Good continuity of care is considered desirable and is often referred to as an essential component in creating a more patient-centered health care. However, what is meant by continuity of care is not entirely self-evident and there are different ways to quantify and address it. The purpose of this study is to introduce a method for continuous measurement of continuity, where visits between patients and physicians in various care clinics are of interest. Five established measurements (indices) of continuity of care were evaluated; MFPC, K, COC, MCI and SECON. Calculations on these indices were made using hospital visits-related data from January 2011 to April 2015, where a  time window of 1.5 years was used when calculating index values. The results from the calculations show a high correlation between all indices when calculated on an average of all patients at a clinic. Based on this, properties such as intuitive interpretation and simple calculations made MFPC-index this study’s single choice of index. It can be used to examine the change of  a clinic’s patient’s continuity over time. The index also allows to assign a value to a physician, showing how much continuity that doctor contributes to all its patients. A tool was also developed to visualises how many visits each patient has had with how many different doctors at a clinic. This tool allows the identification of individual patients whose continuity can be seen as undesired. These three components of the method for continuous measurement of continuity can be seen as representations of continuity from a system’s, physician’s and patient’s perspective.

This master thesis deals and analyzes the problems in the area of Business Continuity and Disaster Recovery strategy. It proposes a possible solutions, its practical implementation in the real environment of bank. Part of this work speaks about theoretical background, second part of this work analyzes the current situation, which describes the deficiencies in the given directions and in the end are explained my practical advices for implementation of the Business Continuity and Disaster Recovery strategy.

Lichens are, in most cases, sensitive to anthropogenic factors such as air pollution, global warming, forestry and fragmentation. Two studies are included in this thesis. The first is an evaluation of the importance of old oak for the rare epiphytic lichen Cliostomum corrugatum (Ach.) Fr. This study analysed whether C. corrugatum was limited by dispersal or restricted to tree stands with an unbroken continuity or the substrate old oaks. The results provide evidence that the investigated five populations in Östergötland, Sweden, of C. corrugatum exhibit substantial gene flow, an effective dispersal and a small genetic variation between the sites. Most of the genetic variation was within the populations. Thus, C. corrugatum is more dependent of the substrate old oaks, rather than limited by dispersal. The second study investigated possible range shift of some common macrolichens, due to global warming, from 64 sites in southern Sweden comparing the two years 1986 and 2003. The centroid of three lichen species had moved a significant distance, all in a north east direction: Hypogymnia physodes (L.) Nyl. and Vulpicida pinastri (Scop.) J.-E. Mattsson and M. J. Lai on the tree species Juniperus communis L. (50 and 151 km, respectively) and H. physodes on Pinus sylvestris L. (41 km). Considering also the non-significant cases, there is strong evidence for a prevailing NE direction of centroid movement.

<p>Lichens are, in most cases, sensitive to anthropogenic factors such as air pollution, global warming, forestry and fragmentation. Two studies are included in this thesis. The first is an evaluation of the importance of old oak for the rare epiphytic lichen Cliostomum corrugatum (Ach.) Fr. This study analysed whether C. corrugatum was limited by dispersal or restricted to tree stands with an unbroken continuity or the substrate old oaks. The results provide evidence that the investigated five populations in Östergötland, Sweden, of C. corrugatum exhibit substantial gene flow, an effective dispersal and a small genetic variation between the sites. Most of the genetic variation was within the populations. Thus, C. corrugatum is more dependent of the substrate old oaks, rather than limited by dispersal. The second study investigated possible range shift of some common macrolichens, due to global warming, from 64 sites in southern Sweden comparing the two years 1986 and 2003. The centroid of three lichen species had moved a significant distance, all in a north east direction: Hypogymnia physodes (L.) Nyl. and Vulpicida pinastri (Scop.) J.-E. Mattsson and M. J. Lai on the tree species Juniperus communis L. (50 and 151 km, respectively) and H. physodes on Pinus sylvestris L. (41 km). Considering also the non-significant cases, there is strong evidence for a prevailing NE direction of centroid movement.</p>

