The purpose of this project is to determine National Insurance Company Limited (NAT) customer preferences for using claims systems via the Internet.

Background Close, continuous and efficient collaboration between different professions and sectors of care is necessary to provide patient-centered care for individuals with mental disorders. The lack of structured collaboration between in- and outpatient care constitutes a limitation of the German health care system. Since 2012, a new law in Germany (§64b Social code book (SGB) V) has enabled the establishment of cross-sectoral and patient-centered treatment models in psychiatry. Such model projects follow a capitation budget, i.e. a total per patient budget of inpatient and outpatient care in psychiatric clinics. Providers are able to choose the treatment form and adapt the treatment to the needs of the patients. The present study (EVA64) will investigate the effectiveness, costs and efficiency of almost all model projects established in Germany between 2013 and 2016. Methods/design A health insurance data-based controlled cohort study is used. Data from up to 89 statutory health insurance (SHI) funds, i.e. 79% of all SHI funds in Germany (May 2017), on inpatient and outpatient care, pharmaceutical and non-pharmaceutical treatments and sick leave for a period of 7 years will be analyzed. All patients insured by any of the participating SHI funds and treated in one of the model hospitals for any of 16 pre-defined mental disorders will be compared with patients in routine care. Sick leave (primary outcome), utilization of inpatient care (primary outcome), utilization of outpatient care, continuity of contacts in (psychiatric) care, physician and hospital hopping, re-admission rate, comorbidity, mortality, disease progression, and guideline adherence will be analyzed. Cost and effectivity of model and routine care will be estimated using cost-effectiveness analyses. Up to 10 control hospitals for each of the 18 model hospitals will be selected according to a pre-defined algorithm. Discussion The evaluation of complex interventions is an important main task of health services research and constitutes the basis of evidence-guided advancement in health care. The study will yield important new evidence to guide the future provision of routine care for mentally ill patients in Germany and possibly beyond. Trial registration This study was registered in the database “Health Services Research Germany” (trial number: VVfD_EVA64_15_003713).

Liability insurance concerns an insured’s insurance of its legal liability towards a third party for the latter’s loss. This specialised type of insurance is rather neglected in South African insurance law. There is a lack of understanding of the intricacies of liability insurance and its unique challenges. This flows primarily from its complex nature as third-party insurance, which involves legal obligations between multiple parties, and a lack of statutory regulation of the distinctive contractual aspects of liability insurance. Furthermore, limited authority exists on contentious legal aspects as a result of the relatively small number of judicial decisions in this field of law. It is also evident that liability insurance constantly evolves as new grounds of liability emerge and new insurance products develop in response to the changing demands of society. The rise of consumerism and the increase in third-party claims amplify the economic significance of the law of liability insurance in South Africa. A substantial knowledge gap remains in our jurisprudence, irrespective of the recent introduction of new statutory instruments aimed at regulating insurance practice in general. These reforms have not as yet been applied critically to liability insurance, and no specialised legislation in South Africa regulates aspects of this branch of insurance as is the case with microinsurance. The focus in this thesis is on two main issues: the insurer’s duty effectively to indemnify the insured, and the insurer’s defence and settlement of third-party claims brought against the insured. As a subsidiary theme, this thesis analyses legal uncertainties that may persist during pre-contractual negotiations, the liability insurance contract lifecycle, and even after the expiry of the contract. Legal challenges can be addressed by novel and creative application of the national law. Potential solutions can be gleaned from the other progressive jurisdictions reviewed – English and Belgian law. It is evident that this research may prompt Parliament to develop specific rules and regulations for liability insurance contract law. This thesis includes a check list of some of the most important disclosure duties for procuring liability insurance cover, its operation, and claims processes. / Mercantile Law / LL.D.

