Activity-based management accounting in the health care sector, with specific reference to private hospital groups in South Africa

ThesisThe health care sector, worldwide, is characterised by increasing patient loads, more complex procedures - and ever-increasing medical costs, with the cost of hospitalisation being the predominant cost factor absorbing the most resources. Leyenaar (1997: 14) maintains that the health care market has shifted from revenue to a cost focus. Increases in private hospital cost of between 13 and 15 percent at the beginning of 1999 were, according to Bisseker (1999: I), not justified, especially in the light of the healthy fmancial results achieved by many of the listed private hospital groups. Administrators of large medical aid schemes and of managed care companies are having great difficulty in explaining these increases to their members. Member contributions increased by as much as 20 percent, this despite promises that managed care would bring these costs under control (Bisseker, 1999: I ). Another problem facing South African hospitals is currencY related. Since the beginning of 1999, the Rand has lost a great deal of ground against foreign currencies, making it very expensive for hospitals to purchase any medical equipment from the overseas market. Hospitals purchase much of their technologically advanced equipment and medication from foreign countries and with the depreciating Rand, these items become even more expensive. The hospitals must bring this currencY component into their pricing policies. Another factor contributing to the recessionary climate existing in South Africa is one of medical inflation. Medical inflation rates have, over the past few years been much higher than the average inflation rate. An increased emphasis on cost management and cost contaimnent in hospitals, together with managed health care, has created an urgent need amongst health care providers for relevant, accurate, timeous and meaningful cost information (Williams, 1997: 16). In this regard Canby (1995:51) is of the opinion that by tracing healthcare activities and costs back to the events that generate and cause the cost, and by focusing on the process that drives cost, a more accurate measurement of financial information and performance is obtained. This, in tum, will enable private hospital groups to make necessary price changes only if these changes are justified by the information obtained from the new system. The health care industry may use the ABC technique, developed by manufacturing organisations to enhance their profitability, eliminate unnecessary costs and plan for change (Schuneman, 1997: I). This technique, which identifies the relationship between the activity and the source needed to complete it, can thus also be applied successfully to the medical practice. Hospital management systems may use all the components associated with ABMA to effectively control, plan, administer and monitor the activities and resources in the hospital

The linguistic and cognitive mechanisms underlying language tests in healthy adults : a principal component analysis

Pour un processus d’évaluation linguistique plus précis et rapide, il est important d’identifier les mécanismes cognitifs qui soutiennent des tâches langagières couramment utilisées. Une façon de mieux comprendre ses mécanismes est d’explorer la variance partagée entre les tâches linguistiques en utilisant l’analyse factorielle exploratoire. Peu d’études ont employé cette méthode pour étudier ces mécanismes dans le fonctionnement normal du langage. Par conséquent, notre objectif principal est d’explorer comment un ensemble de tâches linguistiques se regroupent afin d’étudier les mécanismes cognitifs sous-jacents de ses tâches. Nous avons évalué 201 participants en bonne santé âgés entre 18 et 75 ans (moyenne=45,29, écart-type= 15,06) et avec une scolarité entre 5 et 23 ans (moyenne=11,10, écart-type=4,68), parmi ceux-ci, 62,87% étaient des femmes. Nous avons employé deux batteries linguistiques : le Protocole d’examen linguistique de l’aphasie Montréal-Toulouse et Protocole Montréal d’Évaluation de la Communication – version abrégé. Utilisant l’analyse en composantes principales avec une rotation Direct-oblimin, nous avons découvert quatre composantes du langage : la sémantique picturale (tâches de compréhension orale, dénomination orale et dénomination écrite), l'exécutif linguistique (tâches d’évocation lexicale - critères sémantique, orthographique et libre), le transcodage et la sémantique (tâches de lecture, dictée et de jugement sémantique) et la pragmatique (tâches d'interprétation d'actes de parole indirecte et d'interprétation de métaphores). Ces quatre composantes expliquent 59,64 % de la variance totale. Deuxièmement, nous avons vérifié l'association entre ces composantes et deux mesures des fonctions exécutives dans un sous-ensemble de 33 participants. La performance de la flexibilité cognitive a été évaluée en soustrayant le - temps A au temps B du Trail Making Test et celle de la mémoire de travail en prenant le total des réponses correctes au test du n-back. La composante exécutive linguistique était associée à une meilleure flexibilité cognitive (r=-0,355) et la composante transcodage et sémantique à une meilleure performance de mémoire de travail (r=.0,397). Nos résultats confirment l’hétérogénéité des processus sous-jacent aux tâches langagières et leur relation intrinsèque avec d'autres composantes cognitives, tels que les fonctions exécutives.To a more accurate and time-efficient language assessment process, it is important to identify the cognitive mechanisms that sustain commonly used language tasks. One way to do so is to explore the shared variance across language tasks using the technique of principal components analysis. Few studies applied this technique to investigate these mechanisms in normal language functioning. Therefore, our main goal is to explore how a set of language tasks are going to group to investigate the underlying cognitive mechanisms of commonly used tasks. We assessed 201 healthy participants aged between 18 and 75 years old (mean = 45.29, SD = 15.06) and with a formal education between 5 and 23 years (mean = 11.10, SD =4.68), of these 62.87% were female. We used two language batteries: the Montreal-Toulouse language assessment battery and the Montreal Communication Evaluation Battery – brief version. Using a Principal Component Analysis with a Direct-oblimin rotation, we discovered four language components: pictorial semantics (auditory comprehension, naming and writing naming tasks), language-executive (unconstrained, semantic, and phonological verbal fluency tasks), transcoding and semantics (reading, dictation, and semantic judgment tasks), and pragmatics (indirect speech acts interpretation and metaphors interpretation tasks). These four components explained 59.64% of the total variance. Secondarily, we sought to verify the association between these components with two executive measures in a subset of 33 participants. Cognitive flexibility was assessed by the time B-time A score of the Trail Making Test and working memory by the total of correct answers on the n-back test. The language-executive component was associated with a better cognitive flexibility score (r=-.355) and the transcoding and semantics one with a better working memory performance (r=.397). Our findings confirm the heterogeneity process underlying language tasks and their intrinsic relationship to other cognitive components, such as executive functions

