This study examined the potential impact on processes of care and patient outcomes upon exposure of supportive and concurrent care provided by primary care providers (PCPs) to their hospitalized patients. A secondary objective was to describe the PCPs who conduct these services, and the patients who receive them. There was a marked, observable trend that PCP visits to their hospitalized patients is on the decline (dropped 10% between 2003 and 2009). The patients who received in-hospital visits from their PCPs had more disease burden and were hospitalized longer than the control group. Patients who received and in-hospital visit from their PCP were more likely to receive home care services and PCP visits post-discharge [adjusted OR 1.20 (95% CI 1.12-1.28)]. They were also less likely to experience the composite outcome of death, hospital readmission, or emergency department visit [aOR 0.95 (95% CI 0.91-0.98)].

Grand Variations is a work for large orchestra built on an original theme and six variations. My primary concerns when composing were communication, continuity, and distortion. To musically communicate an idea repetition is essential, and the type of repetition presented in theme and variations provided what I was looking for. In addition, the fact that the theme will be repeated over and over leads to a built in continuity. The final concern, distortion, may be achieved by pulling away from a more straightforward presentation of the thematic material. Two additional elements played a large role in the work—cyclic forms, and quantum physics. The composition Déserts by Edgard Varese, and the jazz work Nefertiti by Wayne Shorter, both contain strong cyclic features. Nefertiti uses the same melody repeated over and over, while Déserts, on the other hand, repeatedly presents the same musical gestures, and sound objects, but with slight changes to achieve its own cyclic sound world. These two works framed the way that I approached variations, yet are at odds with each other. Through my reading of quantum physics, I found a way to join the two into a working structure, and the book, The Grand Design, by Stephen Hawking and Leonard Mlodinow, helped me to do it. Because of this, I decided early on to honor that influence, and the title Grand Variations reflect that.

In today's business Information technology (IT) and Information plays a key role. Due todevelopment and influence of Information Technology, using systems, IT services andnetworks cannot be avoided in the business and they all need to be protected and secured.In order to ensure such a higher sort of security and protection, the Information securitysystem (ISS) have been used. Still the businesses today are enveloped with higher risks andupshots which are also being narrower and keeping changed consistently. At suchcircumstance the solution providing method should be very unique and narrower to each andevery slot of business, for a competitive and higher security. Thus such compact solutionsbeen given by Business Continuity Planning (BCP) method. Business Continuity Plan, a chiefidea engendered from the stream of information security.This research involves with a case study in regard to the Railway sector in making a BusinessContinuity Planning (BCP) on Network security, System Security and Physical Security of it.Thus the way of presentation been more systematically followed up in order to make thereader to understand the results more easily.Following in the Chapter 1 and Chapter 2, the Introduction and background studies which areneeded to be known to draw a BCP plan on Network, System and Physical Securities. Chapter3 Result section, will gives the recommendation that need to be followed for drawing aNetwork, System and Physical Securities in a railway network. / Done in Southern Indian Railways, India.

The theme of providing predictable criteria for absolute continuity and for mutual singularity of two density processes on a filtered probability space is extensively studied, e.g., in the monograph by J. Jacod and A. N. Shiryaev [JS]. While the issue of absolute continuity is settled there in full generality, for the issue of mutual singularity one technical difficulty remained open ([JS], p210): "We do not know whether it is possible to derive a predictable criterion (necessary and sufficient condition) for "P'T..." (expression not representable in this abstract). It turns out that to this question raised in [JS] which we also chose as the title of this note, there are two answers: on the negative side we give an easy example, showing that in general the answer is no, even when we use a rather wide interpretation of the concept of "predictable criterion". The difficulty comes from the fact that the density process of a probability measure P with respect to another measure P' may suddenly jump to zero. On the positive side we can characterize the set, where P' becomes singular with respect to P - provided this does not happen in a sudden but rather in a continuous way - as the set where the Hellinger process diverges, which certainly is a "predictable criterion". This theorem extends results in the book of J. Jacod and A. N. Shiryaev [JS]. (author's abstract) / Series: Working Papers SFB "Adaptive Information Systems and Modelling in Economics and Management Science"

