Tesis por compendio / [ES] La digitalización en la sanidad sigue poco desarrollada en comparación con muchos otros sectores, pero ofrece la posibilidad de hacer frente a retos cada vez mayores. A partir del caso de un sistema digital de gestión del flujo de trabajo implantado en el quirófano, esta tesis examina cuál podría ser el impacto de la digitalización en la calidad, la eficiencia y la economía de la gestión hospitalaria. La metodología de investigación se basa en un enfoque cuantitativo. En primer lugar, se ha desarrollado una visión general y un análisis del mercado sanitario europeo, así como una amplia y sistemática revisión bibliográfica. Esta se ha enfocado en la eficiencia y el impacto económico de la estandarización y digitalización de los procesos intraoperatorios en el quirófano. Los resultados proporcionaron la base para derivar las preguntas de investigación en torno a los sistemas digitales de gestión del flujo de trabajo. Para cubrir las lagunas de investigación identificadas, se han obtenido y analizado de forma retrospectiva datos de un hospital, como estudio de caso, sobre un sistema digital de gestión del flujo de trabajo, Surgical Process Manager (SPM), en ortopedia y cirugía general. Los datos adicionales proporcionados por los pacientes, se han utilizado de forma retrospectiva para realizar cálculos económicos con el fin de responder a la pregunta principal de la investigación en cirugía general, centrándose en la cirugía de la obesidad. Las principales conclusiones de la tesis muestran que la implantación de sistemas digitales de gestión del flujo de trabajo, como el SPM, mejora la eficiencia y la economía en la cirugía de la obesidad. El análisis de odds ratio (razón de oportunidades/probabilidades) para evaluar el impacto en la calidad no permitió extraer conclusiones ni en ortopedia ni en cirugía de la obesidad. El cálculo coste-beneficio en cirugía de la obesidad mostró un ahorro de costes de 318 euros por paciente, lo que supuso un total de 10.073 euros. Este beneficio económico se consiguió gracias a la disminución de la duración de la estancia (-1,2 días). Por primera vez, esta investigación aporta pruebas sobre el valor económico de los procesos digitalizados y estandarizados en el quirófano en cirugía general y ambulatoria. Los resultados facilitarán las decisiones de inversión en digitalización de la gestión hospitalaria y ofrecerán opciones para superar la carga económica en el mercado sanitario actual. Además, los resultados proporcionan detalles en profundidad sobre estructuras de costes específicas, cálculos, así como reembolsos y cómo medir eficazmente el impacto financiero en los sistemas digitales en el quirófano. / [CA] La digitalització de l'assistència sanitària encara està endarrerida en comparació amb moltes altres indústries, però ofereix el potencial per fer front als reptes creixents. Aquesta tesi examina sobre l'exemple d'un sistema de gestió de flux de treball digital, implementat al quiròfan quirúrgic (OR), quin podria ser l'impacte de la digitalització en la qualitat, l'eficiència i l'economia per a la gestió hospitalària. La metodologia d'aquesta investigació es basa en un enfocament quantitatiu. En primer lloc, es va fer una visió general i anàlisi del mercat sanitari i una extensa revisió sistemàtica de la literatura. Es va centrar en l'eficiència i l'impacte econòmic de l'estandardització i la digitalització dels processos intraoperatoris al quiròfan. Les troballes van proporcionar la base per derivar les preguntes de recerca al voltant dels sistemes de gestió de flux de treball digitals. Per cobrir els buits de recerca identificats, s'han extret i analitzat retrospectivament dades d'hospitals d'un sol centre en un sistema de gestió de flux de treball digital, Surgical Process Manager (SPM), en ortopèdia i cirurgia general i visceral (G&V). S'han utilitzat retrospectivament dades addicionals dels pacients per a càlculs econòmics per concloure la pregunta principal de recerca en G&V amb un enfocament en la cirurgia de l'obesitat. Les principals conclusions de la tesi mostren que la implementació de sistemes digitals de gestió de flux de treball, a partir de l'exemple de l'SPM, millora l'eficiència i l'economia en la cirurgia de l'obesitat. L'anàlisi d'odds ratio per avaluar l'impacte en la qualitat no va permetre treure conclusions ni en ortopèdia ni en cirurgia de l'obesitat. El càlcul cost-benefici en cirurgia de l'obesitat va mostrar un estalvi de costos de 318 € per pacient, que va ascendir a 10.073 €. Aquest benefici econòmic es va aconseguir mitjançant la disminució de la durada de l'estada (-1,2 dies). Per primera vegada la investigació proporciona evidència sobre el valor econòmic dels processos digitalitzats i estandarditzats