Thesis (MA)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: Mega projects have fascinated human beings for as long as history can remember. The urge to build something bigger and better than has ever been done before has always been a driving force behind the human race’s relentless pursuit of technological advancement. It is in this vein that mega projects have evolved over time, as methods of construction improved, so did the scale on which people could attempt new projects. The Channel Tunnel between England and France, the Hoover Dam in America and the Millau Viaduct in the French countryside are some of the biggest examples of infrastructure projects in the world and these are all unequivocally, mega projects. Costing at least $ 250 million and incorporating major technological challenges, mega projects continue to inspire and motivate artists and engineers alike. This thesis seeks to expand people’s understanding of the analysis of these mega projects. Mega project analysis is a field that has struggled to differentiate itself ordinary project analysis. The Gauteng Freeway Improvement Project (GFIP) and the associated e-tolling mega project will be analysed in this thesis. The framework for analysis will be provided by the work of Flyvbjerg, Bruzelius and Rothengatter (2003), who seek to analyse mega project success or failure based on three key indicators of economic sustainability, environmental concerns and the effect of public support. This thesis will use the indicators of economic sustainability and the effect of public support to determine whether the Gauteng Freeway Improvement Project (GFIP) can be viewed as a failed mega project or not. After an in-depth study of the data and material available, this descriptive and explanatory study shows that the GFIP and associated e-tolling mega project is indeed a failed mega project. This is because it has failed the analysis in both categories of economic sustainability and the effect of public support. / AFRIKAANSE OPSOMMING: Megaprojekte het al eeue lank die mens gefasineer. Die neiging van die mens om iets groter en beter te maak as wat al ooit gemaak was het nog altyd baie dryfkrag verskaf vir die mens se strewe na tegnologiese verbetering. Dit is met hierdie idee in gedagte dat megaprojekte met tyd verander het, soos wat boumetodes verbeter het, so ook het die grootte van projekte verander wat mense kon aanpak. Die Channel Tonnel tussen Engeland en Frankryk, die Hoover Dam in Amerika en die Millau Brug in die Franse platteland is voorbeelde van die grootste infrastruktuur projekte ter wêreld en hierdie is al drie, sonder enige twyfel, megaprojekte. Teen ‘n koste van ten minste $ 250 miljoen en met grootskaalse tegnologiese uitdaging, hou megaprojekte aan om vir beide kunstenaars en ingenieurs te motiveer en uit te daag. Hierdie tesis poog om mense se kennis van die analise van megaprojekte te verbreed. Megaprojek analise is ‘n veld wat al jare lank sukkel om verskille te bewerkstellig tussen homself en gewone projek analise. Die “Gauteng Freeway Improvement Project” (GFIP) en die verwante e-toll megaprojek sal geanaliseer word in hierdie tesis. Die raamwerk vir analise sal deur Flyvbjerg, Bruzelius en Rothengatter (2003) verskaf word, waar die outeurs poog om megaprojekte se sukses of mislukking te bepaal gebaseer op die sleutel aanwysers van ekonomiese volhoubaarheid, omgewingskwessies en die effek van openbare ondersteuning. Hierdie tesis sal gebruik maak van die ekonomiese volhoubaarheid en openbare ondersteuning aanwysers om te bepaal of die GFIP beskou kan word as a mislukte megaprojek of nie. Na ‘n in-diepte study van die data en materiaal beskikbaar, sal hierdie beskrywende en verduidelikende studie wys dat die GFIP en verwante e-toll megaprojek inderdaad ‘n mislukte megaprojek is, as gevolg daarvan dat die GFIP megaprojek analise aandui dat die megaprojek misluk het in beide die ekonomiese volhoubaarheid en publieke ondersteunings aanwysers.

