsyn till hur individer vill att samhälleliga resurser ska fördelas. Denna uppsats syftar till att, utifrån ett fördelningsperspektiv med fokus på ålder och initialt hälsotillstånd, empiriskt kartlägga förekomsten av skillnader i preferenser för livskvalitet mätt med PTO respektive TTO, samt att undersöka om de erhållna resultaten överensstämmer med de teoretiska grundantagandena som krävs för att preferenser ska accepteras som kardinala nyttor. För att svara mot syftet utfördes en kvantitativ undersökning på 58 läkar- samt 61 ekonomistudenter. Hälften av studenterna fick PTO-frågor och den andra hälften TTO-frågor. En statistisk bearbetning av insamlad data har gjorts där svaren har jämförts mellan metoderna samt mellan läkar- och ekonomistudenter och kvinnor och män.</p><p>Resultaten från undersökningen visar att både med TTO och PTO anser respondenterna att patienter som befinner sig på en lägre initial nivå ska prioriteras framför patienter som befinner sig på en högre initial nivå samt yngre patienter ska prioriteras framför äldre patienter. Vad gäller hänsyn till patienters ålder uppmättes inga signifikanta skillnader mellan PTO och TTO. Däremot uppmättes en signifikant skillnad mellan metoderna vad gäller hänsyn till initialt hälsotillstånd hos patienter. Mätt med PTO värderas en behandling för de patienter som befinner sig på en lägre initial nivå 28 % högre än en behandling för de patienter som befinner sig på en högre initial nivå medan motsvarande siffra för TTO var 8%. Mellan läkare och ekonomer fanns signifikanta skillnader i frågan gällande ålder i PTO och mellan kvinnor och män återfanns skillnader i båda metoder.</p>

<p>Uppsats behandlar företags kapitalstruktur d v s fördelning mellan främmande och eget kapital. Det finns teorier kring ämnet som menar att ett företags värde påverkas av sammansättningen mellan skulder och eget kapital. Detta föranledde vår problemformulering om att närbesläktade verksamheter uppvisar en likartad skuldsättning. Syftet var att jämföra skuldsätt-ningsgraden mellan kapitalintensiva branscher och kapitaltunna branscher. Utifrån detta ställdes vår hypotes upp om att kapitalkrävande branscherna fastighet och tunga maskiner har en högre skuldsättningsgrad än branscherna läkemedel och tjänster. Vår studie omfattar 52 företag noterade på Stockholmsbörsen. Vi har utgått från en kvantitativ ansats och empirin är hämtad från företagens årsredovisningar samt en enkätundersökning. Med hjälp av teorier som Modigliani och Millers berömda proposition MMI och MMII, Trade Off och Pecking order har vi försökt finna orsakerna till företagens skuldsättningsgrad. Resultaten i vår under-sökning kunde inte stärka vår hypotes, varpå den förkastades. Vidare kunde inget mönster urskiljas i skuldsättningen för de valda branscherna.</p>

<p>Vi undersöker huruvida de två teorierna Pecking order och Trade-off gemensamt kan förklara utformning av kapitalstruktur och hur beslut gällande denna ser ut hos svenska börsnoterade företag. Vi menar att den aktuella kapitalstrukturen är en konsekvens av den historiska utvecklingen inom företag, där tidigare års finansiella över-/underskott leder till dagens kapitalstruktur och att asymmetrisk information och transaktionskostnader gör att intern finansiering är att föredra framför extern. Företag ser dock fördelar med viss skuldsättning, vilket bidrar till att företag sätter upp en målkapitalstruktur i början av aktuell period. Företags benägenhet att justera sin kapitalstruktur mot denna målkapitalstruktur varierar beroende på vilken situation företaget befinner sig i och olika anpassningshastigheter uppstår till följd av att vissa situationer föredras framför andra. Vi undersöker sambandet mellan målkapitalstruktur och finansiella över-/underskott och hur detta påverkar företags förändring i kapitalstruktur. Våra resultat visar att företag är som mest benägna att förändra sin kapitalstruktur när de har ett finansiellt underskott med en kapitalstruktur över sin målkapitalstruktur och minst benägna att förändra sin kapitalstruktur när de har ett finansiellt överskott och en kapitalstruktur under sin målkapitalstruktur. Både Pecking order och Trade-off har inflytande vid förklaring av företags kapitalstruktursförändring, dock har den ena teorin större betydelse än den andra beroende på vilken situation företag befinner sig i.</p>

