Aneurysmal subarachnoid hemorrhage (SAH) is a devastating disease with mean age of 59 years. SAH accounts for 5% of all stroke and more than one quarter of potential life years lost through stroke. With the advanced neurosurgical methods of today two thirds of the patients survive. We know, however, that various cognitive, psychiatric and physical impairments are common that affect quality of life, social life, and the ability to work in the aftermath of SAH. The overall aim constituting this PhD dissertation is to better understand some of the challenges often faced by those surviving SAH. Two SAH patient cohorts have been studied. The first followed 96 consecutively included patients during the first year after ictus. Spasticity and cognitive impairment was assessed after 6 months and the Swedish stroke register follow-up form was used to investigate family support and the use of medical and social services. Return to work was assessed at 12 months. The second cohort assessed attention deficits using the test of variables of attention (T.O.V.A.) at 7 months after ictus in 19 patients with moderate to good recovery. Spasticity was just as common in our SAH patients as after other stroke, though it was rarely treated pharmacologically. By assessing cognitive impairment at 6 months after ictus using the Montreal cognitive assessment, 68% of the patients could be correctly predicted as having returned/not returned to work at 12 months. Seventeen percent of the patients had not had a follow-up appointment 6 months after ictus. These patients were older, more often living alone, had a lower quality of life, more depressive symptoms and more cognitive impairment compared to those having had a follow-up appointment. Twenty percent had had a follow-up in primary care. Seventy-eight percent of those with moderate to severe disability were living in their own accommodations. Fifty-eight percent of the patients had attention deficits. Challenges after SAH were common and often dealt with in the home environment of the patients. The results of this thesis highlight the importance of assisting the patients and their relatives in their struggle back to life after SAH.

Diese kumulative Dissertation besteht aus drei eigenständigen Arbeiten aus dem Bereich der empirischen Rechnungslegungsforschung. In jeder Arbeit werden ökonometrische Methoden angewandt, um Hypothesen bezüglich bestimmter Wirkungen und Folgen von Rechnungslegung zu bestätigen oder zu verwerfen. Die erste Arbeit untersucht die freiwillige Anwendung von Rechnungslegungsstandards. Ausgehend von den besonderen institutionellen Begebenheiten Deutschlands werden Determinanten der freiwilligen Anwendung der Deutschen Rechnungslegungs Standards (DRS) identifiziert. Die Ergebnisse einer multinomialen logistischen Regression zeigen, dass die Anwendung getrieben wird durch die Unternehmensgröße, den Wirtschaftsprüfer sowie Fremdkapitalgeber-Agency Probleme. Die Anwendung wird nicht getrieben durch die öffentliche Wahrnehmung eines Unternehmens. Die zweite Arbeit untersucht die Auswirkungen der freiwilligen IFRS-Erstanwendung auf die Rückstellungsbilanzierung von deutschen börsennotierten Unternehmen. Die Änderungen in der Rechnungslegungsqualität durch den Wechsel der Rechnungslegung gemäß HGB zu den IFRS werden durch die Anwendung eines „same firm-year approach“ ermöglicht. Die Ergebnisse zeigen eine signifikant höhere Informationsdarstellung nach IFRS. Dies gilt besonders für Firmen, die typischerweise weniger Anreize für eine gute Rechnungslegungsqualität besitzen. Die dritte Arbeit untersucht den Effekt von Mehrfachmandaten auf die Firmenperformance von deutschen börsennotierten Unternehmen. Das Vorkommen von Mehrfachmandaten wird aus verschiedenen Blickwinkeln betrachtet, da die Wirkung auf die Firmenperformance nicht eindeutig vorhergesagt werden kann. Die Ergebnisse deuten auf einen negativen Zusammenhang zwischen Mehrfachmandaten und Firmenperformance. Positive Eigenschaften von Boardmitgliedern wirken diesem Ergebnis nur begrenzt entgegen. / This cumulative PhD-thesis consists of three papers within the field of empirical accounting research. In each paper established empirical methodology is applied in order to validate or reject predictions on certain accounting outcomes. The first paper deals with voluntary accounting compliance. Taking advantage of the institutional setting in Germany, the paper identifies determinants of voluntary compliance with German Accounting Standards (GAS). The results of an ordered logistic regression show that compliance is driven by size, the auditor’s affiliation to the institution that develops the GAS and debt agency problems. The results do not reveal a relationship between compliance and public exposure. The second paper investigates effects of voluntary IFRS adoption on accounting quality based on provision disclosure using a sample of publicly listed German firms. Changes in accounting quality measures resulting from the transition from German GAAP to IFRS are assessed using a same firm-year approach. Results show that disclosure level is significantly higher under IFRS. The results are consistent with the notion that IFRS adoption has a positive impact on the disclosure aspect of accounting quality regarding accounting for provisions. Positive changes are stronger for firms that typically have fewer incentives to provide accounting information for a broad investor base. The third paper investigates the effect of multiple board appointments on firm performance for a sample of publicly listed German firms. The incidence of multiple board appointments is investigated from several angles since multiple board appointments can be characterized along numerous dimensions and their effect on firm performance is not unequivocally predictable. The results indicate that multiple board appointments negatively affect firm performance. Director characteristics that are expected to have a positive influence on firm performance do not counteract this finding.