Thesis (MDF)--Stellenbosch University, 2011. / The aim of this research report is to analyse the feasibility of Open Road Tolling (ORT) and its development in South Africa through the Gauteng Freeway Improvement Project (GFIP). ORT represents the next generation of Electronic Toll Collection (ETC) and this research report will assess to what extent the GFIP scheme is in line with other comparable tolling schemes; and is the institutional environment amenable to ORT. This will allow one to gauge the feasibility of the scheme and its potential for acceptability and success. The research report outlines the number of risks that come with an ORT scheme and these include amongst others collection risk, enforcement, technology, privacy and public acceptance. The success of the GFIP will largely be determined by how well these risks are mitigated and how the benefits can be marketed to the users. The literature review illustrates that whether road pricing schemes have failed to move forward, have been implemented, are currently under development, or still in the planning stage as a concept there are several consistent lessons and critical success factors one should apply when structuring a scheme. In the discussions with stakeholders, the following conclusions with regards to the feasibility of ORT and its development in South Africa were as follows: The factors which need to be addressed include political risk, effective marketing of the scheme to the public, obtaining political will and support, building trust between the scheme developer and the user, managing perceptions and acknowledgement of the fact that the scheme will need to prove itself over time. Inadequate demonstration of equity for the user along with poor communication would compromise public acceptance and the success of the scheme. Incorporating interoperability yields benefits in terms in terms of network externalities, the ability to use a single transponder for multiple tolling plazas and points, along with the potential for alternative uses for the transponder. ORT as a viable solution for the GFIP is feasible from a technical point in that it's the only way in which one can collect tolls from a high volume network and not cause disruptions in the flow of traffic. However, there are a number of persistent residual risks that SANRAL cannot entirely mitigate and some fall under the realm of political risk. While SANRAL has applied best practice principles in structuring the GFIP with the aim of providing value for money for the user and as far as possible tackling the issue of affordability, there are certain realities, such as the recent global financial crisis, the infrastructure backlog of the country, users paying for roads which were free and challenges with overall service delivery which place a strain on the legitimacy of the GFIP ORT scheme.

<p>AB Svenska Spel är ett statligt ägt monopolföretag som levererar spel och lotter till det svenska samhället. I detta examensarbete har AB Svenska Spel och dess avdelning ombudsekonomi verkat som fallföretag. Avdelningen, vilken är placerad vid huvudkontoret i Visby, valdes ut då ekonomichefen deklarerade att deras arbetssätt upplevdes ineffektivt av medarbetarna.</p><p>Examensarbetet inleddes med en förstudie där olika förbättringsområden inom avdelningen identifierades, där ett beslut sedan fattads att två av dessa områden som skulle vara i fokus i examensarbetet. De delar i avdelningen som skulle granskas var kreditbevakning samt arbetsflödet och de interna överlämningarna. Gemensamt för de identifierade förbättringsområdena var att dessa kunde ses som symtom på att avdelningen inte arbetade systematiskt med kvalitetsutveckling eller med en tydlig verksamhetsstyrning. Detta innebar i praktiken att avdelningens övergripande ramverk, riktlinjer och målstyrning helt saknades.</p><p>Vad avdelningens funktion och syfte var, hur medarbetarna bidrog till resterande organisation eller hur de bidrog externt till det svenska samhället kunde inte redogöras för. Inte heller någon dokumenterad information om detta återfanns och var inte uttalad. Medarbetarna kunde vidare inte redogöra för hur avdelningens interna arbetsmoment och arbetsuppgifter tillsammans bidrog till en enhetlig avdelning som gemensamt arbetade mot samma riktning. Följaktligen arbetades ett övergripande ramverk fram för avdelningen genom att insamlat material har kombinerats med existerande teorier om verksamhetsstyrning, till exempel offensiv kvalitetsutveckling och processkartläggning.</p><p>För att skapa en helhet har avdelningens uppdrag och huvudprocess identifierats och sedan brutits ned i nya riktlinjer och arbetsdokument som rör kreditbedömningarna och på så sätt har arbetet konkritiserats och effektiviserats. Resultatet är att en röd tråd skapats mellan AB Svenska Spels övergripande vision och målbild och avdelningen ombudsekonomi genom att en anpassad affärsidé och vision skapats vilken är en förlängning på ett formulerat uppdrag. För att ytterligare konkritisera hur avdelningen kan styras samt hur mätning och nyckeltal kan användas har ett balanserat styrkort skapats. Vidare har resultatet med examensarbetet bidragit till att systematiska angreppssätt presenteras för att främja analys och ständiga förbättringar. Genom att anpassa hörnstensmodellen till avdelningen har nya värdegrunder skapats som ska verka som en stabil grund för långsiktigt hållbart arbete.</p><p>Då examensarbetet inte inkluderar att resultatet som presenteras i denna rapport implementeras på avdelningen eller kan påvisa en reell effekthämtning har en åtgärdsplan och förslag till fortsatt arbete tagits fram och överlämnats till avdelningschefen. Detta ska möjliggöra att det systematiska arbetssättet fortskrider, förbättras ytterligare och det förändrade tankesättet bibehålls.</p> / <p>AB Svenska Spel is a state-owned company that delivers games and lottery to the Swedish society. In this essay, Svenska Spel and its unit ombudsekonomi acted as a case company. The unit, which is located at the Headquarters in Visby, was selected when the Chief Financial Officer declared that the employees felt that their workflow was ineffective and in need of change. Ombudsekonomi is part of the Finance Department and works with the company's establishment process for new customers, accounts receivable and management of the company's collection of debts.</p><p>This essay began with a pre-study which intended to identify areas of improvement within the department, which then would form the basis for this essay. The pre-study pointed out several  primarily, development of the unit's credit surveillance, head process and workflow, as well as internal handovers.</p><p>Common for all identified areas was that the unit didn ́t plan their work systematically or with total quality management, which is to be seen as a symptom of the lack of overall framework, policies and well-defined goals. The employees couldn ́t describe the function and purpose of the unit, or how they contributed to Svenska Spels organization or to the Swedish society. Neither could they express how the unit's internal actions and tasks together contributed to the common cause or how to work together to reach it, and we couldn't find any (for the unit) defined goals, vivion or overall assignment.</p><p>Therefore, a general framework was put together combining theories of total quality management and processes, mapping with the official strategies, vision and goals that were found in the Svenska Spel annual report. To enable this, information was collected, modified and reformulated to fit the unit's work situation. A mission, vision and strategy was made and new processes were established. This, together with new guidelines and documents for work practices, should make it possible for all the emplyees to work against the same goal in an effective and rationalized way that creates more value for the unit.</p><p>The result of this essay is the creation of a main thread from Svenska Spels overall existing framework down to the unit's work, as well as a new defined goal. To illustrate how this work can be implemented in different perspectives, a balance scorecard has been created including suggestions for measurement and key performance indicators. Furthermore, the result of this essay contributes to the unit's systematic approach to promote the analysis and continuous improvement based on fundamental proposed values.</p><p>However, this project does not include implementation of the results and is therefore not going to ensure the outcomes. An action and application plan for further work will be handed over to the unit's Team Leader. This ensure that the systematic work approach progress, is further improved and that the proposed mind set is maintained.</p>