a la sala d'operacions en G&V. Els resultats facilitaran les decisions d'inversió en la digitalització de la gestió hospitalària i oferiran opcions per superar la càrrega econòmica del mercat sanitari actual. A més, les troballes proporcionen detalls detallats sobre estructures de costos específiques, càlculs, així com el reemborsament i com mesurar eficaçment l'impacte financer en els sistemes digitals de l'OR. / [EN] Digitalization in healthcare still lags compared to many other industries but offers the potential to cope with increasing challenges. This thesis examines the example of digital workflow management implemented in the surgical Operating Room (OR) and what the impact of digitalization on quality, efficiency and economics for hospital management could be. The methodology for this research is based on a quantitative approach. First, an overview and analysis of the healthcare market and an extensive systematic literature review were carried out. It was focused on the efficiency and economic impact of standardization and digitalization of intraoperative processes in the OR. The findings provided the basis for the research questions around digital workflow-management-systems. Single-center hospital data on a digital workflow-management-system, Surgical Process Manager (SPM), has been retrospectively extracted and analyzed in orthopedics and general & visceral surgery (G&V) to fill identified research gaps. Additionally, provided patient data has been retrospectively used for economic calculations to conclude the main research question in G&V, focusing on obesity surgery. The main findings of the thesis show that implementing digital workflow management systems, in the example of the SPM, improves efficiency and economics in obesity surgery. The odds ratio analysis to assess the impact on quality did not allow conclusions in orthopedics or obesity surgery. The cost-benefit calculation in obesity surgery showed cost savings of 318 € per patient, totaling 10,073€. This economic benefit was achieved by decreasing the length of stay (-1.2 days). For the first time, research provides evidence of the economic value of digitized and standardized processes in the OR in G&V. The results will facilitate investment decisions in digitization of hospital management and offer options to overcome the financial burden in the current healthcare market. Also, the findings provide in-depth details on specific cost structures, calculations, reimbursement, and how to effectively measure the financial impact on digital systems in the OR. / Von Schudnat, C. (2024). An economic analysis of digitalized and standardized workflows within the operating room [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/203008 / Compendio

Background: Nowadays, organizations face an increased occurrence and magnitude ofsystemic risks in their supply chain. For SMEs, these risks are even more prominent due toresources and capacity constraints, especially if they are positioned within global trade dyadssuch as the Europe-Asia dyad. As is it reasonable to assume that the near future will see otherexamples of disrupting events within this dyad, this study focuses on SMEs in the Europe-Asiadyad facing systemic risks. Purpose: The purpose of this study is to uncover how European SMEs within Europe-Asiadyads can strategically navigate and optimize their SCRM approach to counter systemic risks,harmonizing the adoption of the SCRM process and a cost-benefit approach to enhance theirrisk preparedness. Methods: This study has a qualitative and deduction approach with an exploratory purpose.Data is gathered though semi structured interviews within five case companies. Findings/Contribution: SMEs who are more dependent on the Europe-Asia dyad usually havemore SCRM practices in place. As a result, SMEs with solid SCRM processes have an increasedlevel of risk preparedness. However, SMEs also aim to stay agile to leverage for their smallsize and limited resources. The empirical findings also show that SMEs with less preparednessoften rely on a fast and agile reactive measure to tackle risks in their Europe-Asia supply chain.This level of preparedness directly influences the level of which SMEs use CBA within SCRM,which the leads to even more preparedness to systemic risks. Furthermore, SMEs with a highlevel of preparedness utilize CBA on a more advanced level than SMEs who showcase lowerpreparedness. It also offers valuable insights for both academics and practitioners on optimizingSMEs' risk management strategies. Keywords: Small and Medium Enterprises (SMEs) – Supply Chain Risk Management (SCRM)– Europe-Asia Dyad – Systemic Risks – Risk Preparedness – Cost-Benefit Analysis (CBA)