he aim of this thesis is to carry out an appraisal of a financial condition of a company. In the first part, theoretical start-points of Financial Analysis are scrutinised, with an introduction of the company followed. By taking the advantage of the Financial Analysis method, the financial condition of the company is appraised and the outcomes are compared with competition. In the second part, proceedings for risk elimination in the company management are suggested.

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No description available.

The theme of this thesis is attitude of the Communist Party and Czechoslovak totalitarian regime to Zionism in 1947-1957. The main aim of the archive research was to map gradual change of the communist regime from its position of the supporter of Zionism to that one of convinced anti-Zionism (nearly to anti-Semitism). Support of Zionism was primarily presented by help to the nascent state of Israel in 1947-1949. The evidence is given by the role of Czechoslovakia at meetings of the United Nations General Assembly in 1947 and its role as a member of United Nations Special Committee on Palestine. Furthermore, supplies of military equipment to Israel, diplomatic support, demographic support and training of Jewish brigade in Czechoslovak territory in 1948. Gradual change to anti-Zionist position at the end of 1940s and beginning of 1950s is illustrated with complicated negotiations on economic cooperation and with interfering of the regime in running of Jewish religious communities and Zionist organisations. During the first half of 1950s the support turned into downright opposition and lead in a diplomatic quarrel caused by the Slánský trial which had definitely anti-Semitic and anti-Zionist dimension. Utterly anti-Zionist position of the regime is also supported with further politically motivated trials -...

This Inuvialuit ‘story’ revolves around the Inuvialuit uprising and resurgence against government and industrial encroachment, and the self determination efforts to regain sovereignty of traditional territories. This ‘story’ also discusses how meaningful consultation made the Inuvialuit Final Agreement a reality, through which Inuvialuit land rights and freedoms were formally acknowledged and entrenched in the Canadian Constitution. Through meaningful consultation, Inuvialuit have become ‘meaningful participants’ in sustainable and future-making decisions of Inuvialuit nunangat (Inuvialuit lands) and waters, with respect to the Inuvialuit People and natural beings that Inuvialuit depend upon and maintain relationship with. As ‘meaningful participants’, Inuvialuit have the sovereign rights to “make meaning” and carve out a future as a sovereign nation within the country of Canada. This Inuvialuit ‘story’ is told with an informal framework through which it decolonizes academia, while also highlighting Indigenous voice through an Indigenous lens and worldview. The government and industry are called upon to meaningfully consult with Indigenous Peoples who have not only inhabited Turtle Island for millennia, but who have inherent Indigenous rights and freedoms, as Indigenous embodiment and well-being, and temporality and future-making are entangled with homelands. / Graduate

La fibrillation auriculaire (FA), l’arythmie cardiaque la plus courante est un facteur de risque majeur pour le développement de l’accident vasculaire cérébral ischémique (AVC). Les anticoagulants oraux directs (AOD) ont largement remplacé la warfarine en usage clinique pour la prévention des AVC dans la FA. Cette recherche a examiné deux défis méthodologiques importants qui peuvent survenir dans les études observationnelles sur l’efficacité et l’innocuité comparatives des AOD et de la warfarine. Premièrement : un biais d’information résultant d’une classification erronée de l’exposition au traitement à la warfarine suite aux ajustements de doses fréquentes qui ne sont pas adéquatement consignés dans les données de dispensations pharmacologiques. Deuxièmement : un biais de sélection, en raison de la censure informative, généré par des mécanismes de censure différentiels, chez les patients exposés aux AOD, ou à la warfarine. À l’aide des données administratives du Québec, j’ai mené trois études de cohortes rétrospectives qui ont portées sur toutes les personnes ayant initié un anticoagulant oral de 2010 à 2016. Ces études étaient restreintes aux résidents du Québec couverts par le régime public d'assurance médicaments (environ 40% de la population au Québec), c’est-à-dire : des personnes âgées de 65 ans et plus; des bénéficiaires de l’aide sociale; des personnes qui n’ont pas accès à une assurance-maladie privée; et les personnes à leur charge. Dans la première étude, nous avons émis l'hypothèse que les données