AB Svenska Spel är ett statligt ägt monopolföretag som levererar spel och lotter till det svenska samhället. I detta examensarbete har AB Svenska Spel och dess avdelning ombudsekonomi verkat som fallföretag. Avdelningen, vilken är placerad vid huvudkontoret i Visby, valdes ut då ekonomichefen deklarerade att deras arbetssätt upplevdes ineffektivt av medarbetarna. Examensarbetet inleddes med en förstudie där olika förbättringsområden inom avdelningen identifierades, där ett beslut sedan fattads att två av dessa områden som skulle vara i fokus i examensarbetet. De delar i avdelningen som skulle granskas var kreditbevakning samt arbetsflödet och de interna överlämningarna. Gemensamt för de identifierade förbättringsområdena var att dessa kunde ses som symtom på att avdelningen inte arbetade systematiskt med kvalitetsutveckling eller med en tydlig verksamhetsstyrning. Detta innebar i praktiken att avdelningens övergripande ramverk, riktlinjer och målstyrning helt saknades. Vad avdelningens funktion och syfte var, hur medarbetarna bidrog till resterande organisation eller hur de bidrog externt till det svenska samhället kunde inte redogöras för. Inte heller någon dokumenterad information om detta återfanns och var inte uttalad. Medarbetarna kunde vidare inte redogöra för hur avdelningens interna arbetsmoment och arbetsuppgifter tillsammans bidrog till en enhetlig avdelning som gemensamt arbetade mot samma riktning. Följaktligen arbetades ett övergripande ramverk fram för avdelningen genom att insamlat material har kombinerats med existerande teorier om verksamhetsstyrning, till exempel offensiv kvalitetsutveckling och processkartläggning. För att skapa en helhet har avdelningens uppdrag och huvudprocess identifierats och sedan brutits ned i nya riktlinjer och arbetsdokument som rör kreditbedömningarna och på så sätt har arbetet konkritiserats och effektiviserats. Resultatet är att en röd tråd skapats mellan AB Svenska Spels övergripande vision och målbild och avdelningen ombudsekonomi genom att en anpassad affärsidé och vision skapats vilken är en förlängning på ett formulerat uppdrag. För att ytterligare konkritisera hur avdelningen kan styras samt hur mätning och nyckeltal kan användas har ett balanserat styrkort skapats. Vidare har resultatet med examensarbetet bidragit till att systematiska angreppssätt presenteras för att främja analys och ständiga förbättringar. Genom att anpassa hörnstensmodellen till avdelningen har nya värdegrunder skapats som ska verka som en stabil grund för långsiktigt hållbart arbete. Då examensarbetet inte inkluderar att resultatet som presenteras i denna rapport implementeras på avdelningen eller kan påvisa en reell effekthämtning har en åtgärdsplan och förslag till fortsatt arbete tagits fram och överlämnats till avdelningschefen. Detta ska möjliggöra att det systematiska arbetssättet fortskrider, förbättras ytterligare och det förändrade tankesättet bibehålls. / AB Svenska Spel is a state-owned company that delivers games and lottery to the Swedish society. In this essay, Svenska Spel and its unit ombudsekonomi acted as a case company. The unit, which is located at the Headquarters in Visby, was selected when the Chief Financial Officer declared that the employees felt that their workflow was ineffective and in need of change. Ombudsekonomi is part of the Finance Department and works with the company's establishment process for new customers, accounts receivable and management of the company's collection of debts. This essay began with a pre-study which intended to identify areas of improvement within the department, which then would form the basis for this essay. The pre-study pointed out several  primarily, development of the unit's credit surveillance, head process and workflow, as well as internal handovers. Common for all identified areas was that the unit didn ́t plan their work systematically or with total quality management, which is to be seen as a symptom of the lack of overall framework, policies and well-defined goals. The employees couldn ́t describe the function and purpose of the unit, or how they contributed to Svenska Spels organization or to the Swedish society. Neither could they express how the unit's internal actions and tasks together contributed to the common cause or how to work together to reach it, and we couldn't find any (for the unit) defined goals, vivion or overall assignment. Therefore, a general framework was put together combining theories of total quality management and processes, mapping with the official strategies, vision and goals that were found in the Svenska Spel annual report. To enable this, information was collected, modified and reformulated to fit the unit's work situation. A mission, vision and strategy was made and new processes were established. This, together with new guidelines and documents for work practices, should make it possible for all the emplyees to work against the same goal in an effective and rationalized way that creates more value for the unit. The result of this essay is the creation of a main thread from Svenska Spels overall existing framework down to the unit's work, as well as a new defined goal. To illustrate how this work can be implemented in different perspectives, a balance scorecard has been created including suggestions for measurement and key performance indicators. Furthermore, the result of this essay contributes to the unit's systematic approach to promote the analysis and continuous improvement based on fundamental proposed values. However, this project does not include implementation of the results and is therefore not going to ensure the outcomes. An action and application plan for further work will be handed over to the unit's Team Leader. This ensure that the systematic work approach progress, is further improved and that the proposed mind set is maintained.