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This thesis develops quantitative methods which incorporate transportation modeling for tactical and operational home health logistics planning problems. We define home health nurse routing and scheduling (HHNRS) problems, which are dynamic periodic routing and scheduling problems with fixed appointment times, where a set of patients must be visited by a home health nurse according to a prescribed weekly frequency for a prescribed number of consecutive weeks during a planning horizon, and each patient visit must be assigned an appointment time belonging to an allowable menu of equally-spaced times. Patient requests are revealed incrementally, and appointment time selections must be made without knowledge of future requests. First, a static problem variant is studied to understand the impact of fixed appointment times on routing and scheduling decisions, independent of other complicating factors in the HHNRS problem. The costs of offering fixed appointment times are quantified, and purely distance-based heuristics are shown to have potential limitations for appointment time problems unless proposed arc cost transformations are used. Building on this result, a new rolling horizon capacity-based heuristic is developed for HHNRS problems. The heuristic considers interactions between travel times, service times, and the fixed appointment time menu when inserting appointments for currently revealed patient requests into partial nurse schedules. The heuristic is shown to outperform a distance-based heuristic on metrics which emphasize meeting as much patient demand as possible. The home health nurse districting (HHND) problem is a tactical planning problem which influences HHNRS problem solution quality. A set of geographic zones must be partitioned into districts to be served by home health nurses, such that workload is balanced across districts and nurse travel is minimized. A set partitioning model for HHND is formulated and a column generation heuristic is developed which integrates ideas from optimization and local search. Methods for estimating district travel and workload are developed and implemented within the heuristic, which outperforms local search on test instances.