<p>This thesis is an attempt to describe how different environmental factors influence life history traits in different populations, sexes and developmental stages in the moor frog, <i>Rana arvalis. </i>The studied populations are located along 1100 km latitudinal gradient, with pH varying between 4.0 and 8.5. I have used data from both natural populations and common garden experiments. </p><p>Reproducing moor frogs were larger and older at high latitudes, indicating a selective advantage of large size at high latitudes and/or earlier reproduction at low latitudes. When controlling for age I found that frogs were older and smaller at low pH, which may be a result of a reduced growth rate due to acid stress. The both sexes respond differently to different environments, with the lowest sexual dimorphism in body size found in the acid environments. This is possibly caused by a trade-off between growth and reproduction. Being large is considered to be advantageous, in females due to increased fecundity, and in males due to higher ability to compete for mates, while the cost of high growth is a reduced possibility to survive until the next mating season. Moor frog embryos originating from an acid population survived better under acid stress than embryos from a neutral population. Using quantitative genetic techniques I found strong maternal effects and small additive genetic variation for the traits in acid and non acid populations. The variation in acid stress tolerance owed largely to non-genetic effects. Females from acid localities lay larger eggs, which probably improves the performance of tadpoles under acid conditions. The trade-off between egg size and fecundity was stronger in acid populations indicating that females in acid populations reduced fecundity to increase offspring size. Finally, frogs from acidified environments were more asymmetric in skeletal traits further indicating the developmental stress created by acidification.</p>

<p>For ectotherms living in seasonal environments, time available for development and growth is often constrained by the length of the growth season. Declining season length towards higher latitudes often select for latitudinal clines in development and growth rates, exhibiting increasing growth and developmental rates towards the north. However, the physiological and ecological factors enabling these clines are poorly understood.</p><p>Our study system included eight populations of <i>Rana temporaria</i> along a 1500 km latitudinal gradient. We found increased growth rates in populations at higher latitudes to be the result of higher growth efficiency, partly due to increased relative gut length. Populations with higher growth rates also exhibited lower standard metabolic rates, implying that fast-growing individuals are able to achieve high growth rates by spending less energy on maintenance metabolism under low activity conditions.</p><p>Predator densities, and antipredatory defenses in prey, are assumed to decrease towards higher latitudes. While all study populations responded to predator presence by decreasing activity and foraging, high latitude populations maintained higher activity levels in the presence of the predator. In trials with a free-ranging predator, high latitude tadpoles experienced higher mortality than those from the low latitudes. The higher activity level in the northern populations increases mortality under predation risk, but is probably needed to maintain high growth and development rates.</p><p>When competing over resources, tadpoles from the low latitude population were inferior competitors, as indicated by their longer development time when raised together with high latitude tadpoles. We found no effect of latitude on size-corrected burst speed. The general effect of predator presence on burst speed depended on food availability, with well fed tadpoles being faster in the absence, and food restricted being faster in the presence of a predator.</p>

<p>Ett företags kapitalstruktur och i förlängningen dess val av finansiering för strategiska</p><p>investeringar omgärdas av motstridiga uppfattningar och teorier. Vi har genomfört en</p><p>fallstudie av Home Properties AB, ett renodlat hotellfastighetsägarbolag noterat på</p><p>Stockholmsbörsens lista för medelstora bolag.</p><p>Uppsatsens syfte är att beskriva hur Home Properties agerar och resonerar vid finansiering av</p><p>strategiska investeringar och jämföra beskrivningen med Åkerbloms hypotes om sär- och</p><p>samfinansiering, pecking order teorin och static trade-off modellen. I syftet ingår också att ge</p><p>förslag på vidare forskning.</p><p>Enligt pecking order teorin prioriterar företag internt kapital framför externt. Vid finansiering</p><p>av strategiska investeringar väljer Home Properties emellertid inteckningslån först. I Home</p><p>Properties fall förklaras företagets val av finansieringskällor bättre av static trade-off</p><p>modellen och Åkerbloms hypotes om sär- och samfinansiering. Anledningen är delvis att</p><p>Home Properties strävar efter ett soliditetsmål för att åstadkomma en optimal kapitalstruktur</p><p>vilket inte överensstämmer med pecking order teorin.</p><p>Home Properties val av finansiering kan inte helt och hållet förklaras av vare sig pecking</p><p>order teorin, static trade-off modellen eller Åkerbloms hypotes om sär- och samfinansiering.</p><p>Efter utförd fallstudie kan vi konstatera att Home Properties vid finansiering av strategiska</p><p>investeringar i regel vänder sig till (1) särfinansiering (2) internt kapital (3) gemensamt</p><p>låneutrymme och (4) nytt eget kapital/ lån/ hybrid. En viktig förutsättning för denna ordnings</p><p>giltighet är att soliditetsmålet inte störs långsiktigt.</p>