Background ICU readmissions within 72 hours after discharge from the intensive care unit (ICU) is a problem because this leads to higher mortality and longer hospital stays. This is a particular problem for the hospital studied for this thesis because there are only three fully equipped ICU beds available.   Aim To prevent readmissions by introducing nursing rounds as a concept of “communities of practice” (CoP) and to identify supportive and prohibitive mechanisms in the improvement work and knowledge needed for further improvement work in similar settings.   Methods Questionnaires, focus groups, Nelson’s improvement ramp, and qualitative content analysis.   Results There were no readmissions from the participating ward after the nursing rounds started, but the reason for this is not clear. The staff experienced the nursing rounds as valuable and they reported greater feelings of confidence, increased exchange, and use of their own knowledge.   Discussion The findings presented here support that hypothesis that CoP builds knowledge that can improve patient care. The information provided to the participants during the improvement project was identified as the most supportive mechanism for improvement work, and a lack of resources was seen as the most prohibitive mechanism.

This research presents an analysis of multiphase flow classified as dispersed solid and characterized by solid - gaseous medium granular mineral materials (silica) in a transport process in a discharge chute. The device is subsequently inserted into the tubular chamber with a rotatable differential pressure and temperature, to drag the mineral in the discharge chute which carries the flow direction of the mineral two exit points for the process. The objective of this work is to analyze the behavior of the material in the original geometry of the discharge chute, identifying flow paths, pressure loss and velocity discharge and subsequently propose a modified geometry permits to make a comparison between them, applying dynamic computational fluid. This study and simulation of the behavior of the scale models were developed considering the physical and chemical characteristics of the material as well as process data, generating information for creating the models, processing, and post -analysis simulation in CFX 12.0 software. The results of the simulations by comparison between the original geometry of the discharge chute and the modified geometry showed considerable variations in pressure drop, reduced velocities, and also the discharge points of sedimentation of the material due to better flow characteristics. The study leads to the conclusion that the modification made and simulated by CFD between geometries, has resulted in pressure discharge velocities in the gas phase and the solid phase decreases, and an improvement in the flow path which reduces wear and lessens sedimentation of material inside the machine. / Esta pesquisa apresenta uma análise de escoamento multifásico classificado como disperso contínuo e caracterizado pelo meio sólido-gasoso de material mineral granulado (sílica) em um processo de transporte em uma calha de descarga. O equipamento esta inserido posteriormente a uma câmara tubular rotativa com diferencial de pressão e temperatura, para o arraste do mineral na calha de descarga, que realiza o direcionamento do fluxo mineral por dois pontos de saída para o processo. O objetivo deste trabalho é realizar a análise do comportamento do material na geometria original da calha de descarga, identificando as trajetórias de fluxo, perda de pressão e velocidade de descarga e posteriormente propor uma geometria modificada permitindo a realização de uma comparação entre ambas, aplicando dinâmica dos fluidos computacional. O estudo e simulação do comportamento dos modelos foram desenvolvidos em escala, considerando as características físicas e químicas do material assim como dados de processo, gerando informações para criação dos modelos, processamento, simulação e pós-análise no software CFX 12.0. Os resultados obtidos pela comparação das simulações entre a geometria original da calha de descarga e a geometria modificada mostraram variações consideráveis de perda de pressão, redução das velocidades de descarga e também dos pontos de sedimentação do material devido a melhores características de escoamento. A pesquisa permite concluir que a modificação realizada e simulada por meio de CFD entre as geometrias, resultou em reduções de pressão, velocidades de descarga na fase gasosa e na fase sólida, além de uma melhoria na trajetória de fluxo o que reduz o desgaste e diminui sedimentação de material no interior do equipamento.