El título del trabajo es “Análisis comparativo técnico y económico de la resistencia al ataque a los sulfatos del concreto f’c=280kg/cm2 adicionado con ceniza de bagazo de caña de azúcar con respecto a puzolanas comerciales”, está investigación tiene como objetivo determinar si es conveniente reemplazar a las puzolanas comerciales (diatomita y ceniza volante), por la ceniza de bagazo de caña de azúcar, sustituyendo parte del cemento portland tipo I y adicionarlas en diferentes porcentajes de 5%, 7% y 10%, para evaluar su comportamiento en la resistencia a los sulfatos y resistencia a la compresión. Los resultados obtenidos de compresión nos dicen que, si es posible reemplazar la ceniza de bagazo de caña de azúcar hasta 10% por las puzolanas comerciales, ya que llega a cumplir con la resistencia requerida a los 28 días de 280 kg/cm2 por un precio menor de S/22.81 referente al diseño patrón. Los resultados de resistencia a los sulfatos nos indican que la ceniza de bagazo de caña de azúcar al 5% es la que responde mejor ante las sales Na2SO4 con una variación máxima de longitud de la barra de 0.177% en 12 semanas de curación con una concentración de 50g/900 ml. El resultado del análisis comparativo de la resistencia a los sulfatos con el valor económico nos da que, el reemplazo de 5% de ceniza de bagazo de caña de azúcar tiene la mejor relación en cuanto a variación de 0.177% a un costo de S/661.39, está es la adición más conveniente en referencia al costo-beneficio. / The title of the work is "Comparative technical and economic analysis of the resistance to attack on sulfates of concrete f'c=280kg/cm2 added with sugarcane bagasse ash with respect to commercial pozzolans", this research aims to determine if it is convenient to replace commercial pozzolans (diatomite and fly ash), with sugarcane bagasse ash, substituting part of the Portland cement type I and adding them in different percentages of 5%, 7% and 10%, to evaluate their behavior in resistance to sulfates and resistance to compression. The results obtained from compression tell us that, if it is possible to replace sugarcane bagasse ash up to 10% with commercial pozzolans, since it meets the required resistance at 28 days of 280 kg/cm2 for a lower price of S/22.81 referring to the standard design. The sulfate resistance results indicate that 5% sugarcane bagasse ash responds best to Na2SO4 salts with a maximum bar length variation of 0.177% in 12 weeks of curing at a concentration of 50g/900 ml. The result of the comparative analysis of sulfate resistance with the economic value gives us that the replacement of 5% of sugarcane bagasse ash has the best ratio in terms of variation of 0.177% at a cost of S/661.39, this is the most convenient addition in reference to cost-benefit.

La investigación se desarrolló en la empresa Servicios Generales ADJ EIRL, en la cual se planteó como objetivo mejorar la gestión de inventarios para aumentar los ingresos. En primer lugar, se diagnosticó la gestión de inventario actual de dicha empresa para lo que se empleó la metodología de matriz ABC, se calcularon indicadores de rotura de stock, el nivel del servicio, el costo de mantenimiento y el costo de oportunidad. En segundo lugar, se determinaron las herramientas de ingeniería y metodología para la mejora en la gestión de inventarios, los cuales fueron la aplicación del modelo P, la implementación de un software EGA futura, la capacitación para los colaboradores y la implementación de la 5’S. Finalmente, se realizó un análisis económico de la propuesta donde se determinó que el beneficio de la empresa con la propuesta sería de S/.1,7. Así es como se llegó a la conclusión que, con la propuesta, los ingresos de la empresa aumentarán a S/. 164 289,65; su nivel de servicio se incrementará en un 95% y sus costos disminuirán considerablemente, dando como resultado final que la implementación de la propuesta es viable. / The research was developed at the company Servicios Generales ADJ EIRL, in which the objectives of improving the inventory management of the company to increase revenue were set, as the first objective was to diagnose the current inventory management of the company General services ADJ EIRL where the ABC matrix was made, indicators of stock breakage, service level, maintenance cost and opportunity cost were calculated; The second objective was to determine the engineering tools for the improvement of inventory management in the company Servicios Generales ADJ EIRL, which were the application of the P model, implementation of a future EGA software, training for employees and the implementation of the 5'S; Finally, the last objective was to carry out an economic analysis of the proposal where it was determined that the profit of the company with the proposal would be S / .1.7; thus it was concluded that with the proposal the company will increase its income to S /. 164 289.65; its service level will increase by 95% and its costs

