Productivity growth in the construction industry is low compared to other industries, and a large unnecessary part of a construction worker’s workday is taken up by nonvalue-creating work, such as waiting, or shifting and handling of building materials. Low productivity in construction projects makes it difficult to keep to schedules and can entail costs to construction companies when delays occur. This project aims to evaluate and investigate, on behalf of Skanska Hus Ume˚a, how productivity in the construction of new apartment buildings can be improved. To carry out this assignment, a large number of qualitative and quantitative interviews have been conducted with employees at Skanska. A survey study has also been sent out to investigate how productivity in selected parts of the construction process is experienced by employees at Skanska. The interviews and the survey study have been used as a starting point for the development of mathematical models with the aim of improving the productivity at Skanska Hus in Ume˚a’s construction sites. The project has resulted in a number of proposals for improvements that can be implemented in Skanska’s current working methods to increase productivity at their construction sites. An implementation of the Data Envelopment Analysis optimization model has identified technical effective and ineffective elements in the construction process, indicating which areas Skanska Hus in Ume˚a should focus on improving. Based on these areas, concrete proposals for new working methods have been prepared and presented based on principles and tools within Lean Construction. The degree project has also resulted in a calculation program that standardizes the working method for the construction of interior walls, resulting in increased productivity as well as time and cost savings. Finally, a model for weekly production follow-up has been created to increase employee engagement, ensure high productivity throughout the construction process and create conditions for future productivity development through data collection. / Produktivitetsutvecklingen i byggbranschen är låg jämfört med andra branscher och en stor del av en yrkesarbetares arbetsdag utgörs av icke värdeadderande arbete, som till exempel väntan, förflyttning och onödig materialhantering. Låg produktivitet inom byggprojekt gör det svårt att hålla uppsatta tidplaner och innebär därmed en kostnad för både byggföretag och kunder när förseningar uppstår. På uppdrag av Skanska Hus i Umeå har detta examensarbete syftat till att utvärdera och undersöka hur produktiviteten vid nyproduktion av flerbostadshus kan förb¨attras. För att besvara problemställningarna har ett stort antal kvalitativa och kvantitativa intervjuer genomförts med anställda på Skanska. En enkätstudie har även skickats ut för att undersöka hur utvalda moment i byggprocessen upplevs av medarbetare på Skanska. Intervjuerna och enkätstudien har använts som underlag vid framtagandet av matematiska modeller med syftet att öka produktiviteten på Skanska Hus i Umeås byggarbetsplatser. Examensarbetet har resulterat i en implementering av optimeringsmodellen Data Envelopment Analysis vilken har identifierat tekniskt effektiva och ineffektiva moment i byggprocessen. Resultatet från Data Envelopment Analysis indikerar vilka områden Skanska Hus i Umeå bör fokusera på att förbättra. Utifrån dessa områden har konkreta förslag på nya arbetssätt tagits fram och presenteras utifrån principer och verktyg inom Lean Construction. Examensarbetet har även resulterat i ett beräkningsprogram som standardiserar arbetssättet vid uppbyggnad och beklädnad av innerväggar vilket ger en ökad produktivitet samt tid- och kostnadsbesparingar. Slutligen har en modell för veckovis produktionsuppföljning skapats för att öka engagemanget hos medarbetarna, säkerställa en hög produktivitet genom hela byggprocessen samt skapa förutsättningar för framtida produktivitetsutveckling genom insamling av data.

Information Technology systems are in today's digitalized society taken for granted. Within the public sector there are, as in the private sector, a lot of digital systems that unfortunately are not entirely integrated into the municipality businesses. The systems are not coordinated with other systems that the workers interact with in their day-to-day activities. This has several effects such as unnecessary costs of licenses or support, not to mention wasted working hours. The purpose of digitalization to optimize businesses fails due to lack of control and structure in the systems used, what systems are acquired and for what purpose, and whether the systems are followed up and further worked on. To secure the integration of systems, requirement specifications and procurement processes need to be reviewed. There is also a need for investment to make sure the follow-up is done properly. Coordination, structure, and control is the answer to effectivizing and optimizing municipal activities using the possibilities enabled by digitalization. / Informationsteknologiska verksamhetssystem tas i dagens digitaliserade samhälle för givet. Inom den offentliga sektorn finns det, precis som i den privata, en hel del digitala system, som dessvärre inte är helt integrerade i verksamheterna. Systemen samspelar inte med andra system som medarbetare möter i vardagen. Detta följs av olika konsekvenser i form av onödiga kostnader av licenser eller support, för att inte tala om nedlagd arbetstid. Digitaliseringens syfte att optimera verksamheter fallerar på grund av att det finns en bristande kontroll och struktur på de system som finns i verksamheten, vilka system som köps in och till vad, samt huruvida systemen följs upp och arbetas vidare på. För att säkra systemintegrationen bör kravspecifikationer och upphandlingsprocessen ses över, samt lägga investeringsmedel på att uppföljningen blir gjord ordentligt. Samordning, struktur och kontroll är svaret för att effektivisera och optimera kommunala verksamheter med hjälp av digitaliseringens alla möjligheter.