Delivering health care services in an efficient and effective way has become a great challenge for many countries due to the aging population worldwide, rising health expenses, and increasingly complex healthcare delivery systems. It is widely recognized that models and analytical tools can aid decision-making at various levels of the healthcare delivery process, especially when decisions have to be made under uncertainty. This thesis employs stochastic models to improve decision-making under uncertainty in two specific healthcare settings: inpatient flow management and infectious disease modeling. In Part I of this thesis, we study patient flow from the emergency department (ED) to hospital inpatient wards. This line of research aims to develop insights into effective inpatient flow management to reduce the waiting time for admission to inpatient wards from the ED. Delayed admission to inpatient wards, also known as ED boarding, has been identified as a key contributor to ED overcrowding and is a big challenge for many hospitals. Part I consists of three main chapters. In Chapter 2 we present an extensive empirical study of the inpatient department at our collaborating hospital. Motivated by this empirical study, in Chapter 3 we develop a high fidelity stochastic processing network model to capture inpatient flow with a focus on the transfer process from the ED to the wards. In Chapter 4 we devise a new analytical framework, two-time-scale analysis, to predict time-dependent performance measures for some simplified versions of our proposed model. We explore both exact Markov chain analysis and diffusion approximations. Part I of the thesis makes contributions in three dimensions. First, we identify several novel features that need to be built into our proposed stochastic network model. With these features, our model is able to capture inpatient flow dynamics at hourly resolution and reproduce the empirical time-dependent performance measures, whereas traditional time-varying queueing models fail to do so. These features include unconventional non-i.i.d. (independently and identically distributed) service times, an overflow mechanism, and allocation delays. Second, our two-time-scale framework overcomes a number of challenges faced by existing analytical methods in analyzing models with these novel features. These challenges include time-varying arrivals and extremely long service times. Third, analyzing the developed stochastic network model generates a set of useful managerial insights, which allow hospital managers to (i) identify strategies to reduce the waiting time and (ii) evaluate the trade-off between the benefit of reducing ED congestion and the cost from implementing certain policies. In particular, we identify early discharge policies that can eliminate the excessively long waiting times for patients requesting beds in the morning. In Part II of the thesis, we model the spread of influenza pandemics with a focus on identifying factors that may lead to multiple waves of outbreak. This line of research aims to provide insights and guidelines to public health officials in pandemic preparedness and response. In Chapter 6 we evaluate the impact of seasonality and viral mutation on the course of an influenza pandemic. In Chapter 7 we evaluate the impact of changes in social mixing patterns, particularly mass gatherings and holiday traveling, on the disease spread. In Chapters 6 and 7 we develop agent-based simulation models to capture disease spread across both time and space, where each agent represents an individual with certain socio-demographic characteristics and mixing patterns. The important contribution of our models is that the viral transmission characteristics and social contact patterns, which determine the scale and velocity of the disease spread, are no longer static. Simulating the developed models, we study the effect of the starting season of a pandemic, timing and degree of viral mutation, and duration and scale of mass gatherings and holiday traveling on the disease spread. We identify possible scenarios under which multiple outbreaks can occur during an influenza pandemic. Our study can help public health officials and other decision-makers predict the entire course of an influenza pandemic based on emerging viral characteristics at the initial stage, determine what data to collect, foresee potential multiple waves of attack, and better prepare response plans and intervention strategies, such as postponing or cancelling public gathering events.

There is currently no satisfactory account of how judges of the Supreme Court of India and High Courts in the states are appointed, transferred, impeached or employed postretirement. For a higher judiciary commanding immense public attention, enjoying wide constitutional powers of judicial review, this is a conspicuous gulf in academic literature. This thesis intends to bridge this gulf by providing such an account. Part I extracts the Constituent Assembly Debates pertaining to these four facets of judicial functioning, describes key developments over time and analyses the extant processes in operation today. On this basis it makes three arguments: first, appointments to the higher judiciary and transfer of judges between High Courts follow processes that are indefensible as a matter of constitutional law; second, impeachment operates in an excessively slow and inefficacious manner; third, the pervasiveness of post-retirement employment of judges in government-appointed positions demonstrates inadequate attention to institutional design. Most crucially, each of these four aspects gives rise to significant concerns pertaining to judicial independence, accountability or both. This is not a peculiarly Indian problem— in several countries, the values of judicial independence and accountability have been deemed to be in tension, often irreconcilably. Part II tackles this widely articulated tension by providing a conceptual framework to understand these concepts. Its main argument is that both judicial independence and accountability are necessary for 'an effective judiciary'. Whether indeed the processes governing the four selected facets of judicial functioning in India lead to an effective judiciary is assessed in Part III. Where they are found lacking, appropriate reform is suggested. Such reform is intended to ensure that the selected processes operate in a manner that is justifiable in terms of judicial independence and accountability in principle and is efficacious in practice.

Los centros de salud públicos y privados en el Perú a pesar de tener una tasa de pacientes alta presentan una digitalización mínima esto debido a la poca inversión en sistemas o aplicaciones que ayuden a la organización y actualización de la información de los pacientes que desean recibir atención médica. Como consecuencia se tiene un proceso de reserva de citas médicas deficiente que carece de calidad y tiempos largos para la atención de las personas. En este contexto, se tienen diversos casos de estudio sobre aplicaciones y sistemas estandarizados que han logrado optimizar y reducir tiempos en el proceso de reserva y atención médica ambulatoria. Por lo que el objetivo de este artículo es explicar nuestra investigación que desarrolla una aplicación móvil con geolocalización que permite la búsqueda de diferentes policlínicos y reserva de citas médicas ambulatorias; y una aplicación web para policlínicos que no cuentan con un sistema de reserva de citas online. La solución tecnológica en general fue validada tanto por siete policlínicos como por pacientes reales. Como resultado de esta validación se obtuvo que una vez implementada la solución tecnológica, se produciría una mejora y satisfacción del 40% en el proceso del sistema de reserva de consultas médicas ambulatorias en policlínicos y del 35% en pacientes. / Despite having a high rate of patients, public and private health centers in Peru present minimal digitization due to the low investment in systems or applications that help to organize and update the information of patients who wish to receive medical care. As a consequence, there is a poor medical appointment reservation process that lacks quality and long times for the care of people. In this context, there are several case studies on standardized applications and systems that have managed to optimize and reduce times in the reservation process and outpatient medical care. Therefore, the objective of this article is to explain our research that develops a mobile application with geolocation that allows the search for different polyclinics and reservation of outpatient medical appointments; and a web application for polyclinics that do not have an online appointment reservation system. The technological solution in general was validated both by seven polyclinics and by real patients. As a result of this validation, it was obtained that once the technological solution was implemented, there would be an improvement and satisfaction of 40% in the process of the reservation system for outpatient medical consultations in polyclinics and 35% in patients. / Trabajo de investigación