Yes / Payment incentives are known to influence healthcare but little is known about the impact of paying directly for achieved outcomes. In England, novel purchasing (commissioning) of National Health Service (NHS) stop smoking services, which paid providers for quits achieved whilst encouraging new market entrants, was implemented in eight localities (primary care trusts (PCTs)) in April 2010. This study examines the impact of the novel commissioning on these services. Accredited providers were paid standard tariffs for each smoker who was supported to quit for four and 12 weeks. A cluster-controlled study design was used with the eight intervention PCTs (representing 2,138,947 adult population) matched with a control group of all other (n=64) PCTs with similar demographics which did not implement the novel commissioning arrangements. The primary outcome measure was changes in quits at four weeks between April 2009 and March 2013. A secondary outcome measure was the number of new market entrants within the group of the largest two providers at PCT-level. The number of four-week quits per 1,000 adult population increased per year on average by 9.6% in the intervention PCTs compared to a decrease of 1.1% in the control PCTs (incident rate ratio 1108, p<0001, 95% CI 1059 to 1160). Eighty-five providers held 'any qualified provider' contracts for stop smoking services across the eight intervention PCTs in 2011/12, and 84% of the four-week quits were accounted for by the largest two providers at PCT-level. Three of these 10 providers were new market entrants. To the extent that the intervention incentivized providers to overstate quits in order to increase income, caution is appropriate when considering the findings. Novel commissioning to incentivize achievement of specific clinical outcomes and attract new service providers can increase the effectiveness and supply of NHS stop smoking services.

Yes / For most people, home is the preferred place of care and death. Despite the development of specialist palliative care and primary care models of community based service delivery, people who are dying, and their families/carers, can experience isolation, feel excluded from social circles and distanced from their communities. Loneliness and social isolation can have a detrimental impact on both health and quality of life. Internationally, models of social and practical support at the end of life are gaining momentum as a result of the Compassionate Communities movement. These models have not yet been subjected to rigorous evaluation. The aims of the study described in this protocol are: (1) to evaluate the feasibility, acceptability and potential effectiveness of The Good Neighbour Partnership (GNP), a new volunteer-led model of social and practical care/support for community dwelling adults in Ireland who are living with advanced life-limiting illness; and (2) to pilot the method for a Phase III Randomised Controlled Trial (RCT). DESIGN: The INSPIRE study will be conducted within the Medical Research Council (MRC) Framework for the Evaluation of Complex Interventions (Phases 0-2) and includes an exploratory two-arm delayed intervention randomised controlled trial. Eighty patients and/or their carers will be randomly allocated to one of two groups: (I) Intervention: GNP in addition to standard care or (II) Control: Standard Care. Recipients of the GNP will be asked for their views on participating in both the study and the intervention. Quantitative and qualitative data will be gathered from both groups over eight weeks through face-to-face interviews which will be conducted before, during and after the intervention. The primary outcome is the effect of the intervention on social and practical need. Secondary outcomes are quality of life, loneliness, social support, social capital, unscheduled health service utilisation, caregiver burden, adverse impacts, and satisfaction with intervention. Volunteers engaged in the GNP will also be assessed in terms of their death anxiety, death self efficacy, self-reported knowledge and confidence with eleven skills considered necessary to be effective GNP volunteers. DISCUSSION: The INSPIRE study addresses an important knowledge gap, providing evidence on the efficacy, utility and acceptability of a unique model of social and practical support for people living at home, with advanced life-limiting illness. The findings will be important in informing the development (and evaluation) of similar service models and policy elsewhere both nationally and internationally. TRIAL REGISTRATION: ISRCTN18400594 18(th) February 2015.