Made available in DSpace on 2014-06-11T19:28:25Z (GMT). No. of bitstreams: 0 Previous issue date: 2008-06-12Bitstream added on 2014-06-13T19:36:59Z : No. of bitstreams: 1 miyazaki_vk_me_prud.pdf: 1931950 bytes, checksum: ecf1c5afbf11b070259d88f04aaa49fa (MD5) / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Com a aceleração do processo de urbanização no país, várias cidades cresceram populacionalmente e se expandiram territorialmente de forma significativa nas últimas décadas. Nesse contexto, vários centros urbanos passaram por transformações importantes, tais como o fortalecimento dos papéis desempenhados na rede urbana, configuração de aglomerações territorialmente contínuas e intensificação das interações espaciais entre municípios diferentes. Cidades de menor porte também passam a apresentar configurações territoriais contínuas com intensas interações espaciais intermunicipais, constituindo aglomerações urbanas. A aglomeração é compreendida como o processo de junção de centros urbanos distintos, tanto pela intensificação das interações espaciais quanto pela configuração de áreas territorialmente contínuas ou com tendências neste sentido. A partir destas considerações, a presente pesquisa analisou a expansão territorial e a intensificação dos fluxos entre as cidades de Presidente Prudente, Álvares Machado e Regente Feijó, na perspectiva do processo de aglomeração urbana. Os dados coletados e organizados apontam para uma forte vinculação entre Álvares Machado e Presidente Prudente, tanto pelos fluxos quanto pela expansão territorial. Diante desses resultados, compreende-se que a aglomeração urbana, enquanto forma (materialização do processo) fica evidente apenas entre Presidente Prudente e Álvares Machado. Já Regente Feijó e Presidente Prudente apresentam, até o momento, apenas uma tendência à continuidade territorial e uma significativa intensificação dos fluxos, evidenciando um processo de aglomeração ainda em curso. Esta distinção entre forma e processo constitui-se em um ponto importante para a discussão. / With the acceleration of the urbanization process in the country, many cities increased the populations and expanded your territory with significant way in the last decades. In that context, many urban centers were transformed, before the invigoration of the papers executed in the urban net, configuration of territorial continuous agglomeration and intensification of the space interactions between different municipal districts. Smaller cities also starts to demonstrate continuous territorial configurations with intense interactions space inter cities, constituting urban agglomerations. The agglomeration is understood as the process of junction of different urban centers, as the intensification of the space interactions as for the configuration of continuous areas or with tendencies in this way. Starting from these considerations, this search analyzed the territorial expansion and the intensification of the flows among the Presidente Prudente, Álvares Machado and Regent Feijó, in the perspective of the process of urban agglomeration. The collected and organized data show a strong link between Álvares Machado and Presidente Prudente, as the flows as for the territorial expansion. With these results, we understood that the urban agglomeration, while it forms (materialization of the process) is evident just between analyzed the territorial expansion and the intensification of the flows between the cities: Presidente Prudente and Álvares Machado. Already Regent Feijó and Presidente Prudente present until now, just a tendency to the territorial continuity and a significant intensification of the flows, evidencing an agglomeration process still in course. This distinction between form and process is an important point for the discussion.

This thesis is concerned about Business Continuity Management with the focus on determination of the RTO and RPO parameters. The work is divided into two main parts. The first section briefly describes theoretical issues of Business Continuity Management in conjunction with IT Service Continuity Management. Then there are described various technologies that are currently used to ensure continuity and recovery of IT systems. In conclusion of the theoretical part, the work focuses on the process of Business Impact Analysis. This thesis thus offers a comprehensive view of main principles and benefits that these concepts have for company and how they should be integrated with each other. It provides an overview of various technologies, their link to RTO and RPO parameters and also the definition of steps of disaster recovery procedure. The work also briefly defines the basic procedure for determination of the RTO and RPO parameters, subsequent steps needed to design recovery solutions and analyzes various aspects which need to be considered when defining the parameters of continuity. The second practical part is based on the previous theoretically defined procedure and its aim is to analyze the data acquired during the questionnaire investigation in chosen company to determine the parameters of continuity for the applications in use and then suggest appropriate ways of addressing their backup and recovery. The result of this thesis is therefore a description of the analysis and practical application of methods for setting the parameters for continuity of information systems and the subsequent establishment of necessary measures.

IT solutions must be protected so that the business can continue, even in the case of fatal failures associated with disasters. Business continuity in the context of disaster implies that business cannot continue in the current environment but instead must continue at an alternate site or data center. However, the BC/DR concept today is too fragmented, as many different frameworks and methodologies exist. Furthermore,many of the application-specific solutions are provided and promoted by software vendors, while hardware vendors provide solutions for their hardware environments. Nevertheless, there are concerns that BC/DR solutions often do not connect to the technical components that are in the lower layers, which function as the foundationfor any such solutions; hence, it is equally important to connect and map the requirements accordingly. Moreover, a shift in the hardware environment, such as cloud computing, as well as changes in operations management, such as outsourcing,add complexity that must be captured by a BC/DR solution. Furthermore, the integrated nature of IT-based business solutions also presents new challenges, as it isno longer one IT solution that must be protected but also other IT solutions that are integrated to deliver an individual business process. Thus, it will be difficult to employa current BC/DR approach. Hence, the purpose of this thesis project is to design, develop, and present a novel way of addressing the BC/DR gaps, while supporting the requirements of a dynamic IT environment. The solution reuses most elements fromthe existing standards and solutions. However, it also includes new elements to capture and present the technical solution; hence, the complete solution is designatedas a framework. The new framework can support many IT solutions since it will havea modular approach, and it is flexible, scalable, and platform and application independent, while addressing the solution on a component level. The new framework is applied to two application scenarios at the stakeholder site, and theresults are studied and presented in this thesis.