A raíz de la pandemia del Covid-19, si uno desea acudir a una cita médica, debe tomar las medidas necesarias para evitar ser contagiado, ya que en los centro médicos se presentan negligencias de las autoridades por no hacer efectivo el protocolo de bioseguridad, por lo que, los pacientes van a sus citas médicas de manera presencial con la gran angustia de ser infectados y llevar el virus a sus hogares. Es así como nace MediGo con el objetivo de brindar un servicio de asistencia médica mediante un aplicativo móvil que permitirá al paciente realizar sus consultas desde la comodidad de su hogar con una flexibilidad de horarios para reservar citas médicas, así como la facilidad de integrarse a una comunidad de personas con sus mismos intereses. Para validar el modelo de negocio propuesto, se realizaron diferentes experimentos que abarcó el diseño de prototipos de la app tanto para usuarios y personal médico, entrevistas a expertos, programadores, entre otros. Asimismo, se utilizó el método Concierge para validar los ingresos del proyecto a través de las redes sociales. Por otro lado, se elaboraron los planes de marketing, finanzas y recursos humanos, lo que nos permitió proyectar el negocio y determinar su rentabilidad a lo largo del tiempo. Finalmente, todo lo mencionado anteriormente nos indica que MediGo es un negocio viable, muy atractivo e innovador en el rubro de medicina, que da respuesta a una necesidad real y actual. / In the wake of the Covid-19 pandemic, if you want to go to a medical appointment, you must take the necessary measures to avoid getting, since in medical centers there can be negligence by the authorities for not enforcing the biosafety protocols, therefore, patients go to their medical appointments in person with great concern of getting infected and taking the virus home. This is how MediGo was born with the aim of providing a medical assistance service through a mobile application that allows the patient to make their consultations from the comfort of their home with flexible schedules to book medical appointments, as well as the ease of joining a community of people with the same interests. To validate the proposed business model, different experiments were carried out that included the design of application prototypes for both users and medical personnel, interviews with experts, programmers, among others. Likewise, the Concierge method was used to validate the income of the project through social networks. On the other hand, the marketing, finance and human resources plans were made, which allowed us to project the business and determine its profitability over time. Finally, everything mentioned above indicates that MediGo is a viable, very attractive and innovative business in the field of medicine, which responds to a real and current need. / Trabajo de investigación

High patient no-show rates increase health care costs, decrease healthcare access, and reduce the clinical efficiency and productivity of health care facilities. The purpose of this exploratory qualitative single case study was to explore and analyze the managerial intervention strategies healthcare administrators use to reduce patient no-show rates. The targeted research population was active American College of Healthcare Executives (ACHE), Hawaii-Pacific Chapter healthcare administrative members with operational and supervisory experience addressing administrative patient no-show interventions. The conceptual framework was the theory of planned behavior. Semistructured interviews were conducted with 4 healthcare administrators, and appointment cancellation policy documents were reviewed. Interpretations of the data were subjected to member checking to ensure the trustworthiness of the findings. Based on the methodological triangulation of the data collected, 5 common themes emerged after the data analysis: reform appointment cancellation policies, use text message appointment reminders, improve patient accessibility, fill patient no-show slots immediately, and create organizational and administrative efficiencies. Sharing the findings of this study may help healthcare administrators to improve patient health care accessibility, organizational performance and the social well-being of their communities.

No description available.