Syfte Konkurrensen i fastighetsmäklarbranschen ökar vilket innebär att fastighetsmäklarna blir allt mer beroende av att vårda sina kunder och skapa långsiktiga kundrelationer. Syftet med denna undersökning är att få större kunskap om hur mäklare arbetar med kunduppföljning i det dagliga arbete samt få en djupare förståelse för varför det egentligen är viktigt med uppföljning. Undersökningens problemfrågor är: Varför är det viktigt med kunduppföljning för en fastighetsmäklare? Hur arbetar fastighetsmäklare med kunduppföljning i praktiken? Metod Undersökningen är gjord utifrån en kvalitativ metodansats då den huvudsakliga frågeställningen i undersökningen kräver en beskrivning av verkligheten. Intervjuer, med en låg grad av strukturering och standardisering, har gjorts med fastighetsmäklare. Tillvägagångssättet är deduktivt, d.v.s. undersökningen utgår från teorin. Resultat & slutsats Fastighetsmäklare arbetar med uppföljning av den främsta anledningen att bevara relationen med kunden så att den genererar lönsamhet på olika sätt. Detta sker genom att få nöjda kunder som blir lojala kunder och återkommer vid nästa bostadsaffär samt rekommenderar mäklaren till vänner och bekanta. Förslag till fortsatt forskning  Undersöka vilken kundernas syn på uppföljning är. Undersöka till vilken grad kunduppföljning har positiv respektive negativ effekt på kundrelationen. Ta fram mätbar data över hur lönsamt det egentligen är att arbeta med kunduppföljning. Uppsatsens bidrag Undersökningen har lyft fram frågan om hur viktigt det är för en säljare att arbeta med kunduppföljning. Det har även kartlagts hur fastighetsmäklare arbetar med uppföljning av kunder i det vardagliga arbetet. / Aim The competition in the real estate market is increasing which means that the real estate agents are becoming increasingly dependent on customer care and to build long term relationships with their customers. This study aims to gain a larger knowledge of how the realtor work with follow-up in the daily work and gain a deeper understanding of why it´s important to do customer follow-up. The question at issue is: Why is customer follow-up important for a real estate agent? How does a real estate agent follow-up the customers in practice? Method This study is based on a qualitative method, because the main question in the study requires a description of the reality. Interviews, with a low degree of structure and standardization, have been made with professional real estate agents. The approach to the study is deductive, i.e. it´s based on theory. Result & Conclusions The main reason estate agents use follow-up is to maintain the relationship with the customer so it can generate profit to the realtor in different ways. This happens through satisfied customers who becomes loyal customers, returns when it´s time for the next property transaction and becomes recommended to the customers friends and acquaintances. Suggestions for future research Exploring the customers´ views on follow-up. Investigate to what extent the follow-up have positive or negative effect on customer relationships. Develop measurable data on how profitable it really is to work with followup. Contribution of the thesis The study has highlighted the issue of how important it is for a seller to work with customer follow-up. We also have mapped how estate agents use customer follow-up in their everyday work.