Corneal Tissue Engineering: New Applications for Corneal Stromal Stem Cells

The WHO estimates 10 million people in the World are blinded by corneal disease. For many conditions, transplantation of a donor cornea may restore vision. However, there is a global shortage of suitable tissue and a high risk of rejection. The potential of stem cell therapies and tissue engineering approaches to address this significant unmet clinical need was investigated. Limbal epithelial stem cells (LESC) maintain the epithelium, the outermost layer of the cornea, and can be successfully transplanted to restore vision. However, when scarring occurs, transplantation of corneal stroma is required. Human corneal stromal stem cells (CSSC) are involved in stroma maintenance and have previously been shown to restore transparency in cloudy mouse corneas without rejection. This study investigated the development of a surgeon friendly tissue equivalent (TE) for the therapeutic delivery of CSSC and LESCs. For the first time, human corneal rims were rendered transparent for imaging under the iDISCO protocol. CSSC were successfully isolated and characterised with mesenchymal stem cell (MSC) properties confirmed. RAFT-TE, a potential artificial ocular surface, has been extensively investigated by our group using research grade collagen (First Link; not suitable for clinical use). In this thesis, a comparative study was performed to show that Koken collagen (Good Manufacturing Practice compliant) is a suitable replacement for research grade collagen as it did not compromise RAFT-TE properties. Next, co-culture conditions for LESC and CSSC in RAFT-TE were optimised. First, the idea of co-delivering CSSC together with LESCS to the surface of RAFT-TE as a mixed population was trialled. This resulted in unexpected epithelial cell peeling. To overcome this challenge, CSSC were successfully cultured for the first time inside Koken RAFT-TE. CSSC formed cell clusters, remodelled the matrix, and migrated to the surface of the TE. It was also shown that they can be induced to differentiate towards the keratocyte lineage inside the TE. This work highlights the importance of considering clinical manufacturing standards early in the process of development. Overall, it provides valuable insights to develop personalised autologous therapies and off the shelf allogeneic strategies for restoring vision in patients with corneal blindness

Doctor Versus Midwifery-led Care: A Commentary on a Task-shift, not Only Complex but Difficult to Accept

info:eu-repo/semantics/publishedVersio

Pathways Affect Vegetation Structure And Composition In The Atlantic Forest In Southeastern Brazil

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Although impacts generated by gaps can affect vegetation, few studies have addressed these impacts in the Atlantic Forest. Our aim was to investigate the effects of pathways of varying widths on vegetation structure and composition, considering dispersal syndromes, diversity, life forms, successional categories and threatened and exotic species occurrence in the Atlantic Forest. We studied three pathways with widths of 2, 10 and 20 m, intersecting a protected area in southeastern Brazil. To assess edge effects, plots were established adjacent to paths (edge) and 35 m from the edge (neighborhood), and in a control area without pathways. Wider pathways (10 and 20 m) exhibited reduced tree height and diameter, high liana density, exotic species, and a high proportion of pioneer and anemochorous species. In conclusion, our results indicate that the vegetation structure of narrow pathways (2 m) is similar to the control area, and that wide linear gaps cause negative effects on vegetation and extend to a distance of at least 35 m into the forest interior. Considering that linear gaps generate permanent effects to vegetation and may affect other organisms, we suggest that these effects must be considered for successful management of protected areas, including planning and impact mitigation.311108119Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP) [2013/11175-6]Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