Bakgrund: Då kriser inträffar allt oftare är det av stor vikt för organisationer att ha en utvecklad strategi för att hantera dessa störningar. Ett sätt för att hantera risker och kriser är Business Continuity Management som involverar hela processen med planering av åtgärder i förväg, krishantering samt utvärdering efter krisen. Syfte: Syftet med uppsatsen är att identifiera och analysera teorierna kring Business Continuity Management samt huruvida dessa tillämpas praktiskt i stora svenska tillverkande företag. Vidare ämnar studien skapa en djupare förståelse kring hur de studerade företagen, med hjälp av jämförelser och granskning, agerar under en rådande krissituation. Metod: Uppsatsen bygger på en kvalitativ forskningsmetod med där den empiriska materialinsamlingen har skett via semistrukturerade intervjuer. Ytterligare empiriskt material är de studerade företagens års- och kvartalsrapporter. En komparativ forskningsdesign har tillämpats, vilken möjliggör för jämförelser mellan de studerade företagens användning av BCM. Slutsats: Studien kan konstatera att inget utav de studerade företagen tillämpar Business Continuity Management fullt ut. Däremot nyttjas modeller och strategier som ligger i linje med den teoretiska referensramen för BCM. / Background: As crisis occur more and more frequently around the world, it is vital for organizations to have an implemented strategy to cope with these disruptions. One way to manage these crises is Business Continuity Management which involves the entire process of planning actions in advance, crisis management and post-crisis evaluation. Purpose: The purpose of this thesis is to identify and analyse the theories related to Business Continuity Management and whether these theories practically applies in Swedish manufacturing companies. Furthermore, the study aims to create a deeper understanding of how the studied companies, by means of comparisons and review, act in a crisis situation. Method: The thesis is based on a qualitative research method where the empirical material collection has been done via semi-structured interviews. Further empirical material is the annual and quarterly reports of the companies studied. A comparative research design has been applied, which allows for comparisons between the studied companies' use of BCM. Conclusion: The study finds that none of the studied companies fully applies Business Continuity Management. However, models and strategies that are in line with the theoretical frame of reference for BCM are used.

Organisation de la sortie d’hospitalisation et impact sur la santé des patients. Nous avons réalisé une revue systématique afin d’explorer l’association potentielle entre des éléments factuels des processus de sortie d’hospitalisation et de continuité des soins en aval et la survenue d’événements de santé en post-hospitalisation. Les résultats indiquent une absence d’association entre la survenue d’un dysfonctionnement ou d’une action d’amélioration au cours du processus de sortie et la mortalité. Concernant les réhospitalisations ou les passages aux urgences, l’analyse de la littérature apporte une réponse plus nuancée. Parallèlement, l’hétérogénéité constatée entre les études empêche la réalisation d’une synthèse quantitative et entrave une évaluation robuste de l’impact d’éléments factuels des processus de sortie et de continuité des soins sur la santé des patients.Point de vue des patients sur l’organisation de leur sortie d’hospitalisation. Nous avons comparé le point de vue des patients sur le processus de sortie selon deux modes de recueil, auto-questionnaire complété sur un site internet dédié versus entretien téléphonique, en tirant profit de l’infrastructure de l’étude SENTIPAT. Même si le taux de réponse des patients du groupe internet était inférieur à celui des patients du groupe téléphone, les informations rapportées par les patients via Internet ne différaient pas significativement de celles recueillies par téléphone. Nos résultats suggèrent le déploiement d’un système d’information pérenne permettant à des patients volontaires de transmettre leur point de vue sur la sortie d’hospitalisation et incitent à développer le concept de patient sentinelle. / Organization of hospital discharge and impact on patient health outcomes. We made a systematic review of the literature with the aim of exploring associations between components of the hospital-discharge process–including continuity of care thereafter–and patients’ health outcomes in the post-discharge period. Results indicate that none of the studies reported a statistically significant association between the presence of a component or an intervention likely improving the quality of hospital-discharge process and mortality. As regards rehospitalizations or emergency department visits, the analysis of the literature provides a more balanced response. At the same time, the wide heterogeneity observed across the studies prevents from performing a meaningful meta-analysis and no consistent statistical association between components of the hospital-discharge process including continuity of care thereafter and patient health outcomes could be identified.Patients’ opinions on the hospital discharge process. Taking advantage of the SENTIPAT trial, we undertook an ancillary study that compared two methods for collecting patients’ opinions on the discharge process: questionnaire self-completion on a dedicated internet website versus a telephone interview. Although the internet patients’ response rate was lower than that of the telephone patients, estimates of patient satisfaction on the discharge process issued from both modes of administration of the questionnaire were similar. Results advocate for establishing a permanent information system that would enable volunteering patients to express their opinions on hospital discharge and for developing the concept of sentinel patient.

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