sur les réclamations en pharmacie ne reflètent pas correctement la durée de la dispensation de la warfarine. Les écarts entre les renouvellements consécutifs étaient plus grands pour la warfarine que les AOD. Dans cette étude, on a trouvé que l'écart moyen pour les usagers de la warfarine était de 9.3 jours (avec un intervalle de confiance de 95% [IC]: 8.97-9.59), l'apixaban de 3.08 jours (IC de 95%: 2.96--3.20), et de 3.15 jours pour le rivaroxaban (IC de 95%: 3.03-3.27). Les écarts entre les renouvellements consécutifs présentaient une plus grande variabilité chez les personnes qui prenaient de la warfarine comparativement à celles qui prenaient des AOD. Cette variation peut refléter les changements de posologie de la warfarine lorsque la dose quotidienne est ajustée par le professionnel de la santé en fonction des résultats du rapport normalisé international (INR). L’ajustement de la dose peut prolonger (ou raccourcir) la période couverte par le nombre de comprimés délivrés. Dans la deuxième étude, nous avons émis l'hypothèse que la définition de la durée d'exposition basée sur la variable des « jours fournis », disponible dans la base de données, et le délai de grâce fixe, entraîneront une erreur de classification différentielle de l’exposition à la warfarine par rapport aux AOD. Dans cette étude, on a utilisé deux approches pour définir la durée des dispensations : la variable des « jours fournis » disponible dans la base de données ainsi qu’une approche axée sur les données pour la définition de la durée de dispensation qui tient compte des antécédents de distribution précédents. La deuxième étude a révélé qu'en utilisant la variable des « jours fournis », la durée moyenne (et l'écart type) des durées des dispensations pour le dabigatran, le rivaroxaban, et la warfarine étaient de 19 (15), 19 (14), et de 13 (12) jours, respectivement. En utilisant l’approche fondée sur des données, les durées étaient de 20 (16), 19 (15), et de 15 (16) jours, respectivement. Ainsi, l'approche fondée sur les données s’est rapprochée de la variable des « jours fournis » pour les thérapies à dose standard telles que le dabigatran et le rivaroxaban. Une approche axée sur les données pour la définition de la durée de dispensation, qui tient compte des antécédents de distribution précédents, permet de mieux saisir la variabilité de la durée de dispensation de la warfarine par rapport à la méthode basée sur la variable des « jours fournis ». Toutefois, cela n’a pas eu d’impact sur les estimations du rapport de risque sur la sécurité comparative des AOD par rapport à la warfarine. Dans la troisième étude, nous avons émis l'hypothèse que lors de l'évaluation de l’effet d’un traitement continu avec des anticoagulants oraux (l'analyse per-protocole), la censure élimine les patients les plus malades du groupe des AOD et des patients en meilleure santé du groupe de warfarine. Cela peut baisser l'estimation de l'efficacité et de l'innocuité comparative en faveur des AOD. L’étude a démontré que les mécanismes de censure chez les initiateurs d’AOD et de warfarine étaient différents. Ainsi, certaines covariables pronostiquement significatives, telles que l’insuffisance rénale chronique et l’insuffisance cardiaque congestive, étaient associées avec une augmentation de la probabilité de censure chez les initiateurs d’AOD, et une diminution de la probabilité de censure chez les initiateurs de warfarine. Pour corriger le biais de sélection introduit par la censure, nous avons appliqué la méthode de pondération par la probabilité inverse de censure. Deux stratégies de spécification du modèle pour l’estimation des poids de censure ont été explorées : le modèle non stratifié, et le modèle stratifié en fonction de l’exposition. L’étude a démontré que lorsque les poids de censure sont générés sans tenir compte des dynamiques de censure spécifiques, les estimés ponctuels sont biaisés de 15% en faveur des AOD par rapport à l'ajustement des estimés ponctuels avec des poids de censure stratifiée selon l’exposition (rapport de risque: 1.41; IC de 95%: 1.34, 1.48 et rapport de risque: 1.26; IC de 95%: 1.20, 1.33, respectivement). Dans l’ensemble, les résultats de cette thèse ont d’importantes implications méthodologiques pour les futures études pharmacoépidémiologiques. À la lumière de ceux-ci, les résultats des études observationnelles précédentes peuvent être revus et une certaine hétérogénéité peut être expliquée. Les résultats pourraient également être extrapolés à d’autres questions cliniques. / Atrial fibrillation (AF), the most common cardiac arrhythmia is a major risk factor for the development of ischemic stroke. Direct oral anticoagulants (DOACs) replaced warfarin in clinical use for stroke prevention in AF. This research investigated two important