Species-specific Effects Of Ant Inhabitants On Bromeliad Nutrition

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Predator activities may lead to the accumulation of nutrients in specific areas of terrestrial habitats where they dispose of prey carcasses. In their feeding sites, predators may increase nutrient availability in the soil and favor plant nutrition and growth. However, the translocation of nutrients from one habitat to another may depend on predator identity and diet, as well as on the amount of prey intake. Here we used isotopic (N-15) and physiological methods in greenhouse experiments to evaluate the effects of the identity of predatory ants (i.e., the consumption of prey and nest sites) on the nutrition and growth of the bromeliad Quesnelia arvensis. We showed that predatory ants with protein-based nutrition (i.e., Odontomachus hastatus, Gnamptogenys moelleri) improved the performance of their host bromeliads (i.e., increased foliar N, production of soluble proteins and growth). On the other hand, the contribution of Camponotus crassus for the nutritional status of bromeliads did not differ from bromeliads without ants, possibly because this ant does not have arthropod prey as a preferred food source. Our results show, for the first time, that predatory ants can translocate nutrients from one habitat to another within forests, accumulating nutrients in their feeding sites that become available to bromeliads. Additionally, we highlight that ant contribution to plant nutrition may depend on predator identity and its dietary requirements. Nest debris may be especially important for epiphytic and terrestrial bromeliads in nutrient-poor environments.113Fundacao de Amparo a Pesquisa do Estado de Sao Paulo scholarship [2011/10137-8]Fundacao de Amparo a Pesquisa do Estado de Sao PauloConselho Nacional de Desenvolvimento Cientifico e Tecnologico [2010/17204-0]Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq

Yo Cayetana: The Woman in Her Own Words

Much has been said and written about Cayetana de Alba, “Grandee of Spain” and a woman who took an important part in some of the historical moments of her lifetime. The images the media conveyed of her – that of a frivolous woman - is, yet, contradicted by her autobiography. The aim of this paper is, therefore, to investigate Cayetana’s discursive gendered positions from an interdisciplinary standpoint: based on a lexicometric approach of the data collected, the semio-linguistic interpretation highlights the possibilities and modalities of her Self represented in images and emotions involved in the real world and in a historical conjuncture in which the present and the past are articulated. Her words enable us to understand the strategies she uses to construct her identity and her own meanings in the representation of her lived experience in the interstices of the Self and of social relations (Probyn, 1993)

Components interaction in timber framed masonry structures subjected to lateral forces

Structures with timber framed masonry represent a special typology that is frequently found in Europe and other countries of the world. They are traditional buildings, non-engineered, which showed an unexpected redundancy during earthquakes where reinforced concrete buildings (improperly constructed) collapsed. In the paper, aspects regarding the interaction between timber elements and masonry are mainly addressed, that were observed both in experimental studies, but also in the in situ seismic behavior of this type of structure during important earthquakes

Preferences for the administration of Testosterone gel: Evidence from a Discrete Choice Experiment

Objectives: Differences in testosterone replacement therapy (TRT) gel products may affect patient satisfaction, quality-of-life, and treatment response and adherence. This study investigated preferences for TRT gel in terms of formulation and administration. Methods: 525 male adults aged 45 years and over completed a discrete choice experiment. Respondents made repeated choices between two hypothetical testosterone gel treatments described according to four attributes: form, ease of use, impact of use on showering/swimming, and location/dosage of the application. Choice data were analyzed using a latent class model. Results: Three preference classes were identified. Respondents across all classes displayed a preference for the gel being dispensed in smaller units with accurate dosing, waiting shorter times after the gel application before swimming/showering, and using 2.5 gm of gel to be applied to the inner thigh/abdomen as opposed 5 gm to shoulder/abdomen. The importance of these characteristics differed across classes, with preference class membership predicted by age and education level. For instance, younger men (aged 45–64 years) were more likely to belong to a class that prioritized reduced waiting time before being able to undertake activities. Formulation was not an important driver of choice. Conclusions: Preferences demonstrate a predilection for TRT gel dispensed in small units allowing precise dosing, shorter waiting time after application, and application to the inner thigh/abdomen. However, the strength of importance of these characteristics differs between men. This study highlights the attributes of TRT gel considered important to patient subgroups, and which may ultimately affect treatment response, medication adherence, and patient quality-of-life