Chan Wai Hung Fredric. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2006. / Includes bibliographical references (leaves 67-72). / Abstracts in English and Chinese. / Acknowledgement --- p.i / Abstract --- p.ii / 摘要 --- p.iv / Table of contents --- p.vi / Publications --- p.ix / List of figures --- p.x / List of tables --- p.xi / Abbreviations --- p.xii / Chapter Chapter 1 --- Introduction / Chapter 1.1 --- Anticoagulation effect of warfarin --- p.2 / Chapter 1.2 --- Indications of warfarin therapy --- p.3 / Chapter 1.3 --- Monitoring systems for anticoagulation therapy --- p.4 / Chapter 1.4 --- Optimum target intensities for anticoagulation therapy --- p.5 / Chapter 1.5 --- Factors affecting anticoagulation effect of warfarin --- p.6 / Chapter 1.5.1 --- Drugs --- p.7 / Chapter 1.5.2 --- Diet --- p.8 / Chapter 1.5.3 --- Health supplements --- p.8 / Chapter 1.5.4 --- Comorbidities --- p.9 / Chapter 1.5.5 --- Genetic factors --- p.10 / Chapter 1.6 --- Management of anticoagulation therapy in Chinese patients --- p.11 / Chapter 1.7 --- Barriers to optimal INR control --- p.13 / Chapter 1.8 --- Two models of care for anticoagulation therapy - routine medical care and co-ordinated anticoagulation service --- p.14 / Chapter 1.9 --- Outcomes of two models of anticoagulation management --- p.14 / Chapter 1.9.1 --- Clinical outcomes --- p.14 / Chapter 1.9.2 --- Economic outcomes --- p.16 / Chapter 1.10 --- Clinical pharmacist involvement in the management of anticoagulation therapy --- p.17 / Chapter 1.11 --- Anticoagulation management in Hong Kong --- p.18 / Chapter 1.12 --- Hypothesis and objectives --- p.19 / Chapter Chapter 2 --- Materials and Methods / Chapter 2.1 --- Setting and subjects --- p.22 / Chapter 2.2 --- Interventions --- p.23 / Chapter 2.2.1 --- Newly proposed model --- p.23 / Chapter 2.2.1.1 --- Training of clinical pharmacist --- p.23 / Chapter 2.2.1.2 --- Development of management protocol --- p.24 / Chapter 2.2.1.3 --- Treatment algorithm of pharmacist-managed anticoagulation service --- p.25 / Chapter 2.2.1.4 --- Validation of the Coagucheck Pro DM --- p.28 / Chapter 2.2.2 --- Usual practice model --- p.29 / Chapter 2.3 --- Outcome measures --- p.29 / Chapter 2.3.1 --- Primary clinical outcomes --- p.29 / Chapter 2.3.1.1 --- Therapeutic and expanded therapeutic INR ranges --- p.29 / Chapter 2.3.1.2 --- A method to determine the amount of patient-time spent in each INR category --- p.30 / Chapter 2.3.2 --- Secondary clinical outcomes --- p.31 / Chapter 2.3.3 --- Economic outcomes --- p.32 / Chapter 2.3.4 --- Humanistic outcomes --- p.34 / Chapter 2.4 --- Sample size estimation --- p.34 / Chapter 2.5 --- Statistical analysis --- p.35 / Chapter Chapter 3 --- Results / Chapter 3.1. --- Patient demographics and indications --- p.37 / Chapter 3.2. --- Control of INR --- p.42 / Chapter 3.3. --- Incidence of major bleeding and thromboembolism --- p.44 / Chapter 3.4. --- Direct medical cost analysis --- p.46 / Chapter 3.5. --- Patient satisfaction --- p.48 / Chapter Chapter 4 --- Discussion and Conclusion / Chapter 4.1 --- Discussion --- p.51 / Chapter 4.1.1 --- Clinical outcomes of anticoagulation clinic --- p.52 / Chapter 4.1.2 --- Direct medical cost analysis --- p.56 / Chapter 4.1.3 --- Patient satisfaction --- p.59 / Chapter 4.1.4 --- Limitations --- p.62 / Chapter 4.1.5 --- Future studies --- p.63 / Chapter 4.2 --- Conclusion --- p.66 / References --- p.67 / Appendices / Appendix A. Management protocol --- p.73 / Appendix B. Data collection form --- p.96 / Appendix C. PSQ-18 --- p.104