Abstract not only influence on development of basic industries in a country but relate with business cycle. Hi-tech industries grow rapidly and play a key role with ¡§innovation¡¨ in stock market. The trends of hi technology make people forget that traditional industries not only keep existing but play a great role of economic activities. Historically speaking, Electric wire and cable industries still exist and even stably develop.¡C I hope to apply the following theories including innovation management, dependence of resources and product life cycle to explain why traditional industries are not sunset industries. Besides, I also chose Feng-chin Corporation as a case with best skills at magnet wire manufacturing to explain how a company keeps his competitive advantages in the matured market. Through case study and theory applied, the followings are concluded. 1. With less possibilities the products are replaced, the greater possibilities of continuity of the industry. In aspects of attributes of product itself, no alternatives appear to substitute for the copper and therefore the magnet wire industry would not disappear as the raw materials with the copper. Even though we can find the new material to replace the copper, the magnet wire industry will still exist with other alternative to replace the copper. When PLC model are applied, the products with greater continuity represent highly matured products. Hence, the products with greater continuity have the following characteristics including less possibilities to be replaced, highly matured and unclear decline stage, and high dependence of the below companies. 2. In low value added industries, individual company should emphasize on process innovation and diversified customers. The Feng-chin Corporation struggles to innovate technologically and in process by the following ways. (1) They make traditional products into hi-technology industries by raise added values. (2) They concentrate on costing down and their own field (3) They well utilize their resources to enforce the mutual-depend relationship with the below companies. Likewise, in the industries which pursue economic scales to reduce the cost, it is more important to diversify the costumers when they have the following characteristics including high matured products, high pricing products and lower mobility of the equipments. Key words: innovation management product life cycle magnet wire industry continuity

This thesis attemps to examine the continuity and change in the physical character of Anatolian city which have crucial impacts on conservation of cultural values of town. From the mid-nineteenth century to the present time / decline of Ottoman Empire, establishment of Turkish Republic with new regime, wars in National Struggle, natural disasters, the policies of both central and local authorities, new regulations for urban planning and conservation are the reasons determined as major causes for the continuity and the change of historic urban character of towns. Sinop, which was one of Ottoman port city having commercial and military function, is representative of the towns in which the big changes are observed. Therefore, in this thesis Sinop is chosen as a case study. It is aimed to see the reasons and results of continuity and change in its physical character, how they take place in city and the values which heve been lost are analyzed.

Abstract After joining WTO, the domestic architecture market has been developing freely and internationalizedly. And this is an impact for the environment of architect business office.Hence, facing graduatedly large, complex, and complicated technologically intergrated engineer, architects are little by little accessed that it seemed negative influences on futher business once they did nothing for the demands of rapid changing environment. Finally, they will find the solutions to overcome the hard time through improving, downsizing, emerging with other companies or other ways to change the types of organizations. Case study was implemented in this thesis to find the key factors of business continuity through understanding the development patterns of the H.H Chang Architect & Partners Co. and propose the practicable suggestions for the futures after the dead of H.H Chang. There are other four partners interviewed, and that took around six hours. The conclusions are as below, First, they have conventionally stabilized business style. Selection is the first step of shaping the organization indentity. To selection good and proper persons as partners is key to business continuity. They have common personalities of pursuing the stable life and emphasizing the ethics and this had an huge influence on turn over rate of theis company. Besides, the systems which were established by HH Chang are never being questioned and adjusted, and the influence power still exists even he left the TMT (Top Management Team). Excellent systems help them overcome the valley of business recycles. Second, the business continuity is the core value they own. HH Chang has never been taking the company as his own asset. Instead, one thing he only cares is business continuity, and that is the system of public fund for daily operation expenses. This system has been thoroughly implemented and lasted for 35 years. Finally, social responsibility is their business goal.The establishment and continuity of public fund is not only kind of bussiness stability and continuity but also can be seen as social responsibility and employee care. Besides, they also provide better offers to emplyees in this field to attract excellent peple to join them. Key word¡GHH Chang Architect& Partners Co. Business continuity