OBJECTIVES The aim of this analysis was to assess the 7-year long-term safety and effectiveness of a randomized comparison of percutaneous coronary intervention (PCI) with sirolimus-eluting stents (SES) versus minimally invasive direct coronary artery bypass (MIDCAB) surgery for the treatment of isolated proximal left anterior descending lesions. BACKGROUND Long-term follow-up data comparing PCI by SES and MIDCAB surgery for isolated proximal left anterior descending lesions are sparse. METHODS Patients were randomized either to PCI with SES (n ¼ 65) or MIDCAB (n ¼ 65). Follow-up data were obtained after 7 years with respect to the primary composite endpoint of death, myocardial infarction, and target vessel revas- cularization. Angina was assessed by the Canadian Cardiovascular Society classification and quality of life with Short Form 36 and MacNew quality of life questionnaires. RESULTS Follow-up was conducted in 129 patients at a median time of 7.3 years (interquartile range: 5.7, 8.3). There were no significant differences in the incidence of the primary composite endpoint between groups (22% PCI vs. 12% MIDCAB; p ¼ 0.17) or the endpoints death (14% vs. 17%; p ¼ 0.81) and myocardial infarction (6% vs. 9%, p ¼ 0.74). However, the target vessel revascularization rate was higher in the PCI group (20% vs. 1.5%; p < 0.001). Clinical symptoms and quality of life improved significantly from baseline with both interventions and were similar in magnitude between groups. CONCLUSIONS At 7-year follow-up, PCI by SES and MIDCAB in isolated proximal left anterior descending lesions yielded similar long-term outcomes regarding the primary composite clinical endpoint and quality of life. Target vessel revascularization was more frequent in the PCI group. (Randomied Comparison of Minimally Invasive Direct Coronary Artery Bypass Grafting and Percutaneous Coronary Intervention With Drug-Eluting Stents in Patients With Proximal Stenosis of the Left Anterior Descending Coronary Artery; NCT00299429) (J Am Coll Cardiol Intv 2014;-:-–-) © 2014 by the American College of Cardiology Foundation.

Circulating tumor DNA (ctDNA) in peripheral blood of patients with metastatic colorectal cancer appears to be a promising molecular marker that provides various applications. ctDNA levels vary depending on the presence, alternatively on the volume of tumor mass within patient's body, which can be used primarily for early detection of disease progression or recurrence and moreover for evaluating radicality of surgical treatment, all within long-term postoperative follow-up of the patient. Due to minimal invasivity of ctDNA analysis from peripheral blood (so-called liquid biopsy), it is possible to perform it repeatedly at relatively short time intervals. On account of very low fraction of ctDNA in total cell-free DNA (cfDNA) ranging between units and hundreds of percent, the key factor is optimal methodology covering all steps from the isolation process to a sufficiently sensitive detection technology. In this thesis I focus on an optimization of isolation process and analysis of ctDNA obtained from tumor tissue and plasma of selected patients with metastatic colorectal cancer in connection with surgical radicality and correlation with a clinical status of the patients.

Having a newborn can be a big change for families, especially for first-time parents. At hospital discharge, parents are often provided with a lot of information, which can be difficult to retain. Due to shortened postnatal lengths of stay, nurses typically have less time to educate parents, which often results in families feeling overwhelmed. After hospital discharge, it is recommended for families to see a health care provider (i.e., physician, nurse practitioner, or registered midwife) within 72 hours for a follow-up appointment. This follow-up appointment is meant to assess both the mother and newborn to ensure they are both in good health and to provide any needed support. Unfortunately, completing the appointment within this timeframe may not be possible for every family or they may not be aware of its importance. Depending on the family’s model of care, completing the follow-up appointment within 72 hours after hospital discharge can be challenging. Families that have a physician as their health care provider may experience delays in scheduling the follow-up appointment. This can be due to the physician’s lack of availability, as there is a physician shortage in most communities. Furthermore, some families do not have access to a health care provider and, therefore, do not see a care provider after hospital discharge. Completing the follow-up appointment later than when it is recommended, or not at all, can result in negative health consequences for the mother and newborn and can also increase re-admission hospital rates and related costs (Cargill et al., 2007). At the moment, postnatal lengths of stay are shortening but the service delivery has not changed to accommodate this trend (Lemyre et al., 2018). This means that the services typically provided to families in the hospital now need to be provided in the community. The follow-up appointment after hospital discharge is an opportunity to provide these services; however, timely access to a health care provider, specifically a physician, can be challenging. Thus, this thesis explores the development of a general design methodology for a postpartum nurse practitioner-led clinic. The aim of the clinic is to provide timely access to any family that needs to complete the necessary postpartum services after hospital discharge within a community. An analytical model was developed to explore the characteristics of a postpartum nurse practitioner-led clinic and how it would operate (i.e., what services would be offered, the amount of time needed for these services, what is needed to offer these services, etc.). The model conducts a simulation of the appointment scheduling process based on the input values entered into it and evaluates a number of performance metrics (e.g., number of diversions, patient wait times, resource idle time, clinic overtime, number of appointments provided within 72 hours and number of appointments provided beyond 72 hours). The findings from the model can support the potential implementation of a postpartum nurse practitioner-led clinic in any community. Implementing such clinics could increase awareness, further educate parents and increase access to postpartum services.