Ho Toi Sze Joyce. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2005. / Includes bibliographical references (leaves 65-74). / Abstracts in English and Chinese. / Acknowledgement --- p.ii / Contents --- p.iii / Abstract --- p.viii / List of Abbreviations --- p.xvii / List of Tables --- p.xix / List of Figures --- p.xx / Chapter Chapter 1 --- Introduction --- p.1 / Chapter 1.1 --- The role of Non-steroidal anti-inflammatory drugs (NSAIDs) --- p.1 / Chapter 1.2 --- NSAID-induced gastrointestinal (GI) toxicity --- p.1 / Chapter 1.2.1 --- Pathogenesis of NSAID-induced GI toxicity --- p.2 / Chapter 1.2.2 --- GI symptoms --- p.4 / Chapter 1.2.3 --- GI ulcers --- p.4 / Chapter 1.2.4 --- GI complications --- p.5 / Chapter 1.2.5 --- Risk factor for GI complications --- p.6 / Chapter 1.2.6 --- Ulcerogenicity of different NSAIDs in upper GI events --- p.6 / Chapter 1.3 --- Prevention of NSAID-induced GI toxicity --- p.7 / Chapter 1.3.1 --- H2-receptor antagonists --- p.8 / Chapter 1.3.2 --- Misoprostol --- p.8 / Chapter 1.3.3 --- Proton Pump Inhibitor (PPI) --- p.9 / Chapter 1.3.4 --- Selective COX-2 Inhibitors --- p.10 / Chapter 1.3.4.1 --- GI safety of selective COX-2 inhibitors --- p.11 / Chapter 1.3.4.1.1 --- Gastrointestinal outcomes research of rofecoxib --- p.13 / Chapter 1.3.4.1.2 --- Celecoxib Long term Arthritis Safety Study --- p.14 / Chapter 1.3.4.2 --- Cardiovascular toxicity of NSAIDs --- p.15 / Chapter 1.3.4.2.1 --- Cardiovascular toxicity of non-selective NSAIDs --- p.15 / Chapter 1.3.4.2.2 --- Cardiovascular toxicity of selective COX-2 inhibitors --- p.16 / Chapter 1.4 --- Guidelines on the management of osteoarthritis (OA) and rheumatoid arthritis (RA) --- p.21 / Chapter 1.4.1 --- American College of Rheumatology (ACR) Subcommittee --- p.22 / Chapter 1.4.2 --- National Institute for Clinical Excellence (NICE) --- p.23 / Chapter 1.4.3 --- Hong Kong Hospital Authority (HA) --- p.23 / Chapter 1.5 --- Cost of illness of upper GI events in the setting of an emergency room of a regional hospital in Hong Kong and cost analysis of selective COX-2 inhibitor with non-selective NSAID plus gastroprotective agent --- p.24 / Chapter 1.6 --- Objectives --- p.25 / Chapter Chapter 2 --- Cost of illness of upper GI events in the setting of an emergency room of a regional hospital in Hong Kong --- p.26 / Chapter 2.1 --- Methods --- p.28 / Chapter 2.1.1 --- Study site --- p.28 / Chapter 2.1.2 --- Cohort participants --- p.28 / Chapter 2.1.3 --- Resource data collection --- p.29 / Chapter 2.1.4 --- Cost data --- p.30 / Chapter 2.1.5 --- Statistical Methods --- p.31 / Chapter 2.1.6 --- Study perspective --- p.31 / Chapter 2.2 --- Results --- p.31 / Chapter 2.2.1 --- Demographic data --- p.31 / Chapter 2.2.2 --- Total direct medical cost of upper GI complaints in UCH --- p.33 / Chapter 2.3 --- Discussion --- p.35 / Chapter 2.3.1 --- Total direct medical cost of upper GI events --- p.35 / Chapter 2.3.2 --- Cost of upper GI events associated with NSAID usage --- p.38 / Chapter 2.3.3 --- Low dose aspirin on NSAID-induced GI toxicity --- p.38 / Chapter 2.3.4 --- Limitation --- p.39 / Chapter 2.3.5 --- Future study --- p.41 / Chapter 2.4 --- Conclusion --- p.41 / Chapter Chapter 3 --- Cost analysis of selective COX-2 inhibitor versus non-selective NSAID with gastroprotective agent --- p.43 / Chapter 3.1 --- Methods --- p.46 / Chapter 3.1.1 --- Local randomized clinical trial --- p.46 / Chapter 3.1.1.1 --- Study population --- p.46 / Chapter 3.1.1.2 --- Cost data --- p.47 / Chapter 3.1.1.3 --- Statistical Methods --- p.48 / Chapter 3.1.1.4 --- Sensitivity analysis --- p.49 / Chapter 3.1.2 --- Large