Fire Service commanders work in a very dynamic environment. This research investigated the process they use to make sense and thereby develop understanding of situations during the response to a large-scale emergency. In previous research that investigated decision-making and situation awareness in real-life environments, the need for commanders to understand an incident is emphasised. This research aimed to generate new insights into the process individuals follow to build and improve situational understanding. An exploratory project phase was used to focus the research. Data from emergency exercises and interviews resulted in the design for the main study regarding application domain, data sources and methodological issues. For the main study, records of publicly available interviews with senior officers of the New York Fire Department on their experience of the response to the events at the World Trade Center on September, 11 2001 were analysed. Findings include six variations of the sensemaking process structure, which is characterised by distinct stages. A following investigation into why these stages occur took a theory-building approach and revealed two insights. First, process stages are tied to seven hierarchical but interlinked levels of understanding. Second, three groups of underlying mechanisms trigger process stages: four cognitive factors, eight needs to understand and three situational factors. The mechanisms occur in different combinations across process variations and have varying explanatory power. This study contributes to knowledge on the process of building and improving situational understanding and its link to understanding. A micro-level view of the sensemaking process is provided, showing the specific understanding that is gained and evolves along its stages. The view of sensemaking is extended from understanding what is going on and what can be done to include understanding performance of action. A review with experts revealed that findings adequately reflect the thinking of commanders during incident response and might have practical relevance for training and command support.

First Nations foodways have been altered through systemized efforts of colonization and were effectively reduced in part from the creation of stores and through limiting reserve systems. The current research seeks to understand the dietary choices and changes among three generations of Fist Nations women. Research takes place in a remote First Nation community in Northern Ontario. The differing food practices among the three generations of women highlight transformations resulting from a traumatic history. Decreases in the consumption of traditional, land based foods, as well as the practices around these foods (procurement, preparation, knowledge exchange and social engagement) alter the experiences of the younger generations. The conversations/exchanges around food take place within the culturally significant space of the teepee. The teepee is a core element. These exchanges have a tremendous bearing on the overall wellness of these women and their efforts to reclaim and remain culturally resilient.

