Collaborating to achieve higher societal and environmental value creation : the case of Albani

This thesis deals with the complexities faced by the construction company Albani (Lebanon), in its effort to have a positive environmental impact benefiting society as a whole, alongside its normal entrepreneurial activities. This company aims at offering reasonably priced houses to the population of Lebanon, but in order to do so needs to find a good collaborator to begin improving its environmental impact. My first question in the teaching case study focuses on ways to create social value from within the company’s products, processes and activities, noting that good environmental impact alongside good social impact is the end goal of our solution because degradation of the environment is negatively impacting the society’s well-being. Our second question then focuses on ways to engage with the environment to keep social value an ongoing process, and finally, our last question goes through the available managerial tools that the organization can implement to create a collective impact. With my analysis I propose different key tools that construction companies can apply depending on their characteristics. This study can function as a guideline to construction companies by offering them simple practices to overcome common social issues that might be impacting their economic growth and the community’s social growth. They can find advice to spot important social issues, shape their potential collaboration and implement substantial social value creation activities through collective impact.Esta tese foca-se nas complexidades enfrentadas pela empresa de construção Albani (Líbano) no seus esforços para assegurar um impacto ambiental positivo, juntamente com as suas atividades empreendedoras habituais. A companhia tenta oferecer casas a preços razoáveis para a população Libanesa mas, para tal, necessita de um parceiro qualificado para melhorar o seu impacto social. A primeira questão apresentada no CASO DE ESTUDO foca-se nas várias possibilidades para a criação de valor social, partindo dos produtos, processos e atividades da empresa. Simultaneamente, denota-se que impacto ambiental positivo, aliado a um impacto social benéfico é o objetivo final da solução apresentada, uma vez que a degradação ambiental tem um impacto notoriamente negativo no bem-estar da sociedade. A segunda questão concentra-se em determinar abordagens a nível ambiental que permitam assegurar a durabilidade do processo de criação de valor social, enquanto que a terceira e última questão se centra na análise de ferramentas de gestão ao dispor da companhia para criar um impacto coletivo. Através da minha análise, proponho várias ferramentas chave que podem ser aplicadas por outras empresas do setor de construção, dependendo das suas características. Este estudo poderá funcionar como um conjunto de linhas condutoras para essas empresas, oferecendo-lhes abordagens simples para ultrapassar questões sociais comuns, que possam impactar o seu crescimento económico e o progresso social como um todo. Poderão ainda encontrar sugestões para mais facilmente identificar impactos sociais comuns, estruturar a sua potencial parceria e implementar atividades que assegurem o desenvolvimento substancial de valor social através do seu impacto coletivo

Management of coronary disease in patients with advanced kidney disease

BACKGROUND Clinical trials that have assessed the effect of revascularization in patients with stable coronary disease have routinely excluded those with advanced chronic kidney disease. METHODS We randomly assigned 777 patients with advanced kidney disease and moderate or severe ischemia on stress testing to be treated with an initial invasive strategy consisting of coronary angiography and revascularization (if appropriate) added to medical therapy or an initial conservative strategy consisting of medical therapy alone and angiography reserved for those in whom medical therapy had failed. The primary outcome was a composite of death or nonfatal myocardial infarction. A key secondary outcome was a composite of death, nonfatal myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. RESULTS At a median follow-up of 2.2 years, a primary outcome event had occurred in 123 patients in the invasive-strategy group and in 129 patients in the conservative-strategy group (estimated 3-year event rate, 36.4% vs. 36.7%; adjusted hazard ratio, 1.01; 95% confidence interval [CI], 0.79 to 1.29; P=0.95). Results for the key secondary outcome were similar (38.5% vs. 39.7%; hazard ratio, 1.01; 95% CI, 0.79 to 1.29). The invasive strategy was associated with a higher incidence of stroke than the conservative strategy (hazard ratio, 3.76; 95% CI, 1.52 to 9.32; P=0.004) and with a higher incidence of death or initiation of dialysis (hazard ratio, 1.48; 95% CI, 1.04 to 2.11; P=0.03). CONCLUSIONS Among patients with stable coronary disease, advanced chronic kidney disease, and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of death or nonfatal myocardial infarction

Health status after invasive or conservative care in coronary and advanced kidney disease

BACKGROUND In the ISCHEMIA-CKD trial, the primary analysis showed no significant difference in the risk of death or myocardial infarction with initial angiography and revascularization plus guideline-based medical therapy (invasive strategy) as compared with guideline-based medical therapy alone (conservative strategy) in participants with stable ischemic heart disease, moderate or severe ischemia, and advanced chronic kidney disease (an estimated glomerular filtration rate of <30 ml per minute per 1.73 m2 or receipt of dialysis). A secondary objective of the trial was to assess angina-related health status. METHODS We assessed health status with the Seattle Angina Questionnaire (SAQ) before randomization and at 1.5, 3, and 6 months and every 6 months thereafter. The primary outcome of this analysis was the SAQ Summary score (ranging from 0 to 100, with higher scores indicating less frequent angina and better function and quality of life). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate the treatment effect with the invasive strategy. RESULTS Health status was assessed in 705 of 777 participants. Nearly half the participants (49%) had had no angina during the month before randomization. At 3 months, the estimated mean difference between the invasive-strategy group and the conservative-strategy group in the SAQ Summary score was 2.1 points (95% credible interval, 120.4 to 4.6), a result that favored the invasive strategy. The mean difference in score at 3 months was largest among participants with daily or weekly angina at baseline (10.1 points; 95% credible interval, 0.0 to 19.9), smaller among those with monthly angina at baseline (2.2 points; 95% credible interval, 122.0 to 6.2), and nearly absent among those without angina at baseline (0.6 points; 95% credible interval, 121.9 to 3.3). By 6 months, the between-group difference in the overall trial population was attenuated (0.5 points; 95% credible interval, 122.2 to 3.4). CONCLUSIONS Participants with stable ischemic heart disease, moderate or severe ischemia, and advanced chronic kidney disease did not have substantial or sustained benefits with regard to angina-related health status with an initially invasive strategy as compared with a conservative strategy