randomized clinical trial --- p.49 / Chapter 3.1.2.1 --- Study population --- p.49 / Chapter 3.1.2.2 --- Cost data --- p.50 / Chapter 3.2 --- Results --- p.50 / Chapter 3.2.1 --- Local randomized clinical trial --- p.51 / Chapter 3.2.1.1 --- Demographic data --- p.51 / Chapter 3.2.1.2 --- Cost analysis --- p.52 / Chapter 3.2.1.3 --- Sensitivity analysis --- p.53 / Chapter 3.2.2 --- Large randomized clinical trial --- p.54 / Chapter 3.2.2.1 --- Demographic data --- p.54 / Chapter 3.2.2.2 --- Cost analysis --- p.55 / Chapter 3.3 --- Discussion --- p.55 / Chapter 3.3.1 --- Cost analysis --- p.55 / Chapter 3.3.2 --- Sensitivity analysis --- p.59 / Chapter 3.3.3 --- Low dose aspirin on NSAID-induced GI toxicity --- p.59 / Chapter 3.3.4 --- Limitation --- p.60 / Chapter 3.4 --- Future study --- p.62 / Chapter 3.5 --- Conclusion --- p.62 / Chapter Chapter 4 --- Conclusion --- p.63 / Chapter Chapter 5 --- Reference --- p.65 / Appendix Data collection form --- p.75

本論文名為「行政效率測量標準與方法之研究」，除緒言外，共分七章。全文約十二萬字。 在「緒言」中，略述個人研究本文的動機與意旨，以及研究的重點與範圍。第一章「行政效率的概念」，首先闡述行政效率的性質、意義、辨正等。次論行政效率測量的意義，目的及其所遭遇的困難期澄清行政效率的基本概念，以利行政效率測量標準與方法的探討。第二章「行政效率測量標準」，就行政效率的性質，分成三個層次予以討論; 其一為機械性效率，凡行政機關工作屬於機械性者，適用機械性效率測量標準。筆者從各種角度提出七項測量標準，以供參考。其二為組織性效率，凡行政機關組織、人員、管理及運作情況的效率均屬之，適用組織性效率測量標準。筆者亦提出七項測量標準討論。其三為社會性效率，著重行政活動對社會所具的功能與價值等，適用社會性效率的測量標準。筆者提出討論的測量標準有三項。第三章為「行政效率測量方法」，採用統計分析方法與數理公式，論述行政效率測量的方法與技術。其中有的屬於理論性探討，有的則為現行測量辦法，筆者就此些辦法加以論列分析，並舉述實例，俾明其應用。第四章「我國行政效率測量的實施」，略論人事行政局與台北市政府的實施情形，並檢討其利弊，提出建議事項，以供參考改進。第五章「行政效率的測量人員」，鑒於「徒法不足以自行」，「為政在人」，故本章敘述如何遴任及訓練行政效率測量人員。期以人員的優點彌補制度的闕漏。第六章為「我國行政效率測量的展望」，闡明我國目前行政效率測量制度未臻完善，應從速謀求研究改進，加強實施工作簡化，計劃評核術與目標管理等新近管理技術，擬訂妥善的測量標準與方法。最後一章「結論」，綜合全文的研究心得提出報告，強調檢討現行制度缺點，力求改進，健全存政效率測量制度，增進行政效率，實現行政革新。本文研究方式，主要為理論性探討，並佐以若干實例，以求理論與實際相配合，研究範圍包括行政機關的組織、制度、人員及運作等，以求普遍討論效率測量標準與方法。筆者會去信美國當代名行政學者西蒙(Herbert A. Simon)教授，請教有關行政效率測量問題。西蒙教授謙虛表示，最近十幾年來，他的研究工作很少觸及行政效率、測量標準與方法。其主要觀點幾乎已盡括於「行政學士」(Public Adiministration 1956)一書中。但他指出美國這方面的研究趨向於「成本利益分析」(Cost-Benefit Analysis) 。西蒙教授並贈送筆者一書，名為「經由系統分析增進政府效率」(Efficiency in Government through Systems Analysis. by Roland N. Mckean, 1958) 其內容主要敘述利用成本利益分析以抉擇行政活動計劃，但與效率測量亦具有相當密切的關係，故本文會約略論及。

The objective of this thesis is to quantitatively understand the economic performance of protected area management strategies for forest and biodiversity conservation. Examples such as integrated conservation and development and eco tourism are assessed in terms of their ability to deliver on welfare benefits to local communities, and an assessment of the opportunity costs of forest conservation as a land use strategy. In addition the contribution of forest conservation in protected areas can make to poverty alleviation and economic development is also examined. The geographical focus of this study is the Albertine Rift region of East and Central Africa, stretching north from the southern end of Lake Tanganyika through the spine of Africa to the northern end of Lake Albert. The Albertine Rift is one of Africa’s most important landscapes for the conservation of forests and biodiversity. The overarching objective is addressed using a series of case studies empirically valuing the opportunity costs of conserving forests in a selection of sites in the central part of the Albertine Rift. The success of conservation is most often measured against progress in reducing habitat or species loss and not often in terms of the contribution of the protected area to poverty alleviation and local economic development. Achieving improvements of conservation strategies in the social dimension requires objective evidence on their effects. Economic valuation of protected area