Diabetes is emerging as a major threat to health, with global economic and social implications. Recent research has shown that the morbidity and mortality associated with diabetes can be reduced by timely and effective treatment. However, unless people with diabetes have access to this treatment, the impact of diabetes will continue to rise. This thesis therefore explores the current standards of care which people with diabetes receive. It also looks at factors likely to impact on delivery of diabetes care. Studies were conducted at two levels. In the studies described in Chapters 2 and 3, general data applicable to all or nearly all patients with diabetes were collected. This approach substantially eliminates selection bias but precludes the ability to examine clinical outcomes. In the other studies, detailed in Chapters 4, 5 and 6, specific aspects of diabetes care pertaining to more select groups of diabetic subjects were examined. This approach allows clinical parameters to be examined in more detail but is more subject to selection bias. It is hoped that the combination of these two approaches provides a more balanced view of the topic under examination. In Australia, the Medicare Program, a single government controlled universal health insurance fund, provides access to medical services for all residents. Medicare occasions of service data therefore represent the most comprehensive source of information regarding health service utilisation in Australia. The data does not account for people receiving diabetes care through public hospital based services. However, a survey of public hospitals within NSW (n=198), described in Chapter 2, showed that the number of individuals in this category is relatively small and represents only 5.2% of the diabetic population. Using Medicare item codes, and with the permission and assistance of the Commonwealth Department of Health and Aged Care, data were extracted on attendance to medical practitioners and utilisation of diabetes related procedures for people living in New South Wales (NSW) for the individual years between 1993 to 1997. All data were stratified by the presence of diabetes, gender and age group. Individuals were deemed to have diabetes if an HbA1c, which can only be ordered for a person with known diabetes, had been performed over the 5-year period and the sample size adjusted for the incidence of diabetes. Once adjusted, the number of people with diabetes in NSW for the individual years 1993 to 1997 were 143,920, 156,234, 168,216, 177,280 and 185,780. Comparison with 1996 census data confirmed a 91.7% capture of the total NSW population (5,495,900/5,995,545 individuals). The data were retrieved for NSW as a whole and for individual postcodes. Postcodes were then classified by population density as either major urban, urban or rural. On average over the study period, persons with diabetes accounted for 3.1% of the population but they used 5.5% of general practitioner services. As seen in Chapter 2, a large proportion of people with diabetes were also under the care of specialists and consultant physicians, up to 51.2% and 41.8% respectively, a 3 to 4 fold increase when compared with their non-diabetic counterparts. In regard to geographical location, once adjusted for age and gender, the odds ratio of attending a specialist was only slightly higher for people with diabetes living in areas of high population density when compared to people with diabetes living in rural areas. This ratio reached as high as 1.85 in regard to attendance to consultant physicians (Chapter 3). The odds ratio for the non-diabetic population was similar indicating that the difference in access to consultant physicians was not disease specific. Analysis of results showed that despite the increase in service utilisation, large proportions of people with diabetes were not routinely monitored in regard to diabetes and its complications across the State. By 1997, HbA1c was still not performed in over 40% of people with diabetes each year and only 11.6% of the diabetic population had undergone microalbuminuria estimation. Interestingly, the differences in levels of monitoring between rural and urban areas were surprisingly small. Monitoring of diabetes and its complications did improve in all parts of the State over the study period. However, the greatest improvement was seen in rural areas, despite rural patients having fewer attendances to general practitioners and fewer patients attending specialist care. In the face of finite resources and the rising prevalence of diabetes, an increasing number of patients will need to rely on general practitioners to provide diabetes care regardless of where they live. A 'shared care' approach which encourages and supports general practitioners to manage patients with diabetes, while giving them access to specialist services for those patients that require them, is increasingly being advocated as a way of maximising efficacy while minimising costs. Yet if health care professionals leave undone what they think is done by others, shared care can become neglected care. Chapter 4 reports a detailed audit of 200 randomly selected shared care patients who were assessed on two or more occasions. This study showed that the majority of specialist treatment recommendations are implemented by general practitioners. Doctors formally registered with the Diabetes Shared Care Programme and those who write longer referral letters were more likely to implement recommendations than their counterparts. Moreover, the average HbA1c and the complication profile of these patients were similar to those found in various studies around the world. This suggests that diabetes can be well managed by a shared care approach that is adequately integrated. To overcome the problem that data is lacking on those patients that did not return for specialist review, a further 200 shared care patients who were lost to follow up from the shared care system were traced. Information regarding whether treatment recommendations had been implemented was sought from both the referring doctor and the patient. Overall, information on 182 of the 200 patients could be obtained. As discussed in Chapter 5, comparison of the returned and non returned patients' demographic and clinical profiles at time of their initial specialist review showed that general practitioners differentiated between the 'more complicated' patients, choosing to re-refer those with macrovascular disease, while maintaining the care of 'less complicated' patients. Re-referral for specialist review was also dependent on the patient remaining under the care of their original doctor. Encouragingly, general practitioners seemed to take a more active role in the non-returned group. They included more details regarding type and duration of diabetes in the referral letters of patients who were not re-referred for specialist review. They also implemented more treatment recommendations in the non-returned group, with the difference in implementation rate for metabolic recommendations reaching statistical significance. This study also showed that movement of patients between doctors raises concern regarding continuity of care. The multi-factorial nature of diabetes means that best practice is not easily accommodated within a single appointment. Thus continuity of care becomes an important issue. To assess the current status, 479 consecutive patients referred to the Royal Prince Alfred Hospital Diabetes Centre in a 6-month period were recruited and underwent a detailed clinical assessment. They were also questioned regarding the number of general practitioners they attended and the length of time they had been under the care of the referring doctor. The results outlined in Chapter 6 showed that the majority of people with diabetes (87.7%) attended only one general practitioner and had been under the care of that doctor medium to long term. Younger patients, who were relatively healthy apart from the presence of diabetes, were more likely to attend several general practitioners or have changed their general practitioner within the last year. This lack of continuity had little difference on acute outcomes such as glycaemic and blood pressure control. Appropriately, continuity of care increased with increasing age and the increasing prevalence of diabetes complications, mainly macrovascular disease. These studies indicate that further efforts are required to improve the overall standard of diabetes care within Australia. At present there is a heavy dependency on specialist services. As the population ages and the number of people with diabetes increases, much of this burden will fall on general practitioners, as is already evident in rural areas. When provided with appropriate support and infrastructure, general practitioners are able to maintain standards of care through referral of patients with more complex medical problems and by maintaining the degree of continuity appropriate to the patient's needs. However, the collection of relevant information to monitor future trends in diabetes services provision is important. As shown in this thesis, Medicare data represents an easy and cost effective method with which to do so.