Tillgänglighet till ortodontisk vård behövde förbättras. Förbättringsarbetet fokuserade på processen för ortodontisk diagnostik och behandling i allmäntandvården. Syftet med förbättringsarbetet var att på ett mer resurseffektivt sätt identifiera och behandla patienter med ett ortodontiskt behandlingsbehov för att öka tillgänglighet och erbjuda patienterna optimal behandling. Studiens syfte var att utifrån berörda tandläkares erfarenheter utvärdera vad som har betydelse för att insatser för bättre ortodontisk vård fungerar som de gör. Förbättringsarbetet utgick från strukturen i förbättringsrampen. I fallstudien användes data från enkäter, intervjuer och förbättringsarbetet. Gemensam tolkning genomfördes med triangulering. Riktlinjer och förändrade ortodontikonsultationer infördes. Tiden för konsultationer för ortodontisten minskade trots bibehållen mängd patienter. I fallstudien identifierades stödjande och hindrande faktorer av betydelse för utfallet av förbättringsinsatserna.  Förändringar i processen för ortodontisk diagnostik och behandling i allmäntandvården bidrog till att frigöra tid för ortodontisten och därmed förbättrad tillgänglighet till specialisttandvård för patienterna. Stödjande och hindrande faktorer av betydelse för insatser för bättre ortodontisk vård kan komma till nytta vid spridning av arbetssättet. / Access to orthodontic care needed to be improved. The improvement project focused on the process for orthodontic diagnosis and treatment in general practice. The aim of the improvement project was to make the process for orthodontic diagnosis and treatment planning more efficient, to improve accessibility and offer patients optimal treatment. The study aimed to explore the experience of dentists in general practice related to the impact of changes on orthodontic care. The improvement project followed the steps of the improvement ramp. In the case study data from questionnaires, interviews and the improvement project were used. Triangulation was used for interpretation. Guidelines and alterations in orthodontic consultations were introduced. Scheduled time for consultations was reduced, despite no change in the number of patients. The case study identified constraining and enabling factors to be considered in relation to the improvement project. Changes in the process contributed to making consultations less time consuming and thereby useful to improve accessibility to care. The impact of constraining and enabling factors in relation to the improvement efforts can promote transfer of learning to other caregivers in adopting improvement activities.

No description available.

Objectives. Evaluate C-reactive protein (CRP) levels according to weight and physical activity. The study explored how changes in CRP were associated with baseline CRP, weight, and physical activity and changes in these variables. Methods. A randomized controlled study design assigned 348 individuals to the intervention or control group with measurements taken at baseline, 6 weeks, and 6 months of body weight, physical activity, and serum CRP levels. Participants attended an intensive 40-hour educational course delivered over a four-week period. Results. At baseline, CRP was negatively associated with total steps/week, and positively associated with weight, BMI, percent fat, and saturated fat at baseline. CRP significantly decreased through 6 weeks and also through 6 months for only those with high CRP at baseline. For those with high CRP at baseline, the decrease was significant for normal, overweight, and obese groups of people. Changes in weight or physical activity were not significantly associated with changes in CRP. Conclusions. Over 6 week and 6 month follow-up periods, the intervention failed to discriminate changes in CRP. Changes in CRP were only associated with baseline levels of CRP and BMI and were not associated with changes in any of the selected variables considered.

No description available.