resources provides a quantitative means of assessing the promise and performance of conservation policies in achieving welfare benefits to local communities. This thesis provides three case studies each addressing current valuation and social issues in conservation and sets them in a context of managing protected areas in the broad dynamic setting of poverty alleviation and economic growth from a developing economy perspective. In addition two of the empirical studies are as concerned with methodological enquiry and the performance of novel environmental economic valuation techniques, such as the contingent valuation and choice modelling approaches, as the application of results to conservation questions. The empirical studies show that the benefits to local households and communities from their local forests may be greater than at first perceived. Across all protected area categories, biomes and income groups, households derived significant amounts of their overall income from their local protected area with large proportions of the value of goods harvested from forests being consumed in the home. Amongst income groups high income households often appropriated a greater share of the value of forest goods. There was no significant difference found between the household consumption and the sale of protected area products between income groups. The findings indicate that imposing reductions in forest use may increase poverty amongst local people whilst increasing household income will not necessarily reduce forest exploitation. This indicates that community conservation and integrated conservation and development programmes must target the poor forest adjacent households more actively to ensure poverty alleviation, whilst providing improved protection and law enforcement for effective conservation. It is also shown that biodiversity conservation can have an economic return through mountain gorilla eco-tourism. Findings show a disparity between what constitutes eco-tourism and the real values of tourists towards biodiversity conservation and local social benefits from protected areas. Despite showing a high marginal utility for biodiversity conservation, consumers are unwilling to pay for local community benefits from tourism as part of the permit price to view gorillas. Clearly the link between successful conservation and the welfare status of local communities is not sufficiently established in the minds of consumers to influence their spending decisions. The challenges of effectively mobilising communities to protect biodiversity are discussed in the context of the variable impacts of integrated conservation and development programs over the last three decades. Direct payment payments for conservation services schemes are discussed as an innovative tool to add to the gamut of community approaches currently on offer. Payments for conservation schemes are viewed with cautious optimism in terms of their possibility for success. Despite their allure of being more economically and socially efficient at achieving welfare and conservation objectives, given the complex nature of any society, no less research in to social and economic dynamics of protected area use by local communities would be needed to ensure success of such schemes. However, the overwhelming majority of benefits form protected areas are tied up in ecosystem services values. Mechanisms to generate funding and distribute payments for these benefits in terms of offsetting the local opportunity costs are essential to change local behavior and reduce forest degradation and destruction.