Master of Public Health - MPH / Background: According to the Joint United Nations Programme on HIV/AIDS (UNAIDS) 340 000 children between 0-14years of age are living with HIV in South Africa as of 2019. Decentralization of HIV services was included in South Africa’s paediatric guidelines since 2010 in a bid to improve access to care. The current study sought to address the paucity of Eastern Cape (EC) data on the outcomes of down-referred paediatric antiretroviral therapy (ART) patients. These outcomes included retention in care (RIC) and virological suppression after 12 months Methodology: This retrospective analysis was conducted in the Buffalo City Municipality (BCM) district of the EC. The study population included HIV positive males and females, 0-14 years of age at transfer, who were initiated on ART at a tertiary or a regional hospital and subsequently down-referred, between June 2013 and June 2017. Data were collected from electronic databases at the facilities (Tier.net), patient files and patient registers. A descriptive analysis was performed using SPSS Statistics software version 26. Results: In total, 80.1% of patients successfully down-referred to a primary healthcare (PHC) facility, in a median of 42 days. Of those, 95.4% of patients were retained in care at 6 months and 93.1% at 12 months after arrival, with a median of 4 scheduled monthly visits missed. For those with results, virological suppression was maintained in 96.7% of patients at 6 months, 92.2% at 12 months and 96.2% for the entire post-transfer period of 2-14 months. In the 2-14 months post down-referral only 76.9% of patients had at least one viral load (VL) result and 50.3% had one CD4 result. For those with results, immune response (IR) to ART was maintained in 100% of patients at 6 months, 94.3% at 12 months and 97.7% in the 2-14 month period post successful down-referral. Conclusions: This study confirmed that loss to follow-up (LTFU) and treatment interruption at the point of transfer are significant risk factors for paediatric ART patients. This study also demonstrated high levels of RIC once patients had successfully down-referred. However, missed clinic visits suggest possible treatment interruptions for many patients post down-referral. While good virological and immunological responses to ART were maintained at the PHC facilities, suboptimal VL and CD4 monitoring was highlighted by the low proportion of available results. Therefore, while there are a number of issues to address, this study confirms that down-referral is a feasible option for up-scaling paediatric HIV care in the EC.

No description available.

TCC (Transitions of care clinic) is a specialized clinic visit where patients present to their primary clinic after a hospital stay. TCC deploys an interprofessional team to address a gamult of patient concerns. Traditionally, TCC interprofessional team includes a nurse and a doctor. The nurse calls the patient’s house within 2 days to check up on the patient and then they schedule a clinic visit, usually within 7-14 days. However it has been proposed that addition of team members from other disciplines could contribute to better health outcomes for patients seen in TCC. We studied a TCC model with an interprofessional team of not only physicians and nurses but also pharmacists and behavioral therapists for two months. Our aim was to uncover the utility of having a behavioral health team member in TCC visits. This was a prospective study of patients who attended a TCC clinic in a residency setting. An observer collected data on the time the behavioral health provider was in the patient room and the interventions/consultations he/she provided. Data collection is ongoing. We expect to find the following: the percentage of patients within TCC who utilized some form of behavioral therapy in their TCC visits; the percentage of common interventions that were used; average time spent in each visit; average age of patients; and average number of hospitalizations per patient. We expect that these results will demonstrate how behavioral health providers function on interprofessional TCC teams.

Vitamin D insufficiency remains a costly pandemic in veterans. Treatment requires achievement of desired 25-hydroxyvitamin D [25(OH)D] concentrations. The frequency with which 25(OH)D should be measured following treatment remains speculative. A retrospective analysis of veterans with vitamin D insufficiency was conducted. The group was stratified on the basis of initial 25(OH)D and assessed for frequency of follow-up 25(OH)D concentrations. Over 3 years, 278 patients with insufficient 25(OH)D concentrations were identified. Of these, 87 (31%) patients had subsequent levels assessed in the year following initial documentation of vitamin D insufficiency. The likelihood of follow-up testing was unrelated to the initial vitamin D level. In the patients with follow-up 25(OH)D levels, 90% eventually achieved a serum level of 30 ng/mL or greater. Veterans with vitamin D insufficiency have inadequate serial monitoring of 25(OH)D concentrations.