methodological challenges that may arise in observational studies on the comparative effectiveness and safety of DOACs and warfarin. First, an information bias resulting from misclassification of exposure to dose-varying warfarin therapy when using days supplied value recorded in pharmacy claims data. Second, a selection bias due to informative censoring with differential censoring mechanisms in the DOACs- and the warfarin exposure groups. Using the Québec administrative databases, I conducted three retrospective cohort studies that included patients initiating an oral anticoagulant between 2010 and 2016. The studies were restricted to Québec residents covered by the public drug insurance plan (about 40% of Québec’s population), including those aged 65 years and older, welfare recipients, those not covered by private medical insurance, and their dependents. In the first study, we hypothesized that pharmacy claims data inadequately captured the duration of the dispensation of warfarin. Gaps between subsequent dispensations (refill gaps) and their variation are larger for warfarin than for DOACs. In this study, we found that the average refill gap for the users of warfarin was 9.3 days (95% confidence interval [CI]:8.97-9.59), apixaban 3.08 days (95%CI: 2.96--3.20), dabigatran 3.70 days (95%CI: 3.56-3.84) and rivaroxaban 3.15 days (95%CI: 3.03-3.27). The variance of refill gaps was greater among warfarin users than among DOAC users. This variation may reflect the changes in warfarin posology when the daily dose is adjusted by a physician or a pharmacist based on previously observed international normalized ratio (INR) results. The dose adjustment may lead to a prolongation of the period covered by the number of dispensed pills. In the second study, we hypothesized that the definition of duration of dispensation based on the days supplied value and a fixed grace period will lead to differential misclassification of exposure to warfarin and DOACs. This may bias the estimate of comparative safety in favor of DOACs. In this study, we used two approaches to define the duration of dispensations: the recorded days supplied value, and the longitudinal coverage approximation (data-driven) that may account for individual variation in drug usage patterns. The second study found that using the days supplied, the mean (and standard deviation) dispensation durations for dabigatran, rivaroxaban, and warfarin were 19 (15), 19 (14), and 13 (12) days, respectively. Using the data-driven approach, the durations were 20 (16), 19 (15), and 15 (16) days, respectively. Thus, the data-driven approach closely approximated the recorded days supplied value for the standard dose therapies such as dabigatran and rivaroxaban. For warfarin, the data-driven approach captured more variability in the duration of dispensations compared to the days supplied value, which may better reflect the true drug-taking behavior of warfarin. However, this did not impact the hazard ratio estimates on the comparative safety of DOACs vs. warfarin. In the third study, we hypothesized that when assessing the effect of continuous treatment with oral anticoagulants (per-protocol effect), censoring removes sicker patients from the DOACs group and healthier patients from the warfarin group. This may bias the estimate of comparative effectiveness and safety in favor of DOACs. The study showed that the mechanisms of censoring in the DOAC and the warfarin exposure groups were different. Thus, prognostically meaningful covariates, such as chronic renal failure and congestive heart failure, had an opposite direction of association with the probability of censoring in the DOACs and warfarin groups. To correct the selection bias introduced by censoring, we applied the inverse probability of censoring weights. Two strategies for the specification of the model for the estimation of censoring weights were explored: exposure-unstratified and exposure-stratified. The study found that exposure-unstratified censoring weights did not account for the differential mechanism of censoring across the treatment group and failed to eliminate the selection bias. The hazard ratio associated with continuous treatment with warfarin versus DOACs adjusted with exposure unstratified censoring weights was 15% biased in favor of DOACs compared to the hazard ratio adjusted with exposure-stratified censoring weights (hazard ratio: 1.41; 95% CI: 1.34, 1.48 and hazard ratio: 1.26; 95%CI: 1.20, 1.33, respectively). Overall, the findings of this thesis have important methodological implications for future pharmacoepidemiologic studies. Moreover, the results of the previous observational studies can be reappraised, and some heterogeneity can be explained. The findings can be extrapolated to other clinical questions.

För att stödja regioner och industrier att minska växthusgasutsläppen och nå Europeiska unionens mål om klimatneutralitet till år 2050 har EU tagit fram färdplanen “Den gröna given” och fonden för en rättvis omställning (FRO). FRO syftar till att minska negativa socioekonomiska konsekvenser som följer av omställningen mot mindre kolintensiva processer i sårbara regioner och industrier. Två av fyra utpekade svenska regioner är Västerbotten och Norrbotten samt deras metall- respektive stålindustri. Studiens syfte är att med en narrativ analys av Västerbottens och Norrbottens territoriella omställningsplaner och semistrukturerade intervjuer undersöka hur tre policynivåer (nationell, regional och kommunal) uttrycker tolkningar av rättvis omställning. Med hjälp av en abduktiv ansats har tidigare studier fungerat som ett stöd för att identifiera rättviseanspråk (processuell, fördelning, erkännande och återställande) samt berättelser i studiens empiriska material. Studiens narrativa analys har belyst vilka aktörer det är som förväntas genomföra arbetet av omställningen och vilket utfall av vinster och förluster som kan följa. Dessutom tyder studiens berättelser att ett gemensamt arbete är viktigt för en rättvis omställning. Likaså framkommer det att den nationella politiska berättelsen präglar hur den regionala och kommunala berättelsen formas, samt vilka rättviseanspråk som dominerar. Studiens slutsatser är bland annat att återställande-rättvisa dominerar i den nationella berättelsen och att ett fokus finns på tekniska lösningar. Den regionala berättelsen använder främst processuell-rättvisa och betonar vikten av politiskt ansvarstagande. Den kommunala berättelsen använder också processuell-rättvisa men även fördelnings-rättvisa genom att uttrycka att medborgare också bör inkluderas i en rättvis omställning. / To support regions and industries in decreasing their greenhouse gas emissions and reaching the European union's goal regarding climate neutrality by 2050, the EU has presented a set of proposals named “The Green Deal” as well as the Just Transition Fund (JTF). JTF aims to limit the negative socioeconomic consequences that a transition towards less carbon intensive processes in vulnerable regions and industries could result in. Two of the four designated Swedish regions are Västerbotten and Norrbotten and their metal- and iron-industry. The study aims to, with a narrative analysis of Västerbotten’s, and Norrbotten’s Territorial Plans and semi-structured interviews, investigate how three policy levels (national, regional and local) express interpretations of Just Transition. With an abductive approach, previous studies have worked as a support in identifying justice claims (procedural, distributional, recognition, restorative) and stories within the empirical material. The study's narrative analysis has elucidated which parties that are expected to contribute to the transition and what wins and losses that the transition could result in. Furthermore, the studies stories highlight that working together is important in reaching a Just Transition. It also becomes clear that the national political story influences the regional and local policy stories, as well as which justice claims that are dominating. The study’s conclusions are, for example, that the spatial and temporal aspects of the story deepen the understanding of justice, and that recognitional justice is the least used